| Summary: | 碩士 === 高雄醫學大學 === 口腔衛生科學研究所 === 97 === Background：The Theory of Traidic Influence (TTI) by Flay et al suggests that youth smoking is influenced by factors from three domains: intrapersonal factors, socio-environmental factors and broader contextual factors. Many researches have examined the influence of intrapersonal and socio-environmental factors on children smoking; however lack of study explored the realtion of socio-environmental factors and children smoking.
Study objective：The aim of this study was using a multilevel-based study to comprehensively assess the impact of school- and individual-level characteristics in relation to cigarette smoking clustering among elementary schoolchildren.
Methods：This was a cross-sectional study and selected by a random stratified cluster sampling method, where the sampling unit was the school for this study. Data were collected from the sample of 3rd to 6th grade pupils’ (n=2,350；response rates 94%)and their parents’ (n=3,726；response rates 75%), and staff’s (n=52；response rates 100%) smoking behaviors, the struction and school tobacco control policies factors and individual characteristic at 26 elementary schools in Pin-Tung county. The individual- and school-level characteristics regarding smoking were estimated using multi-level logistic regression.
Results：The study found school effects were large in comparison to individual-level effects, and the additional variance which explained 85% and 48% effects. The risk of smoking was significantly associated with those schools without having any anti-tobacco acitivities or curricula [odds ratio (OR)= 3.56, 95%CI=1.53-8.28] and schools located in a mountainous region (OR=3.23, 95% CI=1.17-8.97) while controlling for individual-level characteristics. Other observed individual-level characteristics having a significant relationship to student smoking behavior were immediate social environmental factors in which best friends and family smoked as well as drinking alcohol and chewing betel nuts .
Conclusion：The findings suggest that effective tobacco control policies and preventive programs should be strongly considered for implementation in elementary schools that are putting children at the greatest risk for cigarette smoking.
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