兒童時期壓力生活事件類型與青少年時期不健康飲食行為之關聯性

Abstract

背景： 世界衛生組織指出全球每年大約有70%的死因與非傳染性疾病有關，其中非傳染性疾病的危險因子為吸菸、飲酒過量、身體活動量不足以及不健康飲食。不健康飲食指的是攝取高熱量及低營養價值的食物，例如：吃速食、炸物、甜食、零食等來做判斷。臺灣近年來由於飲食西化的影響，青少年不健康飲食的比例越來越高。而影響不健康飲食行為的因素有很多，其中之一為壓力生活事件之類型，且目前也多以橫斷性研究為主，缺乏較長時間的縱貫性研究，難以深入探討壓力生活事件類型與不健康飲食行為之間的關係。 目的： 本研究欲分析兒童時期壓力生活事件的類型及探討兒童時期的壓力生活事件類型與青少年不健康飲食行為之關係。 方法： 本研究設計為縱貫性研究設計，使用兒童與青少年行為之長期發展研究計畫 (Child and Adolescent Behaviors in Long-term Evolution)，擷取2006年就讀國小六年級的第一世代樣本，以有完整填答國中三年級時之不健康飲食行為者為研究樣本進行資料分析，共2,205名。除了壓力生活事件類型為自變項及不健康飲食行為為依變項外，另納入性別、父母教育程度、家庭經濟狀況及身體質量指數為共變項。 本研究使用Latent Gold 6.0進行壓力生活事件類型之統計分析，並以潛在類別分析方法 (latent class analysis)作為主要統計方法。而壓力生活事件類型與不健康飲食行為的關係則使用SAS 9.4統計軟體，以羅吉斯回歸做分析。

研究結果： 本研究顯示研究樣本於兒童時期所經歷的「壓力生活事件」可以分為兩種類型：「多元壓力組」與「童年穩定組」，且不同壓力生活事件類型與青少年的「不健康飲食行為」有關。相較於童年穩定組，研究樣本於兒童時期所經歷之壓力生活事件若屬於「多元壓力組」，則其有高頻率不健康飲食行為的風險顯著較高¬［勝算比：1.64 (95%信賴區間：1.17－2.29)］。本研究亦發現不健康飲食行為的其他相關因素包括：性別、教育程度及身體質量指數。性別方面，相較於男性，女性有高頻率不健康飲食行為的可能性較低［勝算比：0.64 (95%信賴區間：0.53－0.77)］；教育程度方面，父母有較高學歷者成為高頻率不健康飲食行為的可能性也較低［勝算比：0.60 (95%信賴區間：0.42－0.85)］。另外，身體質量指數愈高，成為高頻率不健康飲食行為的可能性則較低［勝算比：0.95 (95%信賴區間：0.93－0.97)］。 結論： 本研究結果發現兒童時期的壓力生活事件存在著不同類型，且對青少年時期的不健康飲食行為有影響。由此結果，本研究建議除了加強關注青少年不健康飲食行為之外，政府部門在規劃相關介入策略時，也須將不同壓力生活事件之類型一併納入考慮。

Background: According to the World Health Organization, about 70% of global deaths are related to non-communicable diseases every year, and the risk factors for non-communicable diseases are tobacco use, harmful use of alcohol, physical inactivity and unhealthy eating behavior. Unhealthy eating behavior refers to the intake of high-calorie and low-nutritive foods, such as snacking, fast food, drinking sweet drinks or eating fried food, etc. In recent years, due to the influence of westernization of diet in Taiwan, the proportion of unhealthy eating behavior among adolescents has been increasing. There are many factors that affect unhealthy eating behavior, one of which is stressful life events. Most previous studies are cross-sectional studies, and lack of long-term longitudinal studies is difficult to deeply explore the relationship between the types of stressful life events and unhealthy eating behaviors. Aims: This study aims to analyze the types of stressful life events in childhood and to identify the relationship between the types of stressful life events in childhood and unhealthy eating behaviors in adolescents. Methods: This study was designed as a longitudinal study. The data was obtained from the Child and Adolescent Behaviors in Long-term Evolution project. Participants who were in the sixth grade of elementary school in 2006 (Cohort One) and had complete data on unhealthy eating behaviors in the third grade of junior high school were selected as the study sample, resulting in a total of 2,205 individuals. In the current study, stressful life events were the independent variable and unhealthy eating behaviors were the dependent variable. There were also other covariate variables in the study, namely sex, parental education, family economic status and body mass index. The types of stressful life event types were analyzed using latent class analysis, while the relationship between the types of stressful life events and unhealthy eating behaviors was analyzed using logistic regression. Results: Two types of stressful life events were identified in the current study: “childhood stable” and “multi-stress.” The results of multiple logistic regression showed that, compared with adolescents in the childhood stable group, those in the multi-stress group had a higher risk of unhealthy eating behaviors (Odds ratio, OR=1.64, 95% CI=1.17－2.29). In addition, girls were less likely to engage in high-frequency group of unhealthy eating behaviors than boys (adjusted odds ratio, aOR=0.64, 95% CI=0.53－0.77). In terms of education level, adolescents whose parents had higher education levels were less likely to be in the high-frequency group of unhealthy eating behaviors than those whose parents had lower education levels (aOR=0.60, 95% CI=0.42－0.85). Furthermore, adolescents with a higher body mass index had a lower likelihood of being in the high-frequency group of unhealthy eating behaviors (aOR=0.95, 95% CI=0.93－0.97). Conclusion: This study found that there are different types of stressful life events in childhood and have an impact on unhealthy eating behaviors in adolescence. The findings suggested that it is important not only to pay more attention to unhealthy eating behaviors among adolescents but also to consider the influence of different types of stressful life events when developing and implementing the programs.