When people pick up the phone to call a telephone quitline, they are taking an important step towards changing their smoking behavior. The current study investigated the role of a critical cognition in the cessation process--self-efficacy. Self-efficacy is thought to be influential in behavior change processes including those involved in the challenging process of stopping tobacco use. By applying basic principles of self-efficacy theory to smokers utilizing a telephone quitline, this study advanced our understanding of the nature of self-efficacy in a "real-world" cessation setting. Participants received between one and four intervention calls aimed at supporting them through their quit attempt. Concurrent with the initiation of this study, three items (confidence, stress, and urges) were added to the standard telephone protocol and assessed at each call. Two principal sets of hypotheses were tested using a combination of ANCOVAs and multiple regression analyses. The first set of hypotheses explored how self-efficacy and changes in self-efficacy within individuals were associated with cessation outcomes. Most research has found a positive linear relation between self-efficacy and quit outcomes, but this study tested the possibility that excessively high self-efficacy may actually reflect an overconfidence bias, and in some cases be negatively related to cessation outcomes. The second set of hypotheses addressed several smoking-related factors expected to affect self-efficacy. As predicted, higher baseline self-efficacy and increases in self-efficacy were associated with higher rates of quitting. However, contrary to predictions, there was no evidence that overconfidence led to diminished cessation success. Finally, as predicted, shorter duration of quit attempts, shorter time to relapse, and stronger urges all were associated with lower self-efficacy. In conclusion, understanding how self-efficacy and changes in self-efficacy affect and are affected by cessation outcomes is useful for informing both future research and current quitline intervention procedures.

Family adaptation to child developmental disability is a dynamic transactional process that has yet to be tested in a longitudinal, rigorous fashion. In addition, although children with developmental delays frequently have behavior problems, not enough research has examined possible underlying mechanisms in the relation between child developmental delay, adaptation and behavior problems. In the current study, factor analysis examined how best to conceptualize the construct of family adaptation to developmental delay. Also, longitudinal growth curve modeling tested models in which child behavior problems mediated the relation between developmental risk and indices of family adaptation. Participants included 130 typically developing children and their families (Mental Development Index [MDI] > 85) and 104 children with developmental delays and their families (MDI < 85). Data were collected yearly between the ages of three and eight as part of a multi-site, longitudinal investigation examining the interrelations among children's developmental status, family processes, and the emergence of child psychopathology. Results of the current study indicated that adaptation is best conceptualized as a multi-index construct. Different aspects of adaptation changed in unique ways over time, with some facets of adaptation remaining stable while others fluctuated. Child internalizing and externalizing behavior problems were found to decrease over time for both children with developmental delays and typically developing children. Child behavior problems were also found to mediate the relation between developmental risk and family adaptation for over half of the mediation pathways. Significant mediation results indicated that children with developmental delays showed higher early levels of behavior problems, which in turn was associated with more maladaptive adaptation. These findings provide further evidence that families of children with developmental delays experience both positive and more challenging changes in their families over time. This study implies important next steps for research and clinical practice in the area of developmental disability.