A national Asian American cohort for assessing multi-level determinants in cancer etiology: the ASPIRE Cohort

Abstract Asian Americans are the fastest growing and most diverse U.S. racial/ethnic group. They have unique and disparate patterns of cancer, including being the first U.S. racial/ethnic group for whom cancer is the leading cause of death. Their incidence of certain cancers far exceeds those of other groups, including lung cancer among never smoking females, nasopharyngeal carcinoma in Chinese Americans, liver cancer in Southeast Asian Americans, gastric cancer in Korean and Japanese Americans, and thyroid cancer in Filipino Americans. Counter to the prevailing view that Asian Americans have high socioeconomic status and favorable health, certain groups have high rates of poverty, low healthcare access, and low rates of cancer screening. As we acknowledge the importance of the lived experiences of Asian American populations, including chronic stress and weathering due to historical trauma and anti-Asian racism, acclimating to and establishing a life in a new country, and navigating unfamiliar and complex institutions and healthcare systems, we propose a paradigm shift in studies of cancer risk to include the examination of structural and social determinants of health specific to Asian American populations. We propose to establish the national ASPIRE– ASian American ProspectIve REsearch cohort, beginning with 20,000 men and women, ages 40-75 (inclusive of all Asian American ethnic groups and those who are multiracial/ethnic) via focused community-engaged recruitment in six regions that comprise more than a third of the Asian American population (California (Bay Area, Los Angeles, Orange County, Sacramento), New York Metro/North Jersey, and Greater Philadelphia Metro/South Jersey), in addition to national outreach to other U.S. regions. This population-based cohort will include: 1) multiple Asian American communities; 2) collection of data on health behavior exposures across the life course; 3) detailed information on structural, social, and environmental factors; 4) novel assessment of epigenetic age; 5) a precision adaptive design to develop best practices for community-engaged research in traditionally understudied ethnic groups; and 6) methodologic research on analytic approaches to assess small populations and intersectionality. This cohort is supported by a national network of researchers and community partners committed to Asian American health and well-being. We will use transparent and equitable processes among scientific and community collaborators to inform research priorities, data collection and sharing, and dissemination of timely, actionable, and policy-relevant study results. The ASPIRE Cohort will thus be suitable to address multi-level contributors to the unique cancer burden experienced by Asian American populations. This first phase will address structural and social determinants of health and their impacts on multiple pathways to cancer initiation that considers 1) healthcare access and cancer screening, 2) cancer-relevant health behaviors, and 3) social epigenomics of stress embodiment. The ultimate vision of ASPIRE is to serve as a rich, contemporary epidemiologic resource to advance our understanding of cancer etiology and achieve health equity in Asian American populations.