PREVENTIVE ONCOLOGY AWARD--SMOKING CESSATION AND WOMEN

该项目将通过结合教育和研究活动，促进主要调查员的职业发展。 目标是发展戒烟方面的专门知识，特别侧重于女性吸烟者。 吸烟是我们社会中死亡和疾病的主要原因。 更好地理解和强调女性戒烟尤其重要，因为女性戒烟可能比男性更困难。 计划进行两项调查。 第一项是随机临床试验，其中宫颈癌高危女性（n=300）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危险因素，据估计，近31%的宫颈癌相关死亡是由吸烟造成的。 然而，我们不知道任何戒烟试验集中在这个独特的，有风险的人群。此外，这项研究将是第一个测试完整的AHCPR治疗模型，该模型规定向所有吸烟者提供动机和/或行动导向的治疗。 为了克服该模型的几个潜在的局限性，AHCPR的动机干预将辅以在酒精治疗文献中证明有效的动机访谈技术。 此外，除了最初的联系，所有的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动机和戒烟率，2）探索干预可能影响禁欲的因素。项目二将研究抑郁症史在女性戒烟过程中的作用。 有抑郁症史的人比没有抑郁症史的人更难戒烟。 然而，尚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（负面影响，冲动，自我效能和结果预期）的差异。300名女性将根据她们的抑郁史进行分层，并在戒烟后随访一周。 在此期间，将使用生态瞬时评估程序（EMA）对戒烟过程的认知，情感和情境方面进行“实时”评估。信息将通过参与者随时携带的小型手持计算机收集。 本研究的主要目的是评估抑郁症的历史和因素之间的关系，确定为潜在的重要戒烟过程中，根据马拉特和戈登的复发预防理论。 如果在有和没有抑郁症史的女性之间发现这些因素的差异模式，这些变量也将被评估为吸烟失效/复发的潜在介质。 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.