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

项目概要/摘要 描述：慢性疼痛是老年人残疾和生活质量下降的持久根源 - 对于老年非裔美国人来说，结果要严重得多，他们报告疼痛更严重，并且 与白人同龄人相比，疼痛相关的残疾更严重。在疼痛的危险因素中，慢性压力是一个 尤其是强烈的疼痛诱发因素，由于结构性不平等，这种影响对非裔美国人来说更加严重。 家庭压力也是如此，这些同样的不平等会加剧家庭压力，但这种情况很少发生 作为压力-疼痛途径的一部分进行检查。尽管在疼痛研究中家庭支持也被忽视 家庭对于非裔美国人来说具有独特的重要性，他们认为家庭支持对于缓解自我疼痛至关重要。 管理。疼痛研究必须了解家庭压力和支持如何传递风险或恢复力 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。我们建议分析现有数据 非洲裔美国人参与了两个成熟的代表性项目：老龄化健康、中年 美国（MIDUS；N = 721）和健康与退休研究（HRS；N = 2,698），研究疼痛状况如何 为老年非裔美国人发展并坚持。 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）支持测试时间中介并检查疼痛轨迹的时间。我们的目标是 (a) 确定 家庭情绪氛围的具体特征（即婚姻和非婚姻中的支持和压力） 家庭关系）作为疼痛结果（即疼痛发展、 持续性、干扰和严重程度），以及 (b) 确定家庭情绪氛围如何影响疼痛 通过生物行为反应途径（即抑郁和焦虑症状以及炎症）的发病机制。 我们提出了结构性不平等的多维概念，以探索结构性不平等的调节作用 使用人口普查区域级数据来了解歧视、社会经济差异和邻里劣势。的 家庭压力和支持对非裔美国人的独特作用——这是一个未被研究的群体，具有独特和 对家庭、亲属关系网络和公共治疗的重视程度尚不清楚。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如何增强家庭生物行为反应性 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 解释了生物和心理社会因素。我们的工作将为立即翻译奠定基础 针对老年非裔美国人的文化响应的、基于家庭的疼痛自我管理干预措施。

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.