郑州市校外青少年生存质量分析及艾滋病预防干预效果评价
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摘要
艾滋病的全球流行对人类的健康造成了巨大的威胁,其疫情在我国仍处于上升趋势,且正由高危人群向一般人群扩散,青少年是艾滋病感染的脆弱人群,也是我国艾滋病防控的重点人群。我国1/3以上的人口是儿童和青少年,他们是国家、民族的未来,面对艾滋病,他们也是最缺乏自我保护能力的弱势群体,尤其是边远农村地区的青少年处在当地经济不够发达、文化水平低、信息较闭塞的境地,更缺乏预防艾滋病的知识。因此,应特别注重在青少年中,开展普及艾滋病知识的工作。联合国儿童基金会的资料显示,全球范围内,新发生的HIV感染者50%年龄在24岁以下,我国的艾滋病感染者也以青壮年为主体。校外青少年作为青少年人群中特定的一部分,较早地离开学校走上社会,在性生理发育提前与心理成熟滞后的同时,又身处性观念与生活方式改变、色情和毒品等诱惑增加的社会环境中。
然而纵观国内涉及青少年预防艾滋病的研究,多关注在校学生。对于校外青少年,由于其流动性、复杂性和难组织性,仅有极少数研究专门针对校外青少年。该研究的目的在于了解郑州市校外青少年的生存质量,提高郑州市校外青少年艾滋病相关知识知晓水平;扩大艾滋病宣传教育的覆盖面;提高他们性生活时安全套的应用率,形成正确的求医行为,从而降低其感染或传播艾滋病的风险;探索适合校外青少年艾滋病干预模式的运行机制,为该人群艾滋病预防提供理论依据和新思路。
方法
现场调查和干预方法:采用整群抽样的方法,于2008年3月～4月期间,在郑州市中原区美容美发厅、夜总会/卡拉OK厅/歌舞厅、酒吧/茶吧、网吧/电子游戏厅、饭店、超市、副食店和食品加工厂等行业做临时工的人共996为目标人群,对其进行艾滋病知识调查、生存质量测量,然后在该人群中进行艾滋病知识健康教育、发放艾滋病宣传材料和提供咨询服务等综合干预活动,综合干预活动结束后对该部分人群再次进行艾滋病知识、态度和行为调查。最后根据事先设定的纳入标准,从中选择372例校外青少年的调查问卷,作为该研究的数据库。
统计分析方法:采用SPSS16.0进行统计分析。采用Cronbach's Alpha评价诺丁汉健康量表的信度,利用因子分析方法评价诺丁汉健康量表的效度,采用两个或多个独立样本的秩和检验比较不同特征人群生存质量得分。采用配对四格表资料的χ~2检验比较干预前后艾滋病知识的知晓率的变化是否有统计学意义;描述艾滋病知识宣传教育前后目标人群对待艾滋病的态度转变情况以及干预前后对安全套的功能和知识掌握情况并进行统计推断。检验水准α取0.05。
结果
1.目标人群的人口学特征
共调查996人,回收有效问卷372份,其中男性148人,女性224人,年龄最小的15.2岁,最大的23.9岁,平均19.8岁。文化程度构成上,以中学为主,占90.6%;69.9%的校外青少年月收入在200-1000元之间;28.8%的校外青少年有吸烟史;23.1%的校外青少年有饮酒史。
2.校外青少年生存质量分析
2.1诺丁汉量表的信度和效度分析
①信度分析
NHP量表的折半信度系数r=0.73,说明该量表的折半信度良好;整个量表的Cronbach's Alpha=0.775,表明条目间内在的一致性较好;
②效度分析
集合效度和区分效度的试验中,睡眠、社交隔离和情感反应的集合效度试验成功率均较高,分别为80.0%、60.0%和66.7%,且各维度的区分效度成功率均为100%,表明就整个量表来说,具有较好的内容效度;
③量表的可接受性
量表大部分的条目能被回答者正确理解,由调查员询问完成1份问卷平均需要10min。各条目的回答率在95%以上,有较强的实用性和可接受性。
2.2生存质量及影响因素
①情感反应(ER)维度得分的中位数为7.22,躯体活动、精力水平、疼痛、睡眠以及社交隔离5个维度得分的中位数均为0分。
②饮酒人群比不饮酒人群在睡眠维度的得分高,Z=-2.131,P＜0.01;文化程度水平低的人群比文化程度高的人群在疼痛维度得分高,χ~2=8.229,P＜0.01;每周工作时间相对较长的人群比工作时间短的人群在睡眠维度的得分高,χ~2=8.972,P＜0.01。
3.预防艾滋病活动效果评价
3.1干预前后校外青少年艾滋病知晓率
艾滋病知识宣传教育活动实施前,校外青少年艾滋病知识知晓率为39.2%;经过健康教育后,艾滋病知晓率提高到98.9%,差异有统计学意义,χ~2=222.00,P＜0.05。
3.2校外青少年对艾滋病感染者/患者的态度
干预前后,调查对象对待艾滋病病人的态度有一定程度的转变,干预后调查对象对艾滋病人的歧视程度有所降低;如果调查对象怀疑自己患了艾滋病,他们更愿意选择积极的治疗,保持良好的生活态度。
①干预前,有57.3%的调查对象“艾滋病患者应该公开他们的身份”,干预后,有61.8%的调查对象意识到“艾滋病患者应该公开他们的身份”;
②干预前,有18.0%的调查对象选择“会断绝与患艾滋病的朋友来往”,而干预后,此比例降低到8.3%;
③干预前,有41.9%的外来表示“可以接受与艾滋病患者共餐”,干预后此比例提高至83.1%。
3.3校外青少年安全套使用情况和对安全套功能掌握情况
①干预前,有85.5%的研究对象知道安全套有避孕功能,有73.4%的研究对象知道安全套能预防性传播疾病;干预后,知晓率分别提高到97.6%和96.5%,差异有统计学意义,统计量(χ~2)分别为35.12、77.74,P＜0.05;干预前,调查对象知道使用安全套前应查看保质期、排出套中气泡、分辨正反面和不重复使用的认识率分别为61.2%,47.4%,73.3%和95.7%,而干预后,相应的率分别为98.3%,96.6%,93.1%和91.4%。
②有141人(37.9%)承认有过性生活,其中116人使用过安全套,安全套的使用率为82.3%,最近一次性生活安全套使用率为32.3%;健康教育后,有77.4%的人愿意每次性生活都使用安全套。
结论
1.郑州市校外青少年的生存质量表现为较好的状态。
2.郑州市校外青少年艾滋病知识知晓率干预后得以明显提高。
3.通过宣传安全套的功能及使用方法,校外青少年性生活时安全套的使用意向率明显提高,对安全套功能和使用方法的正确认识也明显提高。
4.探讨出了适合郑州市校外青少年的艾滋病干预模式,即:以当地疾病预防控制中心为依托,适当地运用经济杠杆原理,施行综合干预。
AIDS has caused huge threat to humanity's health. Its epidemic situation was still in the trend of escalation in our country, and is speading from high-risk population to general polulation. The young people are the vulnerable people of AIDS infections, also the key crowds which should be prevented. In China, the proportion of young people was above 1/3. And most of them lived in remote rural areas, usually their educational level is low, so they did't know how to protect themselves from being infected by HIV. Therefore, we should pay more attention to the young people about AIDS knowledge of prevention. United Nations Children's Fund's data display, in the global scale, among the HIV infected person who happens newly, 50% of them were under 24 years old people. Out-of-school youth left school early. The growth of natural physiology was rapid than the growth of psychological, and at the same time, they lived in complex social environment with enticements, such as life style changing, pornography and drugs.
Taking a panoramic view of the researches about AIDS prevention in young people, most of them focus on students in school. The study about preventing AIDS among out-of-school youths was very limited, mainly because the out-of-school youths were difficult to being organized. So the activity and study of preventing AIDS among out-of-school youths was more essential. The purpose of this study is to learn the quality of life, improve the level of AIDS-related knowledge of out-of-school youths, so as to make them improve the rate of use condoms in their sex and form correct attitude to HIV/AIDS. At last, this study can prevent the spread of AIDS from the high-risk population to the general population, to provide a theoretical basis and new ideas of preventing AIDS.
Methods
During March to April in 2008, the random chulste sampling was carried out, 372 out-of-school youths were chosen. Multiple-interventions, including health education of AIDS, sending condoms and handbook of AIDS knowledge, face-to-face consulting services were carried out. Then awareness rate of AIDS knowledge, function and usage of condom were evaluated before and after Multiple- interventions. SPSS 16.0was used for statistical analysis, x~2 -test, factor analysis and spearman rank correlationanalysis were used in the statistical analysis. The significant level was 0.05.
Results
1. The general characteristics of out-of-school youths
372 participants were invited to this study. 148 of them were male, 224 of them werefemale. The minimum age was 15.2, the maximum age was 23.9, the average age was19.8. The educational level of out-of-school youths was lower. Middle school andbelow accounted for 90.6%. 69.9 % of them earned 200-1000 yuan per month. 28.8%
of out-of-school youths had the history of smoking. 23.1% of out-of-school youthshad the history of drinking.
2. Quality of life in out-of school youths
2.1 Reliability and validity analysis of Nottingham Health profile
(1) Reliability
Split-half reliability coefficient was 0.73, the scale had a good split-half reliability; Cronbach's Alpha of the profile was 0.775.
(2) Validity
In set validity and discriminate validity of the experiment, sleep, social isolation, and emotional response had higher success rates which were 80.0%, 60.0% and 66.7%, and the dimensions of the success of the discriminate validity was 100%, which indicated that the whole profile had good content validity.
(3) Reliability Most of the entries of profile can be properly understood by the investigators. It spent about 10 minutes to complet the whole questionnaire. The response rate of each items was more than 95%, which shows a stronger relevance and reliability.
2.2 Quality of life and influencing factors
(1) The median score of emotional reaction dimension is 7.22. The median scores in the other 5 dimentions, including physical abilities, energy level, pain, sleep and social isolation were all 0.
(2) The NHP score of the drinking people was significantly higher than those who didn't drink, Z=-2. 131, P<0. 01. The people with lower educational level gothigher score in pain dimention, x~2 =8.229, P<0.01. The people who worked for longer time every week got higher score in sleep dimention than the others, x~2 =8.972, P<0.01.
3. Evaluation of AIDS prevention effect
3.1 Knowledge of AIDS of out of school youths before and after intervention The awareness rate of knowledge was 39.2% before intervention and 98.9% afterintervention, the difference was significant, x~2 =222.0( P <0.01).
3.2 The attitude of out of school youths to AIDS
Before intervention, 55.0% participants thought the identity of AIDS patients should be opened; 18.0% showed they would refuse to keep contact with AIDS patients, 41.9% would eat with AIDS patients together; After intervention, 61.8% participants thought the identity of AIDS patients should be open, the rate of participants would refuse to keep contact with AIDS patients decreased to 8.3%, the rate of participants would eat with AIDS patients together increased to 83.1 %.
3.3 Condom use in sex contact
(1) The opinion about the function and usage of condom: Before intervention, 85.5% of the participants knew that condoms could prevent sexually transmitted diseases, while after intervention, this rate enhanced to 97.6%. And the rate of choosing "read time of validity of condom, discharge bubbles beside the condom, distinguish the face or inverse of condom, or don't use the same condom repeatedly" were 61.2%, 47.4%,73.3% and 95.7% individually, and after the intervention, the corresponding rateenhanced to 98.3%, 96.6%, 93.1% and 91.4%.
(2) 141 participants had premarital sex, the percentage of incidence of premarital sexwas 37.9%. After intervention, 77.4% of participants are willing to use condom eachsexual intercourse.
Conclusion
(1) The quality of life of out of school youths in zhengzhou shows well state.
(2) Knowledge of AIDS of out of school youths in zhengzhou has increased remarkably.
(3) The coverage of AIDS knowledge was expanded, 996 temporary workers in entertainment and service industries were benefited in the intervention.
(4) Through promotion of function of condoms and condom usage, the rate of condom using intention of out of school youths improved markedly.
(5) AIDS intervention models for out of school youths in zhengzhou have beexplored.
然而纵观国内涉及青少年预防艾滋病的研究,多关注在校学生。对于校外青少年,由于其流动性、复杂性和难组织性,仅有极少数研究专门针对校外青少年。该研究的目的在于了解郑州市校外青少年的生存质量,提高郑州市校外青少年艾滋病相关知识知晓水平;扩大艾滋病宣传教育的覆盖面;提高他们性生活时安全套的应用率,形成正确的求医行为,从而降低其感染或传播艾滋病的风险;探索适合校外青少年艾滋病干预模式的运行机制,为该人群艾滋病预防提供理论依据和新思路。
方法
现场调查和干预方法:采用整群抽样的方法,于2008年3月～4月期间,在郑州市中原区美容美发厅、夜总会/卡拉OK厅/歌舞厅、酒吧/茶吧、网吧/电子游戏厅、饭店、超市、副食店和食品加工厂等行业做临时工的人共996为目标人群,对其进行艾滋病知识调查、生存质量测量,然后在该人群中进行艾滋病知识健康教育、发放艾滋病宣传材料和提供咨询服务等综合干预活动,综合干预活动结束后对该部分人群再次进行艾滋病知识、态度和行为调查。最后根据事先设定的纳入标准,从中选择372例校外青少年的调查问卷,作为该研究的数据库。
统计分析方法:采用SPSS16.0进行统计分析。采用Cronbach's Alpha评价诺丁汉健康量表的信度,利用因子分析方法评价诺丁汉健康量表的效度,采用两个或多个独立样本的秩和检验比较不同特征人群生存质量得分。采用配对四格表资料的χ~2检验比较干预前后艾滋病知识的知晓率的变化是否有统计学意义;描述艾滋病知识宣传教育前后目标人群对待艾滋病的态度转变情况以及干预前后对安全套的功能和知识掌握情况并进行统计推断。检验水准α取0.05。
结果
1.目标人群的人口学特征
共调查996人,回收有效问卷372份,其中男性148人,女性224人,年龄最小的15.2岁,最大的23.9岁,平均19.8岁。文化程度构成上,以中学为主,占90.6%;69.9%的校外青少年月收入在200-1000元之间;28.8%的校外青少年有吸烟史;23.1%的校外青少年有饮酒史。
2.校外青少年生存质量分析
2.1诺丁汉量表的信度和效度分析
①信度分析
NHP量表的折半信度系数r=0.73,说明该量表的折半信度良好;整个量表的Cronbach's Alpha=0.775,表明条目间内在的一致性较好;
②效度分析
集合效度和区分效度的试验中,睡眠、社交隔离和情感反应的集合效度试验成功率均较高,分别为80.0%、60.0%和66.7%,且各维度的区分效度成功率均为100%,表明就整个量表来说,具有较好的内容效度;
③量表的可接受性
量表大部分的条目能被回答者正确理解,由调查员询问完成1份问卷平均需要10min。各条目的回答率在95%以上,有较强的实用性和可接受性。
2.2生存质量及影响因素
①情感反应(ER)维度得分的中位数为7.22,躯体活动、精力水平、疼痛、睡眠以及社交隔离5个维度得分的中位数均为0分。
②饮酒人群比不饮酒人群在睡眠维度的得分高,Z=-2.131,P＜0.01;文化程度水平低的人群比文化程度高的人群在疼痛维度得分高,χ~2=8.229,P＜0.01;每周工作时间相对较长的人群比工作时间短的人群在睡眠维度的得分高,χ~2=8.972,P＜0.01。
3.预防艾滋病活动效果评价
3.1干预前后校外青少年艾滋病知晓率
艾滋病知识宣传教育活动实施前,校外青少年艾滋病知识知晓率为39.2%;经过健康教育后,艾滋病知晓率提高到98.9%,差异有统计学意义,χ~2=222.00,P＜0.05。
3.2校外青少年对艾滋病感染者/患者的态度
干预前后,调查对象对待艾滋病病人的态度有一定程度的转变,干预后调查对象对艾滋病人的歧视程度有所降低;如果调查对象怀疑自己患了艾滋病,他们更愿意选择积极的治疗,保持良好的生活态度。
①干预前,有57.3%的调查对象“艾滋病患者应该公开他们的身份”,干预后,有61.8%的调查对象意识到“艾滋病患者应该公开他们的身份”;
②干预前,有18.0%的调查对象选择“会断绝与患艾滋病的朋友来往”,而干预后,此比例降低到8.3%;
③干预前,有41.9%的外来表示“可以接受与艾滋病患者共餐”,干预后此比例提高至83.1%。
3.3校外青少年安全套使用情况和对安全套功能掌握情况
①干预前,有85.5%的研究对象知道安全套有避孕功能,有73.4%的研究对象知道安全套能预防性传播疾病;干预后,知晓率分别提高到97.6%和96.5%,差异有统计学意义,统计量(χ~2)分别为35.12、77.74,P＜0.05;干预前,调查对象知道使用安全套前应查看保质期、排出套中气泡、分辨正反面和不重复使用的认识率分别为61.2%,47.4%,73.3%和95.7%,而干预后,相应的率分别为98.3%,96.6%,93.1%和91.4%。
②有141人(37.9%)承认有过性生活,其中116人使用过安全套,安全套的使用率为82.3%,最近一次性生活安全套使用率为32.3%;健康教育后,有77.4%的人愿意每次性生活都使用安全套。
结论
1.郑州市校外青少年的生存质量表现为较好的状态。
2.郑州市校外青少年艾滋病知识知晓率干预后得以明显提高。
3.通过宣传安全套的功能及使用方法,校外青少年性生活时安全套的使用意向率明显提高,对安全套功能和使用方法的正确认识也明显提高。
4.探讨出了适合郑州市校外青少年的艾滋病干预模式,即:以当地疾病预防控制中心为依托,适当地运用经济杠杆原理,施行综合干预。
AIDS has caused huge threat to humanity's health. Its epidemic situation was still in the trend of escalation in our country, and is speading from high-risk population to general polulation. The young people are the vulnerable people of AIDS infections, also the key crowds which should be prevented. In China, the proportion of young people was above 1/3. And most of them lived in remote rural areas, usually their educational level is low, so they did't know how to protect themselves from being infected by HIV. Therefore, we should pay more attention to the young people about AIDS knowledge of prevention. United Nations Children's Fund's data display, in the global scale, among the HIV infected person who happens newly, 50% of them were under 24 years old people. Out-of-school youth left school early. The growth of natural physiology was rapid than the growth of psychological, and at the same time, they lived in complex social environment with enticements, such as life style changing, pornography and drugs.
Taking a panoramic view of the researches about AIDS prevention in young people, most of them focus on students in school. The study about preventing AIDS among out-of-school youths was very limited, mainly because the out-of-school youths were difficult to being organized. So the activity and study of preventing AIDS among out-of-school youths was more essential. The purpose of this study is to learn the quality of life, improve the level of AIDS-related knowledge of out-of-school youths, so as to make them improve the rate of use condoms in their sex and form correct attitude to HIV/AIDS. At last, this study can prevent the spread of AIDS from the high-risk population to the general population, to provide a theoretical basis and new ideas of preventing AIDS.
Methods
During March to April in 2008, the random chulste sampling was carried out, 372 out-of-school youths were chosen. Multiple-interventions, including health education of AIDS, sending condoms and handbook of AIDS knowledge, face-to-face consulting services were carried out. Then awareness rate of AIDS knowledge, function and usage of condom were evaluated before and after Multiple- interventions. SPSS 16.0was used for statistical analysis, x~2 -test, factor analysis and spearman rank correlationanalysis were used in the statistical analysis. The significant level was 0.05.
Results
1. The general characteristics of out-of-school youths
372 participants were invited to this study. 148 of them were male, 224 of them werefemale. The minimum age was 15.2, the maximum age was 23.9, the average age was19.8. The educational level of out-of-school youths was lower. Middle school andbelow accounted for 90.6%. 69.9 % of them earned 200-1000 yuan per month. 28.8%
of out-of-school youths had the history of smoking. 23.1% of out-of-school youthshad the history of drinking.
2. Quality of life in out-of school youths
2.1 Reliability and validity analysis of Nottingham Health profile
(1) Reliability
Split-half reliability coefficient was 0.73, the scale had a good split-half reliability; Cronbach's Alpha of the profile was 0.775.
(2) Validity
In set validity and discriminate validity of the experiment, sleep, social isolation, and emotional response had higher success rates which were 80.0%, 60.0% and 66.7%, and the dimensions of the success of the discriminate validity was 100%, which indicated that the whole profile had good content validity.
(3) Reliability Most of the entries of profile can be properly understood by the investigators. It spent about 10 minutes to complet the whole questionnaire. The response rate of each items was more than 95%, which shows a stronger relevance and reliability.
2.2 Quality of life and influencing factors
(1) The median score of emotional reaction dimension is 7.22. The median scores in the other 5 dimentions, including physical abilities, energy level, pain, sleep and social isolation were all 0.
(2) The NHP score of the drinking people was significantly higher than those who didn't drink, Z=-2. 131, P<0. 01. The people with lower educational level gothigher score in pain dimention, x~2 =8.229, P<0.01. The people who worked for longer time every week got higher score in sleep dimention than the others, x~2 =8.972, P<0.01.
3. Evaluation of AIDS prevention effect
3.1 Knowledge of AIDS of out of school youths before and after intervention The awareness rate of knowledge was 39.2% before intervention and 98.9% afterintervention, the difference was significant, x~2 =222.0( P <0.01).
3.2 The attitude of out of school youths to AIDS
Before intervention, 55.0% participants thought the identity of AIDS patients should be opened; 18.0% showed they would refuse to keep contact with AIDS patients, 41.9% would eat with AIDS patients together; After intervention, 61.8% participants thought the identity of AIDS patients should be open, the rate of participants would refuse to keep contact with AIDS patients decreased to 8.3%, the rate of participants would eat with AIDS patients together increased to 83.1 %.
3.3 Condom use in sex contact
(1) The opinion about the function and usage of condom: Before intervention, 85.5% of the participants knew that condoms could prevent sexually transmitted diseases, while after intervention, this rate enhanced to 97.6%. And the rate of choosing "read time of validity of condom, discharge bubbles beside the condom, distinguish the face or inverse of condom, or don't use the same condom repeatedly" were 61.2%, 47.4%,73.3% and 95.7% individually, and after the intervention, the corresponding rateenhanced to 98.3%, 96.6%, 93.1% and 91.4%.
(2) 141 participants had premarital sex, the percentage of incidence of premarital sexwas 37.9%. After intervention, 77.4% of participants are willing to use condom eachsexual intercourse.
Conclusion
(1) The quality of life of out of school youths in zhengzhou shows well state.
(2) Knowledge of AIDS of out of school youths in zhengzhou has increased remarkably.
(3) The coverage of AIDS knowledge was expanded, 996 temporary workers in entertainment and service industries were benefited in the intervention.
(4) Through promotion of function of condoms and condom usage, the rate of condom using intention of out of school youths improved markedly.
(5) AIDS intervention models for out of school youths in zhengzhou have beexplored.
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