Female smokers' perspectives on tobacco use and smoking cessation: a qualitative study guided by health belief model

Tobacco use among women remains a significant public health concern. Although overall smoking prevalence has declined locally, the reduction among female smokers has been comparatively slower. Existing cessation strategies may not sufficiently address the unique factors shaping women's smoking behaviour. This study explored female smokers' perspectives on tobacco use and the factors influencing their cessation. A qualitative study was conducted between February 2024 to February 2025 in a primary care setting in Singapore. Semi-structured in-depth interviews (IDIs) were carried out with 14 female smokers aged 21-59 years, recruited through purposive sampling. All interviews were conducted in English, guided by the Health Belief Model (HBM), audio-recorded, transcribed verbatim, and analysed thematically. Five key themes were identified: (1) Perceived susceptibility to smoking and its harm, including concerns about physical appearance, smoking-related symptoms, and health risks to themselves and their children. (2) Perceived severity of health and social risks, such as cardiorespiratory disease, premature mortality, and strong social and cultural stigma associated with female smoking. (3) Perceived benefits of quitting, including improved health, strengthened family relationships, and financial savings. (4) Perceived barriers to smoking cessation, particularly psychosocial and emotional barriers. (5) Cues to action, including public health messaging, encouragement from family and peers, and life-stage transitions that prompted contemplation and motivation to quit. This study highlights the complex interplay of psychological, social, and environmental influences on female smoking behaviour. Interventions should adopt a multifaceted, gender-responsive approach that addresses psychological barriers, enhances self-efficacy, and incorporates sociocultural support to strengthen cessation outcomes.