【作者】 黄晶晶；

【导师】 杨廷忠；

【作者基本信息】 浙江大学 ， 社会医学与卫生事业管理， 2008， 硕士

【摘要】 研究背景当今世界,烟民的人数已经超过了11亿,其中大约82%的烟民处在中低收入国家。中国是烟草生产和消费大国,生产和消费均占全球三分之一以上。目前,中国约有3.5亿吸烟者,居世界各国之首,并逐渐有年轻化的趋势。吸烟与健康关系密切,2002年世界卫生报告中指出,影响健康的前十大危险因素中,吸烟排在第4位。每年,大约有540万人死于吸烟引发的肺部、心脏或其他疾病,每十个死亡的成人中,就有一个是由吸烟引起。到2030年,由吸烟导致死亡的数据可能会上升到800万人每年,即占六分之一的成人死亡数。吸烟者的吸烟行为在损害其自身健康的同时还无意识的伤害了四周群体的健康,吸烟已经成为国家最大的公共卫生损害。然而,不幸的是,吸烟虽然已经明确为当今世界人类健康的最大威胁,烟草的消费却并没有呈现出平稳或下降的趋势,反而烟草使用已到了类似瘟疫流行的程度。吸烟者吸烟的动机就主要归功于尼古丁的成瘾作用,烟草燃烧可释放4000多种化合物质,其中有2000多种是烟草本身就有的,其中相当一部分对人体健康构成威胁,尼古丁就是其中的代表。尼古丁的最大危害就在于其成瘾性,吸烟者一旦成瘾,每30-40分钟就需要吸一支烟,以维持大脑中尼古丁的稳定水平,当达不到这一水平时吸烟者就会感到烦躁、不适、恶心、头痛并渴望补充尼古丁,感觉似乎与鸦片毒品无异。正是因为尼古丁在烟草成瘾中起着主导作用,吸烟成瘾的实质就是尼古丁成瘾。吸烟成瘾亦可以看作是一类受生物、遗传、社会环境、行为、心理等因素影响的复杂疾病,在行为医学中占有一定位置。因此从心理、行为角度出发,探讨成瘾的相关影响因素,为日后制定干预措施、开展健康促进提供参考就显得尤为重要。研究目的:首先通过文献研究,结合相关的行为、心理理论,对吸烟成瘾有大致的了解并确定研究主线。根据调查结果获得人群的吸烟率数据并提取调查人群中的吸烟人群作为研究对象,其次对本次研究引入的尼古丁依赖测量量表(FTND)的信度、效度进行检验并与HSI指数进行一致性等统计学对比,对其进行解释修正。继而根据问卷中的量表得分总值判定吸烟者的成瘾状况。选定一般人口学特征、吸烟行为以及戒烟意向等因素作为潜在影响因素,究竟这些因素是如何影响成瘾性,影响的程度如何,我们在研究中作进一步探讨。研究方法:1.文献研究。通过研究吸烟行为、吸烟成瘾、FTND量表等国内外相关文献,结合心理、行为方面的理论确定研究方向并作出初步假设。2.实证研究。(1)调查对象选择:以杭州、南京、广州、银川四个城市的城镇居民作为研究对象,选取其中的吸烟居民进入本次课题的研究。(2)抽样方法:采用多阶段随机抽样,先在各个城市以城镇社区为基础,各随机抽取若干个社区,再在这些社区中随机选取一定数量的家庭作入户调查,调查对象为该户中一名年满15岁的居民。我们的调查样本总量定为3600份左右,预计回收后进入我们研究的吸烟样本在900份至1200份之间,足以满足本研究的需求。(3)调查内容:主要包括一般社会人口学特征、吸烟的基本情况、尼古丁依赖程度测量量表(FTND)以及戒烟意向等等。(4)调查实施:采用研究组统一制定的问卷进行资料的收集,调查的时间为2008年2月至3月。在选取的社区中由培训合格的调查员入户调查。每位调查对象完成答案后调查员应仔细审核,确认没有漏项后才离开。(5)资料统计分析:采用Cronbach系数法和因子分析法测试FTND量表的信度和效度;采用简单的描述性统计方法分析受访者的各项吸烟率指标、一般人口学特征、吸烟人群的成瘾率的分布等等;运用卡方检验探究一般人口学特征、吸烟行为以及戒烟意向中对吸烟成瘾产生影响的因素;用Logistic回归的方法实施一般人口学特征、吸烟行为以及戒烟意向等和成瘾间的相关多因素分析。研究结果:本次研究问卷的发放和调查过程中均由受过专业训练的调查员严格控制把关以及回收。共发放问卷3600份,回收了3582份,回收率达到99.5%,其中有效问卷的数量为3571份,有效率为99.7%。1.本次调查得到的吸烟人数为1196人,占总人数的33.5%,得出的吸烟率即为33.5%,其中经常吸烟率为24.3%,偶尔吸烟率为9.2%。。这部分吸烟者即是我们这次城市居民吸烟行为成瘾性研究的研究对象,从而确定研究的样本量为1196人,根据以往研究和专家经验,这个数量是完全满足我们研究需要的。男性的吸烟率为52.9%,女性的吸烟率为7.1%。男性经常吸烟率及男性偶尔吸烟率分别为39.2%和13.8%。女性经常吸烟率及女性偶尔吸烟率分别为4.1%和3.0%。2.对FTND量表进行信度检验得到总人群的Cronbach系数值为0.704,各个项目与总分之间的相关系数为0.461-0.819,男性人群量表和女性人群量表的Cronbach系数值分别为0.707和0.700。HSI≥4分为判定成瘾的标准得到的灵敏度、特异度及ROC面积均较高,更符合我们的测量要求。HSI指数的结果和FTND结果的Kappa系数值为0.721。3.1196例吸烟者中,总的成瘾人数为268,总成瘾率为22.4%,其中男性成瘾率为22.7%,女性成瘾率为19.6%。4.一般人口学特征单因素与多因素分析结果:民族这一因素是吸烟成瘾的影响因素。5.吸烟行为单因素与多因素分析结果:每日吸烟量、吸烟初始年龄、吸烟年限、所吸的烟草价格、吸烟频率等多项因素均与成瘾存在显著性关联。6.戒烟意向单因素与多因素分析结果:最符合目前戒烟考虑这一项因素对成瘾存在影响。研究结论:参照以往的研究结论并结合本次研究所得出的一系列实证结果,结论如下:1.本次研究首先得出吸烟率、经常吸烟率以及偶尔吸烟率的分布概况。此外还有四个调查实施城市以及以年龄、职业等等因素划分的不同层次人群的各项吸烟率、经常吸烟率和偶尔吸烟率数据。2.本研究对经典尼古丁依赖测量量表(FTND)进行了可靠性验证,并引入重度尼古丁依赖测量指数(HSI)作对比研究。结果得出我们的中文版FTND量表在全人群、男性人群及女性人群中均表现出较好的信度和效度,其整体关联度甚佳。HSI指数我们的结论是以4分为截断值判别成瘾较为适宜,HSI指数亦表现出就好的灵敏度和特异度,其判定结果与FTND量表的判定结果都较为一致。3.一般人口学方面,单因素与多因素分析提取民族一项为影响成瘾的因素,少数民族人群在吸烟成瘾的危险度上要高于汉族人群,少数民族人群的吸烟状况更应引起关注。4.吸烟行为方面,每日吸烟量、吸烟年限、吸烟频率与成瘾呈正性相关,而吸烟初始年龄、所吸的烟草价格两因素则与成瘾呈负性相关。5.戒烟意向方面,单因素与多因素分析得出最符合目前戒烟考虑这一项因素对成瘾存在影响,以没有考虑过戒烟为对照,正在采取戒烟的一组人群其OR值为0.472,可见考虑戒烟意愿及采取戒烟行动并最终得以戒烟成功的人群一般都是成瘾危险度较低的人群,而成瘾的人群,其吸烟行为的戒断就会愈加困难。更多还原

【Abstract】 BackgroundNowadays,the total number of smokers all over the world has reached more than 1.1 billion,82%of which live in the medium or low income countries.China is the biggest tobacco production and consumption country,the number of smokers in China is about 0.35 billion,more than any other countries,and the young smokers’ proportion is rising.Smoking behavior has great relation with people’s health,world health report of the year 2002 pointed out that among the first ten dangerous factors that influence human health,smoking standed in the fourth position.Every year, about 5.4 million people die from the lung,heart,or other diseases which are induced by smoking,that means ten deaths in the world,there is one making by smoking.By the year 2030,the deaths of smoking may rise to 8 million per year,about one-sixth adult deaths.The smoke behavior not only harms the health of smokers but also unconsciously harms the health of the people around,smoking has been the most harmful factor of the Public health in the country.Unfortunatly,though smoking has been proved the biggest threaten to human health,the consumption of tobacco all over the world is still rising,smoking is popular in many countries.The motivation for smoking mostly owe to the addiction of Nicotine,burning tobacco may release over 4000 compounds,a big part of which is harmful for people’s health.Nicotine is the representative compound.Nicotine may addict smokers.Once the smoker is addiction,he need to smoke every 30 to 40 min to maintain the nicotine level in his cerebra,when the nicotine level falls,he would feel worried,uncomfortable,headache,and eager to smoke,all these feeling and behavior have no different with opium.For nicotine’s leading effection,the hypostasis of tobacco addiction is the addiction on nicotine.We may regard tobacco addiction as a complex diease that influence by biologic, genetic,behavior,mental and other factors.So it is meaningful to explore the factors that influence tobacco addiction from the mental and behavior angle.ObjectivesLiterature research,combining with the behavior and mental theory to make sure our research link.We can get the smoking rate after conducting survey,the smokers should be our research objective.Our research used the Fagerstrom Test for Nicotine Dependence(FTND)to judge addiction.First,we should test the reliability and validity of the FTND,then compare it to the Heavy Smoking Index(HSI).Choose several factors including the samples’ demographic data,smoking behavior,smoking cessation behavior and so on,try to explore the factors which influence the addiction, the influencing extent and the influencing ways.Methods1.Literature research.We reviewed the literature on smoking behavior,addiction, FTND and so on,combining with the behavior and mental theory to make primary supposion.2.Practical research.1)The samples were chosen from urban residents living in the cities of Hangzhou, Nanjing,Guangzhou and Yinchuang.The smokers would be chosen to our farther research.2)Sampling methords.We used multi-stage sampling.Based on the community of each cities,we randomly chose several communities,then chosen a seris of families from these communities,the targets should include a person who is old then 15 in these chosen families.Our total samples were about 3600,in which the smokers should be about 900 to 1200,and it is enough for our research.3)The questionnaire includes the samples’ demographic data,basic smoking situation,FTND,smoking cessation behavior and so on.4)Survey was conducted between February and march in 2008,and used uniform questionnaire established by our research group.Data were obtained randomly via family interview by the professional inquirers.5)Data analysis.Cronbach’s alpha parameter and factor analysis were used to test the reliability and validity of the FTND;Descriptive statistal methords were used to analisis the samples’ demographic data,seals of smoking rates,the addiction rates and so on;Chi-square test was used to explore the relationship between the demographic data,smoking behavior,smoking cessation behavior and the addiction;Logistic regression model was used to conduct muti-factors analysis between the demographic data,smoking behavior,smoking cessation intention and the addiction.Results:Under our inquirers’ strict control,3600 questionnaires were sent,and 3582 returned(response rate 99.5%),of which 3571 questionnaires were proven valid, valid rate is 99.7%.1.The whole number of smokers is 1196,smoking rate is 33.5%,daily smoking rate is 24.3%and occasional smoking rate is 9.2%.Our study of addiction focus on the smokers,so our study samples are 1196,according to previous studies and experience,the number is enough.The male smoking rate is 52.9%,daily smoking rate is 39.2%,occasional smoking rate is 13.8%.The female smoking rate is 7.1%, daily smoking rate is 4.1%,occasional smoking rate is 3.0%.2.Test the FTND,the Cronbach alpha of whole sample is 0.704,relative kappa between each index and the whole score distribute among 0.461 to 0.819,the Cronbach alpha of male sample is 0.707 and female sample is 0.700.We also get the result that HSI with a cutting score≥4 is higher in sensitivity,specificity and ROC area,and it is more suitable for our test demand.The relative kappa between HSI and FIND is 0.721.3.Among the 1196 smokers,the number of people who got smoking addiction is 268,addiction rate is 22.4%,male addiction rate is 22.7%and female addiction rate is 19.6%. 4.Results from reason analysis for demographic data.Nationality affects the smoking addiction.5.Results from reason analysis for smoking behavior.Number of cigarettes per day,age of first start smoking,years of smoking,the price of tobacco,frequency of smoking affects the smoking addiction.6.Results from reason analysis for smoking cessation intention.Consider to take smoking cessation intention affects the smoking addiction.Conclusion:Compare with previous studies and base on our research we drew several conclusions:1.First,we get the smoking rate,daily smoking rate and occasional smoking rate.2.Test the FTND,and compare it with the HSI.The Chinese version of FIND shows good sensitivity and specificity in whole sample,male sample and female sample.When using the HSI as test tool,it is more suitable to take HSI with a cutting score≥4 to distinguish addiction,and it also shows good sensitivity and specificity.The test result of HSI is consistent to that of the FTND.3.Results from reason analysis for demographic data shows that nationality is a influential factor, minority people are more dangerous than Han people in smoking behavior,that means we should pay more attention to the health of minority people.4.Results from reason analysis for smoking behavior.Number of cigarettes per day,years of smoking and frequency of smoking are positive factors of addiction.Age of first start smoking and the price of tobacco are negative factors of addiction.5.Results from reason analysis for smoking cessation behavior.Consider to take smoking cessation behavior affects the smoking addiction.People who never consider to take smoking cessation behavior shows more dangerous than people who taking smoking cessation behavior in addiction.In other words,for people who addictive it is more difficult to get success in smoking cessation.更多还原