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.
