學生四至十二年級嚼檳榔行為之變化研究：軌跡類型及初次嚼檳榔時間

Changes of Betel Nut Chewing among Students from 4th to 12th Grade: Behavior Patterns and Onset of Betel Nut Chewing

李琪瑞(Chi-Jui Lee)

指導教授 ： 李蘭

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2013年)

https://doi.org/10.6342/NTU.2013.00190

摘要

目的：探討學生四至十二年級嚼檳榔行為的發展軌跡類型及初次嚼檳榔時間，並進一步找出影響因素。
方法：以兒童與青少年行為之長期發展研究計畫，2001年就讀國小四年級學生2687人中，選取2001至2009年間完整回答嚼檳榔、吸菸、飲酒行為或重要自變項題組，可納入軌跡類型分析的研究樣本共2295人，從個人、環境與其他行為層面，探討影響四至十二年級嚼檳榔行為發展軌跡類型的因素，運用群體基礎軌跡模型與羅吉斯迴歸模型進行統計分析。為探討初次嚼檳榔時間及其相關因素，將四年級已嚼檳榔者排除後，進行存活分析的研究樣本共2043人。
結果：1.研究樣本各年級有嚼檳榔的比率，以十二年級時最高（3.46%），六年級時最低（0.29%）。嚼檳榔的發生率以十一及十二年級0.02最高，初次嚼檳榔之風險機率以十一年級0.02最高，五至十二年級從未嚼檳榔的機率為0.93（累積初次嚼檳榔機率為0.07）。2.嚼檳榔的發展軌跡類型共有兩類，「持續不嚼組」佔總樣本93.90%；「明顯上升組」佔6.10%。3.相較於「持續不嚼組」，男性、居住於新竹縣、家庭支持下降、國或高中同儕有嚼檳榔、吸菸機率上升、飲酒機率持續中度或上升者，較可能成為嚼檳榔之「明顯上升組」。4.男性、居住於新竹縣、同儕有嚼檳榔、有吸菸、飲酒行為者，較早初次嚼檳榔的可能性較高。
結論：嚼檳榔比率隨年級增加而上升，十一年級為四至十二年級學生初次嚼檳榔時間之關鍵年級。男性、居住於新竹縣、有同儕嚼檳榔、吸菸、飲酒行為，為嚼檳榔機率明顯上升及較早初次嚼檳榔的顯著影響因素。建議國小階段即開始預防，將男性、有吸菸或飲酒行為、學業表現不好與家庭支持呈下降趨勢的學生納入考量，並且營造不嚼檳榔的支持環境。政策上重視吸菸、飲酒與嚼檳榔的群聚效應，進行檳榔防制工作。

關鍵字

檳榔 ； 學生 ； 長期追蹤 ； 群體基礎軌跡模型 ； 存活分析

並列摘要

Objective: To investigate behavior patterns, onset of betel nut chewing, and the influential factors among students from 4th to 12th Grade.
Methods: Data was obtained from the second cohort of the Children and Adolescent Behaviors in Long-term Evolution project. The original sample numbers were 2,687 students on 4th Grade. Participants included 2,295 students who were followed from 4th to 12th Grade(2001-2009) and completely answered specific items for group-based trajectory model and logistic regression analysis. On the other hand, after excluding the missing values and already had chewed betel nuts on 4th Grade, 2,043 participants for survival analysis. 5 individual-level factors, 6 environmental-level factors, and other 2 behavior-level factors were studied the relation to the behavior patterns and onset of betel nut chewing.
Results: 1.The highest proportion of betel nut chewing among nine grades was on 12th Grade(3.46%), and the lowest proportion was on 6th Grade(0.29%). The highest incident rate of betel nut chewing was 0.02 on 11th and 12th Grade. Besides, the highest hazard rate of beginning betel nut chewing was 0.02 on 11th Grade. During nine years, the cumulative proportion of never chewing was 0.93. 2.There were 2 trajectory patterns of betel nut chewing, including "continuing not chewing"(93.90%) and "the chewing probability obviously increasing"(6.10%). 3.Male, living in Hsinchu County, having had experiences on smoking or drinking, and surrounding peers or friends chewing betel nuts, which caused the increasing chewing probability and earlier onset of betel nut chewing.
Conclusion: The proportion of betel nut chewing increased with time going by, and 11th Grade might be the critical time of onset among students from 4th to 12th Grade. Based on the findings we recommend that the betel nut prevention should start from the elementary-school stage, construct supportive environment without betel nuts, and consider male students with having had smoking or drinking experiences, poor course performance, or poor family support to educate. On political aspect, we should place importance on the cluster effect between smoking, drinking, and chewing betel nuts together when progressing betel nut prevention programs.

並列關鍵字

betel nut ； student ； longitudinal research ； group-based trajectory model ； survival analysis

參考文獻

李景美、張鳳琴、賴香如等人：台北縣市高職學生開始使用成癮物質之危險與保護因子追蹤研究。臺灣衛誌2008；27：399-410。

李燕鳴、張慈桂：原住民與漢族青少年之身心症狀和不利健康生活型態的差異。慈濟醫學1999；11：237-45。

李蘭、林慧宜、晏涵文：預防國中生嚼檳榔之教育效果。醫學教育1998；2：49-64。

李蘭、孫亦君、翁慧卿：台北市國中生物質濫用行為之預測因子。醫學教育1998；2：420-8。

李蘭、晏涵文、劉潔心、關學婉、季瑋珠、林瑞雄：嚼檳榔預防教育先驅研究(Ⅰ)-國中生嚼檳榔現況及影響因素之初探。中華衛誌1992；11：285-94。