...three of the 16 sessions reported lower dietary fat (p<.001) and improved BSE proficiency (p<.001). However, there were no differences in fiber intake at eight months. Women who attended at least three sessions were more likely to be lower in acculturation. Conclusions. The optimal length for health-risk reduction interventions is unknown. Our results suggest that, while participation is associated with improved outcomes, fewer sessions than traditionally offered in most behavioral interventions may be sufficient to effect initial behavior change.

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In the United States, the Latino population growing five times faster than that of the general population (U.S. Bureau of the Census, 2001). Thus, the health needs of this ethnic group are of considerable public health concern. In particular, although breast cancer incidence and mortality rates are lower among Latina women compared to white and black women, it is the most commonly diagnosed cancer and the most common cause of cancer mortality among Latinas (Miller et al., 1996). It has been suggested that interventions targeting behavioral change consistent with breast cancer risk reduction with a focus on dietary and early detection practices are needed (Hiatt & Rimer, 1999). However, the most effective strategies to engage Latina and other underserved populations in screening and prevention programs are unclear (Carter, Pugh, & Monterrosa, 1996; Coates et al., 1999; Kumanyika, Morssink, & Agurs, 1992; Verschuren et al., 1995).

In order to most accurately assess the outcomes of interest, a primary goal of intervention trials is to motivate participants to attend as many sessions as possible (Bowen, Raczynski, George, Feng, & Fouad, 2000). Indeed, increased attendance will potentially improve outcomes (Bowen et al., 2000). Results from a recent large randomized trial of a diverse group of older women showed an association between increased intervention participation and reduction in dietary intake of percentage energy from fat (Bowen et al., 2000). In that study, however, Latinas participated in fewer intervention sessions than African-American or white women (Bowen et al., 2000). To our knowledge, no studies have specifically examined the dose-response relationship between attendance and outcome among Latino women. Demonstrating the optimal level of participation needed to affect specific behavioral changes could have implications for the design of intervention trials in this target population.

Mujeres Felices por ser Saludables (heretofore referred to as Mujeres Felices) was a randomized intervention trial designed to reduce fat intake, increase fiber intake and increase proficiency of breast self exam (BSE) among young, low-acculturated Latinas (Fitzgibbon, Gapstur, & Knight, 2003). Results of that study showed significantly lower fat intake and greater proficiency of BSE but no difference in fiber intake among the intervention versus the control group following the eight-month intervention (Fitzgibbon, Gapstur, & Knight, in press). The primary purpose of this paper is to describe the relationship between number of intervention sessions attended (i.e. level of attendance) and intervention outcome (i.e. dietary fat and fiber intake and BSE proficiency at the eight-month follow-up interview).

METHOD

PROCEDURES

Mujeres Felices was a randomized controlled intervention trial designed to evaluate the efficacy of a combined dietary and breast health intervention targeting young, low-acculturated Latinas. All recruitment, data collection and intervention activities were conducted at the Erie Family Health Center in Chicago, Illinois. This center primarily serves an immigrant Latino population.

The baseline characteristics of the study population, recruitment strategies, and main outcomes are described in detail elsewhere (Fitzgibbon & Gapstur, in press; Gapstur & Fitzgibbon, in press). Briefly, participants were screened for willingness to participate and pre-eligibility. Eligibility criteria included self-identification as Latina, between the ages of 20 and 40-years-old, a body mass index less than or equal to 35 kg/[m.sup.2], and willingness to be randomized and attend 16 sessions over an eight-month period. Following the signing of informed consent documents, data were collected at a baseline Health Center Visit (HCV), which included BSE proficiency and completion of three, 24-hour recalls within one month of the baseline HCV. A total of 256 women were randomized to either the classroom intervention (n=127) or mail (control, n=129) group. Eight months post-randomization, data were collected at the eight-month HCV. Institutional Review Board (IRB) approval was obtained from Northwestern University and Erie Family Health Center.

THEORETICAL MODEL OF MUJERES FELICES.

The Mujeres Felices intervention was grounded in behavior change theories, including the Transtheoretical Model (Prochaska & DiClemente, 1992) and Social Cognitive Theory (SCT; Bandura, 1986) providing strategies for tailoring the intervention to the individual. Briefly, according to the Transtheoretical Model, individuals will perceive and be willing to change behavior as it...

NOTE: All illustrations and photos have been removed from this article.



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