The prevalence of smoking among cervical cancer survivors is strikingly high and smoking has been strongly linked to cervical cancer. Estimates of smoking prevalence among cervical cancer survivors have been reported in the literature as ranging from 44% to 48%. Continuing to smoke after a cancer diagnosis is associated with an increased risk of cancer recurrence, second primary cancers, and other smoking-related morbidities. This study will evaluate the efficacy and cost-effectiveness of a theoretically- and empirically- based Motivation And Problem-Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors in a large, safety net public healthcare system. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory-based treatment strategies within an overarching motivational framework. MAPS was designed to be appropriate for all smokers regardless of their motivation to change, and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process. Because MAPS comprehensively addresses multiple issues important to the individual and relevant to change through the creation of a Wellness Program (e.g., stressors, anxiety, depression, family conflicts, finances, fear of cancer recurrence), we believe it is particularly appropriate for treating this population. Participants will be current smokers who have been diagnosed with cervical cancer (N=300) recruited through the Harris Health System. Participants will be followed for a period of 18 months, and will be randomly assigned to one of two treatment groups: 1) Standard Treatment [ST] or 2) MAPS. ST will consist of a mailed packet of materials including a letter referring smokers to the Texas Quitline, free nicotine replacement therapy when they are ready to quit, and standard self-help materials. ST will be mailed a total of 3 times (at Baseline, 6 and 12 months). MAPS will consist of ST plus 6 proactive telephone counseling sessions delivered over a 12-month period. All assessments will be administered via telephone and occur at baseline and 3, 6, 12 and 18 months after baseline. The primary outcome is abstinence from tobacco at 18 months and the secondary outcomes are abstinence from tobacco at other assessments, as well as quit attempts, cigarettes per day, use of the Texas Quitline across all post-baseline assessments, and cost-effectiveness.
The specific aims are to: 1) Compare the efficacy of a MAPS approach to promoting and facilitating smoking cessation to ST among cervical cancer survivors; 2) Assess the effects MAPS on hypothesized treatment mechanisms (motivation, agency, and stress/negative affect) and the role of those mechanisms in mediating MAPS effects on abstinence from smoking; and 3) Compare the cost-effectiveness of MAPS and ST.
Smoking prevalence among cervical cancer survivors is strikingly high. Smoking has been strongly linked to cervical cancer and continuing to smoke after a cancer diagnosis is associated with an increased risk of cancer recurrence, second primary cancers, and other smoking-related morbidities. This study will evaluate the efficacy and cost-effectiveness of a theoretically- and empirically-based 'Motivation And Problem-Solving' (MAPS) approach to promoting and facilitating smoking cessation among cervical cancer survivors within a large, safety net public healthcare system.