南台灣原住民公務機關檳榔戒除研究

Study in the Cessation of the Areca Nut by Southern Taiwan Aboriginal Government Organization

高雅琴(Ya-Chin Kao)

指導教授 ： 謝天渝

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2005年)

摘要

研究背景：
由於原住民嚼食檳榔盛行率遠較一般人口高，檳榔戒除的推廣隨著國際癌症研究中心發佈檳榔本身為第一類致癌物質的訊息之後更顯的刻不容緩，雖然在衛生單位大力推廣下，民眾不乏接受衛生教育的機會，然而嚼食檳榔行為仍未見明顯改善，因此本研究希望透過社區健康營造推動｢檳榔減量、新形象運動｣，以公務員為介入對象，藉由本身行為的改變逐漸影響部落的民眾。
研究目的：
本研究主要藉由｢檳榔減量、新形象運動｣計畫介入前後的改變情形，來測試該計畫推行的成效，並且探討人格特質與嚼食檳榔的關係以及嚼食檳榔行為相關因素。
研究方法：
本研究以牡丹鄉及獅子鄉的公務員為研究對象，牡丹鄉為『衛教追蹤組』實施｢檳榔減量、新形象運動｣，亦即衛生教育之外，加入促進活動及行為追蹤；而獅子鄉為『衛教組』指實施如同衛教追蹤組的衛生教育方式而不施予促進及追蹤活動，六個月後進行評價以了解推行成效。資料統整後以JMP5.01版進行統計分析。
研究結果：
本研究共有120位公務員參與，衛教追蹤組共有69位，衛教組有51位。採用相同衛教介入後兩組知識（p=0.5065）及態度（ p=0.2428）增加的比例沒有顯著差異。進一步分析有嚼食檳榔者，在檳榔濫用程度下降方面，衛教追蹤組顯著的多於衛教組（p=0.0379）；檳榔嚼食顆數減少的比例衛教追蹤組亦顯著高於衛教組（p=0.0349），介入後完全戒除的比例雖未達統計顯著差異（p=0.2753），但衛教追蹤組有3人達到完全戒除，而衛教組沒有。
嚼食檳榔相關因素方面，迴歸分析發現年齡是檳榔濫用程度的重要因素（p=0.0018），而知識分數增加(OR=0.32, p=0.0435)、嚼食顆數下降(OR=7.95, p=0.0002)及同時使用檳榔和酒(OR=14.52, p=0.0125)，是最能有效預測濫用程度下降的因素。在嚼食顆數減少與否的部分，非檳榔濫用者(OR=0.23, p=0.0118)是具有預測力的變項。而人格特質與檳榔相關行為在本研究中沒有顯著的影響。
結論：
完善的檳榔介入計畫能夠有效的使檳榔知識、態度傾向正向的改變，而衛生教育再加上促進活動及行為追蹤，對於行為的影響更加明顯。而相關因素的分析顯示檳榔介入若能夠及早在年輕的族群中建立正向的觀念，對於日後檳榔行為有更深遠的影響。此外研究中並未顯示人格特質為重要影響因素，因此社區介入計畫較不需顧慮人格特質的個別因素，而應可考量傾向於可近性及普及化，使一般大眾易於接納並樂意參與。

關鍵字

公務機關 ； 原住民 ； 戒除 ； 檳榔

並列摘要

Background：
The prevalence of areca/betel quid chewing among aborigines is higher compared to the non-aboriginal population. Following the announcement by the International Agency for Research on Cancer (IARC) on the highly carcinogenic nature of the areca nut it has become even more urgent to discourage abuse. The problem of areca nut chewing remains highly pervasive despite ongoing campaigns by relevant government institutions that have led to improved overall health awareness among the general public. This study wishes to promote the decrease in areca nut chewing through an ‘improved image campaign’ directed at local civil servants and implemented by local Health Promotion Centers. It was hoped that they in turn would further gradually influence their fellow tribesmen.
Purpose：
The purpose of this study was to measure the level of success of the campaign by determining the degree of change in areca nut related knowledge, attitudes and ractice. Furthermore it was hoped to find any correlation between personal traits and areca nut chewing. Lastly it was hoped to discover the determinant factor in chewing areca nut.
Methods：
The participants were civil servants from 2 aboriginal communities in PingTung County- Mudan Shire and ShiZi Shire with the Mudan Shire as the experimental group. The following steps were implemented-health education, campaigning to decrease areca nut use and follow up on behavioral change. Only the same health education was implemented in ShiZi Shire making them the control group. After 6 months there was a follow up to measure results. Data was organized and analyzed by version JMP 5.01 software to generate results.
Results：
There were a total of 120 civil servants altogether participating in the study-69 in the experimental group and 51 in the control group. After adopting the same education model there was no significant difference between the two groups in knowledge (p=0.5065) and attitudes (p=0.2428). Further analysis was made of the areca nut chewers. The level of drop in abuse was significantly higher in the experimental group than in the control group (p=0.0379).In comparison with the control group the quantity of areca nut chewed also dropped significantly in the experimental group.3 of the participants in the experimental group had completely ceased areca nut chewing where none had in the control group.
It was further discovered that age was an important factor in regards to level of abuse (p=0.0018). Knowledge (OR=0.32, p=0.0435) and quantity of areca nut chewed (OR=7.97, p=0.0002) and abuse of areca nut chewing combined with alcohol consumption are the most important variables in predicting the reduction of abuse. Level of abuse is the most important variable in predicting the quantity of areca nut chewed (OR=0.23, p=0.0118).Furthermore, personal traits in regards to areca nut chewing had no significant relevance.
Conclusions：
It was clear that a well planned and executed intervention plan combining education, campaigning and follow up on behavior positively influenced the behavior of areca nut chewers. This research showed that the younger people are exposed to intervention the more positive the lasting the results on behavior. The research further revealed that personal traits were not a vital factor. This leads to the conclusion that in regards to decreasing areca nut chewing any community intervention plan needs not to focus on individual factors but rather encourage the general population to support the ideals of the campaign. By making the campaign more accessible and popular community members will become more willing participants.

並列關鍵字

aboriginal ； cassation ； areca nut ； government organization

參考文獻

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