California WISEWOMAN - The proposed program outlined in this grant application builds upon the CA WISEWOMAN Program’s extensive expertise developed over the past 17 years to address heart disease, one of the leading causes of death for women. The CA WISEWOMAN clinic-based model has proven successful in screening and providing risk reduction counseling, followed by health coaching sessions. In collaboration with select clinic providers, CAWISEWOMAN Program aims to extend preventative health services to low income, under- or uninsured women 35-64 years of age who are eligible for California National Breast and Cervical Cancer Early Detection Program (CNBCCEDP) services and are at risk for cardiovascular disease (CVD). To ensure program success, the CA WISEWOMAN Team will conduct environmental scans, gather data from various sources, and collaborate with clinic and community partners, including community-based lifestyle change programs. The CA WISEWOMAN Program will partner with other Centers for Disease Control and Prevention-funded programs at state, local, county, and community levels to implement team-based care models that reduce CVD risk and link community resources and clinical services that support comprehensive bi-directional referrals and follow-up systems. The CA WISEWOMAN Program aims to improve short, intermediate, and long-term outcomes through various measures, such as increased reporting, monitoring, and tracking of clinical data; adherence to evidence-based guidelines, policies, and data sharing; and increased engagement in self-management and participation in healthy behavior support services. By the end of the five-year project period, the CA WISEWOMAN Program intends to achieve long-term outcomes, including increased blood pressure control and improved detection, prevention, and control of cardiovascular disease among women in California. To ensure the CA WISEWOMAN Program implements health equity solutions throughout all phases of the program, the team will work closely with other state agencies, local health departments, and other key community stakeholders and partners. The CA WISEWOMAN Program will implement strategies in areas with disproportionately lower incomes and in minority communities with high risk factors for CVD. The program will assess CVD risk factors and provide services to reduce those risks through improved diet, physical activity, tobacco cessation, and medication adherence support. Additionally, the program plans to mitigate social support barriers to improve outcomes, including hypertension prevention, detection, control, and management. The CA WISEWOMAN Program aims to serve an estimated 4000 women over the five-year project period by reducing the risk factors associated with CVD among women ages 35-64 by promoting and implementing tracking and monitoring evidence-based clinical measures, team-based care models, and linking community resources and clinical services shown to improve health and wellness, and health care quality for patients at risk of and with CVD.