摘要
一、研究目的
本研究针对武汉市青少年药物行为及其影响因素进行研究,以期达到以下目的:①描述武汉市青少年药物滥用流行特征;②系统分析影响青少年药物滥用的危险因素;③建立青少年药物滥用的结构方程模型;④建立以学校为基础的青少年药物滥用干预模式;⑤制订干预的教材和干预方案;⑥对初一学生实施干预并对干预效果进行评估。为开展以学校为基础的青少年药物滥用预防提供指导。
二、研究方法
1.青少年药物滥用流行特征及其影响因素模型
本研究采取分层随机整群抽样的原则进行抽样,共有来自武汉市15所初中、高中、职业高中和1所市立大学的3018名学生参加了问卷调查(其中男生占46.9%),调查是无记名和自愿的。调查内容包括研究对象的基本情况、对海洛因/可卡因/大麻/冰毒/摇头丸/K粉的滥用情况及相关因素。采取频数、均数、标准差、统计图表等进行描述性分析,采用卡方检验及Fisher精确概率法比较性别、年级、学校之间的差异,采取协方差分析对性别进行调整,采用相关分析计算Cronbachα系数,采用探索性因子分析了解各变量之间的关系,采用确证性因子分析构建测量模型,采用结构方法模型进行评价、修正以确定最佳模型。采用EPIDATA3.0对所有数据进行双次录入,以减少录入错误,采用SPSS10.0和SAS9.0对数据进行统计分析。
2.青少年药物滥用干预模式及效果评估
在武汉市四个城区选择中等水平的初中各一所,共有593名初一的学生参与了本项目。按“以学校为基础的青少年药物滥用一级干预模式”对所有初一学生实施干预。干预教材共有七课,由研究人员对学生采用多媒体教学,每个班单独授课,每次40分钟,共7次。所有的课程在2006年11～12月份完成。干预结束3个月后对学生进行评估调查,比较干预前后药物滥用倾向、拒绝效能、对毒品的好奇率等指标的变化,并采取配对Logistic回归分析模型的广义计算法分析影响干预效果的有关因素。
三、研究结果
1.青少年药物滥用性别、年龄和学校分布特征
武汉市青少年六种毒品的总滥用率为3.58%,男女生分别为5.37%和2.00%,初中、高中、职业高中和大学分别为2.27%, 3.07%, 8.28%和3.25%。在中学阶段,药物滥用率随年级升高而上升,分别为初一1.6%,初二2.98%,高一3.12%,高二5.87%,大学略高于高一年级水平,为3.25%。
在所有108名毒品尝试者中,有66人报告曾尝试过2种或2种以上的毒品,占61.1%,其中男生49人,女生17人。
2.青少年对每一种毒品的滥用情况
青少年对摇头丸、海洛因、冰毒、K粉、可卡因和大麻的滥用率分别为2.82%, 1.23%, 1.36%, 2.42%, 1.62%和1.42%,其中男生对这六种毒品的滥用率分别为4.17%, 2.12%, 2.40%, 3.68%, 2.83%和2.48%,女生分别为1.63%, 0.44%, 1.31%, 0.56%和0.50%。在中学阶段,随着年级的升高,摇头丸和K粉呈上升趋势,特别是男生。大学则与初二水平相接近。高中、职业高中和大学生滥用最多的毒品为摇头丸和K粉,高中摇头丸和K粉的滥用率分别为2.59%和2.26%,职业高中分别为6.49%和5.15%,大学分别为2.53%和2.53%,而他们对其他毒品的滥用率在1%～2%之间。
3.青少年药物滥用倾向情况
在3018名青少年中,10.7%的学生有药物滥用倾向,男女分别为13.58%和8.19%,初中、高中、职业高中和大学分别为8.1%, 6.9%, 23.5%,和17.3%。初一、初二、高一、高二、职高高一、职高高二分别为:5.2%, 11.3%, 6.2%, 7.5%, 19.1%, 29.5%,可以看出:职业高中最高,从初一到初二有一个明显的上升趋势,初二是初一的2倍。
学生对每一种毒品的滥用倾向不同,他们对摇头丸和K粉的滥用倾向较高,分别为9.3%和7.9%,对海洛因、冰毒、可卡因和大麻的滥用倾向则较低,分别为5.4%, 5.4%, 6.2%和5.6%。六种毒品均表现出随年龄升高而上升的趋势,其中摇头丸和K粉的下降趋势不明显,其他毒品在15～16岁之间有短暂的下降然后呈缓慢上升的趋势,19岁以后上升速度加快。
4.与青少年药物滥用相关的其他特征
在对毒品的认知上,不认识常见毒品的学生所占的比例分别为:摇头丸(6.6%),海洛因(2.3%),冰毒(4.4%),K粉(14.4%),可卡因(12.1%)和大麻(5.7%);认为它们不具有成瘾性的比例分别为:摇头丸(17.7%),海洛因(2.7%),冰毒(5.8%),K粉(13.2%),可卡因(8.2%),大麻(4.9%);认为摇头丸、海洛因、冰毒、K粉、可卡因和大麻试一、二次没关系的发生率分别为25.4%,3.4%,4.0%,15.1%,6.5%,5.5%;认为摇头丸、海洛因、冰毒、K粉、可卡因和大麻戒除容易的发生率分别为13.1%, 4.8%, 5.8%, 9.4%, 6.9%和6.4%。
15.8%学生对毒品好奇;14%～18%的学生对毒品表现出不憎恨/厌恶/恐惧; 42.3%的学生认为毒品很容易获得;5.2%的学生报告在过去一年内有人向他们提供过毒品;24.0%的学生认为自己的同学使用过毒品;这五个率均表现出男生高于女生,职业高中高于其他类型的学校,尤其是对摇头丸、K粉,从初一到初二滥用率迅速上升。82.8%的学生在好朋友请自己尝试毒品时会坚决拒绝,其中职业高中学生最低,尤其是针对摇头丸和粉。
5.青少年药物滥用的影响因素模型
采用结构方程模型对数据进行拟和,各项参数均显示出较好的拟和效果。模型结果显示:可觉察的社会规范、对吸毒后果的正评价和负评价、毒品提供、药物滥用倾向直接影响青少年药物滥用行为。拒绝效能和毒品获得的感知对药物滥用行为没有直接的作用,拒绝效能是通过药物滥用倾向的中介作用来影响药物滥用行为。社会规范、对吸毒后果的正评价/负评价除直接作用外,还可以通过药物滥用倾向的中介作用影响药物滥用行为。另外,对吸毒后果的正评价对社会规范具有直接的影响作用。
6.青少年药物滥用干预策略及干预效果评估
在对青少年药物滥用的有关特征进行分析基础上,借助有关心理行为理论,设计了认知(Cognition)-动机(Motivation)-情商(Emotion intelligence)-抵御技能(Resistance skill)(CMER)模式,制订了本研究的干预教材(共7学时),通过提高学生对毒品的认知,提高行为技能,减少药物滥用动机,增强其抵御效能,最终达到降低药物滥用倾向,预防和降低药物滥用行为的发生。通过干预前后的比较,结果显示:干预3个月后,青少年药物滥用倾向较干预前下降了17.5%,其中对海洛因/可卡因/大麻的滥用倾向下降19.2%,冰毒下降9.5%,但对摇头丸、K粉的干预效果不太明显,其滥用倾向分别上升了9.5%和11.8%。学生对六种毒品的好奇率均显著下降,下降幅度从35.7%(摇头丸)到70.9%(大麻)。他们对朋友提供毒品的拒绝率有所上升(+3.5%),这种上升主要表现在对海洛因/可卡因/大麻的拒绝上,但他们对摇头丸、K粉和冰毒的拒绝率则略有下降。除“几乎任何人特别烦恼和不快时他们会吸毒”、“对大多数吸毒者来说,医生是最重要的毒品来源”和“药物成瘾与意志力不强有关”三个条目外,在其他知识的认知上均优于干预前。青少年干预后对毒品可及性的认知以及对周围成人吸毒人数的估计略优于干预前,但对可觉察的父母对待自己吸毒态度、可觉察的小伙伴对待自己吸毒态度以及对周围小伙伴吸毒人数的估计这三个方面无明显的干预效果。其药物滥用动机显著地低于干预前(P<0.05),而其自信心则较干预前有显著的提高(P<0.05)。
四、结论
毒品,特别是新型毒品对青少年的威胁日趋严重,而他们对毒品(特别是新型毒品)的认知能力、拒绝效能等均处于较低水平,许多青少年对待毒品采取的是好奇、接纳的态度,使得他们对毒品缺乏应有的免疫力。建立在16所学校数据基础上的药物滥用影响因素模式能较好地为心理行为理论所解释;在该模式的指导下,借助于行为改变相关理论,建立起来的以学校为基础的CMER干预模式能有效地降低药物滥用倾向,提高拒绝效能,减少学生对毒品的好奇,对青少年药物滥用具有较好的早期预防效果,同时该预防干预模式能有效地提高青少年对毒品的认知,纠正青少年对待药物滥用的态度,降低其吸毒动机。提示以提高认知、降低动机、技能情感教育相结合而建立的以学校为基础的CMER干预模式、干预方案能有效地预防青少年药物滥用,并具有重要的推广价值。
五、创新之处
1.首次利用相关心理行为理论,采用结构方程模型对青少年药物滥用行为的影响因素进行分析,建立了针对中国青少年的药物滥用影响因素模型;
2.首次建立了以学校为基础的CMER毒品预防干预模式,并且取得了较好的短期预防干预效果;
3.编制了以心理行为理论为基础、以学生不尝试毒品为目的的青少年药物滥用一级干预的教材,包括学生用书、教师用书、多媒体课件与影像资料。该套材料得到了老师和学生的认可和接受。
Objective
Basing on the data about illegal drug use behaviors and regarding risk facotors from the adolescents in Wuhan, China, the study aimed at:①to describe the epidemiological characteristics of illegal drug use among Wuhan adolescents,②to study systematically the risk factors of drug abuse,③to construct the structural equation model on adolescent drug abuse,④to estabolish school-based preventive intervention model on drug abuse,⑤to make the intervention materials and protocol,⑥to conduct intervention on 7th grade school students using our designed intervention program and evaluate effect of the program.The purpose is to supply guide on prevention of drug abuse among schools in the future.
Methods
1. Epidemiology of illegal drug use and its risk model among Wuhan dolescents.
With stratified randomly group sampling, 3018 students (46.9% boys) from fifteen middle schools, high schools, vocational high schools and one municipal-owned university in Wuhan completed paper-and-pencil questionnaires. The survey is anonymous and voluntary. The questionnaire covered demological characteristics, use of heroin, cocaine, marijuana, methamphetamine (ice), MDMA, ketamine, and risk factors regarding drug use. The frequency, means, standard deviant, figures and tables were used for description of drug use behaviors, the GLM was used for the adjustment of gender. Correlation analysis was use for the Cronbachαcoefficients. Explanatory Factor Analysis (EFA) was used for determine the dimensions of the seven constructs measuring drug abuse behaviors and its risk factors. Confirmatory Factor Analysis (CFA) was use to assess the adequacy of the proposed factor structure (measurement model) and the relationships among the latent and manifest variables, and to confirm the measurement model. Structural Equation Model (SEM) was used to compare and modify a proposed hypothetical model with a set of actual data. Data were manually entered into computer with 100% double-entry for quality control purpose with EPIDATA 3.0. All statistical analyses were conducted on personal computer using the software SAS9.0 and SPSS10.0.
2. Preventive intervention model on adolescent drug abuse behaviors and evaluation on intervention effects
The participants included 593 7th graders from 4 schools with median educational level, which locates four administral districts in urban area of Wuhan. The invention was conducted among these four schools with“Cognition-Motivation-Equotion intelligent, CMER”mocel. The intervention totally had seven sessions with 40-minute class time and the sessions were delivered class by class between November and December in 2006. Three months after intervention, the evaluation survey was conducted for comparison in some variables such as drug abuse behaviors, refusal efficacy, curiosity on drugs between pre-intervention and post-intervention. Generalized Estimation Equation (Gee model) was used for evaluating the factors influencing intervention effects.
Results
1. Adolescent illegal drug use by gender, age and school type.
The prevalence rate of drug use among Wuhan adolescents is 3.58%. The rate was 5.37% for boys and 2.00% for girls, and 2.27% for middle schools students, 3.07% for high school students, 8.28% for vocational school students, 3.25% for college students. In the secondary school stage, the prevalent rate increased by grades with the rate of 1.6%, 2.98%, 3.12%, 5.87% for 7th graders, 8th graders, 10th graders and 11th graders respectively. The use rate for college students was 3.25%, which was higher than that for 10th graders.
Among 108 drug users, 66 students (61.1%) reported ever to use two and over drugs with 49 boys and 17 girls.
2. Adolescent use of any drugs
The prevalent rates for MDMA, heroin, ice, ketamine, cocaine and marijuana were 2.82%, 1.23%, 1.36%, 2.42%, 1.62% and 1.42% respectively. And the use rates of these six illegal drugs were 4.17%, 2.12%, 2.40%, 3.68%, 2.83% and 2.48% for boys, 1.63%, 0.44%, 1.31%, 0.56% and 0.50% for girls respectively. During secondary middle stage, the rates of MDMA and ketamine risen with grade, especially for boys. And for the college students, the rate was close to that for 8th graders. MDMA and ketamine were two most common used drugs among high schools, vocational schools, and college students, with 2.59% and 2.26% for high school students, 6.49% and 5.15% for vocational school students, 2.53% and 2.53% for college students. The rate for other four drugs ranged from 1%~2%.
3. Suceptible to drugs Among 3018 students, 10.7% was susceptible to drugs with 13.6% for boys and 8.2%
for girls. Susceptible rates were 8.1%, 6.9%, 23.5% and 17.3% for middle schools, high schools, vocational schools and college school students respectively, and 5.2%, 11.3%, 6.2%, 7.5%, 19.1%, 29.5% for 7th graders, 8th graders, 10th graders, 11th gaders and college students respectively. It shows that the rate of vocational school students ranked the first, and the rate for 8th graders increased two times as the same as that for 7th graders.
The susceptibility to different drugs is different. The susceptible rate was higher to MDMA (9.3%) and ketamine (7.9%) than to heroin (5.4%), ice (5.4%), cocaine (6.2%), marijuana (5.6%). The rates for six drugs increased with ages firstly and then had a short drop between 15 and 16 years, after 19 years, it began increasing again. But for the MDMA and ketamine, there were not obvious drop.
4. Other characteristics regarding drug use
Regarding the recognition of illegal drugs, the students who did not know MDMA, heroin, ice, ketamine, cocaine and marijuana covered 6.6%, 2.3%, 4.4%, 14.4%, 12.1%, 5.7% respectively. The rates who did not know the addiction of MDMA, heroin, ice, ketamine, cocaine and marijuana were 17.7%, 2.7%, 5.8%, 13.2%, 8.2%, 4.9% respectively. The rates who thought no matter to trial once or twice of MDMA, heroin, ice, ketamine, cocaine and marijuana were 25.4%,3.4%,4.0%,15.1%,6.5%,5.5% respectively. The rates who though it easy to quit from MDMA, heroin, ice, ketamine, cocaine and marijuana use were 13.1%, 4.8%, 5.8%, 9.4%, 6.9% and 6.4% respectively.
15.8% students was curious of illegal drugs, 14%~18% was not hate, digust of or fear about these drugs, 42.3% students thought it was easy to get the drugs, 5.2% reported that someone ever supplied them drugs in the past year, 24.0% thought their classmates ever used drugs. All of these five rates were higher for boys than for girls, for vocational school students than for other tyes of schools. Especially for MDMA and ketamine, it increased quickly from 7th graders to 8th graders. 82.8 percent showed that they would definitely refuse when their good friends asked them to trial the drugs. But the refusal rate was the lowest among vocational schools, especially to the MDMA and ketamine.
5. The risk factor model regarding adolescent drug use
The SEM was used to test the proposed model and got the good fit index. In the SEM model, perceived social norm, positive/negavitve assessment on consequence of drug use, supplied drugs by others, and susceptibility to drugs can predict adolescent drug use behaviors directly or mediated by susceptibility. And the refusal efficacy predicted the drug use behaviors mediated by susceptibility to drug. In addition, positive assessment on consequence of drug use can directly predict perceived social norm.
6. Intervention stragety on adolescent drug use and evaluation of intervention effect.
Basing on the epideomiological characteristics of adolescent drug use and with the help of some psychological and behavioral theories, the CMER model were designed and regarding materials were made for the prevention purpose by increasing recognition on drugs and behavior skills, decreasing motive of drug use, enforcing refusal efficacy. By comparing with pre-intervention, three months after ending intervention, the susceptibility decreased by 19.2% to heroin/cocaine/ marijuana and 9.5% to ice, but increased by 9.5% and 11.8 to MDMA and ketamine respectively. The curiority rate of these six drugs significantly decreased ranged from 35.7% (MDMA) to 70.9% (marijuana). The refusal rate of drugs had slightly increase (3.5%), mainly on the heroin/cocaine/ marijuana, but the rate slightly decreased on MDMA, ketamine and ice. Except for three items of“for the majority of drug users, doctor is the most important source of drugs”,“almost everyone will use drug when he/she was very disturbed or unhappy”and“drug use is related with low willpower”, the recognition of other items is better than pre-intervention. The cognition on accessibility of drugs, perceived adult drug use increased after post-intervention, but the recognition on perceived parent/friends attitude on their own drug use and perceived peer drug use did not show significant improvement. After intervention, the motives to use drugs siginificantly lowered and self-esteem increased (P<0.05).
Conclusion
Drugs, especially new types of drugs (named as club drugs) are becoming a serious threat to adolescent. In contrast, the adolescents have relative low recognition and refusal efficacy. A lot of adolescents take the attitude of curiosity and acceptance on illegal drugs, and they are lack of immunology on these substances. The SEM model, basing on the data from 16 schools, can be explained by some psychological and behavioral theories. With the help of the SEM model and regarding theories, we designed school-based CMER preventive intervention program. The program can decrease adolescent curiosity and susceptiblilty to drugs, increase refusal efficacy and have good short prevention effect on drug use. Meanwhile, the program can improve the adolescent recognition on illegal drugs, correct their wrong attitude, decrease motive of drug use. These indicated that our school-based CMER model and intervention protocol, focusing on recognition increase, motive decrease and integration of skills and affection eduction, can prevent adolescents from drug use. It suggests that CMER program have important value to extend in other schools.
Innovation
1. It is the first time to estabilish the predict model of drug use focusing on Chinese adolescents, by use of psycho-behavioral theories and SEM model.
2. It is the first time to establish the school-based CMER prevention program and have got good short intervention effect.
3. The intervention materials were designed, which was based on psycho-behavioral theories and aimed to prevent adolescents from initial drug use. The materials include student textbook, teacher guide, multi-media slides and vedio. It got the recognition and reception from students and teachers.
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