ABSTRACT - PROJECT 2. Cancer survivors living in persistent poverty (PP) areas suffer greater cancer disparities which are magnified in non-Hispanic Black (hereafter Black) populations. In PP areas, Social Determinants of Health (SDH), including poor living environments have negative behavioral consequences such as poor diet, physical inactivity, and obesity. Implementing programs that counter these health behavior consequences require contextual adaptation and multilevel implementation strategies that target upstream factors (poor physical and social environment, etc.) contributing to disparities. Yet, we know of no prior efficacious diet and physical activity intervention for cancer survivors and their co-survivors (friends and family) that has been adapted and implemented in the specific PP context using multilevel implementation strategies. Thus, the overall goal of this application is to reduce health disparities experienced by cancer survivors and their co-survivors living in primarily Black PP areas by improving health behaviors. To achieve this goal, we will use established Implementation Science frameworks and significant input from multiple local stakeholders to adapt two efficacious interventions into a new community-delivered LEAP Program, and implement and evaluate this program. Our specific aims are: Aim 1 -Adapt efficacious diet and physical activity interventions designed for cancer survivors (and their co-survivors) to the PP context and SDH. Building off two efficacious diet and physical activity interventions for cancer survivors (and their co-survivors), BEAT Cancer and RENEW, we will adapt them into the LEAP Program. The adaptation process will focus on acceptability, feasibility, sustainability, and SDH in PP areas. Aim 2 - Implement the LEAP program in PP areas using multilevel implementation strategies. We will identify implementation strategies, develop a LEAP Implementation Toolkit, and implement the LEAP program. Aim 3 - Evaluate LEAP program implementation in PP areas. Using a mixed methods approach, we will examine 3 types of outcomes: implementation (readiness, reach, acceptability, fidelity, sustainability), service (safety, cost), and client (diet quality, physical activity, body mass index, quality of life). We will use a 2-cluster prospective design in which our work will start in 4 PP census tracts (Cluster 1) and be replicated in the remaining 5 PP census tracts (Cluster 2) where the other Center for Cancer Control in Persistent Poverty Areas (C3P2) project will intervene to improve the living environment (built and social). This will allow us to examine whether PP living environment improvements enhance the adaptation and implementation of the LEAP program. By leveraging the C3P2 infrastructure and efficacious interventions, this project will advance capacity for implementation of health promotion in PP areas.