Showing papers in "Health Education & Behavior in 1998"

The Religion-Health Connection: Evidence, Theory, and Future Directions

Abstract: The volume and quality of research on what we term the religion-health connection have increased markedly in recent years. This interest in the complex relationships between religion and mental and physical health is being fueled by energetic and innovative research programs in several fields, including sociology, psychology, health behavior and health education, psychiatry, gerontology, and social epidemiology. This article has three main objectives: (1) to briefly review the medical and epidemiologic research on religious factors and both physical health and mental health; (2) to identify the most promising explanatory mechanisms for religious effects on health, giving particular attention to the relationships between religious factors and the central constructs of the life stress paradigm, which guides most current social and behavioral research on health outcomes; and (3) to critique previous work on religion and health, pointing out limitations and promising new research directions.

Identifying and Defining the Dimensions of Community Capacity to Provide a Basis for Measurement

Abstract: Although community capacity is a central concern of community development experts, the concept requires clarification. Because of the potential importance of community capacity to health promotion, the Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention (CDC), convened a symposium in December 1995 with the hope that a consensus might emerge regarding the dimensions that are integral to community capacity. This article describes the dimensions that the symposium participants suggested as central to the construct, including participation and leadership, skills, resources, social and interorganizational networks, sense of community, understanding of community history, community power, community values, and critical reflection. The dimensions are not exhaustive but may serve as a point of departure to extend and refine the construct and to operationalize ways to assess capacity in communities.

Intervention Mapping: A Process for Developing Theory and Evidence-Based Health Education Programs:

Abstract: The practice of health education involves three major program-planning activities: needs assessment, program development, and evaluation Over the past 20 years, significant enhancements have been made to the conceptual base and practice of health education Models that outline explicit procedures and detailed conceptualization of community assessment and evaluation have been developed Other advancements include the application of theory to health education and promotion program development and implementation However, there remains a need for more explicit specification of the processes by which one uses theory and empirical findings to develop interventions This article presents the origins, purpose, and description of Intervention Mapping, a framework for health education intervention development Intervention Mapping is composed of five steps: (1) creating a matrix of proximal program objectives, (2) selecting theory-based intervention methods and practical strategies, (3) designing and organizing a program, (4) specifying adoption and implementation plans, and (5) generating program evaluation plans

Religion's Role in Promoting Health and Reducing Risk Among American Youth

Abstract: Although past research has long documented religion's salutary impact on adult health-related behaviors and outcomes, relatively little research has examined the relationship between religion and adolescent health. This study uses large, nationally representative samples of high school seniors to examine the relationship between religion and behavioral predictors of adolescent morbidity and mortality. Relative to their peers, religious youth are less likely to engage in behaviors that compromise their health (e.g., carrying weapons, getting into fights, drinking and driving) and are more likely to behave in ways that enhance their health (e.g., proper nutrition, exercise, and rest). Multivariate analyses suggest that these relationships persist even after controlling for demographic factors, and trend analyses reveal that they have existed over time. Particularly important is the finding that religious seniors have been relatively unaffected by past and recent increases in marijuana use.

Physical Activity and Minority Women: A Qualitative Study

Abstract: Few physical activity research studies have been conducted with minority women. The purpose of this study was to explore patterns of physical activity among minority women. Focus groups were conducted with volunteers older than age 40. Each group was led by a trained moderator familiar with the ethnic community targeted. The sessions were audiotaped and professionally transcribed. Constructs were researched and codes were developed. Data were analyzed using NUD*IST qualitative analysis program. While participants did not identify themselves as "exercisers," they indicated they got enough physical activity from caregiving, housekeeping, and workday activities. The most common environmental barriers to becoming more physically active included safety, availability, and cost. Personal barriers included lack of time, health concerns, and lack of motivation. Results indicate the importance of terminology and assessment when conducting physical activity research in these populations. Also, results suggest many barriers are changeable with policies and interventions.

The Authoritative Parenting Index: Predicting Health Risk Behaviors Among Children and Adolescents

Abstract: Public health research demonstrates increasing interest in mobilizing parental influence to prevent health risk behaviors among children and adolescents. This research focuses on authoritative parenting, which previous studies suggest can prevent health risk behaviors among youth. To evaluate the reliability and validity of a new survey measure of authoritative parenting, data from studies of (1) substance use in a sample of 1,236 fourth- and sixth-grade students; (2) weapon carrying and interpersonal violence in a sample of 1,490 ninth- and tenth-grade students, and (3) anger, alienation, and conflict resolution in a sample of 224 seventh- and eighth-grade students were analyzed. The Authoritative Parenting Index had a factor structure consistent with a theoretical model of the construct; had acceptable reliability; showed grade, sex, and ethnic differences consistent with other studies; and identified parenting types that varied as hypothesized with multiple indicators of social competence and health risk behaviors among children and adolescents.

The African American Minister as a Source of Help for Serious Personal Crises: Bridge or Barrier to Mental Health Care?

Abstract: Using data from the National Survey of Black Americans, this article explores the role of African American ministers in the help seeking of African Americans for serious emotional problems. The authors explore which demographic characteristics and psychosocial factors are related to contacting Black clergy for help, whether certain types of personal problems increase the likelihood of clergy contact, and whether those who go to ministers are also likely to seek help from other professional help sources. Results indicate that women are more likely than men to seek help from ministers. People with economic problems are less likely to contact clergy, while those with death or bereavement problems are more likely to seek help from the clergy. Regardless of the type or severity of the problem, those who contact clergy first are less likely to seek help from other professionals. It is recommended that African American clergy and mental health professionals engage in a mutual exchange of information to increase access to professional care among African Americans with serious personal problems.

The Impact of Computer-Tailored Feedback and Iterative Feedback on Fat, Fruit, and Vegetable Intake:

Abstract: A randomized trial was conducted to study the impact of individualized computer-generated nutrition information and additional effects of iterative feedback on changes in intake of fat, fruits, and vegetables. Respondents in the experimental group received computer-generated feedback letters tailored to their dietary intake, intentions, attitudes, self-efficacy expectations, and self-rated behavior. After the first feedback letter, half of the experimental group received additional iterative feedback tailored to changes in behavior and intentions. The control group received a single general nutrition information letter in a format similar to the tailored letters. Computer-tailored feedback had a significantly greater impact on fat reduction and fruit and vegetable intake than did general information. Iterative computer-tailored feedback had an additional impact on fat intake. The results confirm that computer-generated individualized feedback can be effective in inducing recommended dietary changes and that iterative feedback can increase the longer term impact of computer-tailored nutrition education on fat reduction.

Practical Assessment of Adult Literacy in Health Care

Abstract: Low literacy is a pervasive and underrecognized problem in health care. Approximately 21% of American adults are functionally illiterate, and another 27% have marginal literacy skills. Such patients may have difficulty reading and understanding discharge instructions, medication labels, patient education materials, consent forms, or health surveys. Properly assessing the literacy level of individual patients or groups may avoid problems in clinical care and research. This article reviews the use of literacy assessments, discusses their application in a variety of health care settings, and cites issues providers need to consider before testing. The authors describe informal and formal methods of screening for reading and comprehension in English and Spanish including the Rapid Estimate of Adult Literacy in Medicine, the Wide Range Achievement Test-3, the Cloze procedure, the Test of Functional Health Literacy in Adults, and others. Practical implications and recommendations for specific use are made.

Factors That Contribute to Effective Community Health Promotion Coalitions: A Study of 10 Project ASSIST Coalitions in North Carolina:

Abstract: The purpose of this study was to identify factors that contribute to the effectiveness of community health promotion coalitions. Member survey data from 10 coalitions formed as part of North Carolina Project ASSIST were analyzed at the coalition level to identify factors related to member participation, member satisfaction, quality of the action plan, resource mobilization, and implementation. The results suggest that coalitions with good communication and skilled members had higher levels of member participation. Coalitions with skilled staff, skilled leadership, good communication, and more of a task focus had higher levels of member satisfaction. Coalitions with more staff time devoted to them and more complex structures had greater resource mobilization, and coalitions with more staff time, good communication, greater cohesion, and more complex structures had higher levels of implementation. Neither member participation nor member satisfaction correlated with the other measures of coalition effectiveness.

Reaching Seriously At-Risk Populations: Health Interventions in Criminal Justice Settings

Abstract: More than 6 million people are under some form of criminal justice supervision in the United States on any given day. The vast majority are arrested in and return to urban, low-income communities. These are men, women, and adolescents with high rates of infectious diseases such as HIV/AIDS, other sexually transmitted diseases (STDs), and tuberculosis (TB), as well as substance abuse and other health problems. A review of recent literature indicates that an increasing problem for these populations is that they have had little prior access to primary health care or health interventions, and many are returning to their communities without critical preventive health information and skills, appropriate medical services, and other necessary support. Periods of incarceration and other criminal justice supervision offer important opportunities to provide a range of health interventions to this underserved population, and general evaluations show the potential for this strategy. Public health and criminal justice agencies have the expertise and should collaborate to provide interventions needed by incarcerated populations. Moreover, many recently released inmates require primary care for HIV/AIDS, other STDs, and TB. Consequently, timely discharge planning is essential, as are linkages with community-based organizations and agencies that can provide medical care, health education, and necessary supportive services.

Preventing the Spread of Genital Warts: Using Fear Appeals to Promote Self-Protective Behaviors

Abstract: A fear appeal campaign to decrease the spread of genital warts was conducted and evaluated. Theoretically guided by the Extended Parallel Process Model, this field study illustrated why fear appeal campaigns often appear to fail in public health arenas. Five hypotheses, which predicted when and under what conditions fear appeal campaigns would fail or succeed, were tested and supported. The results demonstrated that fear appeals can be powerful persuasive devices if they induce strong perceptions of threat and fear (which motivate action) and if they induce strong perceptions of efficacy with regard to a recommended response (which channels the action in a health protective direction). Recommendations to researchers and public health practitioners are offered.

Public Health and Health Education in Faith Communities

Abstract: This special issue of Health Education & Behavior is devoted to broadly examining the interconnections among public health, health education, and faith-based communities. In addition to a focus on questions related to the practice of public health and health education within religious settings (e.g., program development, implementation, and evaluation), the articles in this issue examine a broad range of both substantive and methodological questions and concerns. These articles include contributions that address (1) various theoretical and conceptual issues and frameworks explaining the relationships between religious involvement and health; (2) substantive reviews of current research in the area; (3) individual empirical studies exploring the associations between religious involvement and health attitudes, beliefs, and behaviors; (4) evaluations of health education programs in faith communities; and (5) religious institutions and their contributions to the development of health policy. The articles comprising the issue are selective in their coverage of the field and provide different and complementary perspectives on the connections between religious involvement and health. It is hoped that this approach will appeal to a broad audience of researchers, practitioners, policy makers, and others from health education, public health, and related social and behavioral science disciplines.

Social Support and Coping Behaviors of Low-Income Families Experiencing Food Insufficiency in North Carolina

Abstract: The Food Research and Action Center estimates that approximately 12% of all families with children younger than 12 years old experience food insufficiency in the United States. The authors conducted 16 focus groups with 141 participants, who were either at risk or experienced food insufficiency, to learn about coping strategies. Individual and network-level coping mechanisms were used to manage insufficient food supply. Social networks included family, friends, and neighbors. The assistance provided included food aid, information, and emotional support. Not all networks were relied on or accessed by everyone. Most participants reported that they relied on family members first, followed by friends, and then neighbors. Parents found reliance on anyone as stressful and often threatening. In conclusion, as the social welfare system becomes constrained, more and more households may experience food insufficiency. Responsive policies are therefore needed to assist low-income families.

A Longitudinal Study Predicting Patterns of Cigarette Smoking in Late Childhood

Abstract: Early initiation of cigarette smoking so strongly predicts future smoking that several investigators have advocated delaying the age of initiation as a prevention strategy. To complement retrospective studies of early initiation, this study assessed prospectively patterns of smoking behavior in a sample of 401 children who were surveyed in the fifth, sixth, and seventh grades. The principal findings were (1) modeling of smoking by parents and friends is sufficient to influence children to initiate smoking, particularly when children also have low behavioral self-control, and (2) when modeling occurs in combination with poor adjustment to school, low parental monitoring, easy access to cigarettes, and other risk attributes, early initiators are significantly more likely to continue smoking. The results suggest that delaying initiation of smoking without also modifying child attributes and socialization factors that predict early initiation and persistent smoking is unlikely to reduce the proportion of children who become habitual smokers.

Black Churches as Therapeutic Systems: A Group Process Perspective

Abstract: This article examines Black churches as therapeutic systems that provide psychological and physical support to African American communities. Systems theory and group relations theory are used as conceptual frameworks to discuss Black churches as indigenous community resources. Instrumental to a systems approach is an understanding of Black churches and the religious experiences they support as part of a dynamic process that may vary across churches while maintaining certain basic similarities. It is also important to explore how Black churches may function differently from one another in addressing the needs of their membership and surrounding community. Consequently, a group process perspective is used to examine how roles and functions of the church may vary as they relate to their particular congregation. Examining the role of Black churches as supportive networks provides invaluable information to professional health providers who are interested in working with Black churches as community-based organizations.

Detroit's East Side Village Health Worker Partnership: Community-Based Lay Health Advisor Intervention in an Urban Area

Abstract: In recent years, there have been few reports in the literature of interventions using a lay health advisor approach in an urban area. Consequently, little is known about how implementation of this type of community health worker model, which has been used extensively in rural areas, may differ in an urban area. This article describes the implementation of the East Side Village Health Worker Partnership, a lay health advisor intervention, in Detroit, Michigan, and notes how participatory action research methods and principles for community-based partnership research are being used to guide the intervention. Findings are presented on how the urban context is affecting the design and implementation of this intervention. Implications of the findings for health educators are also presented and include the utility of a participatory action research approach, the importance of considering the context and history of a community in designing a health education intervention, and the importance of recognizing and considering the differences between rural and urban settings when designing a health education intervention.

Impact of Work Site Health Promotion on Stages of Dietary Change: The Working Well Trial

Abstract: The stages of change construct has been applied to healthful dietary behavior in cross-sectional studies. This report examines associations of stages of change with diet prospectively and addresses whether (1) baseline stage of change predicts participation, (2) forward changes in stage movement were greater in treatment work sites, and (3) change in stage was associated with adoption of healthful diets, using data from a cohort of 11,237 employees. Findings indicate that persons in later stages of change reported higher participation levels. Employees from intervention work sites who were in preaction stages at baseline were much more likely to shift into action and maintenance stages than controls. Changes in dietary stage of change were associated with decreases in fat intake and increases in fiber, fruit and vegetable intake. Net change in diet due to the intervention was modest. Stage of change appears to be useful for understanding mediators of health promotion intervention effectiveness.

Social Support and Readiness to Make Dietary Changes

Abstract: This article examines the relationship between reported social support and readiness to increase fruit and vegetable consumption, based on the Transtheoretical Stage of Change Model. Data were collected as part of the baseline assessments for a work site intervention study promoting increased consumption of fruits and vegetables. Among workers who did not live alone, household support was significantly higher for those of Hispanic and African American heritage than other groups, and was also higher among men, nonsmokers, and those living with adults compared to those living only with children. In multivariate analyses, coworker support was significantly associated with being in preparation compared to precontemplation/contemplation. Household support was not significantly related to readiness to change in multivariate analyses. The effectiveness of work site nutrition education interventions is likely to be enhanced by teaching participants to provide social support to coworkers and family members.

Breast Cancer Screening Adherence: Does Church Attendance Matter?

Abstract: Little is known about the health behaviors of church attendees. This article reviewed telephone interview data of 1,517 women who were church members from 45 churches located in Los Angeles County to determine their breast cancer screening status and to identify the key predictors of screening. Almost all of this sample (96%) reported attending church at least once a month. Key predictors of screening included physician-patient communication, ethnic background, and having medical insurance. Although church-related predictors were not significantly related to screening adherence, the authors compared community-based screening rates from another sample to their sample rates and found that, when controlling for income and education, church members fared better on mammography screening than women who were community residents. This finding suggests that frequent church attendance contributes to better mammography screening status and that the relationship between religious involvement and health behaviors needs further explanation.

Intention to Have a Mammogram in the Future Among Women Who Have Underused Mammography in the Past

Abstract: This study investigated associations between confidence in one's ability to discuss mammography with health providers and to obtain regular mammograms (self-efficacy), social network members' attitudes toward mammograms (social influence), mammography experiences, and intention to have a mammogram in the next 1 to 2 years among women who were not in adherence with screening guidelines. Data were collected as part of a baseline assessment for a work site intervention study. Women 52 years and older completed a self-administered survey. Those not in compliance with screening guidelines (n = 194) were included in the analyses. Logistic regression revealed that self-efficacy and strong supportive social influences were significantly associated with mammography intention (odds ratio [OR] = 2.50, OR = 2.22, respectively), adjusting for prior mammography use. Findings suggest that interventions designed to promote mammography should build women's confidence in their ability to discuss mammography with health providers and to obtain regular mammograms. Intervention among social networks may also be an effective means of promoting mammography.

Improving Breast Cancer Control Among Latinas: Evaluation of a Theory-Based Educational Program:

Abstract: The study evaluated a theory-based breast cancer control program specially developed for less acculturated Latinas. The authors used a quasi-experimental design with random assignment of Latinas into experimental (n = 51) or control (n = 37) groups that completed one pretest and two posttest surveys. The experimental group received the educational program, which was based on Bandura's self-efficacy theory and Freire's empowerment pedagogy. Outcome measures included knowledge, perceived self-efficacy, attitudes, breast self-examination (BSE) skills, and mammogram use. At posttest 1, controlling for pretest scores, the experimental group was significantly more likely than the control group to have more medically recognized knowledge (sum of square [SS] = 17.0, F = 6.58, p < .01), have less medically recognized knowledge (SS = 128.8, F = 39.24, p < .001), greater sense of perceived self-efficacy (SS = 316.5, F = 9.63, p < .01), and greater adeptness in the conduct of BSE (SS = 234.8, F = 153.33, p < .001). Cancer control programs designed for less acculturated women should use informal and interactive educational methods that incorporate skill-enhancing and empowering techniques.

The Healthy Neighborhoods Project: A Local Health Department's Role in Catalyzing Community Development

Abstract: Studies show that community development approaches to health education may lead not only to improved social, economic, and health status but also to increased individual participation in health education and preventive health care activities. However, because of categorical funding restraints and philosophical issues, local health departments have rarely given control of defining project outcomes to the community. One such project was in a low-income urban neighborhood in the San Francisco Bay Area. In this Healthy Neighborhoods Project, the health department catalyzed community development and organization in a multiethnic public housing complex. As a result, an empowered community successfully advocated to improve public safety by installing street speed humps and increased street lighting. After project completion, residents initiated several additional health actions, including the removal of a neighborhood tobacco billboard. This article describes the project, which may serve as a model for other urban public health programs to explore their role in community empowerment.

Weight Loss Education: The Challenge of a New Paradigm

Abstract: Health educators and others typically rely on three weight loss strategies to combat obesity. These include (1) medical intervention, (2) caloric restriction, and (3) fat gram restriction. The empirical evidence for these approaches in producing long-term weight loss is weak. However, much media attention has been given to a weight loss paradigm that seemingly does not fall into the aforementioned categories, which has been called the intuitive eating paradigm. Currently there is no empirical evidence to validate this paradigm. The focus of this article is to present an overview of this weight loss paradigm, discuss its potential benefits for health education in relation to current weight loss paradigms, and critically evaluate it in terms of the usefulness and ethical appropriateness for health education.

Psychosocial Factors Associated With Youth Involvement in Community Activities Promoting Heart Health

Abstract: This study examined factors that influence youth participation in heart disease prevention activities among 2,609 ninth graders in six inner-city public high schools. Constructs derived from social cognitive, empowerment, and community development theories informed the conceptual framework employed. Study participants were diverse with respect to gender, ethnicity, parent education, acculturation, and academic achievement. Perceived incentive value, self-efficacy, outcome expectancies, sense of community, and perceived policy control were all significantly associated with participation in community activities promoting heart health. In multivariate analyses, perceived incentive value, defined as the extent to which participants valued a heart-healthy environment, was most strongly associated with community participation, accounting for 11.9% of the total variance. These findings have implications for designing school curricula and after-school and community programs targeting adolescents' involvement in health advocacy activities.

Poverty: the main cause of ill health in urban children.

Abstract: Being poor is in itself a health hazard; worse, however, is being urban and poor. Much worse is being poor, urban, and a child. But worst of all is being a street child in an urban environment. This article will provide some background on the status of street children on a global basis, make linkages between street children and their frequent condition as working and exploited children, and detail the health impacts of the increasing poverty concentrated in poor urban slums and squatter settlements. Although some specific information on street children is provided, the social and economic factors that have a negative impact on the well-being of the broader population of poor, urban children are analyzed. The division between street children and their urban poor counterparts still living within some sort of family support system cannot be sharply defined. Programs and strategies that have been successful in improving the health and well-being of poor children in general and street children in particular are discussed.

Sociopsychological Correlates of Motivation to Quit Smoking Among Low-SES African American Women

Abstract: This article examines correlates of desire and plans to quit smoking among 248 young, low-socioeconomic status African American women, using variables derived from the health belief model (HBM) and the theory of reasoned action. Consistent with these theoretical models, stronger concern about the effect of smoking on one's health and having close others who want the smoker to quit increased motivation to quit smoking. However, motivation was not associated with specific HBM components regarding lung cancer. Heavier smoking and stronger perceptions regarding the functional utility of smoking decreased motivation to quit, but not as much as expected in this study population. Consistent with a process of change approach to smoking cessation, the factors that moved smokers from not planning to planning to ever quit were different from factors associated with further motivation level among the smokers who did plan to ever quit.

CINCH: An Urban Coalition for Empowerment and Action

Abstract: CINCH (Consortium for the Immunization of Norfolk's Children) is an urban coalition that was developed in 1993 to improve childhood immunization rates in Norfolk, Virginia. CINCH involves diverse citizens and institutions in effective community-based assessment, planning, and action. A needs assessment from 1993 found that only 49% of Norfolk 2-year-olds were adequately immunized. Using this data, CINCH developed a plan focused on education and communication, support for at-risk families, increased access to immunizations, and improved immunization delivery. After federal funding ended in 1995, members voted to expand the scope of the coalition to address additional child health needs and to broaden the membership. CINCH is a model for a sustainable city-citizen learning environment that intervenes to "help families help themselves to better health." The coalition is presented as an organization that focuses on community empowerment and development. The stages of coalition development and implications for...

Community-Based Health Education for Urban Populations: An Overview:

Abstract: The history ofpublic health has been intimately linked with the history of cities. Cities are both the birthplaces of the great epidemics of infectious diseases, environmental pollution, and social problems such as addiction and violence and the source of public health innovation such as clean water systems, public sanitation, and the community health education campaign.`14 In the broader society, cities have also had this dual identity. On one hand, they are the centers of human civilization, the places that draw people from the countryside to find work, culture, and excitement.5 On the other hand, the neon lights and anonymity of \"sin city\" are believed to lure people into lives of dissipation and ill health. Urban crime, poverty, and pollution exemplify the dangers of the city. The urban physical and social environments have a profound impact on health and disease. Moreover, an increasing proportion ofthe world's population now lives in cities.6 Yet, in the past decades, public health researchers have shown remarkably little interest in the urban environment as an object of study. Social epidemiologists have generally focused on other variables such as class, race, ethnicity, gender, or poverty status to explain differences in patterns of health and disease. Health education researchers have primarily posited social psychological theories that offer generic explanations of individual or group health behavior rather than an understanding of the interactions between a particular social and physical environment and behavior. As a result, public health professionals working with urban populations have a limited body of epidemiological and intervention research to guide their practice. The evidence that does exist suggests that urban populations, especially low-income residents of cities, bear a disproportionate burden of ill health. Rates of such diverse conditions as HIV infection, asthma, lead poisoning, violence, and substance abuse are higher in urban than nonurban areas.'13 Rural and suburban populations also face serious health problems. But the combination of increasing urbanization and increasing concentration of poverty in urban areas-trends occurring both in the developed and developing world-means that a growing proportion of the world's health problems is now found in cities.6'7 Furthermore, the close links between cities and their surrounding suburban and rural areas\"4 allow health problems that go unchecked to move from urban to nonurban areas. Many U.S. suburbs are now experiencing rising rates of violence, substance abuse, and HIV infection-problems previously thought to be limited to urban areas.'5 Abetter understanding of the factors that shape the health status of urban populations may help to inform policies and programs that improve the health ofsuburban and rural populations as well. Indeed, it is unlikely that the United States will be able to achieve many of the

Learn, Share, and Live: Breast Cancer Education for Older, Urban Minority Women:

Abstract: 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.