{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T14:13:13Z","timestamp":1791295993871,"version":"4.1.0"},"reference-count":45,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,12,30]],"date-time":"2023-12-30T00:00:00Z","timestamp":1703894400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"California Tobacco-Related Disease Research Program (TRDRP)","award":["T30IP0998"],"award-info":[{"award-number":["T30IP0998"]}]},{"name":"San Diego State University state start-up and jump start funds","award":["T30IP0998"],"award-info":[{"award-number":["T30IP0998"]}]},{"name":"TRDRP\u2014Cornelius Hopper Diversity Award","award":["T30IP0998"],"award-info":[{"award-number":["T30IP0998"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Dysmenorrhea is highly prevalent, ranging from 16% to 91% among women, and it can lead to multiple reproductive disorders. However, risk factors associated with dysmenorrhea remain unexamined. Cold exposures can significantly disturb blood circulation and prostaglandin production in the uterus, leading to dysmenorrhea. This study investigated the relationship between cold exposures and dysmenorrhea, as well as potential disparities between Asians and Whites and the potential cultural influences on these associations. This was a cross-sectional survey among 197 Asian and 222 non-Asian women recruited from the U.S., with more than 40% from California. We assessed cold exposures, such as the frequency of consumption of cold water\/drinks and ice cream, as well as room temperatures at home and public places, for both summer and winter over the past 12 months. The type of cold exposure associated with dysmenorrhea differs between Asian and White women. We found that among Asian women, a higher frequency of ice cream consumption in winter (beta = 1.19, p = 0.0002 when comparing high to low categories) was associated with dysmenorrhea; however, among White women, increased consumption of cold water\/drinks in winter (beta = 0.49, p = 0.04 when comparing high to low categories) was also associated with dysmenorrhea. Higher home room temperatures in winter were associated with reduced severity of dysmenorrhea among White women but not among Asian women. All these associations supported our hypothesis and were stronger among women who lived in states with colder winters. However, there are a few exceptions. For instance, women who drank cold water\/drinks less frequently during their menstrual period were more likely to experience more severe dysmenorrhea. In conclusion, this study provides crucial evidence to support the link between cold exposures and dysmenorrhea among Asians and Whites. The associations contradictory to our hypothesis are likely due to reserved causation influenced by Asian cultural practice. This paper sheds light on an understudied area that profoundly affects women\u2019s quality of life.<\/jats:p>","DOI":"10.3390\/ijerph21010056","type":"journal-article","created":{"date-parts":[[2023,12,31]],"date-time":"2023-12-31T06:37:12Z","timestamp":1704004632000},"page":"56","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Cold Exposures in Relation to Dysmenorrhea among Asian and White Women"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1679-3511","authenticated-orcid":false,"given":"Tianying","family":"Wu","sequence":"first","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA"},{"name":"Moores Cancer Center, School of Medicine, University of California, San Diego, CA 92037, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassie","family":"Doyle","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy","family":"Ito","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neeraja","family":"Ramesh","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepali Karina","family":"Ernest","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noe C.","family":"Crespo","sequence":"additional","affiliation":[{"name":"Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, CA 92182, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3310-184X","authenticated-orcid":false,"given":"Fang-Chi","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7817-3516","authenticated-orcid":false,"given":"Eyal","family":"Oren","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA 92182, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,12,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1093\/epirev\/mxt009","article-title":"The prevalence and risk factors of dysmenorrhea","volume":"36","author":"Ju","year":"2014","journal-title":"Epidemiol. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/nrendo.2013.255","article-title":"Endometriosis: Pathogenesis and treatment","volume":"10","author":"Vercellini","year":"2014","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Yeh, C.H., Muo, C.H., Sung, F.C., and Yen, P.S. (2022). Risk of Ischemic Heart Disease Associated with Primary Dysmenorrhea: A Population-Based Retrospective Cohort Study. J. Pers. Med., 12.","DOI":"10.3390\/jpm12101610"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101186","DOI":"10.1016\/j.cppeds.2022.101186","article-title":"Dysmenorrhea in adolescents","volume":"52","author":"Gutman","year":"2022","journal-title":"Curr. Probl. Pediatr. Adolesc. Health Care"},{"key":"ref_5","first-page":"106","article-title":"Dysmenorrhea and cold exposure","volume":"30","author":"Mergler","year":"1985","journal-title":"J. Reprod. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"MacDonald, D.I., Wood, J.N., and Emery, E.C. (2020). Molecular mechanisms of cold pain. Neurobiol. Pain, 7.","DOI":"10.1016\/j.ynpai.2020.100044"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"154","DOI":"10.4161\/chan.4692","article-title":"Mechanisms of cold pain","volume":"1","author":"Foulkes","year":"2007","journal-title":"Channels"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.niox.2022.06.007","article-title":"Reduced nitric oxide synthesis in winter: A potential contributing factor to increased cardiovascular risk","volume":"127","author":"Liddle","year":"2022","journal-title":"Nitric Oxide"},{"key":"ref_9","first-page":"391","article-title":"Heat, cold and inflammation","volume":"38","author":"Schmidt","year":"1979","journal-title":"Z. Rheumatol."},{"key":"ref_10","first-page":"37","article-title":"Cutaneous microvascular response during local cold exposure-the effect of female sex hormones and cold perception","volume":"108","author":"Ksenija","year":"2016","journal-title":"Microvasc. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1111\/srt.12703","article-title":"Perfusion of the skin\u2019s microcirculation after cold-water immersion (10 degrees C) and partial-body cryotherapy (\u2212135 degrees C)","volume":"25","author":"Hohenauer","year":"2019","journal-title":"Ski. Res. Technol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Rennie, M.Y., Rahman, A., Whiteley, K.J., Sled, J.G., and Adamson, S.L. (2015). Site-specific increases in utero- and fetoplacental arterial vascular resistance in eNOS-deficient mice due to impaired arterial enlargement. Biol. Reprod., 92.","DOI":"10.1095\/biolreprod.114.123968"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wang, D., Cheng, X., Fang, H., Ren, Y., Li, X., Ren, W., Xue, B., and Yang, C. (2020). Effect of cold stress on ovarian & uterine microcirculation in rats and the role of endothelin system. Reprod. Biol. Endocrinol., 18.","DOI":"10.1186\/s12958-020-00584-1"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3109\/00016347909157782","article-title":"Prostaglandins and dysmenorrhea. Historical survey","volume":"87","author":"Pickles","year":"1979","journal-title":"Acta Obstet. Gynecol. Scand Suppl."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1097\/01.AOG.0000230214.26638.0c","article-title":"Primary dysmenorrhea: Advances in pathogenesis and management","volume":"108","author":"Dawood","year":"2006","journal-title":"Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e026813","DOI":"10.1136\/bmjopen-2018-026813","article-title":"Primary dysmenorrhea and self-care strategies among Chinese college girls: A cross-sectional study","volume":"9","author":"Chen","year":"2019","journal-title":"BMJ Open"},{"key":"ref_17","first-page":"133","article-title":"Women\u2019s experiences of dysmenorrhoea-preliminary study","volume":"20","author":"Ilczuk","year":"2021","journal-title":"Prz. Menopauzalny"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Armour, M., Smith, C.A., Steel, K.A., and Macmillan, F. (2019). The effectiveness of self-care and lifestyle interventions in primary dysmenorrhea: A systematic review and meta-analysis. BMC Complement. Altern. Med., 19.","DOI":"10.1186\/s12906-019-2433-8"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"16252","DOI":"10.1038\/s41598-018-34303-z","article-title":"Heat therapy for primary dysmenorrhea: A systematic review and meta-analysis of its effects on pain relief and quality of life","volume":"8","author":"Jo","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1089\/acm.2018.0520","article-title":"Traditional Chinese Medicine Self-Care and Lifestyle Medicine Outside of Asia: A Systematic Literature Review","volume":"25","author":"Harvie","year":"2019","journal-title":"J. Altern. Complement. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3467067","DOI":"10.1155\/2016\/3467067","article-title":"More Than Needles: The Importance of Explanations and Self-Care Advice in Treating Primary Dysmenorrhea with Acupuncture","volume":"2016","author":"Armour","year":"2016","journal-title":"Evid.-Based Complement. Altern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Garduno, A., and Wu, T. (2021). Tobacco Smoke and CYP1A2 Activity in a US Population with Normal Liver Enzyme Levels. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18052225"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Kaplan, R.C., Song, R.J., Lin, J., Xanthakis, V., Hua, S., Chernofsky, A., Evenson, K.R., Walker, M.E., Cuthbertson, C., and Murabito, J.M. (2022). Predictors of incident diabetes in two populations: Framingham heart study and hispanic community health study\/study of latinos. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-13463-8"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1096\/fasebj.25.1_supplement.978.9","article-title":"Validation of a physical activity questionnaire against the doublylabeled water standard among a multiethnic population","volume":"25","author":"Wilkens","year":"2011","journal-title":"FASEB J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1158\/1940-6207.CAPR-18-0452","article-title":"Physical Activity and Colorectal Cancer Risk by Sex, Race\/Ethnicity, and Subsite: The Multiethnic Cohort Study","volume":"12","author":"Park","year":"2019","journal-title":"Cancer Prev. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1002\/ijc.28241","article-title":"Mortality risk in former smokers with breast cancer: Pack-years vs. smoking status","volume":"133","author":"Saquib","year":"2013","journal-title":"Int. J. Cancer"},{"key":"ref_27","unstructured":"Dobson, A.J., and Barnett, A.G. (2018). An Introduction to Generalized Linear Models, CRC Press. [4th ed.]."},{"key":"ref_28","unstructured":"Schonbaum, E., and Lomax, P. (1990). Thermoregulation Physiology and Biochemistry, Pergamon Press."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2468","DOI":"10.1097\/j.pain.0000000000000317","article-title":"Heightened cold pain and pressure pain sensitivity in young female adults with moderate-to-severe menstrual pain","volume":"156","author":"Slater","year":"2015","journal-title":"Pain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.ijcard.2005.03.045","article-title":"Seasonal variation of C-reactive protein in apparently healthy Koreans","volume":"107","author":"Sung","year":"2006","journal-title":"Int. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"595","DOI":"10.52082\/jssm.2022.595","article-title":"The Sprint-Interval Exercise Using a Spinning Bike Improves Physical Fitness and Ameliorates Primary Dysmenorrhea Symptoms Through Hormone and Inflammation Modulations: A Randomized Controlled Trial","volume":"21","author":"Huang","year":"2022","journal-title":"J. Sports Sci. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"R1711","DOI":"10.1152\/ajpregu.00127.2007","article-title":"Pain sensations to the cold pressor test in normally menstruating women: Comparison with men and relation to menstrual phase and serum sex steroid levels","volume":"293","author":"Stening","year":"2007","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1016\/0091-6749(88)90968-2","article-title":"Prostaglandin D2 and histamine release in cold urticaria unaccompanied by evidence of platelet activation","volume":"82","author":"Ormerod","year":"1988","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1097\/AOG.0000000000004096","article-title":"Primary Dysmenorrhea: Diagnosis and Therapy","volume":"136","author":"Corey","year":"2020","journal-title":"Obstet. Gynecol."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Wang, Q., Fu, W., Guo, Y., Tang, Y., Du, H., Wang, M., Liu, Z., Li, Q., An, L., and Tian, J. (2019). Drinking Warm Water Improves Growth Performance and Optimizes the Gut Microbiota in Early Postweaning Rabbits during Winter. Animals, 9.","DOI":"10.3390\/ani9060346"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1038\/s41420-023-01309-0","article-title":"Gut microbiota and microbiota-derived metabolites promotes endometriosis","volume":"9","author":"Chadchan","year":"2023","journal-title":"Cell Death Discov."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Jiang, I., Yong, P.J., Allaire, C., and Bedaiwy, M.A. (2021). Intricate Connections between the Microbiota and Endometriosis. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22115644"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.physbeh.2004.05.001","article-title":"Seasonal changes in metabolic and temperature responses to cold air in humans","volume":"82","author":"Westerterp","year":"2004","journal-title":"Physiol. Behav."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1002\/cphy.c130015","article-title":"Cutaneous vasodilator and vasoconstrictor mechanisms in temperature regulation","volume":"4","author":"Johnson","year":"2014","journal-title":"Compr. Physiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1111\/j.1748-1716.2011.02336.x","article-title":"Increased systolic blood pressure after mild cold and rewarming: Relation to cold-induced thermogenesis and age","volume":"203","author":"Kingma","year":"2011","journal-title":"Acta Physiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"c3823","DOI":"10.1136\/bmj.c3823","article-title":"Short term effects of temperature on risk of myocardial infarction in England and Wales: Time series regression analysis of the Myocardial Ischaemia National Audit Project (MINAP) registry","volume":"341","author":"Bhaskaran","year":"2010","journal-title":"BMJ"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/1550-2783-9-44","article-title":"The effect of a cold beverage during an exercise session combining both strength and energy systems development training on core temperature and markers of performance","volume":"9","author":"Lafata","year":"2012","journal-title":"J. Int. Soc. Sports Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jshs.2015.12.002","article-title":"Comparison of the effects of cold water and ice ingestion on endurance cycling capacity in the heat","volume":"6","author":"Naito","year":"2017","journal-title":"J. Sport Health Sci."},{"key":"ref_44","unstructured":"(2023, August 31). Top China Travel. Chinese and Western Culture: Hot Water vs. Cold Water. Available online: https:\/\/www.topchinatravel.com\/china-guide\/hot-water-vs-cold-water.htm."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1038\/nrc1389","article-title":"The multiethnic cohort study: Exploring genes, lifestyle and cancer risk","volume":"4","author":"Kolonel","year":"2004","journal-title":"Nat. Rev. Cancer"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/1\/56\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:44:39Z","timestamp":1760132679000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/1\/56"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,30]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["ijerph21010056"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21010056","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,30]]}}}