Linking Social-Behavior Contextual Factors and Allostatic Load to Chronic Diseases in Asian Americans: A Socioecological Approach to Advancing Precision Medicine - ABSTRACT Asian Americans (AA) are one of the fastest growing demographic groups in the US, recording an 81% growth from 2000 to 2019. The AA population has broad variations in income, education, as well as health and lifestyle behaviors, cardiometabolic conditions, endocrine dysfunction, cancer, and mental illness. We must also acknowledge the lived experiences of the various AA populations, such as re-adjusting to life in a new country, and navigating unfamiliar healthcare systems. AL is a complex clinical construct that offers a unique lens into the cumulative toll of stress and how it manifests as physiological and psychological dysfunctions (i.e. chronic conditions). Unfortunately, lack of stratified data limited our understanding of allostatic load (AL) in the various AA populations. Therefore, we propose a paradigm shift towards understanding the cumulative toll of chronic stress through the concept of allostatic load, its behavioral and contextual correlates, and how AL manifests as chronic diseases among AAs, together and by subgroups. Analyses of stratified data are needed to uncover specific risk patterns by subgroups and reduce chronic disease burdens through population-specific interventions. The All of Us (AoU) Research Program provides unprecedented opportunities for us to close the gaps in literature and advance scientific knowledge. Leveraging the large AA subsample (N = 12,408), we seek to model AL as a complex system to capture a more comprehensive extent of health risk in AA subgroups, identify high-risk groups, and explore how AL as various chronic illnesses. All analyses will be conducted in aggregate AA sample first and then in 4 regional subgroups: East Asian (Chinese, Japanese, Korean), Southeast Asian (Vietnamese, Cambodian, Hmong), South Asian (Indian, Pakistan), and Filipino. The specific aims are as follows: Aim 1: To examine the physiological risk profiles and how sociodemographic, behavioral, contextual, and acculturation-related factors are associated with AL in aggregated AA (Aim 1a) and separate regional subgroups (East Asian, Southeast Asian, South Asian, and Filipino Americans) (Aim 1b). Aim 2: To explore subgroup variations in stress manifestations by examining how AL is associated with multiple chronic conditions in aggregated (Aim 2a) and separate regional subgroups (East, Southeast, South, and Filipino Americans) (Aim 2b). The proposed analyses will help us better understand the etiology and mechanisms of physiological and psychological dysregulation. With dissemination activities jointly led by researchers and clinical/community stakeholders, this study will ultimately guide future behavioral interventions to improve wellbeing in AAs and provide clinical implications for personalized medicine to stress mitigation and chronic disease prevention.
