台灣青壯年男性的吸菸模式與健康生活品質之關係：桃園地區的社區型世代研究

Associations between Smoking Patterns and Health-Related Quality of Life among Taiwanese Young Male Adults: A Community-Based Cohort Study in Taoyuan

目的：吸菸已被證實會產生重大的健康危害與經濟損失，但戒菸效果卻因年齡與國家而有極大差異。本研究主要在探討台灣青壯年男性之吸菸模式與健康生活品質(HRQOL)的關係，以及這些關係是否會因HRQOL面向而有差異。 方法：本研究採縱貫式設計，並選樣自聯新世代研究(LIONS)資料庫。研究對象的納入條件包括：2006-10年間加入LIONS之30-44歲男性，2006-14年間至少有三次不同年份的吸菸資料。HRQOL乃以台灣版健康生活品質問卷來評量會員的自覺身心健康狀態，並用結構式問卷來收集其他共變項資料（如：教育程度、婚姻狀況、運動習慣、精神性障礙、常見重要疾病數、藥物服用量）。最後以線性複迴歸模型於控制初期HRQOL與非吸菸共變項後，評估不同吸菸模式與末次HRQOL（八個次構面與兩個總合分數）之關係。 結果：本研究納入461人，平均38歲與接受12.3年的教育，其中19.4%獨自居住、59.5%有規律運動習慣、23.5%有一定程度的精神性障礙，平均有1.07種常見重要疾病與服用0.08種特定藥物。追蹤期間從不吸菸或持續戒菸者共249人(54.0%)，有139人(30.2%)持續吸菸，新近戒菸者有55人(11.9%)，新近吸菸者僅18人(3.9%)。與從不吸菸或持續戒菸比，新近戒菸者有顯著較差的末次生理總和分數(physical component summary; β=-1.73, p<0.05)與身體生理功能(physical functioning)分數(β=-3.16, p<0.01)，持續吸菸者的末次一般健康狀況(general health)則顯著較佳(β=3.91, p<0.05)。此外，規律運動、精神性障礙與服用藥物量對HRQOL有不同程度影響。 結論：相較於其他年齡族群，青壯年男性對於吸菸與健康狀況之關係可能有不同認知，故戒菸成效較差。因此，未來的戒菸宣導策略應依據各年齡族群所重視之健康議題做修正，以便提高他們的戒菸動機與成效。

 

Purpose: Tobacco smoking has been demonstrated to cause significant adverse health effects and economic losses, but the effectiveness of smoking cessation varies greatly by age and country. The study aims to examine the relationship between smoking patterns and health- related quality of life (HRQOL) in young male adults in Taiwan and whether HRQOL dimensions affect the relationship. Methods: This longitudinal study recruited its subjects from the Landseed Integrated Outreaching Neighborhood Study (LIONS) dataset. Inclusion criteria include: male adults aged 30-44 when enrolled in LIONS during 2006-2010 and with smoking data available in three different years during 2006-2014. The Taiwan version of the 36-item Short-Form Health Survey was employed to measure subjective HRQOL, and a structured questionnaire was used to collect other covariates (e.g., education, marital status, exercise, psychiatric disorder, numbers of significant diseases and specific medicine). With initial HRQOL and non-smoking covariates controlled, a linear multiple regression model was developed to explore the relationship between smoking patterns and HRQOL (including two summary scores and eight construct scales) at a later stage. Results: The study recruited 461 subjects with a mean age of 38 years and an average length of education of 12.3 years. 19.4% of the subjects lived alone, 59.5% exercised regularly, and 23.5% experienced mental disorders. On average, they suffered from 1.07 chronic diseases and took 0.08 kind of specific medicine. During the follow-up, 249 subjects (54.0%) remained never smoking or in smoking cessation, 139 (30.2%) continued to smoke, 55 (11.9%) recently quitted smoking, and 18 (3.9%) became smokers. Compared to those never-smokers or persistent ex-smokers, recent smoke quitters were lower in physical component summary (β=-1.73, p<0.05) and physical functioning (β=-3.16, p<0.01) scores, but persistent smokers had better general health (β=3.91, p<0.05). Additionally, regular exercise, mental disorder, and number of specific medicine exerted varying influences on HRQOL. Conclusion: Young male adults appeared to perform poorer in smoking cessation than their older counterparts due to their different recognition of the relationship between smoking and health. Future strategies of promoting smoking cessation should therefore be modified in response to the top-rated health concerns of smokers in different age groups so as to help improve motivation and efficacy.