SECTION N4: RESEARCH CORE - INTERVENTION STUDY PROJECT SUMMARY The proposed study will evaluate the efficacy of a theoretically- and empirically-based, culturally-tailored Motivation And Problem Solving (MAPS) inten/ention, conducted within a community-based participatory research (CBPR) framework(1-3) for reducing cancer risk related to smoking, poor diet, and physical inactivity. The entire study design and intervention approach builds on a large body of CBPR, outreach, and other research among Latinos by the investigators, all of which has led to the development of the proposed project (see the Preliminary Studies, Administrative Core, and Outreach Core for more detailed discussion of much of this work). High-risk MA individuals (i.e., smokers who are also ovenweight/obese;N = 400) will be recruited from the MA Cohort Study (>19,000 participants), will be followed for a period of 18 months, and will be randomly assigned to one of two groups: Health Education (HE) or MAPS. Participants do not need to be motivated to change their behavior. Assessments occur at Baseline and at 6,12, and 18 months after Baseline. All assessments occur in the participants'homes. Potential participants will be identified via data already collected in the MA Cohort Study. Potential participants will be contacted and screened for eligibility over the phone. A Baseline visit will be scheduled within at least two weeks. At the completion of the Baseline assessment, participants will be randomly assigned to HE or MAPS. Primary outcomes are smoking status, servings of fruits and vegetables, total calories, percent of calories from fat, and both self-reported and objective measures of physical activity (PA). HE is modeled to resemble a brief encounter with a lay health worker and includes brief counseling and self-help materials addressing the three risk behaviors, referrals to available resources, and a home-based exercise kit (e.g., pedometer, exercise ball, strength training cables). When and if a participant is ready to make a smoking cessation attempt, a 6-week supply of free nicotine patches will be provided. HE will occur a total of 3 times (Baseline, 6 months, and 12 months). MAPS will include HE plus 9 proactive, telephone counseling sessions over the 18 month period. The timing of the 9 counseling sessions in MAPS is flexible and determined jointly by the participant and the counselor. MAPS is a holistic, dynamic approach to facilitating behavior change based on a combination of motivational interviewing (Ml) (4,5) and social cognitive theory.(6-8) Moreover, MAPS incorporates key strategies from empirically-validated approaches such as the chronic care model and patient navigation that have been demonstrated to be effective across numerous diseases and conditions. (9-12) MAPS is designed for all individuals regardless of their readiness to change, and specifically targets motivation, agency/self-efficacy, and other key factors of particular relevance to underserved populations (e.g., stressors, family issues, financial resources). Because MAPS revolves around a """"""""wellness program"""""""" that addresses numerous barriers and concerns that are prevalent among underserved populations, it is particularly appropriate for treating high-risk MA individuals. Motivational and social cognitive approaches have been used extensively in the treatment of smoking, diet, and PA. However, to the best of our knowledge, MAPS is among the first treatments to combine these approaches into a comprehensive, holistic intervention model built around the dynamic nature of motivation, target multiple cancer risk behaviors, and focus on high-risk, Spanish-speaking MA individuals.
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