生命早期經驗與青少年身心健康的關係

The Associations of Early-life Experiences and Adolescent Health

張華庭(Hua-Ting Chang)

指導教授 ： 李妙純

國立中正大學/社會科學院/社會福利學系/碩士(2012年)

摘要

近年來，青少年肥胖與憂鬱的盛行率迅速上升，由於青少年是人類發展中的關鍵時期，若在此時期有肥胖或心理健康的問題，則會有很高的風險延續至成年時期，進而對個人、家庭及社會帶來巨大的成本與衝擊。為了檢視發生於特定時期的生命早期經驗是否對青少年身心健康有長期之效果，本研究使用2005年及2007年「台灣教育長期追蹤資料庫」之高中學生為樣本(2005年的平均年齡為16.44歲)，以路徑分析來探討生命早期經驗，例如父母社經地位、出生體重、家庭功能以及健康行為，對青少年心理健康與肥胖之影響。分析有效樣本為10,614人，其中男生有5,281人，女生有5,333人。在控制性別與年齡後，路徑分析顯示在外衍變項中，家庭衝突對男女生心理健康之直接負效果最大(男女生的標準化迴歸係數分別為-0.236及-0.214)，其次為手足關係之直接負效果(-0.078及-0.095)，第三為父母親教育年數之直接負效果(-0.048及-0.045)。在男生的BMI方面，不佳的手足關係正效果最大(0.047)，其次為父母教育年數之直接負效果(-0.033)；而這些變項對女生BMI的直接效果則未達統計顯著性。然而，除了直接效果，間接效果亦不可忽略，特別是家庭衝突導致不良的飲食習慣，而使男女生的心理健康更差，其間接效果之標準化迴歸係數為-0.005及-0.008。此外，不佳的親子與手足關係會增加女生不良的飲食及運動習慣，而使其心理狀況較差(間接效果分別為-0.004及-0.003)，也會間接影響其BMI。因此，若僅以複迴歸分析，將忽略間接效果的意涵。根據本研究的結果，亦呼應Barker的成人疾病胚胎起源假說，青少年的早期經驗對其身心健康有長期之效果。因此，當我們在制定有關青少年的肥胖或是心理健康政策時，不能只關注當前的環境，必須特別留意其生命早期的社會因素，例如，低教育程度父母的營養資訊、懷孕前及懷孕時應注意的健康資訊以避免生出低體重兒、關懷高風險家庭、避免女性青少年過早懷孕生子、加強親職教育等。

關鍵字

青少年健康 ； 生命歷程 ； 出生體重 ； 社經地位 ； 家庭功能 ； 路經分析 ； 台灣教育長期追蹤資料庫(TEPS)

並列摘要

Recently, the prevalence of obesity and depression among adolescents had increased sharply. Adolescence is a critical life stage, and both obese and depressive adolescents were more likely to develop severe obesity and depression in adulthood, and these problems would have huge costs and impacts to individual, family and society. To investigate whether the early life experiences in critical periods would have long term effects on adolescents’ health, this study used 2005 and 2007 senior high school students (average aged 16.44 years old in 2005) data from the Taiwan Education Panel Survey (TEPS). The path analysis was used to examine the effects of family context during early life, such as parental socioeconomic status, birthweight, family function and health behaviour, on adolescents’ mental health and obesity. After records with missing data were deleted and combining with parental data a total of 10,614 adolescent subjects (5,281 were male, and 5,333 were female) were included in the present study. When adjusted for sex and age, the path analyses show that in terms of exogenous variables, family conflict contributed most to direct effect on adolescent mental health (standardized coefficients, b, were -0.236 and -0.214 for male and female respectively). The sibling relationship played as the second most contributor (b=-0.278 and -0.095 for male and female), whereas the parental educational attainment was the third (b=-0.048 and -0.045). Moreover, the direct effects of poor sibling relationship and low parental education contributed most and the second most to higher BMI among male adolescents, respectively (b=0.047 and -0.033). However, they were insignificant among female adolescents. The indirect effect of family conflict on mental health (through its effect on health behaviour) was negative and significant (b=-0.005 for male and -0.008 for female). In addition, poor parent-child and sibling relationship led to poor dietary and exercising behaviour that indirectly worsened female mental health (indirect effect b=-0.004 and -0.003 for parent-child and sibling relationship respectively), and also indirectly affected their BMI. Therefore, if we neglected the indirect effects, the association of family context and adolescent health were under-estimated. Our results confirmed the Barker fetal origins of adult disease hypothesis and indicated that experiences at early life stage have long term effects on adolescents’ health. The results demonstrate some policy implications. First, the adolescent health policy could not only focus on the current circumstances, but also the social and family factors at their early life, for example, nutrition or pre-natal information for low educated parents. Moreover, school and family function should be improved to prevent adolescents’ pregnancy, particularly among low socio-economic or high risk family.

並列關鍵字

adolescent health ； life-course ； birth weight ； parental socioeconomic status ； family functioning ； path analysis ； TEPS

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