Project Summary/Abstract: Gastroesophageal reflux disease (GERD) is the 2nd most common World Trade Center (WTC) certified chronic condition, with pathogenesis connected to WTC dust and fumes exposure and irritation of the esophageal lining leading to prolonged inflammation. Due to the clinical prevalence of GERD, WTC conditions associated with GERD, risk of medication side effects and costs, it is critical to consider Lifestyle Medicine (LM) to optimize management of GERD in certified patients. In addition, WTC first responders have increasingly voiced concerns about possible side-effects related to chronic use of some GERD medications. GERD, similar to the vast majority of chronic conditions, can be managed by adopting lifestyle measures that maximize nutrition, physical activity, sleep, and other healthy habits. Evidence demonstrates that clinicians can be powerful motivators to help patients make behavioral changes that can prevent, treat and even reverse chronic conditions. LM formalizes these efforts by giving clinicians tools that emphasize their role as “health coaches” to identify and support patient readiness and confidence in making lifestyle changes so that they can successfully adopt long-lasting healthy habits. LM techniques, delivered by trained clinicians, have been shown to help patients make significant and long-lasting behavioral change that improves clinical outcomes. As a result of the COVID-19 pandemic, telehealth was successfully integrated into the Mount Sinai WTC Health Program Clinical Center of Excellence (WTCHP CCE) and has become an essential and popular way for patients to receive care. Integrating a LM Program delivered via existing telehealth services would increase opportunity for patient encounters—a crucial factor in facilitating behavior changes that can improve GERD. Educating patients to successfully adhere to LM first-line therapies requires skills and time-opportunity not available to most WTC providers. The objective of this R21 is to evaluate the effectiveness and feasibility of a LM program in responders with certified GERD, to reduce symptoms and/or need for medications. This project will be novel in that: 1) it is based on the evidence-based LM intervention as advised by the American College of Lifestyle Medicine; including health habit assessments, goal identification, readiness/confidence to change, and agreeing to action plans with monthly follow-up for 6 months 2) will be delivered by LM-trained clinicians 3) and will occur via a virtual care platform that incorporates health tracking technology, and the ability to engage and support patients over an extended period of time. Program evaluation will consist of assessment of participant enrollment and retention, feasibility and participant satisfaction with intervention, and effectiveness in lowering GERD symptoms, medication use and helping participants reach their health goals.