基于需求的初中生非法药物滥用预防干预模式效果评价
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摘要
目的
了解初中生非法药物滥用预防教育需求情况,探讨初中生非法药物滥用倾向性及其危险因素,建立初中生非法药物滥用干预模式,制定干预措施并在全国范围内的样本城市进行实施,评价该干预措施的大范围实施效果。
方法
1、需求调查
中学生、教师和家长为研究对象。采用分层整群抽样方法,抽取湖北省襄樊市和大冶市的市级中学和乡镇中学各1所,共592名初中一年级学生,67名思想品德教师、班主任、健康教育教师代表,175名学生家长作为初中生非法药物滥用预防教育需求情况调查的样本;采用自编的《初中生非法药物预防知识课程需求问卷》(分学生、教师和家长问卷),对初中生非法药物滥用预防知识课程需求、开设形式和内容的情况,进行自填匿名问卷调查。采用专题小组访谈的方法,对部分学生进行开放式的调查访谈并录音,记录并总结归纳学生对初中生非法药物滥用预防教育的需求内容和形式等。
2、危险因素分析和干预措施效果评价
将中国地区划分为华东、华南、华西、华北和华中五大区域,采用多阶段抽样方法,在每个区域邀请两个市级或以上教育局参与此项研究,在2周内首先回复的前7所单位纳入项目,对其中两所单位管辖的中小学教师进行初中生非法药物滥用教育骨干教师培训,并在培训后进行培训评价调查,最终149名教师完成了《初中生非法药物滥用预防教育骨干教师培训班评价表》的问卷调查。从7个城市中各抽取一所学校,再从每个学校中抽取初一年级4个班级,其中2个作为对照班级,2个作为干预班级,共1634名学生参与基线调查。
基线调查完成后,由各个学校经过培训的教师,对所在学校的干预班级进行7个学时的初中生非法药物滥用认知-动机-情商和抵御技能(Cognition-Motivation-Emotion and Refusalskills, CMER)干预。干预完成后,对照班级和干预班级同时进行第二次问卷调查,共1550名学生完成了前后两次问卷调查。调查问卷采用自编的《初中生非法药物滥用认知、态度和倾向性调查问卷》,在知情同意的情况下,对抽中的学生进行统一的匿名问卷调查。根据所有研究对象第一次的基线调查资料,统计分析初中生非法药物滥用倾向性及其危险因素;根据两次调查资料分析CMER干预模式的短期效果。
3、统计方法
非法药物滥用倾向性的危险因素的筛选采用Poisson回归分析,各个危险因素导致药物滥用倾向的先后关系探讨采用结构方程模型,药物滥用倾向的预测模型建立采用BP神经网络模型。统计检验根据资料的性质选择合适的统计分析方法,分类型变量的比较采用卡方检验或者Fisher's精确概率法,数值型变量比较采用两独立样本t-检验或t'-检验,以0.05为显著性水平,双侧检验。
结果
1、需求调查结果
没有接受过任何非法药物滥用预防教育的学生为23.48%,并且乡镇的未接受预防教育率高于城区;只有8.62%的学生认为自己知道如何保护自己远离非法药物;86%以上的学生、教师和家长都表示会积极地配合参与学校开展的预防知识教育;学生乐意接受的主要方式是老师讲授、观看相应的教育片、听戒毒人员的现身说法以及讨论的形式;什么是非法药物以及新型毒品、非法药物的危害和如何拒绝非法药物诱惑等是中学生和教师公认的预防教育课程应该开设的内容。
2、危险因素分析结果
多因素Poisson回归分析发现,对非法药物相关事物的态度错误、拒绝非法药物的技能掌握差和较低情商是非法药物使用倾向性的危险因素;结构方程模型结果表明,非法药物知识(F1)、初中生对非法药物相关的态度(F2)、拒绝技能(F3)和情商(F4)对非法药物使用倾向性(F5)具有直接作用,F1还通过对非法药物相关的态度(F2)和拒绝技能(F3 )对非法药物使用倾向性(F5)产生间接作用。结构方程拟合指标GFI=0.941, AGFI=0.922,CFI=0.899,NFI=0.882,PGFI=0.793,RMSEA=0.058,90%CI. RMSEA=0.054～0.062,CN=300。BP神经网络模型的预测非法药物滥用倾向性的准确性均达到了85%以上。
3、干预模式效果结果
对照组经过第一次调查后,非法药物相关知识和技能得分有所提高,但是非法药物滥用成瘾性的知识得分仍没有变化,对“吸毒行为”的态度得分降低,情商得分没有增加,对非法药物的“好奇”人数增加;干预组在干预后,非法药物相关知识提高、态度改善、拒绝技能增加,对非法药物的“好奇”人数减少。第一次调查时,对照组在非法药物相关知识、态度、技能、情商和非法药物使用倾向性方面均不差于干预组,但是干预组经过干预后,干预组对非法药物知识掌握情况、态度端正情况、拒绝毒技能和情商均比对照组好,表现为对非法药物“好奇”的人数比对照组显著减少。
结论
1、中学生、教师、家长都认为非法药物滥用的预防教育非常必要,毒品、新型毒品及其危害和如何拒绝诱惑是中学生和教师都认为应该开设的教育内容,学生乐意通过老师讲授、观看相应的教育片、听戒毒人员的现身说法以及讨论得到这方面的教育,应当开展以需求为基础的系统非法药物的预防教育。
2、非法药物知识、态度、拒绝和自我保护技能和情商都是青少年非法药物滥用的影响因素;再次证实了中学生非法药物滥用预防的认知-动机-情商-拒绝技能(CMER)干预模式的必要性。
3、通过大范围的CMER模式与措施的实施,发现能增强初中生对非法药物预防的知识,减少尝试非法药物的动机,提高拒绝非法药物的拒绝技能和情商,降低非法药物滥用的倾向性。
创新点
1、在国内首次调查和发现了中学生、教师和家长对初中生非法药物滥用预防干预教育内容和形式的需求和乐意配合程度。
2、系统探讨了非法药物滥用及其预防干预评价的统计学方法,根据研究资料建立了Poisson回归、结构方程模型和BP神经网络模型,认为Poisson回归模型可以帮助寻找中学生非法药物滥用倾向性的危险因素,结构方程模型和BP神经网络相结合,探索危险因素之间的关系,并且对非法药物滥用倾向性进行预测效果较好。
3、通过培训和调查中学从事健康教育相关工作的教师,发现他们对非法药物滥用的CMER干预模式、方案和教材非常认同,并保证了初中生非法药物滥用预防CMER项目的延续性和实用性。
4、首次将青少年非法药物滥用预防的CMER模式推广应用到全国七个城市,所得结果有一定的代表性。证实了CMER干预模式、方案和教材在大范围实施的可行性和可接受性。
Objective
To investigate the demand for drug education for adolescents,to explore the liability to illicitdrugs abuse among adolescents and the risk factors,and to develop a prevention model againstillicit drug abuse among junior high schools,to evaluate the effects by implemented on a largescale.
Methods
1.Requirement investigation
The subjects include 592 junior students,175 parents and 67 teachers which were on thevirtue education,health education and supervisors of the classes that the students came from forrequirement questionnaire investigation from an urban school and a rural school in Xiangfan cityand Daye city respectively by means of stratified-clustered sampling.The questionnaire wasJunior High School Illicit Drugs and AIDS Prevention Requirement Questionnaire,consisting ofstudents',teachers' and parents' sub-questionnaire.It probes the requirement of adolescent illicitdrugs and AIDS prevention requirement,such as form and content.The focus group discussionwas adopted,and interviews were recorded and analyzed.
2.Risk factor analysis
Multistage sampling was used.Firstly,two municipal bureaus were invited to participate inthis study from each of the five regions in China,namely,East Region,South Region,West Region,North Region and Centre Region.The first seven responding bureaus were chosen,of which twobureaus also took part in the teachers' training for adolescent illicit drug prevention.At last,149teachers finished the questionnaire Adolescent Illicit Drug Abuse Prevention Education Teachers' Training Assessment.Seven schools were selected by the bureaus,and there were 28 classes,14invention groups and 14 controls.There were 1643 junior students who finished the first baselinequestionnaire.
After the intervention groups completed the adolescent illicit drug prevention educationprogram,1550 students finished the second questionnaire investigation.The questionnaire wasAdolescent Illicit Drug Abuse Cognitions,Attitude and liability,and it was completed by studentsanonymously after their informed consent.The analysis of risk factors against liability to illicitdrugs use was based on the first investigation while the effects of CMER program were measuredon the basis of the two questionnaire investigations.
3.Statstical methods
Poisson regression analysis,structural equation model and back-propagation neural networkwere used to explore the risk factors against liability to illicit drugs use among adolescents.Hypothesis tests were analyzed with independent t-test or t'-test,chi-square test or Fisher's exacttest at the 0.05 level,two-tailed.
Results
1.Results of requirement investigation
There were respectively 23.48% and 20.95% of the junior students who had not received anydrugs related education at all,and the proportion was even larger in rural schools.Only 8.61%and 9.80% of the students did think they know how to keep away from drugs/AIDS.Over 86% ofstudents,teachers and parents agreed to participate in the school-based education of preventionknowledge.The major acceptable forms were lessons by teachers,watching video,listening toaddicts' experience and discussion.The definitions of drugs and new drugs,AIDS,harm of drugsand skills of refusing drugs were considered to be important contents by junior students andteachers.
2.Results of risk factor analysis
The results of multiple Poisson regression analysis indicated that wrong attitude,refusal skillsdeficiency and low emotion quotient (EQ) were risk factors of liability to adolescent illicit drugs abuse.The results of structural equation model showed that illicit drug knowledge (F_1),attitude(F_2),refusal skills (F_3) and EQ (F_4) affected liability to illicit drugs use (F_5) directly,while F_1affected F_5 through F_2 and F_3 indirectly.The goodness indexes of structural equation model werefollowed as GFI=0.941,AGFI=0.922,CFI=0.899,NFI = 0.882,PGFI = 0.793,RMSEA=0.058,90%CI.RMSEA=0.054～0.062,CN=300.The accuracy of BP neutral net model was morethan 80%.
3.Results of effects on the intervention
After the first investigation,the score of knowledge and skills except addiction increased inthe control,while the scores of attitude to illicit drugs use decreased,and the curiosity towardillicit drugs grew.After intervention,the score of knowledge,attitude,refusal skills and EQ havebeen improved in the intervention group.At the first investigation,the scores of knowledge,attitude,refusal skills and EQ were no better than the intervention group.After the intervention,the score of knowledge,attitude,refusal skills and EQ were higher than the control,and fewerstudents showed curiosity to illicit drugs.Conclusion
1.Junior high school students,teachers and parents all thought that it is necessary to organizethe illicit drugs abuse prevention education school-based.And they thought illicit drug,new typedrugs,their harm and how to refuse temptation as the education contents.Students were glad tohave the education from the styles,such as listening from teachers,watching meaningful videos,listening to the addicts' stories and discussion.It is very necessary to develop a systemic illicitdrug abuse prevention education based on requirement.
2.Illicit drug knowledge,attitude,refusal skills and EQ were risk factors of liability to illicitdrugs abuse,which verified the necessity of cognition-motivation-emotion and refusal skills(CMER) prevention program.
3.Based on the large scale CMER intervention,CMER program can enforce the knowledge,reduce the motivation to illicit drugs use,improve the refusal skills and EQ,and reduce theliability to illicit drugs abuse.
Innovation
1.In China,it was the first time to investigate and explore the requirement for content andstyle and cooperationextent.
2.We explored the statistic methods on illicit drug abuse and evaluation of interventionsystematically.Based on data,the Poisson model,structural equation model and BP neural netmodel were established.It was found that Poisson regression model can help to find risk factors toillicit drugs abuse among junior high school students.Combination structural equation model withBP neural net model to explore the relation among risk factors,the effects of prediction the liabilityto illicit drugs abuse among junior high school were good.
3.By means of training teachers on health education among adolescents,we found that theteachers agreed with the CMER model and the related books.The sustainability and practicabilityof the adolescent illicit drugs abuse CMER prevention were guaranteed.
4.It is the first time that adolescent illicit drugs abuse CMER prevention was popularized toseven cities in China,covering Eastern,Southern,Western,Northern and Central areas.It had beentested the practicability and acceptability.
了解初中生非法药物滥用预防教育需求情况,探讨初中生非法药物滥用倾向性及其危险因素,建立初中生非法药物滥用干预模式,制定干预措施并在全国范围内的样本城市进行实施,评价该干预措施的大范围实施效果。
方法
1、需求调查
中学生、教师和家长为研究对象。采用分层整群抽样方法,抽取湖北省襄樊市和大冶市的市级中学和乡镇中学各1所,共592名初中一年级学生,67名思想品德教师、班主任、健康教育教师代表,175名学生家长作为初中生非法药物滥用预防教育需求情况调查的样本;采用自编的《初中生非法药物预防知识课程需求问卷》(分学生、教师和家长问卷),对初中生非法药物滥用预防知识课程需求、开设形式和内容的情况,进行自填匿名问卷调查。采用专题小组访谈的方法,对部分学生进行开放式的调查访谈并录音,记录并总结归纳学生对初中生非法药物滥用预防教育的需求内容和形式等。
2、危险因素分析和干预措施效果评价
将中国地区划分为华东、华南、华西、华北和华中五大区域,采用多阶段抽样方法,在每个区域邀请两个市级或以上教育局参与此项研究,在2周内首先回复的前7所单位纳入项目,对其中两所单位管辖的中小学教师进行初中生非法药物滥用教育骨干教师培训,并在培训后进行培训评价调查,最终149名教师完成了《初中生非法药物滥用预防教育骨干教师培训班评价表》的问卷调查。从7个城市中各抽取一所学校,再从每个学校中抽取初一年级4个班级,其中2个作为对照班级,2个作为干预班级,共1634名学生参与基线调查。
基线调查完成后,由各个学校经过培训的教师,对所在学校的干预班级进行7个学时的初中生非法药物滥用认知-动机-情商和抵御技能(Cognition-Motivation-Emotion and Refusalskills, CMER)干预。干预完成后,对照班级和干预班级同时进行第二次问卷调查,共1550名学生完成了前后两次问卷调查。调查问卷采用自编的《初中生非法药物滥用认知、态度和倾向性调查问卷》,在知情同意的情况下,对抽中的学生进行统一的匿名问卷调查。根据所有研究对象第一次的基线调查资料,统计分析初中生非法药物滥用倾向性及其危险因素;根据两次调查资料分析CMER干预模式的短期效果。
3、统计方法
非法药物滥用倾向性的危险因素的筛选采用Poisson回归分析,各个危险因素导致药物滥用倾向的先后关系探讨采用结构方程模型,药物滥用倾向的预测模型建立采用BP神经网络模型。统计检验根据资料的性质选择合适的统计分析方法,分类型变量的比较采用卡方检验或者Fisher's精确概率法,数值型变量比较采用两独立样本t-检验或t'-检验,以0.05为显著性水平,双侧检验。
结果
1、需求调查结果
没有接受过任何非法药物滥用预防教育的学生为23.48%,并且乡镇的未接受预防教育率高于城区;只有8.62%的学生认为自己知道如何保护自己远离非法药物;86%以上的学生、教师和家长都表示会积极地配合参与学校开展的预防知识教育;学生乐意接受的主要方式是老师讲授、观看相应的教育片、听戒毒人员的现身说法以及讨论的形式;什么是非法药物以及新型毒品、非法药物的危害和如何拒绝非法药物诱惑等是中学生和教师公认的预防教育课程应该开设的内容。
2、危险因素分析结果
多因素Poisson回归分析发现,对非法药物相关事物的态度错误、拒绝非法药物的技能掌握差和较低情商是非法药物使用倾向性的危险因素;结构方程模型结果表明,非法药物知识(F1)、初中生对非法药物相关的态度(F2)、拒绝技能(F3)和情商(F4)对非法药物使用倾向性(F5)具有直接作用,F1还通过对非法药物相关的态度(F2)和拒绝技能(F3 )对非法药物使用倾向性(F5)产生间接作用。结构方程拟合指标GFI=0.941, AGFI=0.922,CFI=0.899,NFI=0.882,PGFI=0.793,RMSEA=0.058,90%CI. RMSEA=0.054～0.062,CN=300。BP神经网络模型的预测非法药物滥用倾向性的准确性均达到了85%以上。
3、干预模式效果结果
对照组经过第一次调查后,非法药物相关知识和技能得分有所提高,但是非法药物滥用成瘾性的知识得分仍没有变化,对“吸毒行为”的态度得分降低,情商得分没有增加,对非法药物的“好奇”人数增加;干预组在干预后,非法药物相关知识提高、态度改善、拒绝技能增加,对非法药物的“好奇”人数减少。第一次调查时,对照组在非法药物相关知识、态度、技能、情商和非法药物使用倾向性方面均不差于干预组,但是干预组经过干预后,干预组对非法药物知识掌握情况、态度端正情况、拒绝毒技能和情商均比对照组好,表现为对非法药物“好奇”的人数比对照组显著减少。
结论
1、中学生、教师、家长都认为非法药物滥用的预防教育非常必要,毒品、新型毒品及其危害和如何拒绝诱惑是中学生和教师都认为应该开设的教育内容,学生乐意通过老师讲授、观看相应的教育片、听戒毒人员的现身说法以及讨论得到这方面的教育,应当开展以需求为基础的系统非法药物的预防教育。
2、非法药物知识、态度、拒绝和自我保护技能和情商都是青少年非法药物滥用的影响因素;再次证实了中学生非法药物滥用预防的认知-动机-情商-拒绝技能(CMER)干预模式的必要性。
3、通过大范围的CMER模式与措施的实施,发现能增强初中生对非法药物预防的知识,减少尝试非法药物的动机,提高拒绝非法药物的拒绝技能和情商,降低非法药物滥用的倾向性。
创新点
1、在国内首次调查和发现了中学生、教师和家长对初中生非法药物滥用预防干预教育内容和形式的需求和乐意配合程度。
2、系统探讨了非法药物滥用及其预防干预评价的统计学方法,根据研究资料建立了Poisson回归、结构方程模型和BP神经网络模型,认为Poisson回归模型可以帮助寻找中学生非法药物滥用倾向性的危险因素,结构方程模型和BP神经网络相结合,探索危险因素之间的关系,并且对非法药物滥用倾向性进行预测效果较好。
3、通过培训和调查中学从事健康教育相关工作的教师,发现他们对非法药物滥用的CMER干预模式、方案和教材非常认同,并保证了初中生非法药物滥用预防CMER项目的延续性和实用性。
4、首次将青少年非法药物滥用预防的CMER模式推广应用到全国七个城市,所得结果有一定的代表性。证实了CMER干预模式、方案和教材在大范围实施的可行性和可接受性。
Objective
To investigate the demand for drug education for adolescents,to explore the liability to illicitdrugs abuse among adolescents and the risk factors,and to develop a prevention model againstillicit drug abuse among junior high schools,to evaluate the effects by implemented on a largescale.
Methods
1.Requirement investigation
The subjects include 592 junior students,175 parents and 67 teachers which were on thevirtue education,health education and supervisors of the classes that the students came from forrequirement questionnaire investigation from an urban school and a rural school in Xiangfan cityand Daye city respectively by means of stratified-clustered sampling.The questionnaire wasJunior High School Illicit Drugs and AIDS Prevention Requirement Questionnaire,consisting ofstudents',teachers' and parents' sub-questionnaire.It probes the requirement of adolescent illicitdrugs and AIDS prevention requirement,such as form and content.The focus group discussionwas adopted,and interviews were recorded and analyzed.
2.Risk factor analysis
Multistage sampling was used.Firstly,two municipal bureaus were invited to participate inthis study from each of the five regions in China,namely,East Region,South Region,West Region,North Region and Centre Region.The first seven responding bureaus were chosen,of which twobureaus also took part in the teachers' training for adolescent illicit drug prevention.At last,149teachers finished the questionnaire Adolescent Illicit Drug Abuse Prevention Education Teachers' Training Assessment.Seven schools were selected by the bureaus,and there were 28 classes,14invention groups and 14 controls.There were 1643 junior students who finished the first baselinequestionnaire.
After the intervention groups completed the adolescent illicit drug prevention educationprogram,1550 students finished the second questionnaire investigation.The questionnaire wasAdolescent Illicit Drug Abuse Cognitions,Attitude and liability,and it was completed by studentsanonymously after their informed consent.The analysis of risk factors against liability to illicitdrugs use was based on the first investigation while the effects of CMER program were measuredon the basis of the two questionnaire investigations.
3.Statstical methods
Poisson regression analysis,structural equation model and back-propagation neural networkwere used to explore the risk factors against liability to illicit drugs use among adolescents.Hypothesis tests were analyzed with independent t-test or t'-test,chi-square test or Fisher's exacttest at the 0.05 level,two-tailed.
Results
1.Results of requirement investigation
There were respectively 23.48% and 20.95% of the junior students who had not received anydrugs related education at all,and the proportion was even larger in rural schools.Only 8.61%and 9.80% of the students did think they know how to keep away from drugs/AIDS.Over 86% ofstudents,teachers and parents agreed to participate in the school-based education of preventionknowledge.The major acceptable forms were lessons by teachers,watching video,listening toaddicts' experience and discussion.The definitions of drugs and new drugs,AIDS,harm of drugsand skills of refusing drugs were considered to be important contents by junior students andteachers.
2.Results of risk factor analysis
The results of multiple Poisson regression analysis indicated that wrong attitude,refusal skillsdeficiency and low emotion quotient (EQ) were risk factors of liability to adolescent illicit drugs abuse.The results of structural equation model showed that illicit drug knowledge (F_1),attitude(F_2),refusal skills (F_3) and EQ (F_4) affected liability to illicit drugs use (F_5) directly,while F_1affected F_5 through F_2 and F_3 indirectly.The goodness indexes of structural equation model werefollowed as GFI=0.941,AGFI=0.922,CFI=0.899,NFI = 0.882,PGFI = 0.793,RMSEA=0.058,90%CI.RMSEA=0.054～0.062,CN=300.The accuracy of BP neutral net model was morethan 80%.
3.Results of effects on the intervention
After the first investigation,the score of knowledge and skills except addiction increased inthe control,while the scores of attitude to illicit drugs use decreased,and the curiosity towardillicit drugs grew.After intervention,the score of knowledge,attitude,refusal skills and EQ havebeen improved in the intervention group.At the first investigation,the scores of knowledge,attitude,refusal skills and EQ were no better than the intervention group.After the intervention,the score of knowledge,attitude,refusal skills and EQ were higher than the control,and fewerstudents showed curiosity to illicit drugs.Conclusion
1.Junior high school students,teachers and parents all thought that it is necessary to organizethe illicit drugs abuse prevention education school-based.And they thought illicit drug,new typedrugs,their harm and how to refuse temptation as the education contents.Students were glad tohave the education from the styles,such as listening from teachers,watching meaningful videos,listening to the addicts' stories and discussion.It is very necessary to develop a systemic illicitdrug abuse prevention education based on requirement.
2.Illicit drug knowledge,attitude,refusal skills and EQ were risk factors of liability to illicitdrugs abuse,which verified the necessity of cognition-motivation-emotion and refusal skills(CMER) prevention program.
3.Based on the large scale CMER intervention,CMER program can enforce the knowledge,reduce the motivation to illicit drugs use,improve the refusal skills and EQ,and reduce theliability to illicit drugs abuse.
Innovation
1.In China,it was the first time to investigate and explore the requirement for content andstyle and cooperationextent.
2.We explored the statistic methods on illicit drug abuse and evaluation of interventionsystematically.Based on data,the Poisson model,structural equation model and BP neural netmodel were established.It was found that Poisson regression model can help to find risk factors toillicit drugs abuse among junior high school students.Combination structural equation model withBP neural net model to explore the relation among risk factors,the effects of prediction the liabilityto illicit drugs abuse among junior high school were good.
3.By means of training teachers on health education among adolescents,we found that theteachers agreed with the CMER model and the related books.The sustainability and practicabilityof the adolescent illicit drugs abuse CMER prevention were guaranteed.
4.It is the first time that adolescent illicit drugs abuse CMER prevention was popularized toseven cities in China,covering Eastern,Southern,Western,Northern and Central areas.It had beentested the practicability and acceptability.
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