Effectiveness of betel-nut chewing prevention program in junior high schools

本研究旨在瞭解與嚼檳榔認知、態度和行為相關的因素，並評量嚼檳榔預防敎育對高雄市國中一年級學生產生的效果。以立意取樣方式，自高雄市選取20所國中，並在每所國中的一年級學生中，挑出性質相近的兩個班，分別納入實驗組或對照組。實驗組學生參加每週一次，每次一小時，合計四小時的敎學活動。共1761位學生為本研究的對象，分別接受前測（介入前）、後測（介入後一週）和追踪評量（介入後三個月）。結果發現：(1)内控傾向較強和家中有人嚼檳榔者，其檳榔認知得分較高；(2)女性、内控傾向較強、對自己課業表現不滿意、不曾遇到他人遞送檳榔、朋友沒嚼檳榔、家人沒嚼檳榔及檳榔認知得分較高者，其反對嚼檳榔的態度越強烈；(3)男性、有吸菸經驗、母親敎育程度較低、曾遇他人遞送檳榔、朋友有嚼檳榔、家人有嚼檳榔及反對嚼檳榔態度較弱者，有嚼檳榔之比率較高；(4)敎育介入活動經證實確能顯著地增進實驗組學生檳榔的認知，加強反對嚼檳榔的態度，而且經過三個月後，介入產生的效果仍持續存在；(5)就實驗組學生而言，在控制了檳榔認知前測得分後，其對教學活動愈感到滿意，檳榔認知後測得分之增加量則愈大，而父親敎育程度為中學以上者，增加幅度也較大；(6)就實驗組學生而言，在控制了反對嚼檳榔態度前測得分後，內控傾向較強及朋友沒嚼檳榔者，其反對嚼檳榔態度後測得分之增加幅度較大。根據本研究發現，建議：(1)針對内控傾向較強的學生可提供『以學習者為中心』之學習經驗；(2)鼓勵家長實行健康行為做子女表率，並幫助子女學習有關健康之知識、建立正確的態度；(3)嚼檳榔預防敎育活動可考慮以男生和已有吸菸經驗者為優先介入對象；(4)敎學活動設計應符合學生興趣使其滿意以增強學習效果。
The purposes of this study were to assess the underlying factors of betel nut chewing knowledge, attitude, and behavior among 7th graders, and to evaluate the effectiveness of a betel nut chewing prevention program for this group. Twenty junior high schools in Kaohsiung City were selected. Two classes whose students had similar characteristics were chosen from each school and then assigned to the intervention group or, comparison group. The students in the intervention group participated in four sessions of betel nut chewing prevention education. In all, 1761 students attended this program. The effectiveness of the intervention was assessed by questionnaires given before the implementation of intervention, immediately after the four sessions, and three months after the last session. Our results showed that, before intervention, students with a stronger internal locus of control, or with family members with a betel nut chewing habit, had higher scores in betel nut chewing knowledge. Students who were female, had a stronger internal locus of control, were not satisfied with their academic grades, had never had someone give them betel nuts, had no friend with a betel nut chewing habit, had no family member with a betel nut chewing habit, or had a higher score of betel nut chewing knowledge, had stronger attitudes against betel nut chewing. Students who were male, had smoking experience, had had someone give them betel nuts, had family member with a betel nut chewing habit, had weaker attitudes against betel nut chewing, or had a mother with lower education, were more likely to chew betel nuts. Students' betel nut chewing knowledge and attitude against betel nut chewing were enhanced by the betel nut chewing prevention program, and the effectiveness of intervention remained three months after the program. After controlling for the pretest score in betel nut chewing knowledge, the students in the intervention group whose fathers had higher education or who were satisfied with the intervention activities made more progress in betel nut chewing knowledge. After controlling for the pretest score in attitude against betel nut chewing, students in the intervention group who had stronger internal locus of control or had no friend with a betel nut chewing habit showed greater improvement in their attitudes against betel nut chewing. On the basis of our findings, we suggest that (1) learner-centered activities can be a good learning experience for students with a strong internal locus of control; (2) parents should provide a good model for a healthy lifestyle and help children learn; (3) male students and those who have smoking experience should be the target groups of betel nut chewing prevention programs; and (4) to increase the effectiveness of intervention, the educational activities need to be designed to meet the students' interests.