American Indian (AI) communities experience higher rates of liver cancer incidence and mortality than the general United States (U.S.) population, particularly in the Southwest Region. Common risk factors for liver cancer include having hepatitis B or hepatitis C, cirrhosis, excessive alcohol consumption, lack of physical activity, non-alcoholic fatty liver disease (NAFLD), and obesity. Notably, a disproportionate prevalence of obesity-related diseases is experienced by AI people in the U.S. when compared to all other racial/ethnic groups, making their health status a key public health issue. Despite the clear need to develop effective liver cancer prevention strategies, health disparities remain among AI communities and within the scientific literature. To address these significant health disparities, the interdisciplinary team and Pascua Yaqui Tribe will investigate strategies to improve liver cancer prevention and health equity for AI communities. We will apply the ‘two-eyed seeing’ paradigm to see from one eye with the strengths of the Yoeme knowledge and ways of knowing, and from the other eye with the strengths integrated scientific approaches for community-engaged research methods. This high impact effort will advance research for liver cancer prevention in a high-risk group that carries a disparate liver cancer burden. The Specific Aims are to: 1) examine Yoeme adults’ attitudes and beliefs of liver cancer health risk (e.g., lifestyle, diet, lived experiences, biological, environmental); 2) assess the prevalence and characterize risk factors for NAFLD, a known risk factor for liver cancer, in a sample of 150 adults recruited from a Pascua Yaqui clinic; and 3) determine the potential for the implementation and dissemination with reciprocity of an existing evidence-based lifestyle-based intervention (DPTP) tailored for NAFLD risk reduction in clinic-based settings. The study team’s efforts are centered in developing a sustainable research agenda for Yoeme communities that fosters interdisciplinary, collaborative research, education, and outreach. This proposed study directly benefits the community by 1) creating representative scientific evidence that can inform health policy and clinical guidelines, 2) increasing access to health services (e.g., liver disease screening) that improve understanding of risk factors related to liver cancer, 3) building culturally relevant research capacity within Yoeme communities that experience a disproportionate burden of obesity-related health disparities, and 4) providing valuable research training to Yoeme people and early- career investigators. Further, this study will provide the interdisciplinary research team, led by Dr. David O. Garcia (Co-Leader/UA) and Dr. Priscilla R. Sanderson (Co-Leader/NAU), in partnership with Dr. Adalberto Renteria (Pascua Yaqui Medical Director; Co-I), with the preliminary data to develop an R01 proposal to test the effectiveness of a culturally and clinically relevant inte...