台北市某高職學生吸菸行為之探討─跨理論模式之應用

Application of the Transtheoretical Model to smoking behavior among a vocational high school students in Taipei city.

劉美媛(Meei-Yuan Liou)

指導教授 ： 呂昌明教授

國立臺灣師範大學/教育學院/衛生教育學系/博士(2005年)

摘要

本研究目的乃是應用跨理論模式，探討台北市某高職學生的吸菸行為，以瞭解其吸菸階段分期及不同吸菸階段與改變方法、自我效能及決策權衡的相關。以台北市某高職學生為對象，採隨機集束抽樣方法進行抽樣，最後取得有效樣本1095份，回應率為93.7%。
結果如下：
一、本研究對象目前吸菸率為20.6%，男生吸菸率為25.6%，女生為6.4%。有7.9%已戒菸，男生已戒菸率是8.8%，女生是5.0%。共有71.5%未曾吸菸，其中有4.0%想嘗試吸菸。目前吸菸者中，有58.0%有意願戒菸。在已戒菸者中，有75%已持續戒菸六個月以上。
二、不同吸菸階段的研究對象，在戒菸改變方法、拒菸自我效能/誘惑、吸菸決策權衡方面，皆有顯著差異。
1.依據所處的吸菸戒除階段，在意圖戒除期給予意識覺醒、情感喚起、自我再評價，在準備戒除期強調增強管理、刺激控制，至於在戒除行動期已經戒菸的青少年，則十種方法皆可採用，而已經戒菸六個月以上者，則除了意識覺醒外，其餘九種方法皆很常用。在推展菸害防制時，如能依據青少年所處的吸菸階段，採用特定的戒菸改變方法，可增加戒菸介入計畫的成效，促使青少年戒菸，達到成功戒菸的目的。
2.在吸菸戒除階段，各種拒菸自我效能/誘惑情境下的得分皆以無意圖戒除期的得分最高，在戒除維持期最低，呈線性降低的趨勢。處於無意圖戒除期者較易受菸癮/習慣的誘惑，已戒菸六個月以上者，則體重控制的誘惑程度最高，受到菸癮/習慣的誘惑最小。在無意圖戒除期者自覺吸菸的好處高於壞處，在意圖戒除期與準備戒除期者，認為吸菸的壞處稍為高於吸菸的好處，到了戒除維持期，自覺吸菸的壞處遠大於好處。研究對象自覺吸菸適應好處與吸菸社會好處的看法相近似。
3.在吸菸獲得階段，想嘗試吸菸者各類情境下之誘惑度都增加，其中以正向社交情境之誘惑最大，體重控制的誘惑最小。在無意圖嘗試期吸菸決策權衡達到平衡，對吸菸壞處、好處之同意度相等，但想嘗試吸菸者則較同意吸菸之好處，包括吸菸的適應好處與吸菸的社會好處，認為吸菸所帶來的好處高於壞處。
研究結果支持跨理論模式的有用性，並提供教育者作為發展不同吸菸階段介入以促進菸害防制的參考。

關鍵字

跨理論模式 ； 吸菸行為 ； 高職學生

並列摘要

The purpose of this study was to assess the relationships of the stages of change with processes of change, self-efficacy/temptation and decisional balance, and to examine the utility of the transtheoretical model in understanding smoking behavior. A random clustered sample of 1095 was recruited from a vocational high school in Taipei city.
Findings showed that current smoking prevalence was 20.6%, 25.6% among boys and 6.4% among girls. The percent of already quitting smoking was 7.9%, 8.8% among boys and 5.0% among girls. The rate of never smokers was71.5%, 4.0% of never smokers were planning to try smoking. 58.0% of current smokers were contemplating quitting, 75% of former smokers were long-term quitters (> 6 months).
Subjects in acquisition and cessation stages were compared on 10 processes of change, self efficacy/temptation and decisional balance. Results strongly support the transtheoretical model. Results indicate that smokers : (a) use the fewest processes of change during precontemplation stage; (b) emphasize consciousness raising, dramatic relief and self-reevaluation during the contemplation stage; (c) emphasize reinforcement management and stimulus control in preparation stage; (d) use all 10 process activities during the action stage; and (e) use all 10 process activities except consciousness raising in maintenance stage.
Participants in acquisition precontemplation scored the lowest and those in cessation precontemplation scored the highest on the self-efficacy/temptation, benefit and decisional balance indices, with the trend reversed on the cons (disadvantages) scale. Smokers at cessation-precontemplation stage were most tempted by habit strength. Exsmokers at cessation- maintenance stage were most tempted by weight control and least tempted by habit strength.
Never smokers were most tempted to try smoking when they anticipated that smoking would help increase positive social mood, and least tempted when they anticipated that smoking would help control body weight.
These findings offer support for the transtheoretical model to apply in the antismoking programs, and implications for use of the findings by educator in developing stage-based interventions.

並列關鍵字

transtheoretical model ； smoking behavior ； vocational high school student

參考文獻

李蘭、潘怜燕、晏涵文、李隆安(1994)：台灣地區成年人之吸菸現況：盛行率及危險因子。中華公共衛生雜誌，13(4)，371-380。

黃淑貞(1997)：大學生健康信念、自我效能、社會支持與吸菸行為研究。學校衛生，31，30-44。

劉美媛、呂昌明(2005)：探討大一學生的吸菸行為─跨理論模式的應用。衛生教育學報，24，47-70。

李景美、張鳳琴、賴香如、李碧霞、陳雯昭(2002)：台北縣高職一年級學生成癮物質濫用之危險與保護因子研究。衛生教育學報，17，73-88。

鄭丁原、溫啟邦、蔡孟娟、蔡善璞(2002)：國人吸菸行為現況：2001年國民健康調查之分析。台灣衛誌，22(6)，453-464。