Extensive epidemiologic evidence now supports a causal association between smoking and cervical cancer. Moreover, detection of cotinine in the cervical mucus of smokers suggests a biologically plausible link between smoking and early cervical abnormalities. Annual routine gynecological exams represent an opportunity to: provide information which links smoking to reproductive health outcomes, enhance motivation for smoking cessation and increase the likelihood of cessation in reproductive age women. Proposed is a randomized trial to assess whether state-of-the-art smoking cessation interventions provided as part of routine follow-up for Pap exams can increase cessation rates relative to usual care. A second objective is to assess whether notification of abnormal test results enhances motivation for and likelihood of smoking cessation. The research will be conducted at Group Health Cooperative of Puget Sound. An automated cervical cytology database will be reviewed to identify recent Pap screenees. A cohort of 700 smokers (350 with normal test results and 350 with a normal results) will be identified through a population based women's health telephone survey. Smokers will be stratified on Pap test result and randomized to one of two intervention conditions: Group 1, usual care or Group 2, self-help with motivational adjuncts. Smokers randomized to Group 1 will receive the usual standard care in the form of provider: assessment of smoking status, advice to quit smoking, referral to available assistance for smoking cessation, and an informational/motivational pamphlet regarding smoking and overall reproductive health. Smokers assigned to Group 2 will receive a self-help booklet, written personalized feedback and 3 telephone calls from a cessation counselor. Smoking cessation outcomes including stage of cessation, level and type of motivation to quit smoking, initial cessation and sustained abstinence will be obtained at baseline, 6 and 15 month follow-up telephone surveys. The overarching goal of the project is to identify effective cancer prevention intervention strategies for healthy women smokers.
