本研究的主要目的在於評價一套以跨理論模式為基礎的高中學生戒菸教育計畫，探討學校實施吸菸學生戒菸教育計畫對吸菸學生菸害知識、拒菸技巧、拒菸自我效能、戒菸決定平衡、戒菸改變過程、戒菸行為改變階段、尼古丁依賴程度、一氧化碳值、及日吸菸量的影響，並瞭解本研究的吸菸學生與輔導教師對於戒菸教育計畫的評價。
本研究設計採用「實驗組對照組前、後測實驗設計」。立意取樣台北市立某兩所完全中學之高一、高二吸菸學生為研究對象。實驗組學生接受連續六週、共十四小時的團體戒菸班課程，並於課餘時間由學校輔導老師提供三次個別化戒菸輔導；而對照組未接受任何介入，僅於問卷後後測完成後，發予菸害防制相關之衛教宣導資料。
實驗組與對照組於戒菸教育計畫介入進行之前、之後及六個月後進行問卷前測、後測、及後後測，藉此瞭解戒菸教育計畫介入之立即成效與延宕效果。資料處理與分析以費雪正確機率考驗、魏氏曼惠特尼考驗、及魏氏帶符號等級考驗進行統計檢定。
本研究主要結果敘述如下：
一、戒菸教育計畫介入，能使實驗組學生「戒菸知識」分數顯著地優於對照組，但「吸菸危害知識」分數則與對照組沒有顯著差異。
二、戒菸教育計畫介入，能顯著提升實驗組學生「拒菸技巧」分數，且進步分數顯著地高於對照組。
三、戒菸教育計畫介入，能顯著提升實驗組學生「拒菸自我效能」分數，進步分數顯著地高於對照組，且有延宕效果。
四、戒菸教育計畫介入，能顯著提升實驗組學生「戒菸改變過程」分數，進步分數顯著地高於對照組，且有延宕效果。
五、戒菸教育計畫介入，能顯著降低實驗組學生「尼古丁依賴程度」，且進步分數顯著地高於對照組。
六、戒菸教育計畫介入，能使實驗組學生在「戒菸行為改變階段」間有正向的移動。
七、戒菸教育計畫介入，能減少實驗組學生的「日吸菸量」。
八、實驗組學生與輔導教師對整體戒菸教育計畫多持正向的評價。
本研究結果可作為未來高中學校進行學生戒菸教育計畫、及衛生與教育主管機關推動學校戒菸教育之參考。未來相關研究可在本研究基礎下，進一步發展適宜台灣本土且具成效的青少年戒菸教育計畫，並探討其成效。

This study aimed at evaluating a transtheoretical model (TTM)-based smoking cessation program for high school students. It explored the impact of setting up smoking cessation program at school on the smoking students’ knowledge of smoking harm, cigarette-refusing skills, self-efficacy in refusing cigarette, decisional balance for giving up smoking, processes of change in giving up smoking, the stage of change in giving up smoking, the score of Fagerstrom test for nicotine dependence, the level of carbon monoxide (CO), and the daily smoking quantity, and tried to understand the smoking students’ and counseling teachers’ evaluation on this smoking cessation educational program.
Experimental design of the study adopted an “experimental group/control group, pre-test and post-test design.” First- and second-year students from two Taipei municipal comprehensive junior-senior high schools were chosen through purposive sampling as the subjects. The students in the experimental group received a 14-hour group smoking cessation course in six consecutive weeks and three sessions of individual smoking cessation counseling by counseling teachers during break time. In contrast, the control group received no intervention except the health education materials about prevention of smoking harm after finishing the post-posttest questionnaire.
Experimental group and control group were given pre-test, post-test and post-posttest questionnaires before, after and six months after the educational intervention of the smoking cessation program, in order to understand the immediate effect and delayed effect of the intervention of the smoking cessation program. The data were processed and analyzed by using the Fisher’s exact probability test, Wilcoxon-Mann-Whitney test, and Wilcoxon signed ranks test for statistical examination.
The main results of this study were as following:
1. The smoking cessation intervention program made a significant difference on the “smoking knowledge” of the experimental group students as contrast to the control group, but there was no significant difference between the groups in the scores of “knowledge of smoking harm.”
2. The smoking cessation intervention program significantly increased the scores of “cigarette-refusing skills” among the students in the experimental group, and their improvement in scores was also significantly higher than the control group.
3. The smoking cessation intervention program significantly increased the scores of “self-efficacy in refusing cigarette” among the students in the experimental group; their improvement in scores was also significantly higher than the control group, and a delayed effect was seen.
4. The smoking cessation intervention program significantly increased the scores of “processes of change in giving up smoking” among the students in the experimental group; their improvement in scores was also significantly higher than the control group, and a delayed effect was seen.
5. The smoking cessation intervention program significantly reduced “the scores of Fagerstrom test for nicotine dependence” among the students in the experimental group, and their improvement in scores was also significantly higher than the control group.
6. The smoking cessation intervention program brought about a positive tendency during “the stage of change in giving up smoking” among students in the experimental group.
7. The smoking cessation intervention program reduced the “daily smoking quantity” among the students in the experimental group.
8. The students in the experimental group and the counseling teachers mostly held a positive evaluation of the overall smoking cessation program.
Results of this study may be used as reference for senior high schools in conducting student smoking cessation programs, and for the health and education authorities in pushing forward school smoking cessation education. In the future, researchers may build on the basis of this study to develop an effective smoking cessation program which is suitable for adolescents in Taiwan, and to explore the effects of the program.

中文參考資料
行政院衛生署（1997）。菸害防制法。台北市：行政院衛生署。
行政院衛生署（1998）。菸害教育實施辦法。台北市：行政院衛生署。
行政院衛生署國民健康局（2004a）。菸害防制專區。上網日期：2004年4月12日。網址：http：//www.bhp.doh.gov.tw/tobacco/
行政院衛生署國民健康局編著（2004b）。台灣菸害防制。台北市：該局。
行政院衛生署國民健康局（2004c，9月）。台灣菸害防制政策。中華民國學校衛生學會主辦，專題講演。全國無菸校園計畫工作坊（北區），台北市。
李杰炫（2000）。青少年戒菸意向之研究：計畫行為理論之應用－以台北縣、市專科吸菸學生為例。未出版之碩士論文，私立靜宜大學青少年兒童福利學系，台中縣。
李淑卿（2003）。戒菸教育計畫介入成效之研究－以台北縣某技術學院學生為對象。未出版之碩士論文，國立台灣師範大學衛生教育學系，台北市。
李景美（2003，10月）。青少年菸害預防－策略層面之探討。醫護科技學刊，5（4），293-307。
李景美主持（2003）。閃亮的青春－台北市無菸校園輔導計畫（行政院衛生署國民健康局委託計畫第一年成果報告DOH-BHP-92001-2）。台北市：國立台灣師範大學衛生教育學系。
李景美主持（2004）。閃亮的青春－台北市無菸校園輔導計畫（行政院衛生署國民健康局委託計畫第二年成果報告DOH-HP-92001-H2）。台北市：國立台灣師範大學衛生教育學系。
李麗傳、張濟萍、郭鐘隆、沈建業（1996）。門診戒菸衛生教育班成效之探討。榮總護理，13（4），369-378。
李蘭主持（1999）。民國八十八年台灣地區成人及青少年之吸菸率及吸菸行為調查：菸害防制法實施一年後之初評（行政院衛生署委託計畫成果報告）。台北市：國立台灣大學衛生政策與管理研究所。
周碧瑟主持（1992）。青少年用藥盛行率與危險因子之探討（二）（行政院衛生署委託研究計畫研究報告DOH81-PA-009）。台北市：國立陽明醫學院公共衛生學研究所。
周碧瑟主持（1999）。台灣地區在校青少年藥物使用流行病學調查研究（行政院衛生署委託研究計畫研究報告DOH88-TD-1064）。台北市：國立陽明醫學院社區醫學研究中心。
馬藹屏（2000）。台灣地區青少年對菸害防制法之認知、遵行意願及遵行行為之研究。未出版之博士論文，國立台灣師範大學衛生教育學系，台北市。
張明惠（2004）。青少年戒菸教育課程介入成效之探討－以台北市某公立高職學生為對象。未出版之碩士論文，國立台灣師範大學衛生教育學系，台北市。
傅瓊瑤主持（1995）。青少年用藥盛行率與危險因子之探討（四）（行政院衛生署委託研究計畫研究報告DOH84-PA-002）。台北市：國立陽明醫學院公共衛生學研究所。
傅瓊瑤主持（1995）。青少年用藥盛行率與危險因子之探討（五）（行政院衛生署委託研究計畫研究報告DOH85-PA-003）。台北市：國立陽明醫學院公共衛生學研究所。
游育苓（1998）。以健康信念模式探討某高職吸菸學生之戒菸意向。未出版之碩士論文，國立台灣大學護理學研究所，台北市。
黃松元、余玉梅、江永盛、陳政友、賴香如、何瑞琴（1991）。台灣地區青少年吸菸行為調查研究。衛生教育論文集刊，5（6），45-66。
黃芷苓（2003）。國中學生戒菸課程發展及介入效果之初探。長庚護理，14（2），121-132。
楊雪華、陳瑞容、李蘭、柯珊如（2002）。台北市某高中一牟級學生的班級人際網絡位置與吸菸行為的關係。台灣衛誌，21（3），164-172。
溫啟邦編著（2004a）。台灣菸草與健康圖鑑（頁66-67）。台北市：聯合醫學基金會。
溫啟邦編著（2004b）。台灣菸草與健康圖鑑（頁74）。台北市：聯合醫學基金會。
葉金川、蔡鶯鶯、李蘭、黃淑貞、徐祥明、賴志冠等（2001）。菸害防制方案建議書。台北市：行政院衛生署。
葉美玲、陳興夏、張惠芬（2002）。網際網路輔助戒菸課程於青少年之成效。台灣醫學，6（5），648-660。
廖梨伶、劉潔心（2002）。運用網際網路於青少年戒菸行為之介入研究。衛生教育學報，17，109-126。
劉潔心、劉貴雲、蔡春美（2000）。青少年互動式戒菸自助手冊教材發展及介入效果之初探性研究。衛生教育學報，13，73-89。
賴志冠（1999）。如何改變不健康行為: 以戒菸為例。基層醫學，14（2），29-32。
魏米秀、呂昌明（1995）。某工專夜間部吸菸男生之戒菸意圖、戒菸行為及其影響因素之研究。衛生教育論文集刊，8，21-32。
魏美珠、林為森（1999）。青少年戒菸教育介入成效之評估。嘉南學報，25，43-55。
嚴道、黃松元、馬藹屏、周曉慧、楊美雪、羅德珮（1997）。台灣都會地區高中高職學生之吸菸行為與其心理健康狀況調查研究。台北市：財團法人董氏基金會。
嚴道主持（1994）。台灣地區高青少年對吸菸、飲酒、檳榔之認知、態度、行為與其心理特質調查研究（行政院衛生署委託研究報告DOH83-HP-I19）。台北市：財團法人董氏基金會。

西文參考資料
Adelman, W. P., Duggan, P., & Joffe, A. (2001). Effectiveness of a high school smoking cessation program. Pediatrics, 107(4), 50.
Alfano, C. M., Zbikowski, S. M., Robinson, L. A., et al., (2002). Adolescent reports of physician counseling for smoking. Pediatrics, 109(3), E47, as cited in Prokhorov, A. V., Hudmon, K. S., & Stancic, N. (2003). Adolescent smoking epidemiology and approached for achieving cessation. Pediatr Drugs, 5(1), 1-10.
Baer, J. S., Holt, C. S., & Lichtenstein, E. (1986). Self-efficacy and Smoking reexamined: construct validity and clinical utility. Journal of Consulting and Clinical Psychology, 54, 846-852.
Bernard, A. L., McKenzie, J. F., & Petrosa, R. (1993). Adescriptive analysis of smoking cessation programs available to health educators. Journal of Health Education, 24, 327-335.
Burt, R. D., & Peterson, A. V. (1998). Smoking cessation among high school seniors. Preventive Medicine, 27, 319-327.
Burton, D. (1994). Tobacco cessation programs for adolescents. In: Richmond, R., Retford, D. C. (Eds). Interventions for smokers, an international perspective. Baltimore, MD: Williams & Wilkins, 95-105, as cited in Prokhorov, A. V., Hudmon, K. S., & Stancic, N. (2003). Adolescent smoking epidemiology and approached for achieving cessation. Pediatr Drugs, 5(1), 1-10.
Centers for Disease Control and Prevention. (2000, October). Youth tobacco surveillance: United States, 1998-1999. Morbidity and Mortality Weekly Report, 49, NO. SS-10.
Centers for Disease Control and Prevention. (2001, November). Youth tobacco surveillance: United States, 2000. Morbidity and Mortality Weekly Report, 50, NO. SS-4.
Charlton, A., Melia, P., & Moyer, C. (1990). Manual on tobacco and youth people for the industrialized world. Geneva: Canadian Cancer Society, Toronto, for UICC, as cited in Prokhorov, A. V., Hudmon, K. S., & Stancic, N. (2003). Adolescent smoking epidemiology and approached for achieving cessation. Pediatr Drugs, 5(1), 1-10.
Chen, CJ., Wen, CP., Tsai, SP., Liaw, KM., Cheng, TY., & Tsai, MC. (2002). Smoking attributable mortality in Taiwan, 1990-2020. In Division of Health Policy Research, National Health Research Institutes (Ed. ), Collection of research papers on tobacco or Health in Taiwan 2002 (pp. 379-400).Taipei: National Health Research Institutes.
Coelho, R. J. (1984). Self-efficacy and cessation of smoking. Psychological Reports, 54, 309-310.
Colby, S. M., Tiffany, S. T., Shiffman, S., & Niaura, R. S. (2000). Measuring nicotine dependence among youth: a review of available approachs and instruments. Drug and Alcohol Dependence, 59, 23-39, as cited in Horn, K., Fernandes, A., Dino, G., Massey, C. J., & Kalsekar, I. (2003). Adolescent nicotine dependence and smoking cessation outcomes. Addictive Behaviors, 28, 769-776.
Coleman-Wallace, D., Lee, J. W., Montgomery, S., Blix, G., & Wang, T. D. (1999). Evaluation of developmentally appropriate programs for adolescent tobacco cessation. Journal of School Health, 69(8), 314-319.
Digiusto, E., & Bird, K. D. (1995). Matching smokers to treatment: Self-control versus social support. Journal of Consulting and Clinical Psychology, 60, 290-295.
Dino, G., Kamal, K., Horn, K., Kalsekar, I., Fernandes, A. (2004). Stage of ghange and smoking cessation outcomes among adolescents. Addictive behaviors, 29, 935-940.
Ershler, J., Leventhal, H., Fleming, R., & Glynn, K. (1989). The quitting experience for smokers in sixth through twelfth grades. Addictive Behaviors, 14(4), 365-378.
Everett, S. A., Husten, C. G., Kann, L., Warren, C. W., Sharp, D., & Crossett, L. (1999). Smoking initiation and smoking patterns among US college student. Journal of American College Health, 48(2), 55-60.
Fiore, M. C., Bailey, W. C., Cohen, S. J., et al., (2000). Treating tobacco use and dependence: Clinical practice guideline. Rockville(MD): US Department of Health and Human Services, as cited in Prokhorov, A. V., Hudmon, K. S., & Stancic, N. (2003). Adolescent smoking epidemiology and approached for achieving cessation. Pediatr Drugs, 5(1), 1-10.
Fritz, D. J. (2003). An intervention for adolescent smoking cessation. University of Missouri-Saint Louis, 2003, 125. AAT3083754.
Garica, M. E., Schmitz, J. M., & Doerfler, L. A. (1990). A fine-grained analysis of the role of self-efficacy in self initiated attempts to quit smoking. Journal of Consulting and Clinical Psychology, 58, 317-322.
Haaga, D. A., & Stewart, B. L. (1992). Self-efficacy for recovery from a lapse after smoking cessation. Journal of Consulting and Clinical Psychology, 60, 24-28.
Healthy Environments and Consumer Safety Branch. (2005, May 20). Canadian Tobacco Use Monitoring Survey (CTUMS). Retrieved May 22, 2005, from http://www.hc-sc.gc.ca/hecs-sesc/tobacco/ research/ctums/index.html
Hellman, R., Cummings, K. M., Haughey, B. P., Zielezny, M. A., & O’shea, R. M. (1991). Predictors of attempting and succeeding at smoking cessation. Health Education Research, 6, 77-86.
Horn, K., Fernandes, A., Dino, G., Massey, C. J., Kalsekar, I. (2003). Adolescent nicotine dependence and smoking cessation outcomes. Addictive behaviors, 28, 769-776.
Johnston, L. D., O’Malley, P. M., & Bachman, J. G. (2001). Cigarette smoking among American teens declines Sharply in 2001 (national press release). Ann Arbor (MI): University of Michigan News and Information Services, 2001 December 19, as cited in Prokhorov, A. V., Hudmon, K. S., & Stancic, N. (2003). Adolescent smoking epidemiology and approached for achieving cessation. Pediatr Drugs, 5(1), 1-10.
Klein, J. D. (1995). Incorporating effective smoking prevention and cessation counseling into practice. Pediatr Ann, 24(12), 646-652, as cited in Prokhorov, A. V., Hudmon, K. S., & Stancic, N. (2003). Adolescent smoking epidemiology and approached for achieving cessation. Pediatr Drugs, 5(1), 1-10.
Lovato, C. Y., & Shoveller, J. A. (1998). Youth smoking cessation in the school setting. Health Canada. From http:// www.commhealth.ihpr.ubc.ca/mohscr/Ch2schoo.PDF.
McNeill, A. D., West, R. J., Jarvis, M., et al. (1986). Cigarette withdrawal symptoms in adolescent smokers. Psychopharmacology, 90(4), 533-536, as cited in Prokhorov, A. V., Hudmon, K. S., & Stancic, N. (2003). Adolescent smoking epidemiology and approached for achieving cessation. Pediatr Drugs, 5(1), 1-10.
Milton, MH., Maule, CO., Yee, SL., Backinger, C., Malarcher, AM., & Husten, CG. (2004). Youth tobacco cessation: A guide for making informed decisions. Atlanta, GA: Centers for Disease Control and Prevention.
Murray, R. P., et al. (1993). Error in smoking measures: Effects of intervention on relations of continence and carbon monoxide to self-reported smoking. American Journal of Public Health, 83(9), 1251-1257.
O’Connell, M. L., Freeman, M., Jennings, G., Chan, W., Greci, L. S., Manta, I. D., Katz, D. L. (2004, January). Smoking cessation for high school students: Impact evaluation of a novel program. Behavior Modification, 28(1), 133-146.
Pan American Health Organization. (2000). Tobacco-free youth: A ”life skills” primer. Washington, DC: Pan American Health Organization.
Perry, C. L., Silvis, G. (1987). Smoking prevention: Behavioral prescriptions for the pediatrician. Pediatrics, 79(5), 790-799. as cited in Prokhorov, A. V., Hudmon, K. S., & Stancic, N. (2003). Adolescent smoking epidemiology and approached for achieving cessation. Pediatr Drugs, 5(1), 1-10.
Peto, R., Darby, S., Deo, H., Silcocks, P., Whitley, E., & Doll, R. (2000). Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. Journal of Epidemiology, 321(7251), 323-329.
Price, J. H., Yingling, F., Dake, J. A., & Telljohann, S. K. (2003). Adolescent Smoking Cessation Services of school-based health centers. Health Education & Behavior, 30(2), 196-208.
Prochaska, J. O. (1979). Systems of psychotherapy: A transtheoretical analysis. Homewood, IL: Dorsey.
Prochaska, J. O., & DiClemente, C. C. (1983). Stage and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.
Prochaska, J. O., Redding, C. A., ＆ Ever, K. E. (1996). The teanstheoretical model and stage of change. In Glanz, K., Lewis, F. M., Rimer, B. K. (Eds.). Health behavior and health education: Theory, research and practice (2nd. chap. 4, pp. 60-84). San Fancisco, CA: Jossey-Bass.
Prokhorov, A. V., Hudmon, K. S., & Stancic, N. (2003). Adolescent smoking epidemiology and approached for achieving cessation. Pediatr Drugs, 5(1), 1-10.
Prokhorov, A. V., Hudmon, K. S., de Moor, C. A., Kelder, S. H., Conroy, J. L., & Ordway, N. (2001). Nicotine dependence, withdrawal symptoms, and adolescent’ readiness to quit smoking. Nicotine Tob Res, 3, 151-155, as cited in Garrison, M. M., Christakis, D. A., Ebel, B. E., Wiehe, S. E., & Rivara, F. P. (2003). Smoking cessation interventions for adolescents: A systematic review. American Journal of Preventive Medicine, 25(4), 363-367.
Sacks, G., Anderson, F. M., Lawless, M., & Thorogood, M. (1992). Smoking behavior before and after attendance at health promotion clinic in general practice. Health Education Journal, 51, 11-15.
Sargent, JD., Mott, LA., & Stevens, M. (1998). Predictors of smoking cessation in adolescents. Arch Pediatr Adolesc Med, 152, 388-393.
Soreness, G., Lando, H., & Rechacek, T. F. (1993). Promoting smoking cessation at the workplace. JOM, 35(2), 121-126.
Stacy, A. W., Sussman, S., Dent, C. W., et al, (1992). Moderators of peer social influence in adolescent smoking. Pers Soc Psychol Bull, 18, 163-172.
Stanislaw, A. E., & Wewers, M. E. (1994). A smoking cessation intervention with hospitalized surgical cancer patients：A pilot study. Cancer Nursing, 17(2), 81-86.
Stevens, P. A., Greens, J. G., & Primavera, L. H. (1982). Predicting successful smoking cessation. Journal of Social Psychology, 118, 235-214.
Stevens, S. L., Colwell, B., Miller, K., Sweeney, D., McMillan, C., & Smith, D. W. (2003). Differences in evaluations of a tobacco awareness and cessation program by adolesvents in four stages of change. Addictive Behaviors, 28, 471-482.
The Global Youth Tobacco Survey Collaborative Group. (2004). Tobacco use among youth: a cross country comparison. Tobacco Control 2002, 11, 252-270.
Tsai, SP., Wen, CP., Hu, SC., Cheng, TY., & Huang, SJ. (2004). Workplace smoking-related absenteeism and productivity costs in Taiwan. Manuscript submitted for publication.
U.S. Department of Health and Human Services. (1990). The Health benefit of smoking cessation: a report of the surgeon general. Atlanta, Georgia for Disease Control, Office on Smoking and Health.
U.S. Department of Health and Human Services. (2000). Health people 2010: Understanding and improving health (2nd ed.). Washington, DC: U.S. Government Printing Office.
Vuckovic, N., Polen, M. R., & Hollis, J. F. (2003). The program is getting us to stop: What teens say about smoking cessation. Preventive Medicine, 37, 209-218.
Wen, C. P., Tsai, S. P., Chen, C. J., & Cheng, T. Y. (2002). The mortality risks of smokers in Taiwan. In Division of Health Policy Research, National Health Research Institutes (Ed. ), Collection of research papers on tobacco or Health in Taiwan 2002 (pp. 300-321).Taipei: National Health Research Institutes.
World Health Organization. (2005). The role of health professionals in tobacco control. Switzerland: World Health Organization.
Zheng, H., Sussman, S., Chen, X., Wang, Y., Xia, J., Gong, J., Liu, C., Shan, J., Unger, J., Johnson, C. A. (2004, December). Project EX-A teen smoking cessation initial study in Wuhan, China. Addictive behaviors, 29, 1725-1733.