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題名：國中生吸菸行為之研究--社會生態學模式之應用
作者：白瑞聰
作者(外文)：Jei-Tsung Pai
校院名稱：國立臺灣師範大學
系所名稱：健康促進與衛生教育學系
指導教授：呂昌明
.
學位類別：博士
出版日期：2008
主題關鍵詞：青少年吸菸；社會生態學模式；階層線性模式；調節作用；中介效果；adolescent smoking；social ecological model；Hierarchical Linear Model；HLM；moderate effect；mediate effect
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本研究的主要目的是以整合與青少年吸菸有關之環境因素與個人因素的社會生態學模式架構來探討國中生的吸菸行為，並檢驗與學校環境有關之生態影響因素。以比率抽樣法自台灣北部某縣市37所有國中部的中等學校隨機抽取3,635位國中生，並透過衛生與教育行政系統，對樣本學生進行團體式的結構問卷調查，共計有效問卷3,604份，有效問卷率99.15%。除使用描述性統計、卡方檢定、獨立雙樣本t檢定、單因子變數分析、相關與回歸等統計方法進行相關之描述與檢定之外，並運用HLM 6.0進行階層線性迴歸(HLM)來分析學校與學生二個層級資料(two-level data)間的調節效果(moderate effect)與中介效果(mediate effect)。研究之重要結果如下：
一、有38.0%的國中生曾經嘗試過吸菸，12.4%目前有吸菸，8.4%吸菸超過100支；而目前有吸菸的學生，有66.9%偶而吸菸、15.7%經常吸菸、17.4%幾乎每天吸菸。多數國中生第一次的吸菸，年齡在十三、四歲，地點在
自己家裡，原因是因為好奇，而朋友、爸爸、同學則是主要的影響者。
二、國中生的自尊普通，偏差行為頻度與同儕吸菸頻度不高、吸菸影響認知答對率僅五成，對吸菸的態度略偏非常負向，自覺拒 菸自我效能佳。而自尊、吸菸影響認知與拒菸自我效能較低者，及吸菸態度較正向、偏差
行為頻度與同儕吸菸頻度較高的國中生，其吸菸率較高。
三、吸菸態度、拒 菸自我效能、偏差行為頻度與同儕吸菸頻度是有效預測國中生吸菸頻度的個人因素，共可解釋吸菸頻度之變異量的41.83%。
四、學校反社會化環境及學校吸菸環境是影響學生吸菸頻度的重要學校因素。學生吸菸頻度的總變異量中，有14.70%是由學校間的差異所造成的，
而學校反社會化環境及學校吸菸環境二者共可解釋其中的82.15%。
五、學校層級之總體解釋變項「學校反社會化環境」，對學生層級之解釋變項「吸菸態度」、「拒菸自我效能」、「偏差行為頻度」與「同儕吸菸頻度」對吸菸頻度的影響，都分別不具調節效果。而學校層級之總體解釋變項「學校吸菸環境」，對學生層級之解釋變項「同儕吸菸頻度」對吸菸頻度的影響雖也不具調節效果，但對「吸菸態度對吸菸頻度的影響」、「拒菸自我效能對吸菸頻度的影響」及「偏差行為頻度對吸菸頻度的影響」則
都具有調節效果(moderate effect)。
六、「吸菸態度」、「拒菸自我效能」與「偏差行為頻度」等學生個人因素，對「學校反社會化環境對吸菸頻度之關係」及「學校吸菸環境對吸菸頻度之關係」具有部分中介效果(partially mediate effect)；而「同儕吸菸頻度」，對「學校反社會化環境對吸菸頻度之關係」雖有部分中介效果，但對「學校吸菸環境對吸菸頻度之關係」則不具有中介效果。且「拒菸自我效能」與「吸菸態度」之中介效果大於「偏差行為頻度」與「同儕吸菸頻度」。
This research examines junior high school students’ smoking within a social ecological framework that incorporates both environmental and individual factors relating to the use of tobacco by adolescents. The ecological influences that are examined correlate with the adolescent’s school environment. The research utilizes data collected from a random sample of 3,604 Miao-Li students via questionnaire from 37 different schools. Hierarchical Linear Regression(HLM) statistical methods are used to analyze the two-level data. The main findings show that school ecological variables are important influence in adolescent tobacco use. The aggregated measure of anti-social behavior and campus smoking of teachers and students are associated with smoking behavior. These relationships are still valid when important individual characteristics such as attitude toward smoking, efficacy of smoking refusing, anti-social behavior, and peer smoking are considered. The aggregated measure of campus smoking of teachers and students can moderate the relationship between attitude toward smoking and smoking behavior, the relationship between efficacy of refusing smoking and smoking behavior, and the relationship between anti-social behavior and smoking behavior. All of the attitude toward smoking, efficacy of smoking refusing, anti-social behavior, and peer smoking can partially mediate the relationship between the aggregated measure of anti-social behavior and smoking behavior, and the relationship between the aggregated measure of campus smoking of teachers and students and smoking behavior. These findings are consistent with a social ecological perspective that views the environment as a primary, independent determinant of behavior. Consequently, policy and prevention should focus on the need of developing ecological prevention models.
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