COMMUNITY OUTREACH FOR CTD SCREENING IN HIGH RISK GROUPS

非裔美国女性背负着不成比例的系统性红斑狼疮(SLE)的负担，SLE是一种无法治愈、致残、毁容、甚至可能致命的结缔组织病(CTD)，在他们中发生得更频繁、更严重。基因携带的遗传因素会增加发展成系统性红斑狼疮的倾向。接触有机溶剂和石油产品也会增加系统性红斑狼疮和其他CTD的风险。在系统性红斑狼疮患者中发现了谷胱甘肽-S-转移酶基因的特定基因模式，该基因控制身体降解许多有毒物质的方式。马萨诸塞州环保部在波士顿的非裔美国人社区罗克斯伯里、北多切斯特和马塔潘(RDM)发现了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、接触危险废物和GST基因模式可能揭示环境毒素、GST基因和RDM非裔美国人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加筛查项目。我们假设，与文化相关的健康教育将减少这一筛查障碍。我们与患有系统性红斑狼疮的非洲裔美国女性的社区组织勇气妇女组织和环境健康评估局公共卫生部合作，提出了一项针对RDM中非裔美国女性的CTD的两阶段研究。第一阶段的主要重点是实施一项社区教育推广计划，以提高人们对四氯化碳和接触有毒废物的认识，这将促进一系列筛查设计，利用环境问卷和手指血样的初始筛查，然后是四氯化碳问卷。此外，从医院数据库中发现的SLE病例也将在第一阶段进行环境筛查和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患者和对照组之间的GST基因模式和环境暴露情况。这项建议的目的或具体目的是：1.提高对CTD以及接触有机溶剂和石油产品的危害的认识；2.通过搜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之间的关联或相互关系。)RDM中的CTD风险。接触石油化合物和有机溶剂；以及c.GST基因；通过调查问卷和手指血样筛查环境暴露和CTD，以进行抗核抗体测试和GST基因模式。

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.