Joseph L. Riley - US grants

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.

21+ years old; Active Follow-up; Address; Adult; African American; Afro American; Afroamerican; Attitude; Awareness; Awarenesses; Behavior; Black Populations; Black or African American; Cancer Prognosis; Cancer Radiotherapy; Cancer Screening for Patients; Cancer of the Pharynx; Cancers; Caring; Characteristics; Cognitive; Communities; Control Groups; County; Cues; Dental; Diagnosis; Document Type; Early Diagnosis; Early Intervention; Early Intervention (Education); Effectiveness; Empirical Research; Florida; Focus Groups; Future; Goals; Habits; Health; Health Promotion; Health behavior; Human, Adult; Individual; Intervention; Intervention Strategies; Knowledge; Legal; Life; Literature; Malignant; Malignant - descriptor; Malignant Neoplasms; Malignant Pharyngeal Neoplasm; Malignant Pharyngeal Tumor; Malignant Tumor; Malignant Tumor of the Pharynx; Malignant neoplasm of pharynx; Measures; Media Campaign; Media Intervention; Medical; Method LOINC Axis 6; Methodology; Modeling; Mortality; Mortality Vital Statistics; Operation; Operative Procedures; Operative Surgical Procedures; Oral; Oral health; Oropharyngeal; Oropharynx; Oropharynxs; Painless; Participant; Patient Self-Report; Peripheral; Persons; Pharnyx Cancer; Pharyngeal Cancer; Population; Pre-Malignant; Predisposition; Premalignant; Preventive; Process; Radiation therapy; Radiotherapeutics; Radiotherapy; Report (document); Reporting; Research; Research Resources; Resources; Risk; Risk Factors; Route; Rural; Rural Community; Rural Population; Salutogenesis; Sampling; Screening for Oral Cancer; Screening for cancer; Screening procedure; Self-Report; Series; Specific qualifier value; Specified; Staging; Surgeon; Surgical; Surgical Interventions; Surgical Procedure; Survival Rate; Susceptibility; Target Populations; Testing; Thinking; Thinking, function; Training; United States; Work; adult human (21+); base; black American; chemotherapy; community intervention; dental health; design; designing; early cancer detection; early detection; experience; follow-up; health disparities; health disparity; health literacy; improved; intervention design; interventional strategy; irradiation; male; malignancy; member; men; men's; mouth lesion; neoplasm/cancer; oral cancer early detection; oral lesion; oral pharyngeal; precancerous; preference; screening; screenings; surgery; therapy design; treatment design

DESCRIPTION (provided by applicant): Older adults are at increased risk to develop prolonged pain and experience greater pain-related loss of physical and psychosocial function compared to younger cohorts. We propose that changes in endogenous pain modulatory capacity accounts for increased incidence of pain and disability in older adults. That endogenous pain modulation dysfunction is related to persistent pain is supported by a number of studies comparing chronic pain patients with healthy controls using a pain-inhibition-by-pain experimental model. Although this research group (and others) has shown age deficiencies using the pain inhibits pain model, other human laboratory models that are known to engage pain modulatory systems have not been tested across the lifespan, each potentially involving different mechanisms. The overarching goal of the proposed research is to characterize age-related changes in pain inhibitory and facilitatory function and to investigate the biopsychosocial mediators and clinical relevance of these changes. Our preliminary data suggest that sophisticated psychophysical methods reflecting net inhibitory or facilitatory effects are sensitive to changes across the lifespan and will provide a more comprehensive and clinically-relevant picture of changes in pain processing associated with aging. This proposed study will enroll 180 human subjects, ages 18-79, who will undergo assessment during three pain modulatory sessions at baseline. The pain modulatory tests will include inhibitory protocols; diffuse noxious controls and offset analgesia, and tests that involve pain facilitation; temporal summation, impaired decay of subthreshold pain (proxy for central sensitization), and a prolonged protocol which we have found produces greater temporal sensitization across repeated trials in older subjects. Individualized temperatures for the contact heat test stimulus will be used so that subjects experience similar, moderate levels of pain. We hypothesize that age will be associated with poorer endogenous pain inhibition from pain inhibitory protocols and increased pain from protocols that facilitate pain. A range of biopsychosocial markers will be measured that we hypothesize will mediate the association between age and variability in pain modulation. These measures include psychosocial factors (catastrophizing, sleep, stress, and negative emotions) and biological markers (blood pressure, 2-endorphin, cortisol, and other hypothalamic-pituitary- adrenal and immune markers). After establishing individual levels of pain facilitation and pain inhibition, we will assess pain during daily life and the impact of pain on quality of life using a series of telephone interviews and novel real-time electronic data capture each month for 6 months. We expect that changes in our pain modulatory tests will account for observed age differences in pain frequency, more pain intensity, number of pain sites, and in quality of life.