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標題: | 探討臺灣青少年含糖飲料攝取行為發展及其相關因素 Examining the Development and Associated Factors of Sugar Sweetened Beverages Consumption among Adolescents in Taiwan |
其他標題: | Examining the Development and Associated Factors of Sugar Sweetened Beverages Consumption among Adolescents in Taiwan |
作者: | 林峻吉 Chun-Ji Lin |
指導教授: | 張齡尹 Ling-Yin Chang |
關鍵字: | 青少年,含糖飲料,群體軌跡,多層次,質性研究, adolescents,sugar-sweetened beverages,group-based trajectory,multi-level analyzed,qualitative study, |
出版年 : | 2022 |
學位: | 博士 |
摘要: | 研究背景:由於含糖飲料攝取導致許多代謝性疾病的發生與惡化,因此減少含糖飲料攝取已是全球公共衛生重要的議題之一。然而,含糖飲料消費市場仍然持續增加,且以亞洲地區青少年族群的含糖飲料攝取行為最為嚴重。由於青少年階段處於行為養成的重要階段,因此找出青少年含糖飲料取行為的影響因素就顯得相當重要。而過去青少年含糖飲料的研究大多著重在個人認知、家庭與同儕因素,缺乏從時間與文化脈絡下探討青少年含糖飲料攝取行為的完整架構。
研究目的:本研究主要為建構臺灣含糖飲料發展世代下青少年含糖飲料攝取行為的影響因素,詳細分為三個研究目的:其一,探討兒童時期憂鬱情緒發展軌跡與青少年階段含糖飲料攝取行為發展軌跡之關係。其二,探討青少年含糖飲料攝取行為於縣市層次中社會規範之關係。最後,探索青少年含糖飲料攝取行為的文化影響。 研究方法:本研究採用質量混合的研究框架,並根據三個研究目的分別進行:(1)以前瞻性世代追蹤研究(Prospective Cohort Studies)之資料庫,進行次級資料分析,本研究共納入1,560名從6歲追蹤至18歲之樣本,並採用群體基礎軌跡分析模型進行分析。(2)以具有全國代表性之橫斷型(Cross-Sectional Study)監測調查資料庫為資料來源,共納入879名15歲至18歲之樣本,並採用多層次分析模型進行分析。(3)質性研究的部分:以1986-1996年出生之世代作為研究對象,並採用焦點訪談與個人深度訪談交互驗證進行。研究共完成10名樣本訪談,其中4位個案以個人深度訪談進行,其餘6名個案組成1場焦點團體訪談,並從焦點訪談中招募3名個案進行個人訪談。 研究結果:針對研究目的一,本研究發現青少年族群含糖飲料攝取行為分為「低持平組」、「上升組」及「高持平組」三種軌跡變化。相較於兒童時期憂鬱情緒軌跡為「低持平組」,若兒童憂鬱情緒軌跡為「中持平組」、「高持平組」與「上升組」者,其青少年時期含糖飲料攝取軌跡為「高持平組」的風險也越高(中持平組:aOR=1.40; 95% CI: 1.07–1.84;高持平組:aOR=2.53; 95% CI: 1.62–3.94;上升組:aOR=1.88; 95% CI: 1.19–2.99)。本研究並進一步證實「睡眠問題」是兒童時期憂鬱情緒發展軌跡與青少年含糖飲料攝取習慣發展軌跡的中介之因素。在研究目的二的部分,本研究發現青少年含糖飲料攝取習慣與同年齡層的社會規範有顯著的關係(aOR=1.76; 95% CI: 1.16–2.66),並且這種關係會受到不同年齡族群社會規範調節。最後,以質性訪談方式針對研究目的三進行探究後,本研究發現臺灣含糖飲料發展世代下成長之青少年族群,其含糖飲料攝取行為係隨著生命歷程的轉化而有所不同。除了生理及心理因素是含糖飲料攝取行為的決定因素之外,時間與環境層次相互的作用亦是影響青少年含糖飲料攝取行為發展的重要因素。 結論:臺灣含糖飲料發展世代下青少年含糖飲料攝取行為極具複雜性,且同時受到個人層次、社會文化層次與時間層次等不同層次的影響。 Background: Sugar-sweetened beverages (SSBs) contributes to metabolic diseases. Therefore, reduction of SSBs intake has become a significant public health issue. However, the consumption of SSBs continues to grow, with most increases observed among adolescent population in Asia, making identification of factors that increase SSBs during adolescence enssential. Nonetheless, most of the prior studies focus on examining the personal-, familial- and peer-level factors of SSBs consumption without considering the influences of time and social-level determinants. In addition, studies that applied both qualitative and quantitative methodology to explore factors contributing to SSBs consumption are limited. Objectives: The purpose of this study was to identify factors of SSBs consumption among adolescents living in an era of rapid development in SSBs. The current study objectives were threefold : (1) examine whether childhood depression trajectories affect trajectories of SSBs consumption during adolescence; (2) investigate the associations between county-level social norms toward SSBs and the consumption of SSBs among adolescents; (3) explore the contextual impact of SSBs consumption among adolescents. Methods: A mixed-method approach was applied to examine study purpose. Specifically, secondary data analysis was conducted for study 1 with the data came from 1,560 adolescents participating in a longitudinal study across grades 2 through 12 in northern Taiwan. Group-based trajectory modeling was used to identify development of childhood depression and SSBs consumption during adolescence. For the second objective, secondary data came from the 2013–2016 Nutrition and Health Survey in Taiwan was analyzed A total of 879 individuals aged 15 to 18 were included in this study, and a multi-level analysis model was used for analyses. Finally, a qualitative design was applied to examine the third objective. Focus group and personal interviews were conducted with 10 cases born in 1986–1996 to understand and construct the framework of SSBs behavior in this generation. Results: (1) Three distinct trajectories of SSBs consumption in adolescence were identified: low-stable (44.3%), increasing (15.0%), and high-stable (40.7%). Individuals with the high-stable relative to the low-stable SSBs consumption trajectories were more likely to belong to the moderate-stable (OR: 1.39, CI: 1.06–1.82), increasing (OR: 1.85, CI: 1.17–2.93) and high-stable (OR: 2.45, CI: 1.58–3.81) trajectoreis of childhood depression than to the low-stable trajectory. Sleep problems significantly mediated the effects of all childhood depression trajectories on SSBs consumption trajectories. (2) The results of the multilevel analyses indicated that the odds of SSBs consumption among adolescents increased as the county-level social norms became more positive toward SSBs (aOR=1.75, 95%CI= 1.17–2.61). In addition, the social norms of young adults living in the same residential areas significantly moderated the association between county-level social norms of adolescents and SSBs consumption among adolescents (aOR = 1.41, 95% CI= 1.10 ¬1.90). (3) The SSBs consumption behaviors were found to vary across different life-course stages. Physiological and psychological factors were both important determinants of SSBs consumption. In addition, the interaction between time and environment was an important factor contributing to the development of SSBs consumption among adolescents. Conclusions: Adolescent SSBs concumpion behavior was complex. Factors at individul-, socio-cultural- and time-levels, as well as their interactions, will all affect SSBs behavior among adolescents. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/83284 |
DOI: | 10.6342/NTU202210126 |
全文授權: | 同意授權(限校園內公開) |
顯示於系所單位: | 健康政策與管理研究所 |
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