PROJECT SUMMARY/ABSTRACT Native Hawaiians (NH) have the highest mortality rates of cardiometabolic diseases, such as heart disease and diabetes, and the lowest life expectancy compared to the other major ethnic groups in Hawai‘i. NH face environmental and economic barriers to healthy eating, which can decrease cardiometabolic risks. They are overrepresented in economically disadvantaged neighborhoods with limited healthy food options, and are also more likely to face food insecurity. The objective of the proposed study is to test the efficacy of MALAMA, a culturally-grounded family-centered backyard aquaponics intervention, to increase consumption of healthy foods, reduce food insecurity, and mitigate cardiometabolic risks in multiple NH communities. Specific Aim 1: Test the efficacy of the MALAMA intervention in increasing consumption of healthy foods and reducing food insecurity in three Native Hawaiian communities. We hypothesize that participants in the intervention group will have greater improvements in healthy food consumption and food security post-intervention compared to participants randomized to the wait-list control group and will maintain these improvements at 12-month follow up. We will implement MALAMA in three Hawaiian Homestead communities using a stepped-wedge wait-list randomized controlled trial design. We will recruit a total of 180 individuals from the three community sites (60 families), and families will be randomly assigned to the intervention group or the wait-list control group at each site. We will assess changes in consumption of healthy foods, food insecurity, and other factors related to healthy eating at baseline, post-intervention, and 1-year follow-up. Specific Aim 2: Determine the impact of the MALAMA intervention on clinical indicators of cardiometabolic disease risk. We hypothesize that participants in the intervention group will have greater improvements in clinical indicators post-intervention compared with participants randomized to the wait-list control group and will maintain these improvements at 12-month follow up. We will measure changes in cardiometabolic disease risk by tracking participants’ blood pressure, cholesterol, HbA1C, body mass index (BMI), and hip-waist measurements to assess changes in cardiometabolic disease risk at baseline, post- intervention, and 1-year follow-up. Specific Aim 3: Identify facilitators and barriers to sustainability of backyard aquaponics. We will conduct interviews with the MALAMA participants and Lima Kokua peer leaders at one-year follow-up. We will identify facilitators and barriers to sustaining an aquaponics system. The findings will allow us to strengthen the MALAMA intervention for broader application in other NH communities. Successful completion of these aims will meet the Healthy People 2030 goal of increasing healthy eating among disparate populations. It will also meet NIMHD goals of reducing health disparities in underserved and underrepresented populati...