校園菸害防制政策與學童吸菸行為之多層次分析研究

School Policy for Tobacco Control in Relation to Cigarette Smoking among Children: A Multilevel Study

黃正銘(Cheng-Ming Huang)

指導教授 ： 黃曉靈

共同指導教授 ： 嚴雅音(Yea-Yzn Yen)

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士班/碩士(2009年)

https://doi.org/10.6832/KMU.2009.00104

摘要

背景：近年Flay等學者提出Theory of Triadic Influence（TTI）多層次理論，指出學童吸菸行為會受到個人社會人口學特質，個人相關的社會環境特質與廣泛的社會環境特質三種層次影響。影響學童吸菸行為之個人社會人口學特質，個人社會環境特質已有很多專家者探討，但只有少數學者探討廣泛的社會環境特質的影響。
研究目的：因此本研究以多層次理論架構與分析探討學校與個人層次特質在國小學童吸菸行為類聚現象之相關。
研究方法：本研究以橫斷式研究設計，以班級為單位，採分層集束隨機抽樣方式選取屏東縣26間國小，並於2008年收集三至六年級學童及其家長、學校教職員之吸菸行為、學校層次結構性與學校菸害防制政策及個人層次特質。有效學生樣本數2,350(回覆率:94%)、家長樣本數3,726(回覆率:75%)與教職員樣本數52位(回覆率:100%)。以多層次邏輯斯迴歸分析，解釋影響學童吸菸行為的個人層次與學校層次相關因素。
結果：研究結果發現學校特質與個人特質對於學童吸菸行為都有影響的效應，可解釋變異量分別為72%與48%。而未推廣戒菸輔導或活動的學校相較於有推廣學校的學童有吸行為的危險率比較高(OR=3.56, 95% CI=1.53-8.28)及學生就讀於山地學校相較於都市型學校的學童有吸菸行為的危險比也比較高(OR=3.23, 95% CI=1.17-8.97)，這些政策的施行情況對於學童個人吸菸行為具有顯著影響。同時在學校感受他人吸菸頻率、朋友與家人在面前吸菸頻率、喝酒與嚼食檳榔之行為，亦顯著影響學童曾經吸菸行為。
結論：本研究建議教育與衛生機構能重視高風險學校及加強校園菸害防制政策與推廣活動，減少國小學童吸菸行為之發生。

關鍵字

學童 ； 吸菸行為 ； 多層次理論 ； 校園菸害防制政策

並列摘要

Background：The Theory of Traidic Influence (TTI) by Flay et al suggests that youth smoking is influenced by factors from three domains: intrapersonal factors, socio-environmental factors and broader contextual factors. Many researches have examined the influence of intrapersonal and socio-environmental factors on children smoking; however lack of study explored the realtion of socio-environmental factors and children smoking.
Study objective：The aim of this study was using a multilevel-based study to comprehensively assess the impact of school- and individual-level characteristics in relation to cigarette smoking clustering among elementary schoolchildren.
Methods：This was a cross-sectional study and selected by a random stratified cluster sampling method, where the sampling unit was the school for this study. Data were collected from the sample of 3rd to 6th grade pupils’ (n=2,350；response rates 94%)and their parents’ (n=3,726；response rates 75%), and staff’s (n=52；response rates 100%) smoking behaviors, the struction and school tobacco control policies factors and individual characteristic at 26 elementary schools in Pin-Tung county. The individual- and school-level characteristics regarding smoking were estimated using multi-level logistic regression.
Results：The study found school effects were large in comparison to individual-level effects, and the additional variance which explained 85% and 48% effects. The risk of smoking was significantly associated with those schools without having any anti-tobacco acitivities or curricula [odds ratio (OR)= 3.56, 95%CI=1.53-8.28] and schools located in a mountainous region (OR=3.23, 95% CI=1.17-8.97) while controlling for individual-level characteristics. Other observed individual-level characteristics having a significant relationship to student smoking behavior were immediate social environmental factors in which best friends and family smoked as well as drinking alcohol and chewing betel nuts .
Conclusion：The findings suggest that effective tobacco control policies and preventive programs should be strongly considered for implementation in elementary schools that are putting children at the greatest risk for cigarette smoking.

並列關鍵字

Schoolchildren ； smoking behavior ； mulitilevel study ； tobacco- control policy

參考文獻

參考文獻

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