從個人、家庭、學校和社區面向探討影響國小學童危害健康行為發展的因素

Abstract

研究背景： 年幼時期所養成的行為，會對成年期的健康產生影響。因此以兒童作為研究對象，有助於促進健康和疾病預防介入計畫的研擬。從個人、家庭、學校和社區等多重面向之「生態模式」進行研究，可以釐清各個層級因素對學童養成危害健康行為的影響。 研究目的： 1. 瞭解研究樣本危害健康行為的分佈及因素結構； 2. 從層級觀點探討個人、家庭、學校及社區因素與研究樣本之 危害健康行為的關係； 3. 比較研究樣本在三年間的危害健康行為之分佈和因素結構； 4. 找出影響研究樣本之危害健康行為產生變化的因素。 研究方法： 使用兒童及青少年行為之長期發展研究（Child & Adolescent Behaviors in Long- term Evolution, 簡稱CABLE）計畫於2001年時之國小四年級世代為研究樣本，同時針對橫斷與縱貫資料，運用描述性分析、雙變項分析和多層級分析等統計方法，進行次級資料分析。 研究結果： 1. 研究樣本於國小六年級時之危害健康行為聚集成以下三類：(1)不良生活習慣類，包括熬夜、吃宵夜、吃速食、憋尿、長時間玩電動及看電視；(2)攻擊行為類，包括用髒話罵人、生氣時摔東西、打人和破壞公物；(3)物質使用行為類，包括吸菸、飲酒和嚼檳榔。 2. 前述三類行為總分會隨班級不同而有差異，且各類行為總分會隨時間而逐年增加。 3. 與研究樣本之危害健康行為有關的變項包括個人因素中的學童性別、學業成就及對學校喜好感；家庭因素中的父母婚姻狀況、職業等級、父母支持程度、家庭活動頻率及處罰程度；學校因素中的校長性別、導師性別、導師年齡、學校大小及導師工作壓力；社區因素中的高等教育比率、低收入戶比率及居住地區。 4. 與危害健康行為三年間變化有關的變項包括個人因素中的性別及與老師的關係；家庭因素中的父母婚姻狀況、父母教育程度、職業等級、父母支持程度之改變、家庭活動頻率之改變和處罰程度之改變；學校因素中的校長性別及學校大小；社區因素中的居住地區。 建議：針對不同因素的行為設計介入方案，介入對象應包括學童、家長及教師，並將社區特性納入考量。家長應多與子女互動，並持之以恆，且避免給予子女不當的處罰。學校應設法減輕教師的工作壓力及增加學童對學校的喜好感。政府應增加社區居民對危害健康行為相關知識的可近性，對低收入戶較多的社區提供補助和福利。

Background: Health behavior in childhood is an important predictor for adult health. Researching on the topic can facilitate the planning for health promotion and disease prevention intervention projects. By applying multi-facet ecological model, effects of personal, familial, school and community factors on childhood health risk behaviors can be better understood. Purposes: 1. To understand the distributions and latent structure of research subjects’ health risk behaviors. 2. To explore the relationships between personal, familial, school, and community factors and research subjects’ health risk behaviors from multilevel perspective. 3. To compare the distributions and latent structure of research subjects’ health risk behaviors in a three-year period. 4.To identify factors related to the change of research subjects’ health risk behaviors. Method: Secondary data analysis was conducted by using the three waves’ data of 4th graders’ cohort of Child & Adolescent Behaviors in Long-term Evolution (CABLE) project from 2001 as the main source of research subjects. Descriptive analysis, correlation analysis, and multilevel analysis were used to analyze cross-sectional and longitudinal data. Results: There are three types of 6th graders’ health risk behaviors: (1) unhealthy behaviors, including staying-up late, eating food before sleeping, eating fast-food, suppressing urination, playing video games over 2 hours, and watching television over 2 hours; (2) aggressive behaviors, including using vulgar language, destroying things when angry, fighting with others, and destroying public property; (3) substance using behaviors, including smoking, drinking alcohol, and chewing betel nut. The subtotal scores of these three types of health risk behaviors varied among classes and increase over time. Personal variables relate to research subjects’ health risk behaviors include sex, school achievement, and the extent to which subject loves his/her school. Familial variables include parent’s marital status, categorie of occupation, parent’s support, family activities, and the extent of punishment. School variables include school principal’s sex, teacher’s sex and age, school size, and teacher’s working stress. Community variables include the rate of educational level above junior college of population over 15 years old, low-income household rate, and residential area. The variables relate to the change of health risk behaviors during the three-year period include student’s sex and the change of relationship with his teacher of personal facet; parent’s marriage status, occupational level, the change of parent’s support, the change of family activities, and the change of the extent of punishment of familial facet; school principal’s sex and school size of school facet; residential area of community facet. Recommendations: In designing intervention projects on prevention, different types of childhood health risk behaviors should be taken into consideration respectively. Target populations should include students, parents and teachers. Community characteristics, especially, should be considered and embraced. For parents, more and constant interactions with children are essential; inadequate punishment should be avoided. Schools must develop a way to help release teacher’s stress and strengthen students’ loves for school. For government, to increase general public’s access to information regarding childhood health risk behaviors and to provide more subsidy and welfare for low income groups are also important.