青少女暴露二手菸與經痛相關性之研究

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Title:	青少女暴露二手菸與經痛相關性之研究
Authors:	郭錦蓉;Chin-Jung Kuo
Contributors:	中國醫藥大學：環境醫學研究所碩士班
Keywords:	二手菸;經痛;月經週期;environmental tobacco smoke;dysmenorrhea;menstrual cycle
Date:	2007-06-28
Issue Date:	2009-08-11 16:56:40 (UTC+8)
Abstract:	摘　要香菸燃燒後會產生4000多種的物質，吸菸或暴露二手菸婦女引起不孕及嬰兒低出生體重、早產等。青少女時期發生經痛是非常普遍的事件，其原因除本身遺傳因素外，暴露二手菸與青少女經痛亦可刺激或加重其嚴重度與發生頻率。然而，國內對於青少女暴露在二手菸所造成影響尚未見有深入的調查研究。故本研究的目的將探討二手菸對經痛的影響及其相關因子。本研究預計在南部某一所高中職學校選取16-18歲女學生做經痛與二手菸問卷調查，包括月經情形、二手菸的暴露、壓力、生活型態如吸菸、喝酒、咖啡因食用、運動…等。並追蹤女學生連續紀錄6個月包括經痛、月經出血量、和其他有關月經症狀和暴露在二手菸情形、壓力等資料。結果顯示在94學年度橫斷式之調查，在一至三年級青少女經痛盛行率為78.7%及95學年度一年級青少女經痛為68.8%。利用Multiple logistic regression調整控制變項有身體質量指數，飲用咖啡因飲料、魚類攝取、飲用冰冷飲料、憂鬱分數、初經年齡與母親經痛情況後，得知暴露二手菸暴露與青少女經痛並無顯著性之相關。若以MMDQ分數分組(≦4分，5-12分，≧12分)時，則暴露二手菸在調整其它變項後則有顯著性相關(OR=1.82，95% CI=1.18-2.83)，以青少女在家中的菸蒂數與吸菸人數來看，與其MMDQ分數高、低之勝算比均呈現出劑量效應之關係。在暴露二手菸與媽媽有經痛的對青少女經痛之交互作用，經多變項羅輯斯迴歸分析顯示只暴露二手菸之勝算比為2.93倍，媽媽有經痛為15.24倍，兩者皆有為10.07倍(95% CI=4.37-23.2)，並無相乘協同作用。在追蹤式研究結果顯示有、無暴露在二手菸青少女有經痛者分別為50.0%與 44.6%之發生率。以GEE分析追蹤暴露二手菸的青少女與經痛的危險性，調整其它變項後，家中吸菸人數在3人以上勝算比為1.49(95%CI=1.18-1.88)。若將MMDQ分組分成高、低兩組時，只暴露二手菸者其勝算比為1.4倍，媽媽有經痛為1.36倍，兩者皆有為1.43倍(95%CI，1.16-1.78)，兩者對青少女經痛皆有顯著性之影響。本研究結論顯示暴露二手菸對青少女經痛有顯著性的影響，因此，衛生單位應加強菸害防制的計畫，以減少青少女暴露二手菸的危害。關鍵詞：二手菸、經痛、月經週期 Abstract It has been concerned that environmental tobacco smoke (ETS) causes the adverse effects on human health. Previous studies have shown that tobacco smoke contains as many as 4000 chemicals. Dysmenorrhea was a high prevalence in adolescent girls. While some women may be genetically predisposed to dysmenorrhea, exposure to environmental tobacco smoke (ETS) may cause the symptom and even enhance its severity. However, the causal relationship remains unclear. The purpose of this study is to establish a relationship between ETS and the onset and severity of dysmenorrhea. Both cross-sectional and longitudinal studies were performed at a senior high school in Taiwan. All subjects (n=884) were interviewed using a questionnaire including 18 moo’s menstrual distress questions (MMDQ). 8-OHdG and cotinine levels in blood (N=182) and urinary (N=121) specimens were determined. Results showed the prevalence of dysmenorrhea and exposure to ETS were 78.7% and 79.9%, respectively. Using a multiple logistic regression model adjusted for covariates (body mass index, coffee and fish consumption, consumption of cold beverages, anxiety score, age at onset of the first menstrual cycle, and dysmenorrhea in the mother), the risk of dysmenorrhea was found to be dependent on the number of cigarette butts at home, but not significant. MMDQ scores were classified into three groups: low (a score of ≦4), medium (a score of 5-12), and high (a score of ≧12). MMDQ scores significantly correlated with the exposure to ETS (OR=1.8, 95% CI, 1.18-2.83), and were dose dependent on the number of cigarettes butts at home. The multivariate logistic regression analysis showed that the risk for dysmenorrheal was independently associated with ETS (OR=2.93) and maternal history of dysmenorrhea (OR=15.2). There were no significant interaction between exposure to ETS and maternal dysmenorrhea. The urinary cotinine and PGE2, and serum 8-OHdG did not correlate with dysmenorrhea after adjusting for other covariates. In conclusion, dysmenorrhea in adolescent girls is significantly associated with the ETS exposure, especially the severity of the their symptoms. Key words：environmental tobacco smoke，dysmenorrhea，menstrual cycle
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