家庭熱量儲存環境對兒童熱量儲存行為及體位影響之模式建構

肥胖是世界各已開發國家所面臨的健康問題，而兒童肥胖為成人肥胖的重要預測因子，使兒童肥胖成為國際重視的健康議題。本研究目的為建立家庭熱量儲存環境對兒童熱量儲存行為及體位影響的因果模式，主要以社會學習理論為架構，納入家庭熱量儲存環境及兒童熱量儲存行為概念形成本研究的理論架構，以瞭解多元層面家庭熱量儲存環境對兒童肥胖的解釋或預測力。本研究為橫斷性研究，以高雄市國小三、四年級兒童及其父母為研究對象，以分層隨機抽樣進行問卷調查；問卷內容包含人口學資料、家庭熱量儲存環境量表及兒童熱量儲存行為量表。量表擬定後，先經由專家效度、內部一致性及二週再測信度的檢定。統計方法包含頻率、百分比、平均值等描述性統計之外，並以LISREL統計軟體 8.80版進行驗證性因素析（Confirmatory Factor Analysis, CFA）檢定各量表的建構效度及刪除不具效度之題目。最後以LISREL統計軟體進行結構方程式模式(Structural Equation Modeling, SEM)檢定，以瞭解所收集的資料是否支持假設的「家庭熱量儲存環境對兒童熱量儲存行為及體位影響之因果模式」。本研究共收集399對國小三、四年級生與其父或母的資料，參與率為51.22％。由結構方程式模式的檢定，經由理論修飾後獲得一個資料支持的模式，此模式雖然χ2值為85.736 （df＝32, p＜.001)，但GFI＝.957, AGFI＝.926, NFI=.889, NNFI=.897, CFI=.927, RMSEA＝.067，顯示此模式是可接受的。由模式中可知，「家庭熱量儲存環境」 (β=.46, t =3.094, p<.001)對「兒童熱量儲存行為」有直接影響力，顯示越傾向於熱量儲存環境的家庭其孩童有越多的熱量儲存行為；「兒童熱量儲存行為」(β=.13, t =1.983, p<.05)對兒童體位有直接影響力，顯示兒童有越高頻率的熱量儲存行為其體位越容易過重或肥胖。「家庭熱量儲存環境」對「兒童熱量儲存行為」解釋變異量為21.0%，「兒童熱量儲存行為」對「兒童體位」解釋變異量為1.8%；「家庭熱量儲存環境」可透過影響「兒童熱量儲存行為」而間接影響「兒童體位」(β=.05, t =1.765, p<.05)，即家庭若提供越趨向熱量儲存的環境，其孩童可能有越高頻率的熱量儲存行為，而致有過重或肥胖的機率越高。本研究建議未來仍須以不同的樣本檢測，以瞭解本研究「家庭熱量儲存環境對兒童熱量儲存行為及體位影響之因果模式」在其他樣本的適用性。本研究結果可供健康專業人員建立以家庭為單位之預防兒童肥胖相關方案的實證資料，進行家庭熱量儲存環境評估，以提早發現兒童逐漸提升中的熱量儲存行為與BMI，有利方案的推展及落實。

關鍵字

兒童；熱量儲存行為；家庭熱量儲存環境；結構方成模式

並列摘要

Childhood obesity is a potential health problem for it’s being a critical predictor of adult obesity. The purpose of this study is to develop a causal model of family energy retention environment to children’s energy retention behavior and their BMI levels. This study adapted a Social Learning Theory as the framework, where combines concepts of family energy retention environment, children’s energy retention behavior, and their BMI levels. In this cross-sectional study, the third and fourth grade students and their parents were recruited by stratified random selection from element schools in Kaohsiung city. The instrument of scales included demographic data, family energy retention environment scale, and children’s energy retention behavior scale. All scales were examined for content validity and test-retest reliability. Confirmatory factor analysis (CFA) was used to test the validity of each scale. Invalid items were deleted according to the CFA results. The hypothesized casual model was tested by Structural Equation Modeling (SEM), using LISREL 8.80 software. Maximum Likehood method was used to test the fit of the model. A total of 399 children-parent dyads were recruited, with a responded rate of 51.22%. The original model was refined and yielded a parsimonious model which suggested family energy retention environment has a significant effect on children’s energy retention behavior (β=.46, t =3.094, p<.001), children’s energy retention behavior has a significant effect on their BMI level (β=.13, t =1.983, p<.05). And through the children’s energy retention behavior, the family energy retention environment has a significant indirect effect on children’s BMI levels (β=.05, t =1.765, p<.05). The construct included in the model accounted for 21.0% variance of children’s energy retention behavior, and 1.8% variance of children’s BMI level. The model proposed in this study should be tested further more in various populations in the future. The model can provide evidence in causal relationships between family energy retention environment and children’s obesity. The finding can be utilized in developing family-based intervention programs and evaluation.