33卷3期

• Link 原著 Original Article
• RCA訴訟與判決裡的科學證據RCA訴訟與判決裡的科學證據
• 林宜平
  Yi-Ping Lin
• 無
  none
• 無
  none
• 219 - 222
• 10.6288/TJPH201534104048

• Link 原著 Original Article
• 職業健康檢查資料的隱私權保護職業健康檢查資料的隱私權保護
• 蔡奉真 、鄭雅文
  Yawen Cheng
• 無
  none
• 無
  none
• 223 - 226
• 10.6288/TJPH201534104041

• Link 原著 Original Article
• 台灣自殺防治十年回顧檢討與展望Suicide Prevention in Taiwan: A Ten-Year Review
• 廖士程、李明濱、龍佛衛、張家銘、吳佳儀
  Shih-Cheng Liao, Ming-Been Lee, For-Wey Lung, Chia-Ming Chang, Chia-Yi Wu
• 台灣 ； 自殺 ； 自殺防治 ； 生命統計 ； 公共衛生
  Taiwan ; suicide ; suicide prevention ; vital statistics ; public health
• 自殺死亡自1997年起進入台灣十大死因之列，並於2006年達到近年高峰，該年自殺粗死亡率為每十萬人19.3人。為因應嚴峻形勢，政府於2005年成立全國自殺防治中心，擔任推動全國性自殺防治工作之整合平臺。我國自殺防治策略，包含全面性、選擇性與指標性策略，以促進醫療及非醫療體系之自殺防治網絡整合為手段，透過臨床研究與資訊分析之實證基礎為策略依據。自2007年起自殺死亡率呈現下降趨勢，至2010年退出十大死因，於2011年由世界衛生組織定義之高自殺死亡率國家進入中度之列。未來除持續推動國家自殺防治策略外，將繼續深植「珍愛生命、希望無限」的精神於各領域，貫徹「思維全球化」、「策略國家化」、「行動在地化」的目標，以達成「自殺防治人人有責」、「人人都是珍愛生命守門人」的理想境界。
  Suicide is a tragic outcome of various bio-psycho-social adversities. In Taiwan, suicide had become one of the top-ten leading causes of death in 1997. The crude suicide mortality rate increased rapidly from 10.0 per 100,000 in 1997 to 19.3 per 100,000 in 2006. In response to this situation, the Ministry of Health and Welfare of Taiwan provided grants to implement the National Suicide Prevention Program. The goal was to promote national suicide prevention strategies, support suicide prevention tasks at the local level, and establish a ”planning nationally and acting locally” philosophy. The Taiwan Suicide Prevention Center (TSPC) was established in September 2005 to prevent suicide by enhancing the efficiency of care delivery networks in Taiwan. The TSPC is a medium to translate the scientific evidence about suicide, especially epidemiological evidence, into public health policy. The TSPC also serves as a platform to coordinate efforts between governmental and non-governmental organizations. The TSPC is in charge of standardizing the national suicide report system and aftercare delivery system, implementing pilot plans, promoting suicide gatekeeper trainings, and organizing community support networks. Every county in Taiwan has to implement the county-level program of suicide prevention, and TSPC plays a leading role in support and evaluation of each county in dealing with its own issues with suicide. The standardized suicide mortality rate went down from 16.8 per 100,000 in 2006 to 12.0 per 100,000 in 2012. Suicide dropped out the top-ten leading causes of death in 2010 and continues to do so today. In order to promote the sustainable management of suicide prevention strategies in Taiwan, the staff of the TSPC is now actively engaged in drafting the Suicide Prevention Act.
• 227 - 239
• 10.6288/TJPH201534103131

• Link 原著 Original Article
• 離開了心理健康就不能稱之為健康，心理健康司宜專責且獨立No Health without Mental Health: An Independent Department of Mental Health Should be Established
• 張珏、王長偉、顏采如、溫桂君
  Chueh Chang, Chang Wei Wang, Cai Ru Gan, Gui Jun Wen
• 組織再造 ； 心理健康司
  Organizational reform ; Department of Mental Health
• 有鑑於2013年7月衛生福利部正式成立前，在所謂朝野協商下立法院堅持將「口腔健康」併入規劃多時的「心理健康司」，作者質疑公共衛生組織架構處置的適當性，衛生署究竟對心理健康的重視程度為何？因此回顧我國從2005開始組織再造心理衛生單位的變遷，2012－2014立院公報中各立委與政府單位對話紀實的摘錄整理，並比較國際組織WHO，和美國、泰國、英國等國家衛生組織架構中，心理健康單位的位階與工作內涵。結果發現早在2005年政府組織再造的規劃藍圖已經確認了在中央層級應設立心理健康的專責單位，2005年至2012年衛福部的規劃至少經歷四個行政院核定版本，皆維持心理健康為獨立的「司」級單位（2005年「健康促進與心理衛生司」、2009年「心理健康與物質濫用防制司」、2010、2012年「心理健康司」）。目前成立「心理及口腔健康司」從立院公報可以看到是政治力及利益團體的介入，既不符合《中央行政機關組織基準法》第22條機關設立的原則，也與WHO和幾個國家組織變遷的不符合，更反應出立法委員與衛生署首長，不了解何謂全民心理健康。口腔健康加入心理健康司，非但沒有增加心理健康的人力與經費，反而出現排斥現象，也誤導對心理健康的意義。因此提出結論與建議：由各國家組織架構瞭解，口腔加入心理健康司是屬不成行政體統。衛生福利部成立已屆一年半，建議應檢討並調整，恢復「心理健康」組織的獨立和其高階組織的定位，並須將公共心理健康普及化。
  According to the negotiating meeting of different parties in Legislation Yuan, there was a decision to integrate Oral Health with the Department of Mental Health (DMH) for the newly organization reformed as Ministry of Health and Welfare (MHW) in July 2013. The authors questioned the appropriation for the organization structure as well as the negligence of mental health of the MHW from Public Health perspective. Using archive document review for the development of establishing the DMH since 2005, debates records published by Legislation Yuan, as well as reference to the organization structure of WHO, USA, British and Thailand. Results show that although the DMH has undergone four or five amendment, mental health duties have still remained to be an independent department. The establishment of the ”Department of Mental and Oral Health” is a clear mistake made by the legislators and governors. This decision was made without understanding the true meaning of mental health and putting no attention on the public health organization structures. Both legislation and government distinctly act against the legal requirement of Article 22 ”Basic Code Governing Central Administrative Agencies Organizations” and are clearly moving towards the opposite direction of the international trends. Furthermore, the competition between the oral and mental health will diminish and confuse the work of mental health for everyone. Legislative consultation claims to review after one year of implementation, and it is strongly recommended to put in real reconsideration that Mental Health unit should remain its independence in highest position; the effects of neglecting public mental health needs can be just as detrimental. Final conclusion and suggestions that it is a bias decision to integrate oral health into Mental Health Department. More efforts need to be made to understand the meaning of 'no health without mental health' as well as the meaning of mental health promotion for all and the definition of mental health /mental ill health in order to return back the appropriate structure of MHW.
• 240 - 253
• 10.6288/TJPH201534103072

• Link 原著 Original Article
• 台灣學童不健康飲食習慣、不良飲食經驗與憂鬱關聯性之探討The Associations among Unhealthy Eating Habits, Bad Eating Experiences and Depression in Taiwanese Youths
• 褚霈貞、蘇美心、楊浩然、郭柏秀
  Pei-Chen Chu, Mei-Hsin Su, Hao-Jan Yang, Po-Hsiu Kuo
• 不規律飲食 ； 飲食行為 ； 飲食偏好 ； 憂鬱
  irregular diet ; eating behaviors ; eating preference ; depression
• 目標：探討不健康飲食行為與飲食偏好之於兒童與青少年的憂鬱情況相關性。方法：本研究以台灣北部及中部549位10－13歲的國中小學童為研究樣本。採用生活調適問卷（Center forEpidemiologic Studies Depression Scale），針對學童進行憂鬱情況分析，研究對象將分為憂鬱（分數＞21分）、中度憂鬱（分數15-21），及正常（分數＜15）族群。飲食行為內容包含不規律飲食、不良飲食經驗、不健康飲食習慣和飲食偏好。分組依據採用卡方檢定和ANOVA檢定，並以羅吉斯回歸檢定飲食行為與憂鬱情況的關聯性。結果：不健康的飲食習慣在國中小學童中相當盛行，最低由47.6%有攝取宵夜之習慣至高達70.5%攝取含糖飲品，且在平均在一周內有3.1餐為不規律飲食。卡方檢定的結果指出，憂鬱組（N=71, 14.4%）相較於中度憂鬱（N=77, 14.6%）與正常（N=379, 71.9%）組，有更不規律的飲食（p=0.005）、不健康的飲食習慣（P＜0.05，分項中宵夜攝取及含糖飲料攝取例外）及不良飲食經驗（p＜0.05，分項中僅食慾被零食影響例外）。在控制性別、年齡、地區下，羅吉斯回歸顯示隨著不健康飲食習慣與的項目累計，會使憂鬱或中度憂鬱的風險上升（ORadj：2.17-6.33）；相同控制背景之下，不良飲食經驗也同樣增加憂鬱的風險（ORadj：1.79-16.5）此外，若學童對蔬菜有較不佳的偏好，也會顯示與憂鬱情況有正相關（p=0.018）。結論：不健康的飲食行為與青少年的憂鬱情況呈現正相關，同時也是憂鬱情況的風險因子。此結果顯示，應更加重視學童飲食行為的改善，以遏止日後青少年憂鬱情況的盛行。
  Objectives: Depression is prevalent in children and adolescents. We investigated whether unhealthy eating habits and eating preferences are associated with depression in Taiwanese youth. Methods: 549 students aged 10-13 years were enrolled from elementary and junior high schools in Taiwan. Using the Center for Epidemiologic Studies Depression Scale, three groups of depression were defined: depression (a score>21), moderate depression (a score between 15-21) and normal (a score<15) groups. We assessed irregular meal time, bad eating experiences, unhealthy eating habits and dietary preferences as their eating behaviors. Chi-square or ANOVA was used for group comparisons. Multivariate logistic regression was used to examine the relationship between eating behaviors and depression. Results: Unhealthy eating habits were common, ranged from 47.6% (midnight snack eating) to 70.5% (sugared beverages drinking). Taiwanese youth had on average 3.1 times per week of having irregular meal time. Depression group (N=71, 14.4%) reported to have more irregular eating meal time (p=0.005), unhealthy eating habits (p<0.05 except for snack eating and sugar beverages drinking), and bad eating experiences to influence appetites (p<0.05 except for appetite influenced by snack) than moderate depression (N=77, 14.6%) and normal (N=379, 71.9%) groups. The risk of depression or moderate depression increased with higher numbers of unhealthy eating habits (OR_(adj) ranged from 2.17-6.33) and bad eating experiences to influence appetites (OR_(adj) ranged from 1.79-16.5), with the irregular eating behavior subgroup showed a trend for a higher risk on depression. Additionally, students who had less preference for vegetables tended to be more depressed (p= 0.018). Conclusions: Commonly observed unhealthy eating behaviors are associated with higher risk of depression in youths. Interventions toward healthy eating behaviors could be considered as potential promoting strategies to reduce the burden of depression among children and adolescents.
• 254 - 267
• 10.6288/TJPH201534103126

• Link 原著 Original Article
• 護理人員代謝症候群盛行率及相關危險因子探討Prevalence of and Risk Factors Associated with Metabolic Syndrome among Nurses
• 張朔衽、廖玟君
  Shuo-Jen Chang, Wen-Chun Liao
• 護理人員 ； 盛行率 ； 代謝症候群
  nurses ; prevalence ; metabolic syndrome
• 目標：護理人員因輪班工作型態及工作繁重，是罹患代謝症候群高危險群，本研究以護理人員體檢生理數據及生活、工作型態問卷資料，調查護理人員罹患代謝症候群盛行率及探討基本特性、生活、工作型態與代謝症候群之相關性。方法：為橫斷性研究，對象為中部某醫學中心護理人員。研究工具為人員體檢生理指標及自填式問卷，回收1,129份有效問卷；其中代謝症候群定義以2007年國健署診斷標準為基準。結果：護理人員代謝症候群盛行率為5.0%。其相關危險因子包括：年齡（OR=1.11）、家族病史（OR=1.93）及目前有慢性病（OR=6.56）、行政護理人員（OR=5.22）、過去一年班別中為大夜（OR=14.15）、每周飲用含糖飲料88－175公克（OR=3.81）的護理人員易有代謝症候群風險；攝取低脂乳品類0－1杯／天較攝取1.5－2杯／天代謝症候群的風險減少68%（OR=0.32）。結論：護理人員的輪班型態、飲食行為與代謝症候群具相關性，建議醫院落實護理人員健康管理政策，追蹤體檢狀況，並對輪班型態進行檢討與修正；制定健康飲食方案與環境，改善護理人員飲食習慣。
  Objectives: Nurses are at an especially high risk for metabolic syndrome (MS) because of their heavy workload and frequent rotating shifts. We investigated nurses' annual physical check-up data and distributed questionnaires regarding lifestyle and work patterns in order to identify the relationship between prevalence of MS indicators and nurses' lifestyles. Methods: In this cross-sectional study, nurses from a medical center in central Taiwan were recruited and 1,129 completed this study. The diagnostic criteria for MS were set by the Bureau of Health Promotion, Taiwan. Results: The prevalence of MS was 5.0%. Older nurses (OR=1.11), and those with a family history of MS (OR=1.93), a history of chronic diseases (OR=6.56), administrative work (OR=5.22) or fixed nightshifts (OR=14.15) had a higher risk of MS. Those who drank beverages with 88-175 grams of sugar per week had a higher risk of MS than those who drank beverages without sugar (OR= 3.81), and those who consumed fewer dairy products (0-1 cups / day) compared with those who consumed more (1.5-2 cups / day) had a lower risk of MS (OR = 0.32). Conclusions: The prevalence of metabolic syndrome was associated with the type of shift work and pattern of diet, especially the night shift, sugary beverages, and dairy products in nurses who rotated shifts. Implications for physical check-ups and health management, shift policy and the eating environment are emphasized in our study.
• 268 - 285
• 10.6288/TJPH201534104003

• Link 原著 Original Article
• 相對剝奪感與健康－負面健康行為中介效果之驗證Relationship between Relative Deprivation and Health: Verification of Mediated Effects from Negative Health Behaviors
• 林晏如
  Yen-Ju Lin
• 相對剝奪感 ； 中介效果 ； Yitzhaki指標 ； 所得分配
  relative deprivation ; mediated effects ; Yitzhaki Index ; income distribution
• 目標：利用Baron和Kenny（1986）的中介效果概念，直接驗證吸菸、飲酒兩項負面健康行為，是否為相對剝奪感和健康的中介變項？方法：利用國家衛生研究院與國民健康署於2009年所進行的國民健康訪問調查（National Health Interview Survey, NHIS）之全國性抽樣資料，並控制個人年齡、婚姻狀況、教育程度、慢性疾病、籍貫及居住地區等變數，並將男、女性分開作分析，先分析吸菸、飲酒是否為中介變項？進而檢視其為完全中介？抑或部分中介？結果：迴歸結果顯示，男性部分，抽菸、喝酒大致存在中介效果；女性部分，抽菸幾無中介效果，但飲酒則和男性一樣，大致存在完全中介效果。結論：若政府意識到所得分配不均所造成的剝奪感，會藉由菸、酒消費以抒發心理不滿情緒，那政府除了提供更完善醫療資源以增進國人健康外，亦應重視收入不均對健康造成的衝擊，尤其當避免貧富差距更趨嚴重。
  Objectives: This study applied the concept of mediated effects, as developed by Baron and Kenny (1986), to determine whether or not negative health behaviors, including smoking and drinking, are mediated factors in the relationship between relative deprivation and health status. Methods: This study used the 2009 National Health Interview Survey (NHIS) obtained from the National Health Research Institutes and Bureau of Health promotion. After controlling for socio-demographic characteristics, we determined if complete or partial mediated effects exist. Results: For males, smoking and drinking are mediated factors between relative deprivation and health status. For females, smoking is not a mediated factor; however, drinking is a mediated factor between relative deprivation and health status. Conclusions: If the government is aware of relative deprivation as a result of an unequal distribution of income, which leads to poor health, the government should not only provide better medical resources to improve an individual's health, but also pay attention to income inequality.
• 286 - 301
• 10.6288/TJPH201534103127

• Link 原著 Original Article
• 探討知識分享行為對於社會交換理論與跨院電子病歷交換意願之中介效果Social Exchange Theory and the Intent to Exchange Cross-Hospital Electronic Medical Records - The Mediating Effect of Knowledge Sharing Behavior
• 張珠萍、鄭天浚、 蔡佳臻、張碩芳
  Chu-Ping Chang, Tien-Chun Cheng, Chia-Chen Tsai, Sho-Fang Chang
• 跨院電子病歷交換 ； 知識分享行為 ； 社會交換理論 ； 偏最小平方法
  cross-hospital electronic medical records exchange ; knowledge sharing behavior ; social exchange theory (SET) ; partial least squares method
• 目標：社會交換理論為探討社會交換行為理論，跨院電子病歷屬社會交換行為並涉及知識分享。本研究以社會交換理論為基礎，探討醫師知識分享行為對社會交換理論主要構念與跨院電子病歷交換意願之中介效果。方法：以問卷調查法，針對南部某醫學中心之醫師，發放260份問卷進行調查，有效回收220份，有效回收率84.62%。採用偏最小平方法進行資料分析，進行收斂效度和區別效度檢測，並以Sobel test進行中介效果檢驗。結果：社會交換理論中，承諾、依賴與互惠、溝通對知識分享行為具顯著正向影響；依賴與互惠對跨院電子病歷交換具顯著正向影響；知識分享行為對於社會交換理論中承諾、依賴與互惠對於跨院電子病歷交換意願具有中介效果。結論：跨院醫師間的承諾、依賴與互惠，可透過落實知識分享行為，強化跨院電子病歷交換的意願。本研究認為醫學研討會、雲端專業知識平台乃至於醫療知識社群可促使醫師間知識分享行為，改善工作績效與病患醫療照護品質，提升跨院電子病歷交換之成效。
  Objectives: Social exchange theory (SET) explores social exchange behavior. Electronic medical record (EMR) exchange includes social exchange behaviors and knowledge sharing behaviors. This study used SET as the theoretical foundation and explored the mediating effect of physicians' knowledge sharing behavior on SET factors and physicians' intent to exchange crosshospital EMRs. Methods: A total of 260 questionnaires were distributed to the physicians of a medical center in southern Taiwan and 220 were returned, yielding a response rate of 84.62%. The data were analyzed with the partial least squares method. The Sobel test was used to determine the mediating effect. Results: Commitment, dependence and reciprocity, and communication had a positive effect on knowledge sharing behavior. Dependence and reciprocity had a positive effect on the intent to exchange cross-hospital EMRs. Knowledge sharing behavior had a mediating effect on commitment, dependence and reciprocity, and the intent to exchange cross-hospital EMRs. Conclusions: Commitment and dependence and reciprocity can enhance physicians' intent to exchange cross-hospital EMRs by increasing knowledge sharing behavior. This study suggested that conferences, a cloud platform for professional knowledge, and a community of knowledge can increase physicians' knowledge sharing behavior, and enhance the performance of crosshospital EMR exchange to improve work efficiency and the quality of health care.
• 302 - 318
• 10.6288/TJPH201534103128

• Link 原著 Original Article
• 注意力不足過動症知識量表之發展及信效度評估Development and Evaluation of the Validity and Reliability of a Questionnaire to Determine Knowledge about Attention-Deficit/Hyperactivity Disorder (Adhd)
• 史麗珠、鍾佳玘、趙國玉、林雪蓉、侯嘉玲、林慧芬
  Lai-Chu See, Chia-Chi Chung, Kuo-Yu Chao, Sheue-Rong Lin, Chia-Ling Hou, Hui-Fen Lin
• 注意力不足過動症 ； 知識量表 ； 信效度 ； 教師及家長
  attention-deficit / hyperactivity disorder (ADHD) ; knowledge questionnaire ; validity and reliability ; teachers and parents
• 目標：發展一份適用於國小老師及一般家長的注意力不足過動症ADHD知識量表，並作信效度評估。方法：量表共10題，包括ADHD症狀、ADHD的出現年齡、流行特質、延誤就醫後果、可能致因、症狀持續、治療方式、停藥時機、行為治療及教師、家長可幫助患童的地方。採專家效度、已知團體差異的建構效度、項目分析、內在一致性、再測信度。研究樣本為參加新北市ADHD衛教活動的國小教師（563位）和一般家長（102位）。結果：專家效度（16位）的CVI=85.0%。項目分析方面，難度指數在29.1%至87.2%間（教師）、46.6%至68.6%間（家長），鑑別指數在24.3%至57.9%間（教師）、55.7%至89.2%間（家長）。教師的答對率（71.4%）顯著優於家長（59.0%），顯示具已知團體差異的建構效度。Cronbach’s α為0.52（教師）、0.69（家長）。22位教師及21位家長在兩週內填寫量表兩次，多落在95%一致性區間內，及沒有特別形態。結論：ADHD知識量表題數精簡，內容涵蓋範圍廣，具良好信效度，可作為測量教師、家長的ADHD知識，及評估衛教對於ADHD知識的增進成效。
  Objectives: The aims of this study were to develop a questionnaire to determine knowledge about attention-deficit/hyperactivity disorder (ADHD) of primary school teachers and parents (not necessarily those with an ADHD child), and to evaluate its validity and reliability. Methods: The study sample consisted of primary school teachers (n=563) and parents (n=102) who participated in ADHD education activities in New Taipei City. The 10 items on the questionnaire included signs, age of onset, epidemiologic characteristics, consequences if treatment were delayed, possible causes, means of treatment, when to stop medication, behavior therapy, and how teachers or parents can help ADHD children. Validity (including expert validity, item analysis, and known-group differences of construct validity) and reliability (including internal consistence and test-retest reliability) were assessed. Results: The mean content validity index (CVI) was 85% for 16 experts. The indices of difficulty were 29.1%-87.2% for teachers and 46.6%-68.6% for parents. The indices of discrimination were 24.3%-57.9% for teachers and 55.7%-89.2% for parents. The mean percentage of correct answers was 71.4% for teachers; this was significantly higher than that of parents (59.0%). Cronbach's a was 0.52 for teachers and 0.69 for parents. A total of 22 teachers and 21 parents completed the questionnaire twice in two weeks. Most of the data were within the 95% limit of agreement and there was no particular pattern. Conclusions: Our questionnaire is brief and covers many items, and it has acceptable psychometric properties. It can be used to assess the ADHD knowledge of teachers and parents, and can also be used to evaluate the educational effects of an ADHD lecture.
• 319 - 334
• 10.6288/TJPH201534103110

• Link 原著 Original Article
• 台灣城市與鄉村國中生睡眠品質與相關因素研究Sleep Quality and Related Factors of Urban and Rural Middle School Students in Taiwan
• 張宇翔、吳德敏、賴香如
  Yu-Siang Jhang, Der-Min Wu, Hsiang-Ru Lai
• 城鄉 ； 國中生 ； 睡眠品質 ； 睡眠規律性
  urban and rural ; middle school students ; sleep quality ; sleep regularity
• 目標：本研究旨在瞭解台灣城鄉國中生睡眠品質現況，並探討其重要之個人、家庭、學校和社區因素。方法：依縣市人口密度，以台北市和花蓮縣分別代表城市和鄉村。採兩步驟隨機抽樣方式，先自每縣市選取3所國中，再自六校各年級中選取四分之一班級為樣本。以匹茲堡睡眠品質問卷（Pittsburgh Sleep Quality Index, PSQI）和自陳結構式問卷進行調查，得1,796份有效資料。分析方法有卡方檢定、獨立樣本t檢定及多元迴歸分析。結果：1.城鄉國中生整體睡眠品質得分（PSQI=6.47和6.28）均大於5分，相對不理想，且城市學生週間睡眠品質較鄉村學生差（t=2.74, p＜ .01）。2.自覺健康狀況、使用電腦習慣、睡眠規律性、家庭關係、學業壓力和人際壓力是城鄉國中生整體睡眠品質的共同因素。3.七項個人、3項家庭和2項學校因素是城市國中生整體睡眠品質的重要因素，共可有效解釋27.5%的變異量。4.五項個人、1項家庭、2項學校和1項社區因素是鄉村國中生的整體睡眠品質的重要因素，共可有效解釋27.4%的變異量。結論：台灣城鄉國中生整體、週間或週末睡眠品質仍有改善空間，且相關因素不盡相同，故未來宜針對城市和鄉村國中學生發展與推動不同睡眠改善介入計畫。
  Objectives: The purpose of this study was to investigate the sleep quality and related personal, family, school, and community factors of urban and rural middle school students in Taiwan. Methods: Based on county population density, Taipei City and Hualien County were selected to represent urban and rural areas, respectively. Based on two-stage random sampling, we first selected three middle schools from each county and then selected one-fourth of the classes from each grade in the six selected schools. Valid data were collected from 1,796 participants by using the Pittsburgh Sleep Quality Index (PSQI) and a self-administered structural questionnaire. The data were analyzed using ?^2 and t tests and multiple regression. Results: (1) The sleep quality of the urban and rural middle school students was not favorable (PSQI = 6.47 and 6.28); on weekdays, the quality of sleep (QOS) of urban students was poorer than that of rural students (t = 2.74, p < .01). (2) Health status, computer use, sleep regularity, family relationships, academic stress, and interpersonal stress were common QOS factors among both urban and rural students. (3) Seven personal, three family, and two school factors were influential and explained 27.5% of the variance of QOS among urban students. (4) Five personal, one family, two school, and one community factor were influential and explained 27.4% of the variance of QOS among rural students. Conclusions: The QOS of urban and rural middle school students must be improved. However, the related factors for each group were different. Improvement programs specific to each group should be developed and implemented to promote the sleep quality of urban and rural students.
• 335 - 347
• 10.6288/TJPH201534103096