୯ҥᆵεᏢϦӅፁғᏢଣ଼நࡹᆶᆅࣴز܌!
ᅺγፕЎ!
Institute of Health Policy and Management College of Public Health
National Taiwan University Master Thesis
Ѡԋԃت܄ޗᔮӦՏᆶϤᅿᆒઓբҔނ፦ޑ٬
Ҕࠠᄊ!
Socio-economic Status and the Use of Six Psychoactive Substances among Male Adults in Taiwan
ࡿཁ!
Chao-Tzu Huang
ࡰᏤ௲Ǻדॣ!റγ!
Advisor: Chih-Yin Lew-Ting, Ph.D.
ύ҇୯ 101 ԃ 7 Д
July, 2012
i
农 农嫅
䳪㕤崘⇘忁ᶨ㬍炻ℑ⸜Ἦ䘬≒≃ˣ㋓㉀ˣ㬉䪹炻㬟㬟⛐䚖ˤ
䛇⽫⛘デ嫅ᶩ侩ⷓ娵䛇⛘㊯⮶炻侩ⷓ⯙⁷㭵奒ᶨ㧋炻ⶴ㛃ㆹᾹ⤥ˣⶴ㛃ㆹᾹ ㆸ攟炻㰺㚱侩ⷓ䳘⽫⛘㔁⮶炻ㆹᶨ⭂怬⛐㷦㰴ᷕ㐠䳊ˤḇ⼰檀冰傥娵嬀忁湤ᶨ佌
⤥⎴⬠炻⼤㬌Ḻ≑冯ㇻ㯋炻ᶫẁ⤛䘬䪹倚ㆹ㚫㯠怈姀⼿炻傥⣈Ἦ⇘⚳䩳⎘䀋⣏⬠
㓧䫾冯䭉䎮䞼䨞炻⛐忁墉⬠佺ㆸ攟炻㗗ㆹ䘬䤷㯋ˤ
䞼䨞炻⼰⣂Ṣ㚫㚧Ἀ忁㧋䘬⬠㬟姕ᶳᶨ⭂䘬㛒Ἦ啵⚾炻娵䁢Ἀㅱ娚⤪ỽˣ ᶵㅱ娚⤪ỽˤỮㆹ娵䁢炻忁㧋䘬⬠䴻㬟㗗⸓≑ㆹᾹ㚜㚱怈夳䘬➢䞛炻᷎朆姕旸㛒 Ἦ䘬㟮㟮ˤ䔊㤕炻䳽⮵ᶵ㗗ㆹ⬠佺䘬䳪溆炻ᶵ䭉㛒Ἦㆹ⛐䣦㚫䘬ảỽ奺句炻ㆹ悥 㚫䘤㎖⬠炻䁢ℐṢ栆䘬䚉ᶨấ⽫≃ˤ
㚨⼴天デ嫅ㆹ㚨ッ䘬⭞Ṣ栀シ㓗㊩ㆹ㓣嬨䡑⢓⬠ỵ炻怬㚱昒ㆹ朊⮵⣏⣏⮷⮷
㋓㉀冯⡻≃⌣⥳䳪ᶵ婒ᶨ⎍⿐妨炻㚨奒ッ䘬Ἀˤ
忁䭯婾㔯䌣䴎㚱ッㆹˣ⸓≑ㆹˣ㓗㊩ㆹ䘬⣏⭞炻ㆹ ⇘Ḯ炰
㗕ヰ 2012.07
ii
㐀 㐀天
䚖⛘烉㍊妶ㆸ⸜䓟⿏䘬䣦㚫䴻㾇⛘ỵ冯ℕ枭䱦䤆䈑岒(厠ˣ惺ˣ㩛㤼ˣ㍸䤆梚㕁ˣ
┉ˣ勞)ἧ䓐ᷳ斄Ὢ炻ᶵ㩊夾╖ᶨ䈑岒䘬㴰屣炻ḇ⊭⏓ᶵ⎴䈑岒䘬㴰屣佌普ˤ 䈡⇍䘬㗗炻㛔䞼䨞娎⚾㍊妶䞍嬀ˣン⹎冯䉨ン⛐䈡⭂䣦㚫䴻㾇佌橼䘬䱦䤆䈑 岒ἧ䓐ᷕ㈖㺼䘬奺刚ˤ
㕡㱽烉ἧ䓐 2005 濜ˬ⚳㮹姒⓷㙐喍䈑潰䓐婧㞍˭ᷳ悐↮屯瀌忚灖㫉䳂屯瀌↮
㜸ᷕ炻㚨⼴↮㜸䘬㧋㛔䁢 18-64 㬚䘬䓟⿏㧋㛔 6087 Ṣˤ冒嬲枭䁢䣦㚫䴻㾇⛘ỵ炻 ẍ借㤕ˣ㔁做䦳⹎冯ℑ侭䘬䳬⎰Ἦ㷔慷ˤ椾⃰ㅱ䓐暁嬲枭↮㜸Ἦ㍷徘㔁做ˣ借㤕
⎬䧖䈑岒㴰屣ᷳ攻䘬斄Ὢ烊㍍叿ẍ Spearman 䚠斄↮㜸佌倂↮㜸㍊妶䈑岒㴰屣
✳ン冯䣦㚫䴻㾇⛘ỵ䘬斄Ὢ烊㚨⼴ẍ⸷ỵ怷廗㕗徜㬠㧉✳慸㶭䞍嬀ˣン⹎冯
䉨ン⮵䱦䤆䈑岒ἧ䓐䘬⼙枧ˤ
䳸㝄烉ᷣ天䳸㝄⤪ᶳ烉(1)㔜橼侴妨炻㔁做ˣ借㤕冯ℕ枭䱦䤆䈑岒ἧ䓐攻忼⇘䴙妰
⬠ᶲ栗叿䚠斄ˤ䈡⇍䘬㗗炻厠ˣ惺ˣ㩛㤼冯㍸䤆梚㕁䘬ἧ䓐侭普ᷕ⛐庫Ỷ㔁做䦳
⹎冯借㤕䫱䳂烊䚠⍵⛘炻┉䘬ἧ䓐⇯ẍ庫檀㔁做䦳⹎借㤕䫱䳂䘬Ṣ䁢⣂ˤ(2)
⏠厠ˣ梚惺ˣ♤㩛㤼ˣ梚䓐㍸䤆梚㕁炻忁⚃枭䱦䤆䈑岒ἧ䓐埴䁢ᷳ攻㚱᷎⬀䘬斄 Ὢ炻℞ᷕ⏠厠冯♤梇㩛㤼䘬᷎⬀⿏㚨⻟烊侴╅勞冯⏠厠ˣ梚惺ˣ╅┉ᷳ攻℟㚱 檀⹎䚠斄⿏炻℞ᷕ勞冯┉ᷳ梚䓐䘬᷎⬀⿏㚨檀ˤ(3)ᶱᾳᷕṳ⚈⫸䔞ᷕ炻䉨 ン炻⊭⏓䓇䎮⽫䎮炻冯䱦䤆䈑岒ἧ䓐䘬斄Ὢ䘮⋩↮唬⻙䘬烊侴䞍嬀⎒冯⏠
厠♤㩛㤼㚱栗叿䘬䚠斄烊㚨⻟䘬㰢⭂⚈䳈㗗ン⹎炻冯㭷枭䱦䤆䈑岒䘬ἧ䓐䘮㚱
⼰⻟䘬䚠斄ˤ(4)佌倂↮㜸䳸㝄ℙ⼿↢ℕ䳬䈑岒ἧ 䓐埴䁢佌橼炻⊭㊔烉(i)⣂⃫ㆸ䘖
✳炻(ii)℠✳ᶱ⃫ㆸ䘖炻(iii)慵厠䘖檀┉勞炻(iv)惺┉暁⤥炻(v)䌐挦梚勞炻ẍ⍲
(vi)䲼㶐䃉䘖ˤ䷥橼Ἦ婒炻䈑岒㴰屣栆✳冯ℑ枭䣦㚫䴻㾇⛘ỵ嬲枭ᷳ攻⏰䎦栗叿䘬 昶㡗斄Ὢ炻崲檀䘬㔁做䦳⹎借㤕ㆸ⯙炻⎹ˬ䌐挦梚勞˭冯ˬ䲼㶐䃉䘖˭炻⍵
ᷳ炻㔁做䦳⹎借㤕䫱䳂崲Ỷ炻⎹㕤ˬ⣂⃫ㆸ䘖˭冯ˬ℠✳ᶱ⃫ㆸ䘖˭ˤ
iii
⺢
⺢嬘烉䈑岒ἧ䓐埴䁢䘬䞼䨞炻ㅱẍ㚜ℐ朊⍲㔜橼⿏䘬夾奺Ἦ㩊夾炻侴朆倂䃎⛐
╖ᶨ䈑岒䘬ἧ䓐ˤ㛒Ἦ䞼䨞ㅱ忋䳸军㮹䛦㖍ⷠ䓇㳣炻ẍ㋽㋱䱦䤆䈑岒䘬㴰屣㗗⤪
ỽ⍿⇘䣦㚫䳸㥳冯䣦㚫⽫䎮䫱⚈䳈䘬⼙枧ˤ䚖⇵⁛㑕冯㔁做ṵ㚱≒≃䘬 䨢攻炻暨䘤⯽㚜㚱㓰ˣ㓷デ⹎㚜檀䘬ṳℍ㍒㕥ˤ
斄挝⫿烉䱦䤆䈑岒ἧ䓐埴䁢ˣ㔁做䦳⹎ˣ借㤕ˣ䣦㚫䴻㾇⛘ỵˣ佌倂↮㜸
iv
Abstract
Purpose: To examine how socio-economic status is associated with the use of six psychoactive substances (cigarette, alcohol, betel nuts, alcoholic tonic beverage, coffee, and tea) among male adults, not only for the consumption of individual substance but also concomitant consuming clusters of different substances. Particularly, this study attempts to explore the roles knowledge, attitude, and health status play in substance use in specific socio-economic groups.
Method: Data on which this study is based come from the “2005 National Health Interview Survey.” A total of 6087 male adults 18-64 years of age are included in this study. Socio-economic status is measured by education and occupation and a
combination of both. Bivariate analysis is used to describe the association between education, occupation and the consumption of each substance. Spearman correlation and cluster analysis are used to explore patterns of substance co-consumption in relation to SES. Finally, ordinal logistic regression model is employed to clarify the effects of knowledge, attitudes and health status on substance use.
Result: The major findings are: (1) Overall, statistically significant association was found between education, occupation and the use of six substances. Particularly, cigarette, alcohol, betel nuts and alcoholic tonic beverage are more likely to be used by participants occupying lower occupational and educational level. On the contrary, coffee is more commonly used by persons with higher educational and occupational positions, (2) Alcohol drinking, smoking, betel nuts chewing, and alcoholic tonic beverage drinking are most often co-existent, and the strongest relationship is found between betel nuts chewing and smoking. Whereas tea drinking, smoking, alcohol drinking, and coffee intake are highly correlated, most common concomitant
consumption is for coffee and tea, (3) Among three sets of intervening factors, health status, both physical and mental health, is weakly correlated with substance use;
knowledge only has significant association with smoking and betel nuts chewing, and the most powerful determinant is attitude, which is strongly correlated with each type of substance use, and (4) Cluster analysis generates the following six distinctive types of substance use: (i) multiple addiction, (ii) typical triple addiction, (iii) heavy smoking and high coffee-tea consumption, (iv) alcohol-coffee double preference, (v) tea favoritism, and (vi) total substance avoidance. In general, significant gradient
associations are present between consumption type and two SES variables. Higher level of educational and occupational attainment leads to the consumption type of “tea
favoritism” and “total substance avoidance” and, in contrast, the lower attainment in education and occupation tends to be engaged in “multiple addiction” and “typical triple addiction.”
v
Suggestions: Research on substance use behavior should take a more comprehensive and holistic perspective without simply focusing only on the use of individual substance each time. Investigations should also be placed in the context of daily life to capture how substance consumption is determined by various structural and socio-psychological factors. Implications from this point of view may inform the current efforts of health communication and education to develop more sensitive and valid interventions.
Key words: psychoactive substance use behavior, education, occupation, socio-economic status, cluster analysis
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䚖 䚖抬
农嫅 ...i
㐀天 ... ii
Abstract ... iv
䚖抬 ... vi
⚾䚖抬 ... viii
堐䚖抬 ... ix
䫔ᶨ䪈 䵺婾 ... 1
䫔ᶨ䭨 䞼䨞側㘗 ... 1
䫔Ḵ䭨 䞼䨞䚖䘬冯⓷柴 ... 6
䫔Ḵ䪈 㔯䌣㍊妶 ... 7
䫔ᶨ䭨 䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ䓐䘬斄Ὢ ... 7
䫔Ḵ䭨 䉨㱩ˣ䞍嬀冯ン⹎冯埴䁢ᷳ斄Ὢ ... 11
䫔ᶱ䭨 䱦䤆䈑岒䘬䣦㚫㔯⊾シ㵝 ... 12
䫔⚃䭨 䱦䤆䈑岒ἧ䓐✳ン ... 14
䫔Ḽ䭨 ⮷䳸 ... 16
䫔ᶱ䪈 䞼䨞㕡㱽 ... 18
䫔ᶨ䭨 屯㕁Ἦ㸸 ... 18
䫔Ḵ䭨 ㉥㧋姕妰 ... 20
䫔ᶱ䭨 䞼䨞㧋㛔 ... 20
䫔⚃䭨 㤪⾝㝞㥳 ... 21
䫔Ḽ䭨 䞼䨞嬲枭 ... 22
䫔ℕ䭨 䞼䨞`姕 ... 26
䫔ᶫ䭨 屯㕁↮㜸冯㕡㱽 ... 26
䫔⚃䪈 䞼䨞䳸㝄 ... 28
䫔ᶨ䭨 㧋㛔䈡岒㍷徘 ... 28
䫔Ḵ䭨 䱦䤆䈑岒ἧ䓐✳ン ... 30
䫔ᶱ䭨 䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ䓐ᷳ斄Ὢ ... 30
䫔⚃䭨 䉨ンˣ䞍嬀⍲ン⹎冯䱦䤆䈑岒ἧ䓐ᷳ斄Ὢ ... 32
䫔Ḽ䭨 ᶵ⎴䣦㚫Ⰼ䳂ᷕ炻䱦䤆䈑岒ἧ䓐ᷳ攻䘬斄Ὢ ... 33
䫔ℕ䭨 ᷕṳ嬲枭䘬槿嫱 ... 34
vii
䫔ᶫ䭨 䱦䤆䈑岒ἧ䓐埴䁢佌橼 ... 36
䫔Ḽ䪈 妶婾 ... 58
䫔ᶨ䭨 䱦䤆䈑岒ἧ䓐埴䁢䘬䚠Ḻ斄Ὢ ... 59
䫔Ḵ䭨 䱦䤆䈑岒ἧ䓐埴䁢䘬䣦㚫Ⰼ䳂シ㵝 ... 60
䫔ᶱ䭨 䉨ン䞍嬀ˣン⹎⛐䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ䓐ᷳ攻䘬奺刚 ... 62
䫔⚃䭨 䞼䨞旸⇞ ... 63
䫔ℕ䪈 䳸婾冯⺢嬘 ... 64
⍫侫㔯䌣 ... 65
viii
⚾
⚾䚖抬
⚾ 1-1 ⎘䀋忚⎋┉濌 ... 4
⚾ 1-2 ⎘䀋勞叱㴰屣濌 ... 4
⚾ 1-3 2000 ⸜-2004 ⸜⎘䀋㍸䤆梚㕁扟ⓖ柵... 5
⚾ 3-1 㛔䞼䨞㤪⾝㝞㥳⚾ ...22
ix
堐 堐䚖抬
堐 3-1 2005 ⸜⚳㮹姒⓷㙐喍䈑㾓䓐婧㞍⓷⌟䧖栆堐 ...19
堐 3-2 借㤕栆⇍⍲䫱䳂⋨↮堐... 23
堐 4-1 䣦㚫Ṣ⎋⬠嬲枭(n=6087) ... 40
堐 4-2 䞼䨞㧋㛔䘬䱦䤆䈑岒ἧ䓐ね⼊... 41
堐 4-3 䞼䨞㧋㛔䘬⎬栆䉨ン↮Ự... 42
堐 4-4 䞼䨞㧋㛔ᷳ䱦䤆䈑岒⌙⭛䞍嬀冯ン⹎↮Ự... 43
堐 4-5 ẍ Spearman 䚠斄↮㜸䚳䱦䤆䈑岒ἧ䓐埴䁢攻ᷳ䚠斄... 43
堐 4-6 借㤕䫱䳂冯㔁做䦳⹎⍲䱦䤆䈑岒ἧ䓐ᷳ斄Ὢ... 44
堐 4-7 䉨ン冯䱦䤆䈑岒ἧ䓐ね⼊... 45
堐 4-8 䞍嬀ˣン⹎冯䱦䤆䈑岒ἧ䓐ね⼊... 46
堐 4-9 ẍ借㤕↮Ⰼ炻䱦䤆䈑岒ἧ䓐埴䁢ᷳ攻䘬䚠斄ね⼊... 47
堐 4-10 ẍ㔁做䦳⹎↮Ⰼ炻䱦䤆䈑岒ἧ䓐埴䁢ᷳ攻䘬䚠斄ね⼊... 48
堐 4-11 䉨ン冯ℕ枭䱦䤆䈑岒ἧ䓐䘬斄Ὢ✳ン ... 49
堐 4-12 ⮵⏠厠冯梚惺ᷳ⸷ỵ怷廗㕗徜㬠↮㜸炻ẍ借㤕↮Ⰼ᷎冯ℐ橼㧋㛔ᷳ䳸㝄 㭼庫 ... 50
堐 4-13 ⮵㩛㤼冯㍸䤆梚㕁ᷳ⸷ỵ怷廗㕗徜㬠↮㜸炻ẍ借㤕↮Ⰼ᷎冯ℐ橼㧋㛔ᷳ 䳸㝄㭼庫 ... 51
堐 4-14 ⮵┉冯╅勞ᷳ⸷ỵ怷廗㕗徜㬠↮㜸炻ẍ借㤕↮Ⰼ᷎冯ℐ橼㧋㛔ᷳ䳸㝄 㭼庫 ... 52
堐 4-15 ⮵⏠厠冯梚惺ᷳ⸷ỵ怷廗㕗徜㬠↮㜸炻ẍ㔁做䦳⹎↮Ⰼ᷎冯ℐ橼㧋㛔ᷳ 䳸㝄㭼庫 ... 53
堐 4-16 ⮵㩛㤼冯㍸䤆梚㕁ᷳ⸷ỵ怷廗㕗徜㬠↮㜸炻ẍ㔁做䦳⹎↮Ⰼ᷎冯ℐ橼㧋 㛔ᷳ䳸㝄㭼庫 ... 54 堐 4-17 ⮵┉冯╅勞ᷳ⸷ỵ怷廗㕗徜㬠↮㜸炻ẍ㔁做䦳⹎↮Ⰼ᷎冯ℐ橼㧋㛔ᷳ
x
䳸㝄㭼庫 ...55 堐 4-18 ℕᾳ佌句橼(Cluster Group)⛐⎬枭䱦䤆䈑岒ἧ䓐埴䁢ᶲᷳ↮Ự ...56 堐 4-19 ⸜漉ˣ䉨ン冯䞍嬀ン⹎ˣ䣦䴻⛘ỵℕᾳ佌句橼䘬斄Ὢ ...57
1
䫔
䫔ᶨ䪈ġ 䵺婾
䫔ᶨ䭨 䞼䨞側㘗
姙⣂㳩埴䕭⬠婧㞍ᶨℵ嫱⮎ˬ䱦䤆ἄ䓐⿏䈑岒˭(psychoactive substance)冯ㄊ
⿏䕭䘤䓇㚱檀⹎䚠斄炻ἳ⤪䴻ⷠ⿏䘬⏠厠忶慷梚惺㚫⮶农⽫埨䭉䕦䕭炻⍲⣂悐 ỵ䗴䕯ᷳ农䕭䌯㬣ṉ䌯䘬⡆≈(Orth et al., 1998; Parkin, Pisani, Lopez, & Masuyer, 1994; Vineis et al., 2004)烊侴♤梇㩛㤼㖻塓䘤䎦冯⎋僼湷兄ᶳ举䵕⊾ˣ⎋僼湷兄䘥 㔹⎋僼䗴䕭嬲㚱⭮↯斄Ὢ(Pindborg, Odont D. Barmes, & Roed-Petersen, 1968;
Thomas & MacLennan, 1992)烊梚䓐┉⇯塓㊯↢冯僶冇䳘傆䗴䕭嬲㚱斄Ὢ(Yu, Mack, Hanisch, Cicioni, & Henderson, 1986)ˤ媪ˬ䱦䤆ἄ䓐⿏䈑岒˭炻ὅ WHO (2011) 䘬⭂佑炻㗗㊯䔞忚ℍᶨᾳṢ䘬幓橼炻㚫⼙枧℞⽫䎮忶䦳䘬䈑岒炻ἳ⤪娵䞍ㆾデね炻 ḇ⯙㗗㊯傥㓡嬲Ṣ栆⽫曰冯䱦䤆シ嬀䘬䈑岒䧙ᷳ炻㛔䞼䨞⮯ᷳ䯉䧙䁢ˬ䱦䤆䈑岒˭ˤ
⚆栏ẍ⼨慓⬠冯℔ℙ堃䓇䚠斄柀➇⮵䱦䤆䈑岒䘬䞼䨞炻䘤䎦⣏悐↮叿慵䱦䤆 䈑岒⛐朆慓䗪ね⠫ᶳ䘬ἧ䓐炻ἳ⤪䱦䤆䈑岒ἧ䓐ˬ埴䁢˭⁷㗗ᶲ䘖ㆾ侭㾓䓐炻⮵
ˬ˭ㆾˬ䕦䕭˭䘬⼙枧炻ẍ⍲䱦䤆䈑岒ἧ䓐䘬䚃埴䌯ẍ冯Ṣ⎋⬠䈡岒䘬斄倗 (Chen, Chen, Fagot-Campagna, & Narayan, 2001; Sorensen & Pechacek, 1986; 昛
匱ˣ㛶嗕炻1999)ˤ忶⍣䞼䨞䘬奨溆炻⭡㖻忈ㆸ屔⁁⍿⭛侭炻᷎⮯㬠㕤ᾳṢ䘬 屔ảˤ侴冯ἧ䓐埴䁢䚠斄䘬Ṣ⎋䣦㚫⬠䈡岒炻㚫⮶农⣏䛦⮵䱦䤆䈑岒ἧ䓐㕷佌䓊 䓇㰉⎵⊾ㆾ侭層㧁䰌䘬ね⼊炻㍸⇘䱦䤆䈑岒⯙㚫冯Ỷ䣦㚫Ⰼ䳂ˣ⍇ỷ㮹ἄ忋䳸炻 ᶼ䞼䨞䘬⺢嬘ḇ⸦᷶悥㗗㔁做⍲庼⮶ᾳṢ炻ẍ㍸檀℞䞍嬀ˣン⹎埴䁢䘬㓡嬲ˤ 䔞ẋ℔ℙ堃䓇䘬婾徘炻⊆≽昶䳂侭ⷠ塓㍷丒ㆸᶵ倥㍐≽侭⊠⏲炻ᶼ㓭シ嬻冒
㙜曚⛐⌙晒⚈⫸ᷕ侴朆䎮⿏䘬⍣性炻⚈㬌忁佌Ṣ暨天㚜慵夾䚋㍏⍲䭉䎮
2
(Lupton, 1995)ˤẍ㩛㤼ἧ䓐䁢ἳ炻⣏䛦䷥㗗⮯♤梇㩛㤼ᷳ埴䁢冯⊆≽昶䳂ˣỶᶳ Ⰼ䳂ἄ忋䳸炻婯⍲㩛㤼ᶨ娆⯙倗゛军冯♤梇㩛㤼䚠斄䘬屈朊⌘尉炻℞ᷕ㚜シ␛叿
⼊尉Ỷᶳ䘬♤梇㩛㤼侭℞埴䁢暨天塓䞗㬋炻ḇ䆇忈↢♤梇㩛㤼㗗Ỷ昶ⰌṢᾹ䘬埴 䁢(悕㵹䍵ˣᶩ⽿枛炻2006)ˤ
䎦ẋ⊾䘬䣦㚫ᶳ䓇⬀䘬Ṣ栆㶙㶙⍿℞␐⚵㓧㱣ˣ䴻㾇⍲䣦㚫䑘⠫䘬⼙枧炻ᾳ Ṣ䘬ˬ冒䓙怠㑯˭℞⮎㗗⼰㚱旸䘬ˤ⎴䎮炻㉥厠ˣ惿惺ㆾ♤㩛㤼䘬Ṣ炻昌Ḯ㤝⮹
㔠⎗傥⚈ˬ冒䓙シ⽿˭怠㑯忁ṃ㖶䞍忻㚫⮵冒幓忈ㆸ ⭛䓂军⤒崘䓇␥䘬埴 䁢⢾炻䳽⣏⣂㔠㗗⚈䓇㳣忤ˣ⎴₽䘬⡻≃ˣ⺋⏲䘬婀べˣⶍἄ䘬暨㯪炻ㆾ㓧⹄
ᶵ䔞㓧䫾䫱䫱㓧㱣ˣ䴻㾇ˣ⍲䣦㚫⚈䳈䘬⼙枧(昛伶曆炻2004)ˤỮ忶⍣⮰⭞庫 䃉⮇奢䱦䤆䈑岒䘬䣦㚫Ⰼ䳂シ㵝炻⎒⮯℞夾䁢䣦㚫Ṣ⎋⬠䈡⽝䘬䴙妰嬲枭炻䴻ⷠ
㍏⇞忁ṃ䣦㚫Ṣ⎋⬠嬲枭侴朆⮑夾⬫(Adler et al., 1994)炻庫⮹㍊妶ἧ䓐䱦䤆䈑岒䘬 忁佌Ṣ冯ṾᾹ側⼴䘬㔯⊾ 忋䳸炻䁢ỽ㝸ᶨ佌橼⭡㖻㚱㝸ṃ䱦䤆䈑岒䘬ἧ䓐佺ㄋ?
⮰⭞䴻䚜㍍⮯䱦䤆䈑岒ἧ䓐埴䁢夾䁢䣦㚫⓷柴ˣ埴䁢ῷⶖἮ忚埴䞼䨞炻⤪
㬌䘬⿅侫㝞㥳ᶳ炻⼰⮹䞼䨞㚫⍣慵夾㗗䓂湤㧋䘬㔯⊾䑘⠫忈ㆸ⬫䘬ἧ䓐埴䁢ˤ
䣦㚫䳸㥳Ⰼ㫉䘬⼙枧炻⁷屏䩖ˣ䴻㾇⡻≃ẍ⍲䑘⠫㰉㝻䫱⓷柴炻㗗ᾳṢ庫㰺 㚱傥≃⍣㍏⇞ㆾ妋㰢䘬炻Ữ⌣㗗㭷ᾳṢ㭷⣑悥⽭枰朊⮵䘬䓇㳣嗽⠫ˤ忁ṃ䣦㚫ね
⠫ᶵỮ䓊䓇ᶵ䘬䓇㳣䉨㱩炻ḇ⭡㖻ὫἧṢᾹ㚱ᶵ⇑䘬埴䁢炻ἳ⤪䁢Ḯㅱ Ẁ䓇㳣⡻≃侴⮶农⏠厠ˣ╅惺䫱埴䁢炻ḇ⯙㗗ṢᾹ⎗傥⚈䁢嗽䘬䣦㚫ỵ伖炻ἧ
⼿⚈ㅱ屯㸸䘬仢᷷炻侴⭡㖻⍣怠㑯㝸䧖ᶵ⇑䘬ⶍἄㆾ⯭ỷ䑘⠫ˤ䁢Ḯ⚆ㅱ忁 㧋䘬嗽⠫炻⼨⼨⭡㖻怠㑯㝸ṃᶵ䘬埴䁢(White, 2002)炻忈ㆸḮ䘬ᶵ℔㬋 (health inequity)䘬ね㱩ˤ
役⸜Ἦ炻ᶵ⸛䫱䘬䞼䨞䓙⍇⃰ᷣ天㍊妶䣦㚫Ⰼ䳂冯㬣ṉ䌯ˣ伡䕭䌯䘬
3
斄Ὢ炻廱侴㩊夾℞ᷕ䘬㨇廱炻Adler and Newman (2002)娵䁢嗽㕤庫Ỷ䣦䴻⛘ỵ䘬Ṣ
⭡㖻⛐庫ⶖ䘬䈑䎮䑘⠫⯭ỷㆾ侭ⶍἄ炻ἳ⤪㑩㒈⏝暄ㆾ侭仢᷷䣦㚫ↅ倂≃ˣ䣦㚫 屯㛔炻⮵䄏嬟䘬⎗役⿏Ỷ炻ẍ⍲⭡㖻㚱ᶵ⇑䘬埴䁢ˤ⎎㚱⬠侭德忶妋慳 㔁做䦳⹎冯䘬斄ὪἮ㩊夾䣦㚫Ⰼ䳂⮵䘬⼙枧炻䘤䎦檀㔁做䦳⹎侭庫ᶵ㖻
⣙㤕ˣ⭡㖻㈦⇘ℐ借ⶍἄˣ庫檀㓞ℍˣỶ䴻㾇⡻≃炻⮵冒䘬䓇㳣冯㚱庫檀 䘬㍏⇞㪲炻ᶼ㚱庫⣂䘬䣦㚫㓗㊩冯䚠斄埴䁢(Ross & Wu, 1995) ˤ䓙㬌⎗䞍炻 䣦㚫Ⰼ䳂䡢⮎㚫忈ㆸ埴䁢䘬ⶖ䔘ˤ
䃞昌Ḯ㘖念⍿⇘慵夾䘬楁厠ˣ惺ˣ㩛㤼䫱炻忁ṃ㚱姙⣂⌙⭛⮎嫱ὅ㒂 䘬䱦䤆䈑岒ᷳ⢾炻℞⮎怬㚱姙⣂栆Ụ䘬䈑岒⛐㖍ⷠ䓇㳣ᷕ塓㮹䛦⺋㲃ἧ䓐炻ἳ⤪
┉冯勞ˤ䓙㕤⚳Ṣ䓇㳣梚梇佺ㄋ䘬㓡嬲冯⍿⇘㫸伶㖍䫱⃰忚⚳⭞ᷳ⼙枧炻⚳Ṣ
⮵┉䘬㴰屣柣䌯徸⸜ᶲ⋯(姙㘢⻟炻2007)炻⽆⚾ 1-1 ⎗䚳↢⎘䀋冒 1989 ⸜Ἦ䓙
⚳⢾忚⎋┉䘬㔜橼ᶲ⋯嵐⊊ˤ侴梚勞䁢ᷕ⚳Ṣ䘬⁛䴙佺ㄋ炻⏛㵹⧇(2007)䘬䞼䨞
㊯↢炻1971 濜⎘䀋䘬灌澼㴰屣濌㭷Ṣ㭷濜㚱 0.27 ℔㕌炻⇘瀈 1981 濜⇯⡆军 0.58
℔㕌炻军 1991 濜潏⡆≈䁢 1.10 ℔㕌ẍᶲ炻1999 濜㚜忼 1.31 ℔㕌炻ḇ栗䣢↢⎘䀋 灌澼䘬㴰屣濌㚱徸濜⡆≈䘬嵐⊊(夳⚾ 1-2)ˤ⎎⢾炻䚠䔞℟㚱⎘䀋⛘㕡㔯⊾䈡刚䘬
㍸䤆梚㕁炻ἳ⤪ᾅ≃忼 Bˣ䵕⢓㭼炻䁢⏓惺䱦大喍炻Ⱄ㕤㊯䣢䓐喍炻℞ᷣ天ㆸấ䁢 䵕Ṿ␥ˣ傢➢愠ˣ┉⚈⍲ᷕ喍楁㕁ˤ㬋⚈䁢㶣≈慵天楁㕁炻ἧ㮹䛦䴻ⷠ婌ẍ䁢 忁ṃ梚㕁䁢ᷕ喍喍惺炻侴ᶼ㚱⣂╅⻟幓ᶵ 幓䘬゛⁷(岜㗱㤟炻2005)ˤ䓙役⸜Ἦ㔜 橼㍸䤆梚瀌ⶪ⟜扟ⓖ濌Ἦ䚳(夳⚾ 1-3)炻䚖⇵⎘䀋㮹䛦㍸䤆梚㕁ᷳἧ䓐ḇ⏰䎦徸⸜
ㆸ攟䘬嵐⊊(㣲⽿㴑炻2006)ˤ⚈㬌昌Ḯ楁厠ˣ惺ˣ㩛㤼ᷳ⢾炻忁ṃ䚖⇵᷎朆䁢℔ℙ 堃䓇⓷柴ᷳ䱦䤆䈑岒䘬㴰屣炻ḇῤ⼿斄㲐炻䈡⇍㗗⬫Ᾱ冯ᶲ徘ˬ㚱⭛˭䈑岒 ἧ䓐ᷳ攻䘬斄Ὢˤ
4
屯㕁Ἦ㸸烉姙㘢⻟(2007)
⚾ 1-1 ⎘䀋忚⎋┉濌
屯㕁Ἦ㸸烉⏛㵹⧇ (2007)
⚾ 1-2 ⎘䀋勞叱㴰屣濌
5
屯㕁Ἦ㸸烉㣲㘢㴑(2006)
⚾ 1-3 2000 ⸜-2004 ⸜⎘䀋㍸䤆梚㕁扟ⓖ柵
䓙㕤⚆栏忶⍣㔯䌣䘤䎦䱦䤆䈑岒䘬ἧ䓐ẍ䓟⿏⯭⣂(Chen, Chen,
Fagot-Campagna, & Narayan, 2001; Ko et al., 1995; 㛶嗕䫱炻1995; 昛匱ˣ㛶嗕炻 1999)炻⛐侫慷䞼䨞䚖䘬⼴炻㛔䞼䨞⮵尉⮯ẍ⎘䀋⛘⋨䘬ㆸ⸜䓟⿏䁢ᷣˤ≈ᶲ姙⣂
䞼䨞䘮㊯↢䱦䤆䈑岒䘬ἧ䓐㚫㚱倂普䘬䎦尉(Chen, Chen, Fagot-Campagna, &
Narayan, 2001; ᶩ⽿枛ˣ㰇㜙Ṗ炻1996; 㛶嗕䫱炻1995; 悕㵹䍵ˣᶩ⽿枛炻2006)炻
⚈㬌㛔䞼䨞⮯⣂䧖䱦䤆䈑岒䲵ℍ↮㜸炻昌Ḯẍ⼨䞼䨞ⷠ夳䘬楁厠ˣ惺冯㩛㤼炻怬
⊭㊔┉ˣ勞ˣ㍸䤆梚㕁䫱炻䚉⎗傥⮯㮹䛦ἧ䓐䘬䱦䤆䈑岒悥↿ℍ侫慷ˤ
㛔䞼䨞娎⚾⮯䣦㚫䴻㾇⛘ỵ䔞ἄᷣ天䘬冒嬲枭炻䱦䤆䈑岒䘬ἧ䓐✳ンἄ䁢䞼 䨞ὅ嬲枭炻㍊妶䱦䤆䈑岒ἧ䓐侭㗗⏎⚈䁢䣦㚫䴻㾇⛘ỵ䘬ᶵ⎴炻侴⼙枧℞⮵䱦䤆 䈑岒䧖栆䘬怠㑯ẍ⍲℞ἧ䓐✳ン炻᷎ᶼ⮯䞍嬀ˣ₡ῤ冯䉨㱩ḇ䲵ℍ䞼䨞侫慷
ᷕˤ啱䓙㍊妶ỵ㕤ᶵ⎴䣦㚫ỵ伖䘬㮹䛦炻℞ἧ䓐ᷳ䱦䤆䈑岒䘬ⶖ䔘炻Ἦ䝕妋℞
ᷕ⎗傥㴱⍲䘬䳸㥳ㆾ㔯⊾ἄ䓐ˤ
6
䫔
䫔Ḵ䭨 䞼䨞䚖䘬冯⓷柴
㛔䞼䨞ᷳ䚖䘬炻⛐㕤㍊妶ㆸ⸜䓟⿏䘬䣦㚫䴻㾇⛘ỵ冯䱦䤆ἄ䓐⿏䈑岒ἧ䓐✳
ンᷳ攻䘬斄Ὢ炻᷎侫慷ᾳṢ䉨㱩冯䞍嬀ˣン⹎⚈䳈⛐℞ᷕ㈖㺼䘬奺刚ˤ侴
℟橼䞼䨞⓷柴⤪ᶳ烉
ᶨˣġ⎬栆䱦䤆䈑岒ἧ䓐埴䁢ᷳ攻䘬䚠Ḻ斄Ὢ䁢ỽ?㗗⏎㚱倂普䘬䎦尉?
Ḵˣġỵ㕤ᶵ⎴䣦㚫ỵ伖䘬䓟⿏炻℞ἧ䓐䱦䤆䈑岒䘬栆⇍冯✳ン㗗⏎㚱ⶖ䔘?
ᶱˣġ⛐ᶵ⎴䣦㚫ỵ伖䘬傰䴉ᷳᶳ炻䞍嬀ˣ₡ῤ冯䉨㱩⤪ỽ⼙枧ᾳṢ⮵䱦䤆䈑 岒䘬ἧ䓐?
7
䫔
䫔Ḵ䪈ġ 㔯䌣㍊妶
䫔ᶨ䭨ġ 䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ䓐䘬斄Ὢ
役⸜℔ℙ堃䓇⮵㕤䱦䤆䈑岒䘬䞼䨞炻ἧㆹᾹ⮵䱦䤆䈑岒ἧ䓐埴䁢㚱㚜忚ᶨ㬍 䘬Ḯ妋炻Ữ忁ṃ䞼䨞⣏⣂⮯䱦䤆䈑岒ἧ䓐埴䁢䔞ㆸ䚠斄䘬桐晒⚈⫸炻侴忁ṃ 桐晒⚈⫸塓夾䁢ᾳṢ䘬怠㑯炻冯埴䁢㧉⺷側⼴㚜⣏䭬⚵䘬䣦㚫䳸㥳⚈䳈䃉斄ˤ⛐
㬌䧖奨溆ᶳ埴䁢嬲ㆸᾳṢ䘬屔ả⓷柴炻䚠⮵⭡㖻⾥䔍⓷柴冯ᾳṢ㖍ⷠ䓇 㳣䴻槿ˣ㔯⊾冯嗽䘬䣦㚫ỵ伖㚱斄ˤᶼẍ⼨䘬䞼䨞⣏⣂㗗⃰怠⭂䈡⭂䘬㝸ṃ䱦 䤆䈑岒炻ἳ⤪楁厠ˣ惺ˣ㩛㤼(Chen, Chen, Fagot-Campagna, & Narayan, 2001; ∱䡏 厗ˣ嫅㵹剔ˣ䪈枮ṩˣ吃ㅱ㫥炻1994)炻㍊妶ἧ䓐㕷佌䘬Ṣ⎋⬠䈡岒炻侴䞼䨞䳸㝄
⣏⣂䁢䓟⿏ˣỶ㔁做䦳⹎ˣỶ䣦㚫⛘ỵ䘬⊆ⶍ昶Ⰼ䁢ᷣ天ἧ䓐侭炻䃞㬌䧖枸⃰姕
⭂㝸ṃ䱦䤆䈑岒䘬㕡⺷炻℞䞼䨞䳸㝄⣏农ᶲ䚠⎴ḇ㗗⎗ẍ枸㛇䘬炻ᶼ䚠斄䞼䨞䱦 䤆䈑岒ἧ䓐埴䁢⸦᷶悥ẍ屈朊⼊尉↢䎦炻㗗䓐ᶨ䧖䯉⊾䘬㕡⺷䰿䔍䘬怠㑯㝸ṃ䫎 嘇Ἦ⺢㥳䱦䤆䈑岒ἧ䓐侭䘬⇣㜧⌘尉(悕㵹䍵ˣᶩ⽿枛炻2006)ˤ
䃞侴⮵㕤忁佌ἧ䓐侭侴妨炻忁ṃ䈡⭂䱦䤆䈑岒䘬ἧ䓐炻㗗ṾᾹ䓇㳣䘬䣦㚫傰 䴉⼊⟹Ḯ忁㧋䘬ῷ⤥炻⚈侴⼊ㆸ℞䈡㬲䘬ˬ䓇㳣✳ン˭炻侴忁㧋䘬ˬ䓇㳣✳ン˭冯
℞嗽䘬䣦㚫ỵ伖⍲䣦㚫䳸㥳㚱斄(悕㵹䍵ˣᶩ⽿枛炻2008)ˤ㚱ᶨṃ䞼䨞栗䣢炻 㝸ṃ䣦㚫Ṣ⎋⚈䳈⤪䣦㚫Ⰼ䳂ˣ⸜漉ˣ⿏⇍ˣ㔁做䦳⹎炻冯䚠斄埴䁢㚱⼰
⣏䘬斄倗炻ᶨᾳṢ⮵㕤䚠斄埴䁢䘬ᾉ⾝ㆾ侭䚠斄䘬埴䁢⼴㝄炻⎗傥䁢⼙枧℞
埴䁢䘬㰢⭂炻侴䣦㚫䴻㾇䑘⠫㍸ὃḮṾᾹ⎗ẍ⽆ḳ忁ṃ埴䁢䘬⟜➇ (Calnan, 1989; Calnan & Rutter, 1986)炻ḇ⯙㗗婒ᶨᾳṢ嗽䘬䣦㚫䑘⠫㚫⼙枧Ṿ䘬
ᾉ⾝ẍ⍲㰢⭂㗗⏎⽆ḳ㝸枭埴䁢ˤ
8
⽟⚳䣦㚫⬠⭞ Weber ⮵䓇㳣✳ン⍲⛘ỵ⛀橼(status group)䘬㤪⾝⍲䎮婾⮵䣦㚫
↮Ⰼ䎮婾㚱⼰⣏䘬届䌣ˤṾ娵䁢Ⱄ㕤⎴ᶨ⛘ỵ⛀橼䘬ㆸ⒉ṓ㚱䚠⎴䘬䈑岒䑘⠫ˣ 倚㛃ˣ㓧㱣⼙枧≃冯䓇㳣✳ン炻᷎㍸↢䓇㳣✳ン䓙䓇㳣埴㬊(life conduct)⍲䓇㳣㨇 㚫(life chance)䳬ㆸ炻䓇㳣埴㬊堐䣢㚱斄ᾳṢ⮵䓇㳣㕡⺷䘬怠㑯炻䓇㳣㨇㚫堐䣢 ᶵ⎴Ⰼ䳂䘬Ṣ⛐䓇␥㬟䦳ᷕ㑩㚱ᶵ⎴䘬㨇㚫⍣䌚⼿暨䘬屯㸸炻冯ᾳṢ䘬䣦䴻⛘
ỵˣ⸜漉ˣ⿏⇍ˣ䧖㕷䫱⚈䳈㚱斄炻ᶼ䓇㳣埴㬊冯䓇㳣㨇㚫Ḻ䚠⼙枧炻⛐㬌䓇㳣 埴㬊䘬䚖䘬᷎朆悥䁢Ḯ䘬䚖䘬炻侴㗗ᶨ䧖㴰屣埴䁢(Weber, 1969)ˤAbel (1991) 娵䁢⎗ẍ⮯䓇㳣㕡⺷ἄ䁢ᶨᾳ↮㜸㤪⾝⍣⋨⇍ᾳṢ㗗Ⱄ㕤⒒ᾳ佌橼炻᷎ᶼ⻟婧䓇 㳣㕡⺷䁢ᶨ䧖䣦㚫⋨⇍䘬ㇳ㭝炻⎗ẍ䧵㤝䓐Ἦ䌚⼿ㆾ䵕㊩㝸䣦㚫⛘ỵˤ
⺞Ỡ Weber 䘬䎮婾炻㱽⚳䣦㚫⬠⭞ Bourdieu (1984)⇯⻟婧Ⰼ䳂ᷳ攻䘬ⶖ䔘ˤ Bourdieu妶婾ᶵ⎴Ⰼ䳂⤪ỽ䴻䓙䓇㳣⑩␛(taste)Ἦἄ⋨昼炻Ṿ娵䁢㚨斄挝䘬㕡⺷℞
⮎㗗⛐㖍ⷠ䓇㳣ᷕ橼䎦炻⛐⁛忼ㆾ⯽䣢ᾳṢ⑩␛ᷳ晃炻⎴㗪ḇ⎹ṾṢ德曚↢斄㕤 冒䣦㚫⛘ỵ䘬妲〗ˤἳ⤪㚱斄ᾳṢ䘬䣦㚫昶䳂側㘗ㆾ侭㔁做䦳⹎炻㚫啱䓙ᶨᾳ Ṣ堐䎦䘬䧖䧖䘬䓇㳣⑩␛⛐Ⰼ䳂ᷳ攻ἄ↢Ḯ⋨⇍(distinction)ˤ
⚈㬌炻䱦䤆䈑岒䘬ἧ䓐᷎ᶵ㗗╖䲼䘬ᾳṢ埴䁢炻℞埴䁢側⼴㚱叿墯暄䘬䣦㚫 㔯⊾シ㵝炻ḇ⎗⮯ᷳ夾䁢䣦㚫䴻㾇⛘ỵ(socio-economic status, SES)䘬䓊䈑ˤ䣦㚫䴻 㾇⛘ỵ㗗ᶨᾳ䵄⎰䘬㷔慷炻忂ⷠ⊭⏓䣦㚫⛘ỵ(social status)炻䓙㔁做Ἦ㷔慷烊ⶍἄ 䉨ン(work status)炻䓙借㤕Ἦ㷔慷烊䴻㾇⛘ỵ(economic status)炻䓙㓞ℍἮ㷔慷(Adler et al., 1994)ˤ⮵㕤 SES 冯䱦䤆䈑岒ἧ䓐ᷳ攻䘬斄Ὢ炻Babor (1994)娵䁢℞ᷕᶨ䧖⎗
傥䘬妋慳䁢㺪䦣`婒(drift hypothesis)炻⚈䁢䈑岒㾓䓐⺽崟ㆸ䘖炻忚侴⇲⻙Ḯ䣦㚫䴻 㾇屯㸸炻ḇ⯙㗗婒䱦䤆䈑岒䘬ἧ䓐⼙枧℞ SES炻侴ᶵ㗗 SES ⼙枧䱦䤆䈑岒ἧ䓐炻 䃞㬌`婒᷎㛒⼿⇘⺋㲃㓗㊩ˤ侴⎎ᶨ䧖⎗傥䘬妋慳䁢炻㥳ㆸ SES 䘬天䳈炷⌛㔁做ˣ 借㤕炸炻⼊⟹ᶨᾳṢ䘬䓇␥㬟䦳ẍ⍲⼙枧℞㙜曚㕤䱦䤆䈑岒ᷕˤ⛐㝸䧖䦳⹎ᶲ炻SES
9
㰢⭂䣦㚫䴻槿ˣ䣦㚫䑘⠫埴䁢炻⚈㬌⬫⎗傥忈ㆸ⮵䱦䤆䈑岒㍍妠㨇㚫䘬⡆
≈᷎㷃⮹旣≃炻䈡⇍㗗恋ṃ℟㚱㱽⼳屔ả⍲檀⹎ὅ岜⿏䘬䱦䤆䈑岒ˤ侴䚠斄䘬䎮 婾炻娵䁢 SES ẋ堐Ḯ⡻≃䘬㙜曚冯䴻槿䘬ⶖ䔘(Adler et al.,1994)ˤ
借
借㤕ẍ⍲㔁做䦳⹎冯䱦䤆䈑岒ἧ䓐埴䁢䘬斄Ὢ
借㤕䘬悐↮炻ᶵ⎴借㤕㚱ᶵ⎴䘬倚㛃ˣ㓞ℍˣⶍἄ䑘⠫冯ⶍἄ⿏岒炻悥㚫⼙
枧埴䁢ˤᶵ⎴ⶍἄ⟜䘬借⟜㔯⊾(occupational culture)㚫⼙枧埴䁢⛐ỽ䧖ね⠫
ᶳ䘤䓇炻ἳ⤪冯ⶍἄ⣍Ờ⎫梗㗪ᶨ崟梚惺炻ㆾ侭ᶳ䎕⼴⛐䣦Ṍ⟜⎰梚惺炻借⟜㔯
⊾㗗⤪ỽ⼙枧ṢᾹ梚惺ẍ⍲⛐ỽ䧖ね⠫ᶳ梚惺炻䪗䚳㬌栆㫉㔯⊾㕷佌䣦㚫㧁㸾 (Ames & Janes, 1987)ˤ役⸜Ἦ炻ⶍἄ⟜⎰⮵景⒉䱦䤆䈑岒ᷳἧ䓐忈ㆸ䘬⼙枧攳
⥳⍿⇘慵夾(Evans, 2004; Sonnenstuhl, 1996)ˤ侴斄㕤借㤕冯䈑岒ἧ䓐䘬⮎嫱䞼䨞炻 Ko et al.(1992)䘬䞼䨞栗䣢炻啵柀ⶍṢ庫⭡㖻♤梇㩛㤼ˤ侴㼀⿄䅽冯㛶嗕(1999)䘬䞼 䨞栗䣢㈨埻⿏ⶍṢ⏠厠䘬⎗傥⿏栗叿檀㕤⮰㤕ㆾ埴㓧Ṣ⒉ˤ⎎㚱䞼䨞⮯借㤕↮䁢 檀炷ᷕ炸䳂⮰㤕Ṣ⒉炻⋲⮰㤕Ṣ⒉ㆾᶨ凔℔⊁Ṣ⒉炻㈨埻ⶍṢ炻ẍ⍲⋲㈨埻ㆾ朆
㈨埻ⶍṢ⚃栆炻䘤䎦ẍ㈨埻ⶍṢ㚱♤㩛㤼ᶼ⏠厠埴䁢侭㚨⣂炷21.1%炸炻♤㩛㤼ᶵ
⏠厠埴䁢侭ẍ⋲㈨埻ㆾ朆㈨埻ⶍṢ㚨⣂炷4.2%炸炷昛匱ˣ㛶嗕炻1999炸ˤḇ㚱䞼 䨞栗䣢炻梚惺ẍ檀䳂⮰㤕Ṣ⒉ˣ檀䳂ᷣ䭉㚨⣂炻⎗傥⚈䁢ṾᾹ暨天ⷠⷠㅱ愔⭜㚫炻
⚈侴梚惺埴䁢㚨⣂(㠩㋗佲ˣ␐倯努ˣỽἑ䍲ˣ嫅⣑㷅ˣ㣲⣽楐炻2004)ˤᶵ忶⣏农 侴妨炻借㤕⛘ỵ崲檀炻䱦䤆䈑岒ἧ䓐埴䁢崲⮹ˤ
㔁做⎗ẍ㰢⭂㛒Ἦ䘬借㤕㨇㚫㓞ℍ炻⛐䣦㚫㳩埴䕭⬠䚠斄䞼䨞䔞ᷕ㔁做䦳
⹎䴻ⷠ㗗䣦㚫䴻㾇⛘ỵ䘬㊯㧁炻⚈䁢㔁做⎗ẍ㗗ᾳṢ䌚⍾䞍嬀䚠斄屯䓊䘬㕡㱽炻 侴忁ṃ䞍嬀⎗傥㚫⼙枧娵䞍炻ἧṾᾹ㚜⭡㖻㍍⍿㔁做䘬妲〗ˣ㚜傥⣈㹅忂炻
᷎䌚⼿怑䔞䘬㚵⊁(Galobardes, Shaw, Lawlor, Lynch, & Davey, 2006)ˤ⎎⢾炻㔁
10
做䦳⹎檀侭㚫㚱庫⣂䘬䣦㚫㓗㊩ẍ⍲ㅱ嬲䓇㳣⡻≃䘬婧怑傥≃炻⚈㬌⮵䓇㳣㚱庫 檀䘬㍏⇞デ(Ross & Wu, 1995)ˤ
斄㕤㔁做䦳⹎冯䈑岒ἧ䓐埴䁢䘬⮎嫱䞼䨞栗䣢炻ㄊ⿏䕦䕭䘬桐晒埴䁢⛐伶⚳
曺⮹⸜䓇㳣ᷕ㗗⼰㘖念䘬䎦尉炻ᶼ䣦㚫䴻㾇⛘ỵ⏰屈䚠斄炻ḇ⯙㗗晐叿℞㔁做
⸜㔠䘬㍸⋯炻℟ㄊ⿏䕭桐晒䘬埴䁢ḇ㚫旵Ỷ(Lowry, Kann, Collins, & Kolbe, 1996)ˤ Ross and Wu (1995)㩊夾㔁做䦳⹎冯䘬斄Ὢ䘤䎦炻㔁做䦳⹎檀侭庫ᶵ㚫⏠厠ˣ 㚫 忳≽ᶼ怑慷䘬梚惺ˤ⎴㧋䘬炻⛐⎘䀋䘬䞼䨞Ṏ䘤䎦栆Ụ䘬䳸㝄炻∱㵹剔䫱Ṣ (2006)䘤䎦炻㔁做䦳⹎Ỷ侭喍䈑㾓䓐ᷳ桐晒栗叿檀㕤㔁做䦳⹎檀侭ˤ㼀Ở䅽冯㛶嗕 (1999)⇯䘤䎦⣏⮰⍲ẍᶲ㔁做䦳⹎侭⏠厠䘬⎗傥⿏栗叿Ỷ㕤⮷⬠⍲ẍᶳ䦳⹎侭ˤ侴 㔁做䦳⹎崲Ỷ℞⏠厠ˣ梚惺ˣ♤㩛㤼䘬埴䁢崲⣂(㠩㔯㓷ˣ悕ㅚ㔯ˣ䌳㗞䡏炻2002)ˤ
⎎㚱䞼䨞㊯↢┉忋挾⸿㴰屣侭㔁做䦳⹎䦳⹎⣏⣂䁢⣏⮰䔊㤕侭炻ᶼ⛐䓇㳣✳栆
✳ᶲ㭼庫慵夾䣦Ṍ⍾⎹(拊⺢⬷炻2003)ˤ
ᶲ徘䞼䨞㊯↢炻䣦㚫䴻㾇⛘ỵ冯埴䁢ᷳ攻㚱叿昶㡗凔䘬斄Ὢ炻栆Ụ䣦㚫 Ⰼ䳂ᶵ⎴忈ㆸᶵ⸛䫱⏰䎦䘬䣦㚫㡗⹎(social gradient)䎦尉(Adler et al., 1994)ˤ䵄⎰ẍᶲ奨溆⎗䞍炻䣦䴻⛘ỵ⎗德忶借㤕ˣ㔁做䦳⹎Ἦ↮Ⰼ炻侴䣦䴻⛘ỵ ᶵ⎴㚫忈ㆸ屯㸸䌚⼿䘬ⶖ䔘炻庫檀䣦㚫䴻㾇⛘ỵ䘬Ṣ℟㚱庫⣂䘬㨇㚫⍣㑩㚱嵛⣈
䘬屯㸸炻Ἦ忼⇘䘬䓇㳣✳ン烊侴ỵ㕤庫Ỷ䘬䣦䴻⛘ỵ侭炻庫⮹㍍妠䚠斄
妲〗ḇ仢᷷屯㸸炻ᶼ⮵㕤℞埴䁢䘬怠㑯㭼庫㰺㚱㍏⇞㪲炻䓊䓇Ḯᶵ⸛䫱炻⚈
㬌ỵ㕤ᶵ⎴䘬䣦㚫䴻㾇⛘ỵ炻⯙㚫㚱ᶵ⎴䘬䓇㳣✳ン炻℞䱦䤆䈑岒䘬ἧ䓐✳ンḇ
⮯㚱ⶖ䔘ˤ
11
䫔
䫔Ḵ䭨ġ 䉨㱩ˣ䞍嬀冯ン⹎冯埴䁢ᷳ斄Ὢ
䞼䨞栗䣢炻伡かㄊ⿏䕭冯⏎⮵㮹䛦䘬⼙枧䓂懭炻䃞侴ㄊ⿏䕭侭⌣ḇ庫㚫
㍉埴㚱䙲䘬埴䁢(㛶嗕䫱Ṣ炻1995)ˤ姙⽿ㆸˣ⼸䤍㖶ˣ⼸䐙㶛䫱Ṣ(2003)⮵⎘
䀋侩⸜Ṣ埴䁢䘬⼙枧⚈䳈↮㜸ḇ䘤䎦炻幓橼䉨㱩庫ⶖ侭炻ἳ⤪伡かㄊ⿏
䕭侭炻⽆ḳ忳≽ᷳ㨇㚫庫⣏炻㍍⍿㳩デ䕓剿㲐⮬㭼䌯庫檀炻ḇ庫ᶵ㚫⏠厠炻⎗傥 㗗⚈䁢伡かㄊ⿏䕭䘬侩Ṣ℟㚱庫檀䘬≽≃冯㭭≃⍣㍉埴㚱䙲䘬埴䁢炻ḇ⎗傥
⚈䁢ㄊ⿏䕭か侭庫ⷠἧ䓐慓䗪屯㸸炻侴庫㚱㨇㚫㍍⍿慓嬟Ṣ⒉䘬⺢嬘ˤ䓙㬌⎗䞍炻 伡かㄊ⿏䕭⎗傥ㆸ䁢⮎埴䓇㳣✳ン䘬廱㨇炻䚠庫㕤ᶨ凔Ṣ侴庫⮹㚱⌙⭛
䘬埴䁢ˤ侴䞼䨞ḇ栗䣢冒奢䉨㱩䁢Ἓ侭炻崲㚱㬋⎹䘬埴䁢(湫㭻厗ˣ恙⓻ 㼌炻1997; ∱伶⩃ˣ⏪㖴㖶炻2006)ˤ䃞㛶嗕䫱Ṣ(1995)⇯䘤䎦冒奢崲ⶖ侭炻䚠 庫㕤冒奢崲Ἓ侭炻崲ⷠ忳≽Ữḇ庫㚫ἧ䓐䱦䤆䈑岒炻晾㔯䌣⯂㛒⮵冒奢
冯埴䁢ᷳ攻䘬斄倗 ↢ᶨ农⿏䘬䳸婾炻ỮㆹᾹḇ⎗ẍ䞍忻冒奢℞⮎㗗Ṣ Ᾱ怠㑯⽆ḳ㝸ṃ埴䁢䘬斄挝⚈䳈ˤ
Jarvis (1994)⮯⏠厠埴䁢普ᷕ⛐庫Ỷ昶Ⰼ䘬䣦㚫䴻㾇⛘ỵ炻㬠⚈㕤⡻≃ἧ䃞炻 忁堐㖶Ṣ⎋嬲枭䁢㚜➢㛔⽫䎮䣦㚫忶䦳䘬㧁姀ˤḇ⯙㗗婒炻庫Ỷ䘬䣦㚫Ⰼ䳂ˣ⣙
㤕ˣ悥ⶪ䓇㳣䑘⠫仢᷷㔁做炻⎗傥冯⽫䎮⡻≃㚱斄炻ᶼ塓娵䁢月⏠厠Ἦ䶑妋ˤ ᶨ枭⮵⎘⊿ⶪ妰䦳干⎠㨇䘬䞼䨞䘤䎦炻ⶍἄ⡻≃䕯䉨(䓇䎮ᶵ怑ˣ䃎ㄖ⍵ㅱˣ䕚⊆
⍵ㅱ)冯Ὣ忚䓇㳣✳ン⏰屈䚠斄炻⏠厠冯ⶍἄ⡻≃䕯䉨㚱栗叿㬋䚠斄(湫㜦⃫ˣ
∱ὸ呱炻2005)ˤ䞼䨞嗽㕤庫Ỷ䣦㚫䴻㾇⛘ỵ炻♤梇㩛㤼䘬妰䦳干⎠㨇䘬䓇㳣
✳ン(悕㵹䍵ˣᶩ⽿枛炻2008)䘤䎦炻楁厠ˣ惺ˣ㩛㤼䫱䱦䤆䈑岒⎗ẍ⛐╖婧ˣ慵墯
⿏檀䘬ⶍἄ䑘⠫ᶳ䘤㎖㍸䤆䘬ἄ䓐炻㩛㤼ˣ厠忂ⷠ㗗⎠㨇ⶍἄᶲ䘬ˬ怑ㅱ⑩˭炻ἧ 䓐䎮䓙⊭㊔㍸䤆ˣ㈺⡻冯䨑⭂ね䵺䫱ˤ⸦᷶㚱⍿姒⎠㨇悥娵䁢♤㩛㤼㚨⣏䘬⤥
嗽㗗㍸䤆炻ᶼ℟䲻⡻冯䨑⭂ね䵺ἄ䓐炻䶑妋姙⣂䴻㾇⡻≃忈ㆸ䘬⽫ね䄑帩烊惺⇯
12
䁢ⶍἄ⼴䘬㓦檮⑩ˤ䓙ẍᶲ䞼䨞⎗夳炻䓇䎮ᶵ怑ˣ䃎ㄖね䵺ˣ䕚⊆䱦䤆䈑岒ἧ 䓐埴䁢ᷳ攻㚱⭮↯斄倗ˤ
昛匱冯㛶嗕(1999)䘤䎦㩛㤼⍲厠⭛ℑ枭娵䞍⚈䳈⮵㗗⏎⏠厠ᶼ♤㩛㤼埴䁢
℟㚱栗叿䘬⼙枧≃ˤ昛㖶剛(2007)ẍ⎘䀋⊿ˣᷕˣ⋿⛘⋨ 397 ỵ㍸䤆梚㕁梚䓐侭䁢 婧㞍⮵尉炻䳸㝄栗䣢炻⛐桐晒娵䞍㕡朊炻梚䓐侭㘖念ᶵ䞍忻ᾅ≃忼 B 䵕⢓㭼㗗
㊯䣢喍炻⍵侴娵䁢⬫Ᾱ㗗㍸䤆梚㕁ˣᶨ凔梚㕁ㆾ惺栆炻侴ᶼᶵ㚫㲐シ䒞⫸⢾⊭墅 ᶲ䘬㧁䣢炻ㆾᶵ䞍忻⺢嬘梚䓐慷ˤ⛐ン⹎㕡朊炻⣂㔠⍿姒侭娵䁢ᾅ≃忼 B ㆾ䵕⢓
㭼昌Ḯ㚱㍸䤆㓰㝄⢾炻怬℟㚱㷃庽䕚⊆ˣ冺䶑⡻≃Ṍ晃ㅱ愔䘬≇傥炻⮹㔠䘬⍿
姒侭㚜㗗娵䁢梚⑩⮵㚱䙲ˣ℟ᾅ偅≇㓰ˤ䓙㬌⎗䞍炻ᶨᾳṢ䘬䉨ン䱦 䤆䈑䈑岒䞍嬀ˣン⹎䘮冯℞ἧ䓐䱦䤆䈑岒䘬埴䁢㚱⭮↯斄倗ˤ
䫔
䫔ᶱ䭨ġ 䱦䤆䈑岒䘬䣦㚫㔯⊾シ㵝
䱦䤆䈑岒ἧ䓐䚠斄䘬₨⺷冯シ佑炻℞⮎㶙㶙㢵㟡㕤ㆹᾹ䘬㔯⊾ᷕ炻栗侴㖻夳 䘬㗗炻忁ṃ䱦䤆䈑岒᷎朆ẍ㚨⍇⥳䘬㧋尴ㆾ≇傥塓㴰屣炻ṾᾹẍ⓮⑩⊾䘬⼊⺷塓
⊭墅炻侴℞ᷕ晙啷叿䴻㾇ˣ䣦㚫ˣ㔯⊾㓧㱣䘬䎦⮎炻ḇ⯙㗗婒╅勞ˣ┉ㆾ⏠
厠炻℞⮎冯╖䲼┉⚈(coffeine)ˣ勞渤(theine)ˣ⯤⎌ᶩ(nicotine)䘬ἧ䓐㗗㚱⼰⣏䘬 ᶵ⎴䘬(Goodman, Lovejoy, & Sherratt, 1995)ˤ⛐悥ⶪ⊾䘬䣦㚫ᷕ炻䓙㕤⺋㲃䘬冯℞
Ṿ佌橼㍍妠炻⚈㬌⎬⺷⎬㧋䘬䱦䤆䈑岒⎗傥⛐ᶵ⎴䘬ね⠫ẍ⍲䣦㚫䑘⠫塓ἧ䓐炻 慵天䘬㗗ㆹᾹᶵ傥楔ᶲ⯙㈲䱦䤆䈑岒䘬ἧ䓐妋嬨䁢℟㚱㶙⇣₨⺷シ佑䘬㊯㧁ㆾ侭 㗗ẍṓ㦪䁢ᷣ䘬ἧ䓐䚖䘬炻⬫Ᾱ⎗傥⎒╖䲼⛘䁢喍⬠䓐徼炻晾䃞⼴侭䘬䓐徼⎗傥 㗗⮹㔠ˤ
13
ḳ⮎ᶲ炻姙⣂埴䁢㗗⍿⇘埴≽侭⛐䘬䣦㚫䳸㥳ˣ佌橼䈡㬲ね⠫䘬⼙枧炻
⛐ᶵ⎴䘬㔯⊾シ㵝ᷳᶳ炻㚫岎Ḱ⎬䧖䱦䤆䈑岒ᶵ⎴䘬シ佑冯₡ῤ(McCracken, 1986)ˤ⽆ᶨᾳ⟜➇⁛怆⇘⎎ᶨᾳ⟜➇㗪炻℞䌚⼿䘬₡ῤ⯙㚫ᶵ⎴ˤ啱䓙斄挝埴 䁢侭ἧ䓐䱦䤆䈑岒ὧ㚫岎Ḱ䱦䤆䈑岒ᶵ⎴シ佑冯₡ῤ炻侴忁ṃ₡ῤ⍾㰢㕤ᶵ⎴䘬 䈡溆炻ἳ⤪⎰㱽⿏ˣ㍸ὃ䘬Ⱄ⿏枸㛇⎗ẍ㍸檀⛘ỵ䘬Ⱄ⿏(Hunt & Barker, 2001)ˤ忁ṃ䈡溆冯℞⚢㚱䘬䈑䎮⿏岒庫䃉斄倗炻侴㗗⍾㰢㕤㗪攻ˣ⛘溆ㆾ℞Ṿ傰 䴉⚈䳈ˤ⛐㝸ṃ柀➇炻ἧ䓐㝸ṃ䱦䤆䈑岒㗗⤪䌚军⮞炻侴⮵℞Ṿ柀➇侴妨⎗傥㗗
⎠䨢夳ㄋ炻ㆾ侭⬴ℐ㰺㚱ảỽ₡ῤ⎗妨ˤἳ⤪炻⛐Ṇ㳚⛘⋨㩛㤼塓岎Ḱ₡ῤ炻Ữ
⛐伶㳚⛘⋨⸦᷶㰺㚱倥倆炻ἧ䓐Ṣ⎋ḇ㤝⮹炻ẍ㩛㤼⛐伶㳚⛘⋨⸦᷶ᶵ㚫塓岎 Ḱảỽ䘬₡ῤ⿏ˤ⍰ㆾ侭⣏⣂㔠䘬䱦䤆ἄ䓐䈑岒⛐伶⚳塓↿䭉䁢忽㱽䈑岒炻⚈㬌
⬫䘬㳩忂㗗ᷣ天㗗ẍ䥩Ṣᶼ䦀⭮䘬忚埴炻䃞侴⛐℞Ṿ⛘⋨忁ṃ䈑岒⎗傥㗗⣏䛦䓇 㳣䘬ᶨ悐ấˤ
悕㵹䍵冯ᶩ⽿枛(2008)䘬䞼䨞䘤䎦炻晾䃞妰䦳干⎠㨇悥㶭㤂䞍忻♤㩛㤼ˣ⏠厠 冯╅惺⮵㕤䘬⌙⭛炻ḇ䚠䔞慵夾炻⌣⸦᷶ᶵ侫ㄖㆺ昌ἧ䓐ㆸ䘖䈑岒炻⚈
䁢忁ṃ䱦䤆䈑岒昌Ḯ㚱㍸䤆ˣ冺⡻冯䨑⭂ね䵺ἄ䓐炻⯂㚱昒Ờ䘬ἄ䓐炻⚈䁢妰䦳 干⎠㨇䘬ⶍἄ劍ᶵ庱⭊㗪炻⣏⣂⎒㚱⎠㨇ᶨṢ⛸⛐干ᶲ炻⮵㝸ṃ⎠㨇侴妨炻䱦䤆 䈑岒⯙㗗㚨⤥䘬昒Ờ䈑炻ᶼ怬℟㚱ⶍἄ攳⥳䘬₨⺷⿏ἄ䓐炻姙⣂⎠㨇㍸⇘攳干⸦
⸜⼴炻䚳⇘妰䦳干⯙朆ⷠ⭛⾽冯䕚䳗炻䁢Ḯ廱㎃借㤕῎⿈䘬ね䵺炻㭷⣑ⶍἄ⇵⯙
㚫⍣屟㩛㤼ㆾ⏠厠ˤGraham (1994)䞼䨞嗽㕤Ỷ䣦㚫䴻㾇㡅ẞ⨎⤛䘬䚠斄埴䁢 䘬✳ン炻䘤䎦晾䃞⨎⤛Ᾱ悥嬎奢⏠厠冯⌙⭛䘬斄倗炻Ữ⏠厠⎗ẍ⸓≑ṾᾹ㷃
⮹⭞⹕䄏嬟冯屯㸸䞕仢䘬⡻≃ˤ䓙㬌⎗䞍炻䱦䤆ἄ䓐䈑岒ἧ䓐⎗傥㗗䣦㚫ᷕ庫⻙
⊊䘬Ṣ炻⮯℞夾䁢⚈ㅱ⡻≃䘬屯㸸炻ẍὧ⮵℞ⶍἄㆾ䓇㳣嗽⠫䘬怲䶋ỵ伖≈ẍ婧 怑ˤ⛐㬌䧖䑘⠫ᶳ炻䱦䤆䈑岒䘬䣦㚫⽫䎮⤥嗽⣏忶㕤Ẁ↢䘬ㆸ㛔炻晾䃞Ṿ Ᾱ悥䞍忻䱦䤆䈑岒⮵䘬⌙⭛炻Ữ䛇㬋天㓡嬲ṾᾹ䘬埴䁢⌣⼰⚘暋(Calnan,
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1989)ˤ
侴䱦䤆䈑岒ḇ⎗傥檀⹎䘬⍿䈡⭂⮰⭞㍏⇞⍲䭉䎮炻ḇ⍿⇘䱦劙昶Ⰼ⮵ἧ䓐 桐⯂⍲⑩␛䘬㍏⇞(Hunt & Barker, 2001)ˤ⒒ᶨ栆䘬䱦䤆䈑岒䈡⇍⍿䘬慓⬠䚠斄柀
➇䘬慵夾炻冯婘⛐ἧ䓐ẍ⍲䣦㚫⭂佑䓂湤㗗⎗㍍⍿ˣ䓂湤㗗ᶵ⎗㍍⍿䘬ᾳṢ埴䁢 㚱斄炻ḇ⯙㗗⒒ṃṢ塓䣦㚫⃩姙⎗ẍ⍣㓡嬲℞シ嬀䉨ンˣ㗗㚱℞㔯⊾ㆾ㓧㱣㪲≃
䘬䈡㬲⿏(悕㵹䍵ˣᶩ⽿枛炻2006)ˤ昌Ḯ℟㚱㍸䤆ˣ冺⡻䘬≇傥⿏ἄ䓐炻䱦䤆䈑岒 ḇ⎗ẍ㗗Ṣ冯Ṣᷳ攻斄ὪṌ㎃䘬⨺ṳ炻⁷㗗䁢Ḯ⺢䩳⍳婤侴婳ṾṢ⏠ᶨ㟡厠(Hunt
& Barker, 2001)炻䓂军⤪⇵徘⼊ㆸ媪䘬⑩␛ㆾ㗗℞Ṿ尉⽝䣦㚫ⶖ䔘⋨昼䘬⼊⺷ˤ ᶵ⎴䱦䤆䈑岒⛐ᶵ⎴昶Ⰼ㚫㚱⑩␛ᶲ䘬ⶖ䔘炻檀昶Ⰼ侭⎗傥娵䁢梚䓐䲭惺䁢ˬ檀 晭˭炻侴♤梇㩛㤼⇯䁢ˬỶ˭ˤ
䫔
䫔⚃䭨ġ 䱦䤆䈑岒ἧ䓐✳ン
ẍ⼨℔ℙ堃䓇⎒㲐慵⮵䈡⭂⌙⭛ᷳ䱦䤆䈑岒䘬䞼䨞炻⾥䔍℞Ṿ栆Ụ䈑岒 ḇ塓䣦㚫ᷕᶵ⎴㕷佌ἧ䓐炻⁷㗗┉ˣ勞ẍ⍲㍸䤆梚㕁ˤ⚈㬌䃉㱽䚳↢㔜橼䣦㚫 ἧ䓐䱦䤆䈑岒䘬ね㱩炻ḇ䃉㱽⼿䞍昌Ḯ楁厠ˣ惺ˣ㩛㤼ᷳ⢾恋ṃ⮵庫䃉⌙⭛ˣ
⼊尉庫ᶵ恋湤屈朊䘬䈑岒炻⇘⸽塓⤪ỽἧ䓐烎冯⌙⭛䈑岒ᷳ㴰屣ᷳ攻㚱ỽ斄 Ὢ炻℞⮎㤝⮹塓㍊妶ˤ
⼰⣂䞼䨞䘮栗䣢埴䁢㚱倂普䘬⎹炻ẍ傥濌梚瀌䁢ἳ炻Ṏ䁢⎘䀋⛘⋨㴰屣侭
䅇䞍䘬㍸灧梚瀌炻忁瀞梚瀌䘬㟠⽫≇傥㗗㍸ὃ㳣濘炻ᶨ枭伶⚳䘬䞼䨞䘤䎦炻ᷣ
天ἧ䓐Ṣ⎋䁢曺⮹⸜⍲⸜庽䘬ㆸ⸜Ṣᶼ忶⍣ᶨ⸜朆湹Ṣ䘬⮹㔠㮹㕷庫⭡㖻ἧ䓐傥 慷梚㕁炻侴⮯惺䱦冯傥慷梚㕁ᶨ崟ἧ䓐⇯ẍ䘥Ṣ⸜庽㕷佌䁢ᷣ(Berger, Fendrich,
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Chen, Arria, & Cisler, 2011)ˤWhichelow, Erzinclioglu, and Cox (1991)㭼庫劙⚳朆⏠
厠侭冯⏠厠侭䘬梚梇✳ン炻䘤䎦䚠庫㕤朆⏠厠侭炻⏠厠侭(⊭⏓慵⹎⏠厠ˣ庽⹎⏠
厠ˣㆺ厠侭)栗叿䴻ⷠ梚䓐惺ˣ┉冯勞炻⯌℞ẍ慵⹎⏠厠侭䁢䃞ˤ⛐⎘䀋ᶩ⽿
枛冯㰇㜙Ṗ(1996)䘬䞼䨞炻ㅱ䓐佌倂↮㜸㱽炻ẍ⋩Ḵ枭埴䁢䳬⎰⏰䎦✳ン䘬 ⶖ䔘炻⮵ 2783 ⎵ 18 㬚ẍᶲ⚳Ṣ忚埴↮栆炻䘤䎦㝸ṃ埴䁢ᷳ攻㚱ᶵ⎴䦳⹎䘬᷎⬀
⿏炻⌛埴䁢㚱倂普䘬⎹ˤἳ⤪⏠厠ˣ梚惺冯♤㩛㤼攻℟㚱檀⹎䚠斄炻侴╅勞冯 㬌ᶱ枭ㆸ䘖埴䁢攻Ṏ㚱᷎⬀⿏ˤ䚠⎴䘬䱦䤆䈑岒⎗傥塓ᶵ⎴㕷佌ἧ䓐炻ᶼᶵ⎴㕷 佌⛐ἧ䓐埴䁢ᶲḇ㚱ⶖ䔘炻⁷㗗冯℞Ṿ䱦䤆䈑岒ἧ䓐䘬䚠斄⿏冯倂普⿏ˤ
┉ˣ勞ˣ傥慷梚㕁⛐⎘䀋℞⮎悥㑩㚱ᶨ⭂ἧ䓐Ṣ⎋(埴㓧昊堃䓇会⚳㮹
⯨, 2006; 㛶嗕䫱Ṣ炻1995)炻䃞⚳ℏ⬠侭⮵忁ṃ䈑岒䘬ἧ䓐埴䁢䞼䨞⼰⮹炻ᶼ⣂⋲
㗗⃰怠⭂䈡⭂㕷佌ˣ䈡⭂䱦䤆䈑岒忚埴婧㞍炻⚈㬌䃉㱽⼿䞍冯℞Ṿ䛦⣂䱦䤆䈑岒 ἧ䓐䘬斄倗炻ẍ⍲佌橼攻䘬ⶖ䔘ˤ⤪憅⮵ 1100 ⎵䆇忈㤕忳廠㤕⊆ⶍ忚埴㍸䤆⎋
㚵㵚梚䓐埴䁢䘬婧㞍(㛶⽑よˣ㜿渿沛炻2006)炻䘤䎦⣏悐↮⍿姒⊆ⶍ㚫⛐ⶍἄデ⇘
䕚῎ˣ⎋㷜ˣ゛ㇻ䜴䜉㗪╅㍸䤆⎋㚵㵚ˤḇ㚫⛐㰺㚱䈡⭂䎮䓙䘬ね㱩ᷳᶳ゛⇘⯙
╅炻ㆾ侭ἄ䁢ㅱ愔䓐徼炻ᶼ㚫㏕惵℞Ṿ梚㕁⤪┉ˣ埣䈃ˣ┌惺ㆾ䰛惺䫱ᶨ崟梚 䓐ˤḇ㚱⬠侭䞼䨞⍇ỷ㮹⮵㕤㬌栆梚⑩ᷳἧ䓐䴻槿冯䚳㱽(⻝䏳ΐ炻2000)炻䘤䎦⍇
ỷ㮹⮯℞䓐㕤≑冰ˣ㍸䤆ㆾ 㚰⫸墄埨䫱䓐徼炻⛐⎬䧖倂㚫ˣ⨂╒╄ㄞˣ悐句ㄞ
℠悥⎗夳⇘梚䓐忁栆梚⑩䘬Ṣˤ
晾䓙忁ṃ䞼䨞⎗ẍ䚳↢⎘䀋㮹䛦⛐䱦䤆䈑岒䘬ἧ䓐ᶲ炻㚱⣂⃫᷎䓐䘬ね⼊炻 ᶼ╖ᶨㆾ᷎䓐✳ン⛐ᶵ⎴佌橼ᷕ塓岎Ḱᶵ⎴䘬シ㵝炻ㆾ㚱ᶵ⎴䘬≇傥ˤỮ⣏农Ἦ 婒炻⣂㔠䘬屯㸸ṵ伖㕤⮵⌙⭛䈑岒ἧ䓐䘬䞼䨞炻庫㛒侫慷晙ㄪ庫⮷䘬䈑 岒炻忁㗗⛐䈑岒栆⇍ᶲ䘬怠㑯ῷⶖˤ⎎ᶨ㕡朊炻⬠侭Ᾱ攳⥳⿅侫埴䁢䘬㛔 岒炻㉳攳ẍ⼨⮯埴䁢夾䁢╖ᶨˣ䌐䩳ˣ↮暊䘬䎦尉炻ḇ⯙㗗⮯埴䁢㔜⎰ˣ
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㬠䲵ˣ慵㕘䳬⎰炻ẍḮ妋⎬埴䁢ᷳ攻䘬䚠斄⿏冯埴䁢㔜橼栗䎦↢䘬✳ン炷ᶩ⽿枛ˣ 㰇㜙Ṗ炻1995炸ˤ
䫔
䫔Ḽ䭨ġ ⮷䳸
䱦䤆䈑岒ἧ䓐冯㴰屣㛔岒ᶲ㗗ᶨᾳ䣦㚫炻⬫栗䣢Ḯ㔯⊾䘬忚䦳ˣ㔯⊾斄㲐 䘬ḳẍ⍲㔯⊾䘬尉⽝ˤ⚈㬌暨天⛐ᶨᾳ朆ⷠ⺋㲃䘬ね⠫ᶳ炻⍣㍊䳊ἧ䓐侭䘬埴䁢
䣦㚫娵⎴炻性䈑⊾Ḯ䱦䤆䈑岒炻ㆾ侭䓐㪲≃䘬奨溆⮯ảỽ⓷柴䘬䃎溆㓦⛐䱦 䤆䈑岒ᶲ(Hunt & Barker, 2001)ˤ䃞侴㬌䩳⟜㖶栗冯姙⣂䱦䤆䈑岒䞼䨞䘬➢㛔`姕 䚠⍵炻恋ṃ䞼䨞`姕朆Ữ怈暊䣦㚫炻ᶼ㈲䱦䤆䈑岒䘬㴰屣夾䁢ᾳṢ䘬㰢⭂炻䃉婾
℞ἧ䓐䘬㗗⏎䁢⎰㱽䘬䱦䤆䈑岒炻䘮⬴ℐ⛘⾥䔍℞ẋ堐䘬⑩␛ㆾ暨㯪悥㗗⍿䣦 㚫婧䭨䘬炻ᶵ婾德忶⨺橼ㆾ㗗㓧㱣姜㯪⼙枧炻䱦䤆䈑岒᷎ᶵ⎒㗗ᾳṢ晐⽫㫚 ἧ䓐ㆾ侭暨㯪䘬≈ⶍ⑩ˤ
ḇ⚈䁢䈑岒㴰屣䘬㛔岒㗗䣦㚫⮶⎹䘬炻⼙枧㴰屣侭怠㑯ἧ䓐ᶵ⎴䘬䱦䤆䈑岒 䘬斄挝㊯㧁炻㗗ṾᾹ䘬䣦㚫⛘ỵˤἧ䓐䱦䤆䈑岒䘬㕡⺷ˣ䧖栆悥尉⽝ḮᶨᾳṢ䘬 䣦㚫⛘ỵ炻⚈㬌⽆ᶨᾳṢ⮵䱦䤆䈑岒₡ῤ䘬㌺⸷ㆾἧ䓐栆⇍䘬ᶵ⎴炻⎗ẍ⍵㗈↢
Ṿỵ㕤⒒ᾳ䣦㚫Ⰼ䳂ˤ䱦䤆䈑岒䘬ἧ䓐ˣ㴰屣冯䓇㳣ᷕ℞Ṿ䈑⑩ㆾ⓮⑩ᶨ㧋炻㗗 㖍ⷠ䈑岒䓇㳣䘬㔯⊾⨺ṳ炻ẍ忁ṃ䈑岒䘬ἧ䓐ᶵ⎒㗗塓梇ℍㆾ⏠ℍ幓橼䘬忶 䦳炻侴ᶼ㗗ṢᾹ冯䣦㚫Ḻ≽䘬⨺ṳ炻⎎ᶨ㕡朊ḇ㗗䣦㚫₡ῤ䘬堐忼䣦㚫ỵ伖䘬 ᾉ嘇冯尉⽝炻᷎ᶼ⏓㚱㔯⊾䘬シ佑炻⛐ᶵ⎴䘬㔯⊾ᷕ岎Ḱ℞ᶵ⎴䘬シ㵝ˤ
䱦䤆䈑岒㴰屣⓷柴䘬䓊䓇⽆Ἦᶵ㗗⛐㕤恋ṃᶵ℟㚱䓇␥䘬䱦䤆䈑岒㛔幓炻侴 㗗↢䎦⛐䱦䤆䈑岒ˣἧ䓐侭ἧ䓐ね⠫ᷳ攻䘬Ḻ≽(Heath, 1992)ˤẍ⼨䘬䞼䨞⍾
17
⎹炻⾥䔍Ḯἧ䓐侭嗽䘬䣦㚫ỵ伖⤪ỽ⼊⟹䱦䤆䈑岒ἧ䓐䘬埴䁢ˣᾉ⾝ẍ⍲シ㵝炻 ḇ⾥䔍ṢᾹ⛐ἧ䓐䱦䤆䈑岒䘬㗪῁炻侫慷⇘䘬᷎ᶵ㗗⎒㚱⓷柴(Hunt & Barker, 2001)炻㓭ㅱ⮯夾慶㓦⣏军㔜橼䣦㚫⟜➇炻Ḯ妋㔜ᾳ䣦㚫⟜➇䘬㔯⊾冯䱦䤆䈑岒ἧ 䓐䘬ᷳ✳ン炻ㇵᶵ㚫忈ㆸ⮵䈡⭂㕷佌䘬⇣㜧⌘尉ˤỮ忁᷎ᶵシ␛叿㝸ṃᾳṢ䱦䤆 䈑岒ἧ䓐⍲㾓䓐䘬⓷柴ᶵ⬀⛐炻侴㗗ᷣ⻝℞⓷柴⍲妋㰢㕡㟰㗗啱䓙䣦㚫㔯⊾⚈
䳈塓㤪⾝⊾炻冯䣦㚫ᷕ䘬㪲≃斄Ὢ⭮ᶵ⎗↮ˤ
18
䫔
䫔ᶱ䪈ġ 䞼䨞㕡㱽
㛔䞼䨞ἧ䓐 2005 濜ˬ⚳㮹姒⓷㙐喍䈑潰䓐婧㞍ᷕ⽫˭⭞㇞朊姒婧㞍冯喍 䈑㾓䓐悐↮屯瀌忚灖㫉䳂屯瀌↮㜸ˤ
⚳㮹姒⓷婧㞍(National Health Interview Survey, NHIS)㗗䓙屉⛀㱽Ṣ⚳⭞
堃䓇䞼䨞昊倗⎰埴㓧昊堃䓇会⚳㮹⯨⭂㛇冱彎ˤ冒 2001 ⸜忚埴ẍἮ炻⬴ㆸ ᶱ㫉ℐ⎘䀋㉥㧋婧㞍ˤ2005 濜䘬姒⓷婧㞍炻㚱揹㕤⚳ℏˣ⢾䚠斄屯妲栗䣢朆㱽喍 䈑潰䓐㚱㖍灥♜慵嵐⊊炻ょ⚳ℏ⯂㛒㚱ẍᶨ凔Ṣ⎋䁢➢䢶ᷳ喍䈑潰䓐婧㞍澷㒂炻 䁢䝕妋⚳ℏ喍䈑潰䓐灈㱩炻ἄ䁢⇞⭂喍䈑潰䓐旚⇞㓧䫾ᷳὅ㒂炻䭉⇞喍⑩䭉瀲⯨
啱㬌㨇㚫冯⚳㮹⯨⍲⚳⭞堃䓇䞼䨞昊ℙ⎴⎰ἄ彎瀲㛔㫉ℐ⚳⿏⚳㮹姒⓷ 婧㞍ⶍἄ炻⮯喍䈑潰䓐嬘柴䲵ℍ忚灖ℐ朊⿏婧㞍ˤ
䫔ᶨ䭨ġ 屯㕁Ἦ㸸
2005⸜⚳㮹姒⓷㙐喍䈑潰䓐婧㞍⓷⌟ℙ↮䁢Ḽ瀞炻㛔䞼䨞ἧ䓐 12-64 㬚 ᾳṢ⓷⌟冯 18-64 㬚ㆸ濜Ṣ冒⠓⓷⌟䘬屯瀌忚灖↮㜸炻ᷣ天㗗⚈䁢忁ℑấ⓷⌟⊭
⏓暨天㚱斄䱦䤆ἄ䓐⿏䈑岒㕡朊䘬ᷣ柴炻ᶼ㗗㚨役㛇䘬屯瀌炻⚈㬌㑯℞䁢㛔䞼 䨞ᷳ↮㜸㛸㕁ˤ㚱斄 2005 ⸜⚳㮹姒⓷㙐喍䈑㾓䓐婧㞍⓷⌟䧖栆ˣℏ⭡冯婧㞍 㕡㱽炻娛⤪堐 3-1ˤ
19
堐 3-1 2005 ⸜⚳㮹姒⓷㙐喍䈑㾓䓐婧㞍⓷⌟䧖栆堐
⓷⌟䧖栆 婧㞍㕡㱽 ℏ⭡
12 㬚ẍᶳ ᾳṢ⓷⌟
Ṣ⒉姒㞍 (朊姒)
䪍➢㛔屯㕁ˣ䉨ンˣ埴䁢ˣ慓䗪 㚵⊁⇑䓐ね⼊ˣ⯭⭞䑘⠫ˣ⭞ᷕ䴻㾇䉨㱩炻 ẍ⍲姒⓷姀⮎ˣ姒⒉奨⮇冯姒⓷忶䦳䉨㱩姀 抬䫱
12-64 㬚 ᾳṢ⓷⌟
Ṣ⒉姒㞍 (朊姒)
ᾳṢ➢㛔屯㕁ˣ䉨ンˣ䕦䕭枸旚ᷳ䞍嬀ˣ 慓䗪㚵⊁⇑䓐ね⼊ˣ埴䁢ˣ冒奢䉨 ン(SF-36)ˣ⯭⭞䑘⠫ˣⶍἄ冯䴻㾇䉨㱩ˣ姒
⓷姀⮎ˣ姒⒉奨⮇⍲姒⓷忶䦳䉨㱩姀抬䫱ˤ 64 㬚ẍᶲ
ᾳṢ⓷⌟
Ṣ⒉姒㞍 (朊姒)
ᾳṢ➢㛔屯㕁ˣ䉨ンˣ慓䗪㚵⊁冯枸旚 ᾅ⇑䓐ね⼊ˣ攟㛇䄏嬟㚵⊁ἧ䓐⍲⯭ỷ⬱
㌺ˣ⽫䎮(CES-D)ˣMMSE 慷堐ˣⶍἄˣ 䴻㾇冯ᾅ晒䉨㱩ˣ姒⓷姀⮎ˣ姒⒉奨⮇⍲姒
⓷忶䦳䉨㱩姀抬䫱ˤ 12-17 㬚
曺⮹濜冒⠓⓷⌟
冒⠓⓷⌟ 厠ˣ惺ˣ㩛㤼冯朆㱽喍䈑䫱⎬栆ㆸ䘖䈑䘬ἧ 䓐ね⼊炻ẍ⍲⿏埴䁢冯℞⬱ℐ㍒㕥䫱柴䚖ˤ 18-64 㬚
ㆸ濜Ṣ冒⠓⓷⌟
冒⠓⓷⌟ 厠ˣ惺ˣ㩛㤼冯朆㱽喍䈑䫱⎬栆ㆸ䘖䈑䘬ἧ 䓐ね⼊䫱柴䚖ˤ
20
䫔
䫔Ḵ䭨ġ ㉥㧋姕妰
㛔婧㞍ᷳ㧋㛔昌℟⎘䀋⛘⋨䘬ẋ堐⿏⢾炻Ṏ⎴㗪℟㚱⎬䷋ⶪ䘬ẋ堐⿏烊⎎⢾炻 侫慷㇞ᷕℐ㞍䘬便㗪炻ẍ⍲㭵橼㇞䯵屯㕁㰺㚱㇞嘇暋ẍ忚埴⭞㇞㉥㧋䫱⚈䳈炻㛔 㫉婧㞍㓡ẍˬṢ˭䁢➢㛔㉥↢╖ỵˤ㧋㛔䘬怠⍾㍉⣂昶㭝↮Ⰼ䲣䴙㉥㧋姕妰 (Multi-stage stratified systematic sampling design)炻ẍᶳ䁢 2005 ⸜⚳㮹婧㞍⓷⌟
㉥㧋㕡㱽烉
ᶨˣġẍ堃䓇会䴙妰⭌㍸ὃ䘬㮹⚳ 93 ⸜ 12 㚰 31 㖍ˬ⎘䀋⛘⋨ᾳṢ㇞䯵屯㕁㨼˭
ᷳ㇞䯵Ṣ⎋屯㕁䁢㉥㧋⸽Ⅎ炻䷥Ṣ⎋㔠䁢 22,615,307 Ṣˤ
ḴˣġẍˬṢ˭䁢➢㛔㉥↢╖ỵ炻婧㞍 23 ᾳ䷋ⶪ⛐⎘䀋⛘⋨姕㚱㇞䯵ᷳⷠỷṢ⎋炷ᶵ
⊭㊔⯭ỷ⚳⢾侭炸炻ᷕ怠㧋㛔炷Ṣ炸⌛䁢⍿姒⮵尉ˤ
ᶱˣġ⎘䀋⛘⋨ 23 ᾳ䷋ⶪ䘬㉥㧋ἄ㤕䦳⸷⬴ℐ䌐䩳炻ὅ䷋ⶪ↮Ⰼ㍉⣂昶㭝↮Ⰼ䲣䴙
㉥㧋姕妰炻䷥妰⎘䀋⛘⋨ 23 ᾳ䷋ⶪ炻358 ᾳˬ悱捖ⶪ⋨˭ℙ↮ㆸ 53 ᾳⰌ⇍炻 ℙ㉥↢ 30,680 Ṣˤ
⚃ˣġ⇑䓐ˬ⿏⇍˭⍲ˬ⸜漉˭ℑᾳ嬲枭忚埴㉥↢㧋㛔冯㭵橼屯㕁䘬ᶨ农⿏㩊⭂炻
㚱䘬⌉㕡㩊⭂䳸㝄⛯䃉栗叿ⶖ䔘炻栗䣢㛔㫉ᷳ㧋㛔℟㚱ẋ堐⿏ˤ
䫔ᶱ䭨ġ 䞼䨞㧋㛔
㛔㫉婧㞍㍉䓐⮎⛘䓘慶婧㞍炻䓙姒⓷⒉⬴ㆸᾳṢ⓷⌟朊姒⼴炻ℵὅ⍿姒⮵尉
Ⱄ濜漉ᷳ冒⠓⓷⌟ṌḰ⍿姒⮵尉炻㍉ᶵ姀⎵䘬㕡⺷炻䓙⍿姒侭冒埴⠓⮓᷎⭮⮩
⼴炻Ṍ䴎姒⒉ⷞ⚆炻⥳⬴ㆸ⓷⌟屯瀌吸普ˤ⮎⛘姒㞍ᷳ➟埴㛇攻䁢㮹⚳ 94 ⸜ 4 㚰 9㖍攳⥳炻䳽⣏悐ấ㧋㛔㕤 7 㚰⸽⬴ㆸ炻㚱⮹悐ấ⛘⋨⚈⬴ㆸ䌯庫Ỷㆾ㚧㎃姒⒉
21
⚈䳈炻⺞军 8 㚰 30 㖍䳸㜇ˤẍ⎘䀋⛘⋨ 23 ᾳ䷋ⶪ⎰Ἕ䘬㧋㛔㔠Ἦ䚳烉12-64 㬚朊 姒⓷⌟ᷕ炻18-64 㬚ㅱ姒㧋㛔㔠㚱 20,508 Ṣ炻⮎晃冒⠓⓷⌟⬴姒Ṣ㔠䁢 14,959 Ṣ炻
⬴姒䌯忼 72.9%炻℞ᷕ䓟⿏䁢 7713 Ṣ(51.6%)ˤ
⛐ 2005 濜ˬ⚳㮹姒⓷㙐喍䈑潰䓐婧㞍˭朊姒⓷⌟冯喍䈑㾓䓐冒⠓⓷⌟ᷳ
悐↮屯瀌忚灖㫉䳂屯瀌↮㜸ᷕ炻⮎晃↮㜸䘬䓟⿏㧋㛔澷䁢 6087 Ṣˤ晾䃞冒⠓冯朊 姒⓷⌟㗗⎴ᶨ⠓䫼侭炻Ữ䓙㕤冒⠓⓷⌟㍉ᶵ姀⎵㕡⺷炻ẍ䃉㱽䚜㍍⮯ℑᾳ㨼㟰
⎰Ἕ炻⚈㬌䞼䨞侭⮯ℑấ⓷⌟䘬㔠ᾳṢ⎋⬠嬲枭姕⭂ㆸᶨᾳ㕘嬲枭炻᷎ὅ㬌㕘嬲 枭ἄ䁢⎰Ἕℑ㨼㟰䘬㟡㒂炻⇒昌ᶵ⎰冯䃉㱽彐嬀䘬㧋㛔⼴炻㚨䳪↮㜸㧋㛔㔠䁢 18-64㬚䘬䓟⿏ 6087 Ṣˤ
䫔
䫔⚃䭨ġ 㤪⾝㝞㥳
㛔䞼䨞⊭⏓ẍᶳℕ䧖䱦䤆䈑岒ἧ䓐埴䁢烉⏠厠ˣ梚惺ˣ♤梇㩛㤼ˣ梚䓐㍸䤆 梚㕁ˣ╅┉冯╅勞䫱ˤᾳṢ䘬䣦䴻⛘ỵ炻⊭㊔借㤕冯㔁做䦳⹎炻㚫德忶ᾳṢ䞍 嬀ˣン⹎冯䉨㱩炻冯䱦䤆䈑岒䘬ἧ䓐(✳ン)䓊䓇ᶵ⎴䘬斄倗(夳⚾ 3-1)ˤ
22
⚾ 3-1 㛔䞼䨞㤪⾝㝞㥳⚾
䫔
䫔Ḽ䭨ġ 䞼䨞嬲枭
㛔䞼䨞䘬ᷣ天嬲枭⊭㊔(1)䣦㚫䴻㾇⛘ỵˣ(2)䉨ンˣ(3)䞍嬀冯ン⹎⚈䳈ˣ (4)䱦䤆ἄ䓐⿏䈑岒䘬ἧ䓐⍲℞柣䌯䦳⹎ˣ(5)➢㛔Ṣ⎋⬠嬲枭忁Ḽ⣏悐↮ˤ⎬嬲 枭䘬㷔濌㕡⺷⤪ᶳ䣢ˤ
ᶨˣġ䣦㚫䴻㾇⛘ỵ
䣦䴻⛘ỵ 借㤕ġ 㔁做䦳⹎ġ
䉨ンġġ
冒奢ġ
䓇䎮ġ ㄊ⿏䕭ġ
⽫䎮ġ 㳣≃ġ
⽫䎮ġ
䱦䤆ἄ䓐⿏䈑岒ἧ䓐✳ンġġ 炷厠ˣ惺ˣ㩛㤼ˣ㍸䤆梚 㕁ˣ┉ˣ勞炸ġ
倂普⿏ġ
ἧ䓐柣⹎ġ
㍏⇞嬲枭ġ
⸜漉ġ
⯭ỷ⛘⋨ġ
䞍嬀冯ン⹎ġġ
㩛㤼⌙⭛䞍嬀 冯ン⹎ġ
23
㛔䞼䨞ᷕ㊯ᷳ借㤕冯㔁做䦳⹎↮䳂Ὢ⍫䄏ㆹ⚳㔁做⬠侭㜿䓇⁛ (2005)ẍ Hollingshead (1957) 䘬ℑ⚈䳈䣦㚫⛘ỵ㊯㔠炷Two Factor Index of Social Position炸 䁢➢䢶炻᷎⍫䄏䣦㚫⮎㱩炻⮯借㤕栆⇍⍲㔁做䦳⹎⎬↮䁢Ḽ䫱䳂ˤ
1. 借㤕烉檀䳂⮰㤕Ṣ⒉ˣ檀䳂埴㓧Ṣ⒉䁢䫔ɚ䳂烊⮰㤕Ṣ⒉ˣᷕ䳂埴㓧Ṣ
⒉䁢䫔ɛ䳂烊⋲⮰㤕Ṣ⒉ˣᶨ凔℔⊁Ṣ⒉䁢䫔ɜ䳂烊㈨埻⿏ⶍṢ䁢䫔ɝ 䳂烊⋲㈨埻ˣ朆㈨埻ⶍṢ䁢䫔ɞ䳂ˤ䓙㕤ˬ䎦⼡幵Ṣ˭ˣˬ䃉㤕ㆾ⣙㤕˭
䃉㱽㬠栆㕤ẍᶲḼ䫱ᷳᷕ炻⚈㬌ᶵ䲵ℍ㛔㫉䞼䨞䭬⚵炻䚠斄借㤕栆⇍夳 堐 3-2ˤ
2. 㔁做䦳⹎烉↮䁢⚳ᷕ䔊㤕⍲ẍᶳ烊檀ᷕ借䔊㤕烊⮰䥹䔊㤕烊⣏⬠㟉昊䔊 㤕ˣ㈨埻⬠昊䔊㤕炻㚱⬠⢓⬠ỵ烊䡑⌂⢓⬠ỵˤ䓙㕤䡑⌂⢓⬠ỵ䘬Ṣ㔠 忶⮹炻⚈㬌䞼䨞侭⮯℞冯⣏⬠㟉昊䔊㤕ˣ㈨埻⬠昊䔊㤕炻㚱⬠⢓⬠ỵ⎰
Ἕ炻ㆸ䁢⣏⬠⍲ẍᶲˤ㍍ᶳἮ䘬䴙妰↮㜸㔁做䦳⹎⛯↮䁢⚳ᷕ⍲ẍᶳ烊 檀ᷕ借烊⮰䥹䔊㤕烊⣏⬠⍲ẍᶲ⚃ᾳ䫱䳂Ἦ忚埴↮㜸ˤ
堐 3-2 借㤕栆⇍⍲䫱䳂⋨↮堐
䫱
䳂 栆⇍ 借㤕栆⇍
ɚ
檀䳂⮰㤕Ṣ
⒉ˣ檀䳂埴㓧 Ṣ⒉
䩳㱽⥼⒉ˣ⣏⮰㟉攟ˣ⣏⮰㔁⭌ˣ慓ⷓˣ⣏㱽⭀ˣ䈡ảㆾ䯉ả 䳂℔⊁⒉ˣ⚳⣏ẋ堐ˣ⮯䳂幵⭀ˣ吋ḳ攟ˣ䷥䴻䎮ˣ⢾Ṍ⭀ˣ 屯昶䳂
ɛ
⮰㤕Ṣ⒉ˣᷕ
䳂埴㓧Ṣ⒉
昊廬ⶪ嬘⒉ˣᷕ⮷⬠㟉攟ˣᷕ⮷⬠侩ⷓˣ嬎⭀ˣ㚫妰ⷓˣ䴻䎮ˣ 壬䎮ˣ䔓⭞ˣἄ⭞ˣ姀侭ˣ枛㦪⭞ˣ㟉䳂幵⭀ˣ⺢䭱ⷓˣ㱽⭀ˣ
㍐ḳˣ⼳ⷓˣⶍ䦳ⷓˣ℔⎠埴嘇䥹攟
24
ɜ
⋲⮰㤕Ṣ⒉ˣ ᶨ凔℔⊁Ṣ
⒉
㈨埻⒉ˣ㈨Ỹˣ⥼ả䳂℔堃Ṣ⒉ˣ䥹⒉ˤ慹圵㨇㥳埴⒉ˣ㴰旚 昲⒉ˣẋ㚠ˣ䷋ⶪ嬘⒉ˣ悱捖㮹ẋ堐ˣ嬎⮇ˣ⮱䳂幵⭀ˣ㺼喅 Ṣ⒉ˣ⮷屯䓊昶䳂ˤ
ɝ ㈨埻⿏ⶍṢ
㈨ⶍˣ㯜暣ⶍˣ⎠㨇ˣ伶檖ⷓˣ伶⭡ⷓˣ⺂ⷓˣㇻ⫿⒉ˣ塩䷓
ⷓˣ⸿⒉ˣ㍐扟⒉ˣ冒侽彚ˣ⢓(⭀)ℝˣ柀䎕ˣ䚋ⶍˣ⊆ⶍ昶 䳂ˤ
ɞ
⋲㈨埻ˣ朆㈨ 埻ⶍṢ
ⶍ⺈ⶍṢˣ⮷屑ˣ彚⣓ˣ㺩⣓ˣ⺢䭱ⶍˣ㶭㻼ⶍˣ暄ⶍˣ冐㗪 ⶍˣⶍ⍳ˣ⺢䭱䈑䚳䭉Ṣˣₙⶍˣ㚵⊁䓇ˣ⭞⹕ᷣ⨎(⣓)ˣ⭞
䭉 屯㕁Ἦ㸸烉㜿䓇⁛(2005)ˤ
Ḵˣġ䉨ン
1. 冒奢烉ẍˬᶨ凔Ἦ婒炻ぐ娵䁢ぐ䚖⇵䘬䉨㱩㗗烉⊭⏓㤝⤥䘬ˣ
⼰⤥ˣ⤥ˣ㘖忂ˣᶵ⤥ˤ˭⓷枭≈ẍ姽Ộˤ
2. 䓇䎮烉㗗⏎㚱ㄊ⿏䕭ˤ(⊭⏓檀埨⡻ˣ䱾⯧䕭ˣ檀埨傪ˣᷕ桐ˣ㯋╀ˣ 僶冇䕭ˣ⽫冇䕭ˣㄊ⿏⏠忻䕦䕭ˣ偅冇䕦䕭ˣ䗴䕯ˣ䱦䤆䕦䕭ˤ) 3. ⽫䎮烉
忁墉䘬⽫䎮㗗ἧ䓐 SF-36 ⎘䀋䇰䓇㳣⑩岒慷堐炻 SF-36 䁢ᶨᾳ ᶨ凔⿏炷generic炸䘬⽫䎮㷔慷ⶍ℟炻᷎ᶵ㗗憅⮵䈡⭂⸜漉ˣ䕦䕭ㆾ㗗㱣 䗪侴姕妰炻ᷣ天㷔慷⍿姒侭幓⽫䉨ン䘬 8 ᾳ㤪⾝炷concept炸炻㛔䞼䨞 Ὢἧ䓐 SF-36 䘬㳣≃炷vitality炸冯⽫䎮炷mental health炸㫉慷堐炻
᷎ẍ䷥↮Ἦẋ堐㔜橼⽫䎮䉨ンˤ
濌堐䓙ˬ奢⼿⃭㺧㳣≃˭ˣˬ㗗ᶨᾳ朆ⷠ䵲⻝䘬Ṣ˭ˣˬ奢⼿朆ⷠ㱖╒炻
25
㰺㚱ảỽḳね⎗ẍ嬻ぐ檀冰崟Ἦ˭ˣˬ奢⼿⽫ね⸛朄˭ˣˬ䱦≃⃭㱃˭ˣˬ奢⼿
ぞぞᶵ㦪ㄪ櫙˭ˣˬ奢⼿䫳䕚≃䪕˭ˣˬ㗗ᶨᾳ⾓㦪䘬Ṣ˭ˣˬ奢⼿䳗˭忁ḅ ᾳ⫸柴䳬ㆸ炻侴⎬柴䘬⚆䫼怠枭䘮䁢ᶨ䚜悥㗗ˣ⣏悐↮㗪攻ˣ䴻ⷠˣ㚱㗪ˣ
⼰⮹ˣ⽆ᶵℕ栆ˤ℞ᷕ⚃柴Ⱄ㕤屈⎹䘬⓷柴炻↮⇍䁢ˬ奢⼿⃭㺧㳣≃˭ˣˬ奢
⼿⽫ね⸛朄˭ˣˬ䱦≃⃭㱃˭ˣˬ㗗ᶨᾳ⾓㦪䘬Ṣ˭炻怠㑯⽆澵䘬Ṣ⼿ 1 ↮ˣ
⼰⮹䘬Ṣ⼿ 2 ↮ˣ㚱㗪䘬Ṣ⼿ 3 ↮ˣ䴻ⷠ䘬Ṣ⼿ 4 ↮ˣ⣏悐↮㗪攻䘬Ṣ
⼿ 5 ↮ˣᶨ䚜悥㗗䘬Ṣ⼿ 6 ↮烊侴℞检Ḽ柴Ⱄ㕤㬋⎹䘬⓷柴炻⛐忁Ḽ柴怠 㑯⽆澵Ṣ⼿ 6 ↮ˣ⼰⮹Ṣ⼿ 5 ↮ˣ㚱㗪䘬Ṣ⼿ 4 ↮ˣ䴻ⷠ䘬Ṣ⼿ 3 ↮ˣ
⣏悐↮㗪攻䘬Ṣ⼿ 2 ↮ˣᶨ䚜悥㗗䘬Ṣ⼿ 1 ↮炻㈲㭷ᾳṢ䘬⼿↮䚠≈⌛䁢 㬌柴䘬妰↮㕡⺷炻䷥↮グ檀堐䣢㳣≃冯⽫瀲灈㱩グˤ
(1) 㳣≃
ẍ慷堐ᷕˬ奢⼿⃭㺧㳣≃˭ˣˬ䱦≃⃭㱃˭ˣˬ奢⼿䫳䕚≃䪕˭ˣˬ奢
⼿䳗˭⚃⫸柴Ἦẋ堐炻䷥↮グỶ堐䣢㳣≃䉨㱩崲ᶵἛˤὅ㳣≃↮㔠↮
䁢ˬⶖ˭ˣˬᷕ䫱˭ˣˬἛ˭ᶱ䳬ˤ (2) ⽫䎮
ẍˬ㗗ᶨᾳ朆ⷠ䵲⻝䘬Ṣ˭ˣˬ奢⼿朆ⷠ㱖╒˭ˣˬ奢⼿⽫ね⸛朄˭ˣ ˬ奢⼿ぞぞᶵ㦪ㄪ櫙˭ˣˬ㗗ᶨᾳ⾓㦪䘬Ṣ˭Ḽ⫸柴Ἦẋ堐炻䷥↮グ Ỷ堐䣢⽫䎮䉨㱩崲ᶵἛˤὅ⽫䎮↮㔠↮䁢ˬⶖ˭ˣˬᷕ䫱˭ˣˬἛ˭
ᶱ䳬ˤ
ᶱˣġ䞍嬀冯ン⹎⚈䳈烉䓙㕤㫉䳂屯㕁䘬旸⇞炻㛔䞼䨞䓐╖ᶨ䘬㩛㤼ἧ䓐䞍嬀Ἦ 䁢㷔慷⮵䱦䤆䈑岒⌙⭛䘬䞍嬀ㆾ桐晒䞍奢ˤ⓷⌟ẍᶳ↿⓷枭≈ẍ姽Ộˤ
1. 䞍嬀
ˬ⌛ἧ㩛㤼ᶵ⏓㶣≈䈑炻ḇ℟㚱农䗴⿏烉⊭⏓ᶵ⎴シˣ⎴シ˭ˤ
26
2. ン⹎
ˬぐ㗗⏎㚫䤩㬊冒䎦㚱炷ㆾ㛒Ἦᷳ炸⫸⤛♤梇㩛㤼烉⊭⏓ᶵ㚫䤩㬊ˣ 㚫䤩㬊˭ˤ
⚃ˣġ䱦䤆ἄ䓐䈑岒
㛔䞼䨞䘬䱦䤆䈑岒⊭⏓烉厠ˣ惺ˣ㩛㤼ˣ⏓惺䱦ㆾᶵ⏓惺䱦ᷳ㍸䤆梚㕁 ㆾ喍惺炷⤪烉ᾅ≃忼 Bˣ䵕⢓㭼ˣ埣䈃ˣ居䈡…炸ˣ┉ˣ勞ˤ
1. 倂普⿏烉ẍἧ䓐冯⏎Ἦ≈ẍ姽Ộˤ
2. ἧ䓐柣⹎烉ὅἧ䓐柣䌯↮䁢ˬ䃉˭ˣˬỶ˭ˣˬ檀˭ᶱ䳬ˤ
Ḽˣġ➢㛔Ṣ⎋⬠嬲枭烉⸜漉ˣ⯭ỷ⛘(⛘䎮ỵ伖)ˤ
䫔
䫔ℕ䭨ġ 䞼䨞`姕
ᶨˣġ䱦䤆䈑岒䘬ἧ䓐埴䁢ᷳ攻㚱倂普䘬䈡⿏ˤ
Ḵˣġỵ㕤ᶵ⎴䣦㚫䴻㾇⛘ỵ䘬䓟⿏䱦䤆䈑岒ἧ䓐栆✳ˣ✳ン㚱ⶖ䔘ˤ ᶱˣġ䣦㚫䴻㾇⛘ỵ⚈䳈㚫德忶䚠斄ᷕṳ⚈䳈⼙枧䱦䤆䈑岒ἧ䓐埴䁢ˤ
䫔ᶫ䭨ġ 屯㕁↮㜸冯㕡㱽
㛔䞼䨞㍉䓐 SPSS19.0 䇰暣儎⣿墅庇橼忚灖屯瀌嗽瀲冯↮㜸炻ὅ㒂䞼䨞㝞㥳 忚灖↮㜸炻⊭⏓ẍᶳ慵溆烉
27
ᶨˣġ⏰䎦䞼䨞㧋㛔ᷳṢ⎋⬠嬲枭ˣ䣦䴻⛘ỵˣ䉨ンˣ䞍嬀冯ン⹎ẍ⍲䱦䤆䈑 岒ἧ䓐✳ン䘬㍷徘ˤ
Ḵˣġ䱦䤆䈑岒ἧ䓐埴䁢ᷳ攻䘬䚠Ḻ斄Ὢ烉䓙㕤䱦䤆䈑岒ἧ䓐嬲枭Ⱄ㕤⸷ỵ嬲枭 (ordinal variable)炻⚈㬌ẍ Spearman 䚠斄↮㜸Ἦ⇅㬍㍊妶⎬䱦䤆䈑岒ἧ䓐埴䁢 嬲枭ᷳ攻䘬䚠斄✳ンˤ
ᶱˣġ䣦䴻⛘ỵˣ䉨ンˣ䞍嬀⍲ン⹎冯䱦䤆䈑岒ἧ䓐ᷳ暁嬲枭↮㜸烉㩊夾ᶵ⎴
䣦䴻⛘ỵˣ䉨ンˣ䞍嬀冯ン⹎䘬䱦䤆䈑岒ἧ䓐埴䁢ᷳ䚠斄炻᷎ẍ⌉㕡㩊
⭂ℑℑᷳ攻䘬䚠斄ˤ
⚃ˣġ䣦䴻⛘ỵ⮵㕤䱦䤆䈑岒ἧ䓐䚠Ḻ斄Ὢ䘬⼙枧烉↮⇍ẍ借㤕冯㔁做䦳⹎↮Ⰼ炻 㩊夾䱦䤆䈑岒ἧ䓐埴䁢ᷳ攻䘬䚠Ḻ斄Ὢˤ
Ḽˣġ䣦㚫䴻㾇⛘ỵˣ䉨ン冯䞍嬀ン⹎⚈䳈䱦䤆䈑岒ἧ䓐ᷳ斄Ὢ烉䓙㕤䱦䤆 䈑岒ἧ䓐Ⱄ㕤⸷ỵ嬲枭炻⚈㬌⃰ἧ䓐⸷ỵ怷廗㕗徜㬠㧉✳(ordinal logistic regression model)↮㜸炻㩊夾⛐㔜橼ね㱩ᷳᶳ炻䉨ンˣ䞍嬀冯ン⹎⮵䱦䤆 䈑岒ἧ䓐䘬斄Ὢ炻㍍叿ẍ借㤕冯㔁做䦳⹎↮Ⰼ↮㜸Ἦ䚳䉨ンˣ䞍嬀冯ン
⹎⮵㕤䱦䤆䈑岒ἧ䓐䘬⼙枧㗗⏎⬀⛐炻啱ẍ㩊夾ᷕṳ䘬㓰㝄ˤ
ℕˣġ䱦䤆䈑岒ἧ䓐埴䁢佌橼↮栆炻㍷徘⎬佌橼ᷳ䈡岒烉⇑䓐佌倂↮㜸⮯㧋㛔↮栆炻 㰢⭂䱦䤆䈑岒ἧ䓐埴䁢佌橼⼴炻⮯忚ᶨ㬍㍷徘⎬佌橼⛐⸜漉ˣ䉨ンˣ䞍 嬀冯ン⹎ˣ䣦㚫䴻㾇⛘ỵ(⌛借㤕冯㔁做䦳⹎)䫱⎬㕡朊䘬䈡岒ˤ
28
䫔
䫔⚃䪈ġ 䞼䨞䳸㝄
⛐ 2005 濜ˬ⚳㮹姒⓷㙐喍䈑潰䓐婧㞍˭⭞㇞朊姒婧㞍冯喍䈑㾓䓐ᷳ悐↮
屯瀌忚灖㫉䳂屯瀌↮㜸ᷕ炻㚨⼴↮㜸䘬㧋㛔䁢 6087 Ṣˤ㛔䪈⮯憅⮵ 6087 ⎵䓟⿏
䘬↮㜸䳸㝄↮ㆸḼ⮷䭨Ἦ⏰䎦烉(1)㧋㛔䈡岒䘬㍷徘炻⊭⏓Ṣ⎋⬠嬲枭ˣ䣦䴻⛘ỵˣ
䉨ンˣ䞍嬀冯ン⹎ẍ⍲䱦䤆䈑岒ἧ䓐✳ン䘬㍷徘ˣ(2)䱦䤆䈑岒ἧ䓐✳ンˣ(3) 䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ䓐埴䁢ᷳ斄Ὢˣ(4)䉨ンˣ䞍嬀⍲ン⹎冯䱦䤆䈑岒ἧ䓐
ᷳ斄Ὢˣ(5)ᶵ⎴䣦䴻⛘ỵᷳ䱦䤆䈑岒ἧ䓐✳ンˣ(6)㩊夾䉨ンˣ䞍嬀冯ン⹎⛐
䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ䓐ᷳ攻㈖㺼䘬奺刚ˣ(7)䱦䤆䈑岒ἧ䓐埴䁢佌橼ᷳᾳṢ䈡 岒炻⊭⏓⸜漉ˣ䉨ンˣ䞍嬀冯ン⹎⍲䣦䴻⛘ỵˤ
䫔ᶨ䭨 㧋㛔䈡岒㍷徘
⛐㧋㛔䈡岒㍷徘㕡朊炻⮯⊭㊔Ṣ⎋⬠䈡岒冯䣦䴻⛘ỵˣ䉨ン⍲䞍嬀冯ン
⹎ẍ⍲䱦䤆䈑岒ἧ䓐ね⼊忁ᶱ⣏悐↮ˤ
ᶨˣġṢ⎋⬠䈡岒冯䣦䴻⛘ỵ
⛐忁 6087 ỵ䓟⿏⍿姒侭ᷕ炻⎬⸜漉Ⰼ䘬㧋㛔↮Ựⶖᶵ⣂炻ẍ 25-34 㬚庫⣂(25.0
%)炻35-44 㬚㫉ᷳ(24.3%)炻55-64 㬚㚨⮹(11.9%)烊⛐⯭ỷ⛘㕡朊炻ẍỷ⛐澱悐䘬Ṣ Ỽ瀈㚨⣏悐↮(43.4 %)炻℞㫉㗗ỷ⛐ᷕ悐(25.9 %)烊⛐䣦䴻⛘ỵ䘬悐↮炻借㤕ẍ䫔 ɞ䳂借㤕(⋲㈨埻ˣ朆㈨埻ⶍṢ)⯭⣂(17.9%)炻䫔ɜ䳂(⋲⮰㤕Ṣ⒉ˣᶨ凔℔⊁Ṣ⒉) 㫉ᷳ(15.3%)烊㔁做䦳灏ẍ檀ᷕ借䔊㤕⯭⣂(31.5 %)炻⚳ᷕ⍲ẍᶳ㫉ᷳ(30.6 %)炻⤪
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堐 4-1 䣢ˤ
Ḵˣġ䱦䤆䈑岒ἧ䓐ね⼊
⛐䱦䤆䈑岒ἧ䓐✳ン䘬悐↮(夳堐 4-2)炻⊭⏓⏠厠炻梚惺炻♤梇㩛㤼炻╅㍸䤆 梚㕁炻┉炻勞䫱ℕ䧖䱦䤆䈑岒䘬ἧ䓐ね⼊ˤ
䱦䤆䈑岒ἧ䓐ね⼊炻⏠厠ˣ梚惺ˣ♤㩛㤼ˣ╅㍸䤆梚㕁䘮ẍᶵ㚦ἧ䓐Ỽ㚨⣂
(44.5%ˣ44.4%ˣ70.6%ˣ67.8%)烊╅┉ẍ㭷忙 1 㫉ẍᶳㆾ⼰⮹╅㚨⣂(34.2%)ˣ
╅勞⇯㗗ẍ㭷⣑ㆾ⸦᷶㭷⣑╅Ỽ㚨⣂(35.9%)ˤ
ᶱˣġ䉨ン⍲䞍嬀冯ン⹎
䉨ン䘬悐↮(夳堐 4-3)炻冒奢㕡朊ẍ娵䁢⤥䘬Ỽ庫⣂(32.3%)烊䓇䎮
㕡朊炻㚱ㄊ⿏䕭侭Ỽ 35.2%烊⽫䎮㕡朊炻ẍ⼰⮹デ⇘䵲⻝ˣ⼰⮹デ⇘㱖╒ˣ
⼰⮹デ⇘ぞぞᶵ㦪⍲ㄪ櫙ˣ⣏悐↮㗪攻悥⽫ね⸛朄ˣ⣏悐↮㗪攻悥デ⇘⾓㦪㚨⣂
(35.1%ˣ40.3%ˣ39.3%ˣ36.5%ˣ33.7%)烊㳣≃䘬悐↮ẍ⣏悐↮㗪攻悥⃭㺧㳣≃ˣ
⣏悐↮㗪攻悥䱦≃⃭㱃ˣ⼰⮹䫳䕚≃䪕ˣ㚱㗪῁デ奢⼰䳗㚨⣂(34.0%ˣ33.3%ˣ 37.2%ˣ33.9%)ˤ
䞍嬀冯ン⹎䘬悐↮(夳堐 4-4)炻䞍嬀㬋䡢Ỽ 42.8%烊ン⹎㬋䡢Ỽ 88.2%ˤ栗䣢㧋 㛔⮵㕤㩛㤼⌛ἧᶵ⏓㶣≈䈑ḇ℟农䗴⿏䘬䞍嬀ῷỶ炻侴⮵㕤䤩㬊冒⫸⤛♤梇㩛 㤼䘬ン⹎⇯ῷ檀ˤ
30
䫔
䫔Ḵ䭨 䱦䤆䈑岒ἧ䓐✳ン
㍷徘⬴㧋㛔䈡岒⼴炻㛔䭨⊭⏓Ḯℕ䧖䱦䤆䈑岒䘬䚠斄↮㜸炻㩊夾䱦䤆䈑岒ἧ 䓐ᷳ攻䘬䚠斄⿏ˤ
ẍ Spearman 䚠斄㩊夾⎬䱦䤆䈑岒ἧ䓐埴䁢ᷳ攻䘬斄Ὢ(夳堐 4-5)䘤䎦ẍᶳ䈡 溆炻䚠斄㚨⻟䘬ἧ䓐埴↢䎦㕤⏠厠ˣ梚惺ˣ♤㩛㤼ˣ梚䓐㍸䤆梚㕁忁⚃枭䱦䤆䈑 岒ἧ䓐埴䁢炻℞ᷕẍ⏠厠♤㩛㤼䘬᷎⬀⿏㚨檀ˤ℞⮎⏠厠ˣ梚惺ˣ♤㩛㤼ᷳ攻 䘬䚠斄⿏㖑䡢䩳炻⍵Ὰ㗗㍸䤆梚㕁䘬梚䓐冯㬌ᶱ枭䱦䤆䈑岒ἧ䓐⏰䎦㬋䚠斄炻 栗䣢╅㍸䤆梚㕁冯忁ṃ埴䁢ᷳ攻㚱᷎⬀䘬斄Ὢˤ堐 4-5 䘬屯㕁栗䣢炻ẍ㍸䤆梚㕁侴 妨炻℞冯梚惺䘬᷎⬀⿏㚨檀炻♤梇㩛㤼㫉ᷳ炻冯╅┉㚨Ỷˤ╅勞冯⏠厠ˣ梚惺
⍲╅┉ᷳ攻䘬䚠斄⿏ḇ栗䣢㬌⚃枭䱦䤆䈑岒ἧ䓐埴䁢⏰᷎⬀䘬斄Ὢ炻℞ᷕ勞冯
┉ᷳ梚䓐䘬᷎⬀⿏㚨檀炻冯⏠厠℞㫉ˤ侴╅┉冯⏠厠ˣ梚惺ˣ㍸䤆梚㕁ᷳ攻 ḇ℟䚠斄⿏炻℞ᷕ冯㍸䤆梚㕁䘬᷎⬀⿏㚨檀ˤ
䫔ᶱ䭨 䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ䓐ᷳ斄Ὢ
ℵἮ㩊夾㛔䞼䨞ᷣ天䘬冒嬲枭冯ὅ嬲枭ᷳ攻䘬斄Ὢ炻䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ 䓐↮Ựね⼊ˤ⛐忁悐↮䘬↮㜸ᷕ炻⎬枭䱦䤆䈑岒ἧ䓐䘬㷔慷悥↮栆䁢䃉ἧ䓐ˣ Ỷἧ䓐ˣ檀ἧ䓐ᶱ䧖䦳⹎ˤ
ᶨˣġ借㤕
椾⃰㗗借㤕冯䱦䤆䈑岒ἧ䓐ᷳ攻䘬斄Ὢ炻⤪堐 4-6 䣢炻㔜橼侴妨炻借㤕冯
31
㚱䱦䤆䈑岒ἧ䓐䘬斄Ὢ䘮忼䴙妰ᶲ栗叿ⶖ䔘ˤ℞ᷕ⏠厠ẍ䫔ɞ䳂借㤕㚨⣂
(53.9%)炻ᶼ借㤕䫱䳂崲Ỷἧ䓐㭼ἳ崲檀烊梚惺ẍ䫔ɝ䳂借㤕㚨⣂(20.0%)烊♤㩛㤼 ẍ䫔ɞ䳂借㤕㚨⣂(23.3%)炻ᶼ晐借㤕䫱䳂崲Ỷἧ䓐㭼ἳ崲檀烊╅㍸䤆梚㕁ẍ䫔ɝ 䳂借㤕㚨⣂(29.7%)炻ᶼ晐借㤕䫱䳂崲Ỷἧ䓐㭼ἳ崲檀烊╅┉ẍ䫔ɚ䳂借㤕㚨⣂
(43.4%)炻ᶼ晐借㤕䫱䳂崲檀℞ἧ䓐㭼ἳ崲檀烊╅勞ẍ䫔ɜ䳂借㤕侭ἧ䓐㚨⣂
(44.6%)ˤ
䓙堐 4-6 䘤䎦炻厠ˣ惺ˣ㩛㤼冯㍸䤆梚㕁䘬ἧ䓐侭普ᷕ⛐借㤕䫱䳂庫Ỷ䘬㕷佌烊
┉䘬ἧ䓐侭⇯普ᷕ⛐借㤕䫱䳂ῷ檀䘬㕷佌烊勞䘬ἧ䓐侭⇯⸛⛯↮Ự⛐⎬借㤕䫱 䳂ˤ
Ḵˣġ㔁做䦳⹎
㍍ᶳἮ㗗㔁做䦳⹎冯䱦䤆䈑岒ἧ䓐ᷳ攻䘬斄Ὢ炻⤪堐 4-6 䣢炻㔜橼侴妨炻㔁 做䦳⹎冯䱦䤆䈑岒ἧ䓐䘬斄Ὢ䘮忼⇘䴙妰⬠ᶲ栗叿ⶖ䔘ˤ℞ᷕ⏠厠ˣ梚惺ˣ♤㩛 㤼⍲╅㍸䤆梚㕁炻䘮ẍ⚳ᷕ⍲ẍᶳ䘬⍿姒侭ἧ䓐㚨⣂炻↮⇍䁢 54.6%ˣ30.3%ˣ 23.1%ˣ25.2%炻ᶼ晐㔁做䦳⹎䘬ᶳ旵侴ἧ䓐㭼ἳḇ崲檀烊╅┉ẍ⣏⬠⍲ẍᶲ㔁 做䦳⹎侭㚨⣂(43.7%)炻ᶼ晐㔁做䦳⹎ᶳ旵ἧ䓐㭼ἳḇᶳ旵烊╅勞⇯ẍ檀ᷕ借㚨⣂
(37.9%)炻冯㔁做䦳⹎攻庫䃉昶㡗⺷䘬斄Ὢˤ
堐 4-6 栗䣢炻㔜橼侴妨炻厠ˣ惺ˣ㩛㤼冯㍸䤆梚㕁䘬ἧ䓐侭普ᷕ⛐㔁做䦳⹎庫 Ỷᷳ㕷佌炻┉䘬ἧ䓐侭普ᷕ⛐㔁做䦳⹎ῷ檀䘬㕷佌烊勞䘬ἧ䓐侭⇯⸛⛯↮Ự⛐
⎬㔁做䦳⹎ˤ
32
䫔
䫔⚃䭨 䉨ンˣ䞍嬀⍲ン⹎冯䱦䤆䈑岒ἧ䓐ᷳ斄Ὢ
㍷徘䣦䴻⛘ỵ冯䈑岒ἧ䓐攻䘬斄Ὢ⼴炻㍍ᶳἮ㩊夾䞼䨞㝞㥳ᷳᷕṳ嬲枭冯䈑 岒ἧ䓐夳䘬斄Ὢˤ
ᶨˣġ䉨ン
堐 4-7 ⏰䎦䉨ン冯䱦䤆䈑岒ἧ䓐ね⼊ˤẍ冒奢Ἦ婒炻㔜橼侴妨炻冒奢
冯䱦䤆䈑岒ἧ䓐䘬斄Ὢ忼䴙妰⬠ᶲ栗叿ⶖ䔘炻℞ᷕ⏠厠ˣ♤㩛㤼冯╅㍸䤆梚 㕁炻䘮ẍ冒奢㘖忂/ᶵ⤥侭ἧ䓐䦳⹎㚨檀炻ὅ㫉䁢 42.7%ˣ14.4%ˣ17.2%ˤ⛐
┉⍲勞䘬ἧ䓐㕡朊炻ẍ冒奢㤝⤥/⼰⤥侭ἧ䓐䦳⹎㚨檀炻檀ἧ䓐侭ὅ㫉䁢 39.3%ˣ37.5%炻ᶼ⣏农晐叿冒奢崲⤥ἧ䓐㭼ἳ崲檀ˤ
㗗⏎か㚱ㄊ⿏䕭⎒㚱⛐冯ἧ䓐┉ˣ勞忁ℑ枭䱦䤆䈑岒ᶲ忼䴙妰⬠ᶲ栗叿ⶖ 䔘炻侴⛐⏠厠ˣ梚惺ˣ♤㩛㤼冯㍸䤆梚㕁䘬ἧ䓐䦳⹎ⶖ䔘ᶵ⣏烊䃉ㄊ⿏䕭侭┉
䘬ἧ䓐䦳⹎庫檀炻ᶼ檀ἧ䓐侭䁢 36.7%炻䚠⮵㕤㚱ㄊ⿏䕭侭䘬 33.0%炻㚱ㄊ⿏䕭侭 勞䘬ἧ䓐䦳⹎庫檀炻檀ἧ䓐侭䁢 38.2%炻䚠⮵㕤䃉ㄊ⿏䕭侭䘬 34.7%ˤ
㳣≃冯䱦䤆䈑岒ἧ䓐䘬斄Ὢ炻⛐ἧ䓐㍸䤆梚㕁ˣ┉冯勞忼⇘䴙妰⬠ᶲ栗叿 ⶖ䔘炻℞ᷕ㳣≃崲ⶖ侭崲ῷ⎹ἧ䓐厠⍲㍸䤆梚㕁炻侴㳣≃崲Ἓ侭炻崲ῷ⎹ἧ䓐勞烊
⽫䎮冯䱦䤆䈑岒ἧ䓐䘬斄Ὢ炻⛐ἧ䓐惺ˣ㩛㤼ˣ㍸䤆梚㕁ˣ┉冯勞䘮忼䴙 妰⬠ᶲ栗叿ⶖ䔘炻℞ᷕ⽫䎮庫ⶖ侭崲ῷ⎹ἧ䓐惺ˣ㩛㤼冯㍸䤆梚㕁烊厠冯
┉䘬ἧ䓐侭⸛⛯↮Ự⛐⎬⽫䎮䦳⹎烊侴⽫䎮崲Ἓ侭崲ῷ⎹ἧ䓐勞梚ˤ
33
Ḵˣġ䞍嬀冯ン⹎
䞍嬀昌┉冯勞ᷳ⢾厠ˣ惺ˣ㩛㤼⍲㍸䤆梚㕁䘬ἧ䓐䘮⏰䎦栗叿䚠斄炻ᶼ 䞍嬀ᶵ㬋䡢侭ἧ䓐㭼ἳ崲檀ˤ侴⛐㛔䞼䨞ᷕ炻ン⹎ℕ枭䱦䤆䈑岒䘬ἧ䓐Ṏ⏰䎦 栗叿䚠斄炻ン⹎ᶵ㬋䡢侭ἧ䓐厠ˣ惺ˣ㩛㤼ˣ㍸䤆梚㕁ẍ⍲勞䘬㭼ἳḇ崲檀(夳堐 4-8)ˤ
䫔
䫔Ḽ䭨 ᶵ⎴䣦㚫Ⰼ䳂ᷕ炻䱦䤆䈑岒ἧ䓐ᷳ攻䘬斄Ὢ
⛐Ḯ妋䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ䓐䘬斄Ὢ炻ẍ⍲䉨ンˣ䞍嬀冯ン⹎⚈䳈冯 䱦䤆䈑岒ἧ䓐䘬斄Ὢᷳ⼴炻㛔䭨㍍叿㍊妶⛐ᶵ⎴借㤕冯㔁做䦳⹎䘬╖ᶨ㫉㧋㛔
ᷕ炻䱦䤆䈑岒ἧ䓐䘬䚠Ḻ斄Ὢ䁢ỽ炻ẍ㬌↮Ⰼ↮㜸⼿ᷳ䳸㝄⏰䎦㕤堐 4-9 ⍲ 4-10
ᶨˣġ借㤕
ẍ借㤕↮ⰌἮ㩊夾(夳堐 4-9)炻䃉婾借㤕䫱䳂䁢ỽ炻䘤䎦⏠厠ˣ♤㩛㤼ˣ梚惺
⍲㍸䤆梚㕁ᷳ攻䘬䚠斄㚨⻟炻䈡⇍㗗⏠厠冯♤㩛㤼攻㚜㗗⤪㬌ˤẍ㍸䤆梚㕁Ἦ婒炻
⬫冯⏠厠䘬斄Ὢ㚨⻙炻侴冯梚惺⍲♤㩛㤼䘬䚠斄庫⻟ˤ军㕤┉冯勞炻ᶵỮℑ侭 攻䘬斄Ὢ䚠⮵⽖⻙炻ᶼ冯℞Ṿ䈑岒ἧ䓐攻䘬斄Ὢ䘮ᶵ⻟炻㭼庫ᶨ农䘬㗗炻昌Ḯ借 㤕䫱䳂ɞᷳ⢾炻┉冯厠䘮㚱忼䴙妰栗叿㯜㸾䘬⻙䚠斄(0.08-0.15)ˤ
劍ẍᶵ⎴䘬借㤕Ⰼ䳂Ἦ䚳炻㍸䤆梚㕁⛐䫔ɝˣɞ䫱庫ỶⰌ䳂冯梚惺㚱㚨⻟䘬 䚠斄炻↮⇍䁢 0.44 冯 0.36(p<0.001)ˤ╅勞⛐䫔ɝˣɞ䫱庫ỶⰌ䳂冯⏠厠㛒忼䴙妰 栗叿㯜㸾ˤ
34
Ḵˣġ㔁做䦳⹎
ẍ㔁做䦳⹎↮ⰌἮ㩊夾(夳堐 4-10)炻䃉婾㔁做䦳⹎䁢ỽ炻䘤䎦⏠厠ˣ♤㩛㤼ˣ 梚惺⍲㍸䤆梚㕁ᷳ攻䘬䚠斄ṵ䵕㊩ᶨ农㬋䚠斄炻⛐⏠厠冯♤㩛㤼攻ḇ㗗⤪㬌ˤẍ
㍸䤆梚㕁Ἦ婒炻⬫冯⏠厠䘬斄Ὢ㚨⻙炻侴冯梚惺⍲♤㩛㤼䘬䚠斄庫⻟ˤ军㕤┉
冯勞炻ℑ侭攻䘬斄Ὢ⡆⻟炻Ữṵ䚠⮵⽖⻙ˤᶵ婾㔁做䦳⹎䁢ỽ炻┉冯厠䘮㚱忼 䴙妰⬠栗叿㯜㸾䘬䚠斄炻冯℞Ṿ䈑岒ἧ䓐攻䘬斄Ὢ炻⛐㔁做䦳⹎⚳ᷕ⍲ẍᶳ㚨ᶵ 㖶栗炻勞冯㍸䤆梚㕁䓂军⏰䎦栗叿屈䚠斄-0.08(p<0.001)ˤ
劍ẍᶵ⎴䘬㔁做䦳⹎Ἦ䚳炻㍸䤆梚㕁⛐㔁做䦳⹎䁢檀ᷕ借ˣ⚳ᷕ⍲ẍᶳ冯梚 惺㚱㚨⻟䘬䚠斄炻↮⇍ 0.38 冯 0.36(p<0.001)ˤ
䫔
䫔ℕ䭨 ᷕṳ嬲枭䘬槿嫱
⛐堐 4-7 䉨ン冯䱦䤆䈑岒ἧ䓐䘬暁嬲枭䚠斄↮㜸䔞ᷕ䘤䎦炻ㄊ⿏䕭冯䱦䤆 䈑岒䘬䚠斄⿏ᶵ檀炻㓭⛐㍍ᶳἮᷕṳ嬲枭䘬槿嫱ᷕ⮯ㄊ⿏䕭忁ᾳ嬲枭㌺昌炻⃰䚳 㔜橼䉨㱩ᶳ䉨ンˣ䞍嬀冯ン⹎ℕ枭䱦䤆䈑岒ἧ䓐䘬斄Ὢ炻ℵ↮⇍ẍ借㤕ˣ 㔁做䦳⹎↮Ⰼ炻㩊夾䉨ンˣ䞍嬀冯ン⹎炻⛐䣦䴻⛘ỵ冯䱦䤆䈑岒ἧ䓐斄Ὢᷕ
㈖㺼䘬奺刚炻䳸㝄↮徘⤪ᶳ烉
ᶨˣġ㔜橼ね㱩
⛐㔜橼ね㱩䘬悐↮(夳堐 4-11)炻⣏农ᶲἮ䚳炻冒奢冯㳣≃冯┉勞䘬ἧ 䓐㚱斄烊侴⽫䎮ˣ䞍嬀冯ン⹎⇯冯厠ˣ惺ˣ㩛㤼ˣ㍸䤆梚㕁䘬ἧ䓐㚱斄炻℞
35
ᷕ厠冯㩛㤼䘬ἧ䓐㚫⍿⇘冒奢䘬⼙枧烊惺冯㍸䤆梚㕁䘬ἧ䓐ḇ㚫⍿⽫䎮
䘬⼙枧ˤ
Ḵˣġẍ借㤕↮Ⰼ
1. ⏠厠烉
ẍ借㤕≈ẍ↮Ⰼ⼴炻䘤䎦冒奢䘬⼙枧廱䁢ᶵ栗叿烊䞍嬀⼙枧⛐䫔ɚˣ ɞ䳂ṵ䁢栗叿烊ン⹎䘬⼙枧ᶵ婾⛐ỽ借㤕䫱䳂䘮䁢栗叿(夳堐 4-12)ˤ 2. 梚惺烉
ẍ借㤕≈ẍ↮Ⰼ⼴炻䘤䎦⽫䎮䘬⼙枧廱䁢ᶵ栗叿烊ン⹎䘬⼙枧ᶵ婾
⛐ỽ借㤕䫱䳂䘮䁢栗叿炻℞ᷕ⮵䫔ɚ䳂䘬⼙枧㚨⣏(夳堐 4-12)ˤ 3. ♤㩛㤼烉
ẍ借㤕≈ẍ↮Ⰼ⼴炻䘤䎦冒奢冯䞍嬀䘬⼙枧廱䁢ᶵ栗叿烊ン⹎䘬⼙
枧昌Ḯ䫔ɜ䳂ᷳ⢾䘮䁢栗叿炻℞ᷕ⮵䫔ɚ䳂䘬⼙枧㚨⣏(夳堐 4-13)ˤ 4. ㍸䤆梚㕁烉
ẍ借㤕≈ẍ↮Ⰼ⼴炻䘤䎦⽫䎮䘬⼙枧⛐䫔ɛˣɞ䳂ṵ䁢栗叿烊䞍嬀 䘬⼙枧廱䁢ᶵ栗叿烊ン⹎䘬⼙枧昌Ḯ䫔ɜ䳂ᷳ⢾䘮䁢栗叿(夳堐 4-13)ˤ 5. ┉烉
ẍ借㤕≈ẍ↮Ⰼ⼴炻䘤䎦冒奢䘬⼙枧⛐䫔ɚˣɛˣɝˣɞ䳂ṵ䁢栗 叿烊㳣≃䘬⼙枧廱䁢ᶵ栗叿(夳堐 4-14)ˤ
6. ╅勞烉
ẍ借㤕≈ẍ↮Ⰼ⼴炻䘤䎦冒奢冯㳣≃䘬⼙枧䘮廱䁢ᶵ栗叿(夳堐 4-14)ˤ
ᶱˣġẍ㔁做䦳⹎↮Ⰼ
36
1. ⏠厠烉
ẍ㔁做䦳⹎≈ẍ↮Ⰼ⼴炻䘤䎦冒奢䘬⼙枧廱䁢ᶵ栗叿烊䞍嬀⼙枧⛐
⮰䥹䔊㤕ẍ⚳ᷕ⍲ẍᶳṵ䁢栗叿烊ン⹎䘬⼙枧ᶵ婾⛐ỽ㔁做䦳⹎䘮䁢栗 叿炻℞ᷕ⮵⣏⬠⍲ẍᶲ䘬⼙枧㚨⣏(夳堐 4-15)ˤ
2. 梚惺烉
ẍ㔁做䦳⹎≈ẍ↮Ⰼ⼴炻䘤䎦⽫䎮䘬⼙枧廱䁢ᶵ栗叿烊ン⹎䘬⼙枧 昌Ḯ⣏⬠⍲ẍᶲ炻℞检ṵ䁢栗叿(夳堐 4-15)ˤ
3. ♤㩛㤼烉
ẍ㔁做䦳⹎≈ẍ↮Ⰼ⼴炻䘤䎦冒奢䘬⼙枧廱䁢ᶵ栗叿烊䞍嬀䘬⼙枧 昌Ḯ⣏⬠⍲ẍᶲ冯⚳ᷕ⍲ẍᶳ炻℞检ṵ䁢栗叿烊ン⹎䘬⼙枧昌Ḯ⣏⬠⍲
ẍᶲ炻℞检ṵ䁢栗叿(夳堐 4-16)ˤ 4. ㍸䤆梚㕁烉
ẍ㔁做䦳⹎≈ẍ↮Ⰼ⼴炻䘤䎦⽫䎮䘬⼙枧昌Ḯ⚳ᷕ⍲ẍᶳ炻℞检ṵ 䁢栗叿烊䞍嬀䘬⼙枧廱䁢ᶵ栗叿烊ン⹎䘬⼙枧昌Ḯ⣏⬠⍲ẍᶲ炻℞检ṵ 䁢栗叿(夳堐 4-16)ˤ
5. ┉烉
ẍ㔁做䦳⹎≈ẍ↮Ⰼ⼴炻䘤䎦冒奢䘬⼙枧昌Ḯ檀ᷕ借炻℞检ṵ䁢栗 叿烊㳣≃廱䁢ᶵ栗叿(夳堐 4-17)ˤ
6. ╅勞烉
ẍ㔁做䦳⹎≈ẍ↮Ⰼ⼴炻䘤䎦冒奢⍲㳣≃䘬⼙枧䘮廱䁢ᶵ栗叿(夳堐 4-17)ˤ
䫔
䫔ᶫ䭨 䱦䤆䈑岒ἧ䓐埴䁢佌橼
37
⇵⸦䭨⇅㬍Ḯ妋䱦䤆䈑岒ἧ䓐埴䁢ᷳ攻䘬斄Ὢᷳ⼴炻忚ᶨ㬍⇑䓐佌倂↮㜸⮯
㧋㛔↮栆ˤ䴻忶䷩墯䘬↮栆忶䦳⼴炻㚨䳪⼿⇘ℕᾳ䱦䤆䈑岒ἧ䓐佌橼(夳堐 4-18)ˤ ẍ⇌⇍↮㜸槿嫱↮佌䳸㝄炻䘤䎦⇌⇍傥≃忼栗叿㯜㸾(p<0.000)炻㓰㝄朆ⷠ⤥炻ὅ
℞⇌⇍↥㔠ᷳ↮䳬㸾䡢䌯䚳炻㬋䡢⇌⇍䌯䁢 94%炻ḇ嫱㖶↮佌䳸㝄列⤥ˤ侴忁ℕ ᾳ佌橼⛐ℕ枭䱦䤆䈑岒ἧ䓐埴䁢䘬↮Ựᶲ⎬℟℞䈡刚炻⎬䳬䘬䈡刚↮⇍㔀徘⤪ᶳ烉
ᶨˣġ䱦䤆䈑岒ἧ䓐埴䁢佌橼
1. ⣂⃫ㆸ䘖✳(n=843)烉Ⱄ㕤㬌栆䘬ㆸ⸜䓟⿏⛐梚惺(61.7%)ˣ♤㩛㤼 (42.1%)ˣ㍸䤆梚㕁(67.7%)ˣ⍲┉(56.9%)䁢ℕ䳬ᷳⅈ炻侴⏠厠(79.7%)
梚勞(43.9%)⇯㫉ᷳˤ
2. ℠✳ᶱ⃫ㆸ䘖(n=706)烉忁㗗Ṣ㔠㚨⮹䘬䳬⇍炻忁栆ㆸ⸜䓟⿏ᷕ㚱檀⏠厠ˣ 梚惺冯♤㩛㤼䘬㭼䌯(79.2%ˣ57.4%ˣ37.1%)ˤ
3. 慵厠䘖檀┉勞(n=1067)烉忁㗗Ⱄ㕤Ṣ㔠庫⣂䘬ᶨ佌炻℞㚨⣏䘬䈡刚⯙㗗 㚨檀䘬⏠厠㭼䌯(92.0%)炻䁢ℕ䳬ᷳⅈ炻侴⮵┉⍲勞䘬㴰屣Ṏ䚠䔞檀 (52.6%ˣ48.5%)ˤ
4. 惺冯┉暁ῷ⤥(n=718)烉忁ᾳ栆⇍㚨⣏䘬䈡刚⯙㗗⮵梚惺(56.0%)⍲╅
┉(46.7%)䘬檀⹎╄⤥炻侴⮵勞䘬ἧ䓐䦳⹎⇯Ỷ(53.5%)ˤ
5. 䌐挦梚勞(n=689)烉忁䳬Ṣ勞䘬ἧ䓐䦳⹎䁢檀(100.0%)炻䁢ℕ䳬ᷳⅈ烊侴
┉䦳⹎ῷỶ(34.3%)ˤ
6. 䲼㶐䃉䘖(n=1567)烉䁢Ṣ㔠㚨⣂䘬ᶨ佌炻忁佌Ṣ⛐⎬枭䱦䤆䈑岒ἧ䓐埴䁢
⛯ῷ⎹䃉ἧ䓐ˤ
Ḵˣġ埴䁢佌橼冯䚠斄⚈䳈
