13卷5期

• Link 原著 Original Article
• 臺灣地區成年人之吸菸現況：盛行率及危險因子The Smoking Status in Adults in Taiwan Area: Prevalence Rates and Risk Factors
• 李蘭、潘怜燕、晏涵文、李隆安
  Lee-Lan Yen, Lin-Yen Pan, Han-Wen Yen, Lung-An Lee
• 成年人 ； 吸菸 ； 盛行率 ； 危險因子
  adult ; smoking ; prevalence rate ; risk factor
• 本研究之目的在瞭解臺灣地區成年人的吸菸盛行情形，並探討與吸菸有關的個人因素。抽樣的第一階段是將臺灣地區分為北、中、南、東、台北市和高雄市等六層，各層內之鄉、鎮、區先按都市化指標排序後，再按人。比率隨機抽出25個地區。抽樣的第二階段孫自各地區隨機抽出六個可訪視的集區，然援將每一集區內相連15戶地址內，18歲以上全體民眾（不論是否有戶籍登記）列為訪視對象。本調查共收到2437人的資料，其中男性1192人，女性1245人。結果發現：(1)未吸菸、偶而吸菸、經常吸菸和已戒菸者在樣本中各佔69.7%，2.3%，240%和4.00/0；(2)739位有吸菸經驗者中，未曾戒菸、戒菸當中、回復吸菸和戒菸成功者各佔60.1%，1.4%，25.4%和13.1%；(3)有吸菸者所佔比率，在二十歲及以上男性樣本之估計值、世界衛生組織標準人。與1992年臺灣地區人。組成之標準化吸菸率分別為50.8%，50.5%和50.7%；在女性樣本則分別為2.9%，2.8%和2.7%；(4)與吸菸「可能性」有關的重要變項包括性別、年齡、教育、籍貫、婚姻、職業、反菸態度、菸害警語的效果評估、及禁菸政策的支持程度。其他變項包括慢性病有無、及對反菸廣告的效果評估等，則與吸菸未達顯著相關。臺灣地區的吸菸率高於歐美國家，極需採取有效的策略予以降低。根據本研究發現，建議戒菸之教育和宣導活動，應特別針對男性、30歲以下、高中、閩南籍及原住民、已婚及鰥寡、和職業等級較低者實施。教育策略宜著重反菸態度、警語效果及政策支持等態度的改變。
  The purposes of this study were to understand the smoking prevalence in Taiwan and to investigate the Personal factors related to smoking behavior. The first step of sampling was to select 25 regions from Taiwan area while the second step of sampling was to select 6 clusters in each region. All adults over 17 years of 15 households being located in each cluster were interviewed. Data on 2437 adults including 1192 males and 1245 females were collected. The results were following: (1) the rates of non-smoker, occasional smoker, current and regular smoker, and former smoker were 69.7%, 2.3%, 48.0%, and 4.0% respectively; (2) the rates of never cessation, during cessation, relape and successful cessation were 60.1%, 1.4%, 25.4% and 13.1% respectively; (3) the current smokers in adults aged 20 and over were 50.9% for males and 2.8% for females in sample estimates; 50.3% for males and 2.7% for females in the standardized rates according to WHO's standard population; and 50.5% for males and 2.7% for females in the standardized rates according to 1992 population in Taiwan area; (4) the significant predictors of smoking were gender, age, education, native place, marriage, occupation, attitude toward refusing smoking, assessment of warning labels, and support of anti-smoking policy. Comparing to the prevalence rate of smoking in industrialized countries, there is a higher rate of smoking in Taiwan area. It is imperative that effective approaches for anti-smoking should be adopted. Based on our findings, the target population of smoking prevention programs are those who are male, aged under 30 years old, educated less than 7 years, Fukien and aborigine, married and widow, and low class laborer. Educational strategies should be emphasized on attitudes change.
• 371 - 380
• 10.6288/CJPH1994-13-05-01

• Link 原著 Original Article
• 健康促進：國民健康的新方向Health Promotion: A New Perspective of Nation's Health
• 江東亮、余玉眉
  Tung-Liang Chiang, Yu-Mei Chao
• 疾病轉型 ； 健康促進 ； 渥太華憲章
  epidemiological transition ; health promotion ; Ottawa charter
• 臺灣地區已完成疾病轉型，進入非傳染性疾病時代。面臨非傳染性疾病的挑戰，先進國家自1970年代起即積極提倡健康促進以為均健之主要策略。由於缺乏政治意願，臺灣地區的健康促進運動發展緩慢，且偏重強調個人責任。因此，我們建議臺灣地區應以渥太華健康促進憲章為發展健康促進策略之指引。
  Taiwan has completed its epidemiological transition and moved into an era of non- infectious diseases. Facing the challenge of non-infectious diseases industrialized countries have enthusiastically advocatd health promotion as one of main strategies for attaining health for all since the 1970s. Due to the lack of political will, Taiwan has made slow progress in health promotion movement. Besides, it has emphasized individual responsibility for health. We thus suggest that the Ottawa charter for health promotion be the guide for developing strategies for health promotion in Taiwan.
• 381 - 387
• 10.6288/CJPH1994-13-05-02

• Link 原著 Original Article
• 影響社區老人對護理之家居住意願的因素Factors Affecting the Willingness of Community Elderly to Reside in a Nursing Home
• 吳淑瓊、賴惠玲、江東亮
  Shwu Chong Wu, Hui-Ling Lai, Tung-Liang Chiang
• 護理之家 ； 居住意願 ； 老人
  nursing home ; willingness to reside ; aged
• 本研究的目的為探討社區老人對護理之家的居住意願及其影響因素。對台北縣市四個社區415位65歲以上老人的調查發現，21.7%的老友回答將來身體不好需人照顧時，願意居住護理之家。又向對數複?歸分析發現，在控制其他重要相關變項下，外省籍、無子女同住、及患較多慢性病的老人具較高的居住意願。
  The study aims to examine the factors associated with the willingness of community elderly to reside in a nursing home as their long-term care arrangement. Information from a survey of 415 older adults living in four communities around Taipei Area indicated 21.5% agree that they would move to a nursing home if they become sick and need others' help. The result of multiple logistic regression suggested that moving to a nursing home was more likely to be agreed by mainlanders, the older adults not living with their children, and those with more chronic conditions.
• 388 - 394
• 10.6288/CJPH1994-13-05-03

• Link 原著 Original Article
• 省市立醫院負擔政策責任項目之專家評估The Policy-Related Responsibilities of Provincial and Municipal Hospitals, Demarcation Utilizing Delphi Technique
• 陳琇玲、楊志良
  Hsiu-Ling Chen, Chih-Liang Yaung
• 政策責任 ； Delphi Method ； Delphi Technique ； 省市立醫院
  policy-related responsibilities ; Delphi Method ; Delphi Technique ; Provincial and Municipal Hospitals
• 全民健康保險實施後，公私立醫院將面對相同服務對象，接受相同醫療費用給付。故未來對公立醫院之角色與功能需重新定位。而合立醫院應如何定位之決定因素，首在於其所承擔之政策責任。至於公立醫院政策責任究竟為何，尚無研究問世，加上此類責任不易定義，且涉及個人主觀判斷，故採用專家效度法(DelPhi Method, Delphi Technique)以界定其範圍。其中又因公立醫院主管機關不一，性質各異，故先以省市立醫院為對象，進行探討。 本研究資料之收集，是透過專家徒度法，郵寄問卷，來探討學者專家所認為省市立醫院應有之“政策責任”範圍。研究結果顯示，若經75%以上專家學者認定，則界定其屬“政策責任任”或“社會責任”時，可依據各項工作屬性歸為五大類，並建議政府分別探取不同措施，以作為公立醫院未來定位之參考。
  The scheduled implementation of the plan of National Health Insurance at the end of 1994 in Taiwan will inevitably result in two things: 1) hospitals, public or private, will face patients of only one status-insured; 2) healthcare prices will be unified and fixed. Therefore, the role and function of public hospitals will need to be redesigned. Public hospital bears policy-related responsibilities bestowed by the government and those responsibilities in return determine the public hospital's role and function. However, no previous research or document ever define the policy-related responsibilities of public hospitals. Moreover, defining this kind of responsibility is ofentimes difficult and involves a great deal of subjective judgement. As far as the definition goes, this paper utilizes the Delphi Method, or Delphi Technique, to lay the basis of demarcation. Since different system of public hospital is dictated by different authorities, this paper focuses on provincial and municipal hospitals. Data used in this research paper is collected through mailing questionnares to experts whose opinions then provide the demarcation criteria for determining the policy-related responsibilities of public hospitals. The demarcation criterion of social or policy-related responsibilities is finalized when over 75 percent of experts approve of it. According to this research, there are five major groups of responses. It is then this paper suggests the authorities concerned make different policy accordingly to handle different kind of responsibilites. Eventually, those policies should be the reference for redesigning the role and function of public hospitals in the future.
• 395 - 404
• 10.6288/CJPH1994-13-05-04

• Link 原著 Original Article
• 公費醫師執業科別、地點、執業機構型態之趨勢研究Trends of Location and Specialty Selection of Government Sponsored Physicians (GSPs)
• 楊慧芬、季瑋珠
  Hui-Fen Yang, Wei-Chu Chie
• 公費醫師
  Government Sponsored Physicians GSPs
• 本研究之目的在瞭解自民國71年至80年分發至行政院衛生署系統之公費醫師服務地點、執業科別、執業機構型態之變化情形。研究對象以衛生署公費醫師電腦檔之資料為依據，並以醫學院學生檔案及衛生署醫事人員資訊系統為輔助資料來源，研究結果如下：分發組別方面：公費醫師選擇特殊科之比例逐年增加，而基層醫療組內外婦兒科逐年漸減。執業機構型態方面：因階段別不同而異。此外隨年代在合立醫院服務之比例漸減，在和立醫療院所的比例漸增；在衛生所服務之比例，第二階段逐年減少，第三階段逐年增加。執業地點方面：第一階段即住院醫師訓練階段主要集中在直轄市及其他地區，第二階段則集中在優先獎勵區及其他地區，隨著年代終優先獎勵區執業之比例增加。基層醫療組公費醫師的特色為第二階段主要在衛生所及優先獎勵區與其他地區服務。基於前述研究的發現與結論，吾人建議衛生及教育主管機關對公費醫師政策應進一步探討，且應對於台灣地區醫師人力專科別分布情形及變遷趨勢，進行深入研究。以符合醫療環境之需，並作為未來政策之參考。
  The objective of this study is to understand the charcteristics of medical institution, specialty and location selection of government sponsored physicians (GSPs) from 1982 to 1991. Subjects of the study are GSPs dispatched from 1982 to 1991. Data are collected from the GSPs file and the medical manpower file in the Department of Health, as well as the student file of each medical school. Important findings are as follows: Specialties such as anesthesia, psychiatry, etc, tend to increase, while primary health care specialties decrease annually. Medical Institutions selected by GSPs changed by time and stage of service. The proportion of public hospitals decreased but that of private hospitals increased. The proportion of health station choice decreased annually in the second stage but increased annually in the third stage of service. National Cities are the favorite locations selected in the first stage of service. But medically under-served areas become the major choice in the second stage and its proportion increased annually. The most remarkable characteristics for the GSPs of the primary health care specialty are that health stations and medically under-served areas are the major choice in the second stage. According to the findings above, we suggested that the trends of medical manpower distribution and specialty choice for GSPs should be more thoroughly evaluated. Policies and regulations related to GSPs dispensation also need to be modified.
• 405 - 418
• 10.6288/CJPH1994-13-05-05

• Link 原著 Original Article
• 台北市八十學年度國中新生的節食意向研究－理性行動理論的應用Dieting Intention in the Seventh Graders in Taipei City, 1991: An Application of the Theory of Reasoned Action
• 李蘭、陳重弘、吳裴瑤、潘文涵
  Lee-Lan Yen, Chung-Hung Chen, Pei-Yao Wu, Wen-Han Pan
• 青少年 ； 節食意向 ； 理性行動理論
  adolescent ; dieting intention ; theory of reasoned action
• 節制飲食是控制體重和預防肥胖的方法之一。為瞭解青少年想要採取節制飲食的行為意向，以系統集束抽樣法，自臺北市八十學年度國中一年級學生共47,173人中，選取1174人為研究樣本。利用體型測量儀器和結構問卷，前往各學校以集體施測方式收集相關資料。應用理性行動理論分析結果，研究對象的個人態度以持中立意見(49.2%)和反對(34.9%)者居多；他人節食規範也以中立意見(52.9%)和反對(32.2%)者居多。整體說來，研究對象的節食意向偏負向（非常不可能者佔2.0%；不可能者佔63.8%；可能者佔33.7%：非常可能者佔0.5%）。與節食意向有關的重要預測變項為體質指數、節食效能、學業成績、和家人支持等四個因素。建議對於青少年，尤其是體型肥胖而且成績稍差者，及早提供節制飲食的教育計畫，藉向自我效能的提高，以及家人的相互支持，促成節制飲食的行為意向，並教導正確的節食方法，使體重得到適當的控制。
  Dietary restraint is a way for weight control and obesity pervention. In order to understand the dieting intention among the adolescents, an investigation was conducted among the seventh graders in Taipei City junior high schools in 1991. The procedure of systematic sampling was employed to select 1,174 students as a sample. The theory of reasoned action was applied to address this problem. A wide distribution of neutral (49.2%) and negative (34.9%) attitudes toward dietary restraint was found. The subjective norms related to dietary restraint was also found to be neutral (52.9%) and negative (32.2%). Overall, the subjects dieting intention tended to be negative (absolutely impossible 2.0%; impossible 63.8%; possible 33.7%; absolutely possible 0.5%). The important predictors of dieting intention included body mass index, dieting efficacy, aclievement score, and family supports. It was suggested that the adolescents, especially the students with overweight and lower achievement scores, should be provided an educational program focused on raising their levels of self-efficacy and family supports. The optimal control of weight can be achieved when a high level of dieting intention is promoted and the correct strategies of dietary restraint are instructed.
• 419 - 431
• 10.6288/CJPH1994-13-05-06

• Link 原著 Original Article
• 中醫門診病人對傳統醫學的認知、態度與行為意向的分析研究Knowledge, Attitude and Behavioral Intention of Chinese Traditional Medicine among Outpatients
• 康健壽、陳介甫、周碧瑟
  Jian-Tso Kang, Chieh-Fu Chen, Pesus Chou
• 中醫 ； 知識 ； 行為
  Chinese traditional medicine ; knowledge ; behavior
• 本研究是以認知、態度、與行為意向三個層面去探討中醫門診病人對傳統醫學的態度，除了分析受訪者對各個問題的反應外，進一步以因素分析法將三個層面的題目歸類分組，並且探討各個共同因素在選擇不同醫院型式時的差異。於民國78年8月至10月之間，對全省有開辦勞保的26家醫院診所進行系統性抽樣與結構式問卷。共得有效樣本362位。結果顯示：(1)認知比例最高者是「中藥因藥性和治療的需要，常製成不同的劑型」，其次是「針灸是中醫常用的治療方法之一」。認知比例最低者是「拔火罐是屬於中醫的治療方法之一」。(2)對中醫的態度方面，同意比例最高的是「西藥的副作用大，而中藥的藥性溫和，不會有副作用」，其次是「西醫的治療時間短，中醫的治療過程較久」。在不同意方面，比例最高的是「西醫診斷較準確，中醫較不準確」。(3)行為意向方面最傾向中醫的有「肌肉拉傷，關節脫臼」與「肌肉關節酸痛，關節炎」。(4)求診教學醫院中醫部的病患較之求診一般中醫診所的病患：對中藥的認知較高，對中西醫藥理與療效的態度較偏向中醫，對神經精神症狀的行為意向較偏向中醫。
  A structured questionnaire was answered by persons visiting the Outpatient Clinics of two types of Chinese traditional medicine, ones in Western-style teaching hospitals, and the others area-matched regular independent Chinese medicine clinics. The purpose of this study is to disclose patients knowledge about, attitude to and behavioral intentions of Chinese traditional medicine. The total number of valid questionnaires was 362. (1) The highest percentage of agreed answers to 15 statements about knowledge of Chinese traditional medicine was Herbal drugs are made in different forms according to drugs character and effect'; the next highest was 'Acupuncture is one of the common therapeutic methods of Chinese medicine'. The lowest percentage was Cupping is one of the treatment methods of Chinese medicine'. (2) For the 14 statements about attitude to Chinese traditional medicine or Western medicine, the one receiving greatest agreement was 'Side effects of western drugs are more pronounced than those of herbal drugs, and the nature of herbal drugs is bland'; the next was 'The effective period for Western medicine to sustain effectiveness is shorter than that of Chinese traditional medicine'. The greatest percentage of disagreement came from 'The diagnostic accuracy of practitioners of Western medicine is greater than that of Chinese traditional medicine'. (3) The most frequent inclination asking the help of Chinese traditional medicine was suffering from symptoms and signs such as 'Muscle sprain, joint dislocation' and 'Muscle ache, arthritis'. Compared to patients visiting regular Chinese medicine clinics, the users of Chinese medicine clinics in Western-style teaching hospitals had better knowledge of herbal drugs, had greater positive attitude to pharmacology and efficacy of Chinese traditional medicine, and tend to seek help from Chinese medicine particularly for neuropsychological symptoms.
• 432 - 441
• 10.6288/CJPH1994-13-05-07

• Link 原著 Original Article
• 台灣地區化妝品之品質檢驗概況（77~79年度）Report on Laboratory Findings of Cosmetic Quality in Taiwan, 1988-1990
• 劉春英、簡俊生、黃文鴻
  Chun-Yin Lin, Chun-Sheng Chien, Weng F. Huang
• 化妝品 ； 檢驗
  cosmietic quality ; laboratory testing
• 80年5月立法院通過之化妝品衛生管理條例部份條文修正案，授權衛生署對於一些未含有醫療或毒劇藥品之化妝品，得免除上市前備案許可之程序。衛生署亦於80年8月公告明定化妝品之範圍及種類，並詳列免予申請備查之一般化妝類別品目。 化妝品衛生管理自此邁入一新階段，藥物食品檢驗局負責全國各類化妝品之檢驗業務，藉此管理制度新舊更替之際，將現行抽驗化妝品檢驗概況詳加敘述，並依照化狀品類別、抽驗地區等分別統計三年（77~79年度）共1722件抽驗檢體之檢驗結果，分析其不合格原因及其對民眾使用之影響，期能對化妝品製造業或政府之化妝品管理有所助益。 統計結果顯示化妝品檢驗不合格率平約達20.3%，而以含藥化狀品之不合格率（平均44.3%）較一般化狀品不合格率（平均11.3%）高出甚多，其中燙髮及染髮用劑最高，分別佔此期間檢驗不合格含藥化妝品之88.0%及8.7%；一般化妝品則以噴髮膠水、定型液及美髮整髮不合格較多，不合格情形中，或含有不符規定之氧化染髮、殺菌劑成分(23.9%)，或含甲醇、Freon成分(46.5%)，或含汞鹽者(5.0%)居多，本報告並就化妝品檢體來源之地區加以分析其不合格率，雖因檢體未具絕對代表性予以統計檢定，其不合格案件之分佈情形仍有其參考價值。
  Recent Amendment of Law for the Control of Cosmetic hygiene delegates the Department of Health with authority to exempt premarket requirement on certain general cosmetics which do not contain medicinal components. The Department of Health promulgated the Public Announcement defining the scope and categories of cosmetics which are eligible for premarket exemption on August of 1992. The regulatory control of cosmetic hygiene therefore entered a new milestone. As the National Laboratories of Foods and Drugs is required by law to perform testings on cosmetic products, this report on laboratory findings of cosmetic quality was prepared to provide laboratory results of 1722 cosmetic samples collected by local health autorities and analyzed by the National Laboratories of Foods and Drugs during 1988 to 1990. An average rate of 20.3% noncompliance with relevant cosmetic regulations was found, and 44.3% and 11.3% noncompliant rate were found in Medicated Cosmetics and General cosmetics respectively. Among the noncompliant Medicated Cosmetics, hair dye products and hair perms represent the major causes of noncompliance, which shared 88.0% and 8.7% of noncompliant Medicated Cosmetics. As for the General Cosmetics, hair spray, hair liquid, and hair style preparations containing hazardous methanol or freon were the major causes of noncomliance (46.5%), followed by containing unlabelled hair dyes or antiseptic ingredients (23.9%), and facial creams containing mercury components (5.0%). The report also descreibes the distribution of non-compliant cosmetics among various regions of Taiwan, though the testing samples may not be perfect representative, such results still bear certain reference pruposes for administrative consideration for further improvement.
• 442 - 450
• 10.6288/CJPH1994-13-05-08