基隆市國中二年級學生開始吸菸行為與學校環境因素之相關

Exploring the correlation between school environment and the smoking onset behavior of 8th grade students in Keelung

廖沛伶(Pei-Ling Liao)

指導教授 ： 陸玓玲

中山醫學大學/健康管理學院/公共衛生學系碩士班/碩士(2009年)

https://doi.org/10.6834/CSMU.2009.00075

摘要

目的：以社會認知理論為理論依據，使用多層次分析方法探討學校層次因素和個人層次因素對於國中二年級學生開始吸菸之影響。 材料與方法：本研究以「九十七年基隆市兒童、青少年在學學生菸害暨健康行為問卷調查及分析評估」為資料來源，基隆市在學之國中學生經由集束抽樣，得438名國中二年級學生為個人層次之樣本，13間學校為學校層次之樣本。以Bandura社會認知理論之概念作為研究理論依據，使用多層次分析法近行統計分析，自變項分為二個層次，在個人層次部分之變項包括：購菸經驗、性別、自我效能(拒菸自我效能)、強化作用(吸菸態度、親友對受訪者吸菸之態度)、結果預期(菸害知識)、環境(家庭狀況、父母親教育程度、就讀學校全面禁菸規定)、情境(親子關係)、觀察學習(親友吸菸狀況、校內外吸菸環境、二手菸暴露狀況)；在學校層次之變項包括：觀察學習(校園吸菸風氣)、環境(校園禁菸環境、校園禁菸政策落實程度)，依變項為開始吸菸行為，分為「從未吸菸者」、「入國中後開始吸菸者」兩類，經ICC（組內相關係數）檢定，學生開始吸菸行為在各學校間具有不可忽略的差異性，應以多層次邏輯斯迴歸進行分析。本研究以SAS9.1版統計軟體進行描述性統計、雙變項分析，以HLM6.0版統計軟體進行多層次回歸分析。 研究結果：就社會認知理論之架構，影響行為之因素包括環境、情境、行為能力、結果預期、結果期望、自我控制、觀察學習、強化作用、自我效能、情緒應付反應、交互決定論，經多層次分析結果發現，影響國二學生開始吸菸行為之因素包括：在個人層次中個人因素有自我效能(拒菸自我效能低)，強化作用(對吸菸的態度正向)；小環境因素有環境(單親家庭)，觀察學習(母親為吸菸者，手足為吸菸者、好朋友為吸菸者、同學中有人吸菸、有發現校 I II 內學生、教職員吸菸)；在學校層次有觀察學習-校園吸菸風氣(國三學生吸菸率)。 結論與建議：本研究以社會認知理論為理論依據，使用多層次分析方法驗證出社會認知理論中部分概念(環境、自我效能、強化作用、觀察學習)與國二學生開始吸菸行為有相關。依研究結果提出以下建議：1.本研究使用次級資料分析，有些社會認知理論之概念無法納入分析，未來研究可以利用調查資料再針對本研究尚未測到之概念(行為能力、結果期望、情緒反應)進行討論。2.家人的吸菸行為明顯影響國二學生吸菸開始行為，本研究結果可以提供衛生及教育單位針對提升家人認知自身對學生的影響力，進而約束自身吸菸行為，降低青少年學習吸菸的機會。3.同儕吸菸狀況為學生開始吸菸行為之主因之ㄧ，建議教育單位可增加學生抵抗同儕壓力的課程內容。4.建議教育實務者控管校園內吸菸風氣，禁菸政策應落實，避免學生在校內觀察到有人違規吸菸行為，尤其教職員本身對校園中建立學生禁菸的角色楷模仍待加強。

關鍵字

青少年開始吸菸行為 ； 學校環境因素 ； 多層次分析 ； 社會認知理論

並列摘要

Objectives: The purpose of this study was to examine the relationship between school environment and onset of smoking behavior using multilevel logistic analysis based on the social cognitive theory among eighth graders in Keelung City.
Method: Four hundred and thirty eight representative grade 8 students of 13 schools were cluster selected from Keelung junior high school students. To explore the relationship between individual level［the experience of buying cigarette, gender, Self-efficacy (refusal self-efficacy), Reinforcements (smoking attitude, family attitude toward smoking, friend attitude toward smoking), Outcome Expectations (knowledge about the risk of smoking), Environment (the parent’s marital status, parent’s education, the rules of total smoking ban in school), Situations (the relationship between offspring and parent), Observational Learning (Smoking state: friend, parent, sibling, smoking in outside and inside of the school, secondhand smoking exposure) ］and school level［Observed Learning (atmosphere of smoking in school), Environment (school-based smoke-free environment, school-based smoke-free policy enforcement) ］. The subjects were divided into two groups (never smoking and begin smoking after junior high school) to examine the relationship between the environment and smoking. According to the Intra-Class Correlation (ICC) which examined the difference between students’ onset of smoking and the school environment, the author used multilevel logistic analysis in the present study.
Results: The influence of onset smoking behavior among grade 8 students not only in individual levels: Self-efficacy (lower self-efficacy to reject smoke), Environment (single parent family) , Reinforcements (positive attitude toward smoking), Observational Learning (parent smoking、sibling smoking, closed
III
IV
friend smoking, classmate smoking, seeing smoking of classmate and office employee in school), but also in school levels: Observational Learning－atmosphere of smoking in school( the prevalence of grade 9 students in the school) was confirmed.
Conclusions: Based on social cognitive theory, this study confirmed the factors associated with teenagers’ onset smoking behavior included Environment, Self-efficacy, Reinforcements, Observational Learning. Accordingly, the author suggested that: 1.This research uses secondary analysis, the concepts of some social cognitive theories are not able to contain in this research. Expecting future research can utilize these survey materials to examine and discuss some of non-done concepts. (ie: behavior capacity, expectations, emotional coping responses). 2. The smoking behavior of family obviously influences grade 8 student’s smoking onset behavior., this result of study can provide the hygiene department and education board to improve family’s influences power to the student, and then restrain oneself from smoking behavior, reduce the chances that teenagers learns to smoke. 3. One of main reason begins student smoking onset behavior is the same generation issue. Propose the education board can encourage rise the number of students to resist the peer pressure to the same generation. 4. Advise educational stuff accuses of begin in charge to smoking issues within the campus, prohibiting, prevent students observe someone smoke behavior in violation of rules and regulations in campus. Especially, administrative and teaching stuffs play an important role model for students to smoking. They may be the key persons to build up a smoking-free school for teenagers.

並列關鍵字

initiation ； adolescent ； smoking behavior ； environment of school ； multilevel logistic analysis ； social cognitive theory

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