Project Summary Many health promotion programs fail to address barriers to successful adoption of healthy behavior. Barriers include lack of knowledge about individual risk and lack of motivation to prevent a disease decades in the future. We propose to increase awareness of individual disease risk through disclosure of individual risks for Alzheimer’s disease and to provide a program to prepare for adoption of health behavior change. Because women in the U.S. have twice the lifetime risk of Alzheimer’s disease (AD) and compelling evidence suggests female-specific cardiometabolic and hormonal changes emerge in midlife that contribute to these sex disparities, the behavioral intervention program is designed specifically for women in midlife. We hypothesize that: 1) disclosure of individual risk information will increase awareness and motivation for health behavior change, particularly among those at higher risk, 2) completing our intervention will increase awareness, motivation, and action that precede health behavior change. Aim 1 is to evaluate whether the intervention increases precursors to health behavior change. Using the electronic health record to identify participants at risk for Alzheimer’s and baseline testing to quantify risk, we will inform participants of their individual Alzheimer’s risk. We will randomize participants to start immediately (or after 12 weeks) the Women’s AD Risk Reduction in Midlife (WARM) program. WARM is a 12 week online education and health coaching program, followed by monthly group support and health coaching. Building on 10+ years of Alzheimer’s prevention programs, WARM will focus on risks specifically elevated in midlife women. We will conduct a randomized controlled trial to assess increased awareness, motivation, and action—precursors to adopting health behavior change. Aim 2 is to Evaluate feasibility and acceptability of the Women’s AD Risk Reduction in Midlife (WARM). We will assess feasibility in terms of 1) completion of educational modules, 2) scores on knowledge assessments. We will assess acceptability via questionnaires (quality of materials, preferred delivery format and frequency, coaching support, preferred timeline, level of commitment, and cost). We will conduct semi- structured interviews with a sub-set of participants. Aim 3 is to Evaluate the effect of WARM on changes in AD risk factors. At baseline and after week 12 we will assess changes in body composition, blood pressure, and blood tests (fats and sugars), and self-reported health behaviors (diet, physical activity, sleep). The project is innovative in its focus on midlife as the critical time to intervene, and disclosure of individual risk information. The focus on successful adoption of health behaviors and the online delivery will enhance successful implementation in later stages. It is innovative in its use of bioinformatics tools to identify a diverse set of participants at increased Alzheimer’s risk.