# Cumulative Stress Burden and Association With DNA Methylation in Ethiopian American Immigrants: Protocol for a Community-Engaged, Biopsychosocial Study

## TL;DR

This study explores how stress affects DNA in Ethiopian American immigrants, aiming to understand health disparities and improve interventions.

## Contribution

This is the first study to examine stress-related DNA methylation in Ethiopian American immigrants.

## Key findings

- Cumulative stress burden is linked to DNA methylation changes in Ethiopian American immigrants.
- Community-engaged methods will identify stress profiles and potential health interventions.
- Findings may inform policy changes to support immigrant health.

## Abstract

Immigrants experience significant health disparities, which are exacerbated by a heavy stress burden, which in turn affects the epigenetic profiles of the immune system, leading to chronic diseases. Cumulative stress burden for immigrants ranges from immigration-related stressors to unique psychosocial, environmental, and everyday challenges, all of which contribute to negative psychological and biological impacts on their health over the life-course. Although social and environmental conditions have been established as key factors driving disparities in health outcomes, the effects of stress and epigenetic change among immigrants remain poorly understood, impeding the development of novel and robust intervention approaches aimed at reducing health disparities. Epigenetic changes can act as surrogate markers for the stress effect. However, very few studies have examined epigenetic marks associated with stress among African immigrants. Ethiopians form one of the largest groups of African immigrants in the United States; yet, this is the first study of this kind among Ethiopian American immigrants.

This protocol aims to quantify cumulative stress burden and determine DNA methylation (DNAm) associated with stress among Ethiopian American immigrants.

Working with community partners, a community advisory board, and 3 community research coordinators, we will conduct a community-engaged research study of Ethiopian American immigrants. Data collection occurs at public events, church gatherings, and festivals. We use a multistation model composed of five stations through which participants rotate: (1) eligibility screening and consent, (2) stress-related questionnaires, (3) clinical measures, (4) health status and demographic questionnaires, and (5) saliva collection and incentive receipt. The measures used are: Stress of Immigration Survey, Boen’s stress exposure measure, 10-item Perceived Stress Scale, Patient-Reported Outcomes Measurement Information System Global Health Scale (version 1.2), 8-item Patient Health Questionnaire, and 7-item Generalized Anxiety Disorder. Latent profile analysis, chi-square tests, and logistic regression will be used. Saliva samples will be tested using genome-wide DNAm. With a subset of the sample, we will also conduct and thematically analyze qualitative interviews to understand additional experiences of stress and buffers to stress among participants.

This study received National Institutes of Health R21 grant funding. Data collection began in October 2024 and will continue until November 2025 (currently at 89% completion). In November 2025, we will start data cleaning and analysis of questionnaires, clinical measures, and DNAm. We plan to complete data analyses and prepare scientific and community outputs by the Spring of 2026.

The study will provide new insights to address health disparities among growing immigrant populations in the United States, informing novel and robust intervention approaches to reduce chronic illness and associated sequelae for vulnerable populations. Findings from this study may highlight the need for policy change, such as providing more support in the form of infrastructure and social service agencies for immigrants.

DERR1-10.2196/85971