PROJECT SUMMARY South Asians, comprised predominantly of Asian Indians, Pakistanis and Bangladeshi immigrants, are the second fastest growing ethnic group in the United States. Our team has created the first longitudinal study of South Asians called the Mediators of Atherosclerosis in South Asians Living in America (MASALA), which has demonstrated significantly poorer cardiovascular health in the aggregated South Asian population compared to other major U.S. race/ethnic groups. However, MASALA has very limited information about the cardiovascular health profiles for Pakistanis and Bangladeshis since MASALA included 83% Asian Indian but only 6% Pakistani and 0.5% Bangladeshi immigrants. Studies from the South Asian subcontinent, the United Kingdom, and Canada have shown significantly higher burden of cardiovascular disease among Bangladeshis and Pakistanis compared to Indians. Socio-cultural context, including socioeconomic position, immigration history, cultural background, and neighborhood factors vary across these three South Asian subgroups and affect how immigrants experience and adjust to a new context, and how they activate resilience resources to cope with stressors that impact cardiovascular health disparities. Our goal is to expand the MASALA study cohort to include more Pakistani and Bangladeshi immigrants leveraging new and existing measures to characterize and understand cardiovascular health disparities in immigrant populations. We propose to recruit 600 Bangladeshi and 550 Pakistani adults between the age of 40-84 years from greater New York City and Chicago areas to add to the ongoing MASALA cohort and compare them to Asian Indians enrolled in MASALA. Our specific aims are to: 1) Determine whether and the extent to which Pakistani and Bangladeshi immigrants have worse cardiovascular health (diet, physical activity, tobacco use, diabetes, hypertension, dyslipidemia, obesity) compared to Indian immigrants already enrolled in MASALA. 2) Identify multilevel risk and protective factors associated with cardiovascular health within and across South Asian subgroups. Test whether acculturation strategies and resilience resources mediate or moderate the association between socio-cultural context and cardiovascular health and explain disparities across the three subgroups. 3) To further interpret our quantitative results, conduct in-depth interviews to elucidate how immigration, acculturation, discrimination, and resilience resources influence South Asians’ cardiovascular health. Studying diverse immigrant populations advances the science of health disparities by understanding how biopsychosocial and ecological characteristics may associate and interact with country of origin to influence cardiovascular health. Our mixed- methods approach for studying the complex, multilevel interactions influencing cardiovascular health disparities in South Asian immigrants offers promise for the development of more effective public health and clinical preve...