This projects plans to develop longitudinally-tailored print materials and telecounseling interventions and compare their effectiveness, individually and in combination, among individuals with one or more risks, including smoking, poor diet, and sedentary behavior.

cancer prevention, diet, nutrition, fruit, vegetables, physical activity, exercise, tobacco, smoking cessation, multiple risks, expert tailored, telecounseling, Internet, web, print

1. Evaluate the hypothesis that tailored print materials combined with tailored telecounseling is more effective than either tailored print materials or tailored telecounseling alone in improving health risk behaviors. The health risk behaviors include cigarette smoking, nutrition, and sedentary behavior.
   
2. Evaluate the hypothesis that tailored telecounseling is more effective than untailored print materials in improving health risk behaviors (identified above).
3. Evaluate the hypothesis that tailored print materials are more effective than untailored print materials in improving health risk behaviors (identified above).
4. Assess the effects of the interventions in the presence of different combinations of multiple risk behaviors.

3,000 Henry Ford Health System members.

Participants in Better Health must be at risk for two of three health behaviors: smoking, low vegetable consumption, and/or sedentary lifestyle. Participants complete a baseline questionnaire and then choose which one of the three risk factors they would like to work on first. They then receive two intervention sessions approximately two weeks apart. They complete a follow-up assessment three months after baseline, again choose a risk factor, and then receive two more intervention sessions. We collect final data 12 months after baseline.

At baseline, participants are randomized into one of four study arms:

• generic print booklets ("usual care" or "off-the-shelf" booklets)
• tailored print booklets
• tailored telecounseling
• tailored print booklets plus tailored telecounseling

Telecounseling involves a telephone call with trained health telecounselor from HFHS. The telecounselors follow open-ended prompts on a computer that have been generated using the participants answers to the questionnaires.

The intervention aims to increase vegetable consumption and exercise and reduce smoking among participants. The tailored interventions employ health education theories such as the Health Belief Model and the Transtheoretical Model to provide participants with information that is relevant to them and that will motivate them to make health behavior changes. Participants also receive information relevant to their health status (e.g., if they have diabetes), preferences (e.g., what kind of exercise they may like), previous and behavior history (e.g., if they've used nicotine patches to quit smoking in the past).

While data is still being analyzed, preliminary findings are summarized here:

• The large majority of participants were categorized as having low vegetable intake and low physical activity. A quarter of participants reported regular cigarette smoking.
• At both the 3- and 12-month follow-up periods, the combined tailored print and telecounseling group consistently outperformed all other treatment arms in reducing the number of behavioral risk factors.

Results of this randomized trial demonstrate a modest effect of combining tailored print and telecounseling interventions.

Strecher, VJ, C Wang, H Derry, K Wildenhaus, C Johnson. Tailored interventions for multiple risk behaviors. Health Educ Research 2002 19(5): 619-626.