| 摘要: | 孩童暴露於環境菸害一直是世界各國所關注的議題，過去研究顯示孩童最主要的二手菸暴露源自於家庭，而父母吸菸是家庭二手菸最主要的來源。因此，有效的孩童二手菸害防治計劃，除了教導孩童二手菸害以及避二手菸的策略之外，吸菸父母的參與亦是重要關鍵。本研究目的在於發展一個以親子為介入對象的家庭二手菸防治措施，以期降低孩童的家庭二手菸暴露程度，並提升父母與其子女的二手菸害知識與反二手菸態度，家庭反菸氛圍以及對吸菸父母的影響、以及子女拒家庭二手菸行為之自我效能。本研究設計採群集式隨機兩組前後測之介入設計，研究對象為新北市六所國小之三至六年級之學童及其吸菸父母共計68對，包括介入組親子33對、對照組親子35對。介入組親子接受為期七週共四次之介入措施，對照組親子則於相同時程提供菸害相關書面資料。介入措施設計參考跨理論模式以及I-Change模式、並經過前驅研究之檢討修正後擬定。參與研究之親子分別於介入前後接受三次問卷測量、以及子女尿液可丁寧濃度測量。主要的測量指標為(1)子女在家中的二手菸暴露程度，包括子女尿液可丁寧濃度測量、以及父母與子女分別自填量表；(2)父母與子女預防子女暴露於家庭二手菸之策略反應。次要測量指標包括 (1)父母與子女的二手菸害知識與反家庭二手菸態度；(2)父母感受家庭反菸氛圍與對家庭反菸氛圍之依從程度；以及(3)子女拒家庭二手菸行為之自我效能。資料分析在兩組間及前後測之指標差異主要採廣義估計方程式（Generalized estimating equation, GEE）分析進行比較。研究結果顯示，介入組子女的家庭二手菸暴露程度介入措施之後明顯低於對照組子女；；介入組父母的孩童家庭二手菸暴露之預防措施在介入三個月後顯著提升；介入組子女的拒家庭二手菸行為提升幅度顯著高於對照組子女；介入組子女的二手菸害知識、父母自覺家人之拒二手菸氛圍以及面對家人拒菸氛圍後之吸菸行為改變程度，相較於對照組子女與父母皆顯著提升。另外，介入措施對於父母的二手菸害知識、父母與子女的拒家庭二手菸態度、以及子女的拒家庭二手菸自我效能皆未達到顯著改變。推測天花板效應以及社會期許誤差的影響，造成知識與態度上未有顯著成效之因。本研究藉由親子互動之介入模式，促進親子間之相互關懷氛圍，其成效可作為未來在國小校園推廣家庭二手菸防制之參考，且介入措施設計及理論之運用，亦可為護理教育訓練專業衛教人才提供指引。建議未來研究可再擴大樣本數，以降低選樣誤差造成的高估或低估研究成效。
Children exposing to environmental tobacco smoke (ETS) has been a global concern in public health. Home environment, especially parental smoking, has been identified as the major exposing source for children. Therefore parents’ involvement becomes critical in preventing program. The purpose of this project is to develop and examine the effects of a parent-child interactive program to decrease the level of children’s exposure to environmental tobacco smoke at home, promote parents’ and children’s preventing strategy, knowledge of its hazard and attitude against environment tobacco smoke. The other purposes included promoting family’s anti-ETS climate that parents perceived and children’s self-efficacy of ETS avoidant behavior.
A clustered randomized controlled trial was administered to 68 parents of school-aged children from six primary schools in New Taipei City, Taiwan. Parents in intervention group accepted a four-session intervention designed based on Transtheoretical model and I-change model, and parents in control group received written materials about tobacco hazard at the same time-period. Parent- and child-reported measures of ETS exposure and children’s urinary cotinine level were obtained at baseline, 7 weeks, and 3-6 months. Parent- and child-reported preventing strategies, avoiding behaviors, knowledge of and attitude toward ETS, perceived family’s anti-ETS climate and its influence, and children’s self-efficacy in avoiding ETS exposure was also measured in 3 time period. Collected data was analyzed by Chi-square test and generalized estimating equation.
Results showed the intervention significantly decrease children’s cotinine level and self-reported number of days that parents smoking in the presence of children after intervention, increase parents’ prevention of children’s ETS exposure 3 months after intervention, and nearly significantly increase children’s ETS avoidant behaviors. Children’s knowledge, parents perceived family’s anti-smoking response and change of smoking behavior afterwards was also significantly promoted for intervention group. Parents in intervention group showed more often smoking outdoors to prevent children’s exposure; however the difference between groups was insignificant. There was no significant difference in parents’ and children’s attitude change, parents’ knowledge, and children’s self-efficacy in avoiding ETS at home between two groups after intervention. Ceiling effect and social desirability bias may be related to the insignificance in knowledge and attitude. A correspondence interaction about caring each other was found during parent-child interactive intervention and is effective on changing parents’ smoking, and then decreasing children’s exposure of environmental tobacco smoke at home. We suggest the program to be applied to primary schools in prevention of children’s environmental tobacco smoke at home. The theoretical base of intervention design can also be guidance to nursing education in training health care providers and designing health education program. We suggest increase of sample size to decrease sample bias in future research. |
