【作者】 罗家有；

【导师】 孙振球；

【作者基本信息】 中南大学 ， 社会医学与卫生事业管理， 2007， 博士

【摘要】 第一章农村中学生暴力遭遇及其危险因素研究目的:(1)了解农村中学暴力遭遇发生率,包括总的发生率以及年龄别、性别发生率等;(2)了解农村中学生暴力遭遇的流行特征,如暴力遭遇类型、遭遇场所、原因和后果等;(3)了解农村中学生暴力遭遇的危险因素,包括人口学、行为和社会心理因素等;(4)为农村中学生暴力干预提供研究依据。方法:本研究为横断面研究,采用WHO暴力遭遇调查问卷,对随机选择的3620名农村中学生进行横断面的询问调查。采用epidata3.0进行数据录入,应用描述性统计方法分析各种类型暴力遭遇发生率及暴力遭遇特征,x~2检验分析各组暴力遭遇发生率的差别。以农村中学生从小至今或过去一年暴力遭遇作为应变量,应用logistic回归模型(Method=BackWard:LR,α_入=0.05,α_出=0.10),以人口学、行为和社会心理等因素为自变量,筛查可能的危险因素。结果:(1)在3620名被调查者中,41.0%的被调查者从小至今遭遇暴力,其中,情感暴力、躯体暴力和性暴力遭遇的发生率分别为27.4%、30.6%和3.2%。33.8%的被调查者在过去一年中遭遇暴力,其中,情感暴力、躯体暴力和性暴力遭遇的发生率分别为21.5%、24.3%和2.0%。(2)男生从小至今和过去一年暴力遭遇发生率(51.3%和42.9%)高于女生(31.2%和25.3%)(x~2=151.54,P＜0.01和x~2=125.06,P＜0.01)。初中女生从小至今和过去一年暴力遭遇发生率(34.8%和29.6%)高于高中女生(27.7%和21.1%)(x~2=11.11,P＜0.01和x~2=18.06,P＜0.01);初中男生过去一年暴力遭遇发生率(45.8%)高于高中男生(39.8%)(x~2=6.50,P＜0.01)。(3)施暴者中比例最多的是同学和校友(40.4%),其次是老师(21.3%)和陌生人(20.0%);学校是暴力遭遇的主要场所(55.7%),其次,放学途中(17.2%)和游乐场所(12.2%)。暴力遭遇的后果常见为心理伤害(67.9%),其次为皮肤擦(淤)伤(30.7%);仅31.8%受害者遭受暴力事件后寻求他人帮助。(4)多因素logistic回归分析结果表明:从小至今,15-16岁年龄组的农村中学生暴力遭遇的危险性相对较高(OR=1.34,P＜0.01),过去一年,13-14岁和15-16岁年龄组的农村中学生暴力遭遇的危险性相对较高(OR=1.48,P＜0.01;OR=1.57,P＜0.01)。从小至今和过去一年,女生遭遇暴力的危险性低于男生(OR=0.49,P＜0.01和OR=0.51,P＜0.01);经常泡网吧者遭遇暴力的危险性高于不或极少泡网吧者(从小至今OR=1.39,P＜0.01和过去一年OR=1.27,P＜0.05,下同);同样,经常玩电游者(OR=1.50,P＜0.05和OR=1.49,P＜0.05)、经常吸烟者(OR=1.82,P＜0.05和OR=2.03,P＜0.05)、经常欺负他人者(OR=3.78,P＜0.01和OR=3.28,P＜0.01)、经常目睹父母吵架者(OR=1.34,P＜0.05和OR=1.39,P＜0.05)遭遇暴力的危险性均较高。学习成绩中等者遭遇暴力的危险性相对较高(OR=1.41,P＜0.01和OR=1.44,P＜0.05);自评自尊水平中等和低等者遭遇暴力的危险性高于自评自尊水平高等者(OR=1.48,P＜0.01;OR=1.24,P＜0.05和OR=1.63,P＜0.01;OR=1.36,P＜0.01)。结论:(1)农村中学生从小至今遭遇暴力发生率为41.0%,过去一年中遭遇暴力发生率为33.8%;(2)施暴者中比例最多的是同学和校友,其次是老师和陌生人;学校是暴力遭遇的主要场所,其次,放学途中和游乐场所。(3)与农村中学生暴力遭遇有关的危险因素包括:人口学因素(如13-14岁和15-16岁年龄、男性)、行为因素(如经常泡网吧、玩电游、吸烟、欺负他人和学习成绩中等)和社会心理因素(如经常目睹父母吵架、自评自尊水平中、低等)。在农村中学生中,应针对上述危险因素,开展暴力预防。第二章农村中学生暴力遭遇及其行为问题研究目的:(1)采用Achenbach儿童行为自陈量表(Yourself Report,YSR)评定与分析农村中学生行为问题;(2)探讨农村中学生行为问题与暴力遭遇的相互关系,为农村中学生暴力“行为干预”提供科学依据。方法:本研究采用横断面研究方法,对3620名随机选择的农村中学生进行问卷调查。暴力遭遇采用WHO暴力遭遇调查问卷,农村中学生行为问题评定采用Achenbach儿童行为自陈量表(CBCL)。采用epidata3.0进行数据录入,应用描述性统计方法分析暴力遭遇发生率及行为问题检出率,x~2检验分析组间暴力遭遇发生率和行为问题检出率的差别;采用logistic回归模型(Method=Baek Ward:LR,α_入=0.05,α_出=0.10)分析农村中学生暴力遭遇与行为有关的危险因素。结果:(1)3260名被调查的农村中学生,1225人(33.8%)在过去一年中经历过暴力遭遇,其中,男生暴力遭遇的发生率(42.9)高于女生(25.3%),差别具有统计学意义(x~2=125.06,P＜0.01);农村中学生总的行为问题检出率为14.3%(519/3620),暴力遭遇组行为问题检出率(22.4%)高于非暴力遭遇组(10.9%)(x~2=99.206,P＜0.01),同样,男生或女生暴力遭遇组行为问题检出率分别为19.8%和26.1%,均高于非暴力遭遇组(8.7%和11.3%)(x~2=45.551,P＜0.01;x~2=65.161,P＜0.01);农村中学生暴力遭遇组各行为问题因子,包括退缩、躯体化、焦虑抑郁、社交、思维、注意、违纪、攻击、自我身份等9个因子,检出率分别为4.2%、11.9%、3.8%、6.7%、4.3%、3.5%、5.6%、4.6%和1.9%,均高于非暴力遭遇组(2.1%、5.3%、1.4%、3.1%、1.5%、1.2%、1.9%、0.9%、0.4%和10.2%),且差别均具有统计学意义(P＜0.05或P＜0.01)。(2)在logistic逐步回归分析中,将可能影响农村中学生暴力遭遇的危险因素,如人口学因素、家庭背景、个人学习成绩等作为控制变量,结果显示:与农村中学生暴力遭遇有关的行为因子,主要是躯体化(OR=2.16,95%CI:1.57-2.97)、社交(OR=1.88,95%CI:1.18-2.99)、思维(OR=1.94,95%CI:1.05-3.60)、违纪(OR=2.29,95%CI:1.27-4.16)、攻击(OR=3.85,95%CI:1.70-8.69)等因子;男生为躯体化(OR=2.13,95%CI:1.26-3.58)、社交(OR=2.25,95%CI:1.05-4.80)、违纪(OR=2.84,95%CI:1.41-5.71)等因子;女生为躯体化(OR=2.29,95%CI:1.54-3.41)、思维(OR=2.72,95%CI:1.09-6.75)、违纪(OR=2.81,95%CI:1.05-7.51)、攻击(OR=16.72,95%CI:3.66-76.35)等因子。结论:(1)农村中学生暴力遭遇组行为问题检出率高于非暴力遭遇组;(2)农村中学生暴力遭遇与其自身的行为问题有关,与暴力相关的行为问题因子包括躯体化、社交、思维、违纪和攻击等因子;(3)农村中学生暴力预防与干预项目的实施,应将有行为问题的农村中学生列入重点人群。第三章自尊在农村中学生行为与暴力遭遇间的中介效应目的:探讨自尊在农村中学生行为与暴力遭遇间的中介效应。方法:本研究采用横断面研究方法,对3620名随机选择的农村中学生进行问卷调查。暴力遭遇采用WHO暴力遭遇调查问卷,农村中学生行为问题评定采用Achenbach儿童行为自陈量表(CBCL),自尊水平的评价采用Rosenberg自评量表。相关分析和多元逐步回归模型分析各测量变量之间的联系,中介效应模型和Sobel-Test检验验证中介变量在自变量与应变量之间的完全或部分中介效应。结果:多元线性逐步回归分析结果表明,加入中介变量(自尊),减少行为与暴力遭遇之间的联系强度(β从0.232到0.226);Sobel检验证实:自尊(中介变量)在行为与暴力遭遇之间起部分中介效应(β从0.232到0.226,Sobel-Z value=2.340,P＜0.05);采用同样的模型,分别对言语、躯体和性暴力遭遇进行分析,结果表明:自尊(中介变量)在行为与言语暴力遭遇之间起部分中介效应(β从0.225到0.200,Sobel-Z value=1.992,P＜0.05);而自尊(中介变量)在行为与躯体暴力或性暴力遭遇之间无中介效应。结论:自尊水平在农村中学生行为与暴力遭遇(尤其言语暴力)之间起部分中介效应。更多还原

【Abstract】 PARTⅠExposure to Violence and Risk Factors among Rural Middle School Students in ChinaObjective:The aim of this study was to estimate the prevalence of exposure to violence and features of violence among rural middle school students in China,and to identify risk factors,which may modify such exposure.The objectives were mainly focused on the fellow aspects.First,it was to estimate the prevalence of exposure to violence,including age prevalence and gender prevalence.Second,it was to describe the features of violence,including types,spots,reason and consquence,ect. Third,it was to identify the possible risk factors,including demographic, behavior and social-psychological facotrs.Finally,it was to provide the basic study data with the interference of violence.Methods:It was a cross-sectional study.A survey using a face-to-face interview was conducted among 3620 middle school students randomly selected from a rural county.Database was established by epidata 3.0. Desciptive statatistic methods were used to analysis the prevalence and features of violence.Chi-square test was used to test the prevalence difference between each group.Logistic regression models were used to assess the possible demographic,behavior and social-psychological risk factors of exposure to violence.Results:Of the 3620 middle school students interviewed,41.0%reported to have experienced victimization during their lifetimes and 33.8%in past year.Among these victims,27.4%reported to have experienced emotional violence,30.6%physical and 3.2%sexual violence during their lifetimes.21.5%reported to have experienced emotional violence, 24.3%physical and 2.0%sexual violence in past year.Males were more likely than females to be victims in both lifetime (51.3%vs 31.2%,x~2=151.54,P＜0.01)and past year(42.9%vs 25.3%, x~2=125.06,P＜0.01).Female students from junior high school were more likely than those from senior high school to be victims in both lifetime (34.8%vs 27.7%,x~2=11.11,P＜0.01)and past year(29.6%vs 21.1%,x~2=18.06,P＜0.01),but males only in past year(45.8%vs 39.8%, x~2=6.50,P＜0.05).The major assaulters were from classmates or schoolmates(40.4%), teachers(21.3%),and strangers(20.0%).Most violence occurred at school(55.7%),followed by on the way to home(17.2%)and playing places(12.2%).As a result,67.9%reported to be harmed in mental health, and 30.7%in physical health.The percent of victims who seek for supports only accounted for 31.8%.Multiple logistic analyses indicated that the students aged at 15-16 years had increasing risk of exposure to violence in both lifetime (OR=1.34,P＜0.01)and last year(OR=1.57,P＜0.01),for the students aged at 13-14 years,only in last year(OR=1.48,P＜0.01).Female students had lower risk of exposure to violence(OR=0.49,P＜0.01 and OR=0.51, P＜0.01 respectively).Victimization was significantly more likely to occur in students,which often surf at internet-clubs(OR=1.39,P＜0.01 and OR=1.27,P＜0.05 respectively),and play electronic games(OR=1.50, P＜0.05 and OR=1.49,P＜0.05 respectively),and smoke(OR=1.82, P＜0.05 and OR=2.03,P＜0.05 respectively),and bully others(OR=3.78, P＜0.01 and OR=3.28,P＜0.01 respectively).Students who were often exposed to frequent quarrelling between parents had the higher odds ratios(OR=1.34,P＜0.05 and OR=1.39,P＜0.05 respectively).Students whose academic performances were at middle levels had higher risk of exposure to violence(OR=l.41,P＜0.01 and OR=1.44,P＜0.05 respectively).Respondents with lower self-esteem were also founded to have the higher odds ratios(OR=1.48,P＜0.01、OR=1.24,P＜0.05 and OR=1.63,P＜0.01、OR=1.36,P＜0.01 respectively).Conclusions:Exposure to violence is prevalent in rural middle school students though the prevalence of exposure to violence in rural middle school student might be lower than that in urban.The major assaulters were from classmates or schoolmates,teachers, and strangers.Most violence occurred at school,followed by on the way to home and playing places.The possible risk factors associated with exposure to violence mainly included demographic factors(13-14 and 15-16 years old,males), behavior factors(surfing at internet-clubs,playing electronic games, smoking,bullying,academic performance at middle level),and social-psychological factors(exposure to frequent quarrelling between parents,and self-esteem at low and middle level).Violence prevention projects target at risk factors should be developed and launched among rural middle school students. PARTⅡA Study on Exposure to Violence and Behavior Problems among Rural Middle School StudentsObjective:First,it was to analysis the prevalence of behavior problems.Second, it was to explore the relationship between exposure to violence and behavior problem,and to provide study data with the behavior interference of violence among rural middle school students.Methods:A cross-section study was conducted in 3620 middle school students randomly selected from rural area.A constructed data instrument and Achenbach Children Behavior Checklist(CBCL)were used to measure the exposure to violence and behavior problems respectively.Database was established by epidata 3.0.Desciptive statatistic methods were used to analysis the prevalence of exposure to violence and of behavior problems.Chi-square test was used to test the prevalence difference between each group.Logistic regression models were used to assess the possible behavior risk factors of exposure to violence.Results:Of the 3620 respondents,the prevalence of exposure to violence in past year was 33.8%(1225/3620).Males(42.9%)were more likely than females(25.3%)to be victimized,and the difference was significant (x~2=125.06,P＜0.01).The prevalence of behavior problems averaged 14.3%(519/3620),and students victimized reported significantly more behavior problems than those no-victimized(22.4%vs 10.95,x~2=99.206, P＜0.01).Similarly,males or females victimized also reported significantly more behavior problems than that no-victimized(19.8%vs 8.7%;x~2=45.551,P＜0.01 and 26.1%vs 11.3%;x~2=65.161,P＜0.01 respectively).The prevalence of behavior problem factors was significantly higher in students victimized than those no-victimized.After controlling factors,such as demographic factors,family background,academic performance et al,the result of multiple regression indicted that behavior problem factors related to exposure to violence were somatic complaints(OR=2.16,95%CI:1.57-2.97)、social problems (OR=1.88,95%CI:1.18-2.99)、thought problems(OR=1.94, 95%CI:1.05-3.60)、delinquent behavior(OR=2.29,95%CI:1.27-4.16)、aggressive behavior(OR=3.85,95%CI:1.70-8.69)in total sample,and somatic complaints(OR=2.13,95%CI:1.26-3.58)、social problems (OR=2.25,95%CI:1.05-4.80)、delinquent behavior(OR=2.84, 95%CI:1.41-5.71)in males,and somatic complaints(OR=2.29, 95%CI:1.54-3.41)、thought problems(OR=2.72,95%CI:1.09-6.75)、delinquent behavior(OR=2.81,95%CI:1.05-7.51)、aggressive behavior (OR=16.72,95%CI:3.66-76.35)in females.Conclusion:The prevalence of behavior problems in respondents victimized was significantly higher than those no-victimized.There was strong relationship between exposure to violence and behavior problems in rural middle school students,and the possible behavior problem factors were somatic complaints、social problems、thought problems、delinquent behavior、aggressive behavior.So the project targeted at adolescent violence prevention and interference should focus on those having behavior problems. PARTⅢBehavior Problems and Exposure to Violence:The Mediating Role of Self-esteem in Rural Middle School StudentsObjective:To test a model in which self-esteem mediated the effects by behavior on exposure to violence in a sample of rural middle school students.Methods:A cross-section study was conducted in 3620 rural middle school students randomly selected from rural area.A constructed data instrument and Achenbach Children Behavior Checklist(CBCL)and Rosenberg self-esteem scale were used to measure the exposure to violence and behavior problems and self-esteem respectively.Relationship and Hierarchical regression analyses were used to test the relationship between variables.Sobel Z-test was used to explore whether self-esteem partially mediated the effects by behavior on exposure to violence with significant difference.Results:Hierarchical regression analyses provided evidence that the addition of self-esteem reduced the links between behavior and exposure to violence(βfrom 0.232 to 0.226).Sobel Z-test predicted that self-esteem partially mediated the effects by behavior on exposure to violence with significant difference(βfrom 0.232 to 0.226,Sobel-Z value=2.340, P＜0.05).Emotion violence,physical violence,and sexual violence were tested by the same model respectively,and the results showed that self-esteem partially mediated the effects by behavior on emotion violence with significant difference(βfrom 0.225 to 0.200,Sobel-Z value=1.992,P＜0.05),but not on physical or sexual violence.Conclusion:Self-esteem partially mediated the effects by behavior on exposure to violence(verbal violence)among rural middle school students.更多还原