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.
