青少年吸菸及飲酒行為與其生活品質之關係：個人、人際及環境層級因素之探討

Relationships of Adolescent Tobacco and Alcohol Use with Their Quality of Life: Exploring the Individual, Interpersonal, and Environmental Influences

郭佩純(Pei-Chun Kuo)

指導教授 ： 鄭守夏 ； 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/博士(2022年)

https://doi.org/10.6342/NTU202200115

摘要

背景：物質使用與健康及生活品質相關，尤其青少年族群更容易受到與使用物質相關的傷害，特別是因物質引發的相關死亡，此外，青少年物質使用與其性別、父母、同儕的物質使用、環境因素有關。然而，過往的研究主要集中在青少年與同性別父母或使用同類型物質的關聯性進行探討，且較缺乏環境對青少年吸菸和酒精使用之影響，及物質使用對青少年生活品質的相關性之本土資料。故，本研究欲從個人、人際關係和環境因素層面探討男女青少年之物質使用及其生活品質之關係。
方法：研究資料係使用 2014 年全國物質使用調查資料庫，共收集4,445 名 12-17 歲之青少年。該調查採分層、多階段、PPS (Probability Proportional to Size)、等機率之抽樣架構，利用觸控式平板電腦之語音-電腦輔助式自我訪談問卷進行資料收集。此外，環境層級變項之測量係使用社會經濟資料服務平台，包含人口普查、內政部和財政部相關資料。三個研究分別使用不同之分析策略：多變量邏輯式迴歸、潛在剖面分析及最小平方法邏輯式迴歸。
結果：青少年飲酒行為在男性與女性都發現，若同儕飲酒則會提高其飲酒之風險(adjusted odds ratio [aOR]=2.57-5.37)，此外，跨越不同性別的父母親，及跨越不同類型物質使用的父母親，與不同性別之青少年飲酒有不同程度之影響性。另，不論性別的青少年吸煙行為亦發現與同儕飲酒有相關 (aOR=3.18-26.35)。然而，在青少年吸菸行為上，僅發現與同性別的父母和使用同種物質的父母親相關。環境層級的因素發現，不論在低或高物質誘惑地區的男性和女性青少年飲酒，皆與母親 (aOR=1.62-2.38) 及同儕 (aOR=2.60-5.65) 飲酒有關。此外，青少男女自身的危險行為與飲酒行為相關僅出現在高物質誘惑地區。另，在高物質誘惑低區，若同儕飲酒 (aOR=5.24) 及青少年翹課 (aOR=5.23) 則與青少男吸煙相關，有性行為經驗則與青少男、女皆相關。最後，不論男性 (β= −0.34, 95% CI −0.08- −0.05)或女性 (β= −0.17, 95% CI −0.06- −0.03) 青少年若有憂鬱之情形，則其生活品質分數較低，若生活在單親家庭之青少女 (β= −0.14, 95% CI −0.03- −0.01) 亦發現有較低之生活品質分數。
結論：父母和同儕之物質使用與青少年使用酒精和煙草存在顯著的性別差異。此外，跨越不同性別之父母及跨越物質之使用對青少年的物質使用有不同之影響。另，在跨越環境特性，高物質誘惑地區，亦發現與男性和女性青少年之較高物質使用風險有關。憂鬱對於不同性別的青少年都發現與較低之生活品質分數相關。本研究之發現，可做為未來針對不同性別青少年之物質使用預防介入，提供性別觀點之相關訊息，尤其是在父母、同儕及其青少年自己的物質使用行為著手，另，同時亦需重視改善青少年之心理健康對其生活品質之促進的重要性。

關鍵字

青少年 ； 飲酒 ； 吸菸 ； 父母 ； 同儕 ； 環境因素 ； 生活品質 ； 性別差異

並列摘要

Background: substance use is a major problem related to health and quality of life. Adolescents are generally more vulnerable to substance use related harm，in particular, substance-related deaths. Adolescent substance use was found related to parental, peer substance use, environment factors, and differ by gender. However, previous researches mainly focus on the adolescents’ substance use association with the same type of substance or same gender of parents. Furthermore, environmental associated with adolescent tobacco and alcohol use, above and beyond individual and interpersonal influences were relative fewer information in Taiwan. Therefore, this study investigated the relationship of individual, interpersonal, and environment factors and adolescents’ substance use and quality of life.
Methods: Data were derived from 4,445 adolescents aged 12–17 years from the 2014 National Survey of Substance Use. The survey inquired about the use of various psychoactive substances in a nationally representative sample of non-institutionalized individuals in Taiwan who were 12 to 64 years old and available for a face-to-face interview. Further, measures of environmental factors were obtained from 2010 data from several administrative sources, including the Taiwan Census, Ministry of Interior, and Ministry of Finance. Environmental-level variables regarding tobacco and alcohol access were obtained from the Internet. Each part of study was use different kind of analysis strategy: multivariate multinomial logistic regression, latent profile analysis, and ordinary least squares.
Results: Adolescents’ drinking behavior was found that peer alcohol use was the strongest variable (adjusted odds ratio [aOR]=2.57-5.37). In addition, cross-gender and cross-substance of parental alcohol and tobacco use were related to varying drinking levels among male and female adolescents alcohol use. Further, adolescents’ smoking behavior was found that peer drinking was the strongest variable (aOR=3.18-26.35). However, same-gender and substance of parental substance use were related to varying smoking levels among male and female adolescents tobacco use. In the low and high substance temptation areas, maternal (aOR=1.62-2.38) and peer dinking (aOR=2.60-5.65) were related to higher risk of adolescents’ alcohol use among male and female. In addition, adolescents’ own risk behaviors associated with higher risk of adolescents’ drinking only in the high substance temptation area. Moreover, peer drinking (aOR=5.24) and truancy (aOR=5.23) were associated male adolescents’ smoking, and who have sexual experience associated with higher risk of male and female adolescents’ smoking, in the high substance temptation area only. At last, depressive symptoms was found the strongest variable related to lower scores of quality of life among male (β= −0.34, 95% CI −0.08- −0.05) and female (β= −0.17, 95% CI −0.06- −0.03) adolescents. Living in single parent family (β= −0.14, 95% CI −0.03- −0.01) was related to lower scores of quality of life only among female adolescents.
Conclusion: Significant gender differences were found between parental and peer substance use and adolescents’ problematic alcohol and tobacco use. Specifically, the intergenerational parental role-modeling associated with smoking on offspring’s drinking were only significant in mother-daughter dyads. Higher substance temptations area was related to male and female adolescents’ problematic substance use. Depressive symptoms were consistence related to adolescents’ lower scores of quality of life. These findings could inform multifaceted adolescent substance use prevention programs, tailoring for males and females and also targeting their parental and peer substance use. To raise the importance of mental health to improve adolescent quality of life.

並列關鍵字

Adolescents ； Alcohol use ； Tobacco use ； Parents ； Peers ； Environmental factors ； Quality of life ； Gender differences

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