In this study, pregnancy was found to increase the likelihood of short-term smoking cessation (6 weeks) in single mothers. Although women were likely to attempt smoking cessation during pregnancy [31, 32], over 60% of mothers who quit smoking during pregnancy relapsed within six months after childbirth. This phenomenon might occur because mothers only had external motivation to quit smoking, such as concerns for their children’s health, but lack internal motivation, and thus only temporarily ceased smoking during pregnancy . Adolescent mothers were also more likely to begin smoking again after cessation . One study reported that pregnant adolescents aged 15 − 19 years had the highest rate of smoking among all pregnant mothers . In the present study, adolescent mothers who smoked accounted for 50% of all participants, indicating that adolescent mothers were more vulnerable to developing smoking habits. These results demonstrated that a smoking relapse prevention program tailored to single mothers and an intensive counseling program for adolescent mothers would be necessary to help single mothers maintain long-term smoking cessation, even after childbirth.
In this study, the likelihood of short-term smoking cessation maintenance (4 and 6 weeks) increased as participants’ Exhaled CO level decreased. This is consistent with a previous report that the rate of successful smoking cessation increased as Exhaled CO level decreased in male university students . The measurement of Exhaled CO level is noninvasive, unlike blood or urine tests, and allows for immediate assessment in all clinical settings . Immediately checking Exhaled CO level also allows individuals to be aware of their smoking status and reinforces their motivation for smoking cessation.
In this study, abstaining from alcohol was an important factor that promoted smoking cessation maintenance in single mothers. This result was consistent with a previous report that smoking was strongly associated with drinking, and those who abuse or were dependent on alcohol would be more likely to smoke and had higher rates of tobacco consumption compared with the general population [38, 39]. Another study reported that adult smokers who had high alcohol consumption levels or previously abused alcohol had higher nicotine dependence and poorer smoking cessation treatment outcomes . While smoking and drinking were independent risk factors for cancer and cardiovascular disease, alcohol and cigarettes could interact when used together to drastically increase the risk of disease . Smoking and alcohol use during pregnancy can significantly affect the neurological and cognitive function of the fetus, causing symptoms of ADHD and learning and memory deficits . However, it has been reported that mothers vary in their levels of awareness about the risks of smoking and drinking. While mothers have been found to follow public health recommendations regarding smoking cessation during pregnancy and acknowledge the need to quit smoking, they are also reported to believe that alcohol consumption during pregnancy is safe as long as it is within a certain amount, due to the lack of clear, standard guidelines written by experts [43, 44]. These results suggest that counselors must emphasize the dangers of smoking and drinking during pregnancy, even in small amounts, through an education and counseling program, as well as recommend smoking cessation and alcohol abstinence.
Most smokers voluntarily attempt to cease smoking but fail to maintain their efforts. The mean likelihood of successfully quitting smoking within 6 − 12 months after the initiation of smoking cessation is 5% or below [45, 46]. This indicates that it is difficult for smokers to quit on their own, and that they require help from others to do so successfully. Such difficulties can be resolved through consistent counseling with an experienced smoking cessation counselor . In this study, the number of counseling sessions attended had the most significant impact on smoking cessation maintenance of single mothers. As the number of smoking cessation counseling sessions tailored for single mothers increased, participants were 3 − 19 times more likely to maintain smoking cessation. This result was consistent with a previous report that a smoking cessation program tailored to pregnant women could effectively promote smoking cessation [48, 49]. Counseling also plays an important role in enhancing motivation to maintain smoking cessation . Motivational enhancement counseling teaches individuals that everyone can have the motivation to change and reinforces internal motivation by explaining in detail the steps required for making the changes necessary for smoking cessation .
In this study, the likelihood of smoking cessation increased as scores on the readiness, confidence, and importance rulers increased at 4, 6, and 12 weeks, respectively, indicating that different motivations must be enhanced at different points during counseling. Counselors should discuss in detail with individuals how to prepare for smoking cessation for the first four weeks, and then focus on enhancing individuals’ confidence in their ability to cease smoking until the end of the sixth week. Further, counselors should emphasize the importance of smoking cessation until the end of the twelfth week, to consistently enhance single mothers’ motivation to maintain smoking cessation.
In this study, the most common reason to quit smoking was “for my health”. Smoking cessation counseling program focusing on single mothers’ health might effectively promote the maintenance of smoking cessation. It had previously been reported that counseling pregnant women briefly for 3 − 5 minutes during a medical examination and providing them with information about smoking increased the rate of smoking cessation by 30 − 70% [51, 52], suggesting that consistent and frequent smoking cessation counseling positively affected the maintenance of smoking cessation. In this study, most participants responded that they had no one to support their efforts to quit smoking, thereby further demonstrating the need for smoking cessation counselors. This finding suggests that counselors should provide high-quality counseling and fulfill their role in providing smoking cessation support, which was in line with a previous study reporting that receiving support from others increased the success rate of smoking cessation .
This study has some limitations that should be noted. First, the results cannot be generalized, since the study only included single mothers who were smokers from a certain area of Seoul. Repeated follow-up studies involving single mothers from different regions across the country should be necessary. Second, since this study used secondary data, only the variables related to smoking cessation services could be examined. Third, the sample size was small, due to the difficulty of finding and enrolling single mothers who were also smokers. The number of participants who maintained smoking cessation for 24 weeks was even smaller.
However, despite these limitations, this study is the first to use data collected by a smoking cessation counselor who regularly visited a single mother facility over six months. This study is meaningful in that it examined factors associated with smoking cessation maintenance in single mothers that were not sufficiently discussed in previous studies. The results of this study may be used as basic data for improving the quality of counseling provided by smoking cessation support services.