卫生研究

目的分析社会因素对北京市小学生健康相关行为的影响。方法采取两阶段(区和学校)、分层(学校类型)、整群(班级)抽样的方法。首先抽取北京市海淀区和丰台区,接着在每个区内随机抽取1所私立、1所公立流动儿童为主的小学,并配以2所户籍儿童为主的小学。在每所小学里4、5、6年级各随机抽取2个班,该班的所有学生和家长作为研究对象。采用自制问卷调查学生和家长的基本信息及与慢性病相关的健康行为、相关知识。最终获得8所小学的学生和家长配对有效问卷1604份。测量的行为有3类11种,包括:尝试吸烟、营养和饮食行为(蔬菜、水果、奶类、早餐摄入频次;口味偏咸、偏油)、静坐生活方式(连续看书、看电视、玩电脑超1小时,在学校及在家是否都锻炼身体)。将每个学生具有危害健康行为的数量分为低、中、高三个水平(0¹种、2³种、≥4种),采用单因素方差分析、卡方检验及多分类有序logistic回归分析人口学特征、学校类型、家庭社会经济状况(SES)、学生健康相关知识、家长健康相关知识和行为对学生危害健康行为数量的影响。结果多分类有序logistic分析表明,男性、年龄大的学生危害健康行为数量更多,OR值分别为1.26(95%CI 1.03¹.53)和1.25(95%CI 1.14¹.37);而家庭SES得分高(OR=0.84,95%CI 0.73⁰.95)、学生健康知识得分高(OR=0.87,95%CI 0.83⁰.91)、家长健康行为得分高(OR=0.87,95%CI 0.83⁰.91)的学生危害健康行为数量较少;户籍状态和学校类型未见显著影响。与户籍儿童相比,流动儿童中男性(OR=1.39,95%CI 1.08¹.79)、家庭社会经济状况(OR=0.85,95%CI 0.73¹.00)具有显著影响,两者其余影响因素类似。结论家庭社会经济地位、学生健康知识和家长的健康行为均对小学生慢性病健康相关行为的养成有重要影响。

Objective To identify social determinants of chronic diseases related behaviors in primary school students in Beijing,China. Methods Cross-sectional study was designed and a two-stage( districts and schools) stratified( school type) cluster( classes) sampling method was adopted. Haidian and Fengtai districts were chosen firstly. One state and one private school with more migrant children were chosen in each district,paired with two state primary schools with more permanent resident children. Two classes from grades 4,5 and 6 from each primary school were selected,all students in which and their parents were included as study subjects. A self-designed questionnaire was adopted to collect demographic information,chronic diseases related behaviors and knowledge from students and their parents. Overall,a total of 1604 paired samples of students and parents were obtained from eight primary schools. Eleven self-reported behaviors were grouped into three,which were trying smoking,dietary intake frequency( vegetables,fruit,milk,and breakfast intake,salty foods,fatty diets),sedentary life style( reading,watching TV and playing PC continuously more than one hour,and having physical activities both in school and at home). According to the number of risk behaviors,three groups were classified as low( 0- 1),medium( 2- 3),and high( 4 +). ANOVA,Chi-square test and ordinal logistic regression analysis were adopted to find the influence of demographic characteristics,school types,social economic status( SES),students' health knowledge,and parents' health knowledge and behaviors on students' number of risk behaviors. Results Ordinal logistic regression analysis showed boys( OR = 1. 26,95% CI 1. 03- 1. 53) and older( OR = 1. 25,95% CI 1. 14- 1. 37)were risk factors for more risk behaviors. Higher SES scores( OR = 0. 84,95% CI 0. 73-0. 95) and higher students' health knowledge scores( OR = 0. 87,95% CI 0. 83- 0. 91),and better parents' health behaviors scores( OR = 0. 87,95% CI 0. 83- 0. 91) were protective factors for the number of risk behaviors. Household registration status and school types had no significant impact yet. Boys( OR = 1. 39,95% CI 1. 08- 1. 79) and lower SES scores( OR = 0. 85,95% CI 0. 73- 1. 00) were significant risk factors for more risk behaviors among migrant students,compared with those in residents students,while other factors had similar impact between two groups. Conclusion Family social and economic status,students' health knowledge and parents' behaviors would have great impact on students' health behaviors cultivation.