Self-efficacy and acceptance of cravings to smoke underlie the effectiveness of quitline counseling for smoking cessation

Kathrin Schuck*, Roy Otten, Marloes Kleinjan, Jonathan B. Bricker, Rutger C.M.E. Engels

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


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.

Original languageEnglish
Pages (from-to)269-276
Number of pages8
JournalDrug and Alcohol Dependence
Publication statusPublished - 1 Sept 2014
Externally publishedYes


  • Mechanisms
  • Mediation
  • Quitline support
  • Smoking cessation
  • Telephone counseling


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