簡易檢索 / 詳目顯示

研究生: 張明惠
論文名稱: 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
指導教授: 李景美
學位類別: 碩士
Master
系所名稱: 健康促進與衛生教育學系
Department of Health Promotion and Health Education
論文出版年: 2004
畢業學年度: 92
語文別: 中文
論文頁數: 166
中文關鍵詞: 青少年戒菸課程高職學生跨理論模式
論文種類: 學術論文
相關次數: 點閱:228下載:88
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報
  • 中文摘要

    本研究的主要目的在以跨理論模式為依據,發展一套適用於青少年的「戒菸課程」,並探討「戒菸課程」的實施對青少年在菸害知識、一氧化碳值、尼古丁依賴程度、日吸菸量、拒菸技巧以及跨理論模式中的行為改變階段、改變方法、決定平衡及自我效能的影響成效和課程的滿意度。本研究採準實驗研究設計,於九十二學年度下學期以台北市某公立高級職業學校一、二年級吸菸學生共13位為實驗組,鄰近學區的某公立高職一、二年級吸菸學生12位為對照組。實驗組提供七週共十四小時的戒菸課程,並於課程期間由輔導員與學生進行一次個別戒菸輔導,對照組則不提供任何介入。
    「戒菸課程」介入前後,實驗組與對照組皆實施前後測。研究資料以SAS 8.0視窗版套裝軟體進行資料分析,描述性統計以次數分配、百分比、平均值、標準差等加以分析,推論性統計以卡方檢定、t-test、單因子共變數分析進行。
    本研究的主要發現:
    一、戒菸課程的實施,能顯著增加實驗組學生之「菸害知識」與「拒絕技巧」。
    二、戒菸課程的實施,能降低實驗組學生之一氧化碳值、減少對尼古丁依賴程度。
    三、戒菸課程的實施,能顯著增加實驗組學生的「整體戒菸改變過程」與「行動面向戒菸改變過程」的經驗。
    四、戒菸課程的實施,能顯著提昇實驗組學生的「負向情境拒菸自我效能」與「正向情境拒菸自我效能」。
    五、研究對象對戒菸課程的教學內容表示有幫助且喜歡,講師與小組輔導老師的教學都獲得學生認同,對課程進行方式有正向的評價。
    本研究的結果可提供青少年戒菸課程之參考。未來研究者可在本研究基礎下,進一步以嚴謹的縱貫性研究與多元評量方法進行實驗,以探討其適用性與成效。

    關鍵字:戒菸課程、跨理論模式、青少年、高職學生

    Abstract

    The main purpose of this study was to evaluate the effects of a smoking cessation program for the adolescents by applying Transtheoretical Model (TTM). The research focused on decreasing the level of carbon monoxide (CO), the score of Fagerstrom test for nicotine dependence, the amount of smoking per day, improving smoking knowledge, the skills of cessation, TTM-related variables such as the stage of change, processes of change, decisional balance for smoking cessation, and enhancing self-efficacy for resisting smoking pressure.
    A quasi-experimental design was used in the study. The subjects of this study were consist of 25 smoking students from two vocational schools. The intervention for the experimental group included 7 weeks of 14 hours structured courses and counseling. On the other hand, the control group did not receive any intervention. Both groups were assessed by the questionnaires before and after the intervention. Frequency, mean, standard deviation, percentage, paired t-test, and one-way ANCOVA were used to analyze the data by using SAS 8.0 for Windows.

    The main results found in this study were as follows:
    1. The smoking cessation program could significantly increase the knowledge of tobacco hazards and the skill of cessation among the experimental group students.
    2. The smoking cessation program could significantly decrease the level of carbon monoxide (CO) and the score of Fagerstrom test for nicotine dependence among the experimental group students.
    3. The smoking cessation program could significantly enhance the experience of Processes of Change among the experimental group students.
    4. The smoking cessation program could significantly enhance the self-efficacy of cessation in negative and positive situations among the experimental group students.
    5. Most subjects who received the interventions felt these activies were interesting, useful, and helpful.
    Based on the results, this study suggest that the program design of smoking cessation could be the basis of other smoking cessation program among adolescences.

    Key words: smoking cessation program, Transtheoretical Model, adolescent, students from the vocational school

    目錄 第一章 緒論..........................................1 第一節 研究緣起....................................1 第二節 研究目的....................................4 第三節 研究問題....................................5 第四節 研究假設....................................6 第五節 名詞界定....................................7 第六節 研究限制....................................9 第二章 文獻探討....................................10 第一節 青少年吸菸行為現況.........................10 第二節 青少年吸菸行為的相關因子...................13 第三節 青少年戒菸行為相關因素之探討...............17 第四節 戒菸課程相關研究探討.......................20 第五節 跨理論模式(Transtheoretical Model,TTM).....25 第三章 研究方法...................................35 第一節 研究設計...................................35 第二節 研究對象...................................36 第三節 研究工具...................................37 第四節 課程設計...................................44 第五節 研究步驟...................................52 第六節 資料處理與分析.............................54 第四章 研究結果...................................56 第一節 研究對象基本資料分析.......................56 第二節 戒菸課程介入對吸菸行為相關因素的影響.......66 第三節 戒菸課程介入對戒菸行為與其相關因素的影響...77 第四節 課程過程評量...............................93 第五節 個別戒菸輔導資料分析......................104 第五章 討論.......................................106 第一節 研究對象的基本資料特性....................106 第二節 戒菸課程實施對研究對象吸菸行為的影響成效..109 第三節 戒菸課程實施對戒菸行為與其相關因素的影響成效.................................................112 第四節 學生對戒菸課程的評價......................114 第六章 結論與建議.................................119 第一節 結論......................................119 第二節 建議......................................121 參考文獻...........................................126 中文部分.........................................126 西文部分.........................................129 附錄一:問卷效度處理之專家名單.....................134 附錄二:「無菸健康成長營」學生意見調查問卷.........135 附錄三:教學活動評量表.............................145 附錄四:個別戒菸輔導評紀錄表.......................150 附錄五:「無菸健康成長營」戒菸課程教案.............153 附錄六:焦點團體討論題綱...........................166

    參考文獻

    中文部分

    王國川(2002):圖解SAS-在變異數分析上的應用。台北市:五南圖書出版社。

    行政院衛生署(1996):菸害防制,中華民國公共衛生概況。台北:行政院衛生署。

    李杰炫(2000):青少年戒菸意向之研究:計劃行為理論之應用—以台中縣、市專科吸菸學生為例。靜宜大學青少年兒童福利學系碩士班碩士論文。

    李淑卿(2002)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。國立台灣師範大學衛生教育學系碩士論文。

    李勝雄(1996):吸菸對健康與運動能力影響的探討。國民體育季刊,25(4),92-103。

    李景美(1990):台北市國民中學三年級男生吸菸行為之情境及家庭狀況因素分析研究。中民國學校衛生學會雜誌,17,38-46。

    李景美(1998):台北市中小學生對菸品廣告之反應研究。健康促進暨衛生教育雜誌,18,13-24。

    李景美、林世華(2003):「閃亮的青春」計畫:台北市無菸校園輔導計畫-第一年成果報告書。行政院衛生署國民健康局委託研究。計畫編號:DOH-BHP-92001-2。

    李景美、苗迺芳、黃惠玲(2000):青少年物質使用之社會學習及社會連結因素研究-以在學生為例。健康促進暨衛生教育雜誌,20,17-31。

    李景美、張鳳琴、賴香如、李碧霞、陳雯昭(2002):台北縣市高職一年級學生成癮物質濫用之危險與保護因子研究。衛生教育學報,17,73-88。

    李新鏘、林宜美、陳美君、陳碧玉譯(1999):健康心理學:行為健康入門。台北市:心理出版社。
    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。

    辛隆士、劉文俊(1995):菸害防制。基層醫學,10(12),227-230。

    卓惠如(1993):影響有吸菸者戒菸的相關因素探討。國立台灣大學公共衛生學研究所碩士論文。

    林岳志、凌瑞中、蕭水銀(1991):菸害。藥學雜誌,7(3),67-69。

    林昇鋒、蕭水銀(1991):吸菸與癌症。藥學雜誌,7(3),70。

    姜博文、蔡世滋(1994):青少年與吸菸。臨床醫學,33(3),151-156。

    柯姍如(2002):家人及好友對高中生吸菸行為之影響。國立台灣大學公共衛生學院衛生政策與管理研究所碩士論文。

    徐達光(1998):青少年戒菸衛生教育模式之建立與評估:從生活型態與消費行為談起。行政院衛生署八十七年度委託研究計畫。計畫編號:DOH87-TD-1081。

    晏涵文、高雅珠(1995):預防吸菸教育計劃介入效果之研究。行政院衛生署暨所屬機關八十三年度研究成果摘要彙編,115-116。

    馬藹屏、嚴道、黃松元、陳政友(2000):台北地區國小高年級學童之自我概念親子適應及友伴關係與其吸菸行為之研究。衛生教育學報,13,37-51。

    張惠芬(2001):探討青少年戒菸課程之成效。國立台北護理學院護理學系研究所碩士論文。

    陳怡如(2001):香菸廣告之接觸認同與吸菸行為之關係---以北縣高職學生為例。國立台灣大學公共衛生學院衛生政策與管理研究所碩士論文。

    陳隆彬(2001):台中縣太平市國中學生拒絕吸菸行為相關因素之研究。國立台灣師範大學衛生教育學系碩士論文。

    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。國立台灣大學護理學研究所碩士論文。

    黃松元(1995):階段式戒菸模式決定與相關因子之研究。行政院國家科學委員會八十四年度委託研究計畫。計畫編號:NSC83-0301-H003-021。

    黃松元、余玉眉、江永盛、陳政有、賴香如、何瑞秦(1991)台灣地區青少年吸菸行為調查研究。衛生教育論文集刊,5,45-66。

    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。

    黃淑貞(2000):吸菸之流行病學研究。國家衛生研究院論壇健康促進與疾病預防委員會文獻回顧研析計畫。計畫編號:FO-HPDP01-05。

    楊銘欽、李玉春(1993):我國吸菸經濟成本之研究。行政院衛生署暨所屬機關八十一年度研究成果摘要彙編,行政院衛生署。

    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。
    劉美媛(1995):台灣地區在校青少年抽煙及飲酒流行率及危險因子的探討。國立陽明大學公共衛生研究所碩士論文。

    劉潔心、劉貴雲、蔡春美(2000):青少年互動式戒菸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。

    潘松義(2001):原住民國中生對吸菸癮酒嚼檳榔之認知態度行為與人格特質之研究調查—以屏東縣泰武、來義、瑪家國中為例。高雄醫學大學口腔衛生科學研究所碩士論文。

    賴志冠、蔡世滋(1994):吸菸與健康。臨床醫學,33(4),242-248。
    顏簡美珠(1999):以小團體模式協助青少年戒菸之試驗及其成效評估。行政院衛生署88年度委託研究計畫,計畫編號:DOH88-TD-1095。

    魏米秀、呂昌明(1995):某工專夜間部男生之戒菸意圖、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。
    顧景怡(2003):4個關鍵步驟擊退菸癮。康健雜誌,57,134-137。

    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:財團法人董氏基金會。

    西文部分

    Alexander, V. P., Karen, S. H., Nancy, S.(2003). Adolescent smoking epidemiology and approaches for achieving cessation. Pediatr Drugs, 5, 1-10.

    Arie, D., Jolanda, R., & Hein, D.V. (1998). Smokers in four stages of readiness to change. Addictive Behaviors, 23, 339-350.

    Black, D. R., & Babrow, A.S. (1991). Identification of campaign recruitment strategies for a stopping smoking cessation intervention for a college campus. Health Education Quarterly, 18, 235-247.

    Breet, A. P., Wayne, F. V., Colleen, A. R., James, O. P., Joseph, S. R., Unto, E. P., Kathryn, S. M. (2001). Stage of change, decisional balance, and tempatations for smoking measurement and validation in a large, school-based population of adolescents. Addictive Behaviors, 26, 551-571.

    Bruce, S. M., Aria, D. C., Denise, L. H., Keith, E. S., Patricia, E., Kai, Y. (1999). Psychosocial, school, and parent factors associated with recent smoking among early-adolescent boys and girls. Preventive Medicine, 28, 138-148 .

    Cheryl, A., Marina, P., Debra, M., & Thomas, V. (2001). Peers, schools, and adolescent cigarette smoking. Journal of Adolescent Health, 29, 22-30.

    Coleman-Wallace, D., Lee, J. W., Montgomery, S., Blix, G., & Wang, D. T. (1999). Evaluation of developmentally appropriate programs for adolescent tobacoo cessation. Journal of School Health, 69, 314-319.

    Diclemente, C. C. (1986). Self-efficacy and the addictive behaviors. Journal of Social and Clinical Psychology, 4, 302-315.

    DiFranza, J. R. (1992). Preventing teenage tobacco addiction. J Fam Pract ,34, 753-756.

    Dino, G., Horn, K.G., Fernandes, A. K., Massey, C. (2001). A 2-years efficacy study of not on tobacco in florida: an overview of program successes in changing teen smoking behavior. Preventive Medicine, 33, 600-605.

    Distefan, J. M., Gilpin, E. A., Choi, W. S., Pierce, J. P. (1998). Parental influences predict adolescent smoking in the united states, 1989-1993. Journal of Adolescent Health, 22, 466-474.

    Elyse, P., Cheryl, A. E., Michael, G. G., Judy, D. E., Ray, N., Edward, G., Nancy, M. G., & Catherine, D. (2001). The development of a decisional balance measure of physician smoking cessation interventions. Preventive Medicine, 33, 261-267.

    Erin, L.O., Karen, B. W., Phillip, J. B. (2003). The transtheoretical model: gender differences across 3 health behaviors. American Journal of Health Behavior, 27, 645-656.

    Fritz, D. J. (2003). An intervention for adolescent smoking cessation. University of Missouri-Saint Louis, 2003, 125. AAT3083754.

    Garrity, R. (1992). An evaluation of approaches to smoking cessation for adolescents. Canberra: ACT Alcohol and Drug Service National Campaign Against Drug Abuse.

    Glynn, T. j. (1989). Essential elements of school-based smoking prevention program. Journal of School Health, 59, 181-188.

    Glynn, T. J., Anderson, D. M., Schwarz, L. (1992). Tobacco-use erduction among high-risk youth: recommendations of a national cancer institute expert advisory panel. Preventive Medicine, 20, 279-291.

    Glynn, T. j., Greenwald, P., Mills, S. M., & Manley, M. W. (1993). Youth tobacco use in the United States-problem, progress, goals, and potential solutions. Preventive Medicine, 22, 568-575.

    Gregory, J. N., Wayne, F. V., Joseph, L. F., & James, O. P. (1998). Dynamic typology clustering within the stages of change for smoking cessation. Addictive Behaviors, 23, 139-153.

    Johnson, C. A., Hansen, W. B., Collins, L. M., & Graham, J. W. (1986). High school smoking prevention: results of a three year longitudinal study. Journal of Behavior Medicine, 9, 439-452.

    Johnston, L. D., O’Malley, P. M., & Bachman, J. G. (1993). National survey results on drug use from the Monitoring the Future Study, 1975-1994, volume1: secondary school students (NIH publication No.95-4026). Washington, DC:U.S Government printing office.

    Kathryn, I. P., Joseph, P. C., Carlo, C. D., Yolanda, F. N., & Patricia, D. M. (1998). Causal relationships of processes of change and decisional balance: stage-specific models for smoking. Addictive Behaviors, 23, 437-448.

    Lando, H., & Lazovich, D. (1998). Reducing smoking among Minnesota teens in managed care. Minnesota Medicine, 81, 60-61.

    Linda, E. C., Paul, T., Jan, K., Ann, C. (2003). Predictive value of aspects of the transtheoretical model on smoking cessation in a, cqmmunity-based large-
    group cognitive behavioral program. Addictive Behaviors, 28, 725-740.

    Marcus, B. H., Simkin, L. R. (1994). The transtheoretical model: application to exercise behavior. Medline and Science in sports and Exercise, 26, 1400-1404.

    Massey, C. J., Dino, G. A., Horn, K. A., Lacey-McCracken, A. G., Jennifer, K. I. (2003). Recruitment barriers and successes of the american lung association’s not-on-tobacoo program. Journal of School Health, 73, 58-63.

    NEA Today (2002). Getting teens to stop smoking: a different kind of challenge. NEA Today, 20, 34.

    Pallonen, U. E., (1998). Transtheoretical measures for adolescent and adult smokers: similarities and differences. Preventive Medicine, 27, A29-A38.

    Pallonen, U. E., Prochaska, J. O.,Velicer, W. F., Prokhorov, A. V., Smith, N. F. (1998). Stages of acquisition and cessation for adolescents smoking:an empirical integration. Addictive Behaviors, 23, 303-324.

    Price, J. H. (2003). Adolescent smoking cessation services of school-based health centers. Health Education & Behavior, 30, 196-208.

    Prochaska, J. O. (1979). Systems of psychotherapy: A transtheoretical analysis. Homewood, IL:Dorsey.
    Prochaska, J. O., & Diclemente, C. C. (1983). Stages 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., & Velicr, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38-48.

    Prochaska, J. O., Diclemente, C. C., & Norcross, J. C. (1992). In search of how people change:Applications to addictive behaviors. American Psychologist, 47, 1102-1114.

    Prokhorov, A. V., de Moor, C. A., Hudmon, K. S., Hu, S., Kelder, S. H., Gritz, E. R. (2002). Predicting initiation of smoking in adolescents: evidence for integrating the stages of change and susceptibility to smoking constructs. Addictive Behaviors, 27, 697-712.

    Reeder, A., Williams, S., McGee, R., & Glasgow, H. (1999). Tobacoo smoking among fourth from students in wellington, new zealand 1991-1997. Australian and New Zealand Journal of Public Health, 23, 494-500.

    Simons M. B., Haynie, D. L., Crump, A. D., Eitel, S. P., & Saylor, K. E. (2001). Peer and parent influences on smoking and drinking among early adolescents. Health Education & Behavior, 28, 95-107.

    Singleton, M. G., Pope, M. (2000). A comparison of successful smoking cessation interventions for adult and adolescents. Journal of Counseling & Development, 78, 448-454.

    Tye JB. (1989). Results of trials by minors’ purchasing cigarettes. Tobacco and Youth Reporter, 4, 5.

    Warren, R. S., John, B. L., John, K. F., Amaya, M. G., Jennifer, M. R. (1999). Beliefs about smoking cessation among out-of-school youth. Drug and Alcohol Dependence,
    54, 251-258.

    Wijatkowski, S., Forgays, D. G., Wrzesniewski, K., & Gorski, T. (1990). Smoker behavior and personality characteristics in Polish Adolescents. The International Journal of the Addictions, 25, 363-373.

    QR CODE