PROJECT SUMMARY/ABSTRACT In the United States, Black individuals are the group most affected by interpersonal discrimination and struc- tural racism and older Black adults experience a disproportionate burden of chronic-pain and related disability. Accumulating evidence suggests both interpersonal discrimination and structural racism may increase the like- lihood of developing chronic pain and worsen chronic pain outcomes. The psychosocial and neurobiological mechanisms through which structural racism and discrimination adversely affect chronic pain-related out- comes, whether these pathways differ from one another, and what factors may protect against these deleteri- ous effects, remain largely unknown. Understanding these mechanisms is critical to identifying modifiable fac- tors that may serve as actionable intervention targets. Our central hypothesis is that structural racism (racial residential segregation and neighborhood socioeconomic disadvantage) and interpersonal discrimination (di- rect and vicarious) will adversely impact chronic pain-related outcomes via different psychosocial and neurobi- ological pathways. The rationale for this project is that structural racism and discrimination directly impact re- ciprocally interactive biological and psychosocial processes, promoting more rapid progression of musculoskel- etal pain and pain-related disability among Black or African American older adults. The central hypothesis will be tested by three specific aims: 1) Characterize the independent and combined impact of structural racism and discrimination on chronic pain-related outcomes; 2) Test hypothesized pathways of psychosocial and bio- logical mediators whereby structural racism and discrimination influence chronic pain-related outcomes; and 3) Identify resilience factors that may protect against the adverse effects of structural racism and discrimination on pain-related outcomes by either reducing the effects of racism/discrimination on psychosocial stressors, bio- logical mechanisms, or both. Under the first aim, structural racism will be measured using racial residential segregation (neighborhood-level Getis-Ord Gi* statistic) and neighborhood socioeconomic disadvantage (Area Deprivation Index). Experiences of discrimination will include both perceived individual discrimination and vi- carious racism. The research proposed in this application is innovative, because it investigates the individual and combined effects of structural racism and discrimination, examines multiple biopsychosocial mechanisms, and measures individual and community resilience. The proposed research is significant because it is ex- pected to improve understanding of the mechanisms whereby structural racism and discrimination impact mar- ginalized persons with chronic pain. Ultimately, this knowledge has the potential to inform multi-level interven- tions to enhance pain outcomes in racialized and underserved peoples.

PROJECT NARRATIVE The proposed research is focused on elucidating the psychosocial and biological pathways through which structural racism and discrimination adversely affect chronic musculoskeletal pain and associated disability in older Black or African American adults. Chronic musculoskeletal disorders are the leading cause of pain and disability worldwide, and older Black adults bear a disproportionate burden of musculoskeletal pain. Therefore, this work has the potential to inform broadly applicable strategies for reducing health disparities.