吸菸青少年之戒菸行為相關因素探討

背景：18歲以下的青少年吸菸率越來越高，雖然大多數的吸菸青少年有戒菸意圖，但是真正戒菸成功的比率卻很低。行政院國民健康局在2004年開始實施戒菸門診，提供18歲以上的成人戒菸服務，但目前青少年可使用的戒菸管道只有戒菸專線及醫療機構開設的戒菸班。青少年戒菸行為是複雜的，也容易受到不同因素影響，使得青少年在戒菸時容易再復發。所以了解青少年在戒菸各階段的影響因素，針對行為改變各階段提供有效的策略是重要的。目的：本研究目的是從青少年戒菸班人員觀點調查吸菸青少年戒菸成功失敗因素和復發高危險情境，以及從吸菸青少年經驗探討青少年戒菸行為之過程及影響因素。方法：本研究方法主要使用量性以及質性研究。量性研究主要針對全台611家有合約戒菸門診之醫療院所篩選出的117家有開設青少年戒菸班醫療院所之承辦人員進行自填式問卷調查。而質性研究是針對北中南東各地區22位有吸菸經驗青少年進行深度訪談，瞭解其戒菸過程。結果：量性研究結果顯示青少年戒菸班人員樣本認為，青少年戒菸成功最主要因素為有明確的戒菸動機(63.8%)；戒菸失敗最主要的因素為同儕誘惑(84.5%)；戒菸復發高危險情境最常見的也是同儕誘惑(95.7%)。青少年戒菸班人員認為在不同戒菸階段中，從無意圖戒菸至意圖戒菸最重要的策略為朋友的支持鼓勵(62.9%)；從意圖戒菸至戒菸行動最重要的策略為學習拒絕吸菸引誘(69.0%)；維持戒菸行為之最重要的策略為強化戒菸意志力及信心(81.9%)。質性研究結果發現，吸菸青少年樣本認為在戒菸過程各階段之影響因素也不同，讓青少年從意圖戒菸到真正開始行動戒菸的影響因素為親自感受到健康的威脅以及菸價上漲負擔變重時；容易復發的高危險情境是與吸菸朋友聚會、心情和精神不好時；能夠維持戒菸行為並且成功的因素是有堅強的動機與意志力、改變菸品及二手菸暴露的環境、轉移注意力、慢慢發現戒菸的好處，以及家人朋友的支持。另外，吸菸青少年樣本認為，吸菸對健康的傷害沒有累積性，就算已有意圖戒菸，但是卻設定真正戒掉菸是未來的事，這現象是造成目前青少年有高比例意圖戒菸，但戒菸行動與成功率相對於偏低的因素。結論：青少年戒菸行為受到環境及同儕的影響很大。青少年對於健康威脅感低，是導致青少年擁有高意圖戒菸卻沒有行動力的原因。青少年若擁有強烈動機與意志力，並且改變二手菸暴露與易取得菸品的環境，可以增強並維持青少年戒菸行為。

關鍵字

青少年；戒菸行為；相關因素；跨理論模式

並列摘要

BACKGROUND: Despite the high prevalence of smoking cessation attempts among adolescents aged less than 18 years, the proportion of success is low, and the smoking rates among this population continue to grow. To combat this trend, in 2004 the Bureau of Health Promotion (BHP) in Taiwan initiated a new program utilizing smoking cessation clinics as a platform to conduct pharmaceutical and behavioral interventions. However, since pharmaceutical treatment for smoking cessation is restricted to adult smokers aged 18 and older, adolescent smokers can only rely on behavioral interventions. Smoking cessation behavior among adolescents is complex, and even among those that do quit, the long-term success rates are low on account of the strong temptation to resume smoking among this age group. Therefore, it is important to investigate what factors influence the efficacy of behavioral interventions targeting this population. PURPOSE: The purpose of this study was to explore factors influencing the success and failure of smoking cessation among adolescents as well as to identify which situations are high-risk for relapse from the perspective of smoking cessation health professionals. We further sought to better elucidate the smoking cessation process among this age group from the perspective of adolescent smokers themselves. METHODS: This study employed a dual-arm approach to investigate adolescent smoking cessation behavior both quantitatively and qualitatively. In the quantitative arm, we utilized a self-administered mailed questionnaire census survey given to smoking cessation health professionals regarding adolescent smoking cessation. These health professionals were sourced from 117 smoking cessation departments with adolescent smoking cessation classes, which were in turn drawn from a total of 611 smoking cessation departments affiliated with nationwide BHP contracted hospitals and health centers in Taiwan providing both pharmaceutical and educational interventions for adult smoking cessation in 2012. The qualitative arm of this study consisted of the in-depth interviews of a purposive sample of 22 adolescents. The residences of these adolescents were evenly distributed geographically across Taiwan, and their results were used to better understand the smoking cessation process from their perspectives. RESULTS: The results of the quantitative arm of this study demonstrated that smoking cessation health professionals regarded the most important factor influencing the success of adolescent smoking cessation to be a clear motivation to quit (63.8%), the most important factor influencing contributing to the failure of adolescent smoking cessation to be peer temptation (84.5%), and the most dangerous situation for smoking relapse to also be peer temptation (95.7%). Smoking cessation health professionals also thought that that most important strategy aiding the transition from having no intent to quit to having an intent to quit among adolescents was to utilize support and encouragement (62.9%). They also thought that the most important strategy encouraging adolescents with an intent to quit to actively engaging in smoking cessation was to learn how to reject smoking temptations (69.0%), and that the most important strategy for maintaining smoking cessation was to strengthen smoking cessation determination and confidence (81.9%). The results of the qualitative arm of this study demonstrated that among the sampled smoking adolescents, a feeling of threatened health and an increased burden of the price of cigarettes encouraged smoking adolescents from having an intent to quit smoking to actually engaging in smoking cessation. The in-depth interviews also revealed that not being in a good mood and gathering with smoking friends were situations in which it was easy to relapse. Firm motivation and determination, changing their surroundings to avoid secondhand smoke and convenient access to tobacco products, diverting their attention, a slow realization of the benefits of smoking cessation, and having the support of friends and family all were beneficial toward both smoking cessation success and maintaining a smoke-free lifestyle. The sampled smoking adolescents in this study also thought that smoking did not have a cumulative deleterious effect on health. They further felt that if they already had the intent to quit, actually quitting was something they would eventually do in the future. This phenomenon is contributory to the high proportion of smoking adolescents that have the intent to quit, and the comparatively small number of smoking adolescents that actually attempt to, and do quit. Conclusion: The smoking cessation behavior of adolescent smokers is strongly influenced by their peers and environment. Adolescent smokers aren’t easily moved by the health threat that smoking represents, which leads to a strong intent to quit, but little in the way of actual action directed toward smoking cessation. The maintenance of smoke-free lifestyles among adolescents can be benefited by having strong motivation and determination, and also by changing both their environments to reduce their secondhand smoke exposure and their ease of access to tobacco products.