title: What mediates the effect of confrontational counselling on smoking cessation in smokers with COPD?
abstract: OBJECTIVE
  Within the framework of a randomized, active treatment controlled trial, we used a mediation analysis to understand the mechanisms by which an intervention that uses confrontation with spirometry for smoking cessation achieves its effects.
  
  
  METHODS
  Participants were 228 smokers from the general population with previously undetected chronic obstructive pulmonary disease (COPD), who were detected with airflow limitation by means of spirometry. They received two equally intensive behavioural treatments by a respiratory nurse combined with nortriptyline for smoking cessation: confrontational counselling with spirometry versus conventional health education and promotion (excluding confrontation with spirometry and COPD).
  
  
  RESULTS
  Cotinine validated abstinence rates from smoking at 5 weeks after the target quit date were 43.1% in the confrontational counselling group versus 31.3% in the control group (OR=1.67, 95%CI=0.97-2.87). The effect of confrontational counselling on abstinence was independently mediated by the expectation of getting a serious smoking related disease in the future (OR=1.76, 95%CI=1.03-3.00), self-exempting beliefs (OR=0.42, 95%CI=0.21-0.84), and self-efficacy (OR=1.38, 95%CI=1.11-1.73).
  
  
  CONCLUSIONS
  We conclude that confrontational counselling increases risk perceptions and self-efficacy, and decreases self-exempting beliefs (risk denial) in smokers with previously undetected COPD. These changes in mediators are associated with a higher likelihood of smoking cessation.
  
  
  CONCLUSIONS
  Apart from the intensity, the content of smoking cessation counselling may be an important factor of success. A confrontational counselling approach as we applied may have the potential to alter smoking-related cognitions in such a way that smokers are more successful in quitting. Nurses can be trained to deliver this treatment.
authors.affiliation: Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands. d.kotz@hag.unimaas.nl
authors.forename: Daniel
authors.initials: D
authors.lastname: Kotz
authors.forename: Marcus J H
authors.initials: MJ
authors.lastname: Huibers
authors.forename: Robert J
authors.initials: RJ
authors.lastname: West
authors.forename: Geertjan
authors.initials: G
authors.lastname: Wesseling
authors.forename: Onno C P
authors.initials: OC
authors.lastname: van Schayck
mesh_terms: D000328:Adult; D016001:Confidence Intervals; D037001:Directive Counseling; D005260:Female; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011594:Psychometrics; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis*; D011788:Quality of Life; D020377:Self Efficacy; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013147:Spirometry; D011795:Surveys and Questionnaires