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

使用二次分析来测试将家庭压力与非裔美国人疼痛发生率和持续时间联系起来的新途径

• 批准号: 10598724
• 负责人: Sarah B. Woods
• 金额: $ 46.19万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-30 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10598724
• 关键词: Adult; African American; African American population; Aging; Anxiety; Caring; Censuses; Chronic stress; Climate; Data; Data Set; Development; Diagnosis; Disadvantaged; Discrimination; Effectiveness of Interventions; Emotional; Epidemiology; Family; Family Characteristics; Family Relationship; Fibrinogen; Goals; Health; Health and Retirement Study; Incidence; Inflammation; Intervention; Kinship Networks; Knowledge; Link; Measures; Mediating; Mediation; Mental Depression; Modeling; Outcome; Pain; Pain Research; Pain interference; Pain management; Participant; Pathogenesis; Pathway interactions; Patient Care; Phase; Physicians; Population; Positioning Attribute; Precision Health; Primary Health Care; Psychosocial Factor; Quality of life; Reporting; Research; Risk; Risk Factors; Role; Sampling; Severities; Source; Specific qualifier value; Stress; Stress Tests; Testing; Time; Translations; United States; Variant; Work; anxiety symptoms; base; biobehavior; biopsychosocial; chronic pain; commune; depressive symptoms; disability; experience; family support; healing; improved; innovation; middle age; modifiable risk; neighborhood disadvantage; novel; pain outcome; pain self-management; pain-related disability; peer; pre-clinical; psychosocial; public health relevance; racism; resilience; secondary analysis; socioeconomic disparity; stress reactivity

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.

项目总结/摘要 描述：慢性疼痛是老年人残疾和生活质量下降的持续原因- 结果是不成比例地更糟的老龄化非洲裔美国人，谁报告更大的疼痛严重程度， 与白色同龄人相比，疼痛相关残疾更严重。在疼痛的危险因素中，慢性压力是一个 尤其是强有力的疼痛促进剂，由于结构性不平等，对非洲裔美国人的影响更糟。 家庭压力也是如此，这种压力因同样的不平等而加剧，但这种情况很少发生。 作为压力-疼痛通路的一部分进行检查。在疼痛研究中，家庭支持也被忽视了， 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疼痛至关重要， 管理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，以及家庭疼痛途径如何受到结构性不平等的影响，以支持 创新的疼痛管理干预措施的发展。我们建议分析现有数据， 非裔美国人参与了两个成熟的，有代表性的老龄健康项目， 美国（MIDUS; N = 721）和健康与退休研究（HRS; N = 2，698），以研究疼痛状况 发展和坚持为老龄化的非洲裔美国人。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; HRS的两年期波（2006- 2020）支持测试时间调解和检查疼痛轨迹的时间。我们的目标是（a）确定 家庭情绪气候的具体特征（即，婚姻和非婚姻中支持和压力 家庭关系）作为疼痛结果的风险或弹性因素（即，疼痛发展， 持续性、干扰和严重性），以及（B）确定家庭情绪气候如何影响疼痛 通过生物行为反应途径的发病机制（即，抑郁和焦虑症状以及炎症）。 我们提出了一个结构性不公平的多维概念，以探讨结构性不公平的调节作用， 歧视，社会经济差距和邻里劣势使用人口普查区级数据。的 家庭压力和对非裔美国人的支持的独特作用-一个未被充分研究的人口， 重要的是强调家庭，亲属关系网络和社区愈合-是未知的。我们的研究将结束 这一差距，以建立结构性因素的基础疼痛差异，加强家庭生物行为反应 疼痛机制研究结果可以为精确健康和识别独特的慢性疼痛特征提供信息 生物和心理社会因素的解释。我们的工作将为立即翻译奠定基础 对老年非裔美国人进行文化响应的以家庭为基础的疼痛自我管理干预。