T. Hart-Johnson

Possible selves as roadmaps

Abstract Possible selves, expectations, and concerns about the coming year, can promote feeling good (“I may not be doing well in school this year, but I will next year.”) or can promote regulating for oneself (“I may not be doing well in school this year, but to make sure I do better next year, I have signed up for summer tutoring.”). We hypothesized that improved academic outcomes were likely only when a possible self could plausibly be a self-regulator. Hierarchical regression analyses supported this conclusion, with more support for the influence of self-regulation on change in behavior and academic outcomes than on affect regulation. N =160 low-income eighth graders improved grades, spent more time doing homework, participated in class more, and were referred less to summer school (controlling for fall grades and the dependent variable of interest) when academic possible selves were plausibly self-regulatory.

Racial-ethnic self-schemas

Racial-ethnic minorities are at risk of academic disengagement: pulling back effort in school. Our model focuses on implications of content of racial-ethnic self-schemas (RES) for disengagement. We postulate that risk increases when individuals are either aschematic (do not have an RES) or in-group only RES schematic (when RES incorporates only the in-group without reference to membership in larger society), and that risk decreases when RES contains both in-group and larger society. This latter RES can take the form of a dual identity, in which one is a member of both in-group and larger society, or a minority identity, in which one is a member of an in-group that must fight to overcome obstacles to attain larger societal resources. Three studies involving African American, Hispanic, American Indian and Arab-Palestinian Israelis corroborate the positive effect of dual and minority RES versus in-group only RES or RES aschematic status.

Cancer-related chronic pain

Disparities in cancer survival and pain rates negatively impact quality of life (QOL). This study examines cancer‐related chronic pain (CP) and its impact on QOL in diverse cancer survivors.

Consistent and breakthrough pain in diverse advanced cancer patients: a longitudinal examination.

Although cancer pain, both consistent and breakthrough pain ([BTP]; pain flares interrupting well-controlled baseline pain), is common among cancer patients, its prevalence, characteristics, etiology, and impact on health-related quality of life (HRQOL) are poorly understood. This longitudinal study examined the experience and treatment of cancer-related pain over six months, including an evaluation of ethnic differences. Patients with Stage III or IV breast, prostate, colorectal, or lung cancer, or Stage II-IV multiple myeloma with BTP completed surveys on initial assessment and at three and six months. Each survey assessed consistent pain, BTP, depressed affect, active coping ability, and HRQOL. Among the respondents (n=96), 70% were white, 66% were female, and had a mean age of 56+/-10 years. Nonwhites reported significantly greater severity for consistent pain at its worst (P = 0.009), least (P < or = 0.001), on average (P = 0.004), and upon initial assessment (P = 0.04), and greater severity for BTP at its worst (P = 0.03), least (P = 0.02), and at initial assessment (P = 0.008). Women also had higher levels of some BTP measures. Ethnic disparities persisted when data estimation techniques were used. Examined longitudinally, consistent pain on average and several BTP measures reduced over time, although not greatly, indicating the persistence of pain in the cancer experience. These data provide evidence for the significant toll of cancer pain, while demonstrating further health care disparities in the cancer pain experience.

The Adequacy of Chronic Pain Management Prior to Presenting at a Tertiary Care Pain Center: The Role of Patient Socio-Demographic Characteristics

UNLABELLED The Pain Management Index (PMI) is used to assess pain medication adequacy in black and white chronic pain patients (18-50 years) at referral to tertiary pain care. Using WHO guidelines for pain treatment, PMI was calculated from pain severity and drug analgesic potency. From 183 patients recruited, 128 provided treatment information for analyses (53% white, 60% female). Most (51.6%) had adequate PMI. Blacks were prescribed fewer pain medications (P = .03); fewer women had adequate medication strength (P = .04). In hierarchical regression, PMI was predicted at entry by female gender, lower MPI, higher affective MPQ, and a gender X age interaction. Younger men experienced better pain management, reducing toward the PMI level of women by age 50. In the final block, black race, being married, affective pain, and gender X age were associated with higher PMI, female gender and being employed were associated with lower PMI. Women, particularly younger women, were at higher risk for inadequate pain management in a primary care environment. These results support variability in chronic pain care and the need for research focusing on whether these disparities persist with specialized pain care. PERSPECTIVE Most people with pain receive initial care in a primary care setting. This study examining the adequacy of pain management prior to specialty pain care showed blacks and women had less adequate pain care at referral. These results suggest the need for interventions and education in the primary care arena to improve pain care.

Cancer Pain: An Age-Based Analysis

OBJECTIVE Although cancer pain (consistent and breakthrough pain [BTP; pain flares interrupting well-controlled baseline pain]) is common among cancer patients, its characteristics, etiology, and impact on health-related quality of life (HRQOL) across the lifespan are poorly understood. DESIGN This longitudinal study examines age-based differences and pain-related interference in young and old patients with cancer-related pain over 6 months. Patients in the community with stage III or IV breast, prostate, colorectal, or lung cancer, or stage II-IV multiple myeloma with BTP completed surveys (upon initial assessment, 3 and 6 months) assessing consistent pain, BTP, depressed affect, active coping ability, and HRQOL using previously validated measures. RESULTS Respondents (N= 96) were 70% white and 66% female, with a mean age of 57±10 years. There were no significant differences in pain severity based upon age. However, the younger group experienced more pain flares with greater frequency (P=0.05). The oldest group had better emotional functioning at baseline but worse physical functioning at 6 months. Younger groups also had worse cognitive functioning at 6 months (P=0.03). Pain interference was independent of age. CONCLUSIONS These data provide evidence for the significant toll of cancer pain on overall health and well-being of young and old adults alike but demonstrate an increased toll for younger adults (especially financially). Beyond race and gender disparities, further health care disparities in the cancer and cancer pain were identified by age, illustrating the need for additional research across the lifespan in diverse cancer survivors.

The Impact of Sexual or Physical Abuse History on Pain-Related Outcomes Among Blacks and Whites with Chronic Pain: Gender Influence

OBJECTIVES Physical and sexual abuses commonly co-occur with chronic pain. We hypothesized that: 1) abuse history questions would form distinct factors that relate differently to pain perceptions and pain outcomes; 2) abuse history consequences on physical and mental health differ by gender; and 3) different abuse types and age of occurrence (childhood vs adolescent/adulthood) predict different negative outcomes. METHODS   Chronic pain patients at a tertiary care pain center provided data (64% women, 50% black) through a confidential survey. Factors were formed for abuse type and age. Linear regression, controlling for socio-demographic information, was used to examine the relationship between abuse and abuse by sex interactions with pain-related outcomes. RESULTS Six 3-item abuse factors (α = 0.77-0.91)-sexual molestation, sexual penetration, and physical abuse-were identified in both childhood and adulthood. Lifetime prevalence of abuse was 70% for men and 65% for women. Women experienced lower physical abuse (P = 0.01) in childhood, and higher penetration (P = 0.02) in adulthood. Decreased general health was associated with all abuse types (P < 0.05) in childhood. Affective pain was associated with all childhood abuse scales and adulthood molestation, though childhood molestation only for men (P = 0.04). Disability was associated with childhood (P = 0.02) and adulthood rape (P = 0.04). Men with childhood or adulthood molestation (P = 0.02; P = 0.02) reported higher post-traumatic stress disorder. CONCLUSIONS Our study confirms physical and mental health, and pain-related outcomes are affected by abuse history for men and women. These results support screening all patients for abuse to improve the survivors overall health and well-being.

The Impact of Chronic Pain on the Health of Black and White Men

Persistent pain, disability, and depression are hallmarks for chronic pain. While disparities based upon race, gender, and class are documented, little is known about pain disparities in minority men. This investigation examines black (6.2%) and white (93.8%) men (N = 1650) presenting for initial assessment at a tertiary care pain center. Racial comparisons utilized analysis of variance; all variables of interest were then placed in a theoretical model using path analysis. The model included race, age, education, neighborhood income, marital status, litigation, substance use, and high blood pressure as predictors and pain, depression, affective distress, posttraumatic stress disorder (PTSD), and disability as outcomes. Black race was associated with lower neighborhood income, education and marriage rates, and higher rates of litigation and high blood pressure. Black men also had higher pain (affective and miscellaneous), disability, and depression. Path analysis found black race was a direct predictor of greater pain, and through pain, was an indirect predictor of depression, affective distress, PTSD, and disability. Path analysis confirmed the complexity of relationships and supported using techniques to understand these relationships. Our data highlight disparities in the pain experience for black men. They also elucidate potential mechanisms through which disparities work in vulnerable and understudied populations.

Body Mass Index and Quality of Life: Examining Blacks and Whites With Chronic Pain

UNLABELLED Obesity contributes to several chronic pain conditions, negatively affecting quality of life (QOL). However, obesitys relationship with chronic pain is poorly understood. This prospective survey study examines obesitys role in chronic pain and subsequent impact on QOL. Black and white patients with chronic pain (N = 183, 18-50 years of age, 64% women, 50% black) were studied to determine predictors for the presence of body mass index (BMI) information in medical records, group BMI differences, and how BMI and pain contribute to mental/physical outcomes. BMI was calculated by using medical records nearest the enrollment date. Sociodemographic data, sleep, pain, functioning, disability, and depression were measured. BMI data were available for 143 subjects (78%), with blacks having a higher BMI (P = .002). Black (P = .08), people with higher pain (P < .01), affective distress (P < .01), and post-traumatic stress disorder scores (P = .07) were less likely to have their BMI recorded. Path analysis tested relationships between sociodemographics, BMI and pain with functioning, depression, and disability. BMI was positively associated with black race and age and predicted poorer physical functioning and greater disability. Pain was not predicted by race or age but was associated with all outcomes. These findings support assessing BMI when managing chronic pain and its negative impact on QOL, especially for minority patients. PERSPECTIVE This study examines the relationships among sociodemographic factors, BMI, and QOL in chronic pain. Our results demonstrate significant racial disparity among chronic pain patients in assessing BMI and quality of pain care. These findings support obesitys negative impact on overall health and the importance of measuring BMI in patients with chronic pain, especially racial and ethnic minorities.

Sleep problems in a racially diverse chronic pain population.

ObjectiveThis study describes and compares sleep disturbances in chronic pain patients while assessing the role of age, race, gender, and psychological health on sleep. MethodsSelf-report data fitted from chronic pain patients (N=4269) presenting for initial assessment were fitted to regression models predicting difficulty falling asleep, difficulty staying asleep, and overall sleep quality. ResultsWe found high prevalence of difficulty falling (71.1%) and staying asleep (78.3%), and relatively poor sleep quality (9.76±2.86; 3=best; 18=worse). Blacks, men, and younger people with chronic pain were at higher risk for poor sleep quality and difficulty falling asleep. Significant interactions between race, age, gender, and sleep were identified. Sleep improved with age, but the gender gap in difficulty falling asleep and poor sleep quality was greatest at younger age, with young men at greatest risk. Young black men had more difficulty staying asleep, with a significant improvement with age. Individuals with chronic pain most at risk for sleep disturbances differed from those identified in general populations. DiscussionThe ability of health professionals to identify individuals at risk for sleep disturbance and to understand the dynamics of sleep, pain, and psychological health could improve healthcare quality.