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研究生: 劉美媛
Meei-Yuan Liou
論文名稱: 台北市某高職學生吸菸行為之探討─跨理論模式之應用
Application of the Transtheoretical Model to smoking behavior among a vocational high school students in Taipei city.
指導教授: 呂昌明
Lu, Chang-Ming
學位類別: 博士
Doctor
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2006
畢業學年度: 94
語文別: 中文
論文頁數: 193
中文關鍵詞: 跨理論模式吸菸行為高職學生
英文關鍵詞: transtheoretical model, smoking behavior, vocational high school student
論文種類: 學術論文
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  • 本研究目的乃是應用跨理論模式,探討台北市某高職學生的吸菸行為,以瞭解其吸菸階段分期及不同吸菸階段與改變方法、自我效能及決策權衡的相關。以台北市某高職學生為對象,採隨機集束抽樣方法進行抽樣,最後取得有效樣本1095份,回應率為93.7%。
    結果如下:
    一、本研究對象目前吸菸率為20.6%,男生吸菸率為25.6%,女生為6.4%。有7.9%已戒菸,男生已戒菸率是8.8%,女生是5.0%。共有71.5%未曾吸菸,其中有4.0%想嘗試吸菸。目前吸菸者中,有58.0%有意願戒菸。在已戒菸者中,有75%已持續戒菸六個月以上。
    二、不同吸菸階段的研究對象,在戒菸改變方法、拒菸自我效能/誘惑、吸菸決策權衡方面,皆有顯著差異。
    1.依據所處的吸菸戒除階段,在意圖戒除期給予意識覺醒、情感喚起、自我再評價,在準備戒除期強調增強管理、刺激控制,至於在戒除行動期已經戒菸的青少年,則十種方法皆可採用,而已經戒菸六個月以上者,則除了意識覺醒外,其餘九種方法皆很常用。在推展菸害防制時,如能依據青少年所處的吸菸階段,採用特定的戒菸改變方法,可增加戒菸介入計畫的成效,促使青少年戒菸,達到成功戒菸的目的。
    2.在吸菸戒除階段,各種拒菸自我效能/誘惑情境下的得分皆以無意圖戒除期的得分最高,在戒除維持期最低,呈線性降低的趨勢。處於無意圖戒除期者較易受菸癮/習慣的誘惑,已戒菸六個月以上者,則體重控制的誘惑程度最高,受到菸癮/習慣的誘惑最小。在無意圖戒除期者自覺吸菸的好處高於壞處,在意圖戒除期與準備戒除期者,認為吸菸的壞處稍為高於吸菸的好處,到了戒除維持期,自覺吸菸的壞處遠大於好處。研究對象自覺吸菸適應好處與吸菸社會好處的看法相近似。
    3.在吸菸獲得階段,想嘗試吸菸者各類情境下之誘惑度都增加,其中以正向社交情境之誘惑最大,體重控制的誘惑最小。在無意圖嘗試期吸菸決策權衡達到平衡,對吸菸壞處、好處之同意度相等,但想嘗試吸菸者則較同意吸菸之好處,包括吸菸的適應好處與吸菸的社會好處,認為吸菸所帶來的好處高於壞處。
    研究結果支持跨理論模式的有用性,並提供教育者作為發展不同吸菸階段介入以促進菸害防制的參考。

    The purpose of this study was to assess the relationships of the stages of change with processes of change, self-efficacy/temptation and decisional balance, and to examine the utility of the transtheoretical model in understanding smoking behavior. A random clustered sample of 1095 was recruited from a vocational high school in Taipei city.
    Findings showed that current smoking prevalence was 20.6%, 25.6% among boys and 6.4% among girls. The percent of already quitting smoking was 7.9%, 8.8% among boys and 5.0% among girls. The rate of never smokers was71.5%, 4.0% of never smokers were planning to try smoking. 58.0% of current smokers were contemplating quitting, 75% of former smokers were long-term quitters (> 6 months).
    Subjects in acquisition and cessation stages were compared on 10 processes of change, self efficacy/temptation and decisional balance. Results strongly support the transtheoretical model. Results indicate that smokers : (a) use the fewest processes of change during precontemplation stage; (b) emphasize consciousness raising, dramatic relief and self-reevaluation during the contemplation stage; (c) emphasize reinforcement management and stimulus control in preparation stage; (d) use all 10 process activities during the action stage; and (e) use all 10 process activities except consciousness raising in maintenance stage.
    Participants in acquisition precontemplation scored the lowest and those in cessation precontemplation scored the highest on the self-efficacy/temptation, benefit and decisional balance indices, with the trend reversed on the cons (disadvantages) scale. Smokers at cessation-precontemplation stage were most tempted by habit strength. Exsmokers at cessation- maintenance stage were most tempted by weight control and least tempted by habit strength.
    Never smokers were most tempted to try smoking when they anticipated that smoking would help increase positive social mood, and least tempted when they anticipated that smoking would help control body weight.
    These findings offer support for the transtheoretical model to apply in the antismoking programs, and implications for use of the findings by educator in developing stage-based interventions.

    書名頁 i 論文口試委員審定書 ii 授權書 iii 誌謝 iv 中文摘要 vi 英文摘要 vii 目錄 x 表目錄 xii 圖目錄 xv 第一章 緒論 1 第一節 研究動機及重要性 1 第二節 研究目的 5 第三節 研究問題 6 第四節 研究假設 6 第五節 名詞界定 7 第六節 研究限制 9 第二章 文獻探討 10 第一節 青少年吸菸概況及相關因素的探討 10 第二節 跨理論模式(Transtheoretical Model, TTM) 16 第三節 跨理論模式在吸菸行為的應用 27 第三章 材料與方法 37 第一節 研究設計 37 第二節 研究對象與抽樣方法 38 第三節 研究工具 38 第四節 研究步驟 47 第五節 資料處理與分析 49 第四章 結果 51 第一節 研究對象基本資料分析 51 壹、 研究對象一般概況 51 貳、 吸菸階段分佈 51 參、 吸菸狀況及親友吸菸情形 52 肆、 社會心理變項 53 第二節 個人背景因素與吸菸階段的關係 69 壹、 社會人口學變項與吸菸戒除階段的關係 69 貳、 社會人口學變項與吸菸獲得階段的關係 70 參、 親友吸菸情況與吸菸戒除階段的關係 70 肆、 親友吸菸情況與吸菸獲得階段的關係 71 伍、 目前吸菸者之吸菸行為相關變項與吸菸戒除階段的關係 71 第三節 個人背景因素與社會心理變項的關係 78 壹、 性別與社會心理變項的關係 78 貳、 年齡與社會心理變項的關係 79 參、 年級與社會心理變項的關係 79 肆、 學期成績與社會心理變項的關係 80 伍、 曾經工作、打工與社會心理變項的關係 81 陸、 有無參加學校社團與社會心理變項的關係 82 柒、 親友吸菸與社會心理變項的關係 83 捌、 菸癮強度與社會心理變項的關係 89 玖、 吸菸頻率與社會心理變項的關係 89 拾、戒菸次數與社會心理變項的關係 90 拾壹、第一次吸菸年齡與社會心理變項的關係 90 第四節 社會心理變項與吸菸階段的關係 122 壹、 改變方法與吸菸戒除階段的關係 122 貳、 拒菸自我效能/誘惑與吸菸階段的關係 124 參、 吸菸決策權衡與吸菸階段的關係 127 肆、 拒菸改變方法、拒菸自我效能/誘惑及吸菸決策權衡等TTM社會 心理變項與吸菸階段的關係 131 第五章 討論 152 第一節 吸菸階段的分佈 152 第二節 社會人口學變項與吸菸階段的關係 155 第三節 吸菸行為相關變項、親友吸菸狀況與吸菸戒除階段的關係 155 第四節 戒菸改變方法與吸菸戒除階段的關係 157 第五節 拒菸自我效能/誘惑與吸菸階段的關係 159 第六節 吸菸決策權衡與吸菸階段的關係 161 第七節 研究限制 164 第六章 結論與建議 166 第一節 結論 166 第二節 建議 167 參考文獻 170 附錄一: 問卷內容效度審查專家學者名單 187 附錄二: 吸菸行為問卷 188 表 目 錄 表1 以TTM研究吸菸行為所用之改變階段之定義及測量標準 19 表2 戒菸改變方法與吸菸階段的關係 23 表3-1 開放式引導問卷題目及目的 39 表3-4-1 戒菸改變方法量表及次量表之內在一致性信度分析 46 表3-4-2 拒菸自我效能/誘惑量表及次量表之內在一致性信度分析 46 表3-4-3 吸菸決策權衡量表及次量表之內在一致性信度分析 47 表3-2 研究目的、研究問題與統計方法一覽表 50 表4-1-1 研究對象基本資料 60 表4-1-2 研究對象吸菸階段:獲得階段及戒除階段 60 表4-1-3 研究對象吸菸階段:獲得階段及戒除階段性別比 61 表4-1-4 研究對象之吸菸盛行率 61 表4-1-5 目前吸菸者之菸癮強度、吸菸頻率 62 表4-1-6 目前吸菸者、已戒菸者之戒菸次數、第一次吸菸年齡 62 表4-1-7 研究對象親友目前之吸菸情形 63 表4-1-8 研究對象各項戒菸改變方法得分表 63 表4-1-9 研究對象戒菸經驗性改變方法次量表 64 表4-1-10 研究對象戒菸行為性改變方法次量表 65 表4-1-11 研究對象吸菸決策權衡量表 66 表4-1-12 吸菸者、已戒菸者之拒菸自我效能/誘惑量表 67 表4-1-13 從不吸菸者、只哈過幾口者之拒菸自我效能/誘惑量表 68 表4-2-1 社會人口學變項與吸菸戒除階段與之關係 73 表4-2-2 社會人口學變項與吸菸獲得階段之關係 74 表4-2-3 親友吸菸情況變項與吸菸戒除階段之關係 75 表4-2-4 親友吸菸情況變項與吸菸獲得階段之關係 76 表4-2-5 目前吸菸者之菸癮強度、吸菸頻率與吸菸戒除階段之關係 77 表4-2-6 目前吸菸者、已戒菸者之戒菸次數及第一次吸菸年齡與吸菸 戒除階段之關係 77 表4-3-1 吸菸者、已戒菸者之性別與社會心理變項之關係 92 表4-3-2 從不吸菸者、只哈過幾口菸者之性別與社會心理變項之關係 93 表4-3-3 吸菸者、已戒菸者之年齡與社會心理變項之關係 94 表4-3-4 從不吸菸者、只哈過幾口菸者之年齡與社會心理變項之關係 95 表4-3-5 吸菸者、已戒菸者之年級與社會心理變項之關係 96 表4-3-6 從不吸菸者、只哈過幾口菸者之年級與社會心理變項之關係 97 表4-3-7 吸菸者、已戒菸者之學期成績與社會心理變項之關係 98 表4-3-8 從不吸菸者、只哈過幾口菸者之學期成績與社會心理變項之關係 99 表4-3-9 吸菸者、已戒菸者之曾經工作(打工)過與社會心理變項之關係 100 表4-3-10 從不吸菸者、只哈過幾口菸者之曾經工作(打工)過與社會心理 變項之關係 101 表4-3-11 吸菸者、已戒菸者之參加學校社團與社會心理變項之關係 102 表4-3-12 從不吸菸者、只哈過幾口菸者之參加學校社團與社會心理變項 之關係 103 表4-3-13 吸菸者、已戒菸者之父親與社會心理變項之關係 104 表4-3-14 從不吸菸者、只哈過幾口菸者之父親與社會心理變項之關係 105 表4-3-15 吸菸者、已戒菸者之母親與社會心理變項之關係 106 表4-3-16 從不吸菸者、只哈過幾口菸者之母親與社會心理變項之關係 107 表4-3-17 吸菸者、已戒菸者之哥哥與社會心理變項之關係 108 表4-3-18 從不吸菸者、只哈過幾口菸者之哥哥與社會心理變項之關係 109 表4-3-19 吸菸者、已戒菸者之弟弟與社會心理變項之關係 110 表4-3-20 從不吸菸者、只哈過幾口菸者之弟弟與社會心理變項之關係 111 表4-3-21 吸菸者、已戒菸者之姊姊與社會心理變項之關係 112 表4-3-22 從不吸菸者、只哈過幾口菸者之姊姊與社會心理變項之關係 113 表4-3-23 吸菸者、已戒菸者之妹妹與社會心理變項之關係 114 表4-3-24 從不吸菸者、只哈過幾口菸者之妹妹與社會心理變項之關係 115 表4-3-25 吸菸者、已戒菸者之同學朋友與社會心理變項之關係 116 表4-3-26 從不吸菸者、只哈過幾口菸者之同學朋友與社會心理變項之關係 117 表4-3-27 吸菸者之菸癮強度與社會心理變項之關係 118 表4-3-28 吸菸者之吸菸頻率與社會心理變項之關係 119 表4-3-29 吸菸者、已戒菸者之戒菸次數與社會心理變項之關係 120 表4-3-30 吸菸者、已戒菸者之第一次吸菸年齡與社會心理變項之關係 121 表4-4-1 不同吸菸戒除階段在戒菸改變方法之多變項變異數分析摘要表 134 表4-4-2 吸菸者、已戒菸者之戒菸改變方法在吸菸戒除階段上的差異 135 表4-4-3 各吸菸戒除階段使用頻率較高的拒菸改變方法 138 表4-4-4 不同吸菸戒除階段在拒菸自我效能/誘惑之多變項變異數分析摘要表 139 表4-4-5 吸菸者、已戒菸者之拒菸自我效能/誘惑在吸菸戒除階段上的差異 139 表4-4-6 不同吸菸獲得階段在拒菸自我效能/誘惑之多變項變異數分析摘要表 141 表4-4-7 從不吸菸者、只哈過幾口者之拒菸自我效能/誘惑在吸菸獲得階段 上的差異 141 表4-4-8 不同吸菸戒除階段在吸菸決策權衡之多變項變異數分析摘要表 145 表4-4-9 吸菸者、已戒菸者之吸菸決策權衡在吸菸戒除階段上的差異 145 表4-4-10 不同吸菸獲得階段在吸菸決策權衡之多變項變異數分析摘要表 147 表4-4-11 從不吸菸者、只哈過幾口者之吸菸決策權衡在吸菸獲得階段上的 差異 147 表4-4-12 不同吸菸戒除階段在TTM社會心理變項之多變項變異數分析 摘要表 150 表4-4-13 不同吸菸獲得階段在TTM社會心理變項之多變項變異數分析 摘要表 15 圖 目 錄 圖1 吸菸獲得階段及戒除階段說明圖 8 圖3-1 研究架構圖 37 圖4-4-1 經驗性改變方法與吸菸戒除階段之關係 136 圖4-4-2 行為性改變方法與吸菸戒除階段之關係 137 圖4-4-3 戒菸改變方法與吸菸戒除階段之關係 137 圖4-4-4 吸菸者、已戒菸者之拒菸自我效能/誘惑與吸菸戒除階段之關係 140 圖4-4-5 不吸菸者、只哈過幾口菸者之拒菸自我效能/誘惑與吸菸獲得階段 之關係 142 圖4-4-6 在吸菸獲得階段之男女性之負向情緒情境T值線形圖 142 圖4-4-7 在吸菸獲得階段之男女性之好奇T值線形圖 143 圖4-4-8 在吸菸獲得階段之男女性之體重控制T值線形圖 144 圖4-4-9 吸菸者、已戒菸者之吸菸決策權衡與吸菸戒除階段之關係 146 圖4-4-10 不吸菸者、只哈過幾口菸者之吸菸決策權衡與吸菸獲得階段之 關係 148 圖4-4-11 在吸菸獲得階段之男女性之自覺吸菸社會好處T值線形圖 149

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