OVERALL PROJECT SUMMARY The overarching goal of the Mid-Atlantic Center for Cardiometabolic Health Equity (MACCHE) is to test the effectiveness of comprehensive, integrated, and multi-level evidence-based strategies for improving cardiometabolic health outcomes among socially disadvantaged populations in Maryland, using community- based participatory research and patient-centered outcomes research principles, and translate them into clinical and public health practice and policy. We will leverage the existing infrastructure of the Johns Hopkins Center for Health Equity, which has applied a comprehensive approach to health equity for over 10 years, a partnership with the University of Maryland Baltimore, and collaborations with Morgan State University and other institutions in the region. MACCHE will include 3 separate, but related intervention studies addressing disparities in cardiometabolic disease; 3 integrated cores (Administrative, Investigator Development, and Community Engagement); an Executive Committee; and a Community Advisory Board. Study 1 is a randomized trial comparing the effectiveness of an evidence-based pregnancy/postpartum health coaching/home visiting intervention to usual home visiting services in reducing postpartum weight retention among Black and Latinx women at high risk for cardiometabolic health disparities; Study 2 is a randomized trial examining the effectiveness of a multi-level intervention of problem-solving training, community health worker (CHW) support and partnership with community facilities for enhancing cardiorespiratory fitness in adults with low socioeconomic status, diabetes, obesity and asymptomatic cardiac dysfunction; and Study 3 is a cluster- randomized trial testing the effectiveness of a multi-level intervention linking self-monitored blood pressure (BP) with telemonitoring, team-based care with pharmacists and CHWs, and provider-level interventions compared to enhanced usual care, for improving BP control among socially disadvantaged adults with uncontrolled hypertension plus diabetes or chronic kidney disease. The Administrative Core will carry out the overall administration of the grant, providing infrastructure and support for data harmonization, management and analysis, patient recruitment and retention, and intervention adaptation and implementation. The Investigator Development Core will establish a pilot project program for early-stage investigators and create a mentoring network and community for pilot project awardees, to support innovative research related to chronic disease disparities. The Community Engagement Core will implement a shared governance structure to reinforce stakeholder leadership and ownership; advance, facilitate, and evaluate MACCHE’s community- engaged research and investigator development initiatives; and employ community-centered strategies to translate, disseminate, and sustain MACCHE initiatives. The MACCHE will advance the science of cardiometabolic disease disparities and facilitate its translation into clinical and public health practice and policy.

OVERALL PROJECT NARRATIVE The overarching goal of the Mid-Atlantic Center for Cardiometabolic Health Equity (MACCHE) is to test the effectiveness of comprehensive, integrated, and multi-level evidence-based strategies for improving cardiometabolic health outcomes among socially disadvantaged populations in Maryland, USA. The MACCHE will advance the science of cardiometabolic disease disparities and facilitate its translation into clinical and public health practice and policy.