37卷4期

• Link 政策論壇 Policy Forum
• 「呷甜甜老康健？呷甜甜呷百二？」「呷甜甜老康健？呷甜甜呷百二？」
• 陳怡君
  Yi-Chun Chen
• 無
  none
• 無
  none
• 351 - 351
• 10.6288/TJPH.201808_37(4).PF01

• Link 公衛論壇 Public Health Forum
• 被忽略的熱帶疾病對非洲人群健康之衝擊與治療藥物取得之困境被忽略的熱帶疾病對非洲人群健康之衝擊與治療藥物取得之困境
• 范家堃
  范家堃
• 無
  none
• 無
  none
• 352 - 359
• 10.6288/TJPH.201808_37(4).106060

• Link 公衛論壇 Public Health Forum
• 混合研究法：創新整合程序混合研究法：創新整合程序
• 
  MICHAEL D FETTERS, SU-I HOU
• 無
  none
• 無
  none
• 360 - 365
• 10.6288/TJPH.201808_37(4).107033

• Link 綜論 Review Article
• 新一代品質報告卡設計思維－病人觀點的客製化需求資訊New generation of quality report card design considerations - patient view of the tailored need for information
• 陳宗泰、陳凱倫、邱銘心
  TSUNG-TAI CHEN, KAI-REN CHEN, MING-HSIN PHOEBE CHIU
• 品質報告卡 ； 病人觀點 ； 公開資訊 ； 客製化
  quality report card ; patient view ; disclosed information ; tailoring
• 美國雖然在1987年開始實施第一個品質報告卡，但是因為成效不彰，2010年即開始改革及宣示公開民眾真正需要且容易了解的資訊。反觀國內，報告卡雖已實施10年左右，但公布的資訊仍以專業的技術品質資訊為主，這類型的資訊雖然也很重要，但不完全是民眾就醫選擇主要參考的資訊，因此，本文提出品質報告卡成功之鏈，第一步即是要客製化病人需求的資訊，本文從報告卡成功設計的架構出發，然後詳細描述客製化病人需求資訊的重要性，以及萃取病人需求資訊的一些考量，期望能給主管機關應用參考，以及引發相關學者進一步的研究。
  Although the U.S. implemented the first quality report card in 1987, due to its ineffectiveness in 2010 the country began to reform and declare that disclosed information should be truly needed and easily understood by citizens. In contrast, quality report card system has been in effective for around 10 years in Taiwan, but the disclosure of information primarily focuses on professional and objective information. While this type of information is also important, it may not completely match the main reference information for choosing health care facilities. Hence, our article proposes a chain of successful report card design in which the first step is to tailor patients' need for information. We start from the framework of successful design and then in greater detail describe the importance of tailoring patients’ needed information along with some considerations of eliciting the information from the patients. We believe this format provides some pragmatic implications for authorities and can help scholars further advance related research.
• 366 - 374
• 10.6288/TJPH.201808_37(4).107011

• Link 綜論 Review Article
• Walk Score^®之相關文獻回顧：身體活動、步行行為及慢性疾病風險A literature review of Walk Score^®: physical activity, walking behavior and risk of chronic diseases
• 賴鼎富、廖邕、薛名淳、 林倩宇
  TING-FU LAI, YUNG LIAO, MING-CHUN HSUEH, CHIEN-YU LIN
• 宜走性環境 ； 身體活動 ； 步行行為 ； 慢性疾病
  Walk Score ; walkability ; physical activity ; walk behavior ; chronic disease
• 世界衛生組織指出身體活動量不足為全球第四位的死亡危險因子，而宜走性環境為促進身體活動、步行行為；減少肥胖、慢性疾病風險的重要決定因子之一。Walk Score^R網站為公開且能快速測量宜走性環境的新興工具，本文將系統性回顧2007年後與Walk Score^R網站及身體活動、步行行為、慢性疾病風險有關的發表研究。本文使用PubMed與華藝線上資料庫搜尋2007至2017年間，以中、英文發表的探討Walk Score^R網站與身體健康相關之文獻，經系統性地篩選後，一共納入28篇符合標準之文獻。現有研究多為橫斷性設計，且集中於加拿大與美國。我們根據健康結果將其歸納成「身體活動/步行行為」、「身體質量指數」、與「慢性疾病/醫療費用」三大範疇。納入回顧的文獻顯示，Walk Score分數與身體活動/步行行為呈正相關，但與慢性疾病的風險呈負相關。建議未來研究採用大數據，以確保研究結果的可靠性；並採取縱貫性設計，建立因果關係之推論，作為由環境層面的介入，有利提升民眾參與身體活動的重要參考。
  According to the World Health Organization, physical inactivity is the fourth most prevalent risk factor for mortality. Studies indicate that environmental walkability is one of the main determinants of physical activity, walking behavior, obesity, and chronic diseases/medical expenditure exposure. The Walk Score^R website, established in 2007, is a public, easy to navigate, and novel measurement of the amenity of a particular urban environment to walking. The aim of this study was to systematically review the literature from 2007-2017 investigating the association of Walk Score^R with several health-related outcomes. The study systematically reviewed literature on the association of Walk Score^R with health-related outcomes, primarily through PubMed and Airiti Library (2007-2017). Twenty-eight articles met the criteria and were included in this study. The majority of studies was cross-sectional and most were from the US and Canada. We generalized the findings into three broad categories: physical activity/walking behavior, body mass index, and chronic diseases/medical expenditure. Most studies reported that Walk Score^R was positively associated with physical activity and walking behavior, but negatively associated with obesity, some chronic diseases (i.e., cardiovascular disease and cancer), and medical expenditure. Future research needs to use large sample sizes and longitudinal design to understanding the causal mechanism between external measures such as Walk Score^R and health-related outcomes and provide encouragement to the public to engage in more physical activity.
• 375 - 393
• 10.6288/TJPH.201808_37(4).107023

• Link 原著 Original Article
• 運用計劃行為理論比較有無子女者之懷孕意圖－以台灣北部某區域醫院之女性護理人員為例A comparison of pregnancy intentions between women with and without children using the Theory of Planned Behavior: a sample of female nurses from a regional hospital in northern Taiwan
• 張曉涵、黃俊豪、羅筱榕
  HSIAO-HAN CHANG, JIUN-HAU HUANG, HSIAO-JUNG LO
• 計劃行為理論；懷孕意圖；有無子女；女性護理人員；台灣
  Theory of Planned Behavior ; pregnancy intention ; women with and without children ; female nurses ; Taiwan
• 目標：運用計劃行為理論之構念（行為態度、主觀規範及自覺行為控制），以台灣北部女性護理人員為例，比較分析有無子女者之懷孕意圖及相關因素。方法：針對北部某區域醫院、20-40歲、非懷孕中之女性護理人員進行網路匿名問卷調查（N=624），使用多變項羅吉斯迴歸進行分析。結果：無子女者，其對懷孕之正面、負面「行為結果評價」態度（AOR=20.43、2.35）、「主觀規範」（AOR=2.93、13.78）以及有利情境下之「自覺行為控制」（AOR=4.95），與其懷孕意圖具顯著關聯。反觀有子女者，其對懷孕之正面「行為結果評價」態度（AOR=23.87、40.50）、「主觀規範」（AOR=7.32）、有利情境（AOR=0.16、0.12）及阻礙情境（AOR=0.19）下之「自覺行為控制」，與其懷孕意圖具顯著關聯。結論：計劃行為理論之五類因素，於有無子女者，對其懷孕意圖之影響程度與方向不同。若欲提升懷孕意圖，針對無子女者，應提升其懷孕之正向態度、加強其重要他人之支持程度，並提供生育有利因素；對有子女者，則應強調懷孕生育之正面結果、加強其非長輩重要他人之支持程度，及改善阻礙因素。
  Objectives: This study compared pregnancy intention and associated factors between women with and without children, using the constructs of the Theory of Planned Behavior (TPB): Attitude toward the Behavior, Subjective Norm, and Perceived Behavioral Control, in a sample of female nurses. Methods: Anonymous online survey data were collected from 20-40-year-old non-pregnant nurses working in a regional hospital in northern Taiwan (N=624). Multivariate logistic regression analyses were conducted. Results: Among childless nurses, their attitudinal evaluations of positive and negative behavioral outcomes (AOR=20.43 and 2.35, respectively), subjective norms (AOR=2.93-13.78), and perceived behavioral control under facilitating conditions (AOR=4.95) were significantly associated with their pregnancy intention. By contrast, among nurses who were already mothers, their attitudinal evaluations of positive behavioral outcomes (AOR=23.87–40.50), subjective norms (AOR=7.32), and perceived behavioral control under facilitating (AOR=0.16–0.12) and constraining (AOR=0.19) conditions were significantly related to their pregnancy intention. Conclusions: Pregnancy intention among childless nurses and those who were already mothers was differentially associated with the five TPB-based factors, both in terms of strength and direction of effect. To increase childless nurses' pregnancy intention, efforts should be made to foster their positive attitudes toward pregnancy, increase their perceived support from significant others, and provide facilitating conditions conducive to pregnancy. By contrast, for nurses who are already mothers, such initiatives should focus on emphasizing the positive outcomes of pregnancy, enhancing their perceived support from significant peers, and reducing the constraining conditions for pregnancy.
• 394 - 406
• 10.6288/TJPH.201808_37(4).106108

• Link 原著 Original Article
• 大學生食品素養自陳量表之建構及其與飲料行為之關係Development and validation of a food literacy self-report inventory and investigation of the relationships between food literacy and dietary behavior among college students
• 羅藝方、楊淑晴、江佳勳、盧家湄
  YI-FANG LUO, SHU-CHING YANG, CHIA-HSUN CHIANG, CHIA-MEI LU
• 食品素養 ； 飲食行為 ； 大學生
  food literacy ; dietary behavior ; college student
• 目標：本研究旨在建構食品素養自陳量表，並進一步探討大學生食品素養與飲食行為之關係。方法：採取分層取樣的方式，資料蒐集時間自2017年5月至6月，正式樣本共394位大學生。結果：經預試（n=202）分析，食品素養自陳量表可區分為「互動性」、「功能性」及「批判性」三構面，各構面Cronbach's α介於.76至.87，全量表信度為.89，可解釋總變異量為66.08%。再以正式樣本（n=394）進行驗證性因素分析，量表個別項目的信度介於.40至.66；因素負荷量介於.63至.81（p＜.001）；潛在變項的組合信度為.80至.86之間；平均變異抽取量為.50至.61之間。模式的各項指標顯示本研究的適配度佳。結論：本研究所建構之食品素養自陳量表具有不錯的信效度。大學生自認為具有中等程度以上的食品素養能力，且有較好的消費者健康和飲食控制行為，但均衡飲食的習慣較差，相對的，偏差飲食行為則較高。此外，大學生的批判性食品素養比功能性和互動性食品素養更能正向預測其飲食行為。
  Objectives: The purpose of this study was to construct a food literacy self-report inventory and to investigate the relationships between food literacy and dietary behaviors among college students in Taiwan. Methods: A nationally representative sample of 394 college students was surveyed using stratified sampling from May to June 2017. Results: In a pilot study (n = 202), items were loaded on the following 3 dimensions in exploratory factor analysis: functional, interactive, and critical food literacy. The Cronbach's a was between .76 and .87, and that of the overall scale was .89 with a total variance of 66.08%. In the formal study (n = 394), we used structural equation modeling to examine the measurement model. The reliability of the individual food literacy scale items ranged from .40 to .66. Moreover, standardized factor loading ranged from .63 to .81 (p < .001), composite reliability from .80 to .86, and the average variance extracted for each dimension from .50 to .61. The indicators revealed that the measurement model had a good fit. Conclusions: The food literacy self-report inventory developed in this study is a reliable and valid measure. The status of food literacy and dietary behavior showed that the college students had at least a medium level of food literacy, and although they had good consumer health and diet control behavior, they had a poor balanced diet and deviant behavior. Additionally, compared with functional and interactive food literacy, critical food literacy positively predicted dietary behavior.
• 407 - 419
• 10.6288/TJPH.201808_37(4).107029

• Link 原著 Original Article
• 台北兒童與母親飲料及糕餅點心中游離糖攝取研究Consumption of free sugar from beverages, snacks, and desserts for children and their mothers in Taipei
• 盧立卿、呂雅婷、徐桂婷、游家佳
  Li-Ching Lyu, Ya-Ting Lu, Kuei-Ting Hsu, Chia-Chia Yu
• 游離糖 ； 飲料 ； 糕餅點心 ； 兒童 ； 世代研究
  free sugar ; beverages ; snacks and desserts ; children ; cohort study
• 目標：本研究澄清各種糖的計算方式，並探討母親與兒童飲料及糕餅點心游離糖（freesugar）的攝取狀況及相關性。方法：本次研究參考食品標示及文獻建立游離糖資料庫，並使用24小時飲食回憶法，評估來自世代研究中57對6歲及40對9歲的兒童及其母親游離糖攝取量。游離糖分成純果汁本身的糖及添加至飲料及食物中的糖，為果汁糖、飲料糖與糕餅點心糖的總和。結果：兒童游離糖平均攝取量及佔總熱量百分比，六歲為22.5±14.8g（6.4±4.3%），九歲為31.6±20.1g（8.0±4.6%），主要來自茶飲料及麵包類，九歲兒童飲料糖與游離糖的攝取量顯著高於六歲兒童（p＜0.05）。分析也發現兒童六歲時與母親攝取飲料糖（r_s=0.28, p＜0.05）跟果汁糖（r_s=0.38, p＜0.01）有顯著相關，但九歲並無顯著相關。結論：本次研究提供了台灣國人游離糖攝取量、食物來源與親子間食物攝取相關性的初步資料。發現兒童六歲時與母親飲食攝取有顯著相關，兒童六歲至九歲游離糖攝取隨年齡增加，雖皆符合國際建議（佔總熱量10%以下），但仍有進步空間。
  Objectives: The purpose of this study was to clarify methods of calculation method of sugars, to estimate the intake, and to compare the intake of free sugar from beverages, snacks, and desserts between children and their mothers. Methods: Data from a prospective cohort included 57 and 40 mother-child pairs when children were at 6 and 9 years old, respectively. Consumption of free sugar was assessed using 24-hour recall. Free sugar was defined as processed and natural sugar in sweets and fruit juices; it was the sum of the sugars in juices, drinks, and snacks, and desserts. Quantification of free sugar was based on content listings on packaged foods and on information provided by several references. Results: The average daily intake of free sugar by 6-year-old children was 22.5±14.8g (6.4±4.3% of daily energy intake), and by 9-yearold children was 31.6±20.1g (8.0±4.6% of daily energy intake). ”Tea drinks” and ”breads” were the greatest sources of free sugar consumed. The consumption of free sugar and sugar in drinks was significantly higher at age 9 than at age 6 (p<0.05). The intake of sugar from drinks (r_s =0.28, p<0.05) and juices (r_s =0.38, p<0.01) was significantly correlated between children and their mothers, when the children were 6 years of age, but not significantly correlated at age 9. Conclusions: These findings provide preliminary data on consumption of free sugar, the main food resources, and correlations between children and their mothers. Free sugar consumption increased from age 6 to 9 years, and there was strong correlation of sugar consumption between mothers and their 6-year-old children. Although the sugar consumption reported met WHO recommendations (less than 10% of daily energy intake), it still has room for improvement.
• 420 - 434
• 10.6288/TJPH.201808_37(4).106134

• Link 原著 Original Article
• 健康資訊傳播對民眾空氣汙染風險認知的影響The impact of health information dissemination on public awareness of air pollution risk
• 鄧詠竹、曾子容、 詹大千
  Yung-Chu Teng, Tzu-Jung Tseng, Ta-Chien Chan
• 空氣汙染；風險認知；資訊傳播；健康資訊
  air pollution ; risk awareness ; information dissemination ; health information
• 目標：室外空氣汙染物被證明會導致健康危害，如何透過健康資訊傳播有效提升民眾的風險認知非常重要。本研究探討民眾空氣污染的風險認知程度、對政府解決能力的信心，是否與資訊的傳播方式、資訊來源的信賴度、或本身的健康狀態等因素有關係。方法：資料使用2016年科技部傳播調查資料庫第一期第五次的調查結果，以邏輯斯迴歸進行統計分析，主要探討哪些個人因素、資訊傳播方式、資訊的信任程度、地區差異等會與民眾對空氣汙染的風險認知有關。結果：58.1%受訪者覺得空汙很可能影響自己的健康，而對於政府改善空汙狀況的信心很低（36.7%）。民眾居住地區、教育程度、個人健康狀態或快樂程度、資訊蒐集的管道、資訊的信賴程度等都對於空氣污染的風險認知或政府處理空汙能力的信心上產生顯著的影響。結論：針對不同地區、特定族群提升電視與網路所提供健康訊息的信賴感及提升對政府處理空污問題的信心，並加強男性、單身、中老年族群對於空污的風險認知。
  Objectives: Outdoor air pollution has been proved hazardous to health. It is notably important to elevate civil awareness and thorough dissemination of health information. This study tried to elucidate the associations between public awareness of air pollution, confidence in government strategies for dealing with air pollution, obtainment of air pollution information from different channels, trust in the information source, and personal health status. Methods: The data were obtained from the fifth survey of the first phase of the Taiwan Communication Survey, funded by the Ministry of Science and Technology, 2016. Personal factors, information dissemination approaches, trust in the information source, and spatial differences were explored with logistic regression to understand respondents’ perception of outdoor air pollution risks and related health behavior. Results: 58.1% of respondentss thought air pollution may affect their own health. About 1/3 (36.7%) of people lacked confidence in strategies for improving air pollution led by the government. Residence, education, personal health status or happiness, information channel, and trust in the information source had significant association with risk awareness and confidence in government air-pollution measures. Conclusions: Our results suggested the importance of enhancing the reliability of health information provided from TV and internet and boosting confidence in government actions to combat air pollution. Finally, awareness of the risk of air pollution can be improved for specific population segments including males, singles and the elderly population.
• 435 - 452
• 10.6288/TJPH.201808_37(4).107009

• Link 原著 Original Article
• 家庭接納對成年期同性戀及雙性戀者身心健康之影響The effect of family acceptance on the physical and mental health of lesbian, gay and bisexual adults
• 楊喬羽、沈瓊桃
  Chiao-Yu Yang, April Chiung-Tao Shen
• 家庭接納 ； 同性戀 ； 雙性戀 ； 健康
  family acceptance ; lesbian/gay ; bisexual ; health
• 目標：本研究旨在探討家庭接納對同性戀及雙性戀者生理及心理健康之影響。方法：透過問卷調查法蒐集620份有效樣本，包括300份同性戀樣本、125份雙性戀樣本及195份異性戀樣本資料。本研究以多變項變異數分析檢驗研究對象自評的生理健康、心理困擾及自殺意念是否因性傾向而存在差異，並以廣義線性模型分析家庭接納對個體生理健康、心理困擾及自殺意念的影響是否因性傾向而有不同。結果：統計分析結果顯示同性戀及雙性戀者之心理困擾及自殺意念均顯著高於異性戀者。不論性傾向為何，家庭接納和身心健康以及自殺意念皆有顯著的相關。此外，家人的接納對同性戀及雙性戀者心理困擾的影響程度顯著高於家庭接納對異性戀者心理困擾的影響。結論：相關機構應針對同性戀及雙性戀者之心理健康需求提供服務，並致力於促進家人對同性戀及雙性戀者之接納，以提升同性戀及雙性戀者之心理健康。
  Objectives: This study investigated the effects of family acceptance on the physical and mental health of LGB adults. Methods: Valid questionnaires were collected from 620 research participants, including 300 lesbians and gays, 125 bisexuals and 195 heterosexuals. The data were analyzed by MANOVA to examine the differences in the self-rated physical health, mental health and suicide ideation among lesbians and gays, bisexuals and heterosexuals. The data were also analyzed by a generalized linear model to examine the difference in the effects of family acceptance on the physical health, mental health and suicide ideation among lesbians and gays, bisexuals and heterosexuals. Results: LGB adults scored significantly higher than heterosexuals did on the scales on mental health symptoms and suicide ideation. Family acceptance was significantly correlated with physical health, mental health, and suicide ideation, regardless of the participants' sexual orientation. Family acceptance had a more significantly effect on LGB's mental health than on that of the heterosexual participants. Conclusions: Related agencies should develop specific mental health services for LGB adults and make efforts to increase family members' acceptance of LGB adults in order to promote their mental health.
• 453 - 463
• 10.6288/TJPH.201808_37(4).106115

• Link 原著 Original Article
• 探究工作壓力、情緒智慧和情緒耗盡之相關性：台灣營養師之實證研究The relationship among work stress, emotional intelligence, and emotional exhaustion: an empirical study on Taiwanese dietitians
• 賴苡汝、 廖梨伶、李貞慧、李佩珊
  I-Ju Lai, Li-Ling Liao, Chen-Hui Lee, Pei-Shan Li
• 營養師 ； 情緒耗盡 ； 情緒智慧 ； 工作壓力
  dietitian ; emotional exhaustion ; emotional intelligence ; work stress
• 目標：本研究旨在瞭解台灣營養師工作壓力、情緒智慧和情緒耗盡之現況，並找出情緒耗盡之預測因子。方法：全國共有320名執業中營養師志願透過線上問卷調查的方式參與本研究，研究工具包括職業壓力指標第二版、情緒智慧量表和職業倦怠量表中文版及個人資料問卷，資料分析方法為描述性統計、單因子變異數分析和多元階層迴歸分析法。結果：工作負荷大為營養師最主要的壓力來源，情緒智慧各面向表現皆高於平均值，情緒耗盡表現則為中度職業倦怠; 在醫院工作的營養師工作壓力較大、情緒耗盡情況較為嚴重。階層迴歸模式顯示所有變項可以解釋營養師情緒耗盡46.2%的總變異量，工作地點、工作壓力和情緒智慧都是情緒耗盡之顯著預測因子。結論：台灣營養師之情緒耗盡情況是一個值得重視的問題，尤其是在醫院工作的營養師問題更為嚴重。本研究發現情緒智慧是情緒耗盡的顯著預測因子，提升營養師的情緒智慧或許是未來改善情緒耗盡的重要策略。
  Objectives: The purposes of this study were to understand the work stress, emotional intelligence, and emotional exhaustion status of Taiwanese dietitians, and to determine the predictors of emotional exhaustion. Methods: A total of 320 practising dietitians voluntarily participated in the online questionnaire survey. The self-administered, structured survey consisted of the Occupational Stress Indicator-2, the Emotional Intelligence Scale, the Maslach Burnout Inventory - Chinese, and questions seeking general information. Descriptive statistics, one-way ANOVA, and hierarchical regression were performed for the analyses. Results: This study found that workload was the main source of work stress among dietitians and they were at moderate levels of burnout. The 5 subscales of emotional intelligence were all higher than the middle point of the measurement scale. Those who worked in hospitals had significantly higher levels of work stress and emotional exhaustion. The final model explained 46.2% of the variance in emotional exhaustion. Work place, work stress, and emotional intelligence were significant predictors of emotional exhaustion. Conclusions: Emotional exhaustion is a noteworthy issue among Taiwanese dietitians, especially for those working in hospitals. The study’s findings suggest a significant association between emotional intelligence and emotional exhaustion; thus, enhancement of emotional intelligence may need to be at the core of future interventions.
• 464 - 474
• 10.6288/TJPH.201808_37(4).107025