INTRODUCTION:Hypertension is a modifiable risk factor for dementia, but its contribution among Asian American ethnic groups remains understudied despite heterogeneity in cardiovascular risk factors. METHODS:Participants were Kaiser Permanente Northern California members aged 60 to 90 years without prevalent dementia at baseline, surveyed between 2002 and 2009 [Chinese (n=4,848), Filipino (n=4,130), Japanese (n=2,786), South Asian (n=823), non-Latino White (n=123,593)]. We used ICD-codes to identify hypertension (assessed 5 y before baseline) and incident dementia through 2020. Within strata of race/ethnicity and baseline age group (60 to 75 and 75 to 90 y), we estimated adjusted and standardized 10-year dementia risk, risk ratios, risk differences, and population attributable fractions (PAFs) using pooled logistic regression, treating death as a censoring event. RESULTS:Among Chinese, Filipino, Japanese, and non-Latino White participants aged 60 to 75 years, PAFs (95% CI) were 12% (-3% to 28%), 23% (4% to 40%), 9% (-7% to 27%), and 8% (5% to 10%), respectively. Effect estimates were null for these groups among participants aged 75 to 90. For South Asian participants, point estimates were consistent with protective associations among those aged 60 to 75 and harmful associations among those aged 75 to 90, although estimates were imprecise. CONCLUSION:Our findings suggest heterogeneity in the effect of hypertension on dementia risk across Asian American ethnic groups and by age.

Background Chronic hepatitis B (CHB) is one of the most widespread liver diseases in the world and disproportionately affects Asian Americans, who are further impacted by the lower quality of life imposed by the infection. Limited English proficiency (LEP) and acculturative stress play an important role in the study of patients with CHB, but the interrelationships of LEP, acculturative stress, and health outcomes are not well studied in this population. This study aims to explore how acculturative stress mediates the relationship between LEP and health outcomes among Korean American patients with CHB. Methods A total of 365 CHB patients completed the enrollment survey. SF-12v2 was used to measure physical and mental component summary scores (PCS-12, MCS-12). The Riverside Acculturative Stress Inventory (n=15, alpha=0.89) measured acculturative stress. Linear regression analyses were conducted. For mediation analyses, structural equation modeling with full information maximum likelihood estimation method was used. The bias-corrected bootstrap confidence interval (CI) method for inferential tests of the indirect effects was also conducted in mediation analysis. Results LEP was associated with higher acculturative stress (β=3.62, p<.01). LEP had a direct effect on physical health and no direct effect on mental health. Acculturative stress partially mediated the relationship between LEP and health outcomes (e.g., PCS-12, MCS-12). Discussion This study indicates that acculturative stress plays an important role in mediating the relationship between LEP and both physical and mental health outcomes. Future studies will develop interventions to achieve better health outcomes by reducing acculturative stress in this population.

INTRODUCTION:The Apolipoprotein E ε4 allele (APOE-ε4) is a well-established dementia risk factor among non-Latino White individuals but remains understudied among Asian Americans. We estimated its association with dementia risk among Chinese, Japanese, Filipino, and non-Latino White older adults in California. METHODS:This longitudinal study included 1078 Chinese, 843 Japanese, 583 Filipino, and 43,821 non-Latino White participants from the Genetic Epidemiology Research in Adult Health and Aging cohort (mean baseline age = 70 years). Dementia was identified using electronic health records. We estimated effects of APOE-ε4 carriership on dementia risk using pooled logistic regression. RESULTS:APOE-ε4 carriership prevalence ranged from 14% among Filipino to 25% among non-Latino White participants. APOE-ε4 carriership was associated with higher dementia risk across groups; 10-year risk ratios (95% confidence interval [CI]) ranged from 1.59 (0.66-3.10) among Filipino to 1.96 (1.36-2.78) among Japanese participants. DISCUSSION:Despite differences in prevalence of APOE-ε4, its association with dementia risk was similar across Chinese, Japanese, Filipino, and non-Latino White participants.

Structural racism is a fundamental driver of health inequities in the US. Structural racism manifests through systems of mutually reinforcing institutions that perpetuate inequities in health through policies, practices, and norms across domains including housing, education, employment, criminal justice, and healthcare. Measures of structural racism that capture the interplay across such domains have been limited and have not addressed how different minoritized racial and ethnic groups may experience specific elements of structural racism. To address this gap, we developed composite measures of structural racism for four US racial and ethnic groups in California (CA) and Hawai‘i (HI). We developed place-based composite measures of structural racism using latent class analysis of city/place-based variables reflecting racial and ethnic-group specific disparities (i.e., residents of minoritized group in comparison to non-Hispanic White residents) incorporating contemporary redlining, residential segregation, education, employment, incarceration, fatal encounters with police, and home rentership. These variables were selected to represent multiple domains of structural racism based on the literature and were anchored on US Census, Home Mortgage Disclosure Act, fatalencounters.org and American Communities Project data for 2000. We also developed a data dashboard to visualize the data and disseminate for ground truthing. For California, we developed composite measures of structural racism for Black and Asian American populations. For Hawai‘i, we developed a composite measure of structural racism for Asian American and Native Hawaiian/Pacific Islander populations. Measures for other racial/ethnic populations are in development. Across 445 cities in CA and 20 cities in HI, the variables that characterized structural racism across domains differed by racial and ethnic group and study site. For example, the measure of Black-White Structural Racism in CA was defined by disparities in poverty, unemployment, redlining, and incarceration; the measure of Asian American-White Structural Racism in CA was defined by disparities in education, poverty, and rentership; and the measure for Native Hawaiian/Pacific Islander-White Structural Racism in HI was defined by disparities across all the domains except incarceration and fatal encounters. Preliminary composite measures of structural racism indicate varying relevance for groups across race and ethnicity as well as geographic context, which indicates context- and group-specific patterns in how structural racism operates. Next, we will examine associations of these structural racism measures with overall mortality and years of life lost in the Multiethnic Cohort (58,072 Asian American, 28,106 Black, 40,190 Latino, and 8,533 Native Hawaiian/Pacific Islander adults). In addition, we will examine mediation by lifestyle behaviors and neighborhood attributes and test for heterogeneity by sex and life stage. Salma Shariff-Marco, Alice Guan, Katherine Lin, Mindy C. DeRouen, Lynne Wilkens, Serge Atherwood, Meera Sangaramoorthy, Debora L. Oh, Kevin Cassel, Gilbert C. Gee, Scarlett L. Gomez, Iona Cheng. The development of racial and ethnic-specific composite measures of structural racism for cancer inequities research: The Multiethnic Cohort Study [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A109.

BACKGROUND AND OBJECTIVES:Limited evidence exists on stroke incidence and its impact on dementia risk in Asian American older adults, a population with lower dementia risk than other racial and ethnic groups. We aimed to estimate the cumulative incidence of stroke and assess its effect on dementia risk over 10 years among Chinese, Filipino, Japanese, South Asian, and non-Latino White older adults in Northern California. METHODS:This cohort study included Kaiser Permanente Northern California members who participated in surveys between 2002 and 2009 with linked electronic health record data through 2020. We included Chinese, Filipino, Japanese, South Asian, and non-Latino White participants aged 60-89 years without history of stroke or dementia at the time of survey (baseline). Incident stroke and incident dementia were identified using International Classification of Diseases codes. We estimated the cause-specific cumulative incidence of stroke at 10 years of follow-up using the Aalen-Johansen estimator. We estimated the effect of incident stroke on dementia risk with risk ratios and risk differences from a weighted Kaplan-Meier survival estimator. We used time-varying inverse probability weights to adjust for confounding and censoring due to loss to follow-up and death. In secondary analyses, we restricted the exposure to ischemic stroke. RESULTS:We included 147,986 participants (Chinese [n = 6,034], Filipino [n = 4,649], Japanese [n = 3,099], South Asian [n = 996], non-Latino White [n = 133,208]); the mean baseline age ranged from 69 to 72 years, and the percentage of female participants ranged from 40% to 63% across groups. The 10-year cumulative incidence of stroke (95% CIs) ranged from 10.7% (9.9%-11.6%) for Chinese participants to 13.7% (12.4%-15.2%) for Japanese participants. Risk ratios relating incident stroke and dementia risk at 10 years of follow-up were 4.3 (3.0-6.4) for Chinese participants, 3.3 (2.2-4.6) for Filipino participants, 4.6 (2.5-6.6) for Japanese participants, 5.4 (1.5-12.4) for South Asian participants, and 2.9 (2.7-3.2) for non-Latino White participants. Restricting analyses to ischemic stroke yielded similar results. DISCUSSION:Stroke incidence is high among Asian American and non-Latino White older adults and is associated with increased dementia risk in all groups. Future research needs to disentangle the pathophysiologic mechanisms involved in the acute event of stroke that trigger and accelerate dementia onset.

Social relationships play a crucial role in shaping health. To better understand the underlying mechanisms, we explored the independent and interactive effects of perceived emotional support (PES) and marital status on body mass index (BMI), eating behaviors, brain reactivity to food images, plasma oxytocin, and alterations in the brain-gut microbiome (BGM) system. Brain responses to food stimuli, fecal metabolites, and plasma oxytocin levels were measured in 94 participants. Structural equation modeling was used to determine the integrated pathways linking social factors to obesity-related outcomes. Marital status and PES interact and independently influence lower BMI, healthier eating behaviors, increased oxytocin levels, food-cue reactivity in frontal brain regions involved in craving inhibition and executive control, and tryptophan-pathway metabolites related to inflammation, immune regulation, and energy homeostasis. These findings suggest that supportive human relationships, particularly high-quality marital bonds, may regulate obesity risk through oxytocin-mediated alterations in brain and gut pathways.

In the last two decades, empirical research has significantly advanced our understanding of the link between discrimination and cardiovascular disease (CVD). This integrated scoping and narrative literature review delineates the extant peer-reviewed research on discrimination and clinical and subclinical CVD in samples that include Black adults, using a multilevel conceptualization of race-related discrimination and racism. We also identify potential intermediary mechanisms in the racism-CVD relationship and propose a comprehensive future research agenda. Using the Population, Exposure and Outcome framework and PRISMA guidelines, we identified 37 empirical reports for inclusion drawn from 1900 to 2024. The bulk of the literature has focused on discrimination and racism that occurs at the interpersonal level (28 studies), while a smaller but growing body of work has examined cultural (5 studies) or institutional and structural-level racism and discrimination (4 studies) in relation to CVD risk. The majority of these studies show that greater exposure to discrimination or racism is associated with increased clinical or subclinical CVD risk. Potential pathways include societal, environmental, psychological, and biological factors; however, few studies have conducted formal tests of mediation. The literature suggests robust relations of multilevel racism and discrimination to manifestations of CVD across diverse exposure and outcome measures in Black adults. Our recommendations to eliminate cardiovascular health inequities in Black communities include enhancing academic scholarship training, securing targeted and protected funding, and adopting more robust methodological approaches.

Discrimination is a social stressor that is associated with adverse health outcomes, but the underlying neural mechanisms remain unclear. The fusiform, including the fusiform face area (FFA) plays a critical role in face perception especially regarding hostile faces during discrimination exposure; and are key regions involved in social cognition. We compared resting-state spontaneous activity and connectivity of the fusiform and FFA, between 153 individuals (110 women) with high (N = 73) and low (N = 80) levels of discrimination (measured by the Everyday Discrimination Scale) and evaluated the relationships of these brain signatures with psychological outcomes and stress-related neurotransmitters. Discrimination-related group differences showed altered fusiform signal fluctuation dynamics (Hurst exponent) and connectivity. These alterations predicted discrimination experiences and correlated with anxiety, depression, and cognitive difficulties. A molecular architecture analysis using cross-modal spatial correlation of brain signatures and nuclear imaging derived estimates of stress-related neurotransmitters demonstrated overlap between discrimination-related connectivity and dopamine, serotonin, gamma-aminobutyric acid (GABA), and acetylcholine. Discrimination exposure associated with alterations in the fusiform and face processing area may reflect enhanced baseline preparedness and vigilance towards facial stimuli and decreased top-down regulation of potential threats. These brain alterations may contribute to increased vulnerability for the development of mental health symptoms, demonstrating clinical relevance of social cognition in stressful interpersonal relationships.

Literature shows heterogeneous age-standardized dementia incidence rates across US Asian American, Native Hawaiian, and Pacific Islanders (AANHPI), but no estimates of population-representative dementia incidence exist due to lack of AANHPI longitudinal probability samples. We compared harmonized characteristics between AANHPI Kaiser Permanente Northern California members (KPNC cohort) and the target population of AANHPI 60+ with private or Medicare insurance using the California Health Interview Survey. We used stabilized inverse odds of selection weights (sIOSW) to estimate ethnicity-specific crude and age-standardized dementia incidence rates and cumulative risk by age 90 in the target population. Differences between the KPNC cohort and target population varied by ethnicity. The sIOSW eliminated most differences in larger ethnic groups; some differences remained in smaller groups. Estimated crude dementia incidence rates using sIOSW (vs unweighted) were similar in Chinese, Filipinos, Pacific Islanders and Vietnamese, and higher in Japanese, Koreans, and South Asians. Unweighted and weighted age-standardized incidence rates differed for South Asians. Unweighted and weighted cumulative risk were similar for all groups. We estimated the first population-representative dementia incidence rates and cumulative risk in AANHPI ethnic groups. We encountered some estimation problems, and weighted estimates were imprecise, highlighting challenges using weighting to extend inferences to target populations.

Evidence on differences in dementia risk by sex and gender is mixed. We aimed to compare lifetime dementia risk by sex/gender among Asian American and non-Latino White adults aged 60 and older. We included Chinese (n = 6415), Filipino (n = 5020), Japanese (n = 3314), South Asian (n = 1061), and non-Latino White (n = 143,667) Kaiser Permanente Northern California members aged ≥60 years who completed health surveys (2002–2020) and were dementia-free at baseline. We estimated cause-specific cumulative dementia incidence from age 60 to 95 years (i.e., lifetime dementia risk, treating death as a competing event) and evaluated sex/gender differences. Lifetime dementia risk was higher among women in all groups, ranging from 7 (95% CI: 2–13) percentage points higher for Japanese women vs. men to 21 (8–38) percentage points higher for South Asian women vs. men. Variations of sex/gender differences across racial and ethnic groups are potentially driven by dementia-free mortality and social and structural factors.

ImportancePerceived social isolation is associated with negative health outcomes, including increased risk for altered eating behaviors, obesity, and psychological symptoms. However, the underlying neural mechanisms of these pathways are unknown.ObjectiveTo investigate the association of perceived social isolation with brain reactivity to food cues, altered eating behaviors, obesity, and mental health symptoms.Design, Setting, and ParticipantsThis cross-sectional, single-center study recruited healthy, premenopausal female participants from the Los Angeles, California, community from September 7, 2021, through February 27, 2023.ExposureParticipants underwent functional magnetic resonance imaging while performing a food cue viewing task.Main Outcomes and MeasuresThe main outcomes included brain reactivity to food cues, body composition, self-reported eating behaviors (food cravings, reward-based eating, food addiction, and maladaptive eating behaviors), and mental health symptoms (anxiety, depression, positive and negative affect, and psychological resilience).ResultsThe study included 93 participants (mean [SD] age, 25.38 [7.07] years). Participants with higher perceived social isolation reported higher fat mass percentage, lower diet quality, increased maladaptive eating behaviors (cravings, reward-based eating, uncontrolled eating, and food addiction), and poor mental health (anxiety, depression, and psychological resilience). In whole-brain comparisons, the higher social isolation group showed altered brain reactivity to food cues in regions of the default mode, executive control, and visual attention networks. Isolation-related neural changes in response to sweet foods correlated with various altered eating behaviors and psychological symptoms. These altered brain responses mediated the connection between social isolation and maladaptive eating behaviors (β for indirect effect, 0.111; 95% CI, 0.013-0.210; P = .03), increased body fat composition (β, −0.141; 95% CI, −0.260 to −0.021; P = .02), and diminished positive affect (β, −0.089; 95% CI, −0.188 to 0.011; P = .09).Conclusions and RelevanceThese findings suggest that social isolation is associated with altered neural reactivity to food cues within specific brain regions responsible for processing internal appetite-related states and compromised executive control and attentional bias and motivation toward external food cues. These neural responses toward specific foods were associated with an increased risk for higher body fat composition, worsened maladaptive eating behaviors, and compromised mental health. These findings underscore the need for holistic mind-body–directed interventions that may mitigate the adverse health consequences of social isolation.

Dementia incidence is lower among Asian Americans than among Whites, despite higher prevalence of type 2 diabetes, a well-known dementia risk factor. Determinants of dementia, including type 2 diabetes, have rarely been studied in Asian Americans. We followed 4846 Chinese, 4129 Filipino, 2784 Japanese, 820 South Asian, and 123 360 non-Latino White members of a California-based integrated health-care delivery system from 2002 to 2020. We estimated dementia incidence rates by race/ethnicity and type 2 diabetes status, and we fitted Cox proportional hazards and Aalen additive hazards models for the effect of type 2 diabetes (assessed 5 years before baseline) on age of dementia diagnosis, controlling for sex/gender, educational attainment, nativity, height, race/ethnicity, and a race/ethnicity × diabetes interaction. Type 2 diabetes was associated with higher dementia incidence in Whites (hazard ratio [HR] = 1.46; 95% CI, 1.40-1.52). Compared with Whites, the estimated effect of diabetes was larger in South Asians (HR = 2.26; 95% CI, 1.48-3.44), slightly smaller in Chinese (HR = 1.32; 95% CI, 1.08-1.62) and Filipino (HR = 1.31; 95% CI, 1.08-1.60) individuals, and similar in Japanese individuals (HR = 1.44; 95% CI, 1.15-1.81). Heterogeneity in this association across Asian subgroups may be related to type 2 diabetes severity. Understanding this heterogeneity may inform prevention strategies to prevent dementia for all racial and ethnic groups.

BackgroundDiscrimination is a recognized psychosocial stressor that has been linked to various negative health outcomes. This study explored the impact of discrimination on gut health, specifically focusing on microbiome changes, predicted metagenomic differences, transcriptomic profiles, and the potential for using a multi-omic approach to predict discrimination to identify discrimination status for an individual. Methods: We conducted a comprehensive investigation involving male and premenopausal female participants, using the Everyday Discrimination Scale to classify them into either high or low discrimination. Multiple questionnaires were administered to evaluate participants’ physiological, psychological, and perceived stressors. Two diet questionnaires were also administered. Stool samples were collected for microbiome analysis and RNA sequencing. Microbial composition changes were analyzed using the Shannon index and Chao1 richness estimator for alpha diversity and the Aitchison distance metric for beta diversity. Differential abundance was evaluated using MaAsLin2, followed by metatranscriptomics sequencing and annotation. A multi-omic approach utilizing random forest was used to assess the predictability of discrimination.ResultsThe study results showed that high discrimination was linked to higher gut microbiome species richness (Chao1, p = 0.02) and significant beta diversity differences (p = 0.04). Prevotella and Ruminococcaceae were both less abundant in the high discrimination group. High discrimination participants also reported higher levels of depression, anxiety, perceived stress, early life adversity, visceral sensitivity, and neuroticism than those in the low discrimination group. Gene expression analysis revealed distinctive patterns, with significant changes in genes associated with environmental sensing (two-component system) and metabolic pathways. In a plot comparing gene transcription to DNA content, certain genes showed higher expression levels in participants who experienced both high and low levels of discrimination. Our random forest classifier demonstrated the capability to accurately differentiate individuals with high and low discrimination in our training cohort (AUC = 0.91).ConclusionThese findings illuminate the substantial impact of discrimination on gut health, encompassing microbiome composition, gene expression, and functional pathways. These findings suggest that discrimination is associated with internal biological changes that can be associated with negative health outcomes, opening research to examine novel pathways that can be used to mitigate the negative health effects of discrimination.

The COVID-19 pandemic exacerbated health disparities among immigrant communities. Delivering accurate information and addressing misinformation on protective measures and vaccination to linguistically disadvantaged groups was critical for mitigating the effects of the pandemic. One group that was especially vulnerable to miscommunication about COVID-19 was non-native English-speaking immigrants. To address these disparities, the Asian American Studies Center and the Fielding School of Public Health at the University of California, Los Angeles, partnered to create a multilingual resource hub, TranslateCovid.org, to disseminate credible and reliable information about COVID-19 safety measures, the science behind the vaccines, and vaccine safety. We identified >1300 verified resources in 60 languages from government, academic, and nonprofit organizations and reposted them on the TranslateCovid website. We also developed public service announcement videos on handwashing, use of face masks, and social distancing in 10 languages and a fact sheet for frequently asked questions in 20 languages. We used a participatory approach to develop strategies for disseminating these resources. We discuss lessons learned, including strategies for forming government, community, and academic partnerships to support the timely development and dissemination of information. We conclude with a discussion on the unique role of universities in promoting equitable access to public health resources among immigrant communities in times of crisis.

As we age, the ability to move is foundational to health. Life space is one measure of a person's ability to move and engage in activity beyond the home. A separate but related concept is activity space, a measurement of a person's spatial behaviors and visited locations that include social networks, neighborhoods, and institutions. In this article, we integrate the literature on life space and activity space, discussing how physical function is not only determined by individual capabilities, but also by the surrounding social and environmental factors, which may limit their agency. We show how structural racism contributes to inequities within this paradigm linking related concepts of movement, agency, belonging, and timing. We also explore implications for research and theory for mobility, social connection, and activity.