In many epidemiologic studies, investigators have reported an inverse relation between nonsteroidal antiinflammatory drugs (NSAIDs) and colon cancer, but fewer researchers have examined the relation with gastric cancer. Cases for this study consisted of incident gastric adenocarcinomas (n = 643) identified between 1993 and 2004 among members of the Multiethnic Cohort (Hawaii and Los Angeles, California). Aspirin and nonaspirin NSAID use was assessed on the basis of a self-administered questionnaire. Multivariate-adjusted hazards ratios and 95% confidence intervals were calculated using Cox proportional hazards regression. Compared with no regular use, regular use of aspirin was associated with a decreased risk of distal gastric cancer (hazard ratio (HR) = 0.73, 95% confidence interval (CI): 0.61, 0.89; P(trend) = 0.009), but use of nonaspirin NSAIDs was not (HR = 1.00, 95% CI: 0.81, 1.24; P(trend) = 0.99). The inverse association with regular aspirin use was observed only for intestinal-type distal gastric adenocarcinoma (HR = 0.66, 95% CI: 0.47, 0.95; P(trend) = 0.01), as opposed to diffuse-type distal gastric adenocarcinoma (HR = 0.92, 95% CI: 0.53, 1.60; P(trend) = 0.45). In this study, the authors found aspirin use to be inversely associated with distal gastric adenocarcinoma, particularly of the intestinal type.