A Prediction Model for Nicotine Dependence of College Smoker

Abstract

Based on a health behavior changing model (Ryan et al., 2008) and health behavior changing process model (Forter et al., 2009) on the basis of the self-determination theory, this study built a hypothetical structural model where autonomy support, life aspirations, basic psychological needs, and self-determination motivation had effects on nicotine dependence of college smokers and tested the model's fitness and hypotheses. Data was collected from 303 college students that were attending university in Seoul, Gyeonggi Province, and Gyeongsangbuk Province, smoked five packs of cigarettes (100 cigarettes) or more in their lifetime, and were currently smoking (WHO, 1998) from November 3~24, 2017. Later, a detailed objective was added to the present study, and it was to test path differences between male and female college smokers. This testing required a sample of 200 subjects in each the male and female group (Ding et al., 1995). In an effort to meet this subject criterion, the investigator collected data from an additional 104 college smokers from August 24~September 5, 2018. The data analyzed a total of 407 college smokers in the study. Collected data was analyzed with the IBM SPSS 25.0 and IBM AMOS 25.0 programs. The findings were as follows: 1. The study assessed the hypothetical structural model for fitness and found that its χ² statistics was 238.317 (p<.001), the degree of freedom (df) was 62, RMSEA was .084, GFI was .918, SRMR was .057, IFI was .903, TLI was .877, CFI was .902, PNFI was .694, and normed χ² was 3.844, which shows that the model did not meet the fitness criteria. The model was then modified with one of the most common modification indices (MIs) used to improve fitness. As a result, χ² statistics was 139.579 (p<.001), degree of freedom (df) was 58, RMSEA was .059, GFI was .951, SRMR was .044, IFI was .955, TLI was .939, CFI was .955, PNFI was .688, and normed χ² was 2.407, which shows that all of the recommended indices were met and that the model was confirmed as the final hypothetical structural model 2. The test results of the hypothetical structural model show that all five hypotheses were supported. The test results were as follows: 1) College smokers' autonomy support had statistically significant effects on their basic psychological needs (β=.122, p=.032). 2) College smokers' life aspirations had statistically significant effects on their basic psychological needs (β=.706, p<.001). 3) College smokers' basic psychological needs had statistically significant effects on their self-determination motivations (β=.657, p<.001). 4) College smokers' self-determination motivations had statistically significant effects on their nicotine dependence (β=-.580, p<.001). 5) There were gender differences in the prediction model for the ni c o ti n e de p e n de nc e o f c ollege sm oke rs . Thei r basi c psychological needs had impacts on their self-determination motivations (∆χ² =4.410, p=.036), which in turn had impacts on their nicotine dependence (∆χ² =6.351, p=.012). There were statistically significant differences in the influence of these causal relations. The findings show that college smokers had their basic psychological needs met according to higher autonomy support from their significant people and their higher life aspirations. Once their basic psychological needs were met, they increased the students' self-determination motivations to carry out healthy behavior and accordingly had direct impacts on their lower nicotine dependence. The influence of causal relations in which basic psychological needs had impacts on self-determination motivations, which in turn had impacts on nicotine dependence, was significantly stronger in the group of female college smokers than in that of male college smokers. These findings point to the importance of interventions to reinforce self-determination motivations for the lower nicotine dependence of college smokers. It was also found that when they were exposed to an environment in which their basic psychological needs were met, they had greater self-determination motivations for physical activities and thus maintained the practice of healthy behavior. The findings of the study raise a need to develop programs designed to provide college smokers with a set of specific guidelines on smoking cessation to promote their self-determination motivations and also individual education and counseling sessions to take into consideration gender characteristics and influential factors so that they will choose interesting methods they prefer themselves and motivate themselves. The findings of the study are expected to serve as basic data in the development of nursing intervention programs to increase the percentage of college smokers that quit smoking.

본 연구는 자기결정성 이론을 근간으로 한 건강행위 변화모델(Ryan et al., 2008)과 건강행위 변화 프로세스 모델(Forter et al., 2009)를 기반으로 흡연대학생의 자율성지지, 미래지향목표, 기본심리욕구, 자기결정성 동기가 니코틴 의존도에 영향을 준다는 가설적 구조모형을 구축하여 모형의 적합성과 가설을 검증하였다. 연구자료는 서울시・경기도・경상북도 소재 대학교에 재학 중인 대학생 중 평생 5갑 이상(100개비)의 담배를 피웠으며, 현재 담배를 피우고 있는(WHO, 1998) 흡연 중인 자를 대상으로 2017년 11월 3일부터 2017년 11월 24일까지 303명의 자료를 수집하였다, 이후 본 연구에서 추가된 세부 목적인 흡연대학생의 성별 간 경로 차이를 검증하기 위해서 남녀 그룹별 각 200명 이상의 표본이 필요하다(Ding et al., 1995)는 대상자수 산출기준을 충족하기 위해 2018년 8월 24일부터 2018년 9월 5일까지 추가로 104명의 자료를 수집하여 총 407명을 대상으로 하였으며. 수집된 자료는 IBM SPSS 25.0과 IBM AMOS 25.0 프로그램을 이용하여 분석하였다. 본 연구결과는 다음과 같다. 1. 가설적 구조모형의 적합도를 평가한 결과 χ²통계량 238.317 (p<.001) 자유도(df) 62, RMSEA .084, GFI .918, SRMR .057, IFI .903, TLI .877, CFI .902, PNFI .694, Normed χ² 3.844로 적합도 평가 기준치를 충족하지 못하였다. 이에 적합도의 개선을 위해 대표적으로 활용되는 수정지수(Modification Indices : MI)를 이용하여 모형을 수정한 결과 χ²통계량 139.579(p<.001), 자유도(df) 58, RMSEA .059, GFI .951, SRMR .044, IFI .955, TLI .939, CFI .955 PNFI .688, Normed χ² 2.407로 모든 권장지수가 충족되었으며 이를 최종 가설적 구조모형으로 확정하였다. 2. 가설적 구조모형을 검증한 결과 5개의 가설이 모두 지지되었으며, 검증 결과는 다음과 같다. 1) 흡연대학생의 자율성지지는 기본심리욕구에 영향을 미치며 통계적으로 유의하였다(β=.122 p=.032). 2) 흡연대학생의 미래지향목표는 기본심리욕구에 영향을 미치며 통계적으로 유의하였다(β=.706, p<.001). 3) 흡연대학생의 기본심리욕구는 자기결정성 동기에 영향을 미치며 통계적으로 유의하였다(β=.657, p<.001). 4) 흡연대학생의 자기결정성 동기는 니코틴 의존도에 영향을 미치며 통계적으로 유의하였다(β=-.580, p<.001). 5) 흡연대학생의 니코틴 의존도 예측모형은 성별 간 차이가 있으며 기본심리욕구가 자기결정성 동기(∆χ² =4.410, p=.036)에, 자기결정성 동기가 니코틴 의존도(∆χ² =6.351, p=.012)에 미치는 인과관계의 영향력이 통계적으로 유의한 차이가 있는 것으로 나타났다. 본 연구결과 의미 있는 사람으로부터의 자율성지지와 미래지향목표가 높을수록 기본심리욕구가 충족됨을 알 수 있었으며 충족된 기본심리욕구는 건강행위 이행을 위한 자기결정성 동기를 향상시켜 흡연대학생의 니코틴 의존도를 낮추는데 직접적인 영향을 미치고 있음을 알 수 있었다. 또한 여자 흡연대학생 집단이 남자 흡연대학생 집단보다 기본심리욕구가 자기결정성 동기에, 자기결정성 동기가 니코틴 의존도에 미치는 인과관계의 영향력이 유의하게 강한 영향을 미치고 있음을 알 수 있었다. 이를 통해 흡연대학생의 니코틴 의존도를 낮추기 위해서는 자기결정성 동기 부여를 강화할 수 있는 중재가 중요함을 알 수 있으며 기본심리욕구가 충족되는 환경에 노출되면 신체활동에 대한 자기결정성 동기가 부여되고 이를 통해 건강행위 이행이 유지됨을 알 수 있었다. 따라서 흡연대학생들에게 자기결정성 동기 증진을 위한 구체적인 금연에 관한 지침을 안내하고, 성별 간 특성을 고려한 개별적이면서 영향요인을 고려한 교육과 상담을 통해 흡연대학생들이 흥미 있고 선호하는 방법을 스스로 선택하여 동기를 부여 할 수 있는 프로그램 개발이 필요할 것으로 생각되며 본 연구 결과가 흡연대학생의 금연율을 높이기 위한 간호중재 프로그램 개발의 기초자료로 이용될 수 있을 것으로 사료된다.