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研究生:張華庭
研究生(外文):Chang, Hua-Ting
論文名稱:生命早期經驗與青少年身心健康的關係
論文名稱(外文):The Associations of Early-life Experiences and Adolescent Health
指導教授:李妙純李妙純引用關係
指導教授(外文):Lee, Miaw-Chwen
口試委員:李中一陳孝平
口試委員(外文):Li, Chung-YiChen, Hsiao-Ping
口試日期:2012-07-09
學位類別:碩士
校院名稱:國立中正大學
系所名稱:社會福利學系暨研究所
學門:社會服務學門
學類:社會工作學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:136
中文關鍵詞: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)
外文關鍵詞:adolescent healthlife-coursebirth weightparental socioeconomic statusfamily functioningpath analysisTEPS
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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。
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.
摘 要 I
英文摘要 II
目 錄 III
圖目錄 IV
表目錄 V
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 8
第二章 文獻探討 9
第一節 青少年之健康狀態 9
第二節 生命歷程方法學 19
第三節 早期經驗與青少年健康之實證研究 30
第三章 研究方法 42
第一節 研究架構 42
第二節 研究問題 44
第三節 資料來源 45
第四節 變項操作型定義 46
第五節 分析方法與模型 53
第四章 研究結果 58
第一節 描述性統計 58
第二節 不同特徵之青少年身心健康 65
第三節 特徵別與青少年健康之線性迴歸分析 69
第四節 影響青少年健康之路徑分析 71
第五節 敏感性分析 90
第五章 討論與研究限制 92
第一節 生命早期經驗之效果 92
第二節 生命歷程之意涵 104
第三節 研究限制與未來研究方向 108
第六章 結論與建議 110
第一節 結論 110
第二節 政策建議 112
參考文獻 115
附錄一 心理健康(第四波高中職學生問卷) 128
附錄二 各變項之相關係數 129

圖目錄
圖2-1 健康之社會決定因素 13
圖2-2 人類發展與健康決定因素之架構 14
圖2-3 青少年健康風險行為與健康結果之生態模型 17
圖2-4 生命歷程中可能影響肺功能/呼吸道疾病的生物與心理社會暴露之方式. 21
圖2-5 生命歷程不同時期暴露影響肺功能自然史的相對重要性 22
圖2-6 生命歷程的因果模式 25
圖2-7 肥胖之生命歷程 33
圖3-1 研究架構圖 42
圖4-1 全樣本心理健康標準化係數路徑圖 79
圖4-2 男生心理健康標準化係數路徑圖 79
圖4-3 女生心理健康標準化係數路徑圖 80
圖4-4 全樣本BMI標準化係數路徑圖 87
圖4-5 男生BMI標準化係數路徑圖 87
圖4-6 女生BMI標準化係數路徑圖 88
圖5-1 青少年BMI與運動次數之關係 102

表目錄
表2-1 台灣地區兒童及青少年肥胖盛行率之相關研究結果 11
表2-2 社會環境影響健康的來源 15
表3-1 行政院衛生署兒童及青少年肥胖定義(BMI標準) 51
表3-2 假設模型之判別指標以及建議指標值摘要表 56
表4-1 樣本描述性統計 61
表4-2 家庭衝突之次數分配表 62
表4-3 青少年(高二)與家人關係次數分配 63
表4-4 青少年(高三)飲食習慣次數分配 64
表4-5 青少年(高三)憂鬱情緒反應程度百分比分布表 64
表4-6 不同青少年特徵之心理健康 66
表4-7 不同青少年特徵之BMI值 68
表4-8 青少年身心健康之線性複迴歸分析結果 70
表4-9 常態性檢定與極端值檢視 72
表4-10青少年心理健康之標準化迴歸係數估計─直接效果 78
表4-11中間變項之標準化迴歸係數估計(直接效果)─心理模型 78
表4-12外衍變項對青少年心理健康之直接及間接效果(標準化係數) 81
表4-13青少年BMI之標準化迴歸係數估計─直接效果 86
表4-14中間變項之標準化迴歸係數估計(直接效果)─BMI模型 86
表4-15外衍變項對青少年BMI之直接及間接效果(標準化係數) 89
表4-16青少年心理健康複迴歸結果 90
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