Lifestyle changes in persons diagnosed with cancer are important because they may impact prognosis, co-morbidities, and survival. This report describes longitudinal changes in lifestyle behaviors and health status among colon cancer survivors (n = 278) and population-based controls (n = 459) in North Carolina (39% African American), and examines demographic and psychosocial correlates of healthy lifestyle changes following a colon cancer diagnosis. Data are from surveys of a population-based cohort of colon cancer patients on diagnosis (the North Carolina Colon Cancer Study, NCCCS) and approximately 2 years post-diagnosis [the North Carolina Strategies to Improve Diet, Exercise, and Screening Study (NC STRIDES)], and population-based controls. Both studies collected information on demographic/lifestyle characteristics and medical history. The NCCCS reflects pre-diagnosis or pre-interview patterns, whereas NC STRIDES queried on current practices. Between the NCCCS and NC STRIDES, colon cancer survivors reported significant increases in vegetable intake, physical activity, and supplement use (all P <0.01) and a non-statistically significant increase in fruit/juice consumption (0.1 serving), with larger fruit/vegetable changes in African Americans than Whites. Controls increased physical activity and supplement use and fewer reported arthritic symptoms (P < 0.05). Survivors who were older and female had an almost 3 times higher likelihood of having used at least one new dietary supplement post-diagnosis, whereas being retired correlated with increased vegetable intake, all P < 0.05. Having more barriers to increasing fruit/vegetable intake was inversely associated with taking a new supplement (P < 0.05 only in controls). Colon cancer survivors reported making significant improvements in multiple health-related behaviors. Health care providers should communicate with persons diagnosed with colon cancer to ensure that they are making healthy lifestyle changes.