Among older urban minority women, for whom breast cancer risk is high and the propensity to be screened is low, both social support and breast cancer knowledge have been linked to mammography use. The authors describe a theory-based breast cancer education program implemented via an existing informal network for low-income urban elderly coordinated by a social service agency. The program is both structured and flexible. Core education sessions include delineated content and methods and are led by health professionals. Participants choose from a variety of follow-up activities to promote screening within their community. Pre and posttests administered among 80 program attendees in two sites indicate significant improvement in knowledge (p < .001). Program attendees in each site also planned and participated in follow-up activities to promote screening among their peers. Learn, Share, and Live seems to be an effective program for promoting breast cancer screening among older, urban, primarily minority women.
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References
1.
1. American Cancer Society: Cancer Facts and Figures, 1994. Atlanta, GA, American Cancer Society, 1994. (Pub. No. 5008.94.)
2.
2. Schoenborn CA: Health habits of U.S. adults, 1985: The "Alameda 7" revisited. Public Health Rep101:571-580, 1986.
3.
3. Ries P: Health of Blackand White Americans, 1985-87. Data from the National Health Interview Survey. Washington, DC, National Center for Health Statistics, 1990.
4.
4. Reed W: Health care needs and services, in Harel Z, McKinney E, Williams M (eds.): Black Aged: Understanding Diversity and Service Needs. Newbury Park, CA, Sage, 1990, pp. 183-204.
5.
5. Harel Z, McKinney E, Williams M (eds.): Black Aged: Understanding Diversity and Service Needs. Newbury Park, CA, Sage, 1990.
6.
6. Proctor EK, Morrow-Howell N, Chadiha L: Adequacy of Home Care Plans for Chronically IIl Elderly: A Final Report to the Agencyfor Health Care Policy and Research. Washington, DC, Agency for Health Care Policy and Research, 1993.
7.
7. Jackson JS: The black American elderly: Research on physical and psychosocial health, in Taylor RJ (ed.): Aging and Supportive Relationships Among Black Americans. New York, Springer, 1988, pp. 259-281.
8.
8. Stewart JH, Foster RS: Breast cancer and aging. Semin Oncol16:41-50, 1989.
9.
9. Centers for Disease Control Cancer Surveillance Section, Epidemiology and Statistics Bureau, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion: Current trends: Deathsfrom breast cancer, United States, 1991. Atlanta, GA, Centers for Disease Control, 1991.
10.
10. Hankey BF, Brinton LA, Kessler LG, Abrams J: Section IV: Breast, in Miller BA, Reis LAG, Hankey BF, et al (eds.): SEER Cancer Statistics Review, 1973-1990. Bethesda, MD, U.S. Department of Health and Human Services, Public Health Service, NIH, NCI, 1991. (DHHS Pub. No. [NIH] 93-2789.)
11.
11. Zapka J, Stoddard AM, Constanza ME, Greene HL: Breast cancer screening by mammography: Utilization and associated factors. Am J Public Health79:1499-1502, 1989.
12.
12. Shapiro S, Venet W, Strax P, Venet L, Roeser R: Tento fourteen-year effects of screening on breast cancer mortality. J Natl Cancer Inst69:349-355, 1982.
13.
13. Fletcher SW, Black W, Harris RP, Rimer BK, Shapiro S: Report of the International Workshop on Screening for Breast Cancer. J Natl Cancer Inst85:1644-1656, 1993.
14.
14. Breen N, Kessler L: Changes in the use of screening mammography: Evidence from the 1987 and 1990 National Health Interview Surveys. Am J Public Health84(1):62-67, 1994.
15.
15. Dawson DA, Thompson GB: Breast Cancer Risk Factors and Screening: United States, 1987. Vital and Health Statistics. Hyattsville, MD, U.S. Department of Health and Human Services, 1990. (Pub. No. [PHS] 90-1500.)
16.
16. Romans MC, Marchant DJ, Pearse WH, Gravenstine JF, Sutton SM: Utilization of screening mammography-1990. Women's Health Issues1:68-73, 1991.
17.
17. Gregorio DI, Cummings M, Michalek A: Delay, stage of disease, and survival among black and white women with breast cancer. Am J Public Health73(5):590-593, 1983.
18.
18. Polednak AP: Breast cancer in black and white women in New York state: Case distribution and incidence rates by clinical stage at diagnosis. Cancer58(3):807-815, 1986.
19.
19. Farley TA, Flannery JT: Late-stage diagnosis of breast cancerin women of lower socioeconomic status: Public health implication. Am JPublic Health79:1508-1512, 1989.
20.
20. Burg MA, Lane DS, Polednak AP: Age group differences in the use of breast cancer screening tests. JAging Health2:514-530, 1990.
21.
21. Harris R, Fletcher S, Gonzalez J: Mammography and age: Are we targeting the wrong women? A community survey of women and physicians. Cancer67:2010-2014, 1991.
22.
22. Rimer BK: Improving the use of cancer screening for older women. Cancer72(suppl.):1084-1087, 1993.
23.
23. Lacey L, Phillips C, Ansell D, Whitman S, Chen E, Nyambie E: An urban community-based cancer prevention screening and health education intervention in Chicago. Public Health Rep104:537-541, 1989.
24.
24. Lacey L: Cancer prevention and early detection strategies for reaching underserved urban, low-income black women: Barriers and objectives. Cancer72(suppl.):1078-1083, 1993.
25.
25. Skinner CS, Zerr AD, Damsen RL: Incorporating mobile mammography units into primary care: Focus group interviews among low-income, inner-city health center patients. Health Educ Research10(2):179-189, 1995.
26.
26. Ayanian JZ, Kohler BA, Abe T, Epstein AM: The relation between health insurance coverage and clinical outcomes among women with breast cancer. NEng JMed329:326-331, 1993.
27.
27. National Cancer Institute, Breast Cancer Screening Consortium: Screening mammography: A missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Survey studies. JAMA264(1):54-58, 1990.
28.
28. Smith RA, Haynes S: Barriers to screening for breast cancer. Cancer69(7):1968-1978, 1992.
29.
29. Skinner CS, Strecher VJ, Hospers H: Physician recommendations for mammography: Do tailored messages make a difference?Am J Public Health84(1):43-49, 1994.
30.
30. Dolan NC, Feifler DR, McDermott MM, McGaghie WC: Adherence to screening mammography recommendations in a university general medicine clinic. J Gen Intern Med10:299-306, 1995.
31.
31. Woolhandler S, Himmelstein DV: Reverse targeting of preventive care due to lack of health insurance. JAMA259:2872-2874, 1988.
32.
32. Roetzheim RG, Vandurme DJ, Brownless HJ, Herold AH, Rubens JP, Woodard L, Blair C: Reverse targeting in a media-promoted breast cancer screening project. Cancer70:1152-1158, 1992.
33.
33. Rimer BK, Resch N, King E, Ross E, Lerman C, Boyce A: Multistrategy health education program to increase mammography use among women ages 65 and older. Public Health Rep4:369-380, 1992.
34.
34. Rimer BK, King E: Why aren't older women getting mammograms and clinical breast exams?Women's Health Issues2:94-99, 1992.
35.
35. Burack RC, Liang J: The acceptance and completion of mammography by older black women. Am J Public Health79(6):721-726, 1989.
36.
36. House JS, Landis KR, Umberson D: Social relationships and health. Science241:540-544, 1988.
37.
37. Connell CM, D'Augelli AR: The contribution of personality characteristics to the relationship between social support and perceived physical health. Health Psychol9(2):192-207, 1990.
38.
38. Fisher E, Auslander W, Sussman L, Owens N, Jackson-Thompson J: Community organization and health promotion in minority neighborhoods. Ethnicity and Disease2:252-272, 1992.
39.
39. Brown D, Gary L: Stressful life events, social support networks, and the physical and mental health of urban black adults. J of Hum Stress13(4):165-174, 1987.
40.
40. Husaini B, Castor R, Linn J, Moore S, Warren H, Whitten-Stovall R: Social support and depression among the black and white elderly. Journal of Community Psychology18:12-18, 1990.
41.
41. Husaini B, Moor S, Castor R, et al: Social density, stressors, and depression: Gender differences among the black elderly. Journal of Gerontology: Psychological Sciences46(5):236-242, 1991.
42.
42. Gibson RC, Jackson JS: The health, physical functioning, and informal supports of the black elderly. Milbank Quarterly65(suppl. 2):421-455, 1987.
43.
43. Dressler W: Extended family relationships, social support and mental health in a southern black community. J Health Soc Behav26:39-48, 1985.
44.
44. Blendon RJ, Aiken LH, Freeman HE, Corey CR: Access to medical care for black and white Americans-A matter of continuing concern. JAMA261(2):278-281, 1989.
45.
45. Orleans CT, Schoenbach VJ, Salmon MA, et al: A survey of smoking and quitting patterns among black Americans. Am J of Public Health79(2): 176-181, 1989.
46.
46. Mitchell RE, Barbarin OA, Hurley DJ: Problem solving, resource utilization, and community involvement in a black and a white community. Am J Community Psychol9(3):233-246, 1981.
47.
47. Birkel RC, Repucci ND: Social networks, information-seeking, and utilization of services. Am J of Community Psychol11: 183-203, 1983.
48.
48. Rogers EM, Kincaid DL: Communication Networks: Toward a New Paradigm for Research. New York, Free Press, 1981.
49.
49. Bloom JR, Grazier K, Hodge F, Hayes WE: Factors affecting the use of screening mammography among African American women. Cancer Epidemiol Biomarkers Prev1:75-82, 1991.
50.
50. Kang SH, Bloom JR: Social support and cancer screening among older Black Americans. J Natl Cancer Inst85:737-742, 1993.
51.
51. Kang SH, Bloom JR, Romano PO: Cancer screening among African American women: Their use of tests and social support. Am J Public Health84(1):101-103, 1994.
52.
52. Eng E: The Save Our Sisters Project: A social network strategy for reaching rural black women. Cancer72(suppl.):1071-1077, 1993.
53.
53. Sung JF, Coates RJ, Williams JE, Liff JM, Greenberg RS, McGrady GA, Avery BY, Blumenthal DS: Cancer screening intervention among black women in inner-city Atlanta-Design of a study. Public Health Rep107:381-388, 1992.
54.
54. Morrow-Howell N, Ozawa MN: Helping networks: Seniors to seniors. The Gerontologist27(1):17-20,1987.
55.
55. Ozawa MN, Morrow-Howell N: Service utilization by well-organized frail elderly individuals. Intl JAging Hum Dev35(3):179-191, 1992.
56.
56. Goodman RM, Steckler A: A model for the institutionalization of health promotion programs. Fam Commun Health11(4):63-78, 1989.
57.
57. Stein JA, Fox SA, Murata PJ, Morisky DE: Mammography usage and the Health Belief Model. Health Educ Q19(4):447-462, 1992.
58.
58. Aiken LS, West SG, Woodward CK, Reno RR: Health beliefs and compliance with mammography-screening recommendations in asymptomatic women. Health Psychol13(2):122-129, 1994.
59.
59. Baranowski T, Perry C, Parcel G: How individuals, environments, and health behavior interact: Social cognitive theory, in Glanz K, Lewis F, Rimer BK (eds.): Health Behavior and Health Education (3rd ed.). San Francisco, Jossey-Bass, 1996, pp. 153-178.
60.
60. Bandura A: Self-efficacy mechanism in physiological activation and health-promoting behavior, in Madden J, Matthysse S, Barchas J (eds.): Adaptation, Learning and Affect. New York, Raven Press, 1986.
61.
61. Strecher VJ, Devellis BM, Becker MH, Rosenstock IM: The role of self-efficacy in achieving behavior change. Health Educ Q13(1):73-92, 1986.
62.
62. Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF, Sandler RS: Improving dietary behavior: The effectiveness of tailored messages in primary care settings. Am J Public Health84(5):783-787, 1994.
63.
63. Strecher VJ, Kreuter MW, den Boer DJ, Kobrin S, Hospers HJ, Skinner CS: The effects of computer-tailored smoking cessation messages in family practice settings. J Family Practice39(3):262-270, 1994.
64.
64. Kreuter MW, Strecher VJ: Changing inaccurate preceptions of health risk: Results from a randomized trial. Health Psychol14:56-63, 1995.
65.
65. Knowles MS: Andragogy in Action: Applying Modern Principles of Adult Learning. San Francisco, Jossey-Bass, 1984.
66.
66. Gardener MA, Greenwell SC, Costich JF: Effective teaching of the older adult. Topics in Geriatric Rehabilitation6(3): 1-14, 1991.
67.
67. Skinner CS, Arfken CL, Sykes RK: Knowledge, perceptions, and mammography stage of adoption among older urban women. Am J Prev Med14(1): in press, 1998.
