Self-efficacy, the personal judgment of one's ability to carry out a particular course of action, is a phenomenon that is central to nursing. Despite widespread recognition of the pivotal role played by self-efficacy in adoption of health behavior, its ability to predict a sustained behavioral change has not been well studied; long-term follow-up studies of even one year are rare. The specific aims of the project proposed here are to: 1) Determine the capacity of self-efficacy to predict maintenance of behavioral change at four years post-intervention; 2) Explore individual attitudes and strategies that facilitate or deter behavioral change using a mixed method approach; 3) Determine the four-year incidence of urinary incontinence (UI) in women who have been instructed in a behavioral modification program (BMP) as compared to their non-instructed counterparts. This project will expand and extend data from the currently funded randomized controlled trial entitled "The MESA Project: Prevention of Urinary Incontinence" that is testing the effectiveness of the BMP in reducing the incidence of UI among postmenopausal women 55 to 80 years of age. We will follow 200 treated cases from the parent project for four years post-intervention to assess the contribution of self-efficacy and other factors to long-term behavioral change. We will recruit an additional 200 cases to comprise an untreated control group in order to assess the impact of treatment on four-year incidence of UI. Because the parent project is the first to test a prevention intervention, the project proposed here provides a singularly unique opportunity to gain knowledge about long-term behavioral change and continence outcomes.