title: Self-efficacy and acceptance of cravings to smoke underlie the effectiveness of quitline counseling for smoking cessation.
abstract: BACKGROUND
  Few studies have examined why smoking cessation interventions are effective. The aim of this study was to examine the mediating processes underlying the effectiveness of cessation counseling administered by the Dutch national quitline.
  
  
  METHODS
  Data were used of a two-arm randomized controlled trial in which smoking parents, who were recruited through primary schools in The Netherlands, received either quitline cessation counseling (n=256) or a self-help brochure (n=256). The endpoint was 6-months prolonged abstinence at 12-months follow-up, with 86.7% outcome data retention. Putative psychological mediators of treatment effectiveness included smoking-related cognitions (positive smoking outcome expectancies, self-efficacy), emotions (negative affect, perceived stress, depressive symptoms), and smoking cue coping methods (avoidance coping, acceptance coping) assessed at 3-months post-measurement.
  
  
  RESULTS
  Quitline cessation counseling significantly decreased positive smoking outcome expectancies and negative affect and increased self-efficacy to refrain from smoking, avoidance of external cues to smoking, and acceptance of internal cues to smoking compared to self-help material. Increased self-efficacy to refrain from smoking in stressful and tempting situations (p<.001) and increased acceptance of cravings to smoke (p<.001) significantly mediated the effect of quitline cessation counseling on prolonged abstinence at 12-months follow-up (explained variance: 25.1%).
  
  
  CONCLUSIONS
  Self-efficacy to refrain from smoking and acceptance of cravings represent an important source of therapeutic change in smoking cessation counseling.
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, PO Box 9104, 6500 HE Nijmegen, The Netherlands. Electronic address: k.schuck@bsi.ru.nl.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Schuck
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, PO Box 9104, 6500 HE Nijmegen, The Netherlands.
authors.forename: Roy
authors.initials: R
authors.lastname: Otten
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, PO Box 9104, 6500 HE Nijmegen, The Netherlands.
authors.forename: Marloes
authors.initials: M
authors.lastname: Kleinjan
authors.affiliation: Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue, PO Box 19024, Seattle, WA 98109, USA; University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, USA.
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Bricker
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, PO Box 9104, 6500 HE Nijmegen, The Netherlands; Trimbos Institute, Netherlands National Institute of Mental Health and Addiction, PO Box 725, 3500 AS, Utrecht, The Netherlands.
authors.forename: Rutger C M E
authors.initials: RC
authors.lastname: Engels
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D003376:Counseling / Q000379:methods*; D066249:Craving; D005260:Female; D006293:Health Promotion; D015277:Hotlines; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D020377:Self Efficacy; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D016896:Treatment Outcome
keywords: Mechanisms; Mediation; Quitline support; Smoking cessation; Telephone counseling