Moving Upstream: Understanding Racism, Firearm Injury Risks, and Resiliency Among Asian Americans

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Abstract Anti-Asian sentiment during the COVID-19 pandemic has elevated the risk of Asian Americans being subjected to racial violence and discrimination, in conjunction with the long-existing racism at both structural and personal levels. We proposed a timely study in response to RFA-MD-21-004– Understanding and Addressing the Impact of Structural Racism and Discrimination on Minority Health and Health Disparities (R01), as our preliminary data provided evidence that there has been a sharp rise of firearm purchases by Asian people nationwide due to increased experiences of racism/discrimination during the COVID-19 pandemic. Racism, a form of violence, and its influence on firearm possession, mental distress symptoms and substance use may put Asian Americans at elevated risk of firearm injury and mortality, stressing the urgent need to understand their risks and resilience-promotive factors against racism. The socio-ecological framework, Resilience Theory, and empirical firearm research suggest understanding the links between racism and firearm risks requires assessment of multiple-level factors and use of a strength-based approach. The objective of this study is to employ mixed methods, including focus groups and longitudinal surveys, integrated with Geographic Information System to investigate multi-level risks and protective factors of firearm injury risks, identify correlates of neighborhood-level structural racism and discrimination (SRD), and understand the mechanisms between these factors and firearm outcomes. Our goals are: 1) Use focus groups to identify Asian Americans' perspectives on SRD and individual-, interpersonal-, and community level promotive factors and inform survey instrument development; 2) Conduct three waves of annual, longitudinal surveys with a sample of 1500 nationally-representative Asian Americans to examine the mechanisms by which racism increases firearm risk through increased substance use, mental distress, and firearm behavior; 3) Identify distinct profiles with selected neighborhood-level SRD indicators that will be influential to Asian American communities and examine their associations with firearm injury risk; and 4) Examine whether cumulative promotive factors mitigate the risk effects from racism among Asian Americans. The expected outcomes of the project will include improving understanding of contextual factors associated with firearm injury and mortality and identifying multiple levels of promotive factors that may mitigate the negative effects of risk exposure specific to Asian Americans. Findings will provide a solid basis to inform evidence-based interventions that prevent firearm injury risks involving Asian Americans. The project is also expected to have a positive impact on addressing health disparities as a result of SRD and individually experienced racism.