1. High Impact Tools for Health Promotion James O. Prochaska, Ph.D. Director and Professor Cancer Prevention Research Center University of Rhode Island Founder Pro-Change Behavior Systems, L.L.C.

2. The Stages of Change: Maintenance Action Action Preparation Preparation Contemplation ContemplationPrecontemplation

3. Intervention Issues 1. Recruitment 2. Retention 3. Progress 4. Process 5. Outcomes

4. Percent of Smokers by Stage Across Three Different Samples SamplePrecont.Cont.Prep.N Rhode Island 42.140.317.64,144 4 Worksites 41.138.720.14,785 California 37.346.716.09,534

5. PC T Scores CAM

6. Stage Transitions

7. Pros and Cons of Arranging Follow-up Appointments T Scores Stage

8. Stages by Processes CONSCIOUSNESS RAISING DRAMATIC RELIEF ENVIRONMENTAL REEVALUATION SELF REEVALUATION PRECONTEMPLATION CONTEMPLATION PREPARATION

9. Stages by Processes PREPARATION ACTION MAINTENANCE SELF LIBERATION COUNTERCONDITIONING STIMULUS CONTROL REINFORCEMENT MANAGEMENT HELPING RELATIONSHIPS

10. 1. Action-oriented Manuals 2. Stage-Matched Manuals 3. Stage-Matched Computers & Manuals 4. Counselors & Stage-Matched Computers Computers Treatment Groups

11. Assessment Periods Percentage

12. Baseline Percentage 6 months12 months18 months Assessment Periods Computer vs. Counseling

13. Baseline Percentage 6 months12 months18 months Assessment Periods Proactive vs. Reactive Recruitment

14. Percentage in Action/Maintenance  2 significant (p <.001) at 6, 12, & 18 months Pre-Action at Baseline Only

15. Smoking Point Prevalence Home % in Action and Maintenance

16. Diet Point Prevalence (all subjects - PO1 School Adult Sample) % in Action and Maintenance

17. Sun Point Prevalence Home % in Action and Maintenance

18. Diabetes Self Management Outcomes: Percent in Action or Maintenance at 12 Months II. SMBG A. Canada B. Hawaii I.Smoking: A. Canada B. Hawaii III. Diet A. Canada B. Hawaii TreatmentAssessment 26 %15 % 25.9 % 15.9 % 40.6 % 24.1 % 31.8 % 11.5 % 38%25 % 28 %18%

19. Impact of Stage-Matched Programs Efficacy X Participation = Impact Efficacy X Participation = Impact n Individual/Clinic: – 30% X 5% = 1.5% n Public Health/Community: – 6% X 75% = 4.5% n Stage-Matched Proactive: – 20% X 75% = 15%

20. Population Health Paradigms Old Paradigm Complemented by Complemented by New Paradigm New Paradigm 1. Individualized Patient 1. Individualized Patient 1. Entire Populations 1. Entire Populations 2. Passive-Reactive Services 2. Passive-Reactive Services 2. Proactive Services 2. Proactive Services 3. Passive Reactive Patients 3. Passive Reactive Patients 3. Proactive Populations 3. Proactive Populations 4. Action-Oriented 4. Action-Oriented 4. Stage-based 4. Stage-based 5. Expert Clinicians 5. Expert Clinicians 5. Expert Systems 5. Expert Systems 6. Standard Treatment 6. Standard Treatment 6. Tailored Treatment 6. Tailored Treatment 7. Clinic Based 7. Clinic Based 7. Home/Work Based 7. Home/Work Based 8. Single Behavior 8. Single Behavior 8. Multiple Behaviors 8. Multiple Behaviors 9. Single Level Interventions 9. Single Level Interventions 10. Efficacy Trials 10. Efficacy Trials 9. Multiple Level 9. Multiple Level Interventions Interventions 10. Effectiveness Trials