| 摘要: | 目的: 本研究的目的旨在探討懷孕婦女環境菸害暴露的相關因素，了解懷孕婦女對菸害暴露防制行為意向之決定因素，以及環境菸害對懷孕初期不適症狀之影響，期能建立懷孕婦女自我察覺環境菸害影響之提醒策略。
方法：本研究為橫斷面之研究調查。以立意取樣方式，於2012年11月至2014年9月期間，在中國醫藥大學北港附設醫院及中山醫藥大學附設醫院婦產科門診，選取十八歲以上經婦產科醫師確診懷孕8-20週之婦女，由收案人員逐題詳細詢問，並協助填寫自擬之結構式問卷，其中包括社會經濟狀況之基本資料、孕產狀況及個人與家庭疾病史、孕期不適症狀量表、環境菸害暴露情況及菸害暴露防制意向及行為決定因素。
結果：總共139位樣本進入本研究分析，其中僅6.5%的婦女曾經吸菸，但均表示已戒除。84%婦女懷孕期間過去一週曾於家中、工作場所或公共場所暴露於環境二手菸。經由皮爾森相關係數分析，環境菸害防制行為意向與懷孕婦女對菸害防制之行為信念、結果評價、主觀規範、控制信念得分皆呈現顯著正相關。以多元迴歸分析結果，在經調控看診醫院、族群、教育程度及負向生產經驗等變項之後，伴侶有吸菸習慣較伴侶無吸菸習慣者增加總二手菸指數2.61分(p<.001***)，工作場所全面禁菸較無相關規定者降低1.22分(p=.45)，而規範信念(B=-0.70，SE0.18，p<.001)及控制信念(B=-0.14，SE0.07，p=.041)亦與總二手菸暴露指數呈顯著負相關。而總二手菸指數與懷孕期間的口乾口渴、胃灼熱、下腹痛、頻尿、心情鬱悶等五項不適症狀，以及不適症狀出現數及不適症狀嚴重度之總量呈現顯著正相關。並且在經多元迴歸分析，以年齡、負向生產經驗、孕期、個人呼吸道與其他慢性疾病史、伴侶吸菸及個人是否曾吸菸等因子調控之後，總二手菸的暴露指數仍與不適的症狀總量呈現顯著正相關(B=1.35，SE0.63，p=.034)。除此之外，經由計算五項顯著症狀在二手菸暴露的敏感性及特異性，以ROC曲線分析結果顯示，當上述若有出現四項以上之不適症狀時，可能代表較高的環境菸害暴露對身體造成影響，可作為其自我察覺策略，提醒孕婦以避開環境菸害以維護自身及胎兒之健康。
結論：此研究提供良好的證據，顯示環境菸害暴露與孕期不適症狀之間的相關性。即使菸害防制新法實施多年，然而孕婦暴露於環境菸害的比例仍然極高，孕期的健康照護與衛生教育，以及國家的環境菸害防制政策應該更著於各環境中二手菸之控制，並提高孕婦對於身體不適症狀的自覺，以避開更進一步的母嬰危害。
Objectives: The aims of this research were to assess factors related to environmental tobacco smoke exposure (ETS), to analyze the behavioral intentions of second-hand smoking prevention and its predictors, and to examine the association between environmental tobacco smoke exposure and discomfort during pregnancy.
Methods: This was a cross-sectional study. Pregnant women within 8-20 weeks of gestation, a convenient sample recruited from a medical center and a local community hospital in central Taiwan from November 2012 to September 2014, were interviewed using structured questionnaires after obtaining their informed consent. The questionnaires gathered basic social economic information, maternal status, personal and family medical history, pregnancy discomfort scale, tobacco smoke exposure status, behavioral intentions, and the predictors of environmental tobacco smoking control.
Results: In total, questionnaires from 139 pregnant women were collected. Only 6.5% of the participants were ex-smokers, and they all reported having already quit smoking. Eighty-four percent of the participants experienced ETS exposure in their households, their workplaces, and/or in public areas. After a Person correlation analysis, the results of our study showed that behavior beliefs, evaluations of behavioral outcomes, normative beliefs, and control beliefs had significant positive relations with behavioral intentions of environmental tobacco control in pregnant women. When using a multiple regression statistics, we found that the participants with a smoking partner had a higher outcome of total secondhand smoke index than those with a non-smoking partner. Those with smoking free acts in their work places had a decrease in their total secondhand smoke indeces. Normative and control beliefs had negative relations with the total secondhand smoke indeces after being adjusted by the respondents’ hospital, ethnicity, educational level, and negative maternal experiences. The discomfort symptoms of thirst, heartburn, lower abdominal pain, frequent urination, and depression were found to be significantly associated with ETS exposure. A final analysis of multiple regression statistics showed that the total severity of discomfort symptoms were significantly related to secondhand smoke exposure after being adjusted for age, employment, maternal stage, personal history of respiratory and other chronic disease, living with a partner who smokes, and personal smoking history. In addition, the presence of at least four of the aforementioned five significant symptoms serves as a signal for the need to raise women's self-awareness to avoid ETS hazards.
Conclusion: This study provides empirical evidence of the adverse relationship between ETS exposure and early pregnancy discomforts. Exposure to ETS in pregnant women remains high, and health education programs targeting this population should be done to enhance their self-awareness to the discomforts related to ETS exposure and prompt them to adopt preventative strategies. |
