於台灣中部職場對於抽菸與嚼食檳榔防制之介入效益

勞動族群占整體人口結構的大部分，並且大多數人將近三分之一的時間花費在職場。重要的是，戒菸和戒除檳榔能夠降低嚴重疾病的風險；從長遠來看，有助於改善健康。本研究分別運用跨理論模式 (transtheoretical model) 與渥太華憲章 (Ottawa Charter) 來推動職場戒菸與戒除檳榔，並且評估介入的效應。對於菸害防制，本研究使用跨理論模式來促進職場戒菸，896名工人從台灣中部海線地區被招募。參與者在介入前的基線、以及六個月後和四年後的追蹤被評估，收集參與者對於工作場所禁菸的認知、菸害知識、戒菸態度、以及相關於菸害預防的行為之數據變化。對於檳榔戒除，根據渥太華憲章的五項行動綱領，制定工作場所健康促進計畫，問卷調查714名於不同職業的工人在介入前和介入後三個月的知識和態度的變化。對於菸害防制，六個月後的戒菸盛行率為31.5% (95%信賴區間 [CI] = 25.4-38.1%)，四年後為10.7% (95% CI = 6.9-15.6%)。在上述時間點，二手菸暴露盛行率、以及參與者對於菸害呈現正確知識的比例先降後升。看到或收到職場提供預防菸害訊息之參與者比率，從基線時的75.6%增至六個月後的95.6% (增加20.0%)，以及在四年後最終增至97.2% (增加21.6%，p < 0.001)。然而，希望職場繼續提供戒菸服務的參與者比率，從基線時的80.0%上升到六個月後的93.6% (增加 13.6%)，然後在四年後降至78.0% (減少2.0%，p < 0.001)。對於檳榔的戒除，無論參與者在介入前的嚼食狀態，他們相關檳榔戒除的知識和態度分數在介入後顯著增加。在咀嚼檳榔者之中，職業對於介入後知識和態度得分的效應是顯著的。進一步地，在介入前咀嚼檳榔且無意願戒除的138名研究對象之中，16名 (11.6%) 在介入後戒除咀嚼檳榔。檢查在介入前無意願戒除的咀嚼者之中無意願戒除的因素，相較於金屬、機械和相關行業者，電子材料製造工人具有較高戒除意願 (勝算比 [OR] = 0.15；95% CI = 0.02-0.94)，旅遊服務者、導遊、清潔工和幫工是最不願意戒除檳榔 (OR = 21.29；95% CI = 2.51-180.81)。跨理論模式在促進職場戒菸的短期效應是可觀的，但從長期來看，效應會減弱。此外，本研究藉由採用渥太華憲章框架的五項行動綱領來提升工人對於戒除檳榔的意識，介入的效應在不同的職業中有所差別，高收入和較佳教育程度的工作者對於戒除檳榔的意識較高。

關鍵字

職場；戒菸；戒除檳榔；跨理論模式；渥太華憲章；效應；知識；態度

並列摘要

The workforce makes up the bulk of the entire population, and most spend nearly a third of their time in the workplace. Notably, smoking cessation and betel nut cessation can reduce the risk of severe illness and helps improve health in the long run. This study used the transtheoretical model and The Ottawa Charter to promote workplace smoking cessation and betel nut cessation and evaluated the effectiveness of the intervention, respectively. For tobacco harm prevention, this study used a transtheoretical model to promote smoking cessation in the workplace, and 896 workers from Taiwan’s central coastline region were recruited. Participants were assessed at baseline before the intervention and after six months and four years of follow-ups. Data on changes in participants’ perception of smoking prohibition in the workplace, knowledge of the hazards of smoking, attitude towards quitting smoking, and behavior related to tobacco harm prevention were collected. For betel nut cessation, a workplace health promotion program was developed under the five action areas of the Ottawa Charter. Questionnaires were administered to examine the changes in the knowledge and attitudes of 714 workers in different occupations before and three months after the intervention. For tobacco harm prevention, the prevalence of smoking cessation was 31.5% (95% confidence interval [CI] = 25.4-38.1%) after six months and 10.7% (95% CI = 6.9-15.6%) after four years. At the abovementioned time points, the prevalence of second-hand smoke exposure and the proportion of people who demonstrated correct knowledge of smoke hazards initially decreased and then increased. The proportion of participants who had seen or received information about tobacco harm prevention provided in the workplace increased from 75.6% at baseline to 95.6% (increased by 20.0%) after six months and finally to 97.2% after four years (increased by 21.6%, p < 0.001). However, the percentage of participants who hoped their workplace continued to provide smoking cessation services rose from 80.0% at baseline to 93.6% (increased by 13.6%) after six months and then fell to 78.0% after four years (decreased by 2.0%, p < 0.001). For betel nut cessation, regardless of subjects’ pre-intervention chewing status, their knowledge and attitude scores related to betel quid cessation increased significantly after the intervention. The effect of occupation was significant on the post-intervention knowledge and attitude scores among chewers. Furthermore, 16 (11.6%) of the 138 study subjects who chewed betel quid before the intervention and had no willingness to quit did quit betel quid chewing following the intervention. The factors contributing to an unwillingness to quit among chewers with no intention to quit prior to the intervention were examined. Workers in the electronic material manufacturing industry had a greater willingness to quit compared to those in the metal, machinery, and related trades (odds ratio [OR] = 0.15; 95% confidence interval [CI] = 0.02-0.94). Travel attendants, tour guides, cleaners, and helpers were the least willing to quit (OR = 21.29; 95% CI = 2.51-180.81). The short-term effectiveness of the transtheoretical model in promoting workplace smoking cessation is substantial, but in the long-term, effectiveness weakens. In addition, this study promoted workers’ awareness of betel quid cessation by adopting the five action areas of the Ottawa Charter framework, the effectiveness of the intervention varied in different occupations. Workers with a high income and better education level were more aware of betel quid cessation.

並列關鍵字

Workplace ； smoking cessation ； betel quid cessation ； transtheoretical model ； Ottawa Charter ； effectiveness ； knowledge ； attitudes

參考文獻

文獻探討

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