PROJECT SUMMARY/ABSTRACT Cervical cancer (CC) is preventable. Still, only 80% of U.S. women report adherence to CC screening guidelines. Lower levels of screening are particularly pronounced among racial and ethnic minorities and patients with lower education levels. The group most likely to be non-adherent with CC screening guidelines is women who use the emergency department (ED) for their usual source of care. The ED setting, therefore, is optimal for the deployment of an intervention to promote CC screening. Short Message Service (SMS) on mobile phones (a.k.a. text messaging) is a low-cost, scalable, and effective means of delivering health behavior interventions. The vast majority of Americans – 95% – own a cell phone, and an estimated 98% of all cell phones have texting capabilities. The overarching goal of the proposed project is to develop a low-cost, scalable SMS intervention to increase CC screening that can be deployed in heterogenous ED settings. The proposed randomized controlled trial will test the efficacy of an SMS- based intervention to increase CC screening uptake among ED patients. Step 1 of the approach is to identify whether the participant is adherent with screening guidelines. Step 2 is to randomize non-adherent participants to one of the two treatment conditions: (1) referral only (control group) or, (2) referral and an SMS-intervention consisting of a series of text messages, grounded in behavioral change theory, aimed at generating intention and motivation to get screened. The investigators’ pilot work demonstrated the feasibility and preliminary efficacy of the proposed approach. To limit costs and increase the scalability of the intervention, determination of adherence with screening guidelines via a self-administered questionnaire on a tablet computer will be evaluated. A total of 1460 non-adherent women, age 21-65, will be recruited from a high-volume urban ED and a low-volume rural ED, randomized among study conditions, and followed-up at 150 days to assess interval CC screening uptake. The Specific Aims of the proposed project are, (1) Compare CC screening uptake between control and intervention groups at follow-up, (2) Compare the impact of in-person (using research staff) vs. self-administered (using a tablet) determination of CC screening adherence on the efficacy of the intervention, and (3) Identify mediators and explore moderators of intervention effects on CC screening at follow-up. The study team has a successful track record of collaboration and combines expertise in CC prevention, emergency medicine, behavioral science, and oncology. This project leverages the universal access setting of the ED to target women most at risk for non-adherence with CC screening guidelines. A low- cost, scalable intervention that is effective in increasing CC screening uptake among this population would decrease CC incidence and save lives. The next step would be a multi-site effectiveness/implementation trial using the NCI Community Oncology Research Program (NCORP) Network.

PROJECT NARRATIVE Invasive cervical cancer is preventable with adequate screening but screening rates are considerably below national goals. Emergency departments care for a disproportionate number of women who are not up to date with recommended cervical cancer screening. This study will evaluate the effectiveness of a mobile technology- based behavioral intervention to increase cervical cancer screening uptake among emergency department patients.