Project WISE

Despite declines in smoking prevalence over the past 4 decades, nearly one-quarter (22.8%) of adults in the United States are regular smokers.  Most smokers report they want to quit someday, but only a small percentage are ready to do so at any given time. Even when ready to quit, most smokers fail to seek formal assistance and prefer to quit on their own. Proactive recruitment is an effective way to reach smokers at all stages of readiness to quit smoking. However, it can be difficult to proactively deliver cessation counseling.

In women, smoking is causally linked to cervical cancer and precancerous cervical lesions, and among those with low-grade cervical abnormalities, quitting smoking can result in healed lesions and lower cervical cancer risk. One way to make women more receptive to a smoking cessation intervention is to capitalize on a "teachable moment" such as during a conversation about an abnormal Pap smear or colposcopy when women may be more receptive to advice on quitting smoking.

The Project WISE intervention targets women who have recently had an abnormal Pap result or colposcopy. The intervention incorporates up to four brief calls (lasting approximately 15 minutes each) over a 6-month period from a counselor who is trained in motivational interviewing and smoking cessation treatment. Using a general content format, counselors tailor the calls based on each woman's readiness to quit smoking, which is assessed at the beginning of each call. The counselors encourage the women to use all cessation aids available to them through their health care organization or other community resources. In addition to the individualized counseling calls, the women are provided with Group Health Cooperative's usual care, which includes a mailed packet containing a letter explaining the association between cervical cancer and smoking, a copy of Clearing the Air (a self-help booklet), and contact information for the Free & Clear phone-based smoking cessation program.

If the women indicate they are ready to quit, the counselor helps them develop action plans for quitting, including advice on setting a quit date, how to prepare for quitting, and a discussion of other treatment options, including the Free & Clear program, pharmacotherapy, and community resources for quitting. If the women indicate they have already quit smoking, counselors focus on relapse prevention strategies. Following each call, the women are sent a brief note recapping the major points discussed and reinforcing any positive changes they have undertaken.

To administer the Project WISE program, time is required:

- To assemble and mail participant packets
- For counselors to engage participants in four 15-minute phone calls over a period of 6 months
- For counselors to document the phone calls and send follow-up notes to participants

The primary audience for Project WISE is women over the age of 18 who have recently had an abnormal Pap exam or colposcopy. 

Project WISE is designed to be administered in health care settings.

The Project WISE toolkit includes the following materials:

- Project WISE Protocol and Treatment Manual
- Clearing the Air booklet
- Informational letter
- Free & Clear Patient Fact Sheet

Counselors implementing the Project WISE curriculum should have competencies in basic motivational interviewing and smoking cessation counseling.

The study was conducted at Group Health Cooperative, an integrated health care organization in western Washington State. Study enrollment ran from March 2000 to September 2003, with data collection completed by September 2004.  Potential participants were identified through automated data records. Women were eligible if they were at least 18 years old; had reported smoking at least 5 cigarettes per day for the past year; had an abnormal Pap smear or colposcopy within the preceding 2 months; could read, speak, and write in English; had a telephone; and were not currently receiving treatment for smoking cessation.

Participants were randomly assigned to the intervention or control group, which received the Group Health Cooperative usual care only.  The participants were predominantly young and White, and nearly half were married or living with a partner. Of the participants, 45.4% had a high school education or less, 83.3% were employed, and the average household income was less than $35,000.  There were no significant differences between treatment groups at baseline with regard to demographic characteristics.

A total of 275 participants were surveyed by phone at baseline, 6 months postenrollment, and 12 months postenrollment. Interviewers were blinded to participants' randomization status. Follow-up retention was high (96% at the 6-month evaluation, 95% at the 12-month evaluation). 

• At the 6-month follow-up, participants in the intervention group were more likely than participants in the control group to report they had not smoked in the past 7 days (p<.05). There were no significant differences in the 7-day-point prevalence of smoking abstinence at 12 months.

Additional Findings
Use of Free & Clear Counseling

• During the 1-year study period, intervention group participants were significantly more likely to have enrolled in Free & Clear counseling than participants in the control group (p<.01).