縣市層級含糖飲料社會規範與青少年含糖飲料攝取習慣關係之多階層研究

Association between the social norm toward sugar sweetened beverages at the county level and the consumption of sugar sweetened beverages among adolescents: a multilevel analysis

目標：利用多層次模式探討縣市層級含糖飲料攝取之社會規範與青少年含糖飲料攝取習慣的關係，並進一步分析不同年齡層社會規範之交互作用的影響。方法：資料來源為「2013– 2016年國民營養健康狀況變遷調查」，研究對象為15歲以上未滿18歲之青少年，共計879位（每縣市大約有40位青少年）。統計分析採用多層次邏輯斯迴歸模型，以估計縣市層級不同年齡世代社會規範與青少年含糖飲料攝取習慣之關係。結果：青少年族群對於含糖飲料的社會規範越正向，該縣市之青少年有攝取含糖飲料習慣的風險越高（aOR=1.75；95%CI: 1.17– 2.61），且該相關性進一步受到同縣市年輕成年族群含糖飲料社會規範的調節（aOR=1.49； 95%CI: 1.17–1.90）。結論：青少年含糖飲料攝取習慣與其居住縣市同年齡層對含糖飲料社會規範有顯著關係，並且該效應會受到該縣市內年輕成年族群社會規範所調節。建議未來針對青少年含糖飲料相關政策推行時，除了考慮青少年族群的整體社會規範外，可同時改變年輕成年族群對含糖飲料的社會規範，以強化其推廣效益。

Objectives: Multilevel analysis was used to explore the association between county-level social norm toward sugar-sweetened beverages (SSBs) and the consumption of SSBs among adolescents. Methods: This study used data from the Nutrition and Health Survey in Taiwan between 2013 and 2016. Data on 879 adolescents were included in the analysis. Personal attitudes toward SSBs for different age groups were aggregated at the county level as the social norm, respectively. Results: A multilevel logistic regression analysis revealed that the likelihood of SSBs consumption among adolescents increased as the social norm toward SSBs in the county improved (adjusted odds ratio [aOR] = 1.58, 95% confidence interval [CI] = 1.11-2.26). In addition, the social norm of young adults (18-24 years) toward SSB living in the same residential areas significantly moderated the association between the county-level social norm of adolescents toward SSBs and the consumption of SSBs among adolescents (aOR = 1.41, 95% CI = 1.10- 1.80). Conclusions: The prevention of overconsumption of SSBs among adolescents may be more effective when the social norm toward SSBs at the county level are considered.