['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.', '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.', '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).'] Are family factors associated with psychological distress and smoking status in chronic obstructive pulmonary disease?