- 學位論文
學童肥胖之個人、家庭與學校因素之多層次分析
Multiplevel modeling for children’s body mass index at individual, family and school level
摘要
研究目的：肥胖之發生除先天遺傳外，尚有後天環境多層次登因素之影響。以往學童肥胖之研究多著重單一層次因素之探討，對於學童肥胖之了解及預防上不夠周嚴。因此本研究以多層次模式探討與學童肥胖之個人、家庭及學校等相關因素，並探討不同體型認知與期待者，其肥胖相關因素之異質性。 材料方法：資料取自『台灣地區國小學童營養健康狀況調查2001-2002』之六歲到十二歲之學童為研究對象(n=2078)。收集了個案及其父母之基本資料、體能活動、飲食頻率及食物喜好、飲食主導者教養態度及飲食行為、以及學校環境等資訊。以因素分析將變項數做有效減少後，將變項納入多層次分析來探討其異質性。 結果：男性學童的肥胖盛行率34.95%，顯著高於女性學童之27.35%。影響學童肥胖的因素，在個人因素：於性別、年級、地區飲食頻率及食物喜好有顯著相關；家庭因素方面，父母親肥胖、民間信仰及教養態度都有顯著相關；學校方面，每週健教時數較高者有較低的肥胖率(P=0.005)。學童BMI Z score的差異，經多層次分析結果發現，胖期待變瘦者與高年級、假日看書、控制的教養態度及母親肥胖有協同性交互作用；而期待變瘦者與攝取較多內臟海鮮類及豆漿、喜好乳酸飲料和內臟類、不吃早餐以及要求吃的營養的教養態度有拮抗性交互作用。 結論：學童個人之年級、食物喜好，以及家庭母親肥胖程度、教養態度，在考慮個人、家庭及學校等層次因素之影響後，仍影響學童的肥胖。本研究結果意味著，學童肥胖之處理及預防上，除個人及家庭之介入外，尚可針對不同體型期待者給予不同的介入方式來教導或修正，以使減重策略正確執行。
並列摘要
Objectives: Obesity occurs due to not only genetic factors but also environmental multilevel factors. However, research on children obesity mostly studied one or few factors which limited it application on prevention. The present study employs multilevel model to analyze the related factors of children obesity on individual, family, and school levels and to investigate the heterogeneity of obesity among people with different cognition and expectation on somatotype. Methods: Total of 2078 eligible school children aged between six and twelve were recruited from the Nutrition and Health Survey in Taiwan during 2001-2002. Individual, family information and school information were collected by questionnaires. Factor analysis is used to group the raw variables for further multilevel analysis to understand the heterogeneity. Results: Prevalence of overweight is 34.95% in boys, and 27.35% in girls respectively. Among the factors significantly related to obesity, the individual level factors include gender, grade, eating frequency, and food preference. The family level factors include parents' BMI, folk religion, and parenting attitude. The school level factor is frequency of health education. The difference of BMI Z score can be explained by different cognition and expectation in somatotype. Plump children wishing to be thinner are synergistic with higher grades, reading at holiday, control parenting attitude, and mother obesity. These children are antagonism with eating more bowels, sea foods and soybean drink, favoring yogurt drinks and bowels, skipping breakfast, and parenting attitude of eating healthy. Conclusion: The present study suggests factors including grade, food preference, mother's BMI, and parenting attitude might be predictors of children's BMI. The future prevention programs may focus on adjusting different cognition and expectation on somatotype in addition to traditional individual, family and school prevention programs.