Cancer Control Research
5R03CA063894-02
Sullivan, Susan E.
REDUCING SMOKING-RELATED RISK FOR CERVICAL CANCER
AbstractThirteen 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.
|