Oral Health Disparities: Actions Taken About Pain

说明（由申请人提供）：2010年健康人口计划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有关的差距。最近发布的首份《口腔卫生总干事报告》涉及最不能够实现最佳口腔健康的人群之间的不平等和差距，并将其后果与导致不必要的疼痛和痛苦联系起来。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，疼痛与感知护理需求、实际牙科护理和生活质量下降的关系更密切。我们进行了以社区为基础的研究，提供证据表明，美国少数民族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卫生服务来应对疼痛。然而，对于种族和民族与个体、社会和经济特征之间的相互作用，作为采取治疗措施治疗口面部疼痛的决定因素，我们知之甚少。该项目建议通过抽样策略来研究寻求护理或自我管理口腔面部疼痛的共同和独特的决策机制，这将允许在种族和民族亚群体之间进行比较。除了非洲裔美国人，我们还针对西班牙裔成年人进行了研究，鉴于他们是美国人口增长最快的种族群体，因此对这一群体的口腔疼痛症状的研究尤其不足。本研究的目的是检验以下假设：1)美国少数族裔和非西班牙裔白人在处理口腔面部疼痛方面的差异；2)种族和民族与疼痛的感觉、情感和时间特征、行为和情感影响以及对护理的态度和信念相互作用，作为访问卫生保健专业人员、从事疼痛自我管理或与他人谈论疼痛的预测因素。研究设计将是一个具有前瞻性纵向面板的横断面基线研究。我们将对社区居住成年人的代表性概率样本进行电话采访，其中包括佛罗里达州迈阿密-戴德县，布劳沃德县和棕榈滩县的西班牙裔和非裔美国人的过采样。佛罗里达州的人口在规模和种族多样性方面都在迅速增加，这为研究不同种族在处理口腔疼痛方面的差异提供了一个独特的机会。本研究建议使用安徒生健康行为模型来解释易感、使能和需求特征作为目标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医疗保健使用模型，纳入广泛的健康行为（跨多个学科的医疗保健访问，自我保健行为和与他人沟通），并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民族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.