title: Family factors are associated with psychological distress and smoking status in chronic obstructive pulmonary disease.
abstract: OBJECTIVE
  The objective of this study was to test three hypotheses in a sample of individuals with chronic obstructive pulmonary disease (COPD): (1) unsupportive family relationships are associated with psychological distress, (2) psychological distress is associated with smoking status and (3) unsupportive family relationships are indirectly associated with smoking status via psychological distress.
  
  
  METHODS
  Cross-sectional data were collected via self-report questionnaires completed by 455 individuals with COPD who had at least a 10-pack-year smoking history. The hypotheses were tested with structural equation modeling.
  
  
  RESULTS
  All three hypotheses were supported. Unsupportive family relationships were associated with psychological distress (β=.67, P<.001), psychological distress was associated with smoking status (β=.40, P<.001), and unsupportive family relationships were indirectly associated with smoking status via psychological distress (β=.27, P<.001).
  
  
  CONCLUSIONS
  Results of this study suggest that family relationships are an important factor to include in future longitudinal research that attempts to elucidate social and psychological influences on smoking behavior.
authors.affiliation: Department of Medicine, National Jewish Health, Denver, CO 80206, USA. holmk@njhealth.org
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Holm
authors.forename: Heather R
authors.initials: HR
authors.lastname: LaChance
authors.forename: Russell P
authors.initials: RP
authors.lastname: Bowler
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Make
authors.forename: Frederick S
authors.initials: FS
authors.lastname: Wamboldt
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D003120:Colorado; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D054541:Family Conflict / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000523:psychology*; D012907:Smoking / Q000453:epidemiology* / Q000523:psychology*; D012944:Social Support; D013223:Statistics as Topic; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires