新竹縣青少年嚼食檳榔的影響因素探討：質性研究

Abstract

背景與目的 口腔、口咽及下咽惡性腫瘤是我國主要癌症之一，104年共有7,628人被初次診斷，並導致2,667人死亡。嚼檳榔是口腔癌的主因之一，而減少嚼檳行為是預防口腔癌的重要策略。台灣青少年嚼食檳榔行為在過去20年間有明顯下降，但國民健康署於105年的調查指出，全國高中職學生嚼檳率仍有2.21%，國中學生則為0.87%，因此著重於校園內嚼檳行為之衛生教育。然而，過去很少有研究在了解台灣青少年開始、持續與中止嚼食檳榔的相關因素，與其對衛教的看法。本研究旨在瞭解青少年嚼食檳榔的因素及他們接觸與感受衛教訊息的情形。 研究方法 本研究為質性研究，針對居住在新竹縣且有使用檳榔經驗的13-18歲青少年進行深度訪談，並以一份簡單問卷了解背景資訊與使用檳榔行為。受訪對象來自學校介紹、社區訪察、與滾雪球方式招募。錄音後訪談內容謄寫成逐字稿，運用架構式分析法分析資料，在動態反覆的過程中產生主題與框架。 研究結果 本研究共訪問八位正在或曾使用檳榔的青少年，全為男生，年齡14-18歲（中位數16歲）；三位為中輟生(均為高中輟學)，五位在學中(四位國中、一位高中)；嚼食1-4年（中位數2年）；第一次嚼檳年齡為12-17歲（中位數13.5歲）。 結果顯示，大致可以三個階段去了解青少年嚼食檳榔行為與相關因素。「開始嚼食檳榔」的相關因素包括同儕影響、主觀動機及初次接觸口感；「持續吃檳榔」的相關因素包括容許性環境、易取得性、獨立經濟來源、心理需求及身心理效應；「中斷或停止」的相關因素包括同儕反應、口腔病變、身體心像改變及衛教經驗。所有受訪者都表示曾經在學校接收過檳榔健康危害的相關衛教宣導，也了解檳榔會導致口腔癌，但多數表示衛教對其影響有限。 結論 從青少年嚼檳行為的經驗、感受與情境為出發點，可了解其受到生理、心理、藥理、社會、文化，與環境等多重因素的影響。即使青少年普遍從衛教宣傳中得知嚼檳榔會導致口腔癌，但上述因素仍使他們開始與持續使用檳榔。將來針對青少年減少檳榔使用行為的介入方案，可針對上述因素優化衛教宣導的內容，並考量檳榔使用行為的社會脈絡因素，從減少容許檳榔使用的環境與青少年取得檳榔的容易度著手，以有效預防青少年使用檳榔。

Background and research aim Oral, oropharyngeal and hypopharyngeal malignancies are among the major cancers in Taiwan. In 2015, 7,628 and 2,667 individuals were first diagnosed with and died from oral cancer in Taiwan, respectively. Chewing betel quid (BQ) is one of the main causes of oral cancer, and reducing chewing BQ is an important strategy to prevent oral cancer. There was a marked decrease in the prevalence of chewing BQ in Taiwanese adolescents in the past 20 years. However, according to the survey by the Health Promotion Administration in 2016, the prevalence of chewing BQ was still 2.21% in senior high school students and 0.87% in junior high school students, and therefore the Taiwanese government had its policies focusing on health education about BQ chewing at schools. Nevertheless, few previous studies have investigated the factors related to the initiation, continuation, and discontinuation of BQ chewing in Taiwanese adolescents and their perspectives on health education. The aim of this study was to understand the factors influencing adolescents’ BQ chewing and their exposures and responses to educational messages. Methods This study is a qualitative study based on in-depth interviews with adolescents aged 13-18 years living in Hsinchu County who had experiences with BQ chewing. A brief questionnaire was used to collect background information and the use of BQ. Participants were recruited from school referrals, community visits, and a snowballing recruiting strategy. All the interviews were audio-recorded and transcribed verbatim. The framework method was used to analyze the data, with themes being identified and a framework being developed in a dynamic, iterative process. Results Eight adolescents who were currently using or had used BQ were interviewed. All participants were male and aged 14-18 years (median 16 years); three already withdrew from school (all of them withdrew from senior high school), and five were currently studying at school (four at junior high school; one at senior high school); they had used BQ for 1-4 years (median 2 years); the first time chewing BQ occurred at age between 12-17 years (median 13.5 years). The results show that there were three stages of BQ chewing that can be used to summarize factor related to this behavior in adolescents. Factors at the stage of ‘starting to chew BQ’ included peer influence, subjective motivation, and initial taste. Factors at the stage of ‘continuing to chew BQ’ included a permissive environment, easy accessibility, independent economic sources, psychological needs and the physio-psychological effects of BQ. Factors associated with ‘stopping BQ chewing’ included peer reactions, oral lesions, changes in body image, and health education experience. All participants indicated that they had been exposed to some health education about the health hazards of BQ chewing at school and they understood that BQ would cause oral cancer, but most said that the influence of health education on their BQ chewing was limited. Conclusion Based on the experiences, perceptions and contexts of adolescents who chewed BQ, multiple factors were found to have an influence on this behavior; they included physical, psychological, pharmacological, social, cultural, and environmental factors. Although teenagers generally learned from health education that chewing BQ causes oral cancer, multifaceted factors contributed to the initiation and continuation of this behavior in this group. Future interventions aimed at reducing the use of BQ in adolescents could optimize the content of the educational materials according to the above factors, consider the social context of BQ chewing, tackle environments that facilitate BQ chewing, and reduce adolescents’ access to BQ. All these considerations may help with more effectively preventing BQ chewing in adolescents.