Although efficacious screening methods exist for breast and cervical cancer, underutilization is common in minority older women. Their cancers are diagnosed at a later stage with a worse prognosis. These cancers are significant for the elderly since over 50% of breast cancers occur in women over age 60. Screening for cervical cancer has contributed to a decline in mortality in all non-elderly populations. the Public Health Service, in its report """"""""Promoting Health/Preventing Disease: Year 2000 Objectives for the Nation"""""""", has determined that the future target population for screening will only be reached with interventions developed to overcome barriers associated with age, race/ethnicity, income, and education. While this consensus document identifies breast cancer screening objectives to be achieved during this decade, it does not provide strategies for meeting these objectives. Action for Health, developed at CWRU, is a unique cancer prevention curriculum designed specifically to overcome barriers int he utilization of breast and cervical cancer screening in minority older women. The program utilizes trained senior adults as peer-trainers and uses a combination of didactic and experience-based learning strategies. We hypothesize that Action for Health will: .result in a sustained change in 70% of program participants in utilization of at least one area of cancer screening: mammography, breast exams and Pap smears. .yield improvement in perceived health status for 70% of the participants. .after adaptation, be as beneficial for a rural population as an urban population. The long range goal is to reduce breast/cervical cancer mortality in minority elders by increased rates of early detection through our cancer prevention curriculum. The objectives are to: 1) document the effectiveness of a program in African-American and Hispanic women in Cleveland; 2) compare the effectiveness of an urban-based program to a curriculum in rural North Carolina. The research design will be a multiple time series quasi-experimental design to evaluate the Action for Health (AFH) cancer prevention curriculum in Cleveland, Ohio for African American and Hispanic elders and pilot projects of a modified AFH cancer prevention curriculum in two rural counties of North Carolina to increase breast and cervical cancer screening. the participants will be studied longitudinally to determine the programs' lasting effects. there will be comparison groups in each state which will not receive the education program and serve as a control group for naturally occurring trends in screening. A validated questionnaire will evaluate the North Carolina pilot and intervention population at baseline and at a four-month follow-up period. The adapted questionnaire will be validated for rural and Hispanic populations.
