2010-2015年國家非傳染性疾病策略對東加共和國學齡 青少年健康行為改變的影響

Abstract

在東加共和國，非傳染性疾病（Non-communicable diseases, NCDs）的風險近年來一直在上升，需要採取策略性對策。為此，東加逐步實施了國家非傳染性疾病策略。本研究旨在分析湯加從 2010 年至 2015 年實施的國家非傳染性疾病策略對學齡青少年健康行為的影響。我們利用全球學校學生健康調查（Global-School Health Survey, GSHS），比較了2010年實施非傳染性疾病戰略前（n=2211）和2017年干預後（n=3333）的數據，重點關注肥胖和超重、飲食習慣、吸煙、飲酒、體育鍛煉和久坐不動的生活方式等方面的行為變化。分析採用了卡方檢驗和邏輯回歸。 研究結果顯示，東加青少年肥胖或超重的總體患病率從2010年的35%略微上升至2017年的37%。此外，女性青少年的肥胖或超重患病率從2010年的37%增至2017年的43%。在飲食習慣方面，低頻食用水果的比例從58%降至49%。此外，東加女性青少年的吸煙和飲酒行為明顯減少。女性青少年的吸煙率從2010年的23%大幅降至2017年的9.2%（OR 0.85，95% CI 0.82-0.87，P值<0.001），飲酒率也從17%大幅降至8.8%（OR 0.88，95% CI 0.85-0.91，P值<0.001）。另一方面，男性青少年吸煙的比例呈現出一定的顯著上升趨勢，但飲酒的比例上升則不明顯。青少年參加低頻率體育活動（每週≤4天）的比例也從2010年的75%顯著下降到2017年的68%（OR 0.95，95% CI 0.93-0.96，P值＜0.001）。每天久坐不動時間超過3小時的青少年比例從29%大幅降至21%（OR 0.94，95% CI 0.92-0.96，P值<0.001）。女性青少年的體育鍛煉水平有了明顯提高。 這些結果表明，東加青少年的健康行為在2010年至2017年間發生了一些重大變化。吸煙率的下降和體育鍛煉的增加表明國家非傳染性疾病策略取得了一定程度的成功。然而，肥胖或超重患病率呈上升趨勢，尤其是在女性青少年中，這表明在未來針對東加青少年的健康政策中，有必要進一步關注並採取符合東加獨特文化和社會經濟背景的干預措施。

In Tonga, the risk of Non-communicable Diseases (NCDs) has been on the rise in recent years, demanding strategic countermeasures. In response, the country has progressively implemented a national NCD strategy. This study aimed to analysis the impact of Tonga's national strategy against NCDs, carried out from 2010 to 2015, on the health behaviors of school-aged adolescents. Using the Global School-Based Student Health Survey (GSHS), I compared the data before the implementation of the NCDs strategy in 2010 (n=2,211) and after the intervention in 2017 (n=3,333), focusing on behavioral changes in areas such as obesity and overweight, eating habits, smoking, alcohol consumption, physical activity, and sedentary lifestyle. The analysis employed chi-square tests and logistic regression. Study results showed that, the overall prevalence of obesity or overweight in Tongan adolescents slightly increased from 35% in 2010 to 37% in 2017. Furthermore, the prevalence of obesity or overweight among female adolescents increased from 37% in 2010 to 43% in 2017. Regarding dietary habits, there was a decrease in low-frequency fruit consumption from 58% to 49%. Additionally, smoking and drinking behaviors significantly decreased among Tongan female adolescents. Smoking rates among female adolescents dramatically decreased from 23% in 2010 to 9.2% in 2017 (OR 0.85, 95% CI 0.82-0.87, p-value <0.001), and alcohol consumption rates also significantly declined from 17% to 8.8% (OR 0.88, 95% CI 0.85-0.91, p-value <0.001). On the other hand, while slightly significant, there was a little increasing trend in smoking and alcohol consumption among male adolescents. The proportion of adolescents engaging in low-frequency physical activity (≤4 days per week) also significantly decreased from 75% in 2010 to 68% in 2017 (OR 0.95, 95% CI 0.93-0.96, p-value < 0.001). The proportion of adolescents spending more than 3 hours a day in sedentary behavior significantly reduced from 29% to 21% (OR 0.94, 95% CI 0.92 to 0.96, p-value < 0.001). A notable improvement in physical activity levels was especially seen among female adolescents. These results indicate that health behaviors among Tongan adolescents underwent several significant changes between 2010 and 2017. The decrease in smoking rates and the increase in physical activity suggest a certain level of success of the national NCD strategy. However, the increasing trend in the prevalence of obesity or overweight, especially among female adolescents, suggests that further attention and interventions compatible with Tonga's unique cultural and socioeconomic context are necessary in future health policies targeting Tongan adolescents.