比較台灣地區嚼食與戒除檳榔行為影響因素之研究

背景: 檳榔是全球排名第四之濫用物質，位居於抽菸、飲酒、和咖啡因之後，雖然過去探討檳榔嚼食與戒除檳榔行為的研究不少，但以同一樣本同時比較檳榔嚼食與戒除之研究較有限。此外嚼食與戒除檳榔行為與時間因素有關，因此分析是應考慮到追蹤時間。研究目的: 探討檳榔嚼食與戒除檳榔之影響因素。研究方法: 研究設計以抽樣調查方法，使用分層多階段集束抽樣調查法與等比隨機抽樣(PPS design)，調查台灣地區年滿十八歲以上成人嚼食檳榔狀況。統計分析以Kaplan-Meier estimates與Cox regression探討影響嚼食與戒除檳榔之重要因素。結果: 研究顯示，性別、教育程度、種族，菸酒行為與檳榔嚼食行為有顯著關係。雖然男性比女性有較高的檳榔嚼食率，但是經由多變項之Cox廻歸分析後，男性是女性1.38倍(95%CI= 1.20-1.59)的機率會有嚼食檳榔習慣，因此性別在檳榔嚼食行為是會受到其他因素影響。男性檳榔嚼食顯著相關之因素包含了種族、飲酒，女性則是教育程度、職業、種族、與菸酒行為。在多變項Cox regression分析指出，性別、教育程度、種族和嚼食與戒除檳榔行為有顯著關係。男性則是女性的1.67倍(95%CI=1.10-2.54)戒除檳榔之機率。此外在戒除檳榔嚼食之顯著因素，男性為教育程度、檳榔種類；女性則為教育程度、種族、與檳榔種類。結論: 在多變項Cox regression分析指出，性別、教育程度、種族和嚼食與戒除檳榔行為有顯著關係。至於職業、菸酒行為只有和檳榔嚼食有影響關係。在推動戒除檳榔之政策或活動時，應該考量與注意女性較少戒除檳榔之特徵。而且也要針對男女性在戒除檳榔影響因素的不同。

關鍵字

檳榔嚼食；戒除檳榔；社區調查；時間變數

並列摘要

Background: Betel quid is the fourth most commonly used substance in the world after tobacco, alcohol and caffeine. Although factors related to betel quid chewing or cessation behavior have been reported previously, few studies simultaneously compared both behaviors in the same population. In addition, it is essential to consider time-to-event concept, since the chance of developing or stopping the habit may vary over time. Study Objective: The purpose of this study was to compare the risk factors for commencement and cessation of chewing behavior in a time-to-event setting. Methods: A stratified multi-stage cluster sampling with selection probabilities proportional to size (PPS) was designed for Taiwanese adults aged 18 years old and above. Kaplan-Meier estimates and Cox proportional hazard regression models were used to compare and calculate the relative risk for related factors to commencement or cessation of chewing habits Results: In multivariable analysis, gender, education, ethnicity, occupation, cigarette smoking and alcohol drinking were significantly associated with starting betel quid chewing behavior. The relative risk (RR) of chewing habit is 1.38-fold (men vs women) multivariablely. Gender had a mild impact on commencement of chewing behavior, which indicated that gender differences are confounded by other factors. In multivariable analysis, gender, education and ethnicity are significantly associated with cessation of betel quid chewing behavior. The RR for cessation habit is 1.67-fold (men vs women) multivariablely. Ethnicity, and alcohol drinking in men, while education, occupation, cigarette smoking and alcohol drinking in women are significantly associated with starting betel quid chewing. In both genders, education and types of quid affected betel quid cessation, however ethnicity is associated with cessation only in women. Conclusion: Gender, education and ethnicity are significantly associated with both starting and cessation of betel quid chewing behavior. Occupation, cigarette smoking and alcohol drinking are only associated with starting the habit. In addition, betel quid prevention programs should consider the characteristic of women who are less likely to quit betel quid behavior.