便利商店可近性與青少年抽菸行為：全國性多階層分析研究

Abstract

背景與目的：學生待在學校裡的時間超過一天的三分之一，不論是到周遭便利商店購買食物、飲料，還是辦理悠遊卡加值等各項雜事都會暴露於收銀檯後方陳列菸品的誘惑。雖然台灣現行法令禁止店家販售香菸給未成年者，但是仍會有部分店家無視禁令而行。因此，本研究之目的為探討便利商店可近性對於青少年過去一年內吸菸行為的脈絡效應影響。 方法：2004年至2006年以多階段隨機群集抽樣方式從387所學校收集到共52,135位全國青少年受試者，選取11-19歲者完成自我陳報問卷來蒐集青少年的社會人口特徵及物質使用經驗。其次，操作地理資訊系統以每所學校為中心劃定直徑一公里的圓，並根據距離學校的遠近計算出加權後的便利商店數量，再將由此算出的便利商店密度分為高中低三等分作為便利商店可近性的指標。此後，再以多階層羅吉斯迴歸分析其與各學校青少年在一年內吸菸盛行率的關連性。 結果：男性、單親家庭、工作與翹課經驗、飲酒經驗、較多零用錢為青少年吸菸的相關危險因子；另外，與國一生相比，除一般高中外的學生依年紀上升而增加吸菸的危險性。在考量成分特性的狀況下，便利商店可近性的可解釋約0.4%學校之間青少年吸菸率的變異量；而周遭為中高密度便利商店的學校與周遭為低密度便利商店的學校比起來，學校青少年在一年內吸菸盛行率的勝算比和95%信賴區間分別為0.86和0.74至1.01、0.75和0.63至0.89。 結論：便利商店在台灣可能不是青少年最主要取得香菸的商業來源，且販菸給予未成年人的禁令執行似乎也在此類型店面執行較為徹底。因此政府應該投入更多精力關注於非便利商店的香菸取得管道，藉此更有效率地達到限制青少年吸菸行為的目的。

Background: Convenience stores cluster near schools were easy for students to reach and various products (i.e. food, beverages) in stores were attractive for them to go. However, the underage sales ordinance in Taiwan was limited the accessibility of cigarettes among adolescent at the same time. Our aim is to assess the contextual effect of the availability in convenience stores near school environments on youth smoking in the previous one year. Methods: The stratified, two-stage and cross-sectional survey was collected by the self-reported questionnaire during 2004-2006. A total of 52,135 participants aged 11 to 19 years were conducted from 387 middle or high schools. The weighted numbers of convenience stores within 1 km around each school was calculated by the geographical information systems. Multilevel logistic regression was performed to the association analysis. Results: The availability of convenience stores showed about 0.4% school-level variance of adolescent smoking with considering the compositional characteristics. The odds ratios (95% confidence interval) of smoking prevalence in the previous one year among schools with medium and high density of convenience stores were 0.86 (0.74–1.01) and 0.75 (0.63–0.89), respectively. Additionally, youths were more likely to smoke within one year if they were: male, single-parent family, alcohol drinking and had a job and higher allowance.

Conclusion: Convenience stores may no longer the most common commercial source of tobacco among youths in Taiwan. High compliance of underage sales ordinance in convenience stores may influence adolescents’ choices. Due to the change of purchasing behavior among youths, the government should put more enforcements of surveillance on the other sources of tobacco.