以計劃行為理論檢視青少年吸菸意圖及衛教介入成效分析：臺灣北部國中生之隨機分派實驗

An Examination of Adolescent Smoking Intention and Effectiveness Evaluation of a Health Education Intervention Based on the Theory of Planned Behavior: A Randomized Controlled Trial among Junior High School Students in Northern Taiwan

王君豪(Chun-Hao Wang)

指導教授 ： 黃俊豪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2019年)

https://doi.org/10.6342/NTU201902529

摘要

背景：菸害防制為重要之公共衛生議題，吸菸亦被證實為最能被預防之死因，而在青少年族群中，菸害議題更加令人憂心：首先，根據Surgeon General之報告，八成規律吸菸者自青少年時期即開始吸菸；其次，越早開始吸菸則越難戒除菸癮，且造成更多之健康傷害；最後，成癮物質入門理論 (Gateway Drug Theory) 指出，吸菸為使用非法成癮物質之重要預測因子。然而，雖青少年之吸菸比例似乎有所下降，但根據國民健康署之調查，由國中進入高中階段後，其吸菸比例卻有明顯升高之趨勢，凸顯國中生菸害防制之重要性。
目的：本研究係以計劃行為理論 (Theory of Planned Behavior, TPB) 為基礎，設計並執行青少年菸害防制衛教介入課程，藉以檢視計劃行為理論構念預測國中生吸菸意圖之能力，並透過隨機分派實驗(randomized controlled trial)，探討是否能透過以計劃行為理論為基礎之衛教介入課程，降低國中生之吸菸意圖。
方法：立意取樣兩所臺灣北部具可比較性之公立國中，透過隨機分派實驗研究設計，將參與學校隨機分派為實驗組（425人）及對照組（392人），之後，進行連續兩周、每週一次各45分鐘之衛教課程，兩組分別為「以計劃行為理論為基礎之衛教介入」及「一般衛教介入」之課程，並藉由匿名自陳式問卷，於介入之前一週與三個月後，分別進行資料收集。統計分析時，運用性別分層以檢視其調節作用。
結果：多變項線性自迴歸分析結果顯示，實驗組於三個月後延宕後測時的吸菸意圖 (β=-.090 至 -.060) 皆顯著較對照組低，證實以計劃行為理論為架構之菸害防制衛教介入課程具有效益。其次，行為態度之正向轉變，特別是針對因吸菸所導致的立即影響 (β=.067至.099)，可預測青少年吸菸意圖之上升；主觀規範之正向轉變中，若學生感受到健康教育老師支持其吸菸，會顯著影響學生之吸菸意圖 (β=.123)；青少女於有利情境下之自覺行為控制若有正向轉變時，其吸菸意圖會顯著上升 (β=.112)，且於阻礙情境下，其吸菸意圖會受性取向調節 (β=.212)。
結論：整體而言，為降低青少年之吸菸意圖，需著重於降低其對於吸菸之正向態度，特別是針對吸菸所帶來之立即影響，而對於青少男，則可著重於降低其重要他人之支持程度，對於青少女，於行為態度之外，則可戮力於減少有利情境之發生，值得一提的是，青少女之性取向為影響其吸菸意圖之調節因子。因此，未來需針對不同性別與性取向之青少年，規劃適性之菸害防制課程，且以計劃行為理論為架構，優化衛教介入之成效。

關鍵字

隨機分派試驗 ； 計劃行為理論 ； 吸菸意圖 ； 衛教介入 ； 國中生 ； 臺灣

並列摘要

Background: Smoking prevention is a crucial public health issue, and smoking has also been proven to be the most preventable cause of death. Youth smoking, in particular, is worrisome in the following ways: First, according to the Surgeon General’s report, almost 80% of regular smokers start smoking since adolescence. Second, smoking is more difficult to quit and more harmful for young smokers. Finally, the Gateway Drug Theory posits that smoking predicts the use of other addictive substances. Although the prevalence of smoking among Taiwanese adolescents seemed to have declined, according to the 2017 Taiwan Health Promotion Administration survey, the prevalence of smoking jumped from 2.7% among junior high to 8.3% among senior high school students, highlighting the importance of smoking prevention for junior high school students.
Objectives: Based on the Theory of Planned Behavior (TPB), this randomized controlled trial evaluated whether the smoking prevention program could lower the smoking intention among junior high school students.
Methods: Two comparable public junior high schools in northern Taiwan were selected through purposive sampling and randomly assigned to the experimental group (n=425) and the control group (n=392). Two weekly 45-minute health education sessions were provided to the participants, with “TPB-based” and “general” health education intervention in the experimental and control groups, respectively. Data were collected using an anonymous self-administered questionnaire at pretest and 3-month follow-up. Statistical analysis was stratified by gender to examine its moderating effects.
Results: The multivariate linear autoregression models revealed that, after adjusting for students’ smoking intention at pretest, background characteristics, and TPB constructs, the students’ smoking intention of the experimental group was significantly lower than that of the control group (β=-.090 to -.060) at 3-month follow-up, demonstrating that the TPB-based intervention was effective in reducing smoking intention among junior high school students. Further, positive changes in the following TPB constructs between pretest and follow-up predicted students’ higher smoking intention at follow-up: (1) ATB, especially for short-term outcomes of smoking (β = .067 to .099); (2) SN, when students perceived health educators to be supportive or not strongly unsupportive of their smoking (β=.123); (3) PBC, among girls under facilitating conditions of smoking (β=.112), and only among non-heterosexual girls under constraining conditions (β=. 212).
Conclusions: In order to reduce junior high school students’ smoking intention, future smoking prevention campaigns can employ the TPB as the theoretical framework for the development and implementation of their health education programs. To decrease students’ smoking intention, efforts should be made to change their positive attitudes toward smoking, especially about the short-term effects of smoking. For boys, decreasing their perceived support for smoking from salient others should be emphasized. By contrast, for girls, focus should be on reducing the facilitating conditions for smoking. Notably, girls’ sexual orientation had moderating effects on their smoking intention. As such, different strategies should be tailored for students of different genders and sexual orientation. These empirical findings can inform future smoking prevention programs for junior high school students.

並列關鍵字

Randomized Controlled Trial ； Theory of Planned Behavior ； Smoking Intention ； Health Education ； Junior High School Students ； Taiwan

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