臺灣博碩士論文加值系統

研究背景：青少年從事性行為增加，要避免非預期懷孕，有正確的避孕知識是首要步驟。文獻顯示國內高中、職學生對避孕知識有待加強的空間，國內父母也很少和子女談論性知識的話題，由學校來教導避孕是必須的。但是家長與學生對學校傳遞避孕資訊的內容的態度可能有差異。親子間的態度差異也可能會受子女的性別和就讀科別不同之影響。

研究目的：瞭解高中學生的性知識及對避孕議題的態度，以及學生與自己家長的態度有何差異？且學生的性知識、態度以及親子之間態度差異是否會因為學生性別或就讀科別不同而有差異。
研究對象和方法：問卷調查三所台南縣市綜合高中2171位學生與家長，並依就讀科別分為一般高中學生與職業科學生。性知識部分主要包含避孕及相關問題如性傳染病、墮胎。避孕議題包括避孕知識內容、避孕措施之可近性、以及緊急避孕。採用多項式邏輯迴歸(multinomial logistic regression)分析學生性別對性知識、的影響(模式一)，學生就讀科別的影響(模式二)，同時考慮學生性別與就讀科別的影響 (模式三)，和控制年齡、單親家庭狀況 (單親 vs. 雙親)、父母教育程度後(國中或以下 vs. 高中或以上) ，學生性別與就讀科別的影響(模式四)。學生及家長對避孕議題態度之差異, 分別以就讀科別和性別為分層變項，採用McNemar’s test 在個別分層做檢定。子女性別和就讀科別，對此差異影響是否會因有程度上的差異，則以條件式邏輯迴歸(conditional logistic regression)分析。

研究結果：根據模式四分析結果，在學生性別影響性知識方面，男生比較了解的知識(答對 vs. 答錯之危險對比值)為「保險套是唯一兼具避孕及防止性病的工具」(男生vs.女生的危險對比值=1.38，95%CI：1.12~1.70)、「使用保險套避孕時，在快射精前戴上便能達到避孕效果」(危險對比值=1.53，95%CI：1.15~2.05)；而女生比較了解的知識為「性行為愈早，發生子宮頸癌機率愈高」(危險對比值=0.32，95%CI：0.24~0.42)、「口服避孕藥可能傷身，應2至3天服用一次，避免持續服用」(危險對比值=0.76，95%CI：0.60~0.95)、「RU486 為有效的口服墮胎丸，於懷孕任何時期均可使用」(危險對比值=0.65，95%CI：0.44~0.96)、「人工流產之後長期的合併症可能包括子宮腔內黏連、子宮頸閉鎖不全、子宮外孕及不孕症等」(危險對比值=0.22，95%CI：0.10~0.47)。在學生就讀科別影響性知識方面，一般高中學生比較了解的知識(答對 vs. 答錯之危險對比值)為「RU486 為有效的口服墮胎丸，於懷孕任何時期均可使用」(一般高中 vs. 職業科危險對比值=2.27，95%CI：1.15~3.41)、「若懷孕超過3~4個月，而需人工流產時，應使用催生引產的方式較為安全」(危險對比值=1.37，95%CI：1.02~1.83)、「人工流產之後長期的合併症可能包括子宮腔內黏連、子宮頸閉鎖不全、子宮外孕及不孕症等」(危險對比值=3.50，95%CI：1.60~7.66)。職業科學生比較了解的知識為「保險套是唯一兼具避孕及防止性病的工具」(危險對比值=0.56，95%CI：0.45~0.70)、「在性行為發生後3天內，可找醫師採取緊急措施，以避免懷孕」(危險對比值=0.75，95%CI：0.58~0.97)。學生性別與就讀科別在避孕知識有交互現象，一般高中男生比較了解(答對 vs. 答錯之危險對比值)「在性行為時，若最後射精於女性體外，就不會導致懷孕」(男生vs.女生的危險對比值=1.26，95%CI：0.99~1.60)，在職業科反而是女生比較了解(危險對比值=0.58，95%CI：0.40~0.84)。一般高中女生比較不知道(不知道 vs. 答錯之危險對比值)「在性行為發生後3天內，可找醫師採取緊急措施，以避免懷孕」(男生vs.女生的危險對比值=0.82，95%CI：0.53~1.27)。在職業科反而是男生比較不知道(危險對比值=2.82，95%CI：1.53~5.19)。在學生性別影響親子配對態度差異方面(學生贊成 vs. 配對家長贊成之危險對比值)，學生在「教導如何使用保險套」(男生親子配對危險對比值=1.15, 95% CI: 0.89~1.49; 女生親子配對危險對比值=2.79, 95% CI: 2.08~3.73)、「教導性交後避孕法」(男生親子配對危險對比值=1.29, 95% CI: 1.02~1.63; 女生親子配對危險對比值=2.28, 95% CI: 1.78~2.93)都比配對家長贊成，且有性別的交互現象。男生親子配對在「教導如何使用保險套」的態度(男生親子配對危險對比值:女生親子配對危險對比值的比值=0.41，95%CI：0.28~0.61)和在「教導性交後避孕法」(男生親子配對危險對比值：女生親子配對危險對比值的比值=0.57，95%CI：0.40~0.80)差異皆比女生親子配對的差異小。在學生就讀科別影響親子配對態度差異方面(學生贊成 vs. 配對家長贊成之危險對比值)，ㄧ般高中學生的配對家長在「教導如何避免婚前性行為」比學生贊成(一般高中親子配對危險對比值=0.58, 95% CI:0.38~0.89)，職業科學生比配對家長贊成(職業科親子配對危險對比值=1.27, 95% CI:0.73~2.23)，且學生贊成比上不贊成的危險對比值會隨著就讀科別的不同而改變 (一般高中學生危險對比值：職業科學生危險對比值的比值=0.47，95%CI：0.23~0.96)

結論：男、女生傾向比較清楚和自己性別有關的知識，男生比較了解保險套避孕法，女生比較了解女生的避孕法及墮胎風險。職業科學生比較了解從事性行為的避孕知識，一般高中學生比較了解避孕失敗後的知識。女生避孕知識在一般高中與職業科的程度不同，可能因為一般高中女生對於未來學業期望比較高，會避免性行為及其負面結果，傾向讓自己會發生婚前性行為的機會較低，因此沒有很強的動機想要獲得避孕知識；職業科女生可能因為學業成就較低，有性行為的比例也比較高，因此有動機、也願意了解避孕知識以保護自己。女生比男生贊成教導如何避免婚前性行為及事後避孕法，反映了女生擔負懷孕的壓力比較大，所以傾向贊成教導她們如何保護自己。子女的性別會影響家長對於教導事前和事後避孕法的態度，相較於對男生的態度，家長對女生的態度會傾向盡量不給予會讓女孩子嘗試「性」的資訊。

Background: Sexual activity has increased among our teenagers. In order to prevent unintended pregnancy, having correct contraceptive knowledge is the vital first step. Studies have shown that there is room for improvement among our regular and alternative high school students regarding their contraceptive knowledge. Parents of these teenagers seldom talk to their children about contraceptive issues. Schools must be responsible for teaching contraceptive knowledge. However, the parents and students may not agree upon the contents of contraceptive information disseminated in the schools. The disagreement may depend on the sex and class type of the students.

Purposes: A school survey was conducted to investigate the sexual knowledge and attitudes toward contraceptive issues among our high school students, and the contraceptive issues upon which the students and their parents may disagree. Furthermore, we want to investigate whether the sexual knowledge and attitudes toward the contraceptive issues may depend on the sex and class type of the students and whether the disagreement upon the contraceptive issues between the students and their parents may be sex- and class type- dependent.
Subjects and methods: 2171 students, who came from three high schools which had both regular and alternative classes and both male and female students, and their parents were surveyed. The sexual knowledge included mainly contraception and the related issues such as sexual transmitted diseases, and abortion. The contraceptive issues included the contents of contraceptive knowledge, accessibility of contraceptive measures and emergency contraception. The effects of sex on the sexual knowledge and attitudes toward the contraceptive issues among the students (Model I), the effects of class type (Model II), the joint effects of sex and class type (Model III), and the joint effects after controlling the covariates of age, family structure (single-parent vs. two-parent family), and the educational levels of the parents (junior high or lower vs. senior high or higher) (Model IV) were investigated by using the multinomial logistic regression. The sample was stratified by sex and in each stratum the attitudinal disagreements between the students and their parents were tested by using the McNemar’s test. The same analysis was applied to the stratified samples by class type. Whether the degrees of disagreement may depend on the sex and class type was investigated by using the conditional logistic regression.

Results: Based on the analysis results from using the Model IV, in regard to the sex difference in contraceptive knowledge, the male students had a higher odds of answering correctly to 「Condom use is the only contraceptive method that can prevent pregnancy and sexually transmitted diseases」in comparisons to the female students (male vs. female [Odds Ratio: OR]=1.38, 95%CI：1.12~1.70)、「Wearing a condom just before ejaculation during a sexual intercourse can achieve contraception」(OR=1.53，95%CI：1.15~2.05); the female students on the other hand had a higher odds of answering correctly to「Early initiation of sexual intercourse may increase the risks of cervical cancers」in comparisons to the male students (OR=0.32，95%CI：0.24~0.42)、「Contraceptive pills have detrimental health effects and the pills should be taken at 2 to 3 days apart, not daily for a period of time」 (OR=0.76，95%CI：0.60~0.95)、「RU486 is effective emergency oral contraception and it can be used any time during pregnancy」(OR=0.65，95%CI：0.44~0.96)、「The induced abortion has long term health consequences such as infertility」(OR=0.22，95%CI：0.10~0.47). The students in regular classes had a higher odds of answering correctly to 「RU486 is effective emergency oral contraception and it can be used any time during pregnancy」 in comparisons to alternative classes (regular vs. alternative classes, OR=2.27，95%CI：1.15~3.41), 「It is more safe to use induced labor to eject a fetus after 3 to 4 months pregnancy」(OR=1.37，95%CI：1.02~1.83), and 「The induced abortion has long term health consequences such as infertility」(OR=3.50，95%CI：1.60~7.66). The students in alternative classes had a higher odds proportion of answering correctly to 「the condom use is the only contraceptive method that can prevent pregnancy and sexually transmitted diseases」(OR=0.56，95%CI：0.45~0.70) in comparisons to regular classes、「Within 3 days after having sex, seeking emergency contraception from obstetric and gynecologic physicians may prevent pregnancy」(OR=0.75，95%CI：0.58~0.97)。In regular classes, the male students has a higher odds of answering correctly to 「Coital withdrawal at the time of ejaculation may prevent pregnancy」in comparisons to the female students (male vs. female students, OR =1.26，95%CI：0.99~1.60). In contrast, female students had a higher odds of answering correctly in comparisons to the male students in alternative classes (OR=0.58，95%CI：0.40~0.84). In regular classes, the female students had a higher odds of answering unknown to 「Within 3 days after having sex, seeking emergency contraception from obstetric and gynecologic physicians may prevent pregnancy」 in comparisons to the male students (male vs. female students, OR=0.82，95%CI：0.53~1.27). In contrast, the male students had a higher odds of answering unknown (OR=2.82，95%CI：1.53~5.19)。Among the matched pairs, a higher percent for 「teaching how to use condoms」、「teaching emergency contraception」 among both the male (OR=1.15, 95% CI:0.89~1.49) (OR=1.29, 95% CI:1.02~1.63) and female students (OR=2.79, 95% CI:2.08~3.73) (OR=2.28, 95% CI:1.78~2.93) than their respective parents was observed and there was sex difference. A higher odds ratio was observed among the male students for 「teaching how to use condoms」 (males’ OR to females’ OR is 0.41，95%CI：0.28~0.61) and for 「teaching emergency contraception」 (males’ OR to females’ OR is 0.57，95%CI：0.40~0.80)。In regard to the differential effects of class type, a higher percent for 「teaching how to avoid premarital sex」was observed among the parents of the students in regular classes (OR=0.58, 95% CI:0.38~0.89), whereas a higher percent was observed among the students in alternative classes (OR=1.27, 95% CI:0.73~2.23). The odds ratios are class-type dependent (OR for regular classes to OR for alternative classes was 0.47，95%CI：0.23~0.96).

Conclusions: Both male and female students know more about the parts of contraceptive knowledge regarding their gender. Male students know more about the contraceptive knowledge regarding condom use, whereas female students know more about the contraceptive knowledge regarding contraceptive pills and the risks of abortion. The students in the alternative classes comparatively had better knowledge of the contraceptive knowledge regarding sexual intercourse, whereas the students in the regular classes had better knowledge of contraceptive failures. The female students in regular classes and in alternative classes had differential contraceptive knowledge. A probable reason was that the female students in regular classes had more aspiration for higher educations. They will avoid having sex early and the adverse consequences associated early sexual intercourse. Therefore, they were more prone not to have premarital sex and have lesser motivation to gain contraceptive knowledge. In contrast, the female students in alternative classes may have stronger motivation and a higher percentage of being sexually experienced due to poorer academic achievement. The female students were more positive on their attitudes toward avoidance of premarital sex and emergency contraception than the male students. This finding revealed that the female students burdened more the pressure caused by unintended pregnancy than the male students. Therefore, the female students were more prone to have positive attitudes toward the issues of protected sex and emergency contraception. Parents of the female students were more conservative than the parents of male students regarding protected sex and emergency contraception.

目錄
第一章緒論
第一節研究背景……………………………………………………1
第二節研究目的……………………………………………………2
第三節研究問題……………………………………………………2
第二章文獻探討
第一節靑少年性行為、懷孕與非預期懷孕趨勢…………………4
第二節青少年避孕行為與知識……………………………………9
第三節性教育教導避孕的挑戰……………………………………12
第三章研究方法
第一節研究對象及研究設計………………………………………20
第二節研究工具……………………………………………………21
第三節資料處理與分析……………………………………………24
第四章研究結果
第一節學生基本資料、性知識及避孕議題的態度………………28
第二節家長基本資料、性知識及避孕議題的態度………………37
第三節就讀科別、性別對學生性知識與避孕議題態度的影響…48
第四節學生與配對家長的比較……………………………………64
第五節就讀科別、性別對態度不同之親子配對的影響…………73
第五章討論
第一節學生的性別與就讀科別對性知識了解的影響……………77
第二節學生的性別與就讀科別對避孕議題態度的影響…………80
第三節配對學生與家長對避孕議題之不同態度…………………84
第六章研究限制與建議……………………………………………86
參考文獻……………………………………………………………88
附錄一學生問卷……………………………………………………157
附錄二家長問卷……………………………………………………164
附錄三以Multinomial Logits Model估計危險對比值…………170

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