Most individuals have more than one cancer risk behavior. Unfortunately, few studies have examined how to address more than one behavior at a time without decreasing the impact of the individual messages. This randomized, controlled trial is designed to test the efficacy of two computer- tailored, stage-based interventions for addressing multiple cancer risk behaviors (mammography and clinical breast exam; PAP testing; sigmoidoscopy and fecal occult blood testing; and smoking). Our objective is to increase cancer prevention and control behaviors at the patient level and at the practice level (in interaction with our practice-based partner project). We will test the relative effectiveness of multiple tailored messages, provided in a participant-determined sequence (sequential) versus an all-at-once method (simultaneous), in female patients of primary care physicians. We will select 4,000 female patients - ages 50-75, and with more than once cancer risk behavior - from the waiting rooms of 68 primary care practices, located in two North Carolina cities. Patients will use a hand- held computer to self-report baseline data on cancer risk behaviors; psychosocial and demographic data; and readiness to change each behavior. Within two weeks of baseline survey, women randomly assigned to either intervention group will receive computer-tailored messages relevant to their specific risk factors, psychosocial information and stages of change. We will conduct telephone follow-up interviews at 6, 12 and 18 months after baseline, and mail up-dated tailored messages after the 6 and 12 month follow-ups. Control patients will not receive messages. Computer-tailored print materials have consistently been found to have a stronger behavioral impact than untailored materials when addressing individual behaviors, but the effects may be mitigated when tailoring on multiple behaviors at one time. We want to reduce overall cancer risk by intervening on multiple behaviors without overwhelming patients or diminishing the impact of individual messages.
