REDUCING SMOKING-RELATED RISK FOR CERVICAL CANCER

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Thirteen thousand five hundred U.S. women will develop cervical cancer in 1992; another 4,400 will die from it. Cervical cancer risk is significantly increased by smoking; if all women at risk for cervical cancer quit smoking, the incidence rate could be reduced by nearly half. The long-term objective of the proposed research is to reduce morbidity and mortality from cervical cancer by reducing smoking prevalence among women. One of the most important teachable moments in which to advise and assist women in quitting smoking may be during clinic visits for cervical cancer screening. A promising intervention strategy is to design educational messages to emphasize smoking-related risk for cervical cancer, train physicians and nurses who provide Pap tests to deliver effective smoking cessation counseling during clinic visits, and use written educational materials adapted to the context of cervical cancer risk reduction. Although this approach has been successfully implemented in other contexts, it has yet to be tested in protocols for cervical cancer screening. This proposal describes an exploratory study which will guide the development of a large-scale randomized intervention trial designed to reduce smoking prevalence among women at risk for cervical cancer. Two promising innovations are proposed. First, cervical samples will be tested for cotinine, which is a biomarker for exposure to smoking, and results will be communicated to women in one of the intervention groups. Second, this is the first research effort to develop and test personalized educational materials designed to communicate smoking-related risk for cervical cancer. The specific aims are to 1) adapt and apply successful smoking cessation strategies from the NCI-sponsored trials in physician-initiated counseling, prenatal smoking cessation counseling, and self-help interventions to the particular context of cervical cancer risk reduction; and 2) compare the relative effectiveness of two counseling interventions, one of which includes information about cotinine detected in cervical samples, with a control group. Smokers recruited from two clinics in the Duke University Medical Center will be randomly assigned to receive either 1) smoking cessation counseling specifically addressing cervical cancer risk, 2) counseling plus personalized feedback on cotinine in cervical samples, or 3) neither counseling nor cotinine feedback. Baseline and follow-up surveys of patients will be conducted to assess changes in knowledge, attitudes and behavior regarding the association between smoking and cervical cancer, perception of risk, and the effect of perceptions and Pap results on readiness to quit. Quit rates are expected to be highest in the group receiving counseling plus cotinine feedback and lowest in the control group; cessation should also be associated with perception of risk and Pap results. This research is an innovative approach to the use of cancer risk education and counseling to facilitate behavior change and reduce cancer risk. Ultimately, this research could contribute to substantial reductions in cervical cancer, and improvements in the standard of health care practice in the prevention and control of cervical and other smoking-related cancers.