Using Secondary Analyses to Test Novel Pathways Linking Family Stress and Pain Incidence and Persistence Among African Americans

项目摘要/摘要 描述：慢性疼痛是老年人残疾和生活质量下降的持久来源- 对于年迈的非裔美国人来说，结果更糟糕，他们报告的疼痛严重程度和 与白人同龄人相比，与疼痛相关的残疾更严重。在疼痛的风险因素中，慢性压力是一种 尤其是强有力的止痛剂，由于结构性不平等，对非裔美国人来说，这种影响更加严重。 家庭压力也是如此，同样的不平等加剧了家庭压力，但这种情况很少见 作为压力-疼痛通路的一部分进行检查。家庭支持在疼痛研究中也被忽视，尽管 家庭对非裔美国人的独特重要性，他们认为家庭支持对自我痛苦至关重要 管理层。疼痛研究必须了解家庭压力和支持如何传递风险或弹性 慢性疼痛，以及家庭疼痛路径如何受到结构性不平等的影响，以支持 开发创新的疼痛管理干预措施。我们建议从以下方面分析现有数据 非裔美国人参与了两个关于老龄化健康、中年生活的成熟的、有代表性的项目 美国(MIDUS；N=721)和健康和退休研究(HRS；N=2,698)，研究疼痛状况 发展并坚持为年迈的非裔美国人服务。MIDUS的10年浪潮提供了以下优势 具体的疼痛干预措施和医生提供的疼痛诊断；两年一次的HRS浪潮(2006-- 2020)支持测试时间调节和检查疼痛轨迹的时间。我们的目标是(A)确定 家庭情感氛围的特殊特征(即婚姻和非婚姻中的支持和压力 家庭关系)，作为疼痛结果的风险或弹性因素(即，疼痛发展， 坚持性、干预性和严重性)，以及(B)决定家庭情感氛围如何影响疼痛 发病机制通过生物行为反应途径(即，抑郁和焦虑症状，以及炎症)。 我们提出了结构性不平等的多维概念化，以探索结构性不平等的调节作用 使用人口普查地区层面的数据分析歧视、社会经济差距和邻里劣势。这个 家庭压力和对非裔美国人的支持的独特作用--这是一个研究不足的群体，具有独特的 对家庭、亲属关系网络和社区治疗的重要重视--是未知的。我们的研究将结束 这一差距旨在确定疼痛差异背后的结构性因素是如何加强家庭生物行为反应的 疼痛机制。这些发现可以为精确的健康和独特的慢性疼痛信号的识别提供信息 这既有生物因素，也有心理社会因素。我们的工作将为即时翻译奠定基础 为年迈的非裔美国人提供文化响应型家庭疼痛自我管理干预。

PROJECT SUMMARY/ABSTRACT DESCRIPTION: Chronic pain is a persistent source of disability and reduced quality of life for aging adults – outcomes that are disproportionately worse for aging African Americans, who report greater pain severity and worse pain-related disability compared to White peers. Among risk factors for pain, chronic stress is an especially potent pain precipitant, an effect made far worse for African Americans due to structural inequities. The same is true for family stress, which is exacerbated by these same inequities, yet it is infrequently examined as part of the stress-pain pathway. Family support is also ignored in pain research, despite the unique importance of family for African Americans, who identify family support as critical for pain self- management. Pain research must understand how family stress and support convey risk or resilience for chronic pain, as well as how family-pain pathways are influenced by structural inequities, in order to support the development of innovative pain management interventions. We propose to analyze existing data from African American participants in two well-established, representative projects on aging health, Midlife in the U.S. (MIDUS; N = 721) and the Health and Retirement Study (HRS; N = 2,698), to study how pain conditions develop and persist for aging African Americans. The 10-year waves of MIDUS provide the advantage of specific pain interference measures and physician-provided pain diagnoses; the biennial waves of HRS (2006- 2020) support testing temporal mediation and examining the timing of pain trajectories. We aim to (a) identify the specific characteristics of family emotional climate (i.e., support and stress in both marital and non-marital family relationships) that operate as risk or resilience factors for pain outcomes (i.e., pain development, persistence, interference, and severity), and (b) determine how family emotional climate influences pain pathogenesis via biobehavioral reactivity pathways (i.e., depression and anxiety symptoms, and inflammation). We propose a multidimensional conceptualization of structural inequity to explore the moderating effects of discrimination, socioeconomic disparity, and neighborhood disadvantage using Census tract-level data. The unique role of family stress and support for African Americans – an understudied population with a unique and important emphasis on family, kinship networks, and communal healing – is unknown. Our research will close this gap to establish how structural factors underlying pain disparities potentiate family-biobehavioral reactivity pain mechanisms. Findings can inform precision health and the identification of unique chronic pain signatures that account for both bio- and psychosocial factors. Our work will lay the groundwork for immediate translation to culturally-responsive family-based pain self-management interventions for aging African Americans.