Research is greatly lacking on older women's physical pain experience. There is increasing recognition that many community-dwelling ethnically diverse older women (our target population), although managing to reside outside of institutions, live with high pain levels. In comparison to European- Americans, older racial and ethnic minorities such as African-Americans and Hispanics are likely to be under- treated for pain, but the scarce literature on this topic is highly conflicting. In the current SC3 grant, the I is testing links between trauma and general physical health as well as general mental health in multiethnic older women. In this resubmitted renewal grant, we will use a comprehensive pain measure to compare mean levels of pain across 3 ethnic groups, and will pilot-test this tool's invariance across these groups. Second, we will validate a new measure of satisfaction with one's health provider and test whether it could be used with multiethnic older women. Finally, we will test an improved pain model based on Lagana' and Hassija's original model of pain published in 2012. We will clarify the relation of trauma to physical pain (not to health in genera, as done in the SC3 research) and will test several potential protective and risk factors for pain. We will use more specific measures of psychopathology than those utilized in the SC3 grant, including a novel non-medical stress tool created by the PI. This stress measure is highly needed in the pain model tested herein, in order to minimize confounding issues that could arise if assessing medical stress instead (given that pain is a component of physical health). In addition to expanding the study of trauma and its health-related consequences to focus more specifically on pain, we will test potential pain predictors including demographics, coping strategies, ethnic identity, social quality of life, as well as satisfaction with and adherence to one's health provider's advice. The long-term goal is to shed light on the neglected topic of geriatric pain among non- clinical multiethnic populations. Upon clarifying the social support and psychopathology paths that lead from trauma to pain, and upon studying the relationship of pain to the aforementioned under-studied factors, future pain studies could be designed to test new psychosocial and medical interventions that could best decrease older women's pain.
Aim 1) Compare mean levels of older women's pain across 3 ethnicities and establish (via structural invariance analysis) whether the Global Pain Scale can be used with an ethnically diverse population. Hypothesis 1: Older African-American women will report lower pain levels than European-Americans at a marginally significant level (p<.10). Hypothesis 2: Regarding the structural invariance of the Global Pain Scale, we expect the multi-group confirmatory factor analysis (comparing African-Americans, Latinas, and European- Americans) to show that this scale can be used successfully with these 3 groups.
Aim 2) Validate the PI's new 6-item measure Satisfaction with and adherence to health provider's advice and establish (using structural invariance analysis) whether it can be used with multiethnic participants. Hypothesis 3: We hypothesized that our new tool is a robust measure, as indicated by its predicted strong reliability, validity, and invariance tested on the 3 ethnic groups.
Aim 3) Test an improved pain model on African-American, Hispanic, and European-American older women. The model's hypotheses are: Hypothesis 4: Venting will be negatively related to pain. Hypothesis 5: Denial will be negatively related to pain. Hypothesis 6: Seeking emotional support will be negatively related to pain. Hypothesis 7: Active coping will be positively related to pain. Hypothesis 8: Religious coping will be negatively related to pain. Hypothesis 9: Coping via substance use will be positively related to pain. Hypothesis 10: Being Hispanic will be positively related to pain. Hypothesis 11: Being Hispanic will be related to lower pain through higher religious coping. Hypothesis 12: Being African-American will be related to lower pain through higher religious coping. Hypothesis 13: Being Hispanic will be negatively related to income. Hypothesis 14: Being African-American will be negatively related to income. Hypothesis 15: Age will be positively related to pain. Hypothesis 16: Being Hispanic will be related to higher pain through lower ethnic identity. Hypothesis 17: Trauma will be positively related to pain. Hypothesis 18: PTSD symptomatology will be positively related to pain. Hypothesis 19: Non-medical stress will be positively related to pain. Hypothesis 20: Trauma will be related to higher pain through higher PTSD. Hypothesis 21: Trauma will be related to higher pain through higher non-medical stress. Hypothesis 22: PTSD symptomatology will be positively related to non-medical stress. Hypothesis 23: Trauma will be related to higher pain through both higher PTSD and higher depression. Hypothesis 24: Depressive symptomatology will be negatively related to social quality of life. Hypothesis 25: Social quality of life will be negatively related to non-medical stress. Hypothesis 26: Social quality of life will be negatively related to pain. Hypothesis 27: Satisfaction with and reported adherence to health provider's advice will be negatively related to pain.
The proposed research will clarify factors related to a neglected research area, pain in non-clinical samples of older women. Its findings could be used to train health providers to decrease their implicit racial biases and increase their cultural competence skills when dealing with multiethnic older women in pain. They could also lay the foundation for the development of effective pain prevention and management programs tailored to specific ethnic groups living with high levels of pain. If successful, these future intervention could potentially translate into fewer doctor visits and a corresponding decrease in medical spending in the U.S.
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