This study determined the effects of a five-day residential smoking cessation program for female heavy smokers. Smoking cessation success rate in female smokers, as reported by South Korea’s Smoking Cessation Support Service, was 33.5% after six months at smoking cessation clinics at public health centers and 11.5% after six months of smoking support service for women [23]. For this study’s participants, success rate for smoking cessation at six months was 43.7%, the highest among smoking cessation support services for female smokers in South Korea. Most female smokers were concerned by the social stigma attached to smoking and tried to conceal that they smoked [24]. Nevertheless, participants stated that they smoked and proceeded through the program with a strong motivation towards smoking cessation. Compared with programs at the Mayo Clinic Nicotine Dependence Center and St. Helene Center, this program used less time and money to achieve considerably high smoking cessation success rate. This study thus provides essential data to support short-term, low-cost, and high-efficiency programs for effective smoking cessation in the future.
The sister-to-sister intervention between female medical staff and smokers increased the rate of smoking cessation at both the six and twelve month follow-ups [25]. Group counseling and self-help group meetings were highly effective for successful smoking cessation in female smokers. Throughout the program, group counseling was conducted for two hours per session for three sessions, where participants shared their emotions and experiences to form a bond around the shared goal of smoking cessation, allowing them to be mutually supportive. As in the previous study, group counseling had a positive effect on smoking cessation success in female smokers.
The KSCMS scores in this study increased significantly after the program. An increase in motivation is associated with positive changes in health behavior [26]. As female smokers’ motivation is lowered by concerns related to time elapsed after smoking cessation, personalized counseling is required to strengthen the motivation to increase smoking cessation success rate [27].
Individuals with high-level negative effect perception of smoking cessation are more likely to continue smoking [28]. The positive effect perception after the program in this study increased, while the negative effect perception decreased, indicating that the ability to voluntarily reinforce smoking cessation behaviors improved in participants after the program.
The fall in smoking cessation self-efficacy can increase the smoking level in smokers and probability of re-smoking in non-smokers [29]. The S-E/T in this study showed lower degree of temptation and higher degree of endurance after the program, indicating an improvement in self-confidence for maintaining smoking cessation. Notably, parts of the program related to smoking cessation motivation, positive effect perception, and self-efficacy should be reinforced to the maximum to enhance smokers’ self-confidence.
Compared to individuals with depression, individuals who were not depressed showed higher probability of successful smoking cessation. Participants’ average age in this study was 50 years. Among women, the prevalence of depression increases during menopause [30] and is two times higher than that in men [31]. Those with lifelong history of depression are twice as likely to smoke as those without depression, and smokers with depression show higher nicotine dependence, with higher probability of experiencing more severe negative emotions after smoking cessation and increased risk of major depressive symptoms [32]. An effective smoking cessation strategy in individuals with depression should involve an appropriate combination of cognitive-behavioral approaches, nicotine replacement therapy, and smoking cessation medication. During this program, emotional changes in participants after smoking cessation were monitored, and appropriate smoking cessation medications and psychological counseling services were provided.
Smoking cessation counseling provided to female undergraduates and emotional laborers in a previous study led to higher smoking cessation success rate with a greater number of smoking cessation counseling sessions [33, 34]. Similarly, in this study, the higher number of smoking cessation counseling sessions was linked to higher smoking cessation success rate. The reason may be continuous counseling for nine or more sessions during 24 weeks after the program, wherein participants’ stage of change related to smoking cessation was checked and appropriate education and treatment were provided to reinforce smoking cessation behaviors.
Compared with male smokers, female smokers are less likely to succeed in smoking cessation because of weight gain after cessation [35]. In a previous study, the group provided with an exercise intervention showed a higher smoking cessation rate than the control group [36]. Another study using yoga and meditation interventions reported a significantly higher smoking cessation rate [37]. Among interventions for smoking cessation, weight control should combine various methods related to physical activity, calorie restriction, and cognitive approaches regarding body image and weight [38]. Health management, including exercise and diet control, was effective in the smoking cessation program as the anxiety factor related to weight gain was reduced [39]. In this study, participants were presented with objective health indicators through health screening; accordingly, the smoking cessation program was performed in combination with exercise and nutritional counseling.
The study’s limitations were as follows: First, participants were female heavy smokers in Seoul. Therefore, the findings may not generalize the total female smoker population in South Korea. Female smokers from more varied regions should be recruited for further studies. Second, this study analyzed secondary data, so only the variables related to the smoking cessation service could be examined. Third, precise cause-effect relationships among various factors with respect to the effects on smoking cessation could not be identified, as questionnaires were filled only on the admission day. Fourth, compared to general smokers, participants were presumed to have stronger smoking cessation motivation, leading to potential selection bias. Fifth, bias could also have been caused by lack of follow-up data for drop-outs due to their resumption of smoking or contact interruption.
Nevertheless, this program played an important role in successful smoking cessation. Finally, considering the general lack of studies on female heavy smokers, this study provides valuable research data.