To test how the Healthy People 2000 Disease Prevention and Health Promotion Objectives related to cancer prevention in women can be promoted, the Southeast Minnesota Women's Health Project will randomize 13 counties to intervention/control and assess outcomes-with two independent random population surveys. Intervention goals include: 1. increasing by 15 percentage points clinical breast exam (CBE) and a mammogram in the past 2 years among women 50 and older; 2. appropriate follow-up of more than 85% of clinical breast exams and mammograms; 3. increasing by 15 percentage points Pap tests within 3 years among women more than 18 years; 4. appropriate follow-up of more than 85% of Pap tests; 5. increasing by 15 percentage points advice and assistance to quit smoking for women who smoke; and, 6. registration of 75% of women equal to or greater than 18 years in a reminder/recall system by the end of the third project year. The intervention will consist of a professional education and practice organization component and a lay education and recruitment/reminder component designed to complement each other. The professional education/practice organization goals include: a. having all primary care practices in the intervention counties install or participate in a reminder/recall: system for clinical breast exams, mammograms, Pap tests, and smoking cessation; b. meeting personally with every primary care clinic in the intervention counties to discuss what the project must provide if the clinic is to participate in goal a; c. working with clinicians (physicians and others as appropriate) to identify, address and overcome the barriers to routine clinical breast exams, mammography, Pap tests, and smoking interventions that are identified by activity b; d. providing periodic update and reinforcing messages to clinicians in the intervention counties. The lay education and recruitment/reminder goals include: a. educating volunteer groups (e.g., the American Cancer Society, aging center staffs, etc.) about the benefits of these interventions; b. recruiting these volunteer groups to disseminate cancer prevention information to other community women; c. encouraging women to enroll in a recall/register program; d. mounting a cancer prevention general awareness campaign in each community; e. identifying opinion leaders and gate keepers for underserved (elderly, minority, poor) groups of women and work with them to facilitate cancer screening in these groups.
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