本研究之目的主要在瞭解國中生拒吸二手菸行為之現況﹐及影響因素。研究架構參考Pender（1987）的健康促進模式加以改編﹐探討修正因素﹑認知知覺因素及拒吸二手菸行為之關係。其修正因素包括背景特性﹑生物特性﹑情境因素及人際影響﹐認知知覺因素包括健康的重要性﹑知覺健康控制﹑知覺健康狀況及知覺自我效能。本研究以桃園市縣立國中生17434人為研究母群體﹐以分層集束抽樣法抽取樣本﹐並利用自填式問卷的方法進行資料收集﹐共得實際樣本數為750人。
本研究所得資料﹐以描述性統計﹑一般性複迴歸及階層式複迴歸等統計方法進行分析﹐而重要結果歸納如下﹕
一﹑研究對象通常對於被動預防二手菸的行為如打開窗戶沖淡煙味或在戶外時選擇離開等﹐較多被使用﹔主動的行為如積極選擇非吸菸區用餐﹑阻止別人吸菸等則較少被採用。
二﹑在認知知覺因素與拒吸二手菸之關係中﹐發現研究對象愈重視健康的重要性﹑愈趨於內控﹑愈強勢他人外控﹑拒吸二手菸控制力愈高﹑一般自我效能愈高﹑拒吸二手菸效能愈高則採取拒吸二手菸行為愈高。而愈趨於機運外控者其採取拒吸二手菸行為愈低。至於自覺健康狀況與拒吸二手菸行為未見顯著影響。
三﹑研究對象在修正因素中之性別﹑年級﹑父﹑母親教育程度﹑呼吸道過敏﹑氣喘﹑生理危害信念﹐具有影響認知知覺因素中之部份變項﹔間接的影響拒吸二手菸行為。而吸菸狀況﹑生理反應﹑同住者吸菸狀況﹑暴露二手菸環境﹑人際影響變項除了透過認知知覺因素中之部份變項間接的影響拒吸二手菸行為外﹐也同時具有直接影響拒吸二手菸行為。另外﹐健康問題中之支氣管炎及中耳炎變項對拒吸二手菸行為則沒有顯著影響。
四﹑在拒吸二手菸行為之階層式複迴歸分析的結果中﹐認知知覺因素在第一階層對拒吸二手菸行為達26.7%的解釋力﹐修正因素在第二階層增加了22.3%的解釋力﹐使得修正因素 ﹑認知知覺因素對拒吸二手菸行為之解釋力達49.0%。
本研究結果可以供衛生教育者作為衛生教育計畫之參考﹐以及國內對於拒吸二手菸行為後續研究之建議。

The purpose of this study was to identify and to describe the relationships among factors which influence the avoidance of environmental tobacco smoke(ETS) in junior high school students. Pender's Health Promotion Model(1987) provided the theoretical framework for the study. A descriptive correctional design was used. The predictor variables in this study were modifying factors and cognitive-perceptual factors. The modifying factors included demographic characteristics, biological characteristics, situational factors, and interpersonal influences. The cognitive-perceptual factors included the importance of health, perceived control of health, perceived self-efficacy, and perceived health status.
The subjects were sampled by the stratified clustered sampling method from a population of 17,434 junior high school students in Taoyuan City. The data were collected by self-administration with valid enrollment of 750 subjects.
The data were analyzed by descriptive statistics, general linear multiple regression and hierarchical multiple regression. The important conclusions were as fallow:
1.According to the results of the ETS Scale study, the subjects took passive behaviors more frequently, such as opening the windows rather than active behaviors, such as asking to stop smoking.
2.There were significant influences between avoidance of ETS and the variables of the importance of health, internal health locus of control, powerful others health locus of control, chance health locus of control, control over exposure to ETS, general self-efficacy, and efficacy to avoid ETS.
3.The modifying factors including the variables of gender, grade of students, parent's educational degree, respiratory allergies, asthma, and physical danger belief affected the behavior of avoidance of ETS indirectly via their impact on cognitive-perceptual. The modifying factors including the variables of smoking status, uncomfortable physical reaction, living with smoker, exposure to ETS, and interpersonal influences affected the behavior of avoidance of ETS both directly and indirectly by their impact on cognitive-perceptual factors.
4.We employed hierarchical multiple regression analysis of avoidance of ETS on cognitive-perceptual factors in a first block and modifying factors in a second block. The cognitive-perceptual factors explained the 26.7% of the variance of avoidance of ETS. With the addition of modifying factors, the total amount of variance explained by all variables increased up to 49.0%.
The results of this study provided information of relationships among factors influencing the avoidance of ETS in junior high school students. They could be the references of the health educational programs and further studies concerning ETS.

參考文獻
中文部份
行政院衛生署（民82）。衛生白皮書。台北﹕行政院衛生署。
行政院環境保護署（民82）。環境菸煙（二手菸）危害知多少。台
北：行政院環境保護署。
呂槃、黃奕清（民81）。衛生教育概論（上冊）。台北：大洋。
沈育娟（民84）。台北市公立國中學生控握信念﹑健康價值與吸菸
行為之研究。國立台灣師範大學衛生教育研究所碩士論文。
吳淑瓊（民73）。自述性之健康測量。中華民國公共衛生學會雜誌﹐
第4期﹐頁19-25。
姜逸群﹑黃雅文（民81）。衛生教育與健康促進。台北﹕文景。
姚元青（民83）。國立台灣師範大學學生飲食行為及其影響因素之
研究。國立台灣師範大學衛生教育研究所碩士論文。
陳靜芝（民76）。國中學生對二手菸之反應及其相關因素之研究。
國立台灣師範大學衛生教育研究所碩士論文。
黃淑貞（民71）。國中男生開始抽菸之誘因及其仿效對象之研究。
國立台灣師範大學衛生教育研究所碩士論文。
黃毓華﹑鄭英耀（民85）。一般性自我效能量表之修訂。測驗年刊﹐
第43期﹐279-286。
趙瑞雯（民85）。高中生體型意識﹑健康控握與飲食行為間之關係
研究。國立台灣師範大學衛生教育研究所碩士論文。
歐曉蓁（民84）。台北縣某國中男生嚼檳榔行為研究。國立台灣師
範大學衛生教育研究所碩士論文。
嚴道﹑黃松元﹑馬藹屏﹑楊美雪﹑周曉慧（民85）。台北市國中學
生之吸菸行為與其心理特質調查研究。台北﹕財團法人董氏基
金會。
外文部份
Bandura, A.(1977). Self-efficacy: Toward a unifying theory of
behavioral change. Psychological Review, 84, 191-215.
Becker, M., Haefner, D., Kasl, S., Kirsht, J., Maiman, L., &
Rosenstock, I.(1977). Selected psychosocial models and
correlates of individual health-related behaviors.
Medical Care, 15(5), 27-43.
Best, J.A., & Steffy, R.A.(1971). Smoking modification
tailored to subject characteristics. Behavior Therapy,44,
580-585.
Brubaker, B.H. (1983).Health promotion: A Linguistic
analysis. Advanced Nursing Science, 5, 1-14.
Cameron, R., & Best, J.(1987). Promoting adherence to health
behavior change intervention: Recent findings from
behavioral research. Patient Counsel Education, 10,
139-154.
Celermajer, D.S., Adams, M.R., Clarkson, P., Pobinson, J.,
McCredie, R., Donald, A., & Deanfield, J.E.(1996). Passive
smoking and impaired endothelium-dependent arterial
dilation in healthy young adults. The New England Journal
of Medicine, 334(3), 150-154.
Clark, J.H., MacPherson, B.V., & Holmes, D.R.(1982). Cigarette
smoking and external locus of control among young
adolescents. Journal of Health and Social Behavior, 23,
253-259.
Cobb, S. (1976). Social support as a moderator of life stress.
Psychosomatic Medicine, 38, 300-314.
Cohen, S., & Syme, S.L.(1985). Social Support and Health. New
York: Academic Press.
Contento, I.R., & Murphy, B.M.(1990). Psycho-social factors
differentiating people who reported making desirable
changes in their diets from those who did not. Journal
Nutrient Education, 22, 6-14.
Duffy, M.E.(1988). Determinants of health promotion in midlife
women. Nursing Research, 37, 358-362.
Emmons, K.M., Abrams, D.B., Marshall, R.J., Etzel, R.A.,
Novotny, T.E., Marcus, B.H., & Kane, M.E.(1992). Exposure
to environmental tobacco smoke in naturalistic settings.
American Journal of Public Health, 82(1), 24-28.
Frank-Stromberg, M., Pender, N.L., Walker, S., & Sechrist,
K.(1990). Determinants of health promoting lifestyle in
ambulatory cancer patients. Social Science in Medicine,
31(10), 1159-1168.
Foster, M.F.(1992). Health promotion and life satisfaction in
elderly black adults. Western Journal of Nursing Research,
14(4), 444-463.
Garcia, A.W., Broda, M.A., Frenn, M., Coviak, C., pender, N.J.,
& Ronis, D.L.(1995). Gender and developmental differences
in exercise beliefs among youth and prediction of their
exercise behavior. Journal of School Health, 65(6),
213-219.
Gillis, A.J.(1993). Determinants of a health-promoting
lifestyle: An integrative review. Journal of Advanced
Nursing, 18, 345-353.
Glantz, S.A., & Parmley, W.W.(1995). Passive smoking and heart
disease. Journal of the American Medical Association,
273(13), 1047-1053.
Gould, S.(1987). Consumer behavior and health promotion: A
reply to Becker's "the tyranny of health promotion." Public
Health Review, 15, 357-364.
Greenberg, R.A., Bauman, K.E., Strecher, V.J., Keyes, L.L.,
Glover, L.H., Haley, N.J., Stedman, H.C., & Loda, F.A.
(1991). Passive smoking during the first year of life.
American Journal of Public Health, 81(7), 848-853.
Greenberg, R.A., Stecher, V.J., Bauman, K.E., Boat, B.W.,
Fowler, M.G., Keyes, L.L., Denny, F.W., Chapman, R.S.,
Stedman, H.C., LaVange, L.M., Glover, L.H., Haley, N.J.,
& Loda, F.A.(1994). Evaluation of a home-based
intervention program to reduce infant passive smoking
and lower respiratory illness. Journal of Behavioral
Medicine, 17(3), 273-290.
Hubbard, P., Muhlenkamp, A.F., & Brown, N.(1984). The
relationship between social support and self-care
practices. Nursing Research, 33, 266-270.
James, W.H., Woodruff, A.B., & Werner, W.(1965). Effect of
internal and external control upon changes in smoking
behavior. Journal of Consulting Psychology, 29, 184-186.
Johnson, J.L., Ratner, P.A., Bottorff, J. L., & Hayduk, L.A.
(1993). An exploration of Pender's Health Promotion Model
using LISREL, Nursing Research, 42(3),132-138.
Kendall, P.C., Finch, A.J., Little, V.L., Chirico, B.M., &
Ollendick, T.H.(1978).Variations in a construct:
Quantitative and qualitative differences in children's
locus of control. Journal of Consulting and Clinical
Psychology, 46, 590-592.
Kershaw, C.R.(1987). Passive smoking, potential atrophy and
asthma in the first five years. Journal of the Royal
Society of Medicine, 80, 683-688 .
Kurtz, M.E., Azikiwe U., & Kurtz, J.C.(1993).Nigerian urban
married women's perceptions of exposure to secondary
tobacco smoke. Health Care for Women International, 14(3),
239-248.
Kurtz, M.E., Johnson, S.M., & Ross-Lee, B.(1992).Passive
smoking: Directions for health education among Malaysian
college students. International Journal of Health
Services, 22(3),555-565.
Law, M.R., & Hackshaw, A.K.(1996). Environmental tobacco
smoke. British Medical Bulletin, 52(1), 22-34.
Leads From the MMWR(1988). Passive smoking: Belifs, attitudes,
and exposures-United States,1986. JAMA, 259(19),
2821-2825.
Levenson, H.(1973). Multidimensional locus of control in
Psychiatric patients. Journal of Consulting and Clinical
Psychology, 41, 397-404.
Lowery, B.(1981). Misconceptions of limitations of locus of
control and the I-E scale. Nursing Research, 30, 294-298.
Lusk, S.L., Ronis, D.L., & Hogan, M.M.(1997). Test of the
Health Promotion Model as a causal model of construction
workers' use of hearing protection. Research in Nursing &
Health, 20, 183-194.
Lusk, S.L., Ronis, D.L., Kerr, M.J., & Atwood, J.R.(1994). Test
of the Health Promotion Model as a causal model of workers'
use of hearing protection. Nursing Research, 43(3),
51-157.
Martinelli, A.M.(1996). A study of Health Locus of Control,
Self-efficacy, Health Promotion Behaviors, and
Environmental Factors related to the Self-report of the
Avoidance of Environmental Tobacco Smoke in Young Adults.
Unpublished doctoral dissertation, Catholic University of
America.
McCaul, K.D., Glasgow, R., O'Neill, H.K., Freeborn, V., & Rump,
B.S.(1982). Predicting adolescent smoking. The Journal of
School Health, 342-346.
Muhlenkamp, A.F., Brown, N.J., & Sands, D.(1985).Determinants
of health promotion activities in nursing clinic clients.
Nursing Research, 34, 327-332.
OcKene, J.K., Benfari, R.C., & Nuttal, R.L.(1982).
Relationship of psychosocial factors to smoking behavior
change in an intervention program. Preventive Medicine,
11, 13-28.
O'Dennell, M.P. (1986). Definition of health promotion.
American Journal of Health Promotion, 1(1), 4-5.
Owie, I. (1984). Smoking behavior of prospective teachers: A
Nigerian case. Journal of American College Health, 32,
205-207.
Parcel, G.S., & Meyer, M.P.(1978). Development of an
instrument to measure children's health locus of control.
Health Education Monographs, 6(2),149-159.
Pender, N.J. (1982). Health Promotion in Nursing Practice(1st
ed.), Norwalk. CT: Appleton-Lange.
Pender, N.J. (1987). Health Promotion in Nursing Practice(2nd
ed.), Norwalk. CT: Appleton-Lange.
Pender, N.J. (1996). Health Promotion in Nursing Practice(3rd
ed.), Norwalk. CT: Appleton-Lange.
Pender, N.J., & Pender, A.R.(1986). Attitudes, subjective
norms and intentions to engage in health behaviors.
Nursing Research, 35, 15-18.
Pender, N.J., Walker, S. N., Sechrist, K.R., & Frank-
Stromborg, M.(1990). Predicting health-promoting
lifestyles in the workplace. Nursing Research, 39(6),
326-332.
Perry, C.L., & Silvis, G.L. (1987). Smoking prevention:
Behavioral prescriptions for the pediatrician.
Pediatrics, 79, 790-799.
Pershagen, G.(1989). Childhood cancer and malignancies other
than lung cancer related to passive smoking. Mutation
Research, 222, 129-135.
Ratner, P.A., Bottorff, J.L., Johnson, J.L., & Hayduk,
L.A.(1994). The interaction effects of gender within the
health promotion model. Research in Nursing & Health, 17,
341-350.
Riffle, K.L., Yoho, J., & Sams J.(1989). Health
promoting behaviors, perceived social support, and
self reported health of Appalachian elderly.
Public Health Nursing, 6(4), 204-211.
Rokeach, M.(1973). The Nature of Human Values. New York: Free
Press.
Rosenbaum, M., & Argon, S.(1979). Locus of control and success
in self-initiating attempts to stop smoking. Journal of
Clinical Psychology, 35, 870-872.
Rotter,J.B.(1966). Generalized expectancies for internal
versus external control of reinforcement. Psychological
Monographs: General and Applied, 80, 1-28.
Rotter,J.B.(1975). Some problems and misconceptions related
to the construct of internal versus external control of
reinforcement. Journal of Consulting and Clinical
Psychology, 43, 56-67.
Segall, M.E., & Wynd, C.A.(1990).Health conception, health
locus of control and power as predictors of smoking
behavior change. American Journal of Health Promotion,
4(5), 338-372.
Sherer, M., Maddux, J.E., Mercandante, B., Prentice-Dunn, S.,
Jacobs, B., & Rogers, R.W.(1982). The self-efficacy scale:
Construction and validation. Psychological Reports, 51,
663-671.
Strecher, V.J., Bauman, K.E., Boat, B., Fowler, M.G.,
Greenberg, R., & Stedman, H.(1989). The development and
formative evaluation of a home-based intervention to
reduce passive smoking by infants. Health Education
Research,4(2), 225-232.
Strecher, V.J., Bauman, K.E., Boat, B., Fowler, M.G.,
Greenberg, R., & Stedman, H.(1993). The role of outcome
and efficacy expectations in an intervention designed to
reduce infants' exposure to environmental tobacco smoke.
Health Education Research, 8(1), 137-143.
Strecher, V.J., Devellis, B.M., Becker, M.H., & Rosenstock,
I.M.(1986).The role of self-efficacy in achieving health
behavior change. Health education quarterly, 13(1),
73-91.
Strickland, B.(1978). Internal-external expectancies and
health-related behaviors. Journal of Consulting and
Clinical Psychology, 46(6), 1192-1211.
Tager, I.B.(1989). Health effects of "passive smoking" in
children. Chest, 96(5), 1161-1164.
Wallston, B.S., Wallston, K.A., Kaplan, G.D., & Maides,
S.(1976). Development and validation of the health locus
of control (HLC) Scale. Journal of Consulting Psychology,
44, 580-585.
Wallston, K.A., Maides, S., & Wallston, B.S.(1976). Health-
related information seeking as a function of health-
related locus of control and health value. Journal of
Research in Personality, 10, 215-222.
Wallston, K.A., & Wallston, B.S.(1978).Locus of control and
health: A review of the literature. Health Education
Monographs, 6(2), 107-115.
Wallston, K.A., Wallston, B.S., & DeVellis, R.(1978).
Development of the multidimensional health locus of
control(MHLC) scales. Health Education Monographs, 6(2),
160-170.
Walsh, V.R.(1985). Health beliefs and practices of runners and
nonrunners. Nursing Research, 34, 353-356.
Weitzel, M.H.(1989). A test of the health promotion model with
blue collar workers. Nursing Research, 38(2), 99-104.
Yorcheski, A., & Mahon, N.E.(1989). A causal model of positive
health practices: The relationship between approach and
replication. Nursing Research, 38, 88-93.
Zimmerman, R.S., & Connor, C.(1989). Health promotion in
context: The effects of significant others on health
behavior change. Health Education Quarterly, 16, 57-75.