目的：本研究目的主要有二：一是瞭解台灣地區成年人初次吸菸行為隨不同出生世代之改變情形，以政治及社會經濟變化為主要架構進一步探討初次吸菸相關行為之趨勢變化。二是針對成年男性，進一步檢驗初次吸菸年齡與其後來之社經地位的關係及可能相關之因素。

方法：本研究採用國民健康局於2002年十月至2003年三月所進行之具有全國代表性的「台灣地區九十一年國民健康促進知識、態度與行為調查」進行描述性之二手資料分析，本研究將所有受訪者分為四個不同出生世代，包括台灣光復初期（1943-1952出生者）、經濟起飛時期（1953-1962出生者）、經濟繁榮時期（1963-1972出生者），及洋菸開放進口時期（1973-1982出生者）。
問卷內容則針對三個面向：(1)吸菸狀態，(2)初次吸菸行為，及(3)社經地位。首先，所有參與者依照其一生中是否吸菸超過100支來分組，若是則為曾經吸菸者（ever smokers），反之則視為從未吸菸者（never smokers）。另外，曾經吸菸者再進一步區分為目前仍吸菸者（持續每日吸菸者、偶而吸菸者或是目前已戒菸但未超過六個月者）及已戒菸者（已戒菸超過六個月者）。至於初次吸菸場所分為六類，包括自家、其他人家中（包括親友、同事或是同學）、學校或職場、軍中、餐廳或娛樂場所及其他場所。初次吸菸原因包括七個類別，包括好奇、跟隨他人、抒解壓力、社交活動、無聊、軍中配菸及其他原因。影響初次吸菸之關鍵人物分為七群，包括父親、其他家族成員（除父親外）、同學或朋友、同事、軍中同袍、自己本身及其他人。.
最後，關於所有參與者社經地位分類是先以「英國註冊總分類表（British Registrar General's Classification /BRGC）」來區分五個不同的職業類別，包括第一級（專業級）、第二級（中等級）、第三級（技術級）、第四級（半技術級）和第五級（非技術級）。教育程度則以總教育年數分成五類，包括少於或等於6年（國小以下），7至9年 (國中)，10至12年 (高中職)及等於或大於13年 (大學以上)。最後以Hollingshead 所設計的「社會地位指數法（Index of Social Position /ISP）」，將社經地位分為五級，包括最高級、中高級、中級、中低級及最低級。本研究將26696位年滿15歲以上受訪者之資料，以SPSS視窗版套裝軟體(version 8.0)進行各項統計分析，其中包括描述性統計，以次數和百分比表示，以描述各變項的分佈情形；另外分析性統計方面則以卡方檢定(Chi-Square test)分析不同組別間不同變項間的差異，若定義P值為0.05以下，則判定為具有統計上之顯著差異。

結果：2002年臺灣地區成年男性及女性吸菸率分別為51.8%及5.3%，進一步分析近三十年來吸菸盛行率之變化趨勢發現，其與政府吸菸政策執行有相關性，而與經濟發展之潮流較無相關。根據不同出生世代結果顯示初次吸菸年齡有愈來愈年輕的趨勢。進一步分析其他初次吸菸資料得知，(1).初次吸菸場所隨年齡愈來愈年輕，男性由軍中轉到學校、職場或娛樂場所，而女性則由自己家中轉而至上述公共場域。(2).初次吸菸原因主要是好奇，但愈是年輕之世代，其影響愈重；至於無聊、抒解壓力及跟隨別人則隨年齡愈來愈年輕而由重要因子已轉變為不重要因子。(3).影響初次吸菸的關鍵人物，則隨年齡愈來愈年輕由親戚或是家人轉變為同學或是朋友。(4).此外，再進一步分析成年男性曾吸菸者的社經地位，發現其初次吸菸年齡早晚與之後社經地位高低呈現顯著負相關。另外，無論該曾吸菸男性目前是否已戒菸成功，其生涯吸菸年數百分比愈高或是嘗試戒菸次數愈少者，均與其往後之低社經地位呈顯著相關；而此關係在目前仍吸菸者間比已戒菸者間較為明顯。

討論：整體而言，歷史的、社會文化及政治經濟等因素 都對吸菸有所影響，而其影響包括吸菸盛行率、初次吸菸年齡及相關初次吸菸行為。然而，由本研究顯示菸害防制相關政策遠較於經濟變遷對台灣地區成人吸菸率有所影響，而這可能導因於正向的菸害防制策略將明顯有助於防止民眾開始吸菸或是增加開始戒菸的想法。另外，本研究顯示和其他國家一樣，在台灣地區初次吸菸年齡有愈來愈年輕化的趨勢。而本研究更發現民眾愈早開始吸菸，其社經地位也有愈低的相關性。而愈少的吸菸年數與愈多次的戒菸次數與其高社經地位有相關。為了避免民眾初次吸菸愈來愈年輕及其可能伴隨產生之低社經地位，我們需要重視初次吸菸行為相關因素，包括初次吸菸場所、初次吸菸原因及影響初次吸菸之關鍵人物，而這些將有助於未來菸害防制政策之制訂。

Purposes: The objectives of the thesis are: (1) to explore the trends of initial smoking behaviors under the political and socio-economic contexture in Taiwan, stratified by different birth cohort; (2) to further examine the association between age of smoking initiation and adulthood socioeconomic status among males.

Methods: 26,696 participants aged over 15 were selected by using the method of systematic random sampling, based on the national survey between October 2002 and March 2003 in Taiwan. In this study, the subjects were divided into 4 birth cohorts— post-retrocession period (1943-1952)/ age of 50-59, economic take-off period (1953-1962)/age of 40-49, economic prosperity period (1963-1972)/age of 30-39, and tobacco importation period (1973-1982)/age of 20-29.
The questionnaires were selected from three dimensions: (1) smoking status, (2) initial smoking behaviors, and (3) socioeconomic status. First, all participants were divided as “never” smokers or as “ever” smokers (having never smoked or smoked fewer than 100 cigarettes in one’s lifetime vs. having smoked more than 100 cigarettes in one’s lifetime). Besides, “ever” smokers were categorized into two major classes: “current” smokers and “past” smokers based on their current smoking status (continuous daily smokers, occasional smokers and those who had not quit smoking for more than six months vs. those who had smoked before but quit smoking for at least six months). Second, places of initial smoking were divided into six groups: home, other people’s home (including relatives, friends, colleagues or classmates), schools or workplaces, the military, restaurants and entertainment settings, and others. Reasons of initial smoking were divided into seven groups: curiosity, following others, relieving stress, social activities, boredom, allotment of cigarettes in the military, and others. Key persons who affected smoke initiation were divided into seven groups: father, other family members, classmates or friends, colleagues, military fellows, the self, and others.
Finally, the participants were confirmed about their socioeconomic status, such as occupation and educational level by means of both British Registrar General's Classification (BRGC) and Hollingshead’s Index of Social Position (ISP). According to the BRGC, occupation was divided into 5 categories: Social Class I (professional), II (intermediate), III (skilled), IV (partly skilled) and V (unskilled). Educational level was indicated by total years of education, in the classification of educational milestones: ≦6 (elementary school or lower), 7-9 (junior high school), 10-12 (senior high school), ≧13 (college or higher). We also divided the subjects into five “social classes” by the Hollingshead’s ISP classification: upper, upper-middle, middle, lower-middle, and lower. The data were analyzed by using descriptive and bivariate analysis, with P<0.05 considered statistically significant.

Results: The prevalence of smoking among males and females in Taiwan in 2002 was 51.8% and 5.3%, respectively. The trend of smoking prevalence showed significant association with the changes of tobacco-related policies rather than with the flows of economic development. From different birth cohort, the trend of earlier age at smoking initiation was presented, and changes of initial smoking behaviors included: (1) changes of initial smoking places from military (males), home (females) to schools, workplaces or entertainment settings; (2) shifts of initial smoking reasons from boredom, following others to curiosity; (3) changes of key persons affecting first smoking from their family and relatives to classmates and friends. After further analyses the relationship between age of smoking onset and subsequent socioeconomic status among males, strong association was found in ever smokers. In past and current smokers, the lifetime smoking years and numbers of quit attempts were also significantly associated with subsequent socioeconomic status; meanwhile, the associations among current smokers were stronger than those among past smokers.

Discussion: Overall, the historical, socio-cultural and political economic factors have some impacts upon smoking, including smoking prevalence, age at smoking initiation and related initial smoking behaviors. However, from our analyses, political policies, rather than economic changes, tend to influence the smoking prevalence in Taiwan, namely, the policy of tobacco control has greater impacts on smoking cessation. In addition, greater numbers of younger adults initiate to smoke earlier and earlier over time in Taiwan. The earlier one initiates smoking in the lifetime, the lower socioeconomic status one is likely to achieve later in his life. On the other hand, less duration of lifetime smoking and more quit attempts contribute to the elevation of his/her socioeconomic status. For avoiding the increase of people who initiate to smoke at their earlier age and the possibility of lower subsequent socioeconomic status, we need to put more emphasis on the tendency of initial smoking places, reasons and key persons who affected smoking initiation. Therefore, we believe that our findings on the trends of initial smoking behaviors have important implications for future smoking policy-making.

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