臺灣博碩士論文加值系統

為探討接受門診戒菸治療者之戒菸成效，並進一步找出相關因素，本研究利用行政院衛生署國民健康局建置之門診戒菸治療資料庫，進行次級資料分析。2003年11月至2004年12月期間，接受門診戒菸治療之18歲以上吸菸者為本研究的分析樣本。結果發現，六個月及一年的「持續戒菸成功率」分別為18.9%及7.9%；六個月及一年的「點戒菸成功率」分別為22.5%及16.8%。依戒菸後回復吸菸的時間長短分類，估算早期、中期及晚期的「復吸比率」時，分別為25.3%，13.8%及35.5%；整體的復吸比率則為74.5%。根據多變項統計分析結果，與「持續戒菸成功」有關之因素，在個人因素方面有年齡、職業等級、菸齡、尼古丁成癮度、過去戒菸次數、睡眠品質、是否運動、飲酒頻率、喝咖啡頻率；在環境因素方面為同住有吸菸家人數；在戒菸治療因素方面有戒菸治療次數、醫療院所層級。與已戒菸者「回復吸菸」有關之因素，在個人因素方面有尼古丁成癮度、過去戒菸次數、睡眠品質、是否運動、飲酒頻率；在環境因素方面為同住有吸菸家人數；在戒菸治療因素方面為醫療院所層級。因此建議，分別參考本研究發現有利戒菸成功及容易復吸之因素，在提供戒菸治療的醫療院所內設計並推動有效的戒菸介入計畫和措施，以提高戒菸成功率及預防已戒菸者回復吸菸。

In order to investigate the effectiveness and related factors of outpatient therapy for smoking-cessation, the database of outpatient therapy for smoking-cessation established by the Bureau of Health Promotion, Department of Health, Executive Yuan was used for secondary data analysis. The smokers of 18 years old and above who had received the outpatient therapy for smoking cessation between November 2003 and December 2004 were the study subjects. Results show that the “continuous abstinence rates” of 6 months and 1 year are 18.9% and 7.9%, respectively. The “point-prevalence abstinence rates” of 6 months and 1 year are 22.5% and 16.8%, respectively. Relapse rates in terms of early stage, middle stage and late stage after quitting are 25.3%, 13.8% and 35.5%, respectively while the overall relapse rate is 74.5%. The factors related to “continuous abstinence” are individual factors including age, occupational level, smoking age, nicotine dependence degree, past quit smoking attempts, sleep quality, exercise, frequencies of drinking and coffee use; the environmental factor of the number of family members who are smoking; and therapy factors including the number of therapy sessions and the level of medical institution. The factors related to the “relapse of smoking” are individual factors including nicotine dependence degree, past quit smoking attempts, sleep quality, exercise and drinking frequency; the environmental factor of the number of family members who are smoking; and the therapy factor of the level of medical institution. It was suggested that the factors related to successful cessation and relapse of smoking should be referred to develop an effective intervention for smoking cessation in medical institutes.

口試委員會審定書
致謝 …………………………………………………………… i
中文摘要 ………………………………………………………… ii
英文摘要 ………………………………………………………… iii
內容目錄 ………………………………………………………… iv
圖表目錄 ………………………………………………………… vi

第一章 緒論 ……………………………………………………… 1
第一節 研究動機 ……………………………………………… 1
第二節 研究目的 ……………………………………………… 6
第二章 文獻探討 ………………………………………………… 8
第一節 戒菸之定義及測量 …………………………………… 8
第二節 戒菸之方式 …………………………………………… 10
第三節 戒菸之行為改變過程 ………………………………… 16
第四節 影響戒菸成效之因素 ………………………………… 18
第五節 回復吸菸之相關因素 ………………………………… 25
第三章 研究方法 ………………………………………………… 27
第一節 研究架構 ……………………………………………… 27
第二節 資料來源 ……………………………………………… 29
第三節 研究樣本 ……………………………………………… 30
第四節 研究變項 ……………………………………………… 34
第五節 資料分析 ……………………………………………… 38
第四章 結果 ……………………………………………………… 39
第一節 研究樣本背景 ………………………………………… 39
第二節 研究樣本之戒菸成功情形及復吸情形 …………… 44
第三節 研究樣本戒菸成功類型依個人、環境及戒菸治療等因素
之比較 ………………………………………………… 47
第四節 研究樣本復吸類型依個人、環境及戒菸治療因素之比較57
第五節 與研究樣本戒菸結果有關之因素 …………………… 66
第五章 討論 ……………………………………………………… 79
第一節 門診戒菸個案之戒菸結果 …………………………… 79
第二節 研究限制 ……………………………………………… 85
第六章 結論與建議 ……………………………………………… 87
第一節 結論 …………………………………………………… 87
第二節 建議 …………………………………………………… 89
參考文獻 ………………………………………………………… 95
附錄 …………………………………………………………… 105
附錄一 「個案六個月成功率追蹤問卷」 …………………… 105
附錄二 「個案一年成功率追蹤問卷」 ……………………… 109
附錄三 「門診戒菸治療服務計畫個案紀錄表」 …………… 111
附錄四 「職位分類表及說明」 …………………………… 112
個人簡歷 ……………………………………………………… 113


圖表目錄
圖3-1 研究架構 …………………………………………………… 28
圖3-2 各資料檔之建立及串聯 …………………………………… 29
圖3-3 本研究分析樣本之選取流程 ……………………………… 31
圖3-4 研究樣本戒菸成功類型之分佈 …………………………… 32
圖3-5 研究樣本復吸類型之分佈 ………………………………… 32
表2-1 各種戒菸方法成效比較 …………………………………… 11
表3-1 成功追蹤受訪者與未成功追蹤受訪者之比較 ………… 34
表3-2 研究樣本各變項之操作型定義及計分方式 ……………… 35
表4-1 研究樣本之人口學變項及健康狀況之分佈 ……………… 40
表4-2 研究樣本吸菸史戒菸史及生活型態之分佈 ……………… 41
表4-3 研究樣本環境因素及戒菸治療因素之分佈 ……………… 43
表4-4 研究樣本之持續戒菸成功率依性別比較 ………………… 44
表4-5 研究樣本之點戒菸成功率依性別比較 …………………… 45
表4-6 研究樣本之復吸比率依性別比較 ………………………… 46
表4-7 研究樣本之戒菸成功類型依人口學變項及健康狀況比較… 49
表4-8 研究樣本之戒菸成功類型依吸菸史戒菸史及生活型態比較 52
表4-9 研究樣本之戒菸成功類型依環境因素及戒菸治療因素比較 56
表4-10 研究樣本之復吸類型依人口學變項及健康狀況的比較 … 59
表4-11 研究樣本之復吸類型依吸菸史戒菸史及生活型態的比較 62
表4-12 研究樣本之復吸類型依環境因素及戒菸治療因素的比較 65
表4-13 研究樣本之戒菸成功影響因素以polytomous logistic
regression多變項分析 ………………………………… 70
表4-14 研究樣本之復吸影響因素以polytomous logistic
regression多變項分析 ………………………………… 75

中文部分：
1.行政院衛生署國民健康局：2002年台灣地區國民健康促進知識態
度與行為調查。行政院衛生署國民健康局，2002。
2.行政院衛生署國民健康局：2004年成人吸菸行為電話調查。行政
院衛生署國民健康局，2004。
3.徐慧娟：吸菸對台灣老人各類疾病危險性之研究。行政院衛生署
國民健康局委託專題研究報告，2003。
4.林冠品、樓美玲、劉波兒：醫護大學學生戒菸後再回復吸菸的經
驗。護理雜誌 2004;51(6):55-62。
5.衛生署門診戒菸治療管理中心：門診戒菸治療服務2005年期末報
告。行政院衛生署國民健康局門診戒菸治療管理中心，2005。
6.卓惠如：影響有吸菸經驗者戒菸的相關因素探討。未出版碩士論
文，台北市：臺灣大學公共衛生研究所，1993。
7.廖秀珠：戒菸者戒菸維持行為及其相關因素之探討。未出版碩士
論文，台北市：臺灣大學護理研究所，1995。



英文部分：
1.Abergavenny RD: Poor more likely to smoke and less
likely to quit. BMJ 2004; 328:914（17 April）.
2.Alberg AJ, Stashefsky Margalit R, Burke A, Rasch KA,
Stewart N, Kline JA, Ernst PA: The influence of
offering free transdermal nicotine patches on quit
rates in a local health department’s smoking cessation
program. Addict Behav 2004;29(9):1763-78.
3.Albertsen K, Hannerz H, Borg V, Burr H: Work environment
and smoking cessation over a five-year period. Scand J
Public Health 2004; 32(3):164-71.
4.Bandura A: Social foundations of thought and action: A
social cognitive theory. New York: Prentice Hall, 1986.
5.Barrueco M, Jimenez Ruiz C, Palomo L,Torrecilla M, Romero
P, Riesco JA.: Veracity of smokers’ reports of
abstinence at smoking cessation clinics. Arch
Bronconeumol 2005; 41(3):135-40.
6.Bohadana A, Nilsson F, Rasmussen T, Martinet Y: Nicotine
inhaler and nicotine patch as a combination therapy for
smoking cessation. Arch Intern Med 2000; 160(20):3128-34.
7.Cepeda-Benito A, Reynoso JT, Erath S: Meta-analysis of
the efficacy of nicotine replacement therapy for smoking
cessation: differences between men and women. J Consult
Clin Psychol 2004; 72(4):712-22.
8.Chatkin JM, Mariante de Abreu C, Haggstram FM, Wagner
MB,Fritscher CC: Abstinence rates and predictors of
outcome for smoking cessation: do Brazilian smokers
need special strategies? Addiction 2004;99(6):778-84.
9.Cooper TV, Dundon M, Hoffman BM, Stoever CJ: General and
smoking cessation related weight concerns in veterans.
Addict Behav 2005.
10.Cummings KM, Hyland A: Impact of nicotine replacement
therapy on smoking behavior. Annu Rev Public Health
2005; 26:583-99.
11.Doll R, Peto R, Boreham J, Sutherland I: Mortality in
relation to smoking:50 years’ observations on male
British doctors. BMJ 2004;328(7455):1519.
12.Erin C: Smoking relapse models and research.2003. [
www.quit.org.nz/research.html]
13.Filozf C, Fernandez Pinilla MC, Fernandez-Cruz A:
Smoking cessation and weight gain. Obesity Review 2004;
5(2):95-103.
14.Fiore MC, Bailey WC, Cohen SJ, et.al: Treating Tobacco
Use and Dependence. Clinical Practice Guideline.
Rockville,MD, U.S. Department of Health and Human
Services(USDHHS). Public Health Service,2000.
15.Fiore MC, Thompson SA, Lawrence DL, Welsch S, Andrews
K,Ziarnik M, Korberly B, Englund E: Helping Wisconsin
Women quit smoking:a successful collaboration. WMJ
2000:99(2):68-72.
16.Gary AC, Jeff AS, Ivana TC, Wanda LD: Comparison of
nicotine patch alone versus nicotine nasal spray alone
versus a combination for treating smokers. Nicotine Tob
Res 2003;5:181-7.
17.Glanz K, Rimer BK, Lewis FM: Health Behavior and Health
Education-Theory, Research, and Practice (3rd ed.).
Jossey-Bass, 2002.
18.Grandes G, Cortada JM, Arrazola A: An evidence-based
programme for smoking cessation: effectiveness in
routine general practice. Br J Gen Pract 2000; 50
(459):803-7.
19.Hughes JR, Keely J, Naud S: Shape of the relapse curve
and long-term abstinence among untreated
smokers.Addiction 2004; 99:29-38.
20.Hyland A, Li Q, Bauer JE, Giovino GA, Steger C,
Cummings KM: Predictors of cessation in a cohort of
current and former smokers followed over 13 years.
Nicotine Tob Res 2004;6(suppl 3):S363-9.
21.Hymowitz N, Cummings KM, Hyland A, Lynn WR: Predictors
of smoking cessation in a cohort of adult smokers
followed for five years. Tob Control 1997;6(suppl 2):s57- 62
22.Janzon E, Engstrom G, Lindstrom M, Berglund G, Hedblad
B,Janzon L: Who are the “ quitters”? a cross-sectional
study of circumstances associated with women giving up
smoking. Scand J Public Health 2005;33(3):175-82.
23.Ji M, Hofstetter CR, Hovell M, Irvin V, Song YJ, Lee J,
Park H, Paik HY: Smoking cessation patterns and
predictors among adult Californians of Korean descent.
Nicotine Tob Res 2005;7(1):59-69.
24.Kawai H, Shibayama T, Tada A, Kawahara S, Soda R,
Takahashi K: Factors affecting the success or failure
of smoking cessation using nicotine patches
（Japanese）. Nihon Kokyuki Gakkai Zasshi 2005; 43
(3):144-9.
25.Lam TH, Abdullah AS, Chan SS, Hedley AJ: Adherence to
nicotine replacement therapy versus quitting smoking
among Chinese smoker: a preliminary investigation.
Psychopharmacology 2005;177(4):400-8.
26.Levy DT, Romano E, Mumford E: The relationship of
smoking cessation to sociodemographic characteristics,
smoking intensity, and tobacco control policies.
Nicotine Tob Res 2005; 7(3):387-96.
27.Miller N, Frieden TR, Liu SY, Matte TD, Mostashari F,
Deitcher DR, Cummings KM, Chang C, Bauer U, Bassett MT:
Effectiveness of a large-scale distribution programme
of free nicotine patches: a prospective evaluation.
Lancet 2005; 365(9474):1849-54.
29.Moller AM, Pedersen T, Villebro N, Norgaard P:Impact of
lifestyle on perioperative smoking cessation and
postoperative complication rate. Prev Med 2003;36
(6):704-9.
30.Monso E, Campbell J, Tonnesen P, Gustavsson G, Morera
J: Sociodemographic predictors of success in smoking
intervention. Tob Control 2001; 10(2):165-9.
31.Nollen NL, Catley D, Davies G, Hall M, Ahluwalia JS:
Religiosity, social support, and smoking cessation
among urban African American smokers. Addict Behav
2005;30(6):1225-9.
32.Ockene JK, Emmons KM, Mermelstein RL, Perkin KA,
Bonollo DS, Voorhees CC, Hollis JF: Relapse and
maintenance issues for smoking cessation. Health Psychol
2000;19 (1suppl):17-31.
33.Osinubi OY, Sinha S, Rovner E, Perez-Lugo M, Jain NJ,
Demissie K, Goldman M: Efficacy of tobacco dependence
treatment in the context of a “smoke-free grounds”
worksite policy: a case study. Am J Ind Med 2004; 46
(2):180-7.
34.Ossip-Klein , Bigelow G, Parker S, et al:
Classification and assessment of smoking behavior.
Health Psychol 1986; 5(supp1):3-11.
35.Parrott S, Godfrey C: ABC of smoking cessation –
Economics of smoking cessation. BMJ 2004; 328(7445):947-
9.
36.Partin MR, Fu SS, Snyder A, An LC, Nelson DB, Nugent S,
Willenbring ML, Joseph AM: Promoting Repeat Tobacco
Dependence Treatment: Are Relapsed Smokers Interested?
Am J Manag Care 2006; 12:235-43.
37.Piasecki TM, Jorenby DE, Smith SS,Fiore MC, Baker TB:
Smoking withdrawal dynamics: Improved tests of
withdrawal-relapse relation. J Abnorm Psychol 2003;112
(1):14-27.
38.Pizacani BA, Martin DP, Stark MJ, Koepsell TD, Thompson
B,Diehr P: A prospective study of household smoking bans
and subsequent cessation related behaviour: the role of
stage of change. Tob Control 2004;13:23-28.
39.Prochaska JO, DiClemente CC: Stages and processes of
self-change of smoking: Toward an integrative model of
change. J Consult Clin Psychol 1983; 51(3):390-5.
40.Prochaska JO, Velicer WF: The transtheoretical model of
health behavior change. Am J Health Promot 1997; 12
(1):38-48.
41.Raherison C, Marjary A, Valpromy B, Prevot S, Fossoux
H, Taytard A: Evaluation of smoking cessation success in
adults. Respir Med 2005; 99(10):1303-10.
42.Rodriguez-Artalejo F, Lafuente Urdinguio P, Guallar-
Castillon P, Banegas JR: One year effectiveness of an
individualized smoking cessation intervention at the
workplace: a randomized controlled trial. Occup Environ
Med 2003;60(5):358-63.
43.Russall MA, Stapleton JA, Feyerabend C, Wiseman SM,
Gustavsson G, Sawe U, Connor P: Targeting heavy smokers
in general practice:randomisd trial of transdermal
nicotine patches. BMJ 1993;306(6888):1308-12.
44.Schiffman S, Hickcox M, Paty JA: Progression from a
smoking lapse to relapse: Prediction from abstinence
violation effects, nicotine dependence, and lapse
characteristics. J consult clin psychol 1996; 64(5):993-
1002.
45.Schuurmans MM, Diacon AH, Bolliger CT: Effect of pre-
treatment with nicotine patch on withdrawal symptoms
and abstinence rates in smokers subsequently quitting
with the nicotine patch. Addiction 2004;99(5):634-40.
46.Shiffman S, Di Marino ME, Pillitteri JL: The
effectiveness of nicotine patch and nicotine lozenge in
very heavy smokers. J Subst Abuse Treat 2005;28(1):49-55.
47.Shiffman S, Sweeney CT, Dresler CM: Nicotine patch and
lozenge are effective for women. Nicotine Tob Res 2005;
7(1):119-27.
48.Shiffman S, Dresler CM, Rohay JM: Successful treatment
with a nicotine lozenge of smokers with prior failure
in pharmacological therapy. Addiction 2004; 99(1):83-92.
49.Silagy C, Lancaster T, Stead L, Mant D, Fowler G:
Nicotine replacement therapy for smoking cessation.
Cochrane Database Syst Rev 2001;(3):CD000146.
50.Swan GE, Jack LM, Curry S, Chorost M, Javitz H, McAfee
T,Dacey S: Bupropion SR and counseling for smoking
cessation in actual practice: predictors of outcome.
Nicotine Tob Res 2003; 5(6):911-21.
51.Thorsteinn B, Larus JG, Ingileif O, Ake W: Nicotine
nasal spray with nicotine patch for smoking cessation.
BMJ 1999;318:285-9.
52.Tonnesen P, Tonstad S, Hjalmarson A, Lebargy F,Hider
A,Sweet R: A multicentre,randomized,double-
blind,placebo-controlled,1-year study of bupropion SR
for smoking cessation. J Intern Med 2003;254(2):184-92.
53.US Department of Health and Human Services (USDHHS),
Center for Disease Control and Prevention. 2004。
http://www.surgengeneral.gov
54.Watts, Steve A: First-line pharmacotherapy for tobacco
use and dependence, J Am Board Fam Pract 2002;15(6):489- 97.
55.Westmaas JL, Langsam K: Unaided smoking cessation and
predictors of failure to quit in a community sample:
effects of gender. Addict Behav 2005;30(7):1405-24.
56.Westmaas JL, Brandon TH: Reducing risk in smokers. Curr
Opin Pulm Med 2004;10(4):284-8.
57.West R, Gitchell J, DiMarino ME, McNeill A:Impact of Uk
policy initiatives on use of medicines to aid smoking
cessation. Tob Control 2005;14(3):166-71.
58.West R, Hajek P, Nilsson F, Foulds J, May S, Meadows A:
Individual differences in preferences for and responses
to four nicotine replacement products.
Psychopharmacology 2001;153(2):225-30.
59.Willemsen MC, Wagena EJ, Van Schayck CP: The efficacy
of smoking cessation methods available in the
Netherlands: a systematic review based on Cochrane data.
Ned Tijdschr Geneeskd 2003; 147(19):922-7.
60.Yang M C, Fann C Y, Wen C P, Cheng T Y: Smoking
attributable medical expenditures, years of potential
life lost, and the cost of premature death in Taiwan.
Tob Control 2005; 14: i62-i70.
61.WHO European Strategy for Smoking Cessation
Policy,2004。WHO Regional Office for Europe.
[http://www.euro.who.int/tobaccofree/policy/20030826_5]
62.WHO :The Tobacco Atlas. WHO, 2002。
63.http://www.who.int/tobacco/health_priority/en/
[上網日期：2005年12月]
64.http://www.cdc.gov/tobacco/news/QuitSmoking.htm　[上網日
期：2006年02月]
65.http://www.cdc.gov/tobacco/sgr/sgr_2004/posters/20mins.h
tm　[上網日期：2005年12月]