Genetics, Vulnerable Populations and Health Disparities

描述（申请人提供）：基因研究的最终目的是改善人类健康和预防疾病。将新的遗传知识转化为改善健康的成功的一个关键衡量标准是基因组医学在多大程度上减少了现有的健康差距。我们建议开发一个关于“遗传学，弱势群体和健康差异”的CEER，致力于通过深入分析3个关键临床领域：烟草依赖，哮喘和糖尿病，来研究新兴遗传研究和持续存在的健康差异问题的复杂交叉点。这些疾病中的每一种都以高患病率（这些疾病影响了85 M（29%）的美国人），持续的健康差异（按种族/民族和社会经济地位）以及与疾病病因和/或治疗反应相关的重要遗传发现为标志。因此，在治疗和预防这些疾病方面的基因组进步-适当地应用于临床实践-将具有深远的潜力，不仅可以改善我们国家的健康，而且可以减少种族/民族和社会经济方面现有的健康差距。具体目标是：（1）确定与烟草依赖、哮喘和糖尿病遗传研究的开展、交流和转化相关的关键ELSI问题并确定其优先次序;（2）制定研究议程以解决这些问题;（3）分析高度优先的政策相关问题（通过3-4份文件）为正在进行的政策讨论提供信息，并为今后的研究奠定基础;（4）通过完成可行性研究，发展监测紧急基因治疗在美国种族/民族社区和医疗补助与私人保险个人之间公平传播的能力;（5）收集适当的试点数据（6）为少数民族研究生提供培训，并制定培训内容，以鼓励来自代表性不足的少数民族社区的新的ELSI调查员;以及（7）提交具有竞争力的P50 CEER提案。

DESCRIPTION (provided by applicant): The ultimate aim of genetic research is to improve human health and prevent disease. One key measure of success in translating new genetic knowledge into improved health will be the extent to which genomic medicine reduces existing health disparities. We propose to develop a CEER on "Genetics, Vulnerable Populations and Health Disparities" dedicated to examining the complex intersection of emerging genetic research and the persistent problem of health disparities through in-depth analysis of 3 key clinical areas: tobacco dependence, asthma, and diabetes. Each of these conditions is marked by high prevalence (together, these conditions affect 85M (29%) of Americans), persistent health disparities (by race/ethnicity and socioeconomic status) and significant genetic findings related to disease etiology and/or response to treatment. Genomic advances in the treatment and prevention of these conditions - appropriately applied in clinical practice - would thus have far-reaching potential to improve not only our nation's health, but also to reduce existing health disparities across racial/ethnic and socioeconomic lines. Specific aims are: (1) to identify and prioritize key ELSI issues related to the conduct, communication and translation of genetic research on tobacco dependence, asthma and diabetes; (2) develop a research agenda to address these concerns; (3) analyze high priority, policy-relevant issues (through 3-4 papers) to inform ongoing policy discussions and lay the groundwork for future research; (4) develop the capacity to monitor the equitable diffusion of emergent genetic-based treatments across racial/ethnic communities and Medicaid vs. privately insured individuals in the U.S. through completion of a feasibility study; (5) collect appropriate pilot data (e.g. focus groups, key informant interviews) to inform the P5O Center proposal; (6) provide training for a minority graduate student and develop a training component to encourage new ELSI investigators from underrepresented minority communities; and (7) submit a competitive P50 CEER proposal.