Background: Gastric cancer incidence varies greatly among US racial/ethnic groups. Few studies have examined ethnicity, birth country, immigration and cultural diet as gastric cancer risk factors in the US. These factors, in combination with known risk factors may narrow a target population for gastric cancer screening. Methods: Two racially diverse hospital systems were used to recruit gastric cancer cases using the cancer registry, and primary care (PC) controls from waiting rooms or phone. Community controls were recruited at community gatherings. Participants were eligible if 40-85 years old, not under endoscopic surveillance and without genetic syndromes. The survey items (n = 227) included conventional risk factors, plus items about ethnicity, birth country, acculturation, and ethnic diet. Results: Of 150 participants, 39 cases, 41 PC-controls, and 44 community controls were eligible for analysis. PC-controls generally completed phone interviews (72% vs 28%), while community controls generally completed paper surveys (92% vs 8%). Gastric cancer cases were more likely to be foreign born (85% vs. 49%, p = < 0.01), from a country with gastric cancer incidence > 5 per 100,000: (62% vs. 30%, p = < 0.01) and report daily consumption of cultural food at ages 15 to 18 (69% vs. 35%, p = < 0.01) compared to controls. Cases were also older, male, Hispanic, and had stronger family history of gastric cancer. Cases and controls had similar frequency of alcohol consumption, smoking, acculturation, and barbequed food consumption. In multivariate analysis, increased age (per year, aOR 1.4, 95%CI 1.07-1.21), daily consumption of cultural foods at ages 15 to 18 (aOR 19.58, 95%CI 1.54-248.99), having less than high school education (aOR 7.24, 95%CI 1.49-35.10), and being foreign born (aOR 11.81, 95%CI 1.69-82.64) were associated with case status. Conclusions: A risk assessment tool that addresses awareness of gastric cancer risk factors, ethnicity, cultural habits and immigration patterns has potential to identify high-risk persons from multicultural areas within the US, who might benefit from endoscopic screening for gastric cancer. (Support: UG1CA189823)