Oral Health Disparities: Actions Taken About Pain

描述(由申请者提供)：2010年健康人的主要目标之一是消除不同人口群体之间的健康差距，重点是与种族和族裔相关的差距。最近，卫生局局长关于口腔健康的第一份报告谈到了那些最不能实现最佳口腔健康的人之间的不平等和差距，并将其后果归因于导致不必要的痛苦和痛苦。研究表明，疼痛是口腔疾病最常见的影响，与其他主观体征或症状相比，疼痛与感知的护理需求、实际的牙科护理和生活质量下降更相关。我们进行了以社区为基础的研究，提供证据表明，美国少数族裔成年人患口腔面部疼痛的风险增加，并且不太可能使用口腔健康服务来应对疼痛。然而，关于种族和民族之间的相互作用以及个人、社会和经济特征作为口腔面部疼痛治疗行动的决定因素的相互作用，人们知之甚少。该项目建议研究寻求护理或自我管理口腔面部疼痛的决定所依据的共同和独特的机制，抽样战略将允许在种族和民族亚群之间进行比较。除了非裔美国人，我们还瞄准了拉美裔成年人，鉴于他们代表着美国增长最快的种族群体，这一群体在口腔疼痛症状方面的研究尤其不足。这项研究的目的是检验以下假设：1)少数族裔美国人和非西班牙裔白人在控制口腔面部疼痛方面的行动差异；2)种族和种族与疼痛的感觉、情感和时间特征、行为和情感影响以及关于护理的态度和信念相互作用，作为去看卫生保健专业人员、从事疼痛自我管理或与他人谈论疼痛的预测因素。研究设计将是一项具有前瞻性纵向面板的横断面基线研究。我们将对社区居住的成年人进行具有代表性的概率样本的电话采访，其中将包括佛罗里达州迈阿密-戴德县、布罗沃德县和棕榈滩县的拉美裔和非裔美国人的过度抽样。佛罗里达州的人口在规模和种族多样性方面都在迅速增长，这为我们提供了一个独特的机会来检查在采取行动控制口腔疼痛方面的种族差异。这项研究建议使用安徒生健康行为模型来解释易感、支持和需要特征，作为有针对性的健康促进行为的预测因子。该项目的独特贡献将是使用经过验证的卫生保健使用模式，纳入广泛的健康行为(跨多个学科的卫生保健访问、自我保健行为和与他人交流)，以及纳入西班牙裔美国人。由于文化可以对疾病的主观体验产生重大影响，对疼痛症状的反应的差异可能有助于解释在应对口腔疾病时考虑(或不考虑)的行为选择的差异。这一信息对通过促进获得护理和利用适当服务的干预措施减少口腔健康方面的种族和族裔差异具有重要的卫生政策意义。

DESCRIPTION (provided by applicant): One of the primary goals of Healthy People 2010 is to eliminate health disparities among different segments of the population, with substantial emphasis given to disparities associated with race and ethnicity. The recent, first-ever Surgeon General's Report on Oral Health addresses the inequities and disparities among those least able to achieve optimal oral health, and relates the consequences as leading to needless pain and suffering. Studies show that pain is the most commonly reported impact of oral disease and is more strongly associated with perceived need for care, actual dental care, and diminished quality of life than other subjective signs or symptoms. We have conducted community-based studies that provide evidence that US minority adults are at increased risk for orofacial pain and are less likely to use oral health services in response to pain. However, there is little known about the interplay between race and ethnicity with individual, social, and economic characteristics as determinants of taking therapeutic action for orofacial pain. This project proposes to examine common and unique mechanisms underlying decisions to seek care or self-manage orofacial pain with a sampling strategy that will allow for comparisons among race and ethnic subgroups. Along with African- Americans, we have targeted Hispanic adults, a group that is particularly understudied regarding painful oral symptoms, given that they represent the fastest growing ethnic group in America. The aims of this study are to test hypothesis regarding: 1) Differences in the action taken to manage orofacial pain between minority Americans and non-Hispanic Whites; 2) That race and ethnicity interact with the sensory, emotional, and temporal characteristics of pain, behavioral and emotional impacts, and attitudes and beliefs about care as predictors of visiting a health care professional, engaging in pain self-management, or talking to others about pain. The study design will be a cross-sectional baseline study with a prospective longitudinal panel. We will conduct telephone interviews with a representative probability sample of community-dwelling adults, which will include oversampling of Hispanics and African-Americans within Miami-Dade, Broward, and Palm Beach counties in the state of Florida. Florida's population is rapidly increasing in both size and ethnic diversity and offers a unique opportunity to examine the interethnic differences in the actions taken to manage oral pain. This study proposes to use the Andersen Behavioral Model of Health to account for predisposing, enabling, and need characteristics as predictors of the targeted health enhancing behaviors. Unique contributions of this project will be the use of a validated model of health care use, the inclusion of a broad range of health behaviors (health care visits across multiple disciplines, self-care behaviors, and communicating with others), and the inclusion of Hispanic Americans. As culture can have a significant impact on the subjective experience of illness, differences in response to painful symptoms may help explain differences in behavioral options considered (or not considered) in response to oral disease. This information has important health policy implications for reducing the race and ethnic disparities in oral health through interventions that facilitate access to care and utilization of appropriate services.