卫生研究

目的探讨家庭环境、心理韧性、校园欺凌与青春前期青少年烟草使用的关联性。方法按照整群抽样的原则,以班级为单位,于2018年2—11月抽取百色市区县5所小学四至六年级的4792名学生,其中男性2522人(52.63%),女性2236人(46.66%),性别缺失34人(0.71%);平均年龄为(11.8±0.5)岁;市区学生2721人(56.78%),县城学生2071(43.22%);壮族4313人(90.00%),汉族365人(7.62%),其他民族(瑶族、苗族、彝族等)98人(2.05%)。应用一般家庭环境问卷、青少年心理韧性量表、校园欺凌问卷、烟草使用问卷进行测评,利用Logistics回归分析研究变量之间的效应关系。结果尝试吸烟的人数为467人,总检出率为9.75%。吸烟的检出人数为334人,总检出率为6.97%。男生烟草尝试和吸烟行为均高于女生(χ²分别为57.230和56.013,P<0.001)。多因素Logistics回归分析显示,男生出现烟草尝试的危险性是女生烟草尝试的2.37倍(OR=0.468,95%CI 0.377～0.582),男生吸烟的危险性是女生的2.32倍(OR=0.422, 95%CI 0.324～0.551);年长的青少年更多出现烟草尝试(OR=1.609,95%CI 1.446～1.791)和吸烟行为(OR=2.026,95%CI 1.776～2.310);校园欺凌增加青少年吸烟行为的危险性(OR=1.106,95%CI为1.073～1.140)。心理韧性(个人力)、家庭亲密度、家庭规则能有效降低青少年烟草尝试(个人力,OR=0.964,95%CI=0.951～0.976;家庭亲密度,OR=0.946,95%CI 0.892～0.984;家庭规则,OR=0.949,95%CI 0.930～0.965)和吸烟行为(个人力,OR=0.962,95%CI 0.947～0.977;家庭亲密度,OR=0.937,95%CI 0.885～0.992;家庭规则OR=0.952,95%CI 0.932～0.973)的危险性。结论校园欺凌增加青少年吸烟行为的危险性。心理韧性(个人力)、家庭亲密度、家庭规则能有效降低青少年烟草尝试和吸烟行为。

OBJECTIVE The study aimed at association of family life, resilience and bullying on the use of tobacco in preadolescents. METHODS A total of 4792 students from 5 junior schools in Baise City were recruited with cluster-sampling method, filled with questionnaire of family life, resilience, parents' Control, bullying, initiation of tobacco and smoking from Feb. to Nov. 2018. The sample comprised of 52.63% male students and 46.66% female students. The average age was(11.8±0.5). There were 56.78% of students lived in city and 43.22% of students lived in county town; The nationality of the sample was as follows: Zhuang nationality 90.00%,Han nationality 7.62%,other minorities(Yao nationality, Miao nationality, Yi nationality, et al)2.05%. The Logistic regression was used to explore the effect. RESULTS There were 9.75% and 6.97% of the sample reported initiation of tobacco and smoking respectively. The initiation of tobacco and smoking of boys were higher than that of girls(initiation of tobacco: χ²=57.230, P<0.001; smoking: χ²=56.013, P<0.001). The multivariate Logistic analysis showed gender was statistically significant factor of initiation of tobacco(OR=0.468, 95%CI 0.377-0.582) and smoking(OR=0.422, 95% CI 0.324-0.551), and age was statistically significant factor of initiation of tobacco(OR=1.609, 95% CI 1.446-1.791) and smoking(OR=2.026, 95%CI 1.776-2.310). Bullying was statistically significant factors of smoking(OR=1.106, 95% CI 1.073-1.140). Three protective factors were associated with a lower likelihood of initiation of tobacco(individual power: OR=0.964, 95% CI 0.951-0.976; family cohesion, OR=0.946, 95% CI 0.892-0.984; family rules, OR=0.949, 95%CI 0.930-0.965) and smoking(individual power: OR=0.962, 95% CI 0.947-0.977; family cohesion, OR=0.937, 95%CI 0.885-0.992; family rules, OR=0.952, 95%CI 0.932-0.973)in the final subscale model. CONCLUSION Bullying increased the risk of smoking, while Individual power, family cohesion and family rules were associated with a lower likelihood of initiation of tobacco and smoking in preadolescents.