37卷5期

• Link 政策論壇 Policy Forum
• 減糖之意涵與關鍵策略Challenge and strategy for sugar reduction
• 潘文涵、葉乃華、洪淑怡
  Wen-Harn Pan, Nai-Hua Yeh, Shu-Yi Hung
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  none
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• 475 - 480
• 10.6288/TJPH.201810_37(5).PF02

• Link 綜論 Review Article
• 台灣公共衛生教育之發展與挑戰Development and challenge of public health education in Taiwan
• 陳為堅、黎伊帆、連盈如、 張純琦、江東亮
  WEI J. CHEN, YI-FAN LI, YIN-JU LIEN, CHUN-CHI CHANG, TUNG-LIANG CHIANG
• 公共衛生教育 ； 公共衛生人力 ； 教育評鑑 ； 公共衛生師法 ； 個人認證
  public health education ; public health manpower ; education accreditation ; Public Health Specialist Act ; personal certificate
• 台灣的公共衛生（以下簡稱公衛）教育與國家整體的公衛發展有密切的關係。本文旨在整理並回顧台灣公衛教育的發展與演進，作為進一步改革台灣公衛教育的參考。我們先依歷史資料及教育部1998至2015年之統計資料，將台灣公衛教育的發展歷史分成四個時期：草創期（1939到1970年），茁壯期（1971到1990年），擴充期（1991到2007年），及重整期（2007年之後），詳細回顧有關公衛系所之設立、教師結構、與學生人數等實證資料。其次，我們探討這些結果與趨勢所顯示的議題與挑戰，包括核心課程、能力測驗、系所評鑑、及人力需求。最後，我們提出對於未來的一些展望，像是建立專業組織以進行機構評鑑、通過公衛師法以推動專業認證、以及開發新興公衛人力巿場。
  Public health education in Taiwan has been parallel with the nation's public health development, reflecting the health demands in the society. This study aimed to empirically review the evolution of public health education in Taiwan, and discuss the future direction of education reform in public health. First, after reviewing the historical documents and the statistical databases created by the Ministry of Education from 1998 to 2015, we divided the nation's development of public health education into four stages: founding stage (1993-1970), thriving stage (1971-1990), rapid-expansion stage (1991-2007), and reorganization stage (after 2007). We then reviewed the trend of the establishment of public health-related departments or institutions, the composition of faculty, and the number of enrolled students in the higher education. Second, we discussed critical issues revealed by these empirical data, including core courses, competence examination, the evaluation of departments/institutions, and job markets. Lastly, we suggested some directions for future reforms, such as establishing professional organization to conduct accreditation for departments/institutions, advocating Public Health Specialist Act to certify professionals, and fostering emerging human resources market for public health professionals.
• 481 - 498
• 10.6288/TJPH.201810_37(5).107031

• Link 綜論 Review Article
• 醫院整合醫學照護制度（Hospitalist）對住院照護品質的影響，台灣文獻綜論Effects of hospitalist systems on the quality of inpatient care in Taiwan: a literature review
• 汪秀玲、洪純隆
  HSIU-LING WANG, SHEN-LONG HOWNG
• 醫院整合醫療主治醫師 ； 品質衡量 ； 住院天數 ； 死亡率 ； 病人滿意
  hospitalist?;?quality measure?;?length of stay?;?mortality?;?patient satisfaction
• 因應高齡多重慢性病及急診擁塞，台灣於2015年試行醫院整合醫學制度（Hospitalist，簡稱HP），已有部分醫院參與。儘管先前國際研究HP表現逾20年，但關於HP能否改善照護品質仍有分歧，本文藉由文獻回顧的綜合發現，探討台灣HP模式對住院照護品質之影響。作者搜尋PubMed資料庫、華藝線上圖書館以及衛福部HP計畫成果發表會議研究摘要，發表或陳現台灣HP效率、臨床結果之初級資料被納入，排除概念性文章，23份文獻中17份符合準則納入分析，並根據Donadedian品質三面向（結構－過程－臨床結果）衡量，摘錄品質資料以評估HP之表現。結果顯示台灣HP病房平均醫師人力為7人、病床46床，HP排值模式為二班（85.71%）或三班（14.29%），醫師以內科專科領域為主（65.71%）。與傳統病房模式比較，47項品質衡量中31項呈現HP表現較佳（65.96%）、16項HP表現較差（34.04%）。整體而言，HP模式能降低轉入加護病房率（50%）、醫糾件數（100%），但病人滿意度降低（66.67%）；HP模式能縮短住院天數（50%）、醫療費用降低（100%）、急診待床比率降低（50%）；HP模式能降低14天/30天再住院率（87.50%）、48小時重返急診（100%），但死亡率提高（71.43%）。整體而言，相較於傳統住院照護，HP是有效率的提供者（住院日數、醫療費用減少），HP的臨床品質與傳統模式相當（再入院率降低），然而，死亡率、病人滿意度尚待改善。多數文獻沒有校正干擾因素可能影響研究結果的外部效度。
  Coping with aging, multiple chronic diseases, and hospital emergency congestion, Taiwan implemented a trial program of hospitalist (HP) care provision in some hospitals in 2015. Although more than two decades of international research has examined the performance of HP models, disagreement remains regarding whether HP improves inpatient care quality. This literature review summarizes findings from comparative evaluations to explore the effects of HP models on care quality in Taiwan. We searched PubMed databases, Airiti Library, and Ministry of Health and Welfare national conference reports published or presenting primary data on efficiency and clinical outcomes in Taiwan’s HP systems. A total of 23 articles were identified; conceptual articles were excluded. The remaining 17 articles meeting the inclusion criteria were reviewed. According to Donabedian’s three-concept measures of structure, processes, and outcome, comparative evaluations of quality between HP systems and attending physicians were analyzed. Of publications reviewed, average manpower was seven physicians per 46 beds in HP wards. HP duty scheduling was either three shifts (57.14%) or two shifts (42.86%). Internal medicine was the most common specialty (65.71%). HP models outperformed the traditional ward model in 31 of the 47 quality measures (65.96%); however, 16 evaluations revealed worse performance (34.04%). The reviewed articles demonstrated that HP care reduces admissions to intensive care units (50%), medical malpractice (100%), patient satisfaction (66.67%), average length of stay (50%), medical expenditures (100%), bed waiting times (50%), postdischarge 14-day and 30-day readmission rates (87.5%), and 48-hour returns to the emergency department (100%); however, mortality was higher (71.43%). In summary, Taiwan HP wards are more efficient providers of inpatient care than traditional wards are based on reductions in total medical expenditures and length of stay. The clinical quality of HP wards is comparable to that provided by traditional wards; however, patient satisfaction and mortality are not uniformly improved. Failure of some of the reviewed studies to adjust for confounders may affect the external validity of our results.
• 499 - 513
• 10.6288/TJPH.201810_37(5).106140

• Link 原著 Original Article
• 應用空間資訊技術探討環境綠蔽度與雙相情緒障礙症之空間關聯－以台北都會區為例Association between surrounding greenness and bipolar disorder using spatial informatics: a study in Taipei
• 陳映融、洪語晨、潘文驥、龍世俊、吳治達
  YINQ-RONG CHERN, YU-CHEN HUNG, WEN-CHI PAN, SHIH-CHUN CANDICE LUNG, CHIH-DA WU
• 環境綠蔽度；雙相情緒障礙症；心理健康；常態化差異植生指標；空間資訊技術
  surrounding greenness ; bipolar disorder ; mental health ; Normalized Difference Vegetation Index (NDVI) ; spatial informatics
• 目標：本研究整合地理資訊系統、遙感探測技術以及統計模型，以探討環境綠蔽度與雙相情緒障礙症之關聯。方法：本研究經由健保資料庫承保抽樣歸人檔以獲取2003年至2012年台北都會區（含台北市及新北市）各鄉鎮雙相情緒障礙症之季發生率資訊；並透過MODIS之全球常態化差異植生指標（Normalized Difference Vegetation Index, NDVI）資料庫，以量化環境綠蔽度；最後使用廣義加乘混合模型，在校正社會經濟、人口學、環境、共病症等可取得之風險因子與時空自相關情況下，探討環境綠蔽程度與雙相情緒障礙症發生率之關聯性。結果：研究結果發現，NDVI與雙相情緒障礙症發生率之關聯達到統計上之極顯著水準（p＜0.01），係數值為-0.51（95%CI: -0.68, -0.48），取自然對數後得相對風險值為0.60（95%CI: 0.51, 0.71），代表當鄉鎮之NDVI每上升一個四分位距（IQR=0.33）時，雙相情緒障礙症之發生率會降至原來的0.60倍。結論：由此可知，環境綠蔽度的增加與雙相情緒障礙症發生率的減緩具有正向的關聯性。
  Objectives: This study investigated the association between surrounding greenness and bipolar disorder in the Taipei metropolitan area (Taipei City and New Taipei City) using a geographic information system and remote sensing technologies. Methods: The seasonal incidence of bipolar disorder from 2003 to 2012 for each township in the Taipei metropolitan area was calculated based on medical records extracted from the Longitudinal Health Insurance Database 2000. Surrounding greenness information was collected as the normalized difference vegetation index (NDVI) provided by NASA's Moderate Resolution Imaging Spectroradiometer. The generalized additive mixed model was applied to examine the relationship between surrounding greenness and bipolar incidence after adjusting for socioeconomic status, demographic characteristics, environmental factors, and comorbidity. Results: Accounting for potential confounding variables, we found a statistically significant negative relationship between NDVI and bipolar incidence (regression coefficient: -0.51; 95% confidence interval [CI]: -0.68, -0.48; p<0.01). The adjusted relative risk for bipolar incidence was 0.60 (95% CI: 0.51-0.71) per interquartile range increment (0.33) on NDVI. Conclusions: Surrounding greenness is statistically associated with bipolar incidence in the Taipei metropolitan area.
• 514 - 526
• 10.6288/TJPH.201810_37(5).107047

• Link 原著 Original Article
• 核酸擴增試驗應用於捐血者病毒檢驗之成本效益分析Analysis of cost saving from nucleic acid amplification testing of all blood donations for viral infection in Taiwan
• 許鈴宜、程仁偉、林東燦、魏昇堂、侯勝茂
  LING-I HSU, JEN-WEI CHEN, DONG-TSAMN LIN, SHENG-TANG WEI, SHENG-MOU HOU
• 核酸放大試驗；輸血感染（TTI）；成本
  nucleic acid amplification test (NAT) ; NAT yield case ; transfusion-transmitted infection (TTI) ; cost
• 目標：台灣於2013年全面施行捐血者核酸放大試驗（Nucleic acid Amplification Test, NAT）來篩檢愛滋病毒（HIV），C型肝炎病毒（HCV）及B型肝炎病毒（HBV）。本研究以NAT實施四年所避免之輸血感染數來評估常規免疫酵素法加測NAT之後，相對於只用免疫酵素法檢測可節約之成本。方法：我們以免疫酵素法檢驗血清標記陰性而NAT檢驗陽性（NAT yield case）個案數、可製成血品數、輸血族群未曾感染比例及病毒傳染力來估計可避免輸血感染數（transfusion-transmitted infection, TTI）。雖然捐血加測NAT增加血液供應成本，但加測NAT可節省支出包含TTI之醫療照護成本、道義救濟成本、訴訟成本及HIV帶原捐血者二次傳播醫療成本。我們比較兩者之間的差異來進行成本效益分析。結果：2013-2016年共檢測7,001,347人次，NAT yield case為HIV 6人，HCV 52人及HBV 1,927人。NAT檢驗及人事成本共738,534,700元。TTI估計值為HIV 16.7例、HCV 115.6例、HBV 55.2例，以及HBV潛隱性個案持續捐血至65歲造成TTI 1,032.2例，合計可避免之TTIs共1,219.7例。可節省之醫療照護成本259,075,635元，道義救濟金642,000,000元，法律訴訟97,800,000元，捐血者二次傳播醫療成本28,448,352元，合計1,027,323,987元。結論：2013-2016台灣捐供血系統全面加測NAT實際檢驗支出7.4億元，預估可避免約1,220例TTIs，預估可節省支出10.3億元。以輸血感染事件而言，自全面篩檢至今（2018年3月）未曾發生HIV TTI，篩檢成效明確。
  Objectives: Nucleic acid amplification testing (NAT) of all blood donations for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV) has been performed in Taiwan since 2013. We analyzed the benefits of universal NAT by estimating the number of prevented transfusion-transmitted infections (TTIs) and calculating the saved cost of medical expenditures, relief payments, litigation costs, and medical care for secondary HIV transmission. Methods: We determined the number of NAT yield cases (seronegative NAT-reactive donors) during the study period of 2013–2016. The number of prevented TTIs was estimated based on the number of NAT yield cases after considering the number of blood components produced per donation, recipient susceptibility, and viral infectivity. Results: Among 7,001,347 donations, we identified 6 HIV, 52 HCV, and 1927 HBV seronegative NAT-reactive donors. The expected number of prevented TTIs was 16.7 for HIV, 115.6 for HCV, and 55.2 for HBV. After further considering donations contributed from donors with occult HBV infection, an additional 1032.2 cases of TTIs were prevented. An estimated 1219.7 cases of TTIs were prevented. The cost of NAT during the 4 years was NT$740 million. The estimated savings from medical expenditures, relief payments, litigation costs, and secondary transmissions of HIV from NAT yield cases were respectively NT$259 million; NT$642 million; NT$98 million; and NT$28 million. The savings attributed to NAT screening totaled NT$1,027 million. Conclusions: Universal NAT improves the safety of blood donation. The total cost of NAT in Taiwan was NT$740 million over 4 years. An estimated 1,220 TTIs were prevented, and approximately NT$1,027 million was saved. NAT screening of donor blood is conclusively cost effective.
• 527 - 538
• 10.6288/TJPH.201810_37(5).107024

• Link 原著 Original Article
• 台灣長照體系居家服務利用與結案原因之影響因子探討Exploring the home services utilization and its influencing factors for case closures in Taiwan long-term care system
• 劉立凡、陳佳楨、李懿珍、劉建志
  LI-FAN LIU, JIA-JEN CHEN, YI-CHAN LEE, CHIEN-CHIH LIU
• 居家服務 ； 使用率 ； 結案原因 ； 未滿足需求 ； 長期照護服務
  home services ; utilization ; case closure ; unmet need ; long-term care
• 目標：居家服務於長期照護中相當普遍，而發展以人為本的社區式服務，必須透過縱向資料的累積來了解高齡者之個人特性、服務使用與留住社區之能力。本研究目的在檢視南部某都市的居家服務利用情形、結案原因以及相關影響因素。方法：以南部某都市照顧管理資訊系統（LTC-CM）資料庫2011年至2015年為止曾核定使用居家服務之身心障礙者及老人現況資料進行分析，第一次需求評估中（T0）共有9,889名個案接受服務。Cox回歸分析應用於檢視服務利用兩年內結案原因分析，來找出潛在影響因子。結果：研究期間結案的比例偏高，其中死亡佔20%，離開服務佔41%（主因為個案之家庭網絡尋求其他照顧資源）。扣除死亡後結案的影響因子為一般戶、照顧者負荷較大、中度智力缺損者較易結案。結論：本研究結果實證居家服務的高結案率，建議除服務提供外，應重視個案的服務利用狀況與結案原因，建議未來進一步探討不續用服務者其產生服務缺口的原因。
  Objectives: In order to develop person-centered service delivery in the community, it is important to understand the causal relationships among older adults' personal factors, service utilizations, and the ability to reside in the community from a longitudinal perspective. This study aimed to examine the profile of home services utilization and the reasons for case closures in two years, as well as the related influencing factors, among home service recipients in southern Taiwan. Methods: We analyzed the long-term care dataset of one southern metropolitan area from 2011- 2015, and the records of 9,889 persons aged 50 and over who received home services with an initial need assessment (T0). The Cox Regression Analyses were used to examine the potential risk factors for leaving the services. Results: The high rates of case closures included death (20%) and drop-out (41%), mainly due to the need to search for caregiving resources within family networks. In terms of the influencing factors for leaving the services, those who with non-low household incomes, informal caregiving burden and moderate cognitive impairments were more likely to drop out. Conclusions: This study provides empirical evidence of the high dropout rate and the importance of further investigations to explore the service gap in this context, especially the need to give more attention to those service users who then drop out of the system.
• 539 - 553
• 10.6288/TJPH.201810_37(5).107038

• Link 原著 Original Article
• 少子女化對產科醫師執業空間變遷及產婦就醫可近性之影響Impacts of low birth rates on the geographical distribution of obstetricians and accessibility of obstetrics resources for parturient women
• 林民浩、郭年真、江東亮
  MIN-HAU LIN, RAYMOND N. KUO, TUNG-LIANG CHIANG
• 少子女化；產科；醫療資源；就醫距離；空間分析
  low birth rate ; obstetrics ; health care resources ; travel distance ; spatial analysis
• 目標：少子女化帶來人口結構變遷，使國家發展面臨種種挑戰，健康照護產業無法自免於外，特別是與生育直接相關的產科醫師。本研究使用具代表性實證資料，分析少子女化情境下，產科市場與產科醫師執業空間的變遷，並檢視此番變遷對產婦生產就醫之影響。方法：以全民健康保險研究資料庫全國住院醫療費用清單明細檔及2005年承保抽樣歸人檔，首先分析2005-2009年間，生產件數與產科醫師服務量趨勢，再以空間分析技術，檢視研究期間產科醫師執業空間變遷與產婦就醫可近性的變化。最後透過引力模式，剖析就醫可近性與可用性於產婦就醫選擇的權衡。結果：研究期間全國生產件數減少6.7%、產科醫師減少了5.4%，全國產科醫師平均接生件數僅減少1.6%，前述指標在低都市化地區減幅大於高都市化地區。除退出市場，部分醫師選擇轉換執業地，尤其更傾向轉往區域負荷量離差高的地區執業。而醫師執業空間之變遷，使低都市化地區產婦需移動更遠距離生產就醫，也使其選擇生產地時，可近性的考量會優先於產科服務可用性。結論：少子女化將使低都市化地區產科市場先受衝擊，產科醫師則退出市場或轉換執業地以因應市場改變，進而可能造成產婦就醫可近性惡化並使其就醫選擇受限，特別是低都市化地區、就醫可近性原先即相對較差的群體。
  Objectives: Low birth rates can have substantial social impacts and comprise a challenge for the health care sector, especially obstetrics. To understand their influence on obstetrics services, this study aimed to quantify the impacts of low birth rates on the geographical distribution of obstetricians and the accessibility of obstetrics services for parturient women by using representative empirical data. Methods: Using Nationwide Health Insurance Database, we observed trends in childbirth and the mean number of deliveries per obstetrician from 2005 to 2009. Theoretical frameworks and spatial analysis were employed to analyze the changes in the geographical distribution of obstetricians and the accessibility of obstetrics services for parturient women. Finally, we used a gravity model to analyze the parturient women’s trade-off of between the accessibility and availability of obstetrics services. Results: During the study period, childbirth decreased by 6.7%, and the number of obstetricians decreased by 5.4%. Meanwhile, the mean number of deliveries per obstetrician decreased by 1.6%. The changes in the aforementioned indicators were worse in rural areas than in urban areas. Some obstetricians withdrew from the market, some changed their practice location, especially to areas with a higher carrying capacity. Consequently, parturient women who lived in areas with a low urbanization level had to travel longer distances to obtain obstetrics services; thus, they preferred to obtain services in areas with better accessibility rather than better availability. Conclusions: This study demonstrated that low birth rates can lead to the geographical redistribution of obstetricians, which worsen accessibility for parturient women, particularly those living in rural areas.
• 554 - 564
• 10.6288/TJPH.201810_37(5).107058

• Link 評論 Commentary
• 評論：少子女化對產科醫師執業空間變遷及產婦就醫可近性之影響Commentary: impacts of low birth rates on the geographical distribution of obstetricians and accessibility of obstetrics resources for parturient women
• 洪錦墩
  Chin-Tun Hung
• 無
  none
• 無
  none
• 565 - 565
• 10.6288/TJPH.201810_37(5).10705801

• Link 原著 Original Article
• 檢驗自然資源依賴與肺結核之相關性，2000-2016年Association between natural resource dependence and tuberculosis, 2000-2016
• 張文揚
  WEN-YANG CHANG
• 肺結核 ； 發生率 ； 死亡率 ； 自然資源 ； 時間序列橫斷面固定效果模型
  tuberculosis ; incidence rate ; death rate ; natural resources ; time-series crosssectional model with fixed effects
• 目標：肺結核對世界而言是重大的健康威脅，但是世界各國在千禧年以來防治肺結核的成效表現不一，其中還有退步者。在解釋國家公共衛生議題的成效差異時，近年來被提出的一個解釋，就是國家對自然資源的依賴程度，但是學者對自然資源產生的效果並沒有共識，對肺結核的討論也付之闕如。本研究期望藉由探討自然資源依賴程度與肺結核防治成效之間的關係，補足這部分的研究缺口。方法：本文以時間序列橫斷面方法中的固定效果模型，檢驗2000-2016年之間97至135個不等的國家或政治實體的肺結核與自然資源依賴程度的相關性，並控制人均GDP、政府效率、15-49歲的人口中HIV發生率、0-14歲的人口佔總人口的百分比、5歲以下兒童死亡率（每千例活產兒）、人口密度、都市化程度以及經常性醫療保健支出占GDP比重（%）等幾個解釋變數。結果：在2000-2016年之間，國家對自然資源的依賴程度愈高，肺結核的發生率以及死亡率就愈高，兩者的統計結果均至少達到0.01的顯著水準。結論：根據研究發現，要降低自然資源與肺結核之間的相關性，依賴自然資源程度較高的國家，可能可以藉由：(1)轉型經濟減少對自然資源的依賴；(2)以及（或是）強化對自然資源收益的管理；(3)改善礦區的工作與衛生狀況，來降低肺結核發生率或死亡率。
  Objectives: Tuberculosis (TB) is a major threat to global public health. However, since 2000, the effectiveness of TB control and prevention has varied considerably across countries; the performance has even deteriorated in some countries. To examine differences in public health performance among countries, researchers can determine the degree to which they rely on natural resources. However, scholars have not reached a consensus regarding whether reliance on natural resources is beneficial. In addition, discussions on the link between TB and natural resources are limited. This study filled this gap by exploring the association between natural resource dependence and TB. Methods: This study applied the time-series cross-sectional model with fixed effects to examine the effects of natural resource dependence on TB between 2000 and 2016 in 97–135 countries or political entities. This study controlled for gross domestic product (GDP) per capita, government efficiency, population density, urbanization, incidence of the human immunodeficiency virus among the uninfected population aged 15-49 years, population aged 0-14 years (% total), mortality rate for the population aged under 5 years, and current health expenditure as a percentage of GDP. Results: During the period of 2000-2016, a state's natural dependence level was positively associated with a higher incidence and death rate of TB. Both results reached statistical significance at at least the 0.01 level. Conclusions: On the basis of research findings, the researcher suggests that to more effectively control and prevent TB, countries and political entities that rely on natural resources should (1) diversify their economies to reduce natural resource dependence, (2) strengthen natural resource management, and (3) improve the working and sanitary conditions of mining locations.
• 566 - 581
• 10.6288/TJPH.201810_37(5).107045

• Link 原著 Original Article
• 台灣大學生營業素養測量工具之發展與驗證Development and validation of the nutrition literacy measure for Taiwanese college students
• 廖梨伶、賴苡汝、 施淑芳、 張麗春
  LI-LING LIAO, I-JU LAI, SHU-FANG SHIH, LI-CHUN CHANG
• 營養素養 ； 大學生 ； 測量工具 ； 飲食行為 ； 信效度驗證
  nutrition literacy ; college students ; measure ; eating behavior ; validation
• 目標：發展適用於台灣大學生之營養素養測量工具，並進行信效度驗證。方法：本研究採用便利取樣的方式，由國內六所大學中選取1,269位學生參與此橫斷面研究，評價研究素養測量工具之信效度。本研究回收1,264份有效問卷，男女比例為0.87，大部分學生為大二（38.1%）和大三（26.1%）。營養素養測量工具的發展乃根據台灣之每日飲食指南和國民飲食指標，包括自陳式量表（8題）和情境式測驗量表（32題），以Cronbach's α係數來驗證測量工具的內部一致性信度，效度考驗則採用驗證性因素分析。結果：自陳式量表和情境式測驗量表之Cronbach's α係數分別為0.85和0.81，營養素養測量工具兩部分量表都達到良好模式適配度指標，而情境式測驗量表以項目反應理論分析困難度參數介於-3.22和0.11（可接受範圍介於-4~2）之間。此外，營養素養測量工具兩部分量表都與健康飲食行為呈正相關（r=.417, p＜.001 和r=.125, p＜.001）。結論：本研究所發展之台灣大學生營養素養測量工具為一個具有信效度之測量工具，可應用在營養教育介入計畫執行前之需求評估。
  Objectives: To develop a nutrition literacy measure for Taiwanese college students and evaluate its reliability and validity. Methods: A cross-sectional study using convenience sampling was adopted to evaluate the measure and six universities in Taiwan were included. A total of 1,269 students were recruited and 1,264 valid questionnaires were returned. The ratio of men to women was 0.87. Most students were sophomore (38.1%) and junior (26.1%). The nutrition literacy measure was formulated based on the Dietary Guidelines for Taiwanese and the Daily Food Guides and consisted of 8 self-rated items and 32 scenario-based test items. Cronbach’s a coefficient was used to evaluate the internal consistency reliability, while a confirmatory factor analysis was conducted to validate the measure. Results: Cronbach’s a for the self-rated scale and the scenario-based test was 0.85 and 0.81, respectively. The measure showed a good model fit in 2 parts and the difficulty parameters of the scenario-based test ranged from -3.22 to 0.11 in the item response theory analysis (acceptable range= -4 to 2). Furthermore, scores for 2 parts of the measure were both positively correlated with the healthy-eating behavior scale (r = .417, p < .001 and r = .125, p < .001, respectively). Conclusions: The devised instrument was a valid and reliable measure for assessing nutrition literacy among Taiwanese college students. Specifically, it could be used by practitioners for needs assessment before the implementation of a nutrition education program.
• 582 - 597
• 10.6288/TJPH.201810_37(5).107054