高中、中专生非法药物滥用特征及CMER干预模式的短期效果评价
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摘要
一、研究目的
(1)了解武汉市部分高中、中专生非法药物尝试率,滥用倾向及认知;
(2)建立高中、中专生非法药物滥用的评价量表,确定量表各条目、领域和量表评分方法;
(3)基于CMER干预模式,对高中、中专生进行非法药物滥用的预防干预,利用评价量表与问卷,评价干预效果。
二、研究对象与方法
(1)研究对象
本研究是以学校为单位的类试验研究。根据自愿参加的原则,在武汉市选取两所高中(普通高中和重点高中各一所)、一所职业高中和一所中专学校,各学校一、二年级的1122名学生作为研究对象。
(2)调查方式和内容
采用自填式问卷。调查内容包括:非法药物滥用情况、态度、倾向,动机、抵御技能以及对六种非法药物的(海洛因、可卡因、摇头丸、冰毒、K粉、大麻)认知等。构建非法药物滥用倾向及相关因素的结构方程模型。
(3)非法药物滥用认知、动机、情商、抵御技能评价量表(CMERQ)的编制与评估
参考国内外相关干预材料及本课题组以往的研究积累,查阅文献,在认知(Cognition)-动机(Motivation)-情商(Emotion intelligence)-抵御技能(Resistance skills)(CMER)理论框架指导下,联合心理、健康教育、行为医学等方面的专家对非法药物滥用测量所涉及的内容进行讨论,形成基本条目之后,采用专题组讨论、专家评议等方式形成量表初稿。最后,对量表进行信度和效度的评价。
(4)非法药物滥用的预防干预
在参与调查的学校中选取一、二年级部分班级,以班为单位,分为试验组和对照组。试验组学生接受CMER干预模式,对照组学生不接受任何干预。干预时间为6个课时,内容为:毒品对身体、心理、社会、家庭的危害,对认知功能的损害,识别毒品及不法分子的诱惑方式,抵御毒品的技能等,由经过专门培训的教师向学生授课,授课方式包括讲解、讨论、角色扮演等。
(5)CMER干预模式的短期效果评价
干预前进行基线水平调查。干预后,采用相同问卷进行二次调查。调查前对学生讲解问卷填写的方式和注意事项。
三、结果
(1)高中、中专生非法药物滥用特征
被调查的学生中非法药物滥用率为3.65%(41/1122)。男生滥用率(5.23%)高于女生(2.50%)(P<0.05)。六种非法药物滥用率依次为:海洛因(0.27%)、可卡因(0.89%)、摇头丸(3.12%)、冰毒(1.25%)、K粉(2.05%)、大麻(0.27%)。男女生滥用冰毒、摇头丸和K粉的比率均较高,且男生高于女生(P<0.05)。四类学校的非法药物滥用率差异有统计学意义(P<0.05),中专学校最高,其次为职业高中。六种非法药物在各年龄组的滥用比率差别均无统计学意义(P>0.05)。有21名(1.87%)学生使用过一种以上的毒品。各学校间的非法药物滥用倾向差异有统计学意义(P<0.05),男生高于女生(P<0.05),但各年龄组间差异无统计学意义(P>0.05)。分别有11.19%、7.07%、4.30%、6.09%的学生不能正确识别可卡因、摇头丸、冰毒、K粉是毒品。14.92%的男生和8.31%的女生对毒品好奇,差别有显著统计学意义(P<0.001)。重点高中、普通高中、职业高中与中专学校的学生对毒品的好奇率分别为13.59%、10.38%、18.52%、7.98%,差别有显著统计学意义(P<0.001)。从非法药物滥用倾向及其相关因素的结构方程模型可以看出,非法药物滥用倾向受到应对技能和抵御技能的影响,技能越强,非法药物滥用倾向的可能性越小;同时,抵御技能也受到应对技能的影响。
(2)CMER量表的信度与效度
CMER量表含非法药物滥用的认知、抵御技能、情商三个分量表,内部一致性信度分别为0.853、0.455、0.880;量表各条目的重测信度在0.244-0.702之间。非法药物滥用认知分量表各条目的Kappa值在0.168-0.525之间;抵御技能分量表各条目的Kappa值在0.369-0.566之间。压力应对情绪调节分量表组内相关系数(ICC)在0.473-0.714之间。采用因子分析法,识别出特征根≥1的潜在公因子,三个分量表分别提取10、1、2个因子,其累积贡献率分别为53.44%、46.47%、46.69%。
(3)CMER短期干预效果
干预前药物滥用比率是3.65%(41/1122),干预后药物滥用率降低为2.82%(29/1029),但未见统计学差异(P>0.05)干预后,试验组在非法药物滥用认知的多数条目上得分均高于对照组(P<0.05)。干预后,试验组在非法药物滥用动机上部分条目的得分明显高于对照组及自身干预前得分(P<0.05)。干预后,试验组的好奇率(6.16%)明显降低,不仅低于对照组(8.80%)的好奇率,而且比其自身干预前好奇率(13.81%)显著降低(P<0.01)。干预后,在“娱乐场所”和“生日聚会”的假定场景中,试验组学生较对照组学生更少地表现出非法药物滥用倾向(P<0.05)。干预后,试验组学生选择“直接简单的拒绝”、“拒绝尝试并解释原因”、“拒绝尝试并建议其他活动”和“转移话题”的比例明显增大,尤其是“直接简单的拒绝”和“拒绝尝试并解释原因”两项,试验组学生选择的比率(53.42%、49.09%)高于对照组学生(45.69%、40.61%),差别具有统计学意义(P<0.05)。试验组干预后压力应对和情绪调节均分均高于对照组(P<0.05),且压力应对的均分较自身干预前也有所增高(P<0.05)。
四、结论
1.高中、中专生中有非法药物滥用情况及滥用倾向。部分学生对非法药物抱有好奇心理、对毒品危害的认知有缺陷,尤其在职业高中和中专学校的学生为甚。此外,高中、中专生尚缺乏一定的抵御技能和心理调试技能来避免非法药物滥用的发生。
2、CMER干预模式可以提高高中、中专生毒品相关的知识水平,降低毒品好奇率,建立反毒品动机,掌握有效的毒品抵御技能。3、本研究建立的CMER量表,总体来说各个模块的条目设置合理、内容清晰易懂,各关键量表的条目与量表整体保持了较高的一致性,显示该问卷具有较好的可靠性和有效性,可作为非法非法药物滥用相关信息的评价工具。
本项目的特色与创新之处。
(1)多学科交叉,将预防医学与社会、心理、行为、教育等多学科有机结合;
(2)培训教师作为实施干预方案的主体,多方参与,针对与中学生初次非法药物滥用有关因素进行综合预防,建立全方位、立体式的抵御毒品模式和与之配套的方案和资料集;
(3)将控制毒品的教育与青少年提高EQ、心理素质、抵御毒品行为技能教育相结合,类似毒品一级预防综合干预模式的研究到目前为止国内外尚未见报道。
Objective
(1) To understand the epidemiological characteristics of illegal drug use among students from senior high schools and technical secondary school in Wuhan
(2)To develop an evaluating scale for illegal drug use for students and confirm the item, field, grade of questionnaire.
(3) To evaluate the intervention effects of CMER on drug use, tendency of drug use, attitude, and so on, by questionnaire.
Methods
(1)Participates
The study is a quasi-experiment study. A total of 1122 students voluntarily participated in this study at baseline, rolled in the senior high schools and technical secondary school middle school.
(2)Measure
Self-reported drug use behavior was assessed along with attitudinal, the tendency of drug use, motivation,resistance skills and cognitive to six type of illegal drug (heroin, cocaine, MDMA, Methamphetamine, Ketamine, and marijuana), as well as establishing the structure equation model of tendency of drug use and it’s influencing factors.
(3)Composing the questionnaire about cognition, motivation, emotion intelligence and resistance skills to illegal drug use.
Following foreign intervention materials and ours studies, we developed the item pool of questionnaire under theory framework of CMER, with the guiding of psychologist, experts of health education and behavioral medicine. Then, the first draft was set up after special topic discussion and appraisal of experts. At last, we evaluated the reliability and validity of the questionnaire.
(4)Evaluation to the immediate impact of CMER intervention.
In the experiment group, students received the CMER program for 6 class periods. The curriculum was designed to address the major cognitive, attitudinal, motivation and peer resistance skills as the keys to prevent illicit drug use, such as general drug information, the negative impact of drug use on the body and mind, peer resistance skills. The contents were taught using integrative techniques, such as explaining, discussion, role-playing.
(5)The evaluation of immediate impact of CMER
Students were administered the pretest assessment, a posttest assessment after the intervention, Students from both groups were asked to complete a self-administered questionnaire. Questionnaires were administered during a roughly 15- minute period by a team of two to three trained collectors.
Results
(1) Epidemiological characteristics of illegal drug use among students The prevalence rate of drug use among students is 3.65%. The rate of drug use in boy (5.23%) was higher than that of girls (2.50%). The prevalent rate of heroin, cocaine, MDMA, Methamphetamine, Ketamine, and marijuana were 0.27%, 0.89%, 3.12%, 1.25%, 2.05%, and 0.27% respectively. The rates of MDMA, Methamphetamine, Ketamine use in boys were higher than these of girls (P<0.05). There were significant difference in different school (P<0.05) and the rate of drug use in technical secondary school was the highest. There were no significant difference in different age (P>0.05). There were 1.87% students using more than one drug. Boys were more likely to have tendency to drug use than girls (P<0.05). There were no significant difference of tendency to drug use in different age (P>0.05). There were respectively 11.19%、7.07%、4.30%、6.09% students who know no about cocaine, MDMA, Methamphetamine, Ketamine. 14.92% boys and 8.31% girls were curious to drug use (P<0.001). There were 13.59% students from key high school, 10.38%students from general high school, 18.52%students from occupation education school, and 7.98%students from secondary vocational education school who were curious to drug use (P<0.001). The tendency of drug use was affected by coping skills and peer resistance skills directly. The more students had grasped ability, the lower probability to drug use. Meanwhile, peer resistance skills were affected by coping skills.
(2) The reliability and validity of questionnaire
The questionnaire was included cognitive demain, resistance ability demain and stress and coping skills/emotion adjusting demain. Cronbach’s Alphas were respectively 0.853, 0.455, 0.880 for three domains. The Spearman correlation coefficients between test-retest were from 0.244 to 0.702 for item-to-item scores. The Kappa indexes were from 0.168 to 0.525 for cognitive demain. The Kappa indexes were from 0.369 to 0.566 for resistance ability demain. Intra-class correlation coefficients were from 0.473 to 0.714 for stress and coping skills/emotion adjusting demain. Respectively ten, one, two principle components were developed by factor analysis, with explanations of 53.44%, 46.47%, and 46.69% cumulative.
(3)Evaluation to the immediate impact of CMER intervention.
After intervention, the prevalence rate of drug use reduced from 3.65% to 2.82%, but there was no significant difference (P>0.05). The intervention group intervened by CMER program had significant effects on each variable at the posttest. The scores of some items on knowledge at posttest were significantly higher in the intervention group than those in the control group (P<0.01), as was the score of some items about motivation (P<0.05). The prevalence rate of curious to drug use in experiment group (6.16%) was lower than that of control group (8.80%), as well as experiment group of pretest (13.81%). The intervention group showed lower level of tendency of drug use in hypothetical situation of“club”and“birthday party”than the control group did (P<0.05).Furthermore, the results reported the peer resistance skills of the intervention group was significantly higher than those of the control group, for example, simple direct refusal, reason, suggestions for alternative activities accompanying a refusal. The mean scores on coping style and emotion adjustment at posttest were significantly higher in the intervention group than those in the control group (P<0.05).
Conclusion
(1)Drug use was becoming a serious question to students, especially to students from technical secondary school and occupation education school. In contrast, students have relatively lower cognition and peer resistance skills to drug use. Moreover, some students were curious to drug use.
(2) After intervention, the prevalence rate and the prevalence rate of curious to drug use were lower down. Students improved the cognition and ability to resistant drug use.
(3)A questionnaire was set up to evaluate the intervention of drug use in students. In a word, the items were reasonable and easy to be understood. The items were concordance to the theoretical frame of questionnaire, which proved the questionnaire had a good reliability and validity.
Innovative
(1)The study, which combines sociology, psychology, behavior medicine and education, is extremely innovative.
(2) Training to teachers is the principal part to implement the prevention model. Compositive prevention model aimed at the influences of first drug use to adolescents. And resistance drug model was established, as well as project and materials. (3)It is first time to establish the prevention model combines improving EQ, resisitance skills.
(1)了解武汉市部分高中、中专生非法药物尝试率,滥用倾向及认知;
(2)建立高中、中专生非法药物滥用的评价量表,确定量表各条目、领域和量表评分方法;
(3)基于CMER干预模式,对高中、中专生进行非法药物滥用的预防干预,利用评价量表与问卷,评价干预效果。
二、研究对象与方法
(1)研究对象
本研究是以学校为单位的类试验研究。根据自愿参加的原则,在武汉市选取两所高中(普通高中和重点高中各一所)、一所职业高中和一所中专学校,各学校一、二年级的1122名学生作为研究对象。
(2)调查方式和内容
采用自填式问卷。调查内容包括:非法药物滥用情况、态度、倾向,动机、抵御技能以及对六种非法药物的(海洛因、可卡因、摇头丸、冰毒、K粉、大麻)认知等。构建非法药物滥用倾向及相关因素的结构方程模型。
(3)非法药物滥用认知、动机、情商、抵御技能评价量表(CMERQ)的编制与评估
参考国内外相关干预材料及本课题组以往的研究积累,查阅文献,在认知(Cognition)-动机(Motivation)-情商(Emotion intelligence)-抵御技能(Resistance skills)(CMER)理论框架指导下,联合心理、健康教育、行为医学等方面的专家对非法药物滥用测量所涉及的内容进行讨论,形成基本条目之后,采用专题组讨论、专家评议等方式形成量表初稿。最后,对量表进行信度和效度的评价。
(4)非法药物滥用的预防干预
在参与调查的学校中选取一、二年级部分班级,以班为单位,分为试验组和对照组。试验组学生接受CMER干预模式,对照组学生不接受任何干预。干预时间为6个课时,内容为:毒品对身体、心理、社会、家庭的危害,对认知功能的损害,识别毒品及不法分子的诱惑方式,抵御毒品的技能等,由经过专门培训的教师向学生授课,授课方式包括讲解、讨论、角色扮演等。
(5)CMER干预模式的短期效果评价
干预前进行基线水平调查。干预后,采用相同问卷进行二次调查。调查前对学生讲解问卷填写的方式和注意事项。
三、结果
(1)高中、中专生非法药物滥用特征
被调查的学生中非法药物滥用率为3.65%(41/1122)。男生滥用率(5.23%)高于女生(2.50%)(P<0.05)。六种非法药物滥用率依次为:海洛因(0.27%)、可卡因(0.89%)、摇头丸(3.12%)、冰毒(1.25%)、K粉(2.05%)、大麻(0.27%)。男女生滥用冰毒、摇头丸和K粉的比率均较高,且男生高于女生(P<0.05)。四类学校的非法药物滥用率差异有统计学意义(P<0.05),中专学校最高,其次为职业高中。六种非法药物在各年龄组的滥用比率差别均无统计学意义(P>0.05)。有21名(1.87%)学生使用过一种以上的毒品。各学校间的非法药物滥用倾向差异有统计学意义(P<0.05),男生高于女生(P<0.05),但各年龄组间差异无统计学意义(P>0.05)。分别有11.19%、7.07%、4.30%、6.09%的学生不能正确识别可卡因、摇头丸、冰毒、K粉是毒品。14.92%的男生和8.31%的女生对毒品好奇,差别有显著统计学意义(P<0.001)。重点高中、普通高中、职业高中与中专学校的学生对毒品的好奇率分别为13.59%、10.38%、18.52%、7.98%,差别有显著统计学意义(P<0.001)。从非法药物滥用倾向及其相关因素的结构方程模型可以看出,非法药物滥用倾向受到应对技能和抵御技能的影响,技能越强,非法药物滥用倾向的可能性越小;同时,抵御技能也受到应对技能的影响。
(2)CMER量表的信度与效度
CMER量表含非法药物滥用的认知、抵御技能、情商三个分量表,内部一致性信度分别为0.853、0.455、0.880;量表各条目的重测信度在0.244-0.702之间。非法药物滥用认知分量表各条目的Kappa值在0.168-0.525之间;抵御技能分量表各条目的Kappa值在0.369-0.566之间。压力应对情绪调节分量表组内相关系数(ICC)在0.473-0.714之间。采用因子分析法,识别出特征根≥1的潜在公因子,三个分量表分别提取10、1、2个因子,其累积贡献率分别为53.44%、46.47%、46.69%。
(3)CMER短期干预效果
干预前药物滥用比率是3.65%(41/1122),干预后药物滥用率降低为2.82%(29/1029),但未见统计学差异(P>0.05)干预后,试验组在非法药物滥用认知的多数条目上得分均高于对照组(P<0.05)。干预后,试验组在非法药物滥用动机上部分条目的得分明显高于对照组及自身干预前得分(P<0.05)。干预后,试验组的好奇率(6.16%)明显降低,不仅低于对照组(8.80%)的好奇率,而且比其自身干预前好奇率(13.81%)显著降低(P<0.01)。干预后,在“娱乐场所”和“生日聚会”的假定场景中,试验组学生较对照组学生更少地表现出非法药物滥用倾向(P<0.05)。干预后,试验组学生选择“直接简单的拒绝”、“拒绝尝试并解释原因”、“拒绝尝试并建议其他活动”和“转移话题”的比例明显增大,尤其是“直接简单的拒绝”和“拒绝尝试并解释原因”两项,试验组学生选择的比率(53.42%、49.09%)高于对照组学生(45.69%、40.61%),差别具有统计学意义(P<0.05)。试验组干预后压力应对和情绪调节均分均高于对照组(P<0.05),且压力应对的均分较自身干预前也有所增高(P<0.05)。
四、结论
1.高中、中专生中有非法药物滥用情况及滥用倾向。部分学生对非法药物抱有好奇心理、对毒品危害的认知有缺陷,尤其在职业高中和中专学校的学生为甚。此外,高中、中专生尚缺乏一定的抵御技能和心理调试技能来避免非法药物滥用的发生。
2、CMER干预模式可以提高高中、中专生毒品相关的知识水平,降低毒品好奇率,建立反毒品动机,掌握有效的毒品抵御技能。3、本研究建立的CMER量表,总体来说各个模块的条目设置合理、内容清晰易懂,各关键量表的条目与量表整体保持了较高的一致性,显示该问卷具有较好的可靠性和有效性,可作为非法非法药物滥用相关信息的评价工具。
本项目的特色与创新之处。
(1)多学科交叉,将预防医学与社会、心理、行为、教育等多学科有机结合;
(2)培训教师作为实施干预方案的主体,多方参与,针对与中学生初次非法药物滥用有关因素进行综合预防,建立全方位、立体式的抵御毒品模式和与之配套的方案和资料集;
(3)将控制毒品的教育与青少年提高EQ、心理素质、抵御毒品行为技能教育相结合,类似毒品一级预防综合干预模式的研究到目前为止国内外尚未见报道。
Objective
(1) To understand the epidemiological characteristics of illegal drug use among students from senior high schools and technical secondary school in Wuhan
(2)To develop an evaluating scale for illegal drug use for students and confirm the item, field, grade of questionnaire.
(3) To evaluate the intervention effects of CMER on drug use, tendency of drug use, attitude, and so on, by questionnaire.
Methods
(1)Participates
The study is a quasi-experiment study. A total of 1122 students voluntarily participated in this study at baseline, rolled in the senior high schools and technical secondary school middle school.
(2)Measure
Self-reported drug use behavior was assessed along with attitudinal, the tendency of drug use, motivation,resistance skills and cognitive to six type of illegal drug (heroin, cocaine, MDMA, Methamphetamine, Ketamine, and marijuana), as well as establishing the structure equation model of tendency of drug use and it’s influencing factors.
(3)Composing the questionnaire about cognition, motivation, emotion intelligence and resistance skills to illegal drug use.
Following foreign intervention materials and ours studies, we developed the item pool of questionnaire under theory framework of CMER, with the guiding of psychologist, experts of health education and behavioral medicine. Then, the first draft was set up after special topic discussion and appraisal of experts. At last, we evaluated the reliability and validity of the questionnaire.
(4)Evaluation to the immediate impact of CMER intervention.
In the experiment group, students received the CMER program for 6 class periods. The curriculum was designed to address the major cognitive, attitudinal, motivation and peer resistance skills as the keys to prevent illicit drug use, such as general drug information, the negative impact of drug use on the body and mind, peer resistance skills. The contents were taught using integrative techniques, such as explaining, discussion, role-playing.
(5)The evaluation of immediate impact of CMER
Students were administered the pretest assessment, a posttest assessment after the intervention, Students from both groups were asked to complete a self-administered questionnaire. Questionnaires were administered during a roughly 15- minute period by a team of two to three trained collectors.
Results
(1) Epidemiological characteristics of illegal drug use among students The prevalence rate of drug use among students is 3.65%. The rate of drug use in boy (5.23%) was higher than that of girls (2.50%). The prevalent rate of heroin, cocaine, MDMA, Methamphetamine, Ketamine, and marijuana were 0.27%, 0.89%, 3.12%, 1.25%, 2.05%, and 0.27% respectively. The rates of MDMA, Methamphetamine, Ketamine use in boys were higher than these of girls (P<0.05). There were significant difference in different school (P<0.05) and the rate of drug use in technical secondary school was the highest. There were no significant difference in different age (P>0.05). There were 1.87% students using more than one drug. Boys were more likely to have tendency to drug use than girls (P<0.05). There were no significant difference of tendency to drug use in different age (P>0.05). There were respectively 11.19%、7.07%、4.30%、6.09% students who know no about cocaine, MDMA, Methamphetamine, Ketamine. 14.92% boys and 8.31% girls were curious to drug use (P<0.001). There were 13.59% students from key high school, 10.38%students from general high school, 18.52%students from occupation education school, and 7.98%students from secondary vocational education school who were curious to drug use (P<0.001). The tendency of drug use was affected by coping skills and peer resistance skills directly. The more students had grasped ability, the lower probability to drug use. Meanwhile, peer resistance skills were affected by coping skills.
(2) The reliability and validity of questionnaire
The questionnaire was included cognitive demain, resistance ability demain and stress and coping skills/emotion adjusting demain. Cronbach’s Alphas were respectively 0.853, 0.455, 0.880 for three domains. The Spearman correlation coefficients between test-retest were from 0.244 to 0.702 for item-to-item scores. The Kappa indexes were from 0.168 to 0.525 for cognitive demain. The Kappa indexes were from 0.369 to 0.566 for resistance ability demain. Intra-class correlation coefficients were from 0.473 to 0.714 for stress and coping skills/emotion adjusting demain. Respectively ten, one, two principle components were developed by factor analysis, with explanations of 53.44%, 46.47%, and 46.69% cumulative.
(3)Evaluation to the immediate impact of CMER intervention.
After intervention, the prevalence rate of drug use reduced from 3.65% to 2.82%, but there was no significant difference (P>0.05). The intervention group intervened by CMER program had significant effects on each variable at the posttest. The scores of some items on knowledge at posttest were significantly higher in the intervention group than those in the control group (P<0.01), as was the score of some items about motivation (P<0.05). The prevalence rate of curious to drug use in experiment group (6.16%) was lower than that of control group (8.80%), as well as experiment group of pretest (13.81%). The intervention group showed lower level of tendency of drug use in hypothetical situation of“club”and“birthday party”than the control group did (P<0.05).Furthermore, the results reported the peer resistance skills of the intervention group was significantly higher than those of the control group, for example, simple direct refusal, reason, suggestions for alternative activities accompanying a refusal. The mean scores on coping style and emotion adjustment at posttest were significantly higher in the intervention group than those in the control group (P<0.05).
Conclusion
(1)Drug use was becoming a serious question to students, especially to students from technical secondary school and occupation education school. In contrast, students have relatively lower cognition and peer resistance skills to drug use. Moreover, some students were curious to drug use.
(2) After intervention, the prevalence rate and the prevalence rate of curious to drug use were lower down. Students improved the cognition and ability to resistant drug use.
(3)A questionnaire was set up to evaluate the intervention of drug use in students. In a word, the items were reasonable and easy to be understood. The items were concordance to the theoretical frame of questionnaire, which proved the questionnaire had a good reliability and validity.
Innovative
(1)The study, which combines sociology, psychology, behavior medicine and education, is extremely innovative.
(2) Training to teachers is the principal part to implement the prevention model. Compositive prevention model aimed at the influences of first drug use to adolescents. And resistance drug model was established, as well as project and materials. (3)It is first time to establish the prevention model combines improving EQ, resisitance skills.
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