宜蘭地區國中生肥胖相關知識、態度與行為與家庭飲食主導者關係之探討

Abstract

研究目的 過去對於青少年肥胖的研究，大部分集中於心理影響行為模式。亦即個人從事不利健康的行為，常和個人缺乏正確的知識、態度等問題有關。例如：知識→態度→行為（Knowledge→Attitude→Behavior）模型，卻鮮少質疑模型的假設－人是根據自己的理性認知產生的行為。但這樣的假設卻忽略了個人認知除了受到個人因素的影響，同時也受到家庭權力關係、社會價值與規範等社會脈絡所造成影響往往是更重要的因子，但卻經常被忽視。本研究目的有二：(一)計算宜蘭縣某國中青少年過重(含肥胖)盛行率(二)透過問卷了解家中飲食主導者與肥胖相關飲食與體能活動相關知識、態度與行為之關係。 材料與方法 本研究所使用的資料主要來自宜蘭縣某國中健康中心每學期測量國中生身高、體重之定期資料，以行政院衛生署公佈之兒童與青少年肥胖定義，利用青少年的身體質量指數（BMI）計算宜蘭地區某國中青少年過重（含肥胖）之盛行率。並利用自行發展之學生問卷與家長問卷，隨機選擇羅東地區某國中98學年度300個學生。給予學生問卷填寫完後，由學生帶回家長問卷由家中最主要準備三餐的人填寫家長問卷。依變項為國中生與肥胖相關飲食與體能活動之知識是否具有正確知識的因子之二元因子；態度是否具有認同態度之二元因子；行為是否具有正面行為之二元因子。自變項包含受訪國中生基本資料；家中飲食主導者名稱；家中飲食主導者教育程度；家中飲食主導者職業型態；受訪國中生評估自我體態；家中主要準備三餐者評估受訪國中生體態；健康中心評估受訪國中生體態；受訪國中生認為家庭飲食主導者的體態；受訪國中生與肥胖相關飲食與體能活動之知識面向題目；受訪國中生與肥胖相關飲食與體能活動之態度面向題目；受訪國中生與肥胖相關飲食與體能活動之行為面向題目；家庭飲食主導者與受訪國中生肥胖相關飲食與體能活動之知識面向題目；家庭飲食主導者與受訪國中生肥胖相關飲食與體能活動之態度面向題目；家庭飲食主導者與受訪國中生肥胖相關飲食與體能活動之行為面向題目。 結果 第一部分發現2009年宜蘭地區某國中青少年過重（含肥胖）之盛行率女性為21.85％；男性為32.11％。 第二部份利用羅吉斯回歸分析，結果發現家中飲食主導者對肥胖相關飲食與體能活動具有正確知識，家中國中生對肥胖相關飲食與體能活動的正確知識是家庭飲食主導者不具正確知識的2.24倍（95%CI=1.29-3.88，P=0.0040)。 國中生每星期運動總時數大於(含)90分鐘對國中生肥胖相關飲食與體能活動具有認同態度之勝算比為2.09倍（95%CI=1.14-3.82，P=0.0173)；國中生對肥胖相關飲食與體能活動具有正確知識在肥胖相關飲食與體能活動具有認同態度之勝算比為3.88倍（95%CI=2.15-7.02，P<0.0001)。 低年級(七年級)相較於高年級(八、九年級)肥胖相關飲食與體能活動具有正面行為之勝算比為2.11倍（95%CI=1.01-4.43，P=0.0482)，亦即國中生隨年級增加與肥胖相關飲食與體能活動反而較不具正面行為；國中生肥胖相關飲食與體能活動具有正確知識對國中生肥胖相關飲食與體能活動具有正面行為之勝算比為2.71倍（95%CI=1.35-5.46，P=0.0052)；國中生肥胖相關飲食與體能活動具有認同態度對國中生肥胖相關飲食與體能活動具有正面行為之勝算比為4.10倍（95%CI=2.05-8.20，P<0.0001)；家中飲食主導者對國中生肥胖相關飲食與體能活動具有正面行為對國中生肥胖相關飲食與體能活動具有正面行為之勝算比為5.02倍（95%CI=2.51-10.07，P<0.0001)。 結論 本研究針對宜蘭某國中的國中生，計算國中生過重(含肥胖)盛行率。利用羅吉斯回歸模型探討國中生肥胖相關飲食與體能活動的知識、態度與行為相關因子。研究結果發現國中生與肥胖相關飲食與體能活動的知識與家庭飲食主導者的知識有相關；國中生與肥胖相關飲食與體能活動的態度與國中生本身知識與每週運動的時數多寡有關；國中生與肥胖相關飲食與體能活動的行為與年級、國中生本身知識、態度及家庭飲食主導者的行為有關。意味國中生對肥胖相關飲食與體能活動需要考慮家庭飲食主導者之因素。建議未來進行青少年肥胖預防介入，需考慮家庭層次之家庭飲食主導者的因素。

Objective： Despite a number of studies addressing obesity of adolescents, very few studies have been conducted to address factors associated the adolescents’ family diet leader. The aim of this research is to investigate the prevalence of overweight（including obesity）for adolescents in Yilan and the association between variables with obesity at family diet leader and adolescents by using logistic modeling approach with particular focus on the family contextual determinants including family diet leader’s knowledge,attitude and practice. Method： The prevalence of overweight（including obesity）in adolescent in Yilan by using Department Of Health criteria.BMI (Kg/M2) was caculated from weight and height measured in physical measurement.The study subjects（n=300）were enrolled by random sampling from a junior high school in Yilan.Adolescent’s characteristis（such as demography, physical activity,self bodyimage, family’s diet leader’s bodyimage,knowledge、attitude and practices of obesity in dietary and physical activity in adolescent…） and family’s diet leader’s characteristis（adolescent’s bodyimage,knowledge、attitude and practices of obesity in dietary and physical activity in family’s diet leader…）were collected via questionnaires.

Result： The prevalence of overweight（including obesity）in adolescent in Yilan was 21.85% in female and 32.11% in male respectively.knowledge、attitude and practices of obesity in dietary and physical activity in adolescent. The odds ratio of having correct knowledge with obesity in dietary and physical activity in adolescent for family’s diet leader’s with correct knowledge versus without correct knowledge after adjusted is 2.24.（95%CI=1.29-3.88，P=0.0040). The odds ratio of having identity attitude with obesity in dietary and physical activity in adolescent for having more than 90 mins physical activity in a week in adolescent versus less than 90 mins after adjusted is 2.09（95%CI=1.14-3.82，P=0.0173).The odds ratio of having identity attitude with obesity in dietary and physical activity in adolescent for adolescent’s with correct knowledge versus without correct knowledge after adjusted is 3.88.（95%CI=2.15-7.02，P<0.0001). The odds ratio of having positive behavior with obesity in dietary and physical activity in adolescent for Grade 7 in adolescent versus Grade 8 and 9 after adjusted is 2.11（95%CI=1.01-4.43，P=0.0482).The odds ratio of having positive behavior with obesity in dietary and physical activity in adolescent for adolescent’s with correct knowledge versus without correct knowledge after adjusted is 2.71（95%CI=1.35-5.46，P=0.0052) . The odds ratio of having positive behavior with obesity in dietary and physical activity in adolescent for adolescent’s with identity attitude versus without identity attitude after adjusted is 4.10（95%CI=2.05-8.20，P<0.0001) . The odds ratio of having positive behavior with obesity in dietary and physical activity in adolescent for family’s diet leader’s with positive behavior versus without positive behavior after adjusted is 5.02（95%CI=2.51-10.07，P<0.0001). Conclusion： By using multiple logistic regression adjusting adolescents demography,family diet leader’s demography, physical activity,self bodyimage and so on, we found knowledge and behavior of family diet leader is relative to knowledge and behavior with obesity in dietary and physical activity in adolescents. These results implied that preventive programs beyond individual approaches should be implemented to weight control. And the family diet leader could be appropriate educational targets for health promotion.