應用PRECEDE模式探討高屏地區山地國小學童 吸菸行為及其影響因素

The Application of the PRECEDE Model to Understanding the Factors Associated with Children’s Smoking Behavior in Mountainous schools in Kao-Ping Areas of Taiwan.

張鳳惠(Feng-Hui Chang)

指導教授 ： 黃曉靈

共同指導教授 ： 嚴雅音(Yea-Yin Yen)

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00106

摘要

中文摘要
背景：
菸草使用是導致慢性疾病主要的危險因素之ㄧ，包括口癌症、肺癌、心血管疾病和其他疾病。菸害已成為國際重要的公共衛生議題。吸菸會致成癮性，但為可預防性死亡的主要死因。
國內外研究顯示吸菸盛行率在城鄉是有顯著差異，居住於山區吸菸盛行率高於平地；近年來開始或嘗試吸菸年齡呈下降趨勢，甚至年僅10歲即開始吸菸。從這趨勢來看，青少年預防吸菸在非常早的年齡是需要的。因此，對於山地學童開始吸菸的個人特質和環境相關因素是值得探討的問題。
PRECEDE-PROCEED模式為健康教育與健康促進常用的理論與模式，乃一完整有系統評估的模式，被廣泛運用於有關健康促進與經由衛教改變健康行為、學校、健康政策等相關議題。本研究應用PRECEDE 模式中第四階段的教育因子探討素質因素、增強因素及使能因素與高屏地區山地國小學童吸菸行為及其相關影響因素。
目的：
應用PRECEDE模式中的教育因子探討素質因素（吸菸的態度、菸害的知識）、增強因素（好朋友吸菸、同住家人吸菸、學校教職員吸菸）及使能因素（香菸的可近性、香菸的可獲得性、學校菸害管制措施）與高屏地區山地國小學童吸菸行為及其相關影響因素。
方法：
研究對象為高雄縣及屏東縣就讀山地鄉國小96-97學年度3-6年級的學童，以集束抽樣（cluster sampling），選取20間山地鄉學校，共取得有效樣本1,032份。採用多元式邏輯斯迴歸分析學童的吸菸行為（從未/曾經/目前）與素質因素、增強因素及使能因素相關性。
結果：
結果顯示高屏地區山地學童「曾經」及「目前」吸菸行為盛行率分別為20.7%及7.4%（屏東及高雄縣吸菸行為無顯著差異），第一次吸菸年級以國小三年級為最高；控制干擾因素後，山地鄉學童「曾經」及「目前」吸菸行為的影響因素為吸菸態度（分別的Odds ratio (OR)= 2.02 與5.05）、菸害知識（Odds ratio (OR)= 1.89）、好友吸菸行為（分別的OR=5.87與16.08）、學校教職員吸菸行為（分別的OR=1.71與3.06），學童察覺在校老師（包含辦公人員）及訪客吸菸人數比率偏高（分別為38.8% 與41.1%）。雖然使能因素與學童吸菸行為並無顯著相關，其他資料顯示70.3%學童表示「有買過香菸」與87.3%表示店員會賣菸給他。其它顯著影響學童「曾經」及「目前」吸菸行為的因素有飲酒（分別的OR=4.19與3.43）及嚼食檳榔（分別的OR=1.76與4.79）。
結論：
素質因素(吸菸態度、菸害知識)及增強因素（好朋友及學校教職員吸菸行為）與山地鄉國小男童吸菸行為有顯著相關，研究也證實吸菸與飲酒、嚼食檳榔之間的相關。學童在校感受老師（包含辦公人員）及外來訪客吸菸人數高達四成，其他資料顯示有七成以上學童表示曾經買過香菸且老闆或店員會賣菸給他；另學童第一次吸菸以國小三年級人數為最高。
建議學校落實校園菸害防制政策，推廣菸害教育課程或活動，應於三年級以前施行衛教介入，強化學童菸害知識與正向態度，並同時加強吸菸、飲酒及嚼食檳榔行為。另應加強社區嚴格執行未成年購買香菸規範及學校嚴謹落實校園禁菸規定，以減少青少年吸菸的可能性。

關鍵字

PRECEDE 模式 ； 吸菸 ； 兒童 ； 學校

並列摘要

Background:
Tobacco use is one of the main risk factors for a number of chronic diseases, including oral cancer, periodontal, lung disease, and cardiovascular diseases. In Taiwan, the students in the mountain schools have reported higher prevalence of having tried cigarette smoking compared to students from city schools. The individual and environment-related factors associated with children’s smoking in mountainous area are worth exploring.
Objective:
Applying the education factors of the PRECEDE Model to discuss the association among the Predisposing factors (tobacco-related knowledge and attitude toward smoking), reinforcing factors (smoking status of peer, family and school staff), enabling factors (accessibility and availability of cigarettes, school policy) and children’s smoking behavior in ountainous schools in Kao-Ping Areas of Taiwan .
Methods:
We used the multistage cluster sampling to obtain a representative sample of 3rd to 6th grader in 20 mountainous elementary schools (n=1032). Polytomous logistic regression was used to analysis the relationship between students smoking behavior (Never”/”Ever”/”Current”) and three educational factors.
Results:
The results showed that prevalence of ever and current smoking among children in mountainous school was 21% and 8%, respectively. Other analysis showed that smoking by school children for the first time the number of third graders in the highest (25.5%).After controlling for confounding factors, the significant factors for children’s ever and current smoking behavior attitudes (odds ratio (OR) = 1.08 and 1.19), friends smoked (OR= 4.57and 14.86), school staff smoked (OR = 1.65 and 3.13). Students perceived high rates of smoking teachers and visitors at school (38.8% and 41.1%, respectively). Enabling factors were found to be no significantly correlated to children’s smoking.There are70.3% of students were ever bought cigarettes and 87.3% the boss or clerk could sell the cigarettes to them. Other significant factors on ever and current smoking behavior were alcohol consumption (OR = 4.19 and 3.43) and betel nut chewing (OR = 1.76 and 4.79). Other significant impact on students "ever" and "current" smoking behavior factors are alcohol consumption (OR = 4.19 and 3.43), and betel nut chewing (OR = 1.76 and 4.79, respectively).
Conclusion:
The predisposing factors (attitude toward smoking), and reinforcing factors (best friends and school staff smoked) were significantly related to students’ cigarettes smoking in those mountainous primary School.

並列關鍵字

PRECEDE Model ； Smoking ； Children ； School

參考文獻

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