Gaps in Gastric Cancer Risk Awareness Despite High Preventive Engagement among Korean-Born Adults in the United States.

Korean-born adults in the United States have a disproportionately high risk of gastric cancer (GC), reflecting in part early-life Helicobacter pylori exposure and familial risk. However, little is known about how individuals in this high-risk population understand their GC risk or how awareness relates to preventive behaviors. We conducted a community-based survey and urea breath testing across 14 screening events in New York, New Jersey, and Connecticut from June to October 2025. Among 315 participants, 287 completed the survey and testing. Overall, 48.8% had prior and/or current H. pylori infection, and 18.1% had active infection at screening. Preventive engagement was high, with 78.4% reporting prior upper endoscopy, most commonly for screening. In contrast, 58.9% recognized that H. pylori can cause GC, and 48.8% recognized the elevated GC risk among Koreans. Among 265 participants with complete data, prior endoscopy was more common among those aware of the association between H. pylori and GC (85.2% vs. 68.8%; OR 2.62, p = 0.0012). Current infection was less frequent among those who were aware (14.8% vs. 22.9%; OR 0.58, p = 0.13), although this difference was not statistically significant. The coexistence of high preventive engagement and incomplete risk awareness identifies an important educational gap. These findings support culturally responsive, community-based education that builds on existing preventive behaviors while strengthening understanding of GC risk and H. pylori-related prevention.