Low-income minority women will be provided with a well-established, brief counseling intervention, Stress Inoculation Training (SIT), prior to diagnostic follow-up for abnormal Pap smears. The SIT protocol, based on a transactional model of stress, is derived from our ongoing work with a demographically similar population and is designed to enhance coping with stress in the context of health threats. In addition to improving knowledge, it also targets the cognitive, somatic, and behavioral components of the response to cancer risk. Effects of this intervention on quality of life and adherence will be compared with those of an Extended Health Education (HE) intervention and a Short-Term Health Education (SHE) intervention -- both of which target knowledge, but not the other components, of SIT -- and Usual Care (UC). Nurse-therapists will deliver the interventions in a time-limited, group-structured, relatively low-cost format. Generalizability of the effects will be assessed across two comparable clinic sites (N = 532 per site), that serve the relevant high- risk, low-income population of North Philadelphia. The specific interactions between the psycho-educational interventions and the patient's characteristic coping style will also be assessed, using a well-validated, easy-to-administer measure. This measure distinguishes between monitors, who actively attend to and scan for cues about threat; and blunters, who actively distract from and avoid cognitions and actions that prime anxiety. Subjects will be assessed: pre-intervention (baseline), post-intervention (pre-colposcopy), during the initial colposcopy, and before and during the 6-month and 1-year follow-up colposcopies. Assessments will include confounder (demographic/medical/risk factors, treatment expectation, and homework practice) and moderator variables (coping style); 2) outcome variables (general and disease-related distress and adherence); and 3) intervention mediator (process) variables (cognitive, somatic, behavioral, and knowledge). Using multivariate analyses of covariance and log-linear modeling (as appropriate), we will examine whether SIT is associated with enhanced outcomes, compared to HE, SHE, and UC, particularly for the more highly distressed monitoring group, and whether these effects are mediated by changes in the process variables. The proposed study will bring together two unique strengths: 1) expertise in the assessment and interpretation of dispositional health-relevant coping styles that have been shown to impact on adjustment and adherence to medical regimens and that are expected to interact with different types of interventions; and 2) expertise in the development and component analysis of SIT and related interventions. It will apply these strengths to the delivery and evaluation of highly transportable low-cost interventions tailored to coping style groups, in two hospital settings that fill the role of community facilities and that target traditionally underserved high-risk populations.
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