Regional and geographical differences may explain variability in menopausal symptom occurrence due to development of climate-specific thermoneutral zones leading to population-specific hot flash frequencies. Limited information available regarding menopausal symptoms in underserved women living in extreme heat.

Understanding the perception of menopausal symptoms in underserved women living in extreme heat regions to identify if heat impacts perception of menopausal symptoms was the objective of this study. Women in free, low-income, and homeless clinics in Phoenix were surveyed during summer and winter months using a self-administered, written questionnaire including demographic, climate and menopause related questions, including the Green Climacteric Scale (GCS).

A total of 139 predominantly Hispanic (56 %), uninsured (53 %), menopausal (56 %), mid-aged (mean 49.9, SD 10.3) women were surveyed— 36% were homeless or in shelters. Most women were not on menopausal hormone therapy (98 %). Twenty-two percent reported hot flashes and 26% night sweats. Twenty-five percent of women reported previously becoming ill from heat. More women thought season influenced menopausal symptoms during summer than winter (41 % vs. 14 %, p = 0.0009). However, majority of women did not think temperature outside influenced their menopausal symptoms and that did not differ by season (73 % in winter vs. 60% in summer, p=0.1094). No statistically significant differences seen for vasomotor symptoms between winter and summer months.

Regional and geographical differences may be key in understanding the variability in menopausal symptoms. Regardless of season, the menopausal, underserved and homeless women living in Arizona reported few vasomotor symptoms. In the summer, they were more likely to report that the season influenced their menopausal symptoms rather than temperature suggesting an influence of the season on symptom perception.

Many people use public transportation in their daily lives, which is often praised at as a healthy and sustainable choice to make. However, in extreme temperatures this also puts people at a greater risk for negative consequences resulting from such exposure to heat. In Phoenix, public transportation riders are faced with extreme heat in the summer along with the increased internal heat production caused by the physical activity required to use public transportation. In this study, I estimated total exposure and average exposure per rider for six stops in Phoenix. To do this I used City of Phoenix ridership data, weather data, and survey responses from an ASU City of Phoenix Bus Stop Survey conducted in summer 2016. These data sets were combined by multiplying different metrics to produce various exposure values. During analysis two sets of calculations were made. One keeping weather constant and another keeping ridership constant. I found that there was a large range of exposure between the selected stops and that the thermal environment influences the amount of exposure depending on the time of day the exposure is occurring. During the morning a greener location leads to less exposure, while in the afternoon an urban location leads to less exposure. Know detailed information about exposure at these stops I was also able to evaluate survey participants' thermal comfort at each stop and how it may relate to exposure. These findings are useful in making educated transportation planning decisions and improving the quality of life for people living in places with extreme summer temperatures.