COMMUNITY OUTREACH FOR CTD SCREENING IN HIGH RISK GROUPS

非裔美国女性承受着系统性红斑狼疮（SLE）的不成比例的负担，SLE是一种无法治愈的、致残的、毁容的、潜在致命的结缔组织疾病（CTD），在非裔美国女性中发生得更频繁、更严重。基因中携带的遗传因素增加了发生SLE的倾向。接触有机溶剂和石油产品也会增加SLE和其他CTD的风险。在SLE患者中发现了控制身体降解许多有毒物质的谷胱甘肽- s -转移酶（GST）基因的特定基因模式。马萨诸塞州环境保护部在波士顿的非裔美国人聚居区罗克斯伯里、北多彻斯特和马塔潘（RDM）确定了184个石油和有机溶剂污染地点。由于他们的种族和环境，RDM居民患SLE的风险很高。筛查CTD、暴露于危险废物和GST基因模式可能揭示环境毒素、GST基因和非裔美国人RDM患者SLE易感性之间的联系。从历史上看，非裔美国女性的健康行为是避免参与筛查项目。我们假设与文化相关的健康教育将减少筛查的障碍。我们与以社区为基础的非裔美国SLE妇女组织“勇气妇女”（Women of Courage）以及公共卫生部环境健康评估局合作，提议对非裔美国RDM妇女的CTD进行两阶段研究。第一阶段的主要重点是实施一项社区教育外展计划，以提高人们对CTD和有毒废物暴露的认识，这将促进一系列筛选设计，即通过环境问卷和指尖血样进行初步筛选，然后进行CTD问卷调查。此外，从医院数据库中确定的SLE病例也将被纳入第一阶段的环境筛查和GST基因模式。在第二阶段，我们将进行一项病例对照研究，比较SLE病例和对照组之间的GST基因模式和环境暴露。本建议的目标或具体目的是：提高对连续油管的认识以及接触有机溶剂和石油产品的危害；2. 通过检索五家主要教学医院的数据库，确定所有诊断为RDM的SLE病例。3. 确定a.) RDM中CTD风险b.)石油化合物和有机溶剂暴露之间的关联或相互关系；和c)。GST基因;通过问卷和手指刺血样本筛查环境暴露和CTD，进行抗核抗体测试和GST基因图谱。

African-American women bear a disproportionate burden of systemic lupus erythematosus (SLE), an incurable, disabling, disfiguring, and potentially fatal connective tissue disease (CTD), that occurs more frequently and with greater severity among them. Inherited factors that are carried in the genes increase the tendency to develop SLE. Exposures to organic solvents and petroleum products also increase the risk of SLE and other CTD. Specific gene patterns of glutathione-S-transferase (GST) genes that control the way the body degrades many toxic substances, have been found in SLE patients. The Massachusetts Department of Environmental Protection has located 184 sites of petroleum and organic solvent contamination within Roxbury, North Dorchester and Mattapan (RDM), African-American neighborhoods in Boston. RDM residents are at high risk for SLE due to their ethnicity and their environment. Screening for CTD, exposure to hazardous waste and GST gene patterns may reveal a link between environmental toxins, GST genes, and predisposition to SLE in African-Americans in RDM. Historically, the health behavior of African-American women is to shun participation in screening programs. We hypothesize that culturally relevant health education will reduce this barrier to screening. In partnership with the Women of Courage, a community-based group of African-American women with SLE, and the Department of Public Health, Bureau of Environmental Health Assessment, we propose a two phase study of CTD in African- American women in RDM. The major focus of Phase I is the implementation of a community educational outreach program to increase awareness about CTD and exposure to toxic wastes, that will facilitate a series screening design that utilizes initial screening by environmental questionnaire and fingerstick blood sample followed by CTD questionnaire. In addition, SLE cases that are identified from hospital databases will also be enrolled for environmental screening and GST gene patterns during Phase I. In Phase II, we will perform a case-control study that compares GST gene patterns and environmental exposures between SLE cases and controls. The objectives or specific aims of this proposal are to: 1. Increase awareness of CTD and the hazards of exposure to organic solvents and petroleum products; 2. Identify all diagnosed cases of SLE in RDM by searching databases in five major teaching hospitals. 3. Determine the associations or inter- relationships between a.) risk of CTD in RDM b.) exposure to petroleum compounds and organic solvents; and c.) GST genes; by screening for environmental exposures and CTD with questionnaires and a fingerstick blood sample for anti-nuclear antibody testing and GST gene patterns.