Project Summary Hispanic adolescents are disproportionately burdened by type 2 diabetes (T2D) and social determinants of health (SDoH), which can serve as barriers to behavior change and participation in disease prevention efforts. Telehealth is a potentially effective approach for delivering disease prevention programs in vulnerable communities as it reduces the burden of some SDoH like transportation, childcare needs, and parent work schedules. However, there are no theory- or evidence-based telehealth T2D prevention programs for Hispanic youth. The goal of this career development award is to assist Dr. Erica Soltero in her long-term goal of becoming an independent investigator designing and implementing T2D prevention interventions among high-risk pediatric populations impacted by SDoH. Dr. Soltero’s short-term goals include gaining expertise in the use of mixed- methods, the Self-Determination Theory (SDT), and development of technology-based interventions. In collaboration with her multidisciplinary mentorship team, she has developed a training plan to reach these goals via coursework, workshops, scientific meetings, and mentored research. The purpose of this study is to adapt Everly Little Step Counts (ELSC), an evidence-based, culturally grounded T2D prevention program, for delivery via telehealth and test the feasibility and acceptability of the adapted telehealth intervention. While telehealth is more suited for remotely delivering nutrition education, other technology-based tools are needed to remotely promote physical activity (PA). Thus, we will adapt and integrate our previously tested intervention that uses activity trackers (i.e. Fitbit) and text-messages grounded in the SDT to promote PA into the telehealth program. To ensure that all technology-based components are feasible and considerate of SDoH, we will use a mixed- methods approach across three iterative phases to engage Hispanic adolescents (14-16 years; N=24) and their parents (N=24) in the adaptation process. Once the ELSC-telehealth program is developed, a new sample of Hispanic adolescents (14-16 years; N=40) with obesity (BMI%≥95th) will be recruited from community clinics and randomized to the 12-week ELSC-telehealth intervention or usual care control group. Feasibility and acceptability will be assessed using a priori feasibility criteria (e.g. recruitment, data collection, fidelity) and exit interviews. We will examine the preliminary efficacy of the intervention on PA and T2D risk outcomes (fasting glucose, insulin, insulin resistance and HbA1c). This proposal builds on the investigative team’s previous work in T2D prevention, activity trackers, and text messaging to develop a telehealth delivered T2D prevention program with great potential for reaching and engaging Hispanic youth. This study will advance the science on telehealth as a disease-prevention tool among high-risk youth impacted by SDoH. Completion of the proposed training and research will provide Dr. So...