台灣婦女產後回復吸菸行為影響因素與戒菸專線諮詢效果之探討

戒菸對婦女本身和嬰兒的健康都有助益，但國外系統性的研究指出，七成以上在懷孕期戒菸的婦女，會在生產後回復吸菸，其原因很廣泛，並且少有介入計畫被證明有防止效果，目前國內還沒有相關的介入研究。本論文乃評估戒菸專線模式，對於預防產後婦女回復吸菸的成效，並且以所蒐集的資料探討其相關的影響因素。本論文乃前瞻性之世代研究並採用真實驗設計，於2014年9月至2015年11月期間，在台北市立聯合醫院婦幼院區，有72位符合條件產婦自願加入研究，並以呼氣一氧化碳濃度測量確認其戒菸狀態，對照組僅接受一般衛教指導者，而實驗組則再接受了戒菸專線的電話諮商，評量工具為自行建構之問卷、尼古丁成癮量表及愛丁堡產後憂鬱量表，在產後一周內先接受前測，產後兩個月再進行後測，我們共有23位產婦完成戒菸專線介入，68位完成產後六個月的電話追蹤及採用卡方、t檢定及羅吉斯回歸來分析資料。結果顯示回復吸菸率在產後三個月時為36.8%，並且有較低回復吸菸機率的因素包括只有一個小孩(機率比[OR] = 0.01，95%信賴區間CI= <0.01-0.42，p = 0.016)、過去有戒菸經驗(OR = 0.03，95% CI = <0.01-0.57，p= 0.019)及產後知覺行為控制較好(OR = 0.99，95% CI = 0.98-1.00，p = 0.021)。產後六個月時的回復吸菸率為42.6%，並且有較低回復吸菸機率的因素包括只有一個小孩(OR = 0.04，95% CI = <0.01-0.54，p = 0.015)、過去有戒菸經驗(OR = 0.09，95% CI = 0.01-0.84，p = 0.035) 及產後知覺行為控制較好 (OR = 0.99，95% CI = 0.98-1.00，p = 0.025)，另外菸齡長則較易回復(OR = 1.29，95% CI = 1.04-1.58，p = 0.018)，其他因素則未達到顯著差異。戒菸專線對回復吸菸率、態度、主觀規範和產後憂鬱程度等並無顯著的改變，但對知覺行為控制有正面的影響(p=0.032)。本論文的結論是影響婦女在產後回復吸菸的因素中，以過去的戒菸經驗、胎次和知覺行為控制較為顯著，戒菸專線雖然能提高產婦的行為控制程度，但仍不足以影響其行為，建議未來可以在孕期納入回復吸菸的風險評估機制，並強化行為控制的指導。

關鍵字

吸菸；回復吸菸；孕期；產後期；計劃行為理論；戒菸專線

並列摘要

Introduction: Abstinence from smoking benefits both for woman herself and her baby. However, around seventy percent of women who quit smoking during pregnancy relapsed after delivery. Many associated factors had been studied in past without consensus and most interventions implemented before were proved to have very limited effect. Up to now, no studies have investigated relapse among postpartum women in Taiwan. We analyzed data from a trial of smokers’ helpline to determine its’ effect and influential factors associated with smoking relapse after delivery. Methods: A prospective cohort was conducted at Taipei City Hospital Fuyou Branch during Sep. 2014- Nov. 2015 period. We collected data by self-developed questionnaire combining theory of planned behavior (TPB), Fagerstrom test for nicotine dependence (FTND) and Edinburgh Postnatal Depression Scale (EPDS) from 68 women immediately after delivery, 2 months later and followed up until 6 months. Three multivariable logistic models for validated relapse of smoking at 3 month and 6 months after delivery were created. We also used Mann-Whitney analysis to test differences between those who finished or not the telephone counseling by Taiwan Smokers’ Helpline (TSH). Results: At 3 months, 36.8% cases relapsed with odds lower among multi-parity (odds ratio [OR] = 0.01，95% confidence interval CI= <0.01-0.42，p = 0.016) , women with quit experience (OR = 0.03，95% CI = <0.01-0.57，p= 0.019) and those with better perceived behavior control (PBC) (OR = 0.99，95% CI = 0.98-1.00，p = 0.021). At 6 months, 42.6% relapsed with odds lower among multi-parity (OR = 0.04，95% CI = <0.01-0.54，p = 0.015) , women with quit experience (OR = 0.09，95% CI = 0.01-0.84，p = 0.035) and those with better PBC (OR = 0.99，95% CI = 0.98-1.00，p = 0.025), but greater for those who had longer smoking history (OR = 1.29，95% CI = 1.04-1.58，p = 0.018). Though no significant difference in relapse rate, attitude, subjective norm and depression scale, TSH could improve PBC (p=0.032). Conclusions: Women who had quit experience, multi-parity and better PBC had lower odds of post-partum‘s relapse and TSH, though no effect on relapse rate, could improve PBC.