National data showed that the self-reported smoking prevalence among Korean women was 5.9%, whereas the cotinine-verified prevalence was 13.9% [1], suggesting substantial underreporting in the context of persistent stigma surrounding female smoking in Korea [1,2]. Female workers employed in service and sales occupations have been reported to smoke at higher rates than female workers in other occupations, and emotional labor and job stress have been identified as correlates of smoking in these workers [3,4]. Call center work is a representative emotional labor occupation in which employees must regulate their emotions in response to customer demands and organizational display rules, and approximately one fifth of female call center workers in Korea were reported to be current smokers, with cigarettes suggested as a means of alleviating the emotional burden of work [3].

Smoking cessation is a behavioral process that involves changes in motivation and smoking behavior over time. The transtheoretical model describes this process as progression from no intention to quit through intention and preparation to action and maintenance [5]. Accordingly, the present study classified participants into three groups based on current smoking status and intention to quit: an abstinence group, a quit-intention group, and a no-plan group. Comparing the psychosocial characteristics of these groups may provide more useful information for developing tailored smoking cessation interventions than a binary comparison between current and former smokers.

Several psychosocial factors may be relevant to this process. Social nicotine dependence refers to cognitive and sociocultural dependence characterized by glamorizing, rationalizing, or minimizing the harms of smoking beyond physical nicotine dependence [6,7]. Smoking abstinence self-efficacy, defined as confidence in maintaining abstinence in tempting or stressful situations, is a consistent predictor of subsequent cessation [8]. Together, these constructs represent two opposing cognitive forces, one rationalizing smoking and the other supporting cessation. In addition, emotional labor [9,10], cognitive emotion regulation (CER) strategies [11], and perceived social support [12] may further shape how work-related emotional strain relates to smoking behavior.

A previous study from this survey population showed that female call center workers who currently smoked had higher social nicotine dependence, more permissive smoking attitudes, and higher emotional labor than ex-smokers and never smokers [13]. However, that study focused on smoking status and therefore could not determine whether psychosocial characteristics differed among female workers maintaining smoking abstinence, current smokers intending to quit, and those with no intention to quit. Understanding these group-specific differences may help identify appropriate intervention targets. Therefore, this study compared psychosocial factors—including social nicotine dependence, smoking attitude, smoking abstinence self-efficacy, emotional labor, CER strategies, and social support—across smoking cessation groups among female call center workers and identified factors independently associated with group membership. The findings may provide a basis for developing workplace interventions tailored to smoking status and quit intention among female emotional labor workers.

This study found that cessation stage among female call center workers was mainly distinguished by social nicotine dependence and abstinence self-efficacy rather than by emotional labor or perceived social support alone. Social nicotine dependence increased stepwise from the abstinence group to the quit-intention and no-plan groups, whereas abstinence self-efficacy showed the opposite pattern, and both factors independently distinguished the two current-smoker groups from the abstinence group in multivariable analysis.

The first major finding was the strong role of social nicotine dependence. Each 1-point increase was associated with higher odds of belonging to the current-smoker groups, particularly the no-plan group (OR=1.26). This is consistent with previous KTSND studies showing that scores differ by smoking status and reflect cognitive rationalization of smoking [6,7,15], and it extends the earlier status-based comparison in this population, in which social nicotine dependence rose from never smokers through ex-smokers to current smokers [13], by showing that the gradient extends across the three cessation groups. Because the KTSND can be assessed in former smokers, it may be useful both for identifying smokers resistant to cessation and for monitoring residual smoking-rationalizing beliefs among female workers maintaining abstinence as a marker of relapse risk. Reducing social nicotine dependence may require more than information about the harms of tobacco; cognitive restructuring of beliefs such as “smoking relieves stress” or “smoking is part of workplace breaks” is likely needed.

Abstinence self-efficacy was the second key factor. The abstinence group reported the highest self-efficacy, and lower self-efficacy independently predicted membership in both current-smoker groups even after accounting for social nicotine dependence, emotional labor, CER strategies, social support, and drinking, consistent with social cognitive theory and meta-analytic evidence [8,23]. The negative correlation between social nicotine dependence and self-efficacy further suggests that rationalizing beliefs may undermine confidence in quitting. Interventions for smokers with no intention to quit may therefore need to weaken smoking-rationalizing cognitions first and then build mastery through small, achievable abstinence tasks.

Emotional labor did not differ among the groups and was not an independent predictor; nevertheless, its OR for the quit-intention group was of moderate magnitude (OR=2.18). This does not imply that emotional labor is irrelevant; rather, it may operate as a contextual stressor whose effect depends on cognitive appraisal and coping resources. Emotional labor was positively correlated with both adaptive and maladaptive CER strategies, indicating that workers under higher emotional demands mobilize more cognitive coping overall, and prior research has linked surface acting and emotional dissonance to impaired well-being [9,10]. For cessation, the critical question may be not whether emotional labor is high but whether workers respond to it through adaptive regulation or through smoking-rationalizing beliefs and cigarette use; mediation or moderation models should be tested in future studies. The elevated but imprecise OR for the quit-intention group should therefore be interpreted as a possible trend rather than evidence of an independent effect; limited precision and statistical power may have contributed to the non-significant result.

Adaptive CER strategies were lower in the no-plan group in univariable analysis but not independently associated with group membership after adjustment, suggesting that adaptive cognitive coping is a supportive resource rather than a direct determinant of group membership. The attenuation may partly reflect conceptual overlap with abstinence self-efficacy, because cognitive reappraisal and coping processes can support confidence in managing high-risk situations [8,11,20,23]. CER training may still be clinically useful when explicitly linked to self-efficacy-building exercises. Such training could include identifying automatic smoking-related thoughts after difficult calls, practicing positive reappraisal and refocusing on an action plan, rehearsing brief urge-management statements, and recording successful smoke-free coping episodes to build mastery.

Perceived social support did not differ by cessation stage and was not independently associated with group membership. This likely indicates that general support is less sensitive than cessation-specific support, whose type, source, and specificity determine its effect [12]. General support may not translate into quitting unless it specifically helps workers manage urges after difficult calls or maintain smoke-free routines; interventions may need to assess and strengthen such behavior-specific support. Similarly, drinking frequency differed among groups in univariable comparison but not in the adjusted model, suggesting shared variance with the cognitive determinants; given the well-documented co-use of alcohol and tobacco and its contribution to relapse [24], brief alcohol-risk counseling may still be a useful component of workplace programs.

These findings support workplace interventions tailored to smoking status and quit intention. For smokers with no intention to quit, the first target should be smoking-rationalizing beliefs, followed by gradual enhancement of abstinence self-efficacy. For smokers intending to quit, preparation for high-risk situations, strengthening of abstinence confidence, and practice of adaptive CER are indicated. For female workers maintaining abstinence, relapse prevention should include monitoring residual social nicotine dependence and reinforcing alternatives to smoking during emotionally demanding work situations. In practical terms, these components could be delivered within the natural rhythm of call center work rather than as separate clinic visits. For example, brief (5–10 minute) post-call debriefs led by supervisors or trained peer facilitators could help workers reframe smoking-rationalizing beliefs (e.g., challenging the notion that a cigarette is the only way to recover after a difficult call); short micro-sessions during scheduled work breaks could offer alternative stress-relief routines—paced breathing, light stretching, or peer conversation—to substitute for smoking breaks; and posted or mobile app–delivered prompts could reinforce messages that lower social nicotine dependence and acknowledge small abstinence milestones. Embedding cessation support into existing work breaks and debriefs in this way may improve its feasibility and reach in this time-constrained workforce. Cessation should be framed not as an issue of individual willpower alone but as a behavior shaped by the cognitive and emotional conditions of work.

This study has several limitations. First, participants were recruited through convenience sampling from a limited occupational context, and response rates could not be calculated because the number of employees who received or viewed the invitation was unavailable; therefore, self-selection bias cannot be excluded and generalizability is limited. Second, the cross-sectional design precludes causal inference; whether cognitive factors led to cessation or cessation reshaped cognition remains unclear. Third, smoking status was self-reported and may be underreported given the stigma against female smoking in Korea [1]. Fourth, the relatively small no-plan group may have limited power to detect weaker associations. Nevertheless, this study is meaningful in that it simultaneously examined cognitive, emotional, and social correlates of cessation stage in an understudied group of female emotional labor workers. In conclusion, social nicotine dependence and abstinence self-efficacy were the most robust correlates of smoking cessation group membership, and workplace cessation interventions for female call center workers should prioritize cognitive restructuring of smoking-rationalizing beliefs and enhancement of abstinence self-efficacy, incorporating adaptive emotion regulation tailored to emotionally demanding work.