Impact of Structural Racism and Discrimination on Liver Disease Disparities in High-Risk Asian American Populations Project Summary Structural racism and discrimination (SRD) play an important role in shaping persistent health disparities, including liver disease disparities among racialized Asian Americans (AAs). Despite comprising 7% of U.S. population, AAs account for more than half of all Hepatitis B (HBV) infections in the U.S. Of 2.4 million Americans infected with HBV, 58% are AAs who have the highest HBV prevalence of any racial/ethnic group. Despite CDC and U.S. Preventive Services Task Force recommendations to screen Asian adults who are at high risk for infection, a significant majority of AAs (~68-75%) have never been screened, remaining undiagnosed. SRD manifests in structural inequalities by limited access to care, culturally and linguistically appropriate services/resources, social segregation, mistrust of health system, anti-Asian racism, immigration and poverty in AAs. Most SRD research has examined how structural racism and multilevel determinants disadvantaged healthcare access for Black/African Americans and Latinx, few have included AAs. Our preliminary studies among Chinese, Korean and Vietnamese indicated that HBV screening and linkage to care disparities are attributable to the intersection of multilevel structural barriers. During COVID-19 pandemic, barriers to care for AAs are increasingly affected by anti-Asian racism, hate crimes and discrimination at each level, which impedes HBV screening and care and exacerbates liver disease disparities. The overall goal of this innovative and timely study is to identify structural racism and protective factors in relation to liver disease disparities and impact of SRD on health outcomes by Asian Americans. Guided by an adapted multilevel Socio-Ecological Model, we will leverage 20-year established Regional Cancer Health Disparities Networks to collaborate with community-based organizations and clinical partners in greater Philadelphia and NYC. Specifically, our multidisciplinary team will use mixed methods to: 1) examine the longitudinal association of individual-level SRD lived experiences (e.g., COVID-19 Anti-Asian racism, socio-historical trauma, cultural stereotype racism) and HBV screening and care among 2000 Asian Americans: Chinese, Korean and Vietnamese; 2) examine the impact of institutional-level SRD in healthcare settings (e.g., Anti-Asian racial bias, resources for patient navigators) on HBV screening uptake and care; and 3) elucidate the impact of community-level SRD (e.g., Anti-Asian racism/xenophobia and residential segregation) and protective factors (e.g. residence, social norms/advocacy and neighborhood social cohesion) on impeding or promoting screening and care. Finally, we conduct integrative analysis to examine whether individual, institutional and community-level SRD are associated with HBV screening uptake and linkage to care. This is the first multilevel,...