13卷6期

• Link 原著 Original Article
• 臺灣地區醫院歇業及新設之決定因素The Determinants of Hosptial Closure and Opening in Taiwan
• 謝琇蓮、江東亮
  Hsiu-Lien Hsieh, Tung-Iiang Chiang
• 醫院歇業 ； 醫院新設 ； 開放系統模式
  hospital closure ; hospital opening ; open system model
• 近年來，臺灣的醫療環境變化劇烈，由於醫院間的競爭增加，政府介入的加深，使得醫院的經營面臨許多困難。1982年臺灣地區醫院家數為593家，其中114家(19.2%)，到1989年業已歇業，但同一時期，另有346家醫院新設立。本研究以衛生署既有的醫院電腦檔為分析資料，採開放系統中自然模式，來探討醫院組織本身及環境因素對臺灣地區醫院歇業及新設的影響。本研究重要結果有：(1)以地理分布來看，歇業醫院多位於都市化地區，新設醫院則有向鄉村設立的趨勢；(2)病床數少的醫院易歇業也易新設，但新設醫院的平均規模大於歇業醫院；一般看來，存活醫院從1982年到1989年有擴大規模的傾向；(3)影響醫院新設，除病床數以外，還有醫院的服務科別及社區的農業人口百分比。
  In face of increasing public intervention and competition, hospitals in Taiwan have been in the difficulty of running since 1980s. In 1982 there were 593 hospitals in Taiwan, of them 114 or 19.2% were closed by 1989. During the same period, however, 346 new hospitals were opened. This study used secondary data to investigate the determinants of hospital closure and opening in Taiwan. The results of this study showed: (1) Most of the closed hospitals were located at municipal cities while most of the new hospitals at suburb and rural areas; (2) Bed size was a major determinant of hospital clousure and opening, but the size of new hospitals' was larger than that of the closed hospitals; from 1982 to 1989, the average size of survived hospitals increased; (3) Besides bed size, type of services as well as proportion of agriculture labor were significantly related to hospital opening.
• 453 - 458
• 10.6288/CJPH1994-13-06-01

• Link 原著 Original Article
• 中華民國八十年度醫院評鑑結果之分析Outcome Analysis of the 1991 National Hospital Accreditation Survey
• 蘇喜、戴政
  Syi Su, J. J. Tai
• 醫院評鑑 ； 分數分佈 ； 評鑑通過率 ； 評鑑等級 ； 評量表之信度及效度
  hospital accreditation ; score distribution ; accreditation rate ; accreditation level ; reliability and validity of the forms
• 行政院衛生署所主辦之「八十年度臺灣地區醫院評鑑暨教學醫院評鑑」目的在將受評醫院評為四個等級（分為醫學中心、區域醫院、地區教學醫院、地區非教學醫院四個等級）。本研究旨在分析這次評鑑結果，進而探討1.申請各級別醫院在各大項分數及總分之分佈，2.探究各層級醫院之醫院評鑑通過率，3.醫院評鑑所用評量表之信度與效度，4.各類醫院評鑑等級之分項最低標準（及格分數之切點），5.各層級醫院之缺點分析等。 由此次醫院評鑑之分析我們發現：1.各分項評鑑成績之分佈大都不是常態分佈，而總分（各分項之總和）之分佈較對稱，2.評鑑成績平均通過率為71%，尤以區域醫院最高83.3%，地區教學醫院最低63.6%，3.評鑑之信度及效度仍不甚理想，可經由評量表之重新設計及委員之行前說明來改善，4.由各項最低標準未通過率可了解各層級醫院應努力之方向，5.缺點數分析反應出地區非教學醫院之缺點數反較地區教學醫院、醫學中心及區域醫院少，顯示缺點之不能以「數目」來計算，應考慮其相對應之權數。 總而言之，1.政策如鼓勵「專科」醫院之發展或容許各醫院發展其特色則不應以總分作為評鑑之依據，2.為因應全民健保之需求，目前評鑑合格之地區教學醫院仍嫌不足，應輔導改進，3.應借助信度之提高，評量表之設計及缺點之分析仍可幫助改善現有制度之效率。
  The Health Department of R.O.C. performed the Hospital Accreditation Program again in I99lfor evaluating the four levels of accredited hospitals. The data from this program were used to explore: 1. the score distribution and accreditation rate among variable accreditation levels of hospitals, 2. the passing rate among each accreditation level of hospitals, 3. the cutting boundary of each accreditation level for each studied item, 4. the shortcomings analysis among four different level of hospitals, etc. Review of this program has provided several findings: 1. The score distributions of most subitems don't appear to be normal, while that of total seems to be more symmetric, 2. The average passing rate is 71%, with the highest 83.3% of regional hospital, lowest 63.6% of the district teaching hospital, 3. The defect analysis reveals that the district non-teaching hospital have the no. of defects, less than that of district teaching, medical center and regional hospitals. In short, if hospitals are allowed to develop its own specialty character, the accreditation consideration should not be based on total score. Instead, the specialized subitem scores should be heavily weighted. However, if general hospitals are advocated by policy, the accreditation concern based on total score seems suitable.
• 459 - 472
• 10.6288/CJPH1994-13-06-02

• Link 原著 Original Article
• 台灣地區國民自付醫療費用調查：1992年國民醫療保健支出調查之初步發現National Out-Of-Pocket Medical Expenditures in Taiwan-Primary Report of the 1992 National Medical Expenditure Survey
• 石曜堂、葉金川、楊漢湶、羅紀琼、張明正、吳正儀
  Yao-Tang Shih, Chin-Chuan Yeh, Han-Chuan Yang, Joan C Lo, Ming-Cheng Chang, Jeng-Yi Wu
• 自付醫療支出 ； 健康保險 ； 醫療利用
  Medical Expenditure?;?Health Insurance?;?utilization
• 全民健康保險保險費的收取，是以「量出為入」的方式為主，因此對醫療費用的掌握，是保險財務的重要工作。衛生署於民國81年4月至6月進行「國民醫療保健支出調查」，藉此蒐集相關資料。本調查以全台灣地區現住戶為母全體，共抽樣5500戶，採結構式問卷面訪調查，共計完訪4994戶，21,617人。結果發現：中低收入家庭對醫藥支出有較大的經濟壓力，約42%的受訪戶認為，全年醫藥支出占全家總收入5%~10%時，會影響家庭現有經濟狀況。對於醫療供給的便利性與服務品質，受訪者較多正面評價，但對醫療價格則較多負面評價。西醫門診是民眾最常利用的醫療服務。回推母群體後，15歲以上有保險者各類醫療利用次數皆較無保險者高，其中住院與中醫門診兩類相差約2倍。年齡愈大醫療利用次數愈頻繁，女性平均較男性利用次數高。除中醫門診外，無保險者比有保險者需自付較高的費用，以住院費用差距60%最多。推算民國81年台灣地區民眾自付醫療費用共約為1,300億元，65歲以上老人每人每年自付費用為10,088元，是全人口平均自付費用6,340元的1.6倍。
  The amount of National Health Insurance premium will be based on payments to all medical providers, therefore it is very important to proximate the health care expenditure. The 1992 National Medical Expenditure Survey was held from April to June by Department of Health. All households in Taiwan were assumed as population, from which 5,500 households were randomly selected. A total of 4,994 households and 21,617 individuals were completely interviewed. Low income households suffer more from the medical expenses. 5% to 10% of total family income spent on the medical bill will influence their daily living, expressed by 42% of the sample households. People of age 15 and above with insurance use both outpatient and inpatient services more often than those without insurance, visits of inpatient and traditional Chinese outpatient services of the former are both about two times more of the latter. Besides, the older use more than the younger, women use more than men. Except traditional Chinese medicine outpatient service, the uninsured pay higher out-of-pocket expenses than the insured. The estimate for 1992 national out-of-pocket medical expenditures is 130 billion NT dollars. Per capita annual expense for the old (65 and above) is 10,088 NT dollars, which is 1.6 times more than the national average.
• 473 - 484
• 10.6288/CJPH1994-13-06-03

• Link 原著 Original Article
• 前瞻性付費制度(Prospective Payment System)之醫療管理模式研究Integration and Application of Medical Management Model under Prospective Payment System
• 莊逸洲、陳理
  Yi-Chou Chuang, Lee Chen
• 無none
  P.P.S Prospective Payment System ; Managerial Model ; Practice Parameter ; Concurrent Review ; Retrospective Review ; DRGs Diagnosis Related Groups ; Case payment
• 自1960年代晚期起，美國醫療費用支出開始加速成長，造成醫療財政上極大的壓力，其全國醫療費用總支出佔國民生產毛額(GNP)比例到1992年已接近14%，而世界各國只要實施健康保險或社會保險之國家，均同感醫療費用的上漲所造成的衝擊，各專家學者紛紛投入各項研究，期望抒緩財政危機，1983年美國國會通過社會安全法修正案之決議DRGs/PPS(Prospective Payment/Pricing System Based on DRGs)，將醫療費用支付制度由論件計酬制改為前瞻性付費制度，之後世界各國亦相繼採用，此種以約束費用給付之新方法建立了醫院及醫師、護士等醫療人員唇齒相依之合作觀念，並對改進病患之醫療建立共識。我國之醫療費用持續成長已是不爭的事實，依全民健康保險規劃，有關住院費用將採用診斷關係群(DRGs)作為醫院服務項目的支付基準，但由許欠缺健全的成本會計制度及完整之病歷分類管理，擬先實施單一疾病支付制度(Case Payment)，依此而官，我國與世界許多國家一樣，面臨一個新的醫療給什方式，為求因應醫療與管理人員必需縝密合作、互補所短並建立一套管理制度，以控制醫療成本及維護醫療品質。 為了控制醫療成本及維護醫療品質許多專家提出許多管理之方法與對策如：醫療處置的標準化及住院前、住院中及回溯審查，醫師檔案制度等作業是其中重要一環，醫療資源管理亦扮演不可或缺之角色，甚至組織架構的重整亦為其中一角，這許多方法與對策均有專家研究証實有效，但至今並未有人可將各種有效之管理對茉重整以今揮更高效益，本模式將各專家學者研究今表實際有效之管理方法，如臨床醫療參考基準定義醫療過程及醫療處置標準，以適當的使用醫療服務，另如住院中審查及回溯審查等對醫療作業之成本及品質作持續之改善，其它如設施運用審查、醫師檔案應用、醫師教育訓練等方法經過深入研究、探討，去蕪存精、整合串連起來，為使管理模式之訂定完全被醫療人員接受以確切執行達成管理目的。模式設計時需考量之重點相當多，如充份尊重醫療專業，給予應有之自主性，不以行政手段干預醫療，將行政之角色定位淤幕療作業上，而高效率管理項採行Z理論的策略，Z理論為科學式管理及人際關係管理的綜合體，科學式的管理最重要的發展是目標管理，人際關係管理方面則為參與式管理，將二項管理加以結合，則可獲得一種『參與式目標管理』，作為PPS的管理理論基礎，管理實務作業則以簡單之作業方式進行重點或異常管理，增加作業成功率。另異常之提出並非作為懲處之用，而係作為醫師共同檢討之題目，檢討結果為修正基準之依據。此模式以緊密結合各專業人員各司其職貫穿會串，以收事半功倍之效。為改善現行低效率之人工或紙上作業，並由電腦資訊管理專家就醫療資料特性多次研擬，完成龐大之住院病患管理作業藉由電腦協助之處理模式，並以不增加電腦線上作業之負荷，但可達成各項預先設定之目的為首要重點，此管理模式是將控制醫療成本及維護醫療品質有效方法之串連，是一套可提高效率、有具體效益而簡單可行之管理模式。
  From the late 60's, there has been a huge increase in medical expenses in the US. The ratio of total medical expenses to GNP was nearly 14% in 1992. As a result, heavy burden was put on the country's economy. Similar financial impact can be felt by any country implementing health insurance. Hence, a lot of research was carried out, aiming to lessen such financial crises. When the Prospective Payment/Pricing System (PPS) based on DRGs bill was passed in the US in 1983, the method of payment changed from fee for service to PPS, and was then adopted by many other countries. This new payment method has encouraged the cooperative concept among hospitals, doctors and nurses. It is now evident that medical costs in Taiwan continue to rise sharply. According to the national health insurance scheme, DRGs will be used as the basis for in-patients payments. However, as we are lacking a satisfactory cost accounting system and the management of medical record classification is still not flawless, it is now planned that the method of Case Payment will be used when the system starts. To face the new payment system, medical specialists and hospital management personnel must cooperate closely to control medical cost, and at the same time maintain high quality of health care services. Policies and models proposed to achieve these objectives include standardization of concurrent and retrospective review. Important cores are the estalishment of profiles of medical doctors, the management of medical resources and structural reorganization. Research have shown that such policies are effective. Nevertheless, no one to date has combined all of these to formulate a single comprehensive model. This model includes the procedures involved in defining practice parameters and standards. It also examines the continue improvement in cost and quality control by concurrent and retrospective review. In addition, utilization review, application of doctors profile and continued education for medical practitioners are all parts of the model. With careful editing and compilation, this model is designed to be applicable and effective. Special attention is paid to ensure that the medical professionals are fully respected. The role of the management is to provide administrative support but not to interfere with any practices. Operational procedures for abnormal management, the purpose of which is for revision and discussion but not punishment, must be simple. Medical data analysis is an importnat domain in our model formulation. Information and system analysis experts are consulted to consider how to accomplish all the predetermined goals without increasing computer CPU workload substantially. As the model combines of all effective cost and quality control methods, we anticipate that the use of this simple effective managerial model will increase efficiency and productivity of a hospital.
• 485 - 499
• 10.6288/CJPH1994-13-06-04

• Link 原著 Original Article
• 醫科學生預防醫學教育的新嘗試－SHE Project之介紹及評估An Inovation in Teaching Preventive Medicine for Medical Students-Introduction and Evaluation of the She Project
• 莊人祥、任一安、郭旭崧
  Jen-Hsiang Ghuang, I-An Jen, H. Sung Kuo
• 預防醫學教育 ； 子宮頸抹片檢查 ； 子宮頸癌
  preventive medical education ; Pap smear test ; cervical cancer
• 目前國內醫學系的合共衛生教學，仍未臻理想。本研究的目的在誘導醫學生向其親友進行衛生教育，除可向其中獲得經驗，以彌補課堂之不足外，更希望能確實地落實預防醫學教育。由於子宮頸癌是台灣地區最常見的婦女癌症，故本研究利用陽明醫學院醫、牙三年級學生修習「公共衛生學導論」的時候，規定同學須鼓吹其最親近的女性親友接受子宮頸抹片檢查，並於學期末繳交這份檢驗結果及心得報告，佔成績的10%。我們將此計畫命名為SHE Project(Student-initiated Health Education project)。總共有159位學生修課，學期末共繳回88份抹片檢查結果、158份心得報告和129份不記名問卷。估計學生的計畫執行率達87.4%，成功率達63.3%，學生對此計畫的滿意度亦在85%以上。綜合以上的結果，我們覺得SHE Project是有必要的、可行的、有效的，而且應該繼續推廣下去。
  The public health education programs for medical students in Taiwan is far from desirable. The purpose of this study is to describe and evaluate an inovative education program which requires medical student to persuade their female relatives at risk to have Pap smear tests. We expect that not only will the students benefit from this experience which cannot be taught in the classroom, but the goal of preventive medicine will be surely achieved as well. The study used the data collected from the third-grade medical and dental students who took the course of Introduction of Public Health. All students in the class were asked to persuade their close female relatives to have Pap smear test and deliver the examination report and the written report in the final session. The reports will count 10% of the total score. The whole project was named SHE Project (Student-initiated Health Education Project). There was 159 students in the class and 88 examination reports, 158 written reports and 129 anonymous questionnaires from students were received in the final session. The rate of execution for the project among students was 87.4%, the rate of success for the students to persuade was 63.3%, and the rate of satisfaction of the students to the project was above 85%. As the result, we suggest that the SHE Project is a necessary, feasible, effective and worth promoting program in teaching preventive medicine.
• 500 - 505
• 10.6288/CJPH1994-13-06-05

• Link 原著 Original Article
• 國中性教育效果研究The Effect of Sex Education in a Junior High School in Taipei City
• 晏涵文、李蘭、林燕卿、秦玉梅
  Han-Wen Yen, Lee-Lan Yen, Yen-Chin Lin, Yu-Mei Chin
• 性教育 ； 性知識 ； 性態度
  Sex Education ; Sex Knowledge ; Sex Attitude
• 本研究目的在探討國中學生經過性教育援其性知識、性態度的效果及所使用的性教育教材的適用性情形，並了解學生對此次性教育的評價。 本研究立意取樣台北市南門國中二年級四個班的學生為研究對象兵161人，經隨機分派為實驗組（80人），控制組（81人）採不相等實驗組、控制組設計。兩組學生在性教育前，均接受性知識、性態度問卷前測，經12小時的教學後，對二組學生再施以後測，並使實驗組學生作學習過程評價。所得資料以二因子共變數分析，百分率敘述及x^2考驗進行統計分析，得重要結論和建議如下： 一、在「性知識」總分及「青春期的身體變化」、「兩性角色與關係」分測驗上，接受性教育教學的學生比未接受者，在性知識分數上有增加，達到預期效果。其它分測驗「性教育概念」、「友誼關係」、「負青的性行為」、「婚姻與生育」上，則不論接受性教育與否，測驗分數沒有差別。 二、接受性教育的學生比未接受者在性態度的總分上更正向‧性別角色態度上則更符合雙性化，自慰態度上，異性交往態度更健康，且對婚前性行為態度上，更趨保守。另女生在教學後對性教育的態度顯示出更正向和支持。 三、這是一值得教育行政單位推廣的計劃。 四、本研究仍具有其類推的限制，如須有受過性教育訓練之師資，校方的行政支援等。
  The purposes of this study were to assess the effect of the sex education in a junior high school and the propriety of the sex education materials, and to realize the students' to evaluate intervention. An unequal experiment and control groups design was used in this study. Four classes of 8th Grade students from The Nan-Men Junior High School in Taipei City were purposively selected as a sample. Subjects were 161 students, 80 students were randomly assinged to the experiment group while the other 81 to the control group. Both groups attended a pre-test of the sex knowledge and attitude. The experiment group participated in a 12-hour sex education activity. After the intervention, both groups attended a post-test, and the experiment group also did a process evaluation. Using The Two-Factor Analysis of Covariance, Percentile Description and X^2-Test to analyze the data, the conclusions were: 1) The experiment group's scores of the ”Sex knowledge”, ”Physcial Changes in Puberty” and ”Gender Roles and Relationship” were higher than those of the control group. On the other hand, the experiment group's scores of the ”Concepts of Sex Education”, ”Friendship”, ”Responsible Sexual Behavior” and ”Marriage and Fertility” did not differ from those of the control group. 2) The experiment group's attitudes toward the ”Sexual Attitude”, ”Gender Roles”, ”Masturbation”, ”Dating” and ”Premarital Sexual Behavior” were more positive than those of the control group. Additionally, female students' attitudes showed more positive than those of male students. 3) This project could be recommended to the educational departments for giving a trial. 4) This study was limited in generalization, because of the lack of sex education training for teachers and administrative unmatch.
• 506 - 515
• 10.6288/CJPH1994-13-06-06

• Link 原著 Original Article
• 互動關係量表之應用及其效度研究A Validation Study of the Scale for the Assessment of Dyadic Interaction for Mother-Child Interaction
• 蕭淑貞
  Shu-Jen Jhiau
• 互動關係 ； 主要照護者 ； 兒童 ； 評量表
  Dyadic interaction ; Primary caregiver ; Child ; Assessment scale
• 「互動關係量表」(Scale for the Assessment of Dyadic Interaction)是由美國兒童精神科醫師Dr. Horacek所發展，用來評估兒童與其主要照顧者互動的關係。此量表是依據兒童發展結構理論(the structural theory)而設計出來的，它包括二十二個項目。本研究主要目的在於探討複製(replicate)此「互動關係量表」，應用朴高危險性家庭之可信度與有效性問題。在本文中此二十二個項目及二類目（情感關係類目、獨立／象徵性表達類目）之信度與效度皆在本文中被討論。由評量者間的信度，內在一致性(internal consistency)以及同時效度(concurrent validity)的結果顯示「互動關係量表」適用於評量高危險性家庭中母子互動關係，且可預測兒童語言與其適應行為之發展。
  The ”Scale for the Assessment of Dyadic Interaction” (SADI) was developed by Dr. Horacek to assess multiple aspects of the interaction phenomenon between primary caregivers and children with 12 indicators. This study was to replicate Dr. Horacek's original study and evaluate the psychometric properties of the SADI by assessing the dyadic mother-child interaction from 67 high-risk families engaged in a free-play episode. In this study, the reliability and validity for each indicator, two subscale scores in ”affective relationship” dimension and in ”independence symbolic expression” dimension, and the total scores were estimated and discussed. It was found from the result of the interrater reliability, the internal consistency, and the predictive validity that the SADI is well-applicable for assessing mother-child interaction of high-risk families, and can be as a predictor of the child's language and adaptive behavior development.
• 516 - 522
• 10.6288/CJPH1994-13-06-07

• Link 原著 Original Article
• 現行規定下噪音危害之個人採樣與區域採樣差異性之探討Discussion of the Differences of Personal Noise Sampling and Area Sampling under Existing Rules
• 莊昭華、王榮德
  Chao-Hua Chuang, Jung-Der Wang
• 噪音 ； 個人採樣 ； 區域採樣
  Personal noise sampling ; Area sampling
• 勞工個人噪音暴露量一般以個人噪音劑量計(personal dosimeter)之測值為準。但因個人噪音劑量計每次只測定一人，其成本負擔不輕。因此本文欲以噪音計(sound level meter)之區域採樣測值和個人噪音劑量計之個人採樣測值相比較，嘗試建立一複?歸模式以探討用噪音計預測個人噪音暴露量之可行性。將相似作業之勞工，歸為同一個作業區，每個作業區隨機取數人，配戴個人噪音劑量計半個工作天，及利用噪音計測定5分鐘之均能音量(Equivalent Sound Level)，扣除23筆不合適之資料後，共得l41筆資料。利用複?歸方程式分析，以噪音計測值及個人噪音劑量計測定過程中有出現超過115、140 dBA之高噪音訊號，三個變項來預利個人噪音劑量計之則值，則三個變項皆達統計之顯著差異(P=0.0001, 0.0001, 0.0178)，表示作業環境中，有超過115 dBA之短暫高噪音出現時，會使本文噪音計測定值低估之現象加大。向分項作業區測得結果之比較來看，於鋁和鐵鑄、油漆、研磨、車體裝配等作業，屬於高相關性之作業(r=0.96, 0.94, 0.88, 0.84)，而鍛造和壓鑄、機械零件、引擎裝配等作業，兩測定值之相關性較低(r=0.69, 0.67, 0.63)。因此我們推論工廠中，兩到定結果相時隨高及無短暫高噪音出現之作業區，可考慮利用本文之測定方法，先求得兩方法測定值之最適相關方程式，如生產產品無更換，則以後就可利用短暫之噪音計測定來估算其個人噪音暴露量；反之則不適用。
  The most commonly used method to evaluate personal noise exposure is the noise dosimetry method. To determine whether the noise exposure could affect the workers' health, a complete noise survey is essential. To obtain individual noise exposure in a large employee group, however, often takes tremendous time and effort. The purpose of this study is to compare the measurements from personal sampling and area sampling, and to develop an efficient noise survey strategy which can estimate real workers' noise exposure. The employees were categorized into several exposure zones according to the exposure characteristics of noise during their tasks. Several workers were randomly selected from each exposure zones. Each of the selected workers wore noise dosimetry for half of the shift, and a fiveminute noise measurement was taken for each personal sample with a SLM. The result from personal noise dosimetry were compared with the SLM results from the same person. A short term and high noise level of over 115 and 140 dBA were found to indenpendently and significantly affect the dose prediction from the SLM (Using multiple regression analysis, p=0.0001 and p=0.0178). A higher correlation was found between the dosimetry data and the SLM result in the aluminium and iron smelting, painting, grinding, and assembling areas. We conclude that a complete personal noise survey should be performed before the SLM could be used as a reference method to evaluate the workers' noise exposure, and that the SLM may be used to evaluate workers' noise exposure in areas that produce more correlated results between the SLM and dosimetry.
• 523 - 531
• 10.6288/CJPH1994-13-06-08

• Link 其他 Others
• 台灣地區拒菸宣言台灣地區拒菸宣言
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  none
• 今年（83年）5月30、31日為響應世界拒菸日(World No-Tobacco Day)，本會與行政院衛生署、中華民國胸腔病學會、中華民國家庭醫學醫學會共同主辦『台灣地區菸害與健康學術討論會』。會中結合台灣地區有關菸害研究之學者、專家分別就：『吸菸行為及其預防教育之研究』、『吸菸之流行病學及其對健康之危害』、『戒菸方法之比較與評估』、『吸菸之經濟、法律與政策觀』等主題，發表相關研究結果與觀點。並邀集政府與民間團體共同討論，將所得共識擬成『台灣地區拒菸宣言』，於台北市中山堂公開發表。此宣言的發表得到大眾傳播媒體的熱烈?響，對促進給非吸菸者一個較為純淨的生活空間有相當助力。 茲將『台灣地區拒菸宣言』全文刊載於本會雜誌，冀由客會員先進將此宣言精神廣為傳播，以達眾砂成塔之效。
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• 532 - 534
• 10.6288/CJPH1994-13-06-09