Numerous attempts have been made to conduct education and outreach programs on college campuses regarding the topic of breast cancer, and most have fallen short of their goal. This is a challenging consumer audience to effectively reach who either already fear the disease so much they don't attend educational programs or believe that they are immune or untouchable by the disease at this point in time in their lives.

In 2000, a small sorority of 13 female students (alpha Kappa Delta Phi) at the Johns Hopkins University's Homewood Campus wanted to hold a breast cancer awareness program on campus with the goal to promote breast health among young women. They requested assistance with their mission, and asked for guidance and direction from me, in my role as Education and Outreach Director for the Johns Hopkins Breast Center. In reviewing what had been tried at other college campuses, we didn't want to repeat failure. Merely bringing students together wasn't enough to ensure they learned something, and more important, how will we know they learned anything and applied changes in their life style habits in response to what they learned?

Step #1 - Was educating these 13 young and eager college students themselves. This was accomplished by requiring that they become certified as an American Cancer Society Breast Health Educator, a program designed to teach laypeople the basic warning signs of a breast health problem, the value of mammography and how it is performed, and the proper techniques in performing breast self exam as well as the importance of clinical breast exams. Within 6 weeks the students were certified by attending the next 3 hour course offered which was fairly easy to orchestrate since I'm the trainer for the ACS program.

Step #2 - Now that the sorority had made a commitment and demonstrated their true interest in making "breast cancer" their platform, we went about looking at models used in various college and employment settings to inspire individuals to participate in health promotion programs. Models that used a "learn and earn" system seemed to work the best-instant rewards for participation and demonstration of learning achieved.

Step #3 - Defining the goals we wanted to achieve which, focusing on our overall mission of - Providing a Breast Health/Breast Cancer Educational Program for Young Women (and Men) who are College Students and Promoting Personal Application of the Information Used (ie, BSE, lifestyle changes to reduce risk of breast cancer). Specific goals and objectives included:

• Create an interactive event that students will willingly attend with enthusiasm and demonstrate an interest in learning about how to improve and maintain good breast health
• Educate students about at least 8 facts regarding breast health/breast cancer
• Train students how to perform breast self exams
• Educate students about breast reconstruction options for young women facing a diagnosis of breast cancer today
• Educate students as to proactive steps they can take to reduce their risk of developing breast cancer themselves
• Create an event that can be replicated at other college campuses
• Create an event that provides a means of measuring success
• Educate students about the various breast cancer organizations offering resources for: support for patients and families; education of consumers; promoting research for a cure; fostering outreach to communities
• Provide a mechanism for staying in touch with students to update them on new educational information about breast health and breast cancer
• Help to reduce fear of discussing breast cancer, its diagnosis and treatment
• Reach a large number of students at once

Step #4 - I asked the sorority students to create 80 flash card questions about breast health and breast cancer which they had learned from attending and becoming certified through the ACS program. (All questions were true/false or multiple choice). Solicitation letters were written jointly by the Breast Center and the Sorority to obtain door prizes (referred to as "booby prizes" for the event. Hard Rock Café was recruited to provide free food (that you had to earn before you could eat, of course) and more than 800 individually wrapped desserts were prepared by volunteers. The goal was to have the event monetarily be a break even program.

Step #5 - Creating a name for the event. This was great fun! A careful review of clever and whimsical names was done and the name "Breastival™" was selected to represent that this would be a festival celebrating and promoting breast health among young women. It also had not been previously used based on a detailed search conducted through the Trademark Office and well as the Copyright Offices.

Step #6 - I solicited breast cancer organizations to participate. The ACS, Komen Foundation, Young Survival Coalition, Living Beyond Breast Cancer, Men Against Breast Cancer, Mothers Supporting Daughters with Breast Cancer, and the Johns Hopkins Breast Center all agreed to participate in the educational event. Each booth sponsor was instructed in the learning method to be followed-that students would receive a passport card upon arriving to the Breastival™ location accompanied by instructions. "Stop at each booth and answer a flash card question correctly. You will then get your passport card stamped at that booth (each booth having a different stamp color). Upon completion of visiting ALL of the booths, you will be rewarded in the inner circle of the room." Rewards included a free food ticket for Hard Rock Café, a free treats ticket for a dessert of your choice, a free hair care product (700 donated), a free jane cosmetic (900 donated) and a chance to win a booby prize, by dropping your completed passport card in the door prize box. (The card contained on the back the student's name, phone number and email address. We had 102 door prizes for students to win!)

Step #7 - Advertising the event to promote participation.-- Posters were hung in college dorm bathrooms, mass broadcast emails sent, newsletters, website listings and clever messages used to promote the event. This event required considerable planning and clever marketing--- "April 11th is DD Cup Day-come to our Breastival™". "It's 11 o'clock, do you know where your breasts are? Are program starts at 11!" "Learn to take care of them-you only have two!" "Don't be a Boob and miss the Breastival™"! We had a large number of Johns Hopkins breast cancer survivor volunteers there to help staff the event and keep traffic moving, a fraternity to help unload and reload the booth sponsors vehicles at the start and end of the day's events, specific sorority members assigned to carry out specific tasks such as door prize distribution, host the booth sponsors and make sure they received breaks when needed, direct traffic for parking, etc.

We were clear in what we wanted to measure too. These measures, for example, included:

• # of students attending the event
• # of students visiting every breast cancer education booth and answering a breast health/cancer question correctly. (If you got the answer wrong you were told the correct answer and then shown another flash card question to answer)
• # of participants for Jazzercise class demo (to reinforce that exercise is a way to reduce your risk of breast cancer)
• # of students learning the correct technique for performing a breast self exam on a breast model
• # of students who signed the banner saying "I got the message about the importance of my breast health."
• # of students requesting additional information after the event ended
• Survey results of satisfaction as participant of event and educational method used
• Survey planning committee to determine the ease of replicating this event for future years at Hopkins and on other college campuses.

Information was provided verbally as well as in written form whenever possible. Breast Cancer Facts Posters were also posted throughout the room covering all four walls. The day was upbeat, with music playing in between the educational lectures also offered on breast reconstruction, breast cancer risk prevention, and jazzercise demonstrations. There was also a Games corner where students could have play a fun game by making a donation of $1 for our breast cancer research fund. (Games included: Pin the Nipple on the Breast; Guess how many jellybeans are in the largest bra on campus.) The Breastival event itself was free. How did we measure up? Despite it raining all day, and being held on a Wednesday from 11AM to 4PM the program was a huge success!

• Over 600 individuals attended the Breastival™ event
• 347 students completed their Breastival™ passport cards, having visited every booth and answered a flash card question correctly as well as demonstrated on a breast model the correct technique for breast self exam
• 22 students participated in the Jazzercise class. (Lots more watched)
• 252 young women signed the banner recording that they "got the message"
• 326 students provided their email address giving us an easy way to reach them for surveys, educational updates, and notifying them of future health educational events. A subset of these students are now receiving notification reminders to do their BSEs.
• 100% of students responding to our post event survey said that they would attend a Breastival™ event again
• 61% of the students said that they learned something new they didn't know about breast cancer. Examples included: young women also get breast cancer; only a small portion of women getting breast cancer carry a gene for it; men can even get breast cancer; there are organizations for family support; the # 1 risk is being a female.
• The most common flash card question answered incorrectly: That your risk of breast cancer increases with age. (Students thought it decreased after age 65 since their grandmothers weren't getting mammograms as often after that age.)
• 50% of female students responding to the survey said that they were already performing monthly BSEs. Of the 50% who said they were not, 49% said they would do so now having better understood the technique and its intrinsic value

The students who attended were 80% female and 20% male. (Males were lured with a door prize from Hooters). These students went home the following weekend for Easter break and told their siblings about the Breastival™ event. Within one month the Johns Hopkins Breast Center received more than 50 calls requesting information how to hold a Breastival™ on a college campus elsewhere.

Breastival™ has been successfully trademarked by the Johns Hopkins Breast Center and a Breastival™ Resource and Planning Kit created containing everything needed to replicate this successful breast health education program on other college campuses. In April 2002, I will be traveling to Blue Bell, PA where a Breastival™ will take place at Montgomery County Community College, sponsored by the Nursing School students there. (I'm giving a keynote speech there to nursing students that day). The Komen Foundation in Austin Texas is busy at work planning their upcoming Breastival™ event too, as is also a breast center in Canada who will be translating our information into French to hold a "Breastivile"!! So the program is spreading and we couldn't be more pleased.

To view photos from the Breastival™ held at Johns Hopkins visit our website at: www.med.jhu.edu/breastcenter

In recognition of its innovative approach to a challenging problem, that of educating young people about breast cancer with the goal to reduce fear of the disease and promote breast health habits at a young age, Health Care Benchmarks has identified the Johns Hopkins Breastival™ as a "best practices" concept and featured the program in their October 2001 (vol 8, No 10, pages 117-119) Newsletter. (For information how to purchase the kit contact Lillie Shockney by phone at 410-614-2853 or email her at shockli@jhmi.edu)