Colorectal cancer (CRC) is the second leading cause of cancer death; over 150,000 adults are diagnosed with CRC in the United States each year. Adenomatous polyps are a highly prevalent and treatable precursor to CRC. Consistent evidence suggests physical activity, smoking, and diets that are low in fruits/vegetables and high in red meat increase risk for polyps and CRC. Thus decreasing lifestyle risk factors could especially benefit polyp patients. Having polyps diagnosed may be a teachable moment when at-risk individuals may be particularly motivated to change their risk behaviors. The US Preventive Health Services Task Force suggests that those ages 50 and older seek CRC screening, which offers the opportunity to link interventions to this potentially important teachable moment in a large at-risk group. The proposed two-site randomized trial will evaluate a state-of-the-art comprehensive multiple risk factor intervention for polyp patients using a case management model. Polyp patients (N=1425) who agree to participate will be surveyed at baseline (following colon polyp removal) and randomly assigned to either: (1) comprehensive multiple risk factor intervention, including provider recommendations for behavior change, a goal setting session with a health educator, tailored self-help materials, telephone counseling, and personal progress reports; or (2) usual care. Primary outcomes to be assessed include changes in: (1) fruit, vegetable, and red meat consumption; (2) physical activity level; (3) multiple risk factor profile; and (4) smoking cessation (among smokers only). Follow-up assessments will occur at 6 and 12 months after polyp removal, and self-reported changes in diet and smoking will be biochemically validated. A theory-based intervention protocol (based on """"""""social ecological"""""""" Model), computer-assisted counseling, and tailored progress reports will maximize standardization of implementation across the two study sites. The intervention is suited to the managed care environment, thus increasing its potential generalize ability and disseminability. A process tracking system will enable a detailed cost-effectiveness evaluation.
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