Project Summary Latino youth have the highest prevalence of obesity as compared to Black or White youth, and are at high- risk for adult obesity-related complications including cardiovascular disease. Moreover, Latino youth living in rural communities have an increased risk of adult obesity and mortality due to obesity-related chronic disease than Latinos living elsewhere. We synthesized our prior childhood obesity intervention and tailored our evidence-informed, theory-based, multi-family behavioral intervention, Adaptando Dieta y Acción Para Todos (ADAPT), to the acculturation status, language, and national origin or our target population - obese, school aged (8-12 years old) Latino youth and their parents living in rural areas. However, because the role of parent stress on obesity has not been adequately addressed in interventions aimed at reducing obesity in Latino youth, we argue that mindfulness parent stress reduction strategies may be a key component to improving eating and physical activity (PA) behaviors in both children and their parents. This NIH Stage I R34 proposes a refinement and optimization of the original ADAPT obesity intervention protocol to include mindfulness parent stress reduction strategies (now ADAPT+) (Stage IA) and feasibility assessment of ADAPT+ implementation (Stage IB). This mixed methods R34 sets the basis for a Stage 2 larger R01 trial to determine ADAPT+'s efficacy in improving Latino families' eating and PA behaviors. Two main aims guide our application. Aim 1: Refinement of ADAPT+ (ADAPT + mindfulness parent stress reduction) intervention. • We assess acceptability of the integration of mindfulness parenting stress reduction into ADAPT to increase healthy lifestyle behaviors by: conducting a series of focus groups with our community health facilitators/ promotoras and parents of children (8-12 years old) with obesity to obtain feedback about and refine each of our 8 integrated sessions and evaluate optimization of ADAPT+ sessions. Aim 2: Feasibility and Acceptability trial. A randomized trial testing feasibility of ADAPT+ vs. Enhanced Usual Care/EUC conducted in two rural communities evaluates: • study sample selection and recruitment, willingness to be randomized and retention. • fidelity of intervention administration, intervention adherence, and further refinement of manuals. • feasibility of data collection procedures, including collecting a battery of measures from parents and children, data quality and sensitivity of our measures to our intervention effects over time – (pre- post- 3 mos post). • We anticipate that compared to EUC, ADAPT+ dyads will have a lower attrition rate and will report greater satisfaction. We also explore whether our eating, PA and stress indices are sensitive to the intervention. This application is significant, as it addresses an urgent public health epidemic among a specific at-risk, ethnic and geographical minority group; innovative, as it implements a unique intervent...