不同類型社會支持與青少年菸品使用之長期關係

Abstract

研究背景：世界衛生組織指出，世界各地的青少年越來越早開始吸菸。雖然部分研究表明青少年吸菸率相較於過去二十載有顯著的改善，但在近年來青少年的電子煙使用率有增長的趨勢。此外，社會支持被證實是青少年吸菸行為的保護因子且被應用於臺灣的校園菸害防制計畫。然而，過去的研究鮮少探討社會支持對青少年菸品使用之影響以及不同社會支持影響力之差異，同時亦較少分析社會支持與青少年菸品使用之關聯性在不同時間的變化以及性別差異。 研究目的：本研究旨在探討：1) 臺灣青少年在不同時期之菸品使用情形；2) 瞭解不同來源的社會支持（包括：同儕支持、家庭支持及學校支持）與青少年菸品使用情形（包括：「有無使用」以及「使用類型」）之關聯性；3）分析時間及性別的調節作用。 研究方法：本研究為縱貫性研究，使用「青少年世代健康行為長期追蹤調查」之資料，分析104年度至106年度之正式研究世代樣本。該研究為一具有全國代表性之長期追蹤研究，受訪者為104年以102學年度臺灣國中、高中職學生人數為抽樣母體，經多階層抽樣取樣之國中一年級或高中職、五專一年級的學生。總計173間學校、18,645位學生參與第一波測驗。本研究最終排除無三波完整青少年菸品使用資料之樣本，總計分析6,277位學生。分析內容涵蓋社會支持、青少年的菸品使用、求學階段、性別、雙親教育程度、父母吸菸狀態、父母監控、酒精使用以及憂鬱症狀。本研究以廣義估計方程式分析社會支持與青少年菸品使用之關聯性，並檢驗時間和性別是否調節社會支持與青少年有無使用菸品之關係。最後，本研究進一步以多元邏輯斯迴歸探討社會支持與青少年第三波菸品使用類型之關係，同時分析求學階段和性別是否調節社會支持與青少年菸品使用類型之關聯性。 研究結果：青少菸品使用率在2015年至2017年間逐年上升，而有使用菸品的比率在三年間分別為3.63%、3.80%、4.59%；其中，第三波的菸品使用類型（僅使用紙菸、僅使用電子煙、雙重使用）的比率分別為3.83%、0.41%、0.35%。在青少年有無使用菸品方面，學校支持較高的青少年，其使用菸品的風險顯著較低 (OR: 0.94, 95%CI: 0.90–0.98)；而同儕支持以及家庭支持的主要效果則皆未顯著。然而，三種社會支持與青少年有無使用菸品之關係未有時間以及性別的調節作用。在青少年菸品使用類型方面，學校支持較高的青少年，其僅使用電子煙的風險顯著較低 (aOR: 0.77, 95%CI: 0.65–0.92)；而同儕支持以及家庭支持的主要效果則皆未顯著。除此之外，三種不同來源的社會支持與求學階段之交互作用項未達顯著。然而，同儕支持對青少年菸品使用類型的效果存在性別差異─即同儕支持越高的男性青少年，其「僅使用紙菸」的風險顯著較高 (aOR: 1.16, 95%CI: 1.03–1.32)。然而，家庭支持以及學校支持對青少年菸品使用類型的影響不因性別不同而存在差異。 結論：學校支持是青少年菸品使用的保護因子，建議菸害防制策略可針對學校支持進行介入，以降低菸品使用風險。除此之外，在制定同儕支持的介入計畫時，應將性別差異納入考量。

Background: The World Health Organization highlights that the age of smoking initiation has decreased among adolescents globally. While certain studies have demonstrated notable reductions in adolescent smoking rates in comparison to the preceding two decades, an increasing trend of e-cigarette usage among adolescents has been observed. In addition, social support has been shown to be a protective factor for adolescent smoking behavior and has been integrated into Campus Tobacco Hazards Prevention Program in Taiwan. Nevertheless, prior research has seldom examined the impact of social support on adolescent tobacco use, including variations in the effects stemming from diverse sources of social support. Additionally, investigations into the relationship between social support and adolescent tobacco use over time, as well as the potential sex differences, have remained relatively limited. Objective: This study aims to 1) examine the prevalence of tobacco use among Taiwanese adolescents across times; 2) understand the relationship between different sources of social support (i.e., peer, family, and school) and tobacco use, encompassing both the occurrence and patterns of tobacco use, and 3) analyze the moderating effects of time and sex. Methods: The data was from the “Taiwan Adolescent to Adult Longitudinal Study (TAALS)” spanning the years 2015 to 2017. TAALS is the first nationwide longitudinal survey among Taiwan adolescents, with participants sampled from the population of junior high, high school, and vocational school students in Taiwan. The participants were selected using multistage sampling, and a total of 18,645 students from 173 schools participated in the first wave. The final analysis included 6,277 students with complete data on tobacco use across all three waves. The model included social support, tobacco use, educational stage, sex, parental education level, parental smoking, parental monitoring, alcohol use, and depressive symptoms. This study analyzed the association between social support and tobacco use among adolescents by applying generalized estimating equations (GEE). The analyses also examined the moderating effects of time and sex. Additionally, multinomial logistic regression was used to explore the relationship between social support and different patterns tobacco use at Wave 3. The moderating role of educational stage and sex was further analyzed. Results: The prevalence of tobacco use among adolescents gradually increased from 2015 to 2017, with the rates of any tobacco use being 3.63%, 3.80%, and 4.59%, respectively. In addition, at Wave 3, the percentages of different tobacco use patterns (exclusive cigarette use, exclusive e-cigarette use, and dual use) were 3.83%, 0.41%, and 0.35%, respectively. The results of GEE showed that adolescents with higher levels of school support had significantly lower risks of using any tobacco products. However, the main effects of peer support and family support were not significant. Furthermore, no time and sex differences were observed in the relationships between social support and any tobacco use. Regarding patterns of tobacco use at Wave 3, adolescents with higher levels of school support had significantly lower risks of exclusive e-cigarette use. Sex differences in the effects of peer support and patterns of tobacco use were further observed. Specifically, peer support was positively associated with the risks of exclusive cigarette use among males but not females. Conclusion: School support is a protective factor against tobacco use among adolescents. It is recommended to incorporate school support into tobacco control strategies as an intervention to mitigate the risk of tobacco use among adolescents. In addition, it is important to consider sex differences when devising programs that incorporate peer support.