台灣成年男性社會經濟地位與六種精神作用物質的使用型態

Abstract

目地：探討成年男性的社會經濟地位與六項精神物質(菸、酒、檳榔、提神飲料、咖啡、茶)使用之關係，不僅檢視單一物質的消費，也包含不同物質的消費群集。特別的是，本研究試圖探討知識、態度與健康狀態在特定社會經濟群體的精神物質使用中所扮演的角色。 方法：使用2005 年「國民健康訪問暨藥物濫用調查」之部分資料進行次級資料分析中，最後分析的樣本為18-64歲的男性樣本6087人。自變項為社會經濟地位，以職業、教育程度與兩者的組合來測量。首先應用雙變項分析來描述教育、職業和各種物質消費之間的關係；接著以Spearman相關分析和群聚分析探討物質消費型態與社會經濟地位的關係；最後以序位邏輯斯迴歸模型釐清知識、態度與健康狀態對精神物質使用的影響。 結果：主要結果如下：(1)整體而言，教育、職業與六項精神物質使用間達到統計學上顯著相關。特別的是，菸、酒、檳榔與提神飲料的使用者集中在較低教育程度與職業等級；相反地，咖啡的使用則以較高教育程度和職業等級的人為多。(2)吸菸、飲酒、嚼檳榔、飲用提神飲料，這四項精神物質使用行為之間有並存的關係，其中吸菸與嚼食檳榔的並存性最強；而喝茶與吸菸、飲酒、喝咖啡之間具有高度相關性，其中茶與咖啡之飲用的並存性最高。(3)三個中介因子當中，健康狀態，包含生理和心理健康，與精神物質使用的關係皆十分薄弱的；而知識只與吸菸和嚼檳榔有顯著的相關；最強的決定因素是態度，與每項精神物質的使用皆有很強的相關。(4)群聚分析結果共得出六組物質使 用行為群體，包括：(i)多元成癮型，(ii)典型三元成癮，(iii)重菸癮高咖啡茶，(iv)酒咖啡雙好，(v)獨鍾飲茶，以及(vi)純淨無癮。總體來說，物質消費類型與兩項社會經濟地位變項之間呈現顯著的階梯關係，越高的教育程度和職業成就，傾向「獨鍾飲茶」與「純淨無癮」，反之，教育程度和職業等級越低，傾向於「多元成癮」與「典型三元成癮」。 建議：物質使用行為的研究，應以更全面及整體性的視角來檢視，而非僅聚焦在單一物質的使用。未來研究應連結至民眾日常生活，以捕捉精神物質的消費是如何受到社會結構與社會心理等因素的影響。目前健康傳播與健康教育仍有努力的空間，需發展更有效、敏感度更高的介入措施。

Purpose: To examine how socio-economic status is associated with the use of six psychoactive substances (cigarette, alcohol, betel nuts, alcoholic tonic beverage, coffee, and tea) among male adults, not only for the consumption of individual substance but also concomitant consuming clusters of different substances. Particularly, this study attempts to explore the roles knowledge, attitude, and health status play in substance use in specific socio-economic groups. Method: Data on which this study is based come from the “2005 National Health Interview Survey.” A total of 6087 male adults 18-64 years of age are included in this study. Socio-economic status is measured by education and occupation and a combination of both. Bivariate analysis is used to describe the association between education, occupation and the consumption of each substance. Spearman correlation and cluster analysis are used to explore patterns of substance co-consumption in relation to SES. Finally, ordinal logistic regression model is employed to clarify the effects of knowledge, attitudes and health status on substance use. Result: The major findings are: (1) Overall, statistically significant association was found between education, occupation and the use of six substances. Particularly, cigarette, alcohol, betel nuts and alcoholic tonic beverage are more likely to be used by participants occupying lower occupational and educational level. On the contrary, coffee is more commonly used by persons with higher educational and occupational positions, (2) Alcohol drinking, smoking, betel nuts chewing, and alcoholic tonic beverage drinking are most often co-existent, and the strongest relationship is found between betel nuts chewing and smoking. Whereas tea drinking, smoking, alcohol drinking, and coffee intake are highly correlated, most common concomitant consumption is for coffee and tea, (3) Among three sets of intervening factors, health status, both physical and mental health, is weakly correlated with substance use; knowledge only has significant association with smoking and betel nuts chewing, and the most powerful determinant is attitude, which is strongly correlated with each type of substance use, and (4) Cluster analysis generates the following six distinctive types of substance use: (i) multiple addiction, (ii) typical triple addiction, (iii) heavy smoking and high coffee-tea consumption, (iv) alcohol-coffee double preference, (v) tea favoritism, and (vi) total substance avoidance. In general, significant gradient associations are present between consumption type and two SES variables. Higher level of educational and occupational attainment leads to the consumption type of “tea favoritism” and “total substance avoidance” and, in contrast, the lower attainment in education and occupation tends to be engaged in “multiple addiction” and “typical triple addiction.” Suggestions: Research on substance use behavior should take a more comprehensive and holistic perspective without simply focusing only on the use of individual substance each time. Investigations should also be placed in the context of daily life to capture how substance consumption is determined by various structural and socio-psychological factors. Implications from this point of view may inform the current efforts of health communication and education to develop more sensitive and valid interventions.