Healthy Directions was a cancer prevention intervention designed to reduce behavioral risk factors for cancer among working class, multi-ethnic adults in the health care setting. The intervention targeted multiple risk factors (red meat, fruit &vegetables, multi-vitamins, physical activity). Participants in the intervention health centers had significantly greater change in the multiple risk behavior score, which reflects simultaneous change across the 4 risk factors. In addition, the intervention led to significant changes in the individual risk factors, including increased consumption of fruit and vegetable and multi-vitamins, and significantly decreased rates of red meat intake. However, the intervention reach was less than ideal, and there was no significant impact on physical activity. Further, Healthy Directions utilized extensive telephone counseling, which is heavily labor intensive. It is critical that we seek less costly means of delivering cancer prevention interventions. The proposed study is an efficacy study of Healthy Directions-2 (HD-2), which is designed to: (1) increase reach of the intervention into the target population;(2) extend the intervention to include smoking, and increase efficacy of the intervention across all target risk behaviors;and (3) promote and assess long-term maintenance of behavior change. HD-2, a randomized control trial conducted in 10 health centers, will assess whether the intervention effectiveness can be maximized while transferring some of the intervention components to less labor intensive and more disseminable formats. Health centers will be randomized into intervention or usual care. The intervention includes: (1) 'prescription'and brief endorsement of behavior change by the participant's provider;(2) two telephone counseling calls;(3) automated phone reminders;(4) tailored print materials delivered through one of 3 modalities, including the web, email, or print materials;(5) companion materials/resources for social network members;and (6) linkages to key community-based resources. Participants will select modes of interacting with the intervention (e.g. web, email, or print) that are appropriate for their resources/ interests. The self-help condition will receive print materials on the target risk factors, 12 mailings on general health, and access to the HVMA website. Follow-ups will be conducted 1- and 12- mos. post-intervention. The primary outcome is change in the multiple behavior risk score;secondary outcomes include change in each of the 4 risk factors, as well as intervention dose delivered, reach, impact, and cost-effectiveness.
