title: The Pap smear screening as an occasion for smoking cessation and physical activity counselling: effectiveness of the SPRINT randomized controlled trial.
abstract: BACKGROUND
  The organized Cervical Cancer Screening Programme (CCSP) in Italy might represent an occasion to deliver smoking cessation (SC) counselling to women attending the Pap test examination. Evidence of effectiveness of physical activity (PA) promotion and intervention in adjunct to SC counselling is not strong.Objective of the SPRINT trial was to evaluate the effectiveness of a standard SC counselling intervention delivered by trained midwives in the CCSP, and whether the adjunct of a PA counselling to the SC counselling might increase quit rates.
  
  
  METHODS
  We undertook a randomized controlled trial of 1,100 women undergoing the Pap examination in the three study centres Florence, Turin, and Mantua: 363 were randomly assigned to the SC counselling arm, 366 to the SC + PA counselling arm, and 371 to the control group. The intervention was a standard brief SC counselling combined with a brief counselling on increasing PA, and was tailored according to the Di Clemente-Prochaska motivational stages of change for SC and/or PA. Primary outcomes were quit rates, improvement in the motivational stages of change for SC, and reduced daily cigarette consumption. Analysis was by intention to treat.
  
  
  RESULTS
  Participants randomized in both intervention arms and in the preparation stage of change for SC doubled their likelihood of quitting at 6-month follow-up in comparison to controls (odds ratio [OR]=2.1, 95% confidence interval [95% CI]:1.0-4.6). Moreover, participants in the intervention arms and in the contemplation stage were more likely to reduce their daily cigarette consumption after the intervention (OR=1.8, 95% CI:1.1-3.0). Our study did not show any effect of PA counselling on various outcomes.
  
  
  CONCLUSIONS
  Smoking cessation counselling delivered by midwives to smokers in preparation and contemplation stages of change during the Pap-smear screening was effective and should be recommended, given the high number of women attending the cervical cancer screening programme in Italy. Moreover, the daily number of women invited for the Pap-smear examination should be slightly lowered, in order to let midwives deliver SC counselling to smokers.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN52660565.
authors.affiliation: Unit of Environmental and Occupational Epidemiology, Cancer Prevention and Research Institute (ISPO), Via delle Oblate 2, Florence, 50141, Italy. g.gorini@ispo.toscana.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gorini
authors.forename: Giulia
authors.initials: G
authors.lastname: Carreras
authors.forename: Livia
authors.initials: L
authors.lastname: Giordano
authors.forename: Emanuela
authors.initials: E
authors.lastname: Anghinoni
authors.forename: Anna
authors.initials: A
authors.lastname: Iossa
authors.forename: Alessandro
authors.initials: A
authors.lastname: Coppo
authors.forename: Fiorella
authors.initials: F
authors.lastname: Talassi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Galavotti
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Chellini
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D003376:Counseling; D015444:Exercise; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D007558:Italy; D008875:Middle Aged; D008880:Midwifery; D016017:Odds Ratio; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000175:diagnosis; D016540:Smoking Cessation; D014626:Vaginal Smears