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研究生:黃正銘
研究生(外文):Cheng-Ming Huang
論文名稱:校園菸害防制政策與學童吸菸行為之多層次分析研究
論文名稱(外文):School Policy for Tobacco Control in Relation to Cigarette Smoking among Children: A Multilevel Study
指導教授:黃曉靈黃曉靈引用關係
指導教授(外文):Hsiao-Ling Huang
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:口腔衛生科學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:200
中文關鍵詞:學童吸菸行為多層次理論校園菸害防制政策
外文關鍵詞:Schoolchildrensmoking behaviormulitilevel studytobacco- control policy
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背景:近年Flay等學者提出Theory of Triadic Influence(TTI)多層次理論,指出學童吸菸行為會受到個人社會人口學特質,個人相關的社會環境特質與廣泛的社會環境特質三種層次影響。影響學童吸菸行為之個人社會人口學特質,個人社會環境特質已有很多專家者探討,但只有少數學者探討廣泛的社會環境特質的影響。
研究目的:因此本研究以多層次理論架構與分析探討學校與個人層次特質在國小學童吸菸行為類聚現象之相關。
研究方法:本研究以橫斷式研究設計,以班級為單位,採分層集束隨機抽樣方式選取屏東縣26間國小,並於2008年收集三至六年級學童及其家長、學校教職員之吸菸行為、學校層次結構性與學校菸害防制政策及個人層次特質。有效學生樣本數2,350(回覆率:94%)、家長樣本數3,726(回覆率:75%)與教職員樣本數52位(回覆率:100%)。以多層次邏輯斯迴歸分析,解釋影響學童吸菸行為的個人層次與學校層次相關因素。
結果:研究結果發現學校特質與個人特質對於學童吸菸行為都有影響的效應,可解釋變異量分別為72%與48%。而未推廣戒菸輔導或活動的學校相較於有推廣學校的學童有吸行為的危險率比較高(OR=3.56, 95% CI=1.53-8.28)及學生就讀於山地學校相較於都市型學校的學童有吸菸行為的危險比也比較高(OR=3.23, 95% CI=1.17-8.97),這些政策的施行情況對於學童個人吸菸行為具有顯著影響。同時在學校感受他人吸菸頻率、朋友與家人在面前吸菸頻率、喝酒與嚼食檳榔之行為,亦顯著影響學童曾經吸菸行為。
結論:本研究建議教育與衛生機構能重視高風險學校及加強校園菸害防制政策與推廣活動,減少國小學童吸菸行為之發生。
Background:The Theory of Traidic Influence (TTI) by Flay et al suggests that youth smoking is influenced by factors from three domains: intrapersonal factors, socio-environmental factors and broader contextual factors. Many researches have examined the influence of intrapersonal and socio-environmental factors on children smoking; however lack of study explored the realtion of socio-environmental factors and children smoking.
Study objective:The aim of this study was using a multilevel-based study to comprehensively assess the impact of school- and individual-level characteristics in relation to cigarette smoking clustering among elementary schoolchildren.
Methods:This was a cross-sectional study and selected by a random stratified cluster sampling method, where the sampling unit was the school for this study. Data were collected from the sample of 3rd to 6th grade pupils’ (n=2,350;response rates 94%)and their parents’ (n=3,726;response rates 75%), and staff’s (n=52;response rates 100%) smoking behaviors, the struction and school tobacco control policies factors and individual characteristic at 26 elementary schools in Pin-Tung county. The individual- and school-level characteristics regarding smoking were estimated using multi-level logistic regression.
Results:The study found school effects were large in comparison to individual-level effects, and the additional variance which explained 85% and 48% effects. The risk of smoking was significantly associated with those schools without having any anti-tobacco acitivities or curricula [odds ratio (OR)= 3.56, 95%CI=1.53-8.28] and schools located in a mountainous region (OR=3.23, 95% CI=1.17-8.97) while controlling for individual-level characteristics. Other observed individual-level characteristics having a significant relationship to student smoking behavior were immediate social environmental factors in which best friends and family smoked as well as drinking alcohol and chewing betel nuts .
Conclusion:The findings suggest that effective tobacco control policies and preventive programs should be strongly considered for implementation in elementary schools that are putting children at the greatest risk for cigarette smoking.
目錄
中文摘要…………………………………………………………… i

英文摘要…………………………………………………………… iii

第一章 續論……………………………………………………… 1
第一節 研究背景………………………………………………… 1
第二節 研究目的………………………………………………… 3

第二章 文獻探討………………………………………………… 4
第一節 吸菸的危害……………………………………………… 4
第二節 青少年吸菸行為的盛行率……………………………… 7
第三節 多層次理論架構:Theory of Triadic Influence (TTI)理論………………………………………………………………… 10
第四節 多層次模式:多層次分析………………………………… 13
第五節 學校層次特質對於學童吸菸行為之探討……………… 16
第六節 個人層次特質對於學童吸菸行為之探討……………… 26

第三章 材料與方法……………………………………………… 33
第一節 研究對象之選取………………………………………… 33
第二節 研究設計………………………………………………… 34
第三節 研究流程………………………………………………… 36
第四節 研究架構………………………………………………… 38
第五節 研究工具………………………………………………… 40
第六節 內容效度處理…………………………………………… 44
第七節 實施步驟………………………………………………… 45
第八節 變項測量………………………………………………… 46
第九節 資料整理與統計分析…………………………………… 56

第四章 結果……………………………………………………… 61
第一節 個人與學校層次特質分佈狀況………………………… 63
第二節 個人層次特質與學校所在位置之相關性……………… 68
第三節 學校層次特質與學校所在位置之相關性……………… 72
第四節 個人與學校層次特質與健康促進學校之相關性……… 75
第五節 個人層次特質與吸菸行為之相關性…………………… 78
第六節 個人層次特質對於吸菸行為之單變項多層次迴歸分析 79
第七節 學校層次特質對於吸菸行為之單變項多層次迴歸分析 84
第八節 學校層次與個人層次特質對於吸菸行為之多變項多層次迴歸分析……………………………………………………………… 87

第五章 討論……………………………………………………… 89
第一節 學校政策性特質對於學童吸菸行為的相關性………… 90
第二節 學校結構性特質對於學童吸菸行為的相關性………… 95
第三節 個人相關的社會環境特質對於學童吸菸行為的相關性 98
第四節 在校園感受他人吸菸情況對於學童吸菸行為的相關性 100
第五節 社會人口特質對於學童吸菸行為的相關性…………… 101
第六節 其他危險行為特質對於學童吸菸行為的相關性……… 103

第六章 結論與建議……………………………………………… 104
第一節 結論……………………………………………………… 104
第二節 建議……………………………………………………… 106

第七章 研究限制………………………………………………… 107

第八章 對公共衛生政策意義…………………………………… 109

參考文獻………………………………………………………… 110
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