Abstract of the Parent Award (R01MD017961) Food insecurity, defined by the United Nations as inconsistent access to a sufficient quantity of affordable, nutritious food, is a prevalent social determinant of health (SDOH) among safety-net primary care patients. Among adults with food insecurity, conditions like hypertension (hypertension) and type 2 diabetes (type 2 diabetes) are as much as two times more prevalent. Widely available chronic disease self-management education and support (SMES) programs place much emphasis on nutrition education but do not significantly address access to affordable, nutritious food or meals. Notably, simulations have shown that medically-tailored meals for food-insecure adults could be as cost-effective as some commonly prescribed medications. Drawing upon our knowledge of systems engineering and user-centered design, our team created and successfully piloted a novel, dietitian-led sociotechnical intervention called Food Resources & Kitchen Skills (FoRKS). Safety-net primary care patient-participants (N=20 across two pilots) received essential home cooking tools, home delivered lower sodium, lower-carbohydrate Mediterranean-style meals and ingredients, and twice- weekly hands-on home cooking classes. Mean attendance was 87% and mean satisfaction was 4.7/5.0 for delivered foods and 4.9/5.0 for hands-on cooking class. Webex videoconference classes allowed participants to learn and cook together in a socially supportive “space” from their own home kitchen. We proposed a randomized controlled trial to evaluate FoRKS versus enhanced usual care (EUC). Safety-net primary care patients aged 35 years or over with food insecurity and systolic blood pressure ≥120 mm Hg (~40% will also have type 2 diabetes) will be invited, consented, assessed, and randomized. EUC consists of SDOH screening, referrals to food pantries, and assistance enrolling in food programs (e.g., SNAP). EUC also consists of our CDC-approved 5-week SMES program. Those randomized to FoRKS will, in addition to EUC, receive home-delivered meals and ingredient kits, and twice-weekly Webex cooking classes to week 16. In week 17, participants will transition from FoRKS-delivered foods to shopping for affordable, nutritious foods. FoRKS classes will continue in order to maintain learning and social support that may be critical to longer-term engagement and self-efficacy for obtaining and preparing nutritious food. The primary hypothesis is that, relative to EUC, FoRKS participants will experience lower mean systolic blood pressure immediately post-intervention (16 weeks post-baseline). Maintenance to 24-weeks post-baseline will also be assessed. Food security, nutrition, and HbA1c will also be evaluated as will cost-effectiveness and behavioral mechanisms such as learning engagement, self-efficacy, and food resource management skills.