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研究生:李典政
研究生(外文):LI, DIAN-JENG
論文名稱:性少數男性在物質使用之風險因子探討
論文名稱(外文):Investigation on Risk Factors of Substance Use among Sexual Minority Males
指導教授:顏正芳顏正芳引用關係陳秀蘭陳秀蘭引用關係
指導教授(外文):YEN, CHENG‐FANGCHEN, SHIOU‐LAN
口試委員:陳正宗王鵬為徐淑婷林清華
口試委員(外文):CHEN, CHENG-CHUNGWANG, PENG-WEIHSU, SU-TINGLIN, CHING-HUA
口試日期:2022-10-14
學位類別:博士
校院名稱:高雄醫學大學
系所名稱:醫學研究所博士班
學門:醫藥衛生學門
學類:醫學學類
論文種類:學術論文
論文出版年:2022
畢業學年度:111
語文別:中文
論文頁數:104
中文關鍵詞:男性性少數物質使用恐同霸凌家庭情緒症狀同儕支持
外文關鍵詞:Gaysubstance usehomophobic bullyingfamilyemotional symptombisexual menpeer support
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背景/目的
物質使用已成為國際重大之公共衛生議題,而物質使用在性少數群體中亦成為需要被關注的精神健康議題。本研究的目的在探討男性性少數群體中(包含男同志及男性雙性戀)物質使用之相關風險因子為何,並探討中介或調節因子為何。
方法
本研究為橫斷式的自填式問卷式調查研究,共招募500位年齡為20至25歲、性傾向為同性戀(371位)或雙性戀(129位)之男性。問卷的評估項目包括物質使用狀況、人口學變項、家庭及同儕支持、恐同霸凌經驗、過去校園生活經驗、情緒狀態、以及性傾向相關因子。本研究使用單因子羅吉斯迴歸來評估各變項是否為物質使用的顯著相關因子。在單因子羅吉斯迴歸檢定中呈現顯著的因子,將納入向前選取逐步羅吉斯迴歸進一步找出物質使用最佳的風險預測因子。更進一步,我們嘗試建立中介模型和調節中介模型去探討個變項之間的交互作用
結果
本研究發現:4.4%的性少數男性自陳在最近一個月曾有非法物質使用。非法物質使用與較高的憂鬱程度、在國中時出櫃、和恐同網路霸凌經驗有顯著關係。使用止痛劑的比例為9.4%,風險因子為在高中時期出櫃、在高中時期缺課、和較高的焦慮程度。使用安眠鎮靜劑的比例為5.4%,風險因子為較高的憂鬱程度及高中時期缺課。使用香菸的比例為13.8%,相關風險因子為在兒童或青少年時期遭遇傳統和網路型恐同霸凌、較低的教育程度、較高的父親之教育程度、和高中時期缺課。最後,問題性飲酒的比例為5.6%,風險因子為兒童或青少年時期遭遇傳統型恐同霸凌。在中介模型方面,本研究發現,越嚴重的情緒症狀跟越嚴重恐同霸凌史有關,而此關係顯著提高物質使用的嚴重度,並成立完全中介效應。而在調節中介模型方面,同儕支持和社會支持,在情緒到恐同霸凌這段路徑,可削弱中介模型的效應並減少性少數男性物質使用。
結論
本研究探討了性少數男性物質使用的風險因子和保護因子。本研究建議,恐同霸凌須盡早評估及介入,而在校園、社區及家庭營造性少數友善環境,可能有助於減少性少數男性物質使用的風險。

Background/Objective: Substance use in sexual minorities is an important under-studied issue. The aim of the current study was to investigate the risk factors for substance use among gay and bisexual men. We also investigated the interactions between these factors.
Methods: This cross-sectional study included 500 sexual minority men (371 gay and 129 bisexual men) aged from 20 to 25 years. Self-administered questionnaires were used to assess the status of substance use, demographic information, family/peer support, life experience at school, experience of homophobic bullying, emotional symptoms, and factors related to sexual orientation. Univariate logistic regression was used to identify the potential factors associated with substance use. These factors were then entered into forward stepwise logistic regression to determine the predictors of substance use. Mediation and moderated mediation models were used to test the interactions between variables.
Results: In total, 4.4% of the participants reported illegal substance use in the past 1 month. The predictors of illegal substance use were homophobic cyberbullying victimization, disclosing their sexual orientation at junior high school, and higher level of depression. The rate of painkiller use was 9.4%. The risk factors for painkiller use were disclosing their sexual orientation at senior high school, truancy in senior high school, and higher level of anxiety. The rate of sedative/hypnotic use was 5.4%. The risk factors for sedative/hypnotic use were truancy in senior high school and higher level of depression. The rate of smoking was 13.8%, and it was predicted by traditional homophobic bullying victimization, homophobic cyberbullying victimization, lower educational level, higher level of paternal education, and truancy in senior high school. The rate of problematic alcohol use was 5.6%, which was predicted by traditional homophobic bullying victimization. The mediation model demonstrated that a higher level of homophobic bullying victimization was associated with a higher level of substance use, which was mediated by a higher level of emotional symptoms. Moreover, social support and peer support significantly moderated the association from homophobic bullying victimization to emotional symptoms, and thereby reduced the level of substance use.
Conclusions: In this study, we estimated the risks and protective factors for substance use among gay and bisexual men, and found that timely assessments and interventions for homophobic bullying victimization are necessary. Developing a friendly environment for sexual minority groups at school, in the community, and within the family may be beneficial to reduce the risk of substance use.

第一章 背景資料及文獻回顧 1
第一節 物質使用於全球及性少數群體之概況 1
第二節 影響性少數群體物質使用之因素 4
第三節 性少數群體物質使用與恐同霸凌 6
第二章 研究目標 8
第一節 研究目的 8
第二節 研究假設 8
第三章 研究方法 9
第一節 倫理揭露 9
第二節 研究對象 9
第三節 研究進行步驟 11
第四節 各項評估 11
第五節 統計方法 17
第四章 結果 26
第一節 基本資料分佈 26
第二節 各種量表之信度及效度分析 26
第三節 各種物質使用之風險因子 31
第四節 恐同霸凌在情緒與物質使用間的中介效應 43
第五節 社會支持的調節中介效應 47
第五章 討論 61
第一節 性少數男性物質使用之特徵 62
第二節 恐同霸凌與物質使用 63
第三節 出櫃與物質使用 66
第四節 校園與家庭相關因子與物質使用 67
第五節 情緒與物質使用,以及恐同霸凌之中介效應 68
第六節 支持系統影響以及調節中介效應 69
第七節 本研究之特點與限制 71
第六章 結論與建議 74
利益揭露 76
參考文獻 77

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