PROJECT SUMMARY The overarching goal of this candidate’s program of research is to overcome social and environmental barriers to promote behavior change and cardiovascular health equity. The focus on this application is low-income, rural patients, since cardiovascular disease (CVD) prevalence is 40% higher among rural than urban residents. Health behavior counseling and follow-up care are required for patients with an elevated body mass index who have increased risk for CVD. Counseling is most effective when developed with, and tailored to, the patient and offered with resources that support healthy food intake and physical activity. Resource referral and follow- up is particularly important in rural low income residents who often have more severe social needs that impede healthy behaviors. The proposed research will leverage the candidate’s digital health tool (PREVENT) for healthcare teams to use within the clinic visit. PREVENT visually displays patient-reported and electronic health record (EHR) data to facilitate counseling and deliver tailored physical activity and healthy food intake goals and resources. PREVENT may improve the quality of required care and promote cardiovascular health equity. A K12 award enabled the candidate to show that PREVENT is feasible in urban clinics. This research will build upon her K12 work to: 1) collaborate with rural and clinic partners to modify and integrate the PREVENT tool for low-income, rural patients with obesity (Aim 1); and 2) conduct a pilot pragmatic clinical trial of PREVENT to optimize feasibility, acceptability, appropriateness, and potential health equity impact. To achieve the goals of this research and transition to independence, the candidate requires further training in: 1) rural health and health equity; 2) advanced dissemination and implementation science; 3) design and conduct of pragmatic clinical trials; and 4) team management and leadership. Together, the exceptional mentors, internal and external advisors, and institution are committed to assisting the candidate to reach her career development goals and to conduct the proposed research. In summary, this award will build the foundation for the candidate’s career as an independent investigator by providing: 1) the skillset to use dissemination and implementation science and health equity research methods to tailor and equitably implement technology interventions; 2) methodologic and leadership skills to conduct pragmatic clinical trials; 3) a multilevel, scalable program for improving the quality of health behavior counseling; and 4) the pilot data to support the feasibility of a subsequent R01 trial of PREVENT in multiple clinic settings.