應用PRECEDE模式探討屏東地區高職生吸菸行為及其影響因素

The Application of the PRECEDE Model to Understanding the Factors Associated with Vocational High School Student’s Smoking Behavior in Pingtung Area

目的：國內的相關研究指出高職學生的吸菸率為高中生之兩倍以上，本研究應用PRECEDE模式為架構，探討高職學生吸菸行為，分析素質因素（菸害知識、反菸態度、拒菸自我效能）、增強因素（好朋友、家人吸菸行為）及使能因素（學校菸害防制政策、媒體廣告）與學生吸菸行為之相關性。方法：採橫斷性研究，以屏東地區高職生為對象，採方便取樣，共選取3所學校71班。使用自填式問卷收集高職學生吸菸行為及其影響因素。有效問卷共2,127份，回收率85.3%。最後以多元式邏輯斯迴歸分析高職生吸菸行為影響因素。結果：屏東地區高職生目前吸菸者有15.19%（男性佔19.4%，女性佔9.3%），控制干擾因素後，吸菸影響因素，在素質因素有：在校成績排名後者（aOR=4.39; 95%CI: 1.68-11.47）及排名中者（aOR=2.54; 95%CI: 1.06-6.06）；菸害知識（aOR=0.86; 95%CI: 0.77-0.96）、拒菸自我效能（aOR=0.98; 95%CI: 0.97-0.98）；增強因素：好友中有1/4吸菸者（aOR=3.60; 95%CI: 1.24-10.51）及好友中有1/2以上吸菸者（aOR=7.42; 95%CI:2.59-21.27）；使能因素：學校菸害防制政策中，『學校若發現學生在校內吸菸，並無沒收處理方式』則「目前」吸菸行為危險比為0.40倍（aOR=0.40; 95%CI:0.23-0.70）。建議：本研究結果建議學校健康教育者及學校護士於推動高職學生菸害防制計畫時，宜整合此三大因素於菸害防制措施中，以降低高職生吸菸情形。

Objectives: The higher smoking prevalence for vocational high school students compared to that in the high school has been described. The aim was to apply the PRECEDE Model to explore the association between three educational factors (predisposing, reinforcing and enabling factors) and student’s smoking behavior in vocational high schools in Pingtung area. Methods: Cross-sectional study design and the cluster sampling were used to obtain a representative sample in 3 vocational high schools (class=71). Overall, 2,127 students were included by using the structured questionnaire survey. The response rate was 85.3%. Polytomous logistic regression analyzed the relationship between student’s smoking behavior and three educational factors. Results: The results showed that prevalence of current smoking among vocational school students in Pingtung area was15.19% (male student: 19.4%, female student: 9.3%). The significant factors for vocational school student’s current smoking behavior were the predisposing factors i.e. the lower rank in the academic achievement (aOR=4.39; 95%CI: 1.68-11.47) and the middle rank in academic achievement (aOR=2.54; 95%CI: 1.06-6.06), the tobacco hazard knowledge aOR=0.86;95%CI: 0.77-0.96), the self-efficacy on anti-smoking (OR=0.98; 95%CI: 0.97-0.98). The reinforcing factors i.e. one fourth of best friends smoked (OR=3.60; 95%CI: 1.24-10.51) and the half of the friends smoking (OR=7.42; 95%CI: 2.59-21.27). The and enabling factors i.e. school tobacco prevention regulation with “students smoke in school will be forfeited” (aOR=0.40; 95%CI: 0.23-0.70). Application in nursing: the findings further suggest school health educator or school nurses are recommended to integrate these factors into anti-smoking programs to reduce such high school student’s smoking.