檳榔依賴量表（BNDS）的發展

Development of the Betel Nut Dependency Scale (BNDS)

10.6129/CJP.2012.5403.04

李仁豪(Ren-Hau Li)；何明洲(Ming-Chou Ho)；唐子俊(Tze-Chun Tang)；張芳庭(Catherine Foun-Tain Chang)

ROC曲線 ； 依賴 ； 結構方程式模型 ； 量表 ； 檳榔 ； betel nut ； dependency ； ROC (receiver operating characteristic) curve ； scale ； structural equation model

中華心理學刊

54卷3期（2012 / 09 / 01）

331 - 348

繁體中文

鑑於過去檳榔依賴量表的編製在量化程序上的不足，本研究參考過去檳榔量表的試題，編製一份符合心理計量程序的檳榔依賴量表，並設定決斷分數以利臨床上快速篩檢可能的成癮者，進而達到減少罹患口腔癌的機率。樣本透過人力仲介公司經歷近一年五個月的招募，總共獲得257位目前仍在嚼食檳榔的社會人士作為正式樣本，其中，將前六個月招募而來的128人視為預試樣本。試題的來源共39題，乃收集過去國內2份研究檳榔依賴行為的報告以及參考國外知名的相關成癮量表而來，經專家效度的檢驗後，以37題進行後續的量化分析。以預試樣本資料進行探索性因素分析，採用主軸因素萃取法及斜交轉軸方式，在設定3項刪題標準後，獲得11題的3因素結構，分別為「渴求欲望」4題、「戒斷反應」4題、「使用習慣」3題，三個因素的特徵值共解釋63.10%的總變異，內部一致性α信度在.73~.89之間。接著，以正式樣本使用結構方程式模型進行一階三因素二階一因素模型的驗證性因素分析，在多數適配指標都良好的情況下，獲得本量表具有建構效度的訊息。本量表並提出效標關聯效度等效度訊息供參考。最後使用ROC（receiver operating characteristic）曲線法來探討可能的決斷分數，並以試題反應理論最大訊息量的概念決定出一個最穩定的決斷分數24分，作為界定檳榔依賴者的標準。

On behave of the limited development in betel nut dependence scale with adequate psychometric properties, the current study aimed to establish a clinical-relevant quick screening tool on betel nut dependence. The formal participants included 257 betel nut chewers, recruited within one year and five months by human resource agency. Amongst them, the 128 participants recruited in the primary 6 months period were regarded as the preliminary sample. There were 39 items adopted, referencing 2 domestic studies on betel nut dependence and a widely-used smoking addicton scale (the Questionnaire on Smoking Urges-Brief, QSU-Brief); 37 items were selected for quantified analyses after expert validity analysis. Data from the preliminary sample were investigated with exploratory factor analysis by principal axis factoring extraction and direct oblimin rotation method. Based on the 3 item-deletion standards that we set up, we obtained 11 items and 3-factors structure in the scale: craving and desire (4 items), withdrawal response (4 items) and tasting habits (3 items). The eigenvalues of the 3 factors accounted for 63.10% of total variances, and α coefficients of reliability were between .73 ~ .89. Then, data from formal sample were modeled with 3 first-order factors and 1 second-order factor by confirmatory factor analysis using structural equation modeling. Most of model-fit indexes showed good fitting results, suggesting optimal construct validity of the scale. The scale also offered criterion-related validity for reference. Finally, we used ROC (receiver operating characteristic) curve to explore possible cutoff scores. Based on the maximum information method of item response theory, we recommend the cut-off score of 24 to be the most stable approximation to determine potentials of betel nut dependence.

1. Ho, M.-C.,Wang, C.-K.(2010).Can betel nut chewing affect the UFOV size after sleep deprivation?.Chinese Journal of Psychology,52,445-456.
   連結：
2. 溫啟邦、鄭秋汶、鄭丁元、蔡旻光、江博煌、蔡善璞(2009)。國人嚼檳榔的現況與變化─探討嚼檳榔與吸菸之關係。台灣公共衛生雜誌，28，407-419。
   連結：
3. 行政院衛生署（2008）：《905嚼檳榔（健康局人口中心）》。2010年11月20日，摘自行政院衛生署網站，http://www.doh.gov.tw/CHT2006/DisplayStatisticFile.aspx?d=67854&s=1 [Department of Health, Executive Yuan. (2008). 905 betel nut chewing (Population and Health Research Center, Bureau of Health Promotion). Retrieved November 20, 2010, from Department of Health, Executive Yuan Web site: http://www.doh.gov.tw/CHT2006/DisplayStatisticFile.aspx?d=67854&s=1]
4. 行政院衛生署（2010）：《98年度死因統計完整統計表》。2010年11月20日，摘自行政院衛生署網站，http://www.doh.gov.tw/CHT2006/DM/DM2_2_p02.aspx?class_no=440&now_fod_list_no=11397&level_no=-1&doc_no=76512 [Department of Health, Executive Yuan. (2010). 98 complete statistical tables for statistics of death causes. Retrieved November 20, 2010, from Department of Health, Executive Yuan Web site: http://www.doh.gov.tw/CHT2006/DM/DM2_2_p02.aspx?class_no=440&now_fod_list_no=11397&level_no=-1&doc_no=76512]
5. Amarasinghe, H. K.,Johnson, N. W.,Lalloo, R.,Kumaraarachchi, M.,Warnakulasuriya, S.(2010).Derivation and validation of a risk-factor model for detection of oral potentially malignant disorders in populations with high prevalence.British Journal of Cancer,103,303-309.
6. American Psychiatric Association(2000).Diagnostic and statistical manual of mental disorders.Washington, DC:Author.
7. Bagozzi, R. P.,Yi, Y.(1988).On the evaluation of structural equation models.Journal of the Academy of Marketing Science,16,74-94.
8. Baldwin, K. A.,Grinslade, M. S.,Baer, L. C.,Watts, P.,Dinger, M. K.,McCubbin, J.(2005).Higher-order factor analysis of an instrument with dichotomous data.Research in Nursing & Health,28,431-440.
9. Benegal, V.,Rajkumar, R. P.,Muralidharan, K.(2008).Does areca nut use lead to dependence?.Drug and Alcohol Dependence,97,114-121.
10. Bhat, S. J. S.,Blank, M. D.,Balster, R. L.,Nichter, M.,Nichter, M.(2010).Areca nut dependence among chewers in a South Indian community who do not also use tobacco.Addiction,105,1303-1310.
11. Chen, M.-J.,Yang, Y.-H.,Shieh, T.-Y.(2002).Evaluation of a self-rating screening test for areca quid abusers in Taiwan.Public Health,116,195-200.
12. Chu, N.-S.(2001).Effects of betel chewing on the central and autonomic nervous systems.Journal of Biomedical Science,8,229-236.
13. Chung, C.-H.,Yang, Y.-H.,Wang, T.-Y.,Shieh, T.-Y.,Warnakulasuriya, S.(2005).Oral precancerous disorders associated with areca quid chewing, smoking, and alcohol drinking in southern Taiwan.Journal of Oral Pathology and Medicine,34,460-466.
14. Cox, L. S.,Tiffany, S. T.,Christen, A. G.(2001).Evaluation of the brief questionnaire of smoking urges (QSU-brief) in laboratory and clinical settings.Nicotine & Tobacco Research,3,7-16.
15. Hair, J. F.,Black, B.,Babin, B.,Anderson, R. E.,Tatham, R. L.(2006).Multivariate data analysis.Upper Saddle River, NJ:Prentice Hall.
16. Ho, M.-C.,Wang, C.-K.(2011).The effect of betel nut chewing on contour and object masking.Attention, Perception, & Psychophysics,73,2583-2593.
17. Killen, J. D.,Fortmann, S. P.(1997).Craving is associated with smoking relapse: Findings from three perspective studies.Experimental and Clinical Psychopharmacology,5,137-142.
18. Linacre, J. M.(2010).A user's guide to WINSTEPS MINISTEP Rasch-Model computer programs.Chicago:Winsteps.com.
19. Lu, C.-T.,Yen, Y.-Y.,Ho, C.-S.,Ko, Y.-C.,Tsai, C.-C.,Hsieh, C.-C.(1996).A case control study of oral cancer in Changhua County, Taiwan.Journal of Oral Pathology & Medicine,25(5),245-248.
20. Morgenstern, J.,Langenbucher, J.,Labouvie, E. W.(1994).The generalizability of the dependence syndrome across substances: An examination of some properties of the proposed DSM-IV dependence criteria.Addiction,89,1105-1113.
21. Nelson, B. S.,Heischober, B.(1999).Betel nut: A common drug used by naturalized citizens from India, Far East Asia, and the South Pacific Islands.Annals of Emergency Medicine,34,238-243.
22. Parkin, D. M.,Bray, F.,Ferlay, J.,Pisani, P.(2005).Global cancer statistics, 2002.CA: A Cancer Journal of Clinicians,55,74-108.
23. Winstock, A.(2002).Areca nut - Abuse liability, dependence and public health.Addiction Biology,7,133-138.
24. Winstock, A. R.,Trivedy, C. R.,Warnakulasuriya, K. A.,Peters, T. J.(2000).A dependency syndrome related to areca nut use: Some medical and psychological aspects among areca nut users in the Gujarat community in the UK.Addiction Biology,5,173-179.
25. World Health Organization(1992).The ICD-10 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines.Geneva, Switzerland:Author.
26. Yang, Y. H.,Chen, C. H.,Chang, J. S.,Lin, C. C.,Cheng,T. C.,Shieh, T. Y.(2005).Incidence rates of oral cancer and oral pre-cancerous lesions in a 6-year follow-up study of a Taiwanese aboriginal community.Journal of Oral Pathology & Medicine,34,596-601.
27. 申秀麗、段亮亮(2009)。檳榔的化學成分及藥理研究進展。宜春學院學報，31(2)，95-97。
28. 余民寧、劉育如、李仁豪(2008)。台灣憂鬱症量表的實用決斷分數編製報告。教育研究與發展期刊，4(4)，231-257。
29. 吳淑真(2003)。Tainan, Taiwan，國立成功大學行為醫學研究所=National Cheng Kung University。
30. 李蘭、晏涵文、劉潔心、關學婉、季瑋珠、林瑞雄(1992)。嚼檳榔預防教育先驅研究（I）─國中生嚼檳榔現況及影響因素之初探。中華民國公共衛生學會雜誌，11，285-294。
31. 唐子俊、蔡吉政、柯志鴻、顏正芳、楊奕馨、蔡瑞修(2008)。行政院衛生署委託研究計畫報告行政院衛生署委託研究計畫報告,台北=Taipei:行政院衛生署=Department of Health, Executive Yuan。
32. 盧怡吟、嚴雅音、蔡文玲、黃正銘、許志成、林雅瑩(2010)。生活壓力、偏差行為與父母管教方式對國小學童吸菸、飲酒、嚼食檳榔行為之相關研究。台灣口腔醫學科學雜誌，26，21-40。
33. 魏麗敏(2009)。青少年嚼食檳榔之心理歷程與行為之分析。諮商與輔導，288，39-43。

1. 何明洲(2021)。檳榔嚼食者的認知神經科學取向研究：系統性回顧。中華心理學刊，63(4)，309-334。