Smoking Cessation for Women at Risk of Cervical Cancer

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DESCRIPTION (provided by applicant): Cigarette smoking has been found to be associated with a two-fold increased risk of developing cervical neoplasia or squamous cell cancer. The constituents of smoke, in concert with human papillomavirus (HPV), may promote the development or progression of cervical neoplasia. Thus, women who are positive for HPV and who smoke are at increased risk for developing cervical cancer. Counseling regarding smoking cessation may be of particular benefit for women undergoing screening at a colposcopy clinic for the evaluation of an abnormal Papanicolaou (Pap) smear. This is considered to be a "teachable moment" for smoking cessation, in that the perceived risk of progression to cervical cancer is heightened. Smoking cessation can reduce this risk as well as other health risks. Additionally, women at the colposcopy clinic represent underserved female smokers in that they are young, of low socioeconomic status, and are more likely to be ethnic or racial minorities. In Phase I, three focus groups of 8 -10 women each will be conducted to adapt an efficacious group-based cognitive-behavioral smoking cessation intervention that is tailored to the needs of women. The adaptations will include modifying the intervention from a group to phone-based delivery format and addressing the unique smoking cessation barriers of the women at our study site colposcopy clinic. In Phase II, the refined materials will be used in a randomized pilot study. Thirty women will be randomized either to an AHRQ + Enhanced Smoking Cessation group (n = 15) or to an AHRQ + Contact Control group (n = 15). Both groups will receive the AHRQ guidelines for smoking cessation (self help materials, brief counseling, recommendation for nicotine replacement therapy) plus phone delivery of either the adapted smoking cessation intervention (AHRQ + Enhanced Cessation) or a health education intervention (AHRQ + Contact Control). Our primary hypothesis is that the women randomized to the AHRQ + Enhanced Cessation group will have higher quit rates then women in the AHRQ + Contact Control group. Thus, we seek to: 1) conduct the formative work to adapt the cessation materials from a group to phone-based format and to address the needs of this population, 2) pilot the recruitment strategy, and 3) conduct a small randomized pilot trial to determine the preliminary efficacy of the materials for smoking cessation. This study, therefore, will serve as a pilot for a larger clinical trial.