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研究生:洪兆嘉
研究生(外文):Chao-Chia Hung
論文名稱:從社會認知理論探討青少年的飲酒行為及相關因素
論文名稱(外文):Investigating the Factors Related to Adolescent Alcohol Use:Based on Social Cognitive Theory
指導教授:李蘭李蘭引用關係
學位類別:博士
校院名稱:國立臺灣大學
系所名稱:衛生政策與管理研究所
學門:醫藥衛生學門
學類:公共衛生學類
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:197
中文關鍵詞:社會認知理論青少年飲酒行為路徑分析模式長期資料分析
外文關鍵詞:social cognitive theoryadolescentdrinking behaviorpath analysislongitudinal data analysis
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本研究共分三篇研究進行,目的在瞭解研究樣本於五至九年級的五年間,其飲酒行為之發展趨勢,並進一步確認研究樣本於九年級時有無飲酒及飲酒行為類型的相關因素。利用兒童及青少年行為之長期發展研究計畫(Child & Adolescent Behaviors in Long- term Evolution, 簡稱CABLE)調查資料,進行次級資料分析。主要的研究變項包括,親職行為、示範因素、社會規範、社會說服、酒品可取得性、飲酒期望及拒絕飲酒的效能。利用SAS9.1及Lisreal 8.0統計軟體以logistic regression, trend analysis, GEE, survival analysis,及path analysis進行長期資料分析。
第一篇研究,將自五年級至九年級(2006)五年均參與調查且未漏答飲酒問題之學生共1,951名當作分析樣本。樣本由五至九年級,五年間飲酒行為變化類型的分佈為「從未飲酒」 (29.88%); 「低頻率飲酒」 (11.89%); 「飲酒頻率由高而低」 (1.59%);「飲酒頻率起起伏伏」 (18.96%);「飲酒頻率由低而高」 (37.06%);「高頻率飲酒」(0.62%); 男生比較可能出現「飲酒頻率由低而高」及「高頻率飲酒」的飲酒頻率增加類型。結果另外發現,學童飲酒行為自五年級至九年級逐年上升。各年度自陳最近一個月有飲酒的盛行率,由5.13%上升至19.48%; 終生飲酒的盛行率由24.55%上升至67.30%,呈現顯著之線性成長趨勢; 六至九年級的飲酒發生率,由14.90%上升至24.00%,亦有顯著上升趨勢。最近一個月飲酒行為,終生飲酒行為,及初次飲酒行為呈現顯著的性別差距。男生於最近一個月飲酒行為,及終生飲酒行為皆顯著高於女生,但是性別差距有縮小的趨勢。
第二篇研究,將九年級(2006年)完成追蹤的學生當作分析樣本,共2,184名。樣本於九年級時,自陳目前有飲酒者佔34.89%。路徑分析結果顯示,父親教育程度、家庭月收入、母親飲酒、同儕飲酒、母親對飲酒的態度、和酒品可取得性,會直接與研究樣本目前有無飲酒有關; 母親飲酒、同儕飲酒、母親對飲酒的態度、和酒品可取得性,則會透過負向飲酒期望及拒絕飲酒的效能間接與研究樣本目前有無飲酒有關。整體而言,研究樣本目前有無飲酒的保護因子,包括:父親教育程度愈高、家庭月收入低、母親不飲酒、飲酒的同儕愈少、母親不贊成青少年飲酒、酒品的可取得性愈不方便、及負向飲酒期望愈高或拒酒效能愈高。
第三篇研究,將九年級(2006年)完成追蹤且曾飲酒的學生當作分析樣本,共1,519名。樣本於九年級時,其飲酒行為可分成三種類型,即高危險飲酒行為(9.55%)、中危險性飲酒行為(22.51%)、低危險性飲酒行為(67.94%)。路徑分析結果顯示,開始飲酒的年齡、同儕飲酒、和酒品可取得性會直接與飲酒行為類型有關。另外,開始飲酒的時間、同儕飲酒及同儕勸酒的壓力會透過認知因素間接與飲酒行為類型有關。綜合上述結果,免於研究樣本成為高危險飲酒行為類型的保護因子,包括: 開始飲酒的年齡愈晚、父親教育程度愈高、飲酒的同儕愈少、酒品可取得性愈不方便、及負向飲酒期望愈高、正向飲酒期望愈低或拒酒效能愈高。
根據本研究結果,建議政府宜重視青少年飲酒比率快速上升的趨勢,研擬預防措施。此外,父母應以身做則不飲酒,亦應明確表達反對青少年飲酒的態度。在有青少年出席的場合,應以一般飲料取代酒類飲料。最後建議透過教育介入及宣導活動,幫助青少年對飲酒建立正確的期望並學習拒酒技巧,以降低青少年飲酒的危害。
This study used a secondary data analysis design. It was aimed to evaluate the trends and demographic differences in drinking behavior and to explore the correlations between personal, environmental, cognitive factors and drinking behavior (current alcohol use, and alcohol use type) from the social cognitive theory perspectives among teens using five-year longitudinal data (5th grade to 9th grade) from the CABE survey (Child and Adolescent Behaviors in Long-term Evolution). Three longitudinal analyses were performed using SAS 9.1 and Lisreal 8.0 statistic software. The statistical analytic approaches included logistic regression, trend analysis, GEE, survival analysis, and path analysis.
The first analysis used the data from 1951 students who had completed annual alcohol use survey for 5 years (data collected from 5th grade to 9th grade). The change pattern (in percentage) in alcohol use reported by the students over the five-years were: (1) never use (29.88%); (2) low use (11.89%); (3) from low use to high use (37.06%); (4) fluctuated (18.96%) ; (5) from high use to low use (1.59%); (6) and high use (0.62%). The change pattern of alcohol use ‘from low use to high use’ and ‘high use’ were most likely to be observed among male students. The prevalence of alcohol use was increased over time. For instance, the change in one-month prevalence rate was from 5.13% to 19.48%. In addition, life-time prevalence rate of alcohol use was increased from 24.55% to 67.3% over the five years. Moreover, alcohol consumption incidence rate from 6th to 9th grade was increased from 14.9% to 24%. Gender differences in one-month alcohol use, life-time alcohol use, and first use of alcohol were observed. The rates for one-month alcohol use and life-time alcohol use were higher in male students than in female students. However, the differences in one-month alcohol use and life-time alcohol use rates between male and female students showed a reduction trend over time.
The second analysis used the data from 2184 students who had completed the alcohol use questionnaire in their 9th grade (Year 2006). Thirty five percent of them were identified as current drinkers. Results from path analysis showed that“father education degree”, “family monthly income”, “mother alcohol use” ,”peer alcohol use”, “mother attitude toward underage drinking”, and “alcohol availability” were the direct factors that significantly affected current alcohol use of the students. In addition, several indirect factors, which were mediated by the cognitive factors,“negative alcohol expectancies” and “alcohol refuse efficacies” , were found to impact students’ alcohol use (i.e. “peer alcohol use”, “mother attitude toward underage drinking”, and “alcohol availability”). The protective factors for alcohol use included higher father education degree, lower family monthly income, mother alcohol no-use, less alcohol use peer, mother attitude against underage drinking, alcohol availability inconvenience, more negative alcohol expectancies and more alcohol refuse efficacies.
The third analysis included the data from 1519 9th graders who had completed the annual alcohol use questionnaire during the 5-year follow-ups and had reported consuming alcohol. Drinking behavior had defined into three levels of alcohol use risks: low, moderate, and high. Among the 1519 students, 9.55% of them were in a high risk of alcohol use; 22.51% in moderate risk, and 67.94% in low risk. Results from the path analysis showed that factors of“the age of first alcohol use“, “peer alcohol use”, and “alcohol availability” directly and significantly affected drinking behaviors of the students. Also, the factors of “the age of first alcohol use“,” peer alcohol use”, “peer offer to drinking” which were mediated by cognitive factors, exerted significant impact on drinking behavior. The protective factor for drinking behavior included late the first use of alcohol, higher father education degree, less alcohol use peer, alcohol availability inconvenience, more negative alcohol expectancies, less positive alcohol expectancies and more alcohol refuse efficacies.
The results of this study suggested that several actions can be taken to against underage drinking. Government agencies should be aware of the rapidly increasing trend in adolescents alcohol use. In addition, parents should avoid becoming a drinker for being a role model for their kids. Moreover, people should always provide soft drinks instead of alcohol beverages to children and adolescence in any social or school activities. Finally, health education should be implemented to help teens to create their expectation on drinking behaviors and approaches of not drinking for preventing health consequences caused by alcohol abuse.
口試委員審定書……………………………………….…. ………………......... ….i
誌謝……………………………………….…. ………………............................. …ii
中文摘要………………………………………………….…. ………………..... ..iii
英文摘要………………………………………………….…. ………………..... .. v
第一章 緒論………………….…………………….…. ………………...…….. …1
第一節 研究動機…………………………………………………… …1
第二節 研究目的…………………………………………………… ..7
第二章 文獻探討……………………………………….………………….…... …8
第一節 飲酒行為的定義與測量…………………………………… …8
第二節 兒童及青少年飲酒行為的發展…………………………… ..15
第三節 兒童及青少年飲酒行為的相關因素……………………… ..17
第四節 社會認知理論的概念及其應用…………………………… ..35
子題一 學生自五年級至九年級飲酒行為之發展…………………………….. ..39
第三章 研究方法……………………………….……………………………... ..41
第一節 研究架構…………………………….……………………... ..41
第二節 研究變項…………………………………………….……... ..42
第三節 資料分析…………………………………………….…..…. ..45
第四章 結果…………………………………….………………........………... ..47
第一節 研究樣本的特質………………………………………...…. ..47
第二節 研究樣本飲酒行為自五年級至九年級之五年變化類型… ..49
第三節 研究樣本飲酒行為之變化趨勢…………………......…….. ..52
第五章 討論與結論………………………………………………………..….. ..74
第一節 兒童飲酒行為的發展……………………………………… ..74
第二節 兒童飲酒行為發展的地區和性別的差異………………… ..76
第三節 本研究的限制……………………………………………… ..78
第四節 建議…………………………………………………………79
子題二 從社會認知理論探討九年級學生有無飲酒之相關因素及影響路徑………………81
第三章 研究方法………………………………………………………83
第一節 研究架構……………………………………………………83
第二節 研究變項………………………………………………………85
第三節 資料分析………………………………………………………93
第四章 結果…………………………………………………………94
第一節 研究樣本的特質………………………………………………94
第二節 研究樣本於九年級時之有無飲酒行為………………………100
第三節 研究樣本之特質因素、環境因素及認知因素與有無飲酒之雙變項分析……………………………………………………………102
第四節 研究樣本之特質因素、環境因素、認知因素與有無飲酒之關係……………………………………………………………………105
第五節 研究樣本有無飲酒相關因素的影響路徑…………………107
第五章 討論…………………………………………………………114
第一節 九年級學生的目前飲酒行為.………………………………114
第二節 與九年級學生目前有無飲酒有關的個人特質因素………116
第三節 與九年級學生目前有無飲酒有關的環境因素………………117
第四節 與九年級學生目前有無飲酒有關的認知因素………………121
第五節 本研究的限制…………………………………………………123
第六節 建議…………………………………………………………124
子題三 從社會認知理論探討有飲酒之九年級學生飲酒行為類型之相關
因素及影響路徑………………………………………………………127
第三章 研究方法……………………………………………………129
第一節 研究架構………………………………………………………129
第二節 研究變項………………………………………………………131
第三節 資料分析……………………………………………………140
第四章 結果……………………………………………………141
第一節 研究樣本的特質……………………………………………141
第二節 有飲酒之研究樣本於九年級(2006年) 時飲酒行為類型之分佈……………………………………………………147
第三節 研究樣本之特質因素、環境因素及認知因素與飲酒行為類型之雙變項分析………………………………………150
第四節 研究樣本之特質因素、環境因素、認知因素與飲酒行為類型之關係…………………………………155
第五節 研究樣本飲酒行為類型相關因素的影響路徑………………158
第五章 討論…………………………………………………………164
第一節 有飲酒之九年級學生的飲酒行為……………………………164
第二節 與有飲酒之九年級學生飲酒行為類型有關的特質因素…167
第三節 與有飲酒之九年級學生飲酒行為類型有關的環境因素…167
第四節 與有飲酒之九年級學生飲酒行為類型有關的認知因素…173
第五節 本研究的限制…………………………………………… 176
第六節 建議……………………………………………………… 177
參考文獻…………………………………………………………181

圖目錄
子題一 學生自五年級至九年級飲酒行為之發展
圖3-1 探討九年級學生從五年級至九年級飲酒行為之發展及相關因素的研究架構………………………………………………………………41
圖4-1 研究樣本飲酒頻率自五年級至九年級之最近一個月盛行率、終生盛行率及發生率趨勢…………………………………………………54
圖4-2 研究樣本自五年級至九年級依居住地區之終生飲酒盛行率
發展趨勢………………………………………………………………58
圖4-3 研究樣本自五年級至九年級之依居住地區之最近一個月飲酒盛行率發展趨勢…………………………………………………………59
圖4-4 研究樣本自五年級至九年級依居住地區之飲酒發生率發展趨勢…………………………………………………………………………60
圖4-5 研究樣本自五年級至九年級依性別之最近一個月飲酒盛行率
發展趨勢…………………………………………………………………65
圖4-6 研究樣本自五年級至九年級依性別之終生飲酒盛行率發展趨勢……………………66
圖4-7 研究樣本自五年級至九年級依性別之飲酒發生率發展趨勢……………………67
子題二 從社會認知理論探討九年級學生有無飲酒之相關因素及影響路徑
圖3-1 探討研究樣本於九年級目前有無飲酒行為之相關因素的研究架構……………………84
圖4-1 研究樣本於九年級時有無飲酒之路徑分析預設模式………………110
圖4-2 研究樣本於九年級時有無飲酒路徑圖及標準化係數………………………………111
子題三 從社會認知理論探討有飲酒之九年級學生飲酒行為類型之相關因素及影響路徑
圖3-1 探討有飲酒之研究樣本於九年級飲酒行為類型之相關因素的
研究架構………………………………………………130
圖4-1有飲酒之研究樣本於九年級時飲酒行為類型路徑分析預設模式…… 160
圖4-2有飲酒之研究樣本於九年級)時飲酒行為類型路徑圖及標準化係數… 161

表目錄
子題一 學生自五年級至九年級飲酒行為之發展
表4-1 研究樣本特質分佈情形及樣本代表性之分析結果……………………………48
表4-2 研究樣本飲酒行為於五年級至九年級之分佈情形……………………50
表4-3 研究樣本目前有無飲酒於五年級至九年級之分佈情形……………50
表4-4 研究樣本於五年級至九年級飲酒行為變化類型……………51
表4-5 研究樣本於五年級至九年級飲酒行為變化類型之性別與地區差異………………………51
表4-6 研究樣本飲酒行為於五年級至九年級之盛行率、發生率及趨勢檢定結果……………………………………………………………53
表4-7 研究樣本飲酒行為於五年級至九年級依居住地區之分佈情形……………………56
表4-8 研究樣本飲酒行為於五年級至九年級之盛行率、發生率依居住地區之狀況及趨勢檢定結果………………………………………57
表4-9 研究樣本飲酒行為於五年級至九年級之盛行率、發生率依地區之比率Z檢定結果…………………………………………………57
表4-10 研究樣本飲酒行為於五年級至九年級依性別之分佈情形………….63
表4-11 研究樣本飲酒行為於五年級至九年級之盛行率、發生率依性別之分佈狀況及趨勢檢定結果……………………………………64
表4-12 研究樣本飲酒行為於五年級至九年級之盛行率、發生率依性別之比率Z檢定結果……………………………………………………64
表4-13 2002年~2006年,研究樣本於各年度之最近一個月有無飲酒行為及性別與地區差異…………………………………………………69
表4-14 2002年~2006年,研究樣本於各年度之終生有無飲酒行為及性別與地區差異……………………………………………………….71
表4-15 研究樣本首次出現飲酒行為時間之分佈情形………………73
表4-16 研究樣本首次出現飲酒行為之存活機率依Log-Rank Test
之檢定結果…………………………………………………………73
子題二 從社會認知理論探討九年級學生有無飲酒之相關因素及影響路徑
表3-1 量表之信效度分析結果…………………………………………92
表4-1 研究樣本個人特質因素資料分佈………………………………96
表4-2 研究樣本環境因素資料分佈……………………………………98

表目錄
表4-3 研究樣本認知因素資料分佈……………………………………99
表4-4 研究樣本於九年級時有無飲酒行為之分佈…………………101
表4-5 研究樣本於九年級時之特質因素、環境因素、認知因素與有無飲酒之雙變項分析……………………………………………………103
表4-6 研究樣本於九年級時之特質因素、環境因素、認知因素與有無飲酒之邏輯斯迴歸分析……………………………………………………106
表4-7 研究樣本於九年級時有無飲酒路徑分析模型之觀察變項分析結果….. 112
子題三 從社會認知理論探討有飲酒之九年級學生飲酒行為類型之相關因素及影響路徑
表3-1 量表之信效度分析結果………………………………………139
表4-1 研究樣本個人特質因素資料分佈……………………………143
表4-2 研究樣本環境因素資料分佈……………………………… 144
表4-3 研究樣本認知因素資料分佈…………………………………146
表4-4 有飲酒之研究樣本飲酒行為類型之分佈……………………148
表4-5 有飲酒之研究樣本的吸菸、嚼檳榔頻率與飲酒行為類型之雙變項分析……………………………………………………………149
表4-6 有飲酒之研究樣本的特質因素、環境因素、認知因素與飲酒行為類型之雙變項分析……………………………………………………………152
表4-7 有飲酒之研究樣本的特質因素、環境因素、認知因素與飲酒行為類型之邏輯斯迴歸分析……………………………………………………………156
表4-8 有飲酒之研究樣本的飲酒行為類型路徑分析模型之觀察變項
分析結果………………………………………………………………..…
162
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