This competitive renewal would build on the productive multidisciplinary research of our CPRU that has generated interventions that could produce greatly increased impacts on populations at high risk for cancer. The goal of this program of research would be to accelerate the process of change of multiple cancer risks through multiple intervention channels to enhance cancer prevention and control. Three integrated projects would evaluate the effectiveness and cost-effectiveness of stage-matched, interactive and individualized interventions delivered through four channels: home, school, worksite and medical practices. Progress would be accelerated through each of five stages of change (precontemplation, contemplation, preparation, action and maintenance) for multiple risk factors: high fat and low fiber diets, sun exposure, smoking, sedentary lifestyle, and adherence to breast cancer screening recommendations. The strengths and synergism of this proposal are enhanced by such elements as: 1) a common stages of change model applicable to entire populations and not just the minority ready to change; 2) assessment of the effects of four separate channels of intervention and the additive effects of adding home-based expert systems to each of the other channels; 3) common measures that have already resulted in unprecedented principles of change for multiple behaviors; 4) a similar set of intervention principles that include motivational and educational strategies for people in the early stags of change, action and relapse prevention strategies for people prepared for action and recycling approaches for people who regress to high risk behaviors; and 5) proactive, interactive and individualized interventions added to three organizational channels that are widely used in community health promotion. The projects are: Enhancing Worksite Cancer Prevention through the Home; Cancer Prevention Via School and Home Channels; Promoting Cancer Prevention through Primary Care. In addition, there is a Developmental Project that will combine public health clinic and home interventions to accelerate smoking cessation in low SES and minority pregnant women. These projects are supported by three strong Cores: Leadership, Evaluation, and Intervention and Technology. This cancer prevention research will continue to contribute to the Year 2000 objectives by testing on the major behavior causes of cancer interventions that will accelerate the process of contemplating, preparing, acting upon and maintaining proven cancer prevention regimes for individuals and organizations. The interventions are potentially cost-effective and can be readily disseminated for use with high risk populations.
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