雙親健康行為群聚類別與母乳哺餵、嬰兒醫療利用及健康之關係

Abstract

研究背景與目的：兒童為國家的未來，促進兒童健康應為健康政策重要目標之一。過去許多研究已證實許多影響兒童或青少年健康之因子，除家庭的社會經濟背景外，其他影響之因素如雙親的健康行為，其所採取之分析取向仍缺乏生態模式的思維，缺乏家庭健康的概念，因此，本研究擬填補此文獻之缺口。本研究之目標為探討雙親健康行為的群聚類別與母乳哺餵、嬰兒醫療利用與健康之相關性。

資料來源：本研究使用由國民健康署所調查，具全國代表性之資料庫「台灣出生世代研究第一波調查」資料，2005年資料中，共有21,248位6個月嬰兒。因研究目的所需，篩選雙親已婚且與嬰兒同住、雙親與嬰兒無重大疾病及失能，嬰兒非早產、無先天性缺陷，以及嬰兒母親無妊娠糖尿病、高血壓及毒血症者，並排除問卷全部皆由代答者(生母之外的主要照顧者)所填寫之資料後，符合之樣本數為13,796人，之後依據不同的分析，有效樣本數而有不同，群聚分析之有效樣本為13,625人，分析影響母乳哺餵之相關因素有效樣本數為13,535人；分析影響嬰兒醫療利用，在急診部分有效樣本數為13,533人，住院部分有效樣本數為13,536人，分析嬰兒健康狀態之有效樣本數則為13,537人。

研究方法：本研究於資料庫中選取可運用之雙親健康行為變項進行群聚分析，並依據群聚分析之結果，運用Multinomial Logit 模型瞭解雙親健康行為群聚類別與母乳哺餵之關係，探討雙親健康行為群聚類別與嬰兒醫療利用之關係時，則運用Logit 模型進行分析，最後，依據依變項之特性，分別運用Logit 模型與Ordered Probit模型分析雙親健康行為群聚類別與嬰兒健康之相關性。

研究結果：依據群聚分析之結果，雙親健康行為的群聚類別可分為三個群聚類別：健康模範家庭共5,640人，佔41.4%、癮君子爸爸家庭共5,645人，佔41.4%、菸酒檳家庭共2,340人，佔17.2%。在母乳哺餵方面，菸酒檳家庭(RRR=0.48, 95% CI: 0.40-0.57)與癮君子爸爸家庭(RRR=0.65, 95% CI: 0.57-0.74)較健康模範家庭，嬰兒較不可能會接受完全母乳哺餵。在嬰兒急診醫療利用方面，生長在菸酒檳家庭中的嬰兒，相較於生長在健康模範家庭的嬰兒，其急診醫療使用(OR=1.19, 95% CI: 1.03-1.36)及住院(OR=1.22, 95% CI: 1.05-1.42)的之可能性較高。在雙親評估嬰兒健康狀況方面，相較於健康模範家庭，菸酒檳家庭的父母，其評估子女的健康狀態較差。在罹患呼吸道疾病、腸胃疾病的可能性，以及出生至6個月得過發燒感染疾病與腸胃疾病的次數方面，不同雙親健康行為群聚類別則無統計上顯著差異。

結論與建議：本研究發現成長於菸酒檳家庭和癮君子爸爸家庭的嬰兒，其接受母乳哺餵的可能性較低、成長於菸酒檳家庭的嬰兒，其急診或住院可能性較高，雙親評估嬰兒健康狀況亦較差。因此，未來在推動健康促進計畫時，該類家庭應為未來衛生教育之重點族群，此外，在衛生教育文宣或倡議訊息中，亦應讓家長瞭解家庭成員，特別是雙親的健康行為對嬰兒醫療利用及健康的影響，並且於適當地介入時機，針對雙親進行衛生教育介入，以達到促進兒童健康之目標。Background and Objectives Children are considered the future of a country, and promoting child health should be one of the topics in a health policy agenda. Previous studies have shown that many factors were have been associated with a child’s health. In addition to the family’s socioeconomic background, and the analytical approach for other significant factors, such as parental health behaviors, were still lacking of an ecological perspective, meaning that it is deficient in the concept of family health. This study, therefore, aims to fill this gap, as the objectives of this study were to investigate the association between a family health behavior cluster with the mother's breastfeeding, infant healthcare utilization, and health status.

Methods We used secondary data from a national representative survey entitled “Taiwan Birth Cohort Study (TBCS)”, which was the research commissioned by the Health Promotional Administration. There were 21,248 infants aged six-months that were surveyed in 2005. In order to analyze the family health behavior clustering phenomena, we selected infants from married two-parent families and who lived with their parents. To consider the validity of the data, we excluded the cases where the questionnaires were completed by the caregivers (i.e. not the mothers). In addition, to avoid any confounding factors such as the health of the infants and parents, we selected the cases where the parents and infants were without catastrophic illnesses, and disabilities, not pre-term, infants without congenital diseases, and mothers who did not have any Gestational diabetes mellitus, hypertension, and Eclampsia during their gestation period. The sample that met the above criteria numbered 13,625. The valid sample varied and was contingent on the dependent variables used in the analysis, 13,535 for analyzing factors associated with breastfeeding, 13,533 for infant emergency care, 13,536 for infant hospital admission, and 13,537 for infant health. This study used the cluster analysis to analyze the parental health behaviors. Based on the results, the multinomial Logit Model was used to analyze the association between breastfeeding and the family health behavior cluster type. To analyze the associations between the family health behavior cluster type and the infant healthcare utilization, this study used the Logit Model. Finally, this study used the Logit Model and the Ordered Probit Model, depending on the type of dependent variables, to analyze the association between the family health behavior cluster type and infant health.

Conclusions and Recommendations This study found that those who were born in a "smoking, alcohol, and drinking family", and a “smoking father family”, were less likely to receive breastfeeding, and those who were born in a “smoking, alcohol, and drinking family” were more likely to have emergency and/or hospital admission, as well as having poorer parent-rated self-health. Therefore, the main target group should focus on the substance use family when implementing the child health promotion program. In addition, it is suggested that the associations between family health behaviors and their impact on the infant healthcare utilization and health status, should be included in the health education materials or campaign messages. Finally, the government, as well as concerned parties, should find an appropriate timing for the health education interventions focusing on the parents in order to achieve their goal of promoting child health.