Prevalence, associates and stage-specific preventive behaviors of myopia among junior high school students in Guangdong province: health action process approach- and theory of planned behavior-based analysis
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摘要:
目的 了解初中生近视发生在个体特征与用眼行为的差异,分析健康行为程式模型(HAPA)与计划行为理论(TPB)变量在近视预防行为的阶段特征。 方法 于2020年7月采用随机整群抽样方法对4 859名初中生进行在线或现场问卷调查。 结果 调查对象有近视及近6个月发生近视的人数分别为3 013人(62 %)、994人(20.5 %)。女生、高年级、父母有近视的初中生近视发生率高(均P < 0.001)。学习日睡眠时间、学习日或休息日课后看书写作业时间、每天2 h户外活动、学习日课间走出教室、假日与父母朋友户外活动、注意读写姿势和读写休息与近视发生明显相关(均P < 0.05)。多因素logistic回归分析结果表明,女生、高年级、父母有近视、低频率的每天2 h户外活动和读写后休息是近视发生的危险因素。近视预防行为在前意向者为1 543人(31.8 %),意向者为1 433人(29.5 %),行动者为1 883人(38.3 %)。男生、低年级学生更多处于行动阶段(均P < 0.001)。除了风险认知在意向者和行动者之间无差异外,其他社会认知变量及近视预防行为水平均为行动者高于意向者、前意向者(P < 0.01)。等级回归模型结果表明,行为态度、行动自我效能是前意向阶段的主要预测变量,风险认知、主观规范、行动自我效能是意向阶段的主要预测变量,行为态度、主观规范、行动与应对自我效能、行为计划与应对是行动阶段的主要预测变量,模型解释力分别为15 %、12 %、20 %。 结论 初中生近视发生率存在个体特征、用眼行为差异;社会认知变量对近视预防行为呈现阶段特征。 -
关键词:
- 近视 /
- 健康行为程式模型(HAPA) /
- 计划行为理论(TPB) /
- 初中生
Abstract:Objective To examine the prevalence of myopia and its related personal eye habits among junior high school students and to explore stage-specific myopia prevention behaviors of the students based on health action process approach (HAPA) and theory of planned behavior (TBA). Methods Using stratified random cluster sampling, we recruited 4 894 students at 6 junior high schools in 5 prefectures of Guangdong province. An anonymous questionnaire survey was conducted among 2 289 students online and 2 570 students on-site during July 2020. Results Of the 4 859 students with valid responses, 3 013 (62.0%) reported being myopic and 994 (20.5%) reported suffering from myopia during past 6 months. The students being female, in higher schooling grade, and with parental myopia reported a significantly higher myopia prevalence rate than other students (P < 0.001 for all). The students′ myopia prevalence differed significantly by sleeping time during school days, proper reading/writing time during school days or weekends, daily outdoor activity, outdoor activity in school days, outdoor activity with parents/friends during free days, posture while reading/writing, and rest time after continuous reading for 40 minutes (all P < 0.05). The results of multivariate logistic regression analysis revealed following risk factors of myopia for the students: being female, in higher schooling grade, with parental myopia, low frequency of outdoor activity for 2 hours per day, and low frequently of having a rest of 10 minutes after reading/writing for 40 minutes. Based on reported frequencies of having daily outdoor activity for at least 2 hours and having a rest of 10 minutes after reading/writing for 40 minutes, we classified 1 543 (31.8%), 1 433 (29.5%), and 1 883 (38.3%) of the students as at the pre-intention, intention, and action stage of developing eye habits for myopia prevention; high proportions of the boy students and the students in low schooling grade were assessed in the action stage. The students at the action stage reported a higher social cognition and better eye habits related to myopia prevention than the students at both pre-intention and intention stage (P < 0.01 for all) but no difference in risk cognition was observed among the students at different stages. The results of hierarchical regression analysis showed that for the students at pre-intention stage, the attitude towards and self-efficacy of action were major predictors for myopia prevention behaviors, jointly explaining 15% of total variance of behavior change; for the students at intention stage, risk perception, subjective norm, and action self-efficacy were major predictors, altogether explaining for 12% of total variance of behavior change; whereas, attitude towards action, subjective norm, action and coping self-efficacy, and behavioral planning and coping were major predictors, explaining 20% of total variance of behavior change, for the students at action stage. Conclusion Among junior high school students, the prevalence of myopia varies with individual characteristic and eye habits; the influence of social cognition variables on myopia prevention behaviors is different among the students at various stages of developing eye habits for myopia prevention. -
表 1 广东省不同用眼行为初中生近视发生情况比较
自变量 近视人数 构成比(%) χ2 值 P 值 自变量 近视人数 构成比(%) χ2 值 P 值 学习日睡眠时间 休息日睡眠时间 ≥ 9 h 892 58.40 12.48 0.00 ≥ 9 h 1691 61.40 0.89 0.36 < 9 h 2121 63.70 < 9 h 1322 62.80 学习日课后看书写作业时间 7.40 0.01 休息日看书写作业时间 8.21 0.00 1~3 h 1366 60.00 1~5 h 2430 61.10 ≥ 4 h 1647 63.80 ≥ 6 h 583 66.30 每天户外活动2 h 46.25 0.00 学习日课间走出教室 8.56 0.00 低 1620 66.70 低 843 65.40 高 1393 57.30 高 2170 60.80 休息日户外活动 15.20 0.00 注意正确的读写姿势 17.01 0.00 低 1644 64.60 低 1110 66.00 高 1369 59.20 高 1903 59.90 注意读写环境 0.00 1.00 读写40 min休息10 min 27.07 0.00 低 678 62.00 低 1410 66.10 高 2335 62.00 高 1603 58.80 表 2 多因素logistic回归分析广东省初中生近视发生的影响因素
因素 比较组 参照组 β $S_{\bar x}$ Wald χ2 值 P 值 OR 值 95 % CI 性别 男性 女性 – 0.56 0.06 80.10 < 0.001 0.57 0.50~0.64 年级 初一 初三 – 0.46 0.10 21.82 < 0.001 0.63 0.52~0.77 初二 – 0.27 0.10 7.12 < 0.01 0.76 0.62~0.93 父亲近视 有 无 0.54 0.08 43.91 < 0.001 1.71 1.46~2.00 母亲近视 有 无 0.71 0.07 95.39 < 0.001 2.04 1.77~2.36 每天2 h户外活动 高 低 – 0.22 0.07 9.63 < 0.01 0.81 0.70~0.92 读写40 min后休息10 min 高 低 – 0.16 0.07 4.98 < 0.05 0.86 0.75~0.98 表 3 社会认知变量在近视预防行为各阶段得分情况(
$ \bar x \pm s$ ,分)认知变量 前意向阶段 意向阶段 行动阶段 近视预防行为 4.45 ± 1.66 5.28 ± 1.56 a 6.74 ± 1.79 ab 风险认知 9.90 ± 2.58 10.25 ± 2.29 a 10.16 ± 2.52 a 结果期待 13.84 ± 2.83 14.94 ± 2.63 a 15.53 ± 2.76 ab 行动自我效能 6.10 ± 1.95 7.23 ± 1.49 a 8.07 ± 1.48 ab 应对自我效能 14.84 ± 4.60 16.69 ± 3.75 a 18.16 ± 3.99 ab 行为计划与应对 9.99 ± 2.56 11.41 ± 1.91 a 12.33 ± 3.99 ab 行为态度 7.02 ± 1.69 7.89 ± 1.43 a 8.52 ± 1.44 ab 主观规范 6.68 ± 1.61 7.35 ± 1.53 a 7.84 ± 1.59 ab 注:与前意向阶段比较,a P < 0.01;与意向阶段比较,b P < 0.01。 表 4 社会认知变量在各阶段间对近视预防行为的预测作用(β)
模型 变量 前意向阶段 意向阶段 行动阶段 1 风险认知 0.04 0.03 0.07 b R2/∆R2 0.00/0.00 0.00/0.00 0.01 b/0.00 b 2 风险认知 0.03 0.03 0.05 a 结果期待 0.12 c 0.05 a 0.19 c R2/∆R2 0.02 c/0.01 c 0.00/0.00 0.04 c/0.04 c 3 风险认知 – 0.01 0.06 a – 0.01 结果期待 0.04 – 0.02 0.05 a 行动自我效能 0.35 c 0.31 c 0.36 c 应对自我效能 0.03 0.05 0.09 c R2/∆R2 0.14 c/0.14 c 0.11 c/0.11 c 0.18 c/0.18 c 4 风险认知 – 0.02 0.06 a – 0.02 结果期待 0.03 – 0.03 0.03 行动自我效能 0.32 c 0.30 c 0.28 c 应对自我效能 0.01 0.04 0.06 b 行为计划与应对 0.06 0.03 0.15 c R2/∆R2 0.15 c/0.14 c 0.11 c/0.11 c 0.19 c/0.19 c 5 风险认知 – 0.02 0.07 b – 0.02 结果期待 0.02 – 0.04 0.02 行动自我效能 0.31 c 0.29 c 0.27 c 应对自我效能 0.01 0.04 0.05 a 行为计划与应对 0.06 0.02 0.13 c 行为态度 0.07 b 0.05 0.05 a 主观规范 0.01 0.06 a 0.06 a R2/∆R2 0.15 c/0.15 c 0.12 c/0.12 c 0.20 c/0.20 c 注:a P < 0.05,b P < 0.01,c P < 0.001;回归因变量为近视预防行为(读写40 min后休息10 min、每天户外活动2 h);R2为模型中所包含的变量对近视预防行为的累积解释变异量,ΔR2为某变量引入模型后该变量在相应模型中对行为的解释变异量。 -
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