PROJECT NARRATIVE Our overall objective is to make progress toward mitigating the challenges that un/underinsured participants in the All of Us Research Program may face when they access care for medically actionable genetic research results. Un/underinsured patients are typically left of out advances in genomics because they cannot afford to follow-up on research findings in the clinical setting, and face myriad barriers to accessing specialized care for lifelong disorders (e.g.

PROJECT NARRATIVE The proposed study contributes to the long-term goal of advancing diverse participation in precision medicine research by mapping the contours of why people, especially African Americans and Latinos, decline, enroll, and stay engaged in the All of Us Research Project. This knowledge will contribute towards the alignment of recruitment and retention strategies in All of Us and similar precision medicine research projects with participants? values and expectations.

PROJECT NARRATIVE This application builds on the R01 study the Ethics of Inclusion: Diversity in Precision Medicine Research and aims to investigate the preferences of African American and Hispanic/Latino communities, including the uninsured, who are being recruited into precision medicine research for different types of genetic test results and their expectations and needs for information and resources to allow for informed, validated follow-up of research results and clinical care.

In the emerging era of precision medicine, there have been increasing calls for diversity and the inclusion of historically under-represented racial and ethnic populations in biobanking and precision medicine research. Recent findings suggest that the lack of diversity in genetic repositories may pose serious challenges to identify genetic variants that are clinically significant in certain populations. These concerns have been linked to ethical concerns over disparities in health and disease among racial and ethnic groups.

The North Coast Conference on Precision Medicine is a national annual mid-sized conference series held in Cleveland, Ohio. The conference series aims to serve as a venue for the continuing education and exchange of scientific ideas related to the rapidly evolving and highly interdisciplinary landscape that is precision medicine research. The topics for each conference coincide with the national conversation and research agenda set by national research programs focused on precision medicine.

Patient engagement is critical for implementation of the genomic component of precision medicine--with care taken to include the perspectives and needs of patients. Yet many patients may experience significant barriers to understanding genetic information and/or using the electronic patient portals that many health systems are using to meet the terms of meaningful use related to the return of laboratory and test results.

A major challenge for precision medicine research is including historically under-represented groups in numbers sufficient to ensure statistically valid inferences of the influence of relevant risk factors, including genetic contributions to disease risk. Precision medicine researchers have recognized the critical need to enhance diversity and have implemented a wide variety of approaches to achieve this.