The proposed research involves the development and field testing of a model weight control program for Cancer Prevention with low income African American women aged 20 to 64 in the Boston area. During year one, extensive formative evaluation will be conducted with members of the potential audience through a combination of qualitative techniques from cultural anthropology and social marketing. The formative procedure will enable the investigators to develop a culturally appropriate intervention program for low income African American women by determining the logistical and cultural barriers and facilitators to successful diet and physical activity changes they encounter in attempts to reach and maintain their desirable weight. Cable television will be the primary program delivery channel. The program will utilize the 'pay per view' feature of cable television to insure integrity of the experimental design and greatly enhance the generalizability and potential replicability of the approach. Principal design features include random assignment of participants to experimental condition, and testing of two major components: interactive verses passive television programming and enhanced vs non-enhanced social support in a two by two factional design. In the IATV condition, participants will interactively participate by telephone in the live cable television delivery of 12 weekly sessions followed by four monthly booster programs. The passive television groups will view the programs without being actively involved. Half of the interactive and passive groups will receive an enhanced 'out of classroom' component with increased social support including telephone problem solving based on motivational in viewing and delivered by trained African American lay health advocates recruited from low income Boston neighborhoods. The other half of the interactive and passing groups will not receive this enhanced social support component. The rest of the participants will be assigned to a 'waiting list' control groups. Process evaluation will include tracking of programs viewed by participants, number and topics of calls into programs, audio recording of the lay health advocates telephone sessions, and comparative costs of the four interventions. Outcome evaluation will include changes in diet and physical activity and weight and body circumference measurements at baseline and 3, 7.5 and 12 months later. The final product will be a model program readily adaptable by health care and public health organizations for their local populations.
