Markham Wolfgang A, Lopez Maria Luisa, Aveyard Paul, Herrero Pablo, Bridle Christopher, Comas Angel, Charlton Anne, Thomas Hywel
School of Health and Social Studies, University of Warwick, Coventry, CV4 7AL, UK.
BMC Public Health. 2009 Jun 4;9:173. doi: 10.1186/1471-2458-9-173.
European trans-national adolescent smoking prevention interventions based on social influences approaches have had limited success. The attitudes-social influences-efficacy (ASE) model is a social cognition model that states smoking behaviour is determined by smoking intention which, in turn, is predicted by seven ASE determinants; disadvantages, advantages, social acceptance, social norms, modelling, perceived pressure, self-efficacy. Distal factors such as country of residence, age and gender are external to the model. The ASE model is, thus, closely related to the Theory of Planned Behaviour. This study assessed the utility of the ASE model using cross-sectional data from Spanish and UK adolescents.
In 1997, questionnaires were simultaneously administered to Spanish (n = 3716) and UK adolescents (n = 3715) who were considered at high risk of smoking. Participants' age, gender, smoking intentions and ASE determinant scores were identified and linear regression analysis was used to examine the mediated, moderated and direct effects of country of residence, age and gender on participants' smoking intentions.
All UK participants were aged 12 or 13 and most Spanish participants were aged between 12 and 14 (range 12-16 years). Amongst 12 and 13 year olds, regular smoking was more common in Spain. Almost half the participants were female (47.2% in Spain; 49.9% in the UK). Gender did not vary significantly according to age. The distribution of ASE determinant scores varied by country and predicted intention. The influence of each ASE determinant on intention was moderated by country. Country had a large direct influence on intention (1.72 points on a 7 point scale) but the effects of age and gender were mediated by the ASE determinants. The findings suggest resisting peer pressure interventions could potentially influence smoking amongst UK adolescents but not Spanish adolescents. Interventions that promote self-efficacy, on the other hand, would possibly have a greater influence on smoking amongst Spanish adolescents.
The ASE model may not capture important cultural factors related to adolescent smoking and the relative contribution of particular ASE determinants to adolescent smoking intentions may differ between countries. Future European trans-national adolescent smoking prevention programmes may benefit from greater understanding of country-level cultural norms.
基于社会影响方法的欧洲跨国青少年吸烟预防干预措施成效有限。态度 - 社会影响 - 效能（ASE）模型是一种社会认知模型，该模型指出吸烟行为由吸烟意图决定，而吸烟意图又由七个ASE决定因素预测；缺点、优点、社会接受度、社会规范、榜样作用、感知压力、自我效能感。诸如居住国、年龄和性别等远端因素在该模型之外。因此，ASE模型与计划行为理论密切相关。本研究使用来自西班牙和英国青少年的横断面数据评估了ASE模型的效用。
1997年，同时向被认为有高吸烟风险的西班牙青少年（n = 3716）和英国青少年（n = 3715）发放问卷。确定参与者的年龄、性别、吸烟意图和ASE决定因素得分，并使用线性回归分析来检验居住国、年龄和性别对参与者吸烟意图的中介效应、调节效应和直接效应。
所有英国参与者年龄为12岁或13岁，大多数西班牙参与者年龄在12至14岁之间（年龄范围12 - 16岁）。在12岁和13岁的青少年中，经常吸烟在西班牙更为常见。几乎一半的参与者为女性（西班牙为47.2%；英国为49.9%）。性别随年龄变化不显著。ASE决定因素得分的分布因国家而异且可预测意图。每个ASE决定因素对意图的影响因国家而异。国家对意图有很大的直接影响（在7分制上为1.72分），但年龄和性别的影响由ASE决定因素介导。研究结果表明，抵制同伴压力干预可能会影响英国青少年吸烟，但对西班牙青少年无效。另一方面，提高自我效能感的干预措施可能对西班牙青少年吸烟有更大影响。
ASE模型可能未涵盖与青少年吸烟相关的重要文化因素，并且特定ASE决定因素对青少年吸烟意图的相对贡献在不同国家可能有所不同。未来欧洲跨国青少年吸烟预防计划可能会从对国家层面文化规范的更深入理解中受益。
