PROJECT SUMMARY (Exploring the Adaption of Mindfulness in Native American Communities to Address Diabetes) Native Americans have higher rates of contracting, experiencing complications from, and death due to diabetes (1)(2)(3). Several factors may influence health disparities in diabetes, including Native cultural beliefs about diabetes and distrust of western medicine resulting in poor health behaviors (3)(4). Further, as stress is known to exacerbate the effects of diabetes physiologically and through poor health behaviors associated with stress (5)(6)(7), the effects of daily stress may be compounded by historical stress in Native communities (8). Mindfulness-meditation may be an effective means to reduce psychological and physiological stress as well as encourage good health behaviors through heightened attention to diabetes management protocols (9)(10). Although previous studies have indicated that mindfulness practices may be welcome in Native communities (11)(12)(13), there is still little known about the process of adapting mindfulness interventions to Native cultural traditions. We propose to (A) work closely with tribal members to develop trust and support for mindfulness research in the first phase of the K99, (B) develop a core Native-specific MBSR class with optional modules that can be tailored to be Tribe-specific in the second phase of the K99, and (C) in the R00 phase, use two- armed feasibility trials to further develop the core Native-specific mindfulness class with tailored modules and to assess the feasibility of our study design among diabetic adults. Primary outcomes are measures of feasibility and acceptability. Secondary outcomes include behavioral and physiological markers of diabetes management. We hope that these data will motivate an R01-level examination into the efficacy of mindfulness as a means to improve diabetes management and reduce complications due to diabetes in Native communities. This K99/R00 is the preliminary step in the ultimate goal of integrating mindfulness programs with Native contemplative practices as a means to holistically address Native health disparities. These efforts may prove particularly important in a population that has shown a notorious distrust for western medicine.