父母關係對青少年期慢性病相關健康生活型態之影響：從家庭系統與生命歷程的觀點

Impacts of Parental Relationship on Adolescents Non-Communicable Diseases (NCDs)-Related Healthy Lifestyle: from Family Systems and Life Course Perspectives

張奕涵(Yi-Han Chang)

指導教授 ： 李蘭

國立臺灣大學/公共衛生學院/健康政策與管理研究所/博士(2016年)

https://doi.org/10.6342/NTU201602309

摘要

背景與目的：健康飲食、運動、吸菸和飲酒是預防慢性病最重要的四項可修正健康行為，而這些行為常在青少年期養成並且持續一生。根據家庭系統理論，父母離婚和父母衝突都會影響教養行為，而教養行為又在孩子的生活型態發展上佔有重要的角色。過去研究少以多重行為的健康生活型態觀點來探討其形成的影響因素，而探討父母影響時常侷限於離婚或教養方式其中單一變項之影響，並未考量兩者之間的關係、離婚與高衝突家庭的比較、和納入不同時期的影響差異。本研究目的包括分析青少年期的健康生活型態；以及參考家庭系統理論及生命歷程觀點，來檢視父母關係（包含父母衝突程度和父母婚姻狀況）、父母教養(包含監督行為與控制行為)對青少年健康生活型態的影響。
方法：資料來自兒童與青少年健康行為長期追蹤計畫，以2001年就讀小學四年級的世代作為樣本，共2597人(51.52%男性)。主要統計方法為長期潛在類別分析(或稱重複測量潛在類別模式)和多項邏輯斯迴歸模型。健康生活型態潛在類別的測量指標來自天天吃蔬果、一週運動三次、不吸菸、不飲酒等四項行為在2001-2013年間的重複測量。父母關係包括2001-2009年測量的父母婚姻狀態及衝突程度，教養行為則包含2004-2006年重複測量之父母監督與控制行為。
結果：以單一健康行為來看，樣本於四年級至大學四年級期間，天天吃蔬果、一週運動三次、不吸菸、不飲酒等四項行為達到標準的盛行率皆呈現下降趨勢。小學五年級至大學二年級的健康生活型態（以天天吃蔬果、一週運動三次、不吸菸、不飲酒四項行為作為指標）可經由重複測量潛在類別模型分為六種長期發展潛在類別(事後機率皆大於0.73)：「正向健康生活型態(23.91%)」、「少動生活型態(18.57%)」、「少蔬果、少動、飲酒生活型態(13.35)」、「少蔬果、少動生活型態(20.30%)」、「早期飲酒生活型態(11.90%)」及「高風險生活型態(11.97%)」。高中三年之健康生活型態則可經由重複測量潛在類別模型分為五種長期發展潛在類別：「少動生活型態(22.38%)」、「少蔬果、少動生活型態(22.51%)」、「正向健康生活型態(23.62%)」、「高風險生活型態(12.43%)」、「少蔬果、少動、飲酒生活型態(19.06%)」等五項。當以高中三年之正向健康生活型態作為參考組時，男性、經歷父母離婚、父母衝突較高、父母監督程度較低、父母控制程度較高者有較高的勝算比發展為較不健康的生活型態。父母監督和父母控制是父母關係對青少年健康生活型態發展影響的中介因子。孩子經歷越長時間的父母衝突，會提高其發展較不健康生活型態的風險。而高衝突的父母若於孩子國小之後離婚，對孩子健康生活型態的發展有保護作用。對於單親家庭的孩子，父母教養行為對其健康生活型態發展之影響較雙親家庭的孩子要更大。
結論：研究結果發現青少年具有不同的潛在健康生活型態類別。孩子在生命歷程早期(兒童期和青少年早期)經歷父母離婚或長時間的父母衝突都會提高其在青少年期發展為不健康生活型態的風險。本研究結果可作為青少年健康生活型態介入，以及離婚家庭相關政策之參考。對於單親家庭的父母需要給予介入或支持政策使其能執行適當的教養行為，幫助青少年培養健康生活型態。

關鍵字

慢性病 ； 生活型態 ； 青少年 ； 父母離婚 ； 父母衝突 ； 教養行為 ； 長期追蹤 ； 潛在類別分析

並列摘要

Background & Objective: To prevent Non-Communicable Diseases (NCDs), physical activity, healthy diet, tobacco use and alcohol use are the most common modifiable behaviors that frequently tending to establish during adolescence and persisting throughout life. According to family systems theory, both parental divorce and exposure to parental conflict are associated with low quality of parenting, which plays an important role in shaping child’s NCD-related lifestyle during adolescence. Few studies have examined the underlying NCD-related lifestyle development patterns measuring from multiple behavior indicators. Furthermore, previous studies have not explicitly examined the direct impact and interaction effect of parental marital status, parental conflict, and parenting on adolescent healthy lifestyle trajectory patterns from a lifecourse perspective. The aims of this study are to i) investigate long-term patterns in adolescent healthy lifestyle, and ii) explore the association of adolescent healthy lifestyle patterns with parental relationship (parental marriage status and parental conflict) and parenting (parental monitoring and parental control behavior) indicators from family systems and lifecourse perspectives.

Methods: A longitudinal sample of 2,597 (4th grade in 2001, 51.52% male) students from the Child and Adolescent Behaviors in Long-term Evolution (CABLE) project was used. Longitudinal latent class analysis (LLCA), also referred to as repeated-measures latent class analysis (RMLCA) and multinomial logistic model were applied to identify NCD-related healthy lifestyle patterns and their predictors. Indicators measuring NCD-related healthy lifestyle patterns came from four variables (eating vegetable/fruit every day, physical activity 3 times a week, tobacco use and alcohol use), which repeatedly measured during 2001-2013. Parental relationship was assessed by parental marriage status and parental conflict from 2001 to 2009, whilst parenting (parental monitoring and parental control behavior) was measured during 2004-2006.

Results: Decreased trends were observed in the prevalence of physical activity, healthy diet, non-tobacco use and non-alcohol use behaviors among students during the study period (from 4th grade to senior). The LCA model identified six latent classes (all posterior probability>0.73) by behavior indicators response probability during 2002-2011 (5th grade to sophomore): “healthy lifestyle (23.91%)”, “inactive lifestyle (18.57%)”, “insufficient vegetable/fruit intake, inactive and drinking lifestyle (13.35)”, “insufficient vegetable/fruit intake and inactivity lifestyle (20.30%)”, “early alcohol use lifestyle (11.90%)”, “high risk lifestyle (11.97%)”. During the high school period (2007-2009), five latent classes (all posterior probability>0.78) were identified: “inactive lifestyle (22.38%)”, “insufficient vegetable/fruit intake and inactivity lifestyle (22.51%)”, “healthy lifestyle (23.62%)”, “high risk lifestyle (12.43%)”, “insufficient vegetable/fruit intake, inactive and drinking lifestyle (19.06%)”. Using the healthy lifestyle class as the reference group, male, parental divorce, higher parental conflict level, lower parental monitoring, and higher parental control were associated with higher odds ratio of relatively unhealthy lifestyle patterns. The mediation effects of parental monitoring and parental control between parental relationship and adolescent healthy lifestyle patterns were confirmed using the sobel test. The more frequently the student was exposed to parental conflict, the greater was the risk of that individual having relatively unhealthy lifestyle. Impacts of parental divorce on adolescent healthy lifestyle were moderated by predivorce marital conflict. Parental divorce that happened later than elementary school period could protect adolescents who experienced high parental predivorce conflict from developing unhealthy lifestyle. For those adolescents who experienced parental divorce, parenting play a more important role on developing healthy lifestyle than adolescents who lived in married families.

Conclusions: Findings showed the existence of heterogeneity of latent NCD-related lifestyle patterns during adolescence among Taiwanese students. Results revealed that both experience of parental divorce and repeated experiences of parental conflict over a student’s early life course are associated with increased risk of poor lifestyle during adolescence. There is a need for interventions and support policies that might enable single parent to have appropriate parenting behaviors and help adolescent who lives in divorced family to develop a healthy lifestyle.

並列關鍵字

non-communicable diseases ； lifestyle ； adolescent ； parental divorce ； parental conflict ； parenting ； longitudinal ； latent class analysis

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