憂鬱、認知及社會影響對台灣南部大學生檳榔使用之解釋

Depression, Cognitive Determinants, and Social Influence in Explaining Betel Nut Chewing among College Students in Southern Taiwan

研究目的：過去文獻已證實ASE模式（Attitude-Social Influence-Efficacy model）可解釋國人檳榔使用的行為，指出檳榔使用結果預期透過自我效能影響嚼檳榔的意圖與行為，社會影響則直接影響意圖與行為。本研究擬修正ASE模式，假設憂鬱可以直接影響嚼檳榔的行為，或透過認知因素間接影響檳榔的使用。研究方法：由南區大學生依分層叢集抽樣出3246名有效樣本，施測檳榔使用意圖與行為量表、檳榔結果預期量表、社會影響量表、拒用檳榔自我效能量表及柯氏憂鬱量表；資料以結構性方程式驗證心理社會因子之模式適配度。研究結果：指出檳榔使用之高正向結果預期需透過低拒用自我效能影響嚼檳榔的意圖與行為；高度社會影響與低拒用自我效能直接影響檳榔使用行為；而憂鬱則透過高正向結果預期和低拒用自我效能，預測嚼檳榔之意圖與行為。研究結論：本研究建議可透過教育與諮商輔導增加大學生學習情緒調控知能，減少檳榔的正向結果預期以及強化拒用自我效能，以預防檳榔的使用。

Purpose: Around Asia, betel nuts, the seed of the Areca palm, are often wrapped in a leaf along with flavorings and chewed for a mild euphoric effect. The harmful aspects of betel nut chewing as a possible cause of oral cancer have been well documented. Given the prevalence of the practice, it is important to understand the psychosocial process. A previous study found that the chewer’s outcome expectancy predicted the intention and behavior of betel nut chewing via refusal self-efficacy. Social influence directly predicted intention and behavior, supporting the attitude social-influence efficacy (ASE) model. Although research has consistently indicated an association between substance abuse disorders and depression, few studies have examined the relation between depression and chewing betel nut. The purpose of this study is to explore whether depression affects the behavior of betel nut chewing directly or indirectly through cognitive factors. We examine a modified ASE model with 2 hypotheses: 1) high positive outcome expectancy, low negative outcome expectancy, high social influence factor, low refusal self-efficacy and high depressed mood affect betel chewing intention and behavior; and 2) refusal self-efficacy and social influence factors influence betel chewing intention and behavior, while outcome expectancy and depression indirectly affect betel chewing intention and behavior via refusal self-efficacy. Methods: Using stratified and cluster sampling, 3,246 valid responses were obtained from students age 18 to 22 (1,498 males and 1,748 females) from 14 colleges in Southern Taiwan in 2003. Measurements included demographic data, betel nut outcome expectancy, social influence, betel nut refusal self-efficacy, betel nut chewing intention, betel nut chewing behavior, and the Ko depression inventory (KDI).U We compared the 2 competing models and examined the relationship among the variables through structural equation modeling (SEM). Results: The second hypothesis model had a better fit than the first one. Outcome expectancy predicted behavior by way of refusal self-efficacy. Low refusal self-efficacy and high social influence directly influenced betel nut chewing intention and behavior. Furthermore, depression via cognitive variables (low refusal self-efficacy and high positive outcome expectancy) predicted intention and behavior. Conclusions: The results indicate that social, cognitive, and emotional factors are the main determinants of betel nut chewing among college students. Also, emotion can affect behavior via cognition. The results of the study serve educational and counseling purposes and illuminate the importance of coping with depression, reduction of positive outcome expectancy, and reinforcement of refusal self-efficacy in preventing the use of betel nut.