1. 本研究雖以隨機方式依人數比例選取各縣市之小學高年級學 生,但各學校、各班級、及學生參與的意願仍為可能影響樣本代表性之 一因素,只選擇台中縣、嘉義市、苗栗縣三縣市時為立意取樣,因限制 於問卷取得方便性之故,故其外推至全國性可能有其限制,外推至其他 年級學童亦有其限制。
2. 身高體重、飲食行為、身體活動、個人及家庭因素等問題採問卷 調查、自我報告型式呈現可能會有所誤差,但我們採取兒童與家長問卷 分開填寫,學童在學校填寫其問卷後回收,家長部分問卷則帶回填寫,
這樣或許可以避免因為家長因素而影響其學童填答之正確性。
3. 至於身高體重資料已拜託學校老師以學童學校健檢資料輔助,應 可提高其正確性;但家長部分之身高體重資料,正確度可能略顯不足,
此為問卷調查之缺點之ㄧ。
4. 本研究問卷並未深入針對飲食內容及身體活動部份做詢問,只能 問及頻率,無法知道其詳細內容;或許可以進一步訪談或採取國際身體 活動量表台灣中文版、及飲食頻率問卷等方式以ㄧ週回憶式詳加詢問,
不過要以此方法詢問國小高年級學童可能有其困難之處。
5. 此研究為橫斷式調查資料的分析,無法控制住影響肥胖之不可觀 察到的因素、過去病史、及特殊疾病等,其因果關係推論上也有所困難。
118
D., et al. (2004). Risk factors for childhood overweight: a prospective study from birth to 9.5 years.[see comment][erratum appears in J Pediatr. 2004
Sep;145(3):424]. [Research Support, U.S. Gov't, P.H.S.]. Journal of Pediatrics,
145(1), 20-25.
Arya, A., & Devi, R. (1991). Influence of maternal literacy on the nutritional status of preschool children. [Abstract]. Indian Journal of Pediatrics, 58(2), 265-268.
Ballard, T. J., & Neumann, C. G. (1995). The effects of malnutrition, parental literacy and household crowding on acute lower respiratory infections in young Kenyan children. [Abstract]. Journal of Tropical Pediatrics, 41(1), 8-13.
Campbell, K. J., Crawford, D. A., & Ball, K. (2006). Family food environment and dietary behaviors likely to promote fatness in 5-6 year-old children. [Research Support, Non-U.S. Gov't]. International Journal of Obesity, 30(8), 1272-1280.
Chu, N. F. (2001). Prevalence and trends of obesity among school children in Taiwan--the Taipei Children Heart Study. International Journal of Obesity & Related
Metabolic Disorders: Journal of the International Association for the Study of Obesity, 25(2), 170-176.
Chu, N. F., Rimm, E. B., Wang, D. J., Liou, H. S., & Shieh, S. M. (1998). Clustering of cardiovascular disease risk factors among obese schoolchildren: the Taipei Children Heart Study. [Comparative Study
Research Support, Non-U.S. Gov't]. American Journal of Clinical Nutrition, 67(6), 1141-1146.
Cole, T. J., Bellizzi, M. C., Flegal, K. M., & Dietz, W. H. (2000). Establishing a standard definition for child overweight and obesity worldwide: international survey.[see comment]. [Research Support, Non-U.S. Gov't]. BMJ, 320(7244), 1240-1243.
Crespo, C. J., Smit, E., Troiano, R. P., Bartlett, S. J., Macera, C. A., & Andersen, R. E.
(2001). Television watching, energy intake, and obesity in US children: results from the third National Health and Nutrition Examination Survey, 1988-1994.
Archives of Pediatrics & Adolescent Medicine, 155(3), 360-365.
Davis, T. C., Long, S. W., Jackson, R. H., Mayeaux, E. J., George, R. B., Murphy, P. W., et al. (1993). Rapid estimate of adult literacy in medicine: a shortened screening instrument. [Abstract]. Family Medicine, 25(6), 391-395.
Dennison, B. A., Erb, T. A., Jenkins, P. L., Dennison, B. A., Erb, T. A., & Jenkins, P. L.
(2002). Television viewing and television in bedroom associated with overweight risk among low-income preschool children. [Research Support, Non-U.S. Gov't].
Pediatrics, 109(6), 1028-1035.
DeWalt, D. A., Dilling, M. H., Rosenthal, M. S., Pignone, M. P., DeWalt, D. A., Dilling,
119
M. H., et al. (2007). Low parental literacy is associated with worse asthma care measures in children. [Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't]. Ambulatory Pediatrics, 7(1), 25-31.
Ding, Y. A., Chu, N. F., Wang, T. W., & Lin, C. C. (1995). Anthropometry and
lipoproteins-related characteristics of young adult males in Taiwan. [Abstract].
International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity, 19(6), 392-396.
Eriksson, J., Forsen, T., Osmond, C., & Barker, D. (2003). Obesity from cradle to grave.
International Journal of Obesity & Related Metabolic Disorders: Journal of the International Association for the Study of Obesity, 27(6), 722-727.
Francis, L. A., Lee, Y., Birch, L. L., Francis, L. A., Lee, Y., & Birch, L. L. (2003).
Parental weight status and girls' television viewing, snacking, and body mass indexes. [Research Support, U.S. Gov't, P.H.S.]. Obesity Research, 11(1), 143-151.
Georgiadis, G., & Nassis, G. P. (2007). Prevalence of overweight and obesity in a national representative sample of Greek children and adolescents. European Journal of
Clinical Nutrition, 61(9), 1072-1074.
Giammattei, J., Blix, G., Marshak, H. H., Wollitzer, A. O., Pettitt, D. J., Giammattei, J., et al. (2003). Television watching and soft drink consumption: associations with obesity in 11- to 13-year-old schoolchildren.[see comment]. [Research Support, Non-U.S. Gov't]. Archives of Pediatrics & Adolescent Medicine, 157(9), 882-886.
Gillis, L. J., & Bar-Or, O. (2003). Food away from home, sugar-sweetened drink
consumption and juvenile obesity. Journal of the American College of Nutrition,
22(6), 539-545.
Glowinska, B., Urban, M., Koput, A., Glowinska, B., Urban, M., & Koput, A. (2002).
Cardiovascular risk factors in children with obesity, hypertension and diabetes:
lipoprotein(a) levels and body mass index correlate with family history of cardiovascular disease. [Comparative Study
Research Support, Non-U.S. Gov't]. European Journal of Pediatrics, 161(10), 511-518.
Ji, C. Y., & Cheng, T. O. (2008). Epidemic increase in overweight and obesity in Chinese children from 1985 to 2005. Int J Cardiol.
Kennen, E. M., Davis, T. C., Huang, J., Yu, H., Carden, D., Bass, R., et al. (2005). Tipping the scales: the effect of literacy on obese patients' knowledge and readiness to lose weight. Southern Medical Journal, 98(1), 15-18.
Levandowski, B. A., Sharma, P., Lane, S. D., Webster, N., Nestor, A. M., Cibula, D. A., et al. (2006). Parental literacy and infant health: an evidence-based healthy start intervention. [Abstract]. Health Promotion Practice, 7(1), 95-102.
Linardakis, M., Sarri, K., Pateraki, M. S., Sbokos, M., Kafatos, A., Linardakis, M., et al.
(2008). Sugar-added beverages consumption among kindergarten children of
120
Crete: effects on nutritional status and risk of obesity. [Comparative Study Research Support, Non-U.S. Gov't]. BMC Public Health, 8, 279.
Lobstein, T., Baur, L., Uauy, R., & TaskForce, I. I. O. (2004). Obesity in children and young people: a crisis in public health.[see comment]. [Review]. Obesity Reviews,
5 Suppl 1, 4-104.
Maffeis, C. (2000). Aetiology of overweight and obesity in children and adolescents.
[Review]. European Journal of Pediatrics, 159 Suppl 1, S35-44.
McArthur, L., Pena, M., & Holbert, D. (2001). Effects of socioeconomic status on the obesity knowledge of adolescents from six Latin American cities. [Research Support, Non-U.S. Gov't]. International Journal of Obesity & Related Metabolic
Disorders: Journal of the International Association for the Study of Obesity, 25(8),
1262-1268.Moon, R. Y., Cheng, T. L., Patel, K. M., Baumhaft, K., & Scheidt, P. C. (1998). Parental literacy level and understanding of medical information. Pediatrics, 102(2), e25.
Nayga, R. M., Jr. (2000). Schooling, Health Knowledge and Obesity. [Abstract]. Applied
Economics, 32(7), 815-822.
Nicklas, T. A., Yang, S. J., Baranowski, T., Zakeri, I., Berenson, G., Nicklas, T. A., et al.
(2003). Eating patterns and obesity in children. The Bogalusa Heart Study.
[Comparative Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.]. American Journal of Preventive Medicine, 25(1), 9-16.
Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., Flegal, K. M., et al. (2006). Prevalence of overweight and obesity in the United States,
1999-2004. [Research Support, Non-U.S. Gov't]. JAMA, 295(13), 1549-1555.
Ogden, C. L., Flegal, K. M., Carroll, M. D., Johnson, C. L., Ogden, C. L., Flegal, K. M., et al. (2002). Prevalence and trends in overweight among US children and adolescents, 1999-2000.[see comment]. JAMA, 288(14), 1728-1732.
Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. (1995). The test of functional health literacy in adults: a new instrument for measuring patients' literacy skills.
[Abstract]. Journal of General Internal Medicine, 10(10), 537-541.
Parry, L. L., Netuveli, G., Parry, J., Saxena, S., Parry, L. L., Netuveli, G., et al. (2008). A systematic review of parental perception of overweight status in children.
[Research Support, Non-U.S. Gov't
Review]. Journal of Ambulatory Care Management, 31(3), 253-268.
Rao, R. S., Chakladar, B. K., Nair, N. S., Kutty, P. R., Acharya, D., Bhat, V., et al. (1996).
Influence of parental literacy and socio-economic status on infant mortality.
[Abstract]. Indian Journal of Pediatrics, 63(6), 795-800.
121
Rhee, K. E., De Lago, C. W., Arscott-Mills, T., Mehta, S. D., Davis, R. K., Rhee, K. E., et al. (2005). Factors associated with parental readiness to make changes for
overweight children. [Research Support, N.I.H., Extramural Research Support, U.S. Gov't, P.H.S.]. Pediatrics, 116(1), e94-101.
Ross, L. A., Frier, B. M., Kelnar, C. J., & Deary, I. J. (2001). Child and parental mental ability and glycaemic control in children with Type 1 diabetes. [Research Support, Non-U.S. Gov't]. Diabetic Medicine, 18(5), 364-369.
Saelens, B. E., Sallis, J. F., Nader, P. R., Broyles, S. L., Berry, C. C., Taras, H. L., et al.
(2002). Home environmental influences on children's television watching from early to middle childhood. [Research Support, U.S. Gov't, P.H.S.]. Journal of
Developmental & Behavioral Pediatrics, 23(3), 127-132.
Schillinger, D., Grumbach, K., Piette, J., Wang, F., Osmond, D., Daher, C., et al. (2002).
Association of health literacy with diabetes outcomes.[see comment]. [Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.]. JAMA, 288(4), 475-482.
Singh, G. K., Kogan, M. D., Van Dyck, P. C., Siahpush, M., Singh, G. K., Kogan, M. D., et al. (2008). Racial/ethnic, socioeconomic, and behavioral determinants of childhood and adolescent obesity in the United States: analyzing independent and joint associations. Annals of Epidemiology, 18(9), 682-695.
Timperio, A., Salmon, J., Ball, K., Baur, L. A., Telford, A., Jackson, M., et al. (2008).
Family physical activity and sedentary environments and weight change in
children. [Research Support, Non-U.S. Gov't [Abstract]]. International Journal
of Pediatric Obesity, 3(3), 160-167.
Viner, R. M., & Cole, T. J. (2005). Television viewing in early childhood predicts adult body mass index.[see comment]. [Research Support, Non-U.S. Gov't]. Journal of
Pediatrics, 147(4), 429-435.
Wang, Y., & Lobstein, T. (2006). Worldwide trends in childhood overweight and obesity.[see comment]. [Research Support, N.I.H., Extramural
Review]. International Journal of Pediatric Obesity, 1(1), 11-25.
Wei, J. N., Sung, F. C., Lin, C. C., Lin, R. S., Chiang, C. C., Chuang, L. M., et al. (2003).
National surveillance for type 2 diabetes mellitus in Taiwanese children.
[Research Support, Non-U.S. Gov't]. JAMA, 290(10), 1345-1350.
Whitaker, R. C., Wright, J. A., Pepe, M. S., Seidel, K. D., & Dietz, W. H. (1997).
Predicting obesity in young adulthood from childhood and parental obesity.[see comment]. [Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.]. New England Journal of Medicine, 337(13), 869-873.
Williams, M. V., Baker, D. W., Honig, E. G., Lee, T. M., & Nowlan, A. (1998). Inadequate literacy is a barrier to asthma knowledge and self-care. [Comparative Study].
122
Chest, 114(4), 1008-1015.
Williams, M. V., Baker, D. W., Parker, R. M., & Nurss, J. R. (1998). Relationship of functional health literacy to patients' knowledge of their chronic disease. A study of patients with hypertension and diabetes. [Research Support, Non-U.S. Gov't].
Archives of Internal Medicine, 158(2), 166-172.
Wu, F. L., Yu, S., Wei, I. L., Yin, T. J., Wu, F.-L., Yu, S., et al. (2003). Weight-control behavior among obese children: association with family-related factors. Journal of
Nursing Research: JNR, 11(1), 19-30.
Xie, B., Chou, C. P., Spruijt-Metz, D., Reynolds, K., Clark, F., Palmer, P. H., et al. (2006).
Weight perception and weight-related sociocultural and behavioral factors in Chinese adolescents. [Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't]. Preventive Medicine, 42(3), 229-234.
內分泌暨糖尿病學會會訊編輯部 (2002). 行政院衛生署公佈-成人肥胖定義/兒童 與青少年肥胖定義及處理原則. 中華民國內分泌暨糖尿病學會會訊
, 15(4),
55-58.王瑞霞, 邱啟潤, 辛錫璋, & 黃鳳香 (1992). 學童與父母親間慢性病危險因子、健 康、知識、生活方式相關性之探討. The Kaohsiung Journal of Medical Sciences,
8(12), 679-691.
行政院衛生署國民健康局 (2006). 民國九十五年國中學生健康行為調查. Status among School Children in Taiwan. 北市醫學雜誌
, 4(2), 147-159.
李坤霖 (2004). 台中市國小高年級學童的含糖飲料飲用行為及其影響因素之研究
.
123
係
. 臺北醫學大學 保健營養學系 碩士論文.
陳玉英, & 方進隆 (1994). 身體活動量與上呼吸道感染關係之研究. 體育學報, 335-349.
陳偉德, & 吳康文 (1994). 單純性肥胖小兒之家庭環境因子 Acta Paediatrica
Sinica, 35(6), 536-541.
陳偉德, 蔡承諺, 陳安琪, 吳淑芬, 林宗文, & 林曉娟 (2003). 台灣地區兒童及青少 年生長曲線圖:依健康體適能訂定之標準. Mid-Taiwan Journal of Medicine,
8(s_2), s85-s93.
陳偉德、江界山、黃伯超 (1999). 台灣地區 : 改訂的生長曲線圖,1997. [Abstract]. 中 臺灣醫學科學雜誌
, 4, 256-263.
童雅玲 (2007 ). 慢性病患者之成人健康知能程度與用藥安全認知之探討—以高雄 縣某地區醫院為例
高雄醫學大學藥學研究所 碩士論文 [摘要].
黃上芙 (2004). 影響國小學童體位因素之相關研究
-
以台北市國小高年級學童為例.
國立台北護理學院 嬰幼兒保育研究所 碩士論文.楊志偉, 曾定強, 侯文萱, & 蘇娳敏 (2007). 健康知能在公共衛生及醫療照顧領域 的應用. 高雄縣醫師會誌
, 24, 頁 45-50.
楊雅安, 劉佩茹, 何建良, & 湯馥君 (2001). 運動量與電視觀賞對學童身體質量指 數之影響. 體育學報, 291-300.
鄒孟婷 (2006). 臺灣成年女性肥胖、自覺肥胖和健康知識與教育程度之關係. 臺灣 家庭醫學雜誌
, 16(4), 237-250.
鄒孟婷, & 鄒孟文 (2003). 健康知識、教育程度與肥胖之關係. 臺灣公共衛生雜誌
, 22:4, 頁 295-307.
劉影梅 (2004). 國際身體活動量表台灣中文版之發展與信效度驗證
. 臺灣大學.
謝慈容 (2004). 國小六年級男、女兒童家庭社經地位及自我概念 對生活適應之影響
.
朝陽科技大學 幼兒保育系 碩士論文.藺寶珍, & 王瑞霞 (1997). 肥胖國中生的體重控制自覺自我效力及其相關因素. 護 理研究
, 5(5), 401-412.
蘇哲能, 張淑鳳, 陳榮基, 潘豐泉, 陳清軒, & 劉偉文 (2008). 台灣健康知能量表之 初探性研究. 臺灣醫學
, 12(5), 525-536.
124
附錄 附錄 附錄
附錄 (Appendices)
ㄧ、 專家效度名單
祝年豐 台中縣衛生局局長 劉夷生 埔里榮民醫院副院長
黃惠煐 中國醫藥大學營養學系主任暨台中市營養師公會理事長 吳昇光 國立台灣體育學院競技運動學系暨研究所專任教授 郝宏恕 中國醫藥大學醫務管理系所暨碩士班副教授
125