PURPOSE. Examine the efficacy of a computer-tailored intervention (CTI) based on the transtheoretical model (TTM) for reducing depression, an increasingly important component of health promotion programs. DESIGN. Pretest-posttest randomized trial. Setting . Participants were recruited and treated at home after being identified in two primary care clinics in Eastern Massachusetts and Chicago, Illinois. SUBJECTS. A total of 350 adults experiencing at least mild symptoms of depression but not involved in or planning to seek treatment for depression. INTERVENTION. A print manual and three CTI reports tailored to stage of change for using effective methods to prevent or reduce depression, other TTM variables, level of depression, and behavior. . Pre-post changes and reliable and clinically significant change on the Beck Depression scale II and pre-post changes on the 20-item Medical Outcomes Study Short Form survey-based measure of physical functioning at 9 months' follow-up. ANALYSIS. t-tests and χ(2) tests. Complete-case analysis and two intention-to-treat analyses-assumption of no change and multiple imputation (MI)-are reported. Exploratory analyses examined whether the effects of the intervention on depression were moderated by five subject characteristics: baseline level of depression, baseline level of physical functioning, baseline stage of change for preventing or managing depression, age, and education. RESULTS. Complete-case and intention-to-treat analyses showed that the intervention group experienced significantly greater improvements in depression (d  =  .220-.355); results for physical functioning were weaker (d  =  .150-.309) and did not reach statistical significance in the MI analysis. The effects of the intervention on reliable and clinically significant change in depression were largest among participants who were experiencing moderate depression (d  =  .363-.519) or severe depression (d  =  .603-.718) or who were in the precontemplation or contemplation stage (d  =  .573-.856) at baseline.

OBJECTIVES:To compare screening practices and beliefs in patients with and without a clinically important family history. DESIGN:We mailed a brief questionnaire asking about family history and a second, longer survey asking about knowledge of and beliefs about colorectal cancer to all respondents with a family history and a random sample of respondents without a family history of colorectal cancer. We reviewed electronic medical records for screening examinations and recording of family history. PARTICIPANTS:One thousand eight hundred seventy of 6,807 randomly selected patients ages 35-55 years who had been continuously enrolled in a large multispecialty group practice for at least 5 years. MEASUREMENTS:Recognition of increased risk, screening practices, and beliefs-all according to strength of family history and patient's age. RESULTS:Nineteen percent of respondents reported a family history of colorectal cancer. In 11%, this history was strong enough to warrant screening before age 50 years. However, only 39% (95% CI 36, 42) of respondents under the age of 50 years said they had been asked about family history and only 45% of those with a strong family history of colorectal cancer had been screened appropriately. Forty-six percent of patients with a strong family history did not know that they should be screened at a younger age than average risk people. Medical records mentioned family history of colorectal cancer in 59% of patients reporting a family history.CONCLUSIONS: More efforts are needed to translate information about family history of colorectal cancer into the care of patients.

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