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Perceived Racial Discrimination and Pain Intensity/Disability Among Economically Disadvantaged Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity

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Abstract

The present study examined the role of anxiety sensitivity (AS; fear of the negative consequences of anxiety) in the relation between perceived racial discrimination and pain-related problems among Latinos seeking health services at a Federally Qualified Health Center. Participants included 145 adult Latinos (87.80% female, Mage = 38.07 years, SD = 11.98, and 96.2% reported Spanish as their first language). Results indicated that perceived racial discrimination was indirectly related to the pain intensity and pain disability through AS. These effects were evident above and beyond the variance accounted for by gender, age, marital status, educational status, employment status, years living in the United States, and number of axis I diagnoses. Overall, the present findings highlight the merit in focusing further scientific attention on the interplay between perceived racial discrimination and AS to better understand and inform interventions to reduce pain problems among Latinos in primary care.

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References

  1. Colby SL, Ortman JM. Projections of the size and composition of the US population: 2014 to 2060. US Census Bureau. 2015;9.

  2. Escarce J, Kapur K. Access to and quality of health care. Hisp Future Am. 2006:410–5.

  3. Green CR, Anderson KO, Baker TA, et al. “The unequal burden of pain: confronting racial and ethnic disparities in pain” Pain Medicine 2004;4(3):277–294. Pain Med. 2005. https://doi.org/10.1111/j.1526-4637.2005.05018.x.

    Article  PubMed  Google Scholar 

  4. Epps CD, Ware LJ, Packard A. Ethnic wait time differences in analgesic administration in the emergency department. Pain Manag Nurs. 2008;9(1):26–32.

    Article  PubMed  Google Scholar 

  5. Nguyen M, Ugarte C, Fuller I, Haas G, Portenoy RK. Access to care for chronic pain: racial and ethnic differences. J Pain. 2005;6(5):301–14.

    Article  PubMed  Google Scholar 

  6. Portenoy RK, Ugarte C, Fuller I, Haas G. Population-based survey of pain in the United States: differences among white, African American, and Hispanic subjects. J Pain. 2004;5(6):317–28.

    Article  PubMed  Google Scholar 

  7. Berry PH, Dahl JL. The new JCAHO pain standards: implications for pain management nurses. Pain Manag Nurs. 2000;1(1):3–12.

    Article  CAS  PubMed  Google Scholar 

  8. Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R. Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. Jama. 2008;299(1):70–8.

    Article  CAS  PubMed  Google Scholar 

  9. Juarez G, Ferrell B, Borneman T. Influence of culture on cancer pain management in Hispanic patients. Cancer Pract. 1998;6(5):262–9.

    Article  CAS  PubMed  Google Scholar 

  10. Sherwood GD, McNeill JA, Palos G, Starck P. Perspectives on pain: a qualitative analysis of the Hispanic pain experience. NT Res. 2003;8(5):364–77.

    Article  Google Scholar 

  11. Cintron A, Morrison RS. Pain and ethnicity in the United States: a systematic review. J Palliat Med. 2006;9(6):1454–73.

    Article  PubMed  Google Scholar 

  12. Calculator CI. Bureau of Labor Statistics, US Department of Labor. 2010.

  13. Gagnon CM, Matsuura JT, Smith CC, Stanos SP. Ethnicity and interdisciplinary pain treatment. Pain Pract. 2014;14(6):532–40.

    Article  PubMed  Google Scholar 

  14. Reyes-Gibby CC, Aday LA, Todd KH, Cleeland CS, Anderson KO. Pain in aging community-dwelling adults in the United States: non-Hispanic whites, non-Hispanic blacks, and Hispanics. J Pain. 2007;8(1):75–84.

    Article  PubMed  Google Scholar 

  15. Edwards RR, Moric M, Husfeldt B, Buvanendran A, Ivankovich O. Ethnic similarities and differences in the chronic pain experience: a comparison of African American, Hispanic, and white patients. Pain Med. 2005;6(1):88–98.

    Article  PubMed  Google Scholar 

  16. Burgess DJ, Grill J, Noorbaloochi S, et al. The effect of perceived racial discrimination on bodily pain among older African American men. Pain Med. 2009;10(8):1341–52.

    Article  PubMed  Google Scholar 

  17. Goodin BR, Pham QT, Glover TL, et al. Perceived racial discrimination, but not mistrust of medical researchers, predicts the heat pain tolerance of African Americans with symptomatic knee osteoarthritis. Health Psychol. 2013;32(11):1117.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Mesch GS, Turjeman H, Fishman G. Perceived discrimination and the well-being of immigrant adolescents. J Youth Adolesc. 2008;37(5):592–604.

    Article  Google Scholar 

  19. Pascoe EA, Smart Richman L. Perceived discrimination and health: a meta-analytic review. Psychol Bull. 2009;135(4):531.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Krogstad JM, López G. Roughly half of Hispanics have experienced discrimination. Fact Tank: news in the numbers. 2016.

  21. Borrell LN, Kiefe CI, Williams DR, Diez-Roux AV, Gordon-Larsen P. Self-reported health, perceived racial discrimination, and skin color in African Americans in the CARDIA study. Soc Sci Med. 2006;63(6):1415–27.

    Article  PubMed  Google Scholar 

  22. Galvan FH, Bogart LM, Klein DJ, Wagner GJ, Chen Y-T. Medical mistrust as a key mediator in the association between perceived discrimination and adherence to antiretroviral therapy among HIV-positive Latino men. J Behav Med. 2017:1–10.

  23. Sirin SR, Rogers-Sirin L, Cressen J, Gupta T, Ahmed SF, Novoa AD. Discrimination-related stress effects on the development of internalizing symptoms among Latino adolescents. Child Dev. 2015;86(3):709–25.

    Article  PubMed  Google Scholar 

  24. Dugan SA, Lewis TT, Everson-Rose SA, Jacobs EA, Harlow SD, Janssen I. Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women’s Health Across the Nation. Pain. 2017;158(9):1656–65.

    Article  PubMed  PubMed Central  Google Scholar 

  25. McNally RJ. Anxiety sensitivity and panic disorder. Biol Psychiatry. 2002;52(10):938–46.

    Article  PubMed  Google Scholar 

  26. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther. 1986;24(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  27. Keogh E, Cochrane M. Anxiety sensitivity, cognitive biases, and the experience of pain. J Pain. 2002;3(4):320–9.

    Article  PubMed  Google Scholar 

  28. Keogh E, Mansoor L. Investigating the effects of anxiety sensitivity and coping on the perception of cold pressor pain in healthy women. Eur J Pain. 2001;5(1):11–22.

    Article  CAS  PubMed  Google Scholar 

  29. Asmundson GJ, Norton PJ, Vlaeyen JW. Fear-avoidance models of chronic pain: an overview. Underst Treat Fear Pain. 2004:3–24.

  30. Asmundson GJ, Taylor S. Role of anxiety sensitivity in pain-related fear and avoidance. J Behav Med. 1996;19(6):577–86.

    Article  CAS  PubMed  Google Scholar 

  31. Norton PJ, Asmundson GJ. Anxiety sensitivity, fear, and avoidance behavior in headache pain. Pain. 2004;111(1):218–23.

    Article  PubMed  Google Scholar 

  32. Drahovzal DN, Stewart SH, Sullivan MJ. Tendency to catastrophize somatic sensations: pain catastrophizing and anxiety sensitivity in predicting headache. Cognit Behav Ther. 2006;35(4):226–35.

    Article  Google Scholar 

  33. Vancleef LM, Peters ML. Pain catastrophizing, but not injury/illness sensitivity or anxiety sensitivity, enhances attentional interference by pain. J Pain. 2006;7(1):23–30.

    Article  PubMed  Google Scholar 

  34. Velasco RV, Bakhshaie J, Walker RL, et al. Synergistic effects of pain intensity and anxiety sensitivity in relation to anxiety and depressive symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting. J Anxiety Disord. 2016;43:23–31.

    Article  PubMed  Google Scholar 

  35. Zvolensky MJ, Garey L, Bakhshaie J. Disparities in anxiety and its disorders. Amsterdam: Elsevier; 2017.

    Book  Google Scholar 

  36. Zvolensky MJ, Bakhshaie J, Paulus DJ, et al. Exploring the mechanism underlying the association between pain intensity and mental health among latinos. J Nerv Mental Dis. 2017;205(4):300–7.

    Article  Google Scholar 

  37. Gee GC, Payne-Sturges DC. Environmental health disparities: a framework integrating psychosocial and environmental concepts. Environ Health Perspect. 2004;112(17):1645.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Geronimus AT, Pearson JA, Linnenbringer E, et al. Race-ethnicity, poverty, urban stressors, and telomere length in a Detroit community-based sample. J Health Soc Behav. 2015;56(2):199–224.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic discrimination and health: findings from community studies. Am J Public Health. 2003;93(2):200–8.

    Article  PubMed  PubMed Central  Google Scholar 

  40. LaVeist TA, Rolley NC, Diala C. Prevalence and patterns of discrimination among US health care consumers. Int J Health Serv. 2003;33(2):331–44.

    Article  PubMed  Google Scholar 

  41. Post RM. Transduction of psychosocial stress into the neurobiology. Am J Psychiatry. 1992;149:999–1010.

    Article  CAS  PubMed  Google Scholar 

  42. Van Winkel R, Stefanis NC, Myin-Germeys I. Psychosocial stress and psychosis. A review of the neurobiological mechanisms and the evidence for gene-stress interaction. Schizophrenia Bull. 2008;34(6):1095–105.

    Article  Google Scholar 

  43. Bandoli G, Campbell-Sills L, Kessler R, et al. Childhood adversity, adult stress, and the risk of major depression or generalized anxiety disorder in US soldiers: a test of the stress sensitization hypothesis. Psychol Med. 2017:1–14.

  44. Ursin H, Eriksen H. Cognitive activation theory of stress, sensitization, and common health complaints. Ann N Y Acad Sci. 2007;1113(1):304–10.

    Article  PubMed  Google Scholar 

  45. Miller C, Newton SE. Pain perception and expression: the influence of gender, personal self-efficacy, and lifespan socialization. Pain Manag Nurs. 2006;7(4):148–52.

    Article  PubMed  Google Scholar 

  46. Watkins KW, Shifren K, Park DC, Morrell RW. Age, pain, and coping with rheumatoid arthritis. Pain. 1999;82(3):217–28.

    Article  CAS  PubMed  Google Scholar 

  47. Flor H, Turk DC, Rudy TE. Relationship of pain impact and significant other reinforcement of pain behaviors: the mediating role of gender, marital status and marital satisfaction. Pain. 1989;38(1):45–50.

    Article  CAS  PubMed  Google Scholar 

  48. Cano A, Mayo A, Ventimiglia M. Coping, pain severity, interference, and disability: the potential mediating and moderating roles of race and education. J Pain. 2006;7(7):459–68.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Macfarlane GJ, Thomas E, Papageorgiou AC, Croft PR, Jayson MI, Silman AJ. Employment and physical work activities as predictors of future low back pain. Spine. 1997;22(10):1143–9.

    Article  CAS  PubMed  Google Scholar 

  50. Chan MY, Hamamura T, Janschewitz K. Ethnic differences in physical pain sensitivity: role of acculturation. PAIN®. 2013;154(1):119–23.

    Article  Google Scholar 

  51. Gerhart LG, Harris S, Mixon J. Beliefs and effective practices of successful principals in high schools with a Hispanic population of at least 30%. NASSP Bull. 2011;95(4):266–80.

    Article  Google Scholar 

  52. Kroenke K. Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and management. Int J Methods Psychiatr Res. 2003;12(1):34–43.

    Article  PubMed  Google Scholar 

  53. Vega WA, Lopez SR. Priority issues in Latino mental health services research. Mental Health Serv Res. 2001;3(4):189–200.

    Article  CAS  Google Scholar 

  54. Lecrubier Y, Sheehan D, Weiller E, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12(5):224–31.

    Article  Google Scholar 

  55. Sheehan D, Lecrubier Y, Harnett Sheehan K, et al. The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry. 1997;12(5):232–41.

    Article  Google Scholar 

  56. Bakhshaie J, Kauffman BY, Viana AG, et al. Synergistic effects of pain intensity and experiential avoidance in relation to anxiety symptoms and disorders among economically disadvantaged latinos in a community-based primary care setting. J Anxiety Disord. 2017;48:54–62.

    Article  PubMed  Google Scholar 

  57. Mena FJ, Padilla AM, Maldonado M. Acculturative stress and specific coping strategies among immigrant and later generation college students. Hispanic J Behav Sci. 1987;9(2):207–25.

    Article  Google Scholar 

  58. Hovey JD, Magaña C. Acculturative stress, anxiety, and depression among Mexican immigrant farmworkers in the Midwest United States. J Immigr Health. 2000;2(3):119–31.

    Article  CAS  PubMed  Google Scholar 

  59. Negi NJ. Battling discrimination and social isolation: psychological distress among Latino day laborers. Am J Community Psychol. 2013;51(1–2):164–74.

    Article  PubMed  Google Scholar 

  60. Taylor S, Zvolensky MJ, Cox BJ, et al. Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychol Assess. 2007;19(2):176.

    Article  PubMed  Google Scholar 

  61. Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133–49.

    Article  Google Scholar 

  62. Von Korff M, Jensen MP, Karoly P. Assessing global pain severity by self-report in clinical and health services research. Spine. 2000;25(24):3140–51.

    Article  Google Scholar 

  63. Gonzalez A, Zvolensky MJ, Vujanovic AA, Leyro TM, Marshall EC. An evaluation of anxiety sensitivity, emotional dysregulation, and negative affectivity among daily cigarette smokers: relation to smoking motives and barriers to quitting. J Psychiatr Res. 2008;43(2):138–47.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Hayes AF, Preacher KJ. Statistical mediation analysis with a multicategorical independent variable. Br J Math Stat Psychol. 2013.

  65. Preacher KJ, Hayes AF. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods. 2008;40(3):879–91.

    Article  PubMed  Google Scholar 

  66. Zhao X, Lynch JG Jr, Chen Q. Reconsidering Baron and Kenny: myths and truths about mediation analysis. J Consum Res. 2010;37(2):197–206.

    Article  Google Scholar 

  67. Chmura Kraemer H, Kiernan M, Essex M, Kupfer DJ. How and why criteria defining moderators and mediators differ between the Baron & Kenny and MacArthur approaches. Health Psychol. 2008;27(2S):S101.

    Article  Google Scholar 

  68. Judd CM, Kenny DA. Data analysis in social psychology: recent and recurring issues. Amsterdam: Wiley; 2010.

    Google Scholar 

  69. McWilliams LA, Asmundson GJ. The relationship of adult attachment dimensions to pain-related fear, hypervigilance, and catastrophizing. Pain. 2007;127(1):27–34.

    Article  PubMed  Google Scholar 

  70. Rosenberg JC, Schultz DM, Duarte LE, Rosen SM, Raza A. Increased pain catastrophizing associated with lower pain relief during spinal cord stimulation: results from a large post-market study. Neuromodulation. 2015;18(4):277–84.

    Article  PubMed  Google Scholar 

  71. Bostwick WB, Boyd CJ, Hughes TL, McCabe SE. Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States. Am J Public Health. 2010;100(3):468–75.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Mathur VA, Kiley KB, Haywood C Jr, et al. Multiple levels of suffering: discrimination in health-care settings is associated with enhanced laboratory pain sensitivity in sickle cell disease. Clin J Pain. 2016;32(12):1076–85.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Pina AA, Silverman WK. Clinical phenomenology, somatic symptoms, and distress in Hispanic/Latino and European American youths with anxiety disorders. J Clin Child Adolesc Psychol. 2004;33(2):227–36.

    Article  PubMed  Google Scholar 

  74. Varela RE, Weems CF, Berman SL, Hensley L, de Bernal MCR. Internalizing symptoms in Latinos: the role of anxiety sensitivity. J Youth Adolesc. 2007;36(4):429–40.

    Article  Google Scholar 

  75. Hartung F-M, Renner B. Perceived and actual social discrimination: the case of overweight and social inclusion. Front Psychol. 2013;4.

  76. Chae DH, Nuru-Jeter AM, Adler NE, et al. Discrimination, racial bias, and telomere length in African-American men. Am J Prev Med. 2014;46(2):103–11.

    Article  PubMed  PubMed Central  Google Scholar 

  77. Craske MG, Wolitzky-Taylor KB, Labus J, et al. A cognitive-behavioral treatment for irritable bowel syndrome using interoceptive exposure to visceral sensations. Behav Res Ther. 2011;49(6):413–21.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Wald J, Taylor S, Chiri LR, Sica C. Posttraumatic stress disorder and chronic pain arising from motor vehicle accidents: efficacy of interoceptive exposure plus trauma-related exposure therapy. Cognit Behav Ther. 2010;39(2):104–13.

    Article  Google Scholar 

  79. Watt MC, Stewart SH, Lefaivre MJ, Uman LS. A brief cognitive-behavioral approach to reducing anxiety sensitivity decreases pain-related anxiety. Cognit Behav Ther. 2006;35(4):248–56.

    Article  Google Scholar 

  80. Campbell LC, Andrews N, Scipio C, Flores B, Feliu MH, Keefe FJ. Pain coping in Latino populations. J Pain. 2009;10(10):1012–9.

    Article  PubMed  Google Scholar 

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Bakhshaie, J., Rogers, A.H., Mayorga, N.A. et al. Perceived Racial Discrimination and Pain Intensity/Disability Among Economically Disadvantaged Latinos in a Federally Qualified Health Center: The Role of Anxiety Sensitivity. J Immigrant Minority Health 21, 21–29 (2019). https://doi.org/10.1007/s10903-018-0715-8

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