PREVENTIVE ONCOLOGY AWARD--SMOKING CESSATION AND WOMEN

该项目将通过教育和研究活动相结合，促进首席调查员的职业发展。其目标是发展戒烟方面的专门知识，特别强调女性吸烟者。在我们的社会中，吸烟是导致死亡和疾病的主要原因。女性对戒烟的理解和重视尤为重要，因为女性戒烟的难度可能比男性更大。已经计划了两项调查。第一项是随机临床试验，其中300名宫颈癌高危女性将根据a)卫生保健政策和研究机构(AHCPR)的戒烟临床实践指南或b)常规护理(UC)进行治疗。吸烟是宫颈癌的一个重要风险因素，据估计，近31%的宫颈癌相关死亡是由吸烟造成的。然而，我们不知道有任何针对这一独特的高危人群的戒烟试验。此外，这项研究将首次测试完整的AHCPR治疗模式，该模式规定为所有吸烟者提供激励和/或以行动为导向的治疗。为了克服该模型的几个潜在局限性，AHCPR的动机干预将被在酒精治疗文献中被证明有效的动机访谈技术补充。此外，除初次接触外，所有咨询都将通过电话进行。这项调查的具体目的是：1)确定AHCPR治疗模式的使用是否增加了宫颈癌高危女性的积极性和戒断率；2)探索干预措施可能影响禁欲的因素。项目二将研究抑郁症病史在女性戒烟过程中的作用。有抑郁史的人比没有抑郁史的人更难戒烟。然而，目前还不清楚是什么原因造成了这种差异。项目二将评估几个理论上重要的变量(负面情绪、冲动、自我效能感和结果预期)的差异。300名女性将根据她们的抑郁史进行分层，并在戒烟后进行为期一周的跟踪调查。在此期间，将使用生态瞬时评估程序(EMA)对戒烟过程中的认知、情绪和情景方面进行“实时”评估。信息将通过参与者随身携带的小型手持计算机收集。这项研究的主要目的是根据Marlatt和Gordon的复发预防理论，评估抑郁症病史与戒烟过程中被确定为潜在重要因素之间的关系。如果有和没有抑郁症病史的女性在这些因素上发现不同的模式，这些变量也将被评估为吸烟减少/复发的潜在中介因素。这种知识很重要，因为它可能导致制定更有针对性的、因此可能更有效的戒烟干预措施。

This project will enhance the career development of the principal investigator through a combination of educational and research activities. The goal is to develop expertise in smoking cessation with a particular emphasis on female smokers. Smoking is the leading cause of death and illness in our society. A greater understanding and emphasis on cessation in women is of particular importance, as women may have more difficulty quitting smoking than do men. Two investigations have been planned. The first is a randomized clinical trial in which women at high risk for cervical cancer (n=300) will be offered treatment based on a) the Agency for Health Care Policy and Research's (AHCPR) Clinical Practice Guideline for Smoking Cessation or b) usual care (UC). Smoking is a significant risk factor for cervical cancer and it is estimated to be responsible for nearly 31 percent of cervical cancer-related deaths. However, we are unaware of any smoking cessation trials focusing on this unique, at-risk population. Additionally, this study will be the first to test the full AHCPR treatment model, which dictates motivational and/or action- oriented treatment be offered to all smokers. To overcome several potential limitations of the model, the AHCPR's motivational intervention will be supplemented with motivational interviewing techniques proven to be effective in the alcohol treatment literature. Furthermore, with the exception of initial contact, all counseling will be conducted by phone. The specific aims of this investigation are to 1) determine if use of the AHCPR treatment model increases motivation and cessation rates among women who are at high-risk for cervical cancer, and 2) explore factors through which the intervention may impact abstinence. Project two will examine the role of depression history on the process of quitting smoking among women. Individuals with a history of depression have greater difficulty quitting smoking than do those without a history of depression. It is unclear, however, what accounts for this difference. Project two will evaluate differences in several theoretically important variables (negative affect, urge, self-efficacy, and outcome expectations). Three hundred women will be stratified based on their depression history and followed for one week post-quitting. During this period, "real-time" assessments of cognitive, emotional, and situational aspects of the quitting process will be conducted using ecological momentary assessment procedures (EMA). Information will be collected via small, hand-held computers carried by the participants at all times. The primary aim of this study is to evaluate the relation between depression history and factors identified as potentially important in the quitting process, based on Marlatt and Gordon's theory of relapse prevention. If differential patterns are found between women with and without a history of depression on these factors, these variables will also be evaluated as potential mediators of smoking lapse/relapse. Such knowledge is important as it may lead to the development of more targeted, and therefore potentially more effective, cessation interventions.