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研究生:白瑞聰
研究生(外文):Jei-Tsung Pai
論文名稱:國中生吸菸行為之研究--社會生態學模式之應用
論文名稱(外文):Understanding Junior High School Students' Smoking: An Social Ecological Approach
指導教授:呂昌明呂昌明引用關係.
指導教授(外文):Chang-Ming Lu
學位類別:博士
校院名稱:國立臺灣師範大學
系所名稱:健康促進與衛生教育學系
學門:民生學門
學類:運動休閒及休閒管理學類
論文種類:學術論文
論文出版年:2008
畢業學年度:97
語文別:中文
論文頁數:324
中文關鍵詞:青少年吸菸社會生態學模式階層線性模式調節作用中介效果
外文關鍵詞:adolescent smokingsocial ecological modelHierarchical Linear ModelHLMmoderate effectmediate effect
相關次數:
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本研究的主要目的是以整合與青少年吸菸有關之環境因素與個人因素的社會生態學模式架構來探討國中生的吸菸行為,並檢驗與學校環境有關之生態影響因素。以比率抽樣法自台灣北部某縣市37所有國中部的中等學校隨機抽取3,635位國中生,並透過衛生與教育行政系統,對樣本學生進行團體式的結構問卷調查,共計有效問卷3,604份,有效問卷率99.15%。除使用描述性統計、卡方檢定、獨立雙樣本t檢定、單因子變數分析、相關與回歸等統計方法進行相關之描述與檢定之外,並運用HLM 6.0進行階層線性迴歸(HLM)來分析學校與學生二個層級資料(two-level data)間的調節效果(moderate effect)與中介效果(mediate effect)。研究之重要結果如下:
一、有38.0%的國中生曾經嘗試過吸菸,12.4%目前有吸菸,8.4%吸菸超過100支;而目前有吸菸的學生,有66.9%偶而吸菸、15.7%經常吸菸、17.4%幾乎每天吸菸。多數國中生第一次的吸菸,年齡在十三、四歲,地點在
自己家裡,原因是因為好奇,而朋友、爸爸、同學則是主要的影響者。
二、國中生的自尊普通,偏差行為頻度與同儕吸菸頻度不高、吸菸影響認知答對率僅五成,對吸菸的態度略偏非常負向,自覺拒 菸自我效能佳。而自尊、吸菸影響認知與拒菸自我效能較低者,及吸菸態度較正向、偏差
行為頻度與同儕吸菸頻度較高的國中生,其吸菸率較高。
三、吸菸態度、拒 菸自我效能、偏差行為頻度與同儕吸菸頻度是有效預測國中生吸菸頻度的個人因素,共可解釋吸菸頻度之變異量的41.83%。
四、學校反社會化環境及學校吸菸環境是影響學生吸菸頻度的重要學校因素。學生吸菸頻度的總變異量中,有14.70%是由學校間的差異所造成的,
而學校反社會化環境及學校吸菸環境二者共可解釋其中的82.15%。
五、學校層級之總體解釋變項「學校反社會化環境」,對學生層級之解釋變項「吸菸態度」、「拒菸自我效能」、「偏差行為頻度」與「同儕吸菸頻度」對吸菸頻度的影響,都分別不具調節效果。而學校層級之總體解釋變項「學校吸菸環境」,對學生層級之解釋變項「同儕吸菸頻度」對吸菸頻度的影響雖也不具調節效果,但對「吸菸態度對吸菸頻度的影響」、「拒菸自我效能對吸菸頻度的影響」及「偏差行為頻度對吸菸頻度的影響」則
都具有調節效果(moderate effect)。
六、「吸菸態度」、「拒菸自我效能」與「偏差行為頻度」等學生個人因素,對「學校反社會化環境對吸菸頻度之關係」及「學校吸菸環境對吸菸頻度之關係」具有部分中介效果(partially mediate effect);而「同儕吸菸頻度」,對「學校反社會化環境對吸菸頻度之關係」雖有部分中介效果,但對「學校吸菸環境對吸菸頻度之關係」則不具有中介效果。且「拒菸自我效能」與「吸菸態度」之中介效果大於「偏差行為頻度」與「同儕吸菸頻度」。
This research examines junior high school students’ smoking within a social ecological framework that incorporates both environmental and individual factors relating to the use of tobacco by adolescents. The ecological influences that are examined correlate with the adolescent’s school environment. The research utilizes data collected from a random sample of 3,604 Miao-Li students via questionnaire from 37 different schools. Hierarchical Linear Regression(HLM) statistical methods are used to analyze the two-level data. The main findings show that school ecological variables are important influence in adolescent tobacco use. The aggregated measure of anti-social behavior and campus smoking of teachers and students are associated with smoking behavior. These relationships are still valid when important individual characteristics such as attitude toward smoking, efficacy of smoking refusing, anti-social behavior, and peer smoking are considered. The aggregated measure of campus smoking of teachers and students can moderate the relationship between attitude toward smoking and smoking behavior, the relationship between efficacy of refusing smoking and smoking behavior, and the relationship between anti-social behavior and smoking behavior. All of the attitude toward smoking, efficacy of smoking refusing, anti-social behavior, and peer smoking can partially mediate the relationship between the aggregated measure of anti-social behavior and smoking behavior, and the relationship between the aggregated measure of campus smoking of teachers and students and smoking behavior. These findings are consistent with a social ecological perspective that views the environment as a primary, independent determinant of behavior. Consequently, policy and prevention should focus on the need of developing ecological prevention models.
中文摘要 I
英文摘要 III
目 次 V
圖 次 VII
表 次 IX
第一章 緒論 1
第一節 研究之背景與動機 1
第二節 研究之重要性 4
第三節 研究目的 7
第四節 研究問題 8
第五節 研究假設 9
第六節 名詞釋義 10
第二章 文獻探討 14
第一節 吸菸行為相關理論 14
第二節 與青少年吸菸有關之心理社會因素 25
第三節 與青少年吸菸、藥物使用及偏差行為有關之學校環境因素 27
第四節 以往研究的一些限制 32
第三章 研究方法 34
第一節 本研究採用之研究方法與原因 34
第二節 研究架構 43
第三節 研究對象 45
第四節 研究工具 47
第五節 資料收集方法 53
第六節 資料分析 55
第四章 結果與討論 59
第一節 研究對象基本資料 59
第二節 研究對象的自尊、學校認同感、偏差行為頻度及其影響因素 69
第三節 研究對象菸品廣告、二手菸暴露及其影響因素 83
第四節 研究對象的吸菸影響認知與態度及其影響因素 88
第五節 研究對象的拒菸自我效能及其影響因素 102
第六節 研究對象的吸菸行為及其影響因素 107
第七節 討論 218
第五章 結論與建議 224
第一節 結論 224
第二節 建議 232
參考文獻 236
附錄 249
附錄一 專家效度處理名單與相關附件 249
附錄二 問卷初稿與正式問卷 262
附錄三 問卷填答主持人工作手冊 299
附錄四 各校中選樣本序號與班級 318

圖次
圖2-1 影響人類行為的社會生態系統 20
圖2-2 影響個人吸菸行為的多層次概念架構 22
圖3-1 研究架構 44
圖4-1 各樣本學校迴歸線截距項的貝氏估計法結果及其95% C.I. 175
圖4-2 隨機係數模型所估計之各樣本學校吸菸頻度與吸菸態度之迴歸線 182
圖4-3 隨機係數模型所估計之各樣本學校吸菸頻度與拒菸自我效能之迴歸線 182
圖4-4 隨機係數模型所估計之各樣本學校吸菸頻度與偏差行為頻度之迴歸線 183
圖4-5 隨機係數模型所估計之各樣本學校吸菸頻度與學生同儕吸菸頻度之迴歸線 183
圖4-6 各樣本學校第二層迴歸模式截距項貝式估計值及其95%C.I(按學校反社會化環境) 188
圖4-7 各樣本學校第二層迴歸模式截距項貝式估計值及其95%C.I(按學校吸菸環境) 189
圖4-8 完整模型下跨層級解釋變項的交互作用(學校反社會化環境吸菸態度) 197
圖4-9 完整模型下跨層級解釋變項的交互作用(學校反社會化環境拒菸自我效能) 197
圖4-10 完整模型下跨層級解釋變項的交互作用(學校反社會化環境偏差行為頻度) 200
圖4-11 完整模型下跨層級解釋變項的交互作用(學校反社會化環境同儕吸菸頻度度) 200
圖4-12 完整模型下跨層級解釋變項的交互作用(學校吸菸環境吸菸態度) 204
圖4-13 完整模型下跨層級解釋變項的交互作用(學校吸菸環境拒菸自我效能) 204
圖4-14 完整模型下跨層級解釋變項的交互作用(學校吸菸環境偏差行為頻度) 207
圖4-15 完整模型下跨層級解釋變項的交互作用(學校吸菸環境同儕吸菸頻度) 207
圖4-16 跨層級解釋變項交互作用的調節效果(學校吸菸環境吸菸態度) 208
圖4-17 跨層級解釋變項交互作用的調節效果(學校吸菸環境拒菸自我效能) 209
圖4-18 跨層級解釋變項交互作用的調節效果(學校吸菸環境偏差行為頻度) 210
圖4-19 執行階層線性模式之中介效果的分析步驟 214


表次

表2- 1 與青少年吸菸行為有關之心理社會因素 25
表3- 1 樣本學校應抽班級與人數一覽表 46
表3- 2 變項計分方式及意義 57
表4- 1 研究樣本基本資料一覽表 61
表4- 2 不同性別之研究樣本在基本資料上的比較 67
表4- 3 研究對象自尊一覽表 70
表4- 4 不同特性之研究對象的自尊比較 71
表4- 5 研究對象之學校認同一覽表 73
表4- 6 不同特性之研究對象的學校認同比較 74
表4- 7 研究對象偏差行為一覽表 76
表4- 8 不同特性之研究對象的偏差行為頻度比較 80
表4- 9 樣本學生菸品廣告暴露情形一覽表 85
表4-10 樣本學生二手菸暴露與菸害討論情形一覽表 86
表4-11 不同性別之研究對象的免費菸品與二手菸暴露比較 87
表4-12 研究對象對吸菸影響的認知 89
表4-13 不同特性之研究對象的吸菸影響認知答對率之比較 92
表4-14 研究對象之吸菸態度 94
表4-15 研究對象吸菸態度之描述性統計 99
表4-16 研究對象之吸菸認知態度與吸菸影響認知之相關矩陣 100
表4-17 不同特性之研究對象的吸菸態度比較 101
表4-18 研究對象之拒菸自我效能一覽表 103
表4-19 不同特性之研究對象的拒菸自我效能比較 105
表4-20 研究對象的拒菸自我效能與其吸菸影響認知及吸菸態度之相關矩陣 106
表4-21 研究對象吸菸情形一覽表 108
表4-22 不同人口特性之研究對象是否曾吸菸之比較 120
表4-23 不同人口特性之研究對象是否曾吸菸超過100支之比較 123
表4-24 不同社會人口特性之研究對象目前吸菸情形之比較 126
表4-25 不同就學與交友特性之研究對象目前吸菸情形之比較 129
表4-26 不同學校環境特性之研究對象目前吸菸情形之比較 132
表4-27 不同個別差異之研究對象的吸菸類型之比較(一) 136
表4-28 不同個別差異之研究對象的吸菸類型之比較(二) 140
表4-29 不同個別差異之研究對象的吸菸類型之比較(三) 143
表4-30 不同個別差異之研究對象的吸菸類型之比較(四) 146
表4-31 不同學校特性之研究對象的吸菸類型之比較 149
表4-32 不同社群化過程之研究對象的吸菸類型之比較 151
表4-33 研究對象之吸菸頻度預測模式逐步回歸分析表(全體學生) 153
表4-34 研究對象之吸菸頻度預測模式逐步回歸分析表(學校權屬別) 154
表4-35 研究對象之吸菸頻度預測模式逐步回歸分析表(學校類型) 155
表4-36 研究對象之吸菸頻度預測模式逐步回歸分析表(學校佐在區域) 156
表4-37 研究對象之吸菸頻度預測模式逐步回歸分析表(學校規模) 158
表4-38 研究對象之吸菸頻度預測模式逐步回歸分析表(學校整體偏差行為頻度) 159
表4-39 研究對象之吸菸頻度預測模式逐步回歸分析表(學校整體偏差行為頻度) 160
表4-40 研究對象之吸菸頻度預測模式逐步回歸分析表(整體學生學校認同度) 162
表4-41 研究對象之吸菸頻度預測模式逐步回歸分析表(學生層級) 162
表4-42 研究對象之吸菸量預測模式逐步回歸分析表(學校層級) 163
表4-43 研究對象之吸菸頻度預測模式逐步回歸分析表(學生層級) 164
表4-44 階層線性迴歸分析之研究階層變項 165
表4-45 各校基本資料與模式第一階層(學生)各解釋變項之描述性統計 167
表4-46 模式依變項(各校樣本學生吸菸頻度)之描述性統計 169
表4-47 模式第二階層解釋變項與依變項之描述性統計 170
表4-48 隨機效果單因子變異數分析模式之結果摘要表 174
表4-49 各個學校之樣本平均數的信度估計值與整體信度指標 175
表4-50-1 隨機係數之迴歸模式之結果摘要表(吸菸態度) 177
表4-50-2 隨機係數之迴歸模式之結果摘要表(拒菸自我效能) 178
表4-50-3 隨機係數之迴歸模式之結果摘要表(偏差行為頻度) 178
表4-50-4 隨機係數之迴歸模式之結果摘要表(同儕吸菸頻度) 179
表4-50-5 隨機係數之迴歸模式之結果摘要表(所有學生階層之解釋變項) 181
表4-51-1 以階層一之各組平均值為階層二之結果變項的迴歸模式摘要表(學校反社會化環境) 187
表4-51-2 以階層一之各組平均值為階層二之結果變項的迴歸模式摘要表(學校吸菸環境) 187
表4-51-3 以階層一之各組平均值為階層二之結果變項的迴歸模式摘要表(所有學校階層之解釋變項) 188
表4-52-1 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校反社會化環境) 191
表4-52-2 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校吸菸環境) 192
表4-52-3 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(所有學校階層之解釋變項) 193
表4-53 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校反社會化環境吸菸態度) 195
表4-54 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校反社會化環境拒菸自我效能) 196
表4-55 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校反社會化環境偏差行為頻度) 198
表4-56 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校反社會化環境同儕吸菸頻度) 199
表4-57 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校吸菸環境吸菸態度) 202
表4-58 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校吸菸環境拒菸自我效能) 203
表4-59 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校吸菸環境偏差行為頻度) 205
表4-60 以階層一的截距與斜率做為階層二之結果變項的迴歸模式摘要表(學校吸菸環境同儕吸菸頻度) 206
表4-61 跨層級解釋變項交互作用的調節效果(學校吸菸環境吸菸態度) 209
表4-62 跨層級解釋變項交互作用的調節效果(學校吸菸環境拒菸自我效能) 210
表4-63 跨層級解釋變項交互作用的調節效果(學校吸菸環境偏差行為頻度) 211
表4-64 個人因素中介學校因素與吸菸頻度之關係一覽表 216
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