發(fā)布時(shí)間：2018-09-01 20:27

【摘要】：研究背景隨著社會(huì)經(jīng)濟(jì)發(fā)展和人們生活水平不斷提高,營養(yǎng)相關(guān)疾病對(duì)人類健康的影響越來越突出。兒童時(shí)期的營養(yǎng)狀況不僅影響他們的智力和體格發(fā)育,而且影響成年后健康狀況及勞動(dòng)生產(chǎn)力。兒童青少年時(shí)期也是飲食行為發(fā)展和形成的關(guān)鍵時(shí)期,飲食行為一旦形成往往會(huì)持續(xù)一生。目前我國中小學(xué)生仍然存在營養(yǎng)知識(shí)缺乏、不吃早餐、經(jīng)常吃不健康零食等問題,通過營養(yǎng)教育,可以使兒童了解合理膳食概念,引導(dǎo)兒童增加奶、蛋、肉、蔬菜水果的攝入。營養(yǎng)教育的方法途徑多、成本低、涉及面廣,已被各國及地區(qū)的政府、衛(wèi)生部門和營養(yǎng)界作為改善兒童營養(yǎng)狀況的主要手段。為了探索適合在我國農(nóng)村小學(xué)的營養(yǎng)教育模式,2014年9月至2016年7月,在河北平泉縣、湖北五峰縣、云南隆陽區(qū)的9個(gè)學(xué)校開展了營養(yǎng)教育研究,了解教育前、后學(xué)校營養(yǎng)教育實(shí)施狀況、研究對(duì)象的營養(yǎng)知識(shí)、態(tài)度及行為,并對(duì)干預(yù)效果進(jìn)行評(píng)價(jià)。研究目的1.評(píng)價(jià)營養(yǎng)教育對(duì)小學(xué)生的營養(yǎng)知識(shí)、態(tài)度和行為的影響。2.為農(nóng)村小學(xué)開展?fàn)I養(yǎng)教育基礎(chǔ)數(shù)據(jù)和科學(xué)建議,積累經(jīng)驗(yàn)。3.總結(jié)可在我國農(nóng)村小學(xué)推廣的營養(yǎng)教育模式。研究對(duì)象本研究是一項(xiàng)為期兩年的干預(yù)研究,采用多階段分層隨機(jī)整群抽樣的方法進(jìn)行抽樣。選取河北平泉、湖北五峰、云南隆陽3個(gè)縣,每個(gè)縣(區(qū))各選擇3個(gè)有食堂的小學(xué),要求學(xué)校距離縣城遠(yuǎn)近不同。從2014年9月開始至2016年7月,在選定學(xué)校開展教師-學(xué)生模式營養(yǎng)教育。學(xué)校的全部在冊(cè)學(xué)生作為教育對(duì)象。選定學(xué)校按年級(jí)分層,以教學(xué)班為單位進(jìn)行隨機(jī)整群抽樣。從2年級(jí)至6年級(jí),每個(gè)年級(jí)抽取1個(gè)班。該班的所有學(xué)生、該校所有的營養(yǎng)課教師、以及該校分管營養(yǎng)教育領(lǐng)導(dǎo)(以下簡稱“學(xué)校領(lǐng)導(dǎo)”)均作為評(píng)估對(duì)象。研究方法研究學(xué)校開展教師-學(xué)生模式的學(xué)校營養(yǎng)教育,包括分發(fā)學(xué)生教材、教師參考教材、由受過培訓(xùn)的教師進(jìn)行課堂授課、張貼宣傳畫、學(xué)生營養(yǎng)知識(shí)演講比賽、教師教案評(píng)比等。分別在2014年9月、2015年6月和2016年6月,對(duì)營養(yǎng)授課教師和調(diào)查學(xué)生進(jìn)行營養(yǎng)知識(shí)問卷調(diào)查、對(duì)學(xué)校領(lǐng)導(dǎo)進(jìn)行訪談。根據(jù)抽樣公式得學(xué)生樣本量為1500人。學(xué)生調(diào)查問卷的項(xiàng)目包括:基本情況、營養(yǎng)知識(shí)、膳食行為、營養(yǎng)態(tài)度等,教師調(diào)查問卷包括基本情況、對(duì)營養(yǎng)課的態(tài)度等,領(lǐng)導(dǎo)訪談主要是學(xué)校營養(yǎng)課開展情況等。研究結(jié)果1小學(xué)營養(yǎng)教育開課情況本研究的營養(yǎng)課共實(shí)施兩輪,每輪為一個(gè)學(xué)年,從2014年9月開始至2015年7月為第一輪,從2015年9月至2016年7月為第二輪。營養(yǎng)課開課頻次達(dá)到每2周1課時(shí),大多安排在地方課、衛(wèi)生與常識(shí)課或安全課中上。根據(jù)學(xué)生教材內(nèi)容制定對(duì)教師培訓(xùn)的內(nèi)容,每學(xué)期1次,每次1.5天,共4次培訓(xùn)。2學(xué)生營養(yǎng)教育效果2.1學(xué)生營養(yǎng)知識(shí)營養(yǎng)教育2年后,農(nóng)村小學(xué)生對(duì)健康的概念、蛋白質(zhì)的食物來源、鈣的食物來源、缺鐵性貧血的預(yù)防、營養(yǎng)早餐的食物組成、飲品的選擇、蔬菜水果不能互相代替、粗糧的營養(yǎng)特點(diǎn)、少吃醬咸菜、合理選擇零食等10個(gè)營養(yǎng)知識(shí)點(diǎn)回答正確率顯著提高,提高的幅度在40.5%-99.5%之間,10個(gè)營養(yǎng)知識(shí)點(diǎn)的回答正確率前后差異均有統(tǒng)計(jì)學(xué)意義(P0.01)。兩年間,營養(yǎng)知識(shí)平均得分逐年增長,并且第二年的增長幅度高于第一年。2.2膳食結(jié)構(gòu)經(jīng)過兩年的營養(yǎng)教育,農(nóng)村小學(xué)生每周奶、肉、蛋的食用頻率明顯增加,每周喝奶的次數(shù)、吃肉的次數(shù)和吃蛋的個(gè)數(shù),由基線調(diào)查時(shí)的每周4.8次、3.8次、4個(gè),分別增加到5.3次、5.2次、4.6個(gè),干預(yù)前后均有統(tǒng)計(jì)學(xué)意義(P0.05)。其中平均每天至少喝一杯奶的比例增長了 9.7個(gè)百分點(diǎn),平均每天至少吃一次肉的比例增長了 15.1個(gè)百分點(diǎn),每天至少吃一個(gè)蛋的比例增長了 9.7個(gè)百分點(diǎn);而且,每周奶、肉、蛋的食用頻率逐年增加的幅度,均是第二年大于第一年。每天吃蔬菜的種類和吃水果的次數(shù)增加不明顯,干預(yù)前后均無統(tǒng)計(jì)學(xué)意義(P0.05)。2.3膳食行為經(jīng)過兩年的營養(yǎng)教育,農(nóng)村小學(xué)生每周早餐的頻次和早餐食物種類顯著增加,早餐頻次由基線調(diào)查時(shí)的每周6.3次增加到6.6次,早餐食物種類由基線調(diào)查時(shí)的平均1.4類增加到2類,干預(yù)前后比較均有統(tǒng)計(jì)學(xué)意義(P0.05)。其中,每天吃早餐的比例累積增長了 7個(gè)百分點(diǎn),早餐食物3類及以上的比例累積增加了 24.9個(gè)百分點(diǎn),第二年的增加幅度均大于第一年。每天吃零食的次數(shù)顯著下降,由基線調(diào)查時(shí)的1.2次下降到1.1次,干預(yù)前后比較有統(tǒng)計(jì)學(xué)意義(P0.05)。其中,每天吃零食3次及以上的比例兩年間累積下降了 3.7個(gè)百分點(diǎn),第一年下降的幅度較大下降了 7.8個(gè)百分點(diǎn),而在第二年出現(xiàn)反復(fù),又上升了 4.1個(gè)百分點(diǎn)。2.4身體活動(dòng)經(jīng)過兩年?duì)I養(yǎng)教育后,農(nóng)村小學(xué)生每天體育活動(dòng)時(shí)間和玩耍的時(shí)間均在增加,每天體育活動(dòng)時(shí)間由73.4分鐘增加到82.1分鐘,每天玩耍時(shí)間由63.2分鐘增加到68.9分鐘,且差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。其中,每天體育活動(dòng)時(shí)間大于等于60分鐘的比例累積增加了 9.6個(gè)百分點(diǎn),每天玩耍的時(shí)間大于30分鐘的比例累積增加了 15.4個(gè)百分點(diǎn)。每天靜坐時(shí)間在干預(yù)前后無統(tǒng)計(jì)學(xué)意義(P0.05)。每天寫作的時(shí)間顯著下降,由72.5分鐘下降到66.9分鐘,在干預(yù)前后有統(tǒng)計(jì)學(xué)意義(P0.05),其中,每天寫作業(yè)時(shí)間超過120分鐘的比例累積減少了 8.1個(gè)百分點(diǎn),第二年減少的幅度大于第一年。2.5營養(yǎng)狀況經(jīng)過兩年?duì)I養(yǎng)教育后,農(nóng)村小學(xué)生的營養(yǎng)狀況持續(xù)改善,更多的調(diào)查學(xué)生營養(yǎng)狀況回復(fù)到正常范圍。營養(yǎng)狀況正常的學(xué)生比例由68.8%上升到了 75.1%,上升了 6.3個(gè)百分點(diǎn);營養(yǎng)不良的比例由18.2%下降到8.3%,下降了 9.9個(gè)百分點(diǎn),差異有統(tǒng)計(jì)學(xué)意義(P0.001)。結(jié)論采取教師-學(xué)生的模式,由經(jīng)過培訓(xùn)的教師講授營養(yǎng)課,通過學(xué)生營養(yǎng)演講比賽和教師教案評(píng)比等多種方式開展?fàn)I養(yǎng)教育,可以提高學(xué)生的營養(yǎng)知識(shí)水平、改善飲食行為,并促進(jìn)學(xué)生健康。開展?fàn)I養(yǎng)教育兩年的效果要好于一年。建議全面普及學(xué)生營養(yǎng)教育,提高學(xué)生的營養(yǎng)素養(yǎng);學(xué)校應(yīng)將營養(yǎng)教育工作納入到日常教學(xué)計(jì)劃,對(duì)學(xué)生進(jìn)行系統(tǒng)全面的營養(yǎng)教育;強(qiáng)化對(duì)教師的營養(yǎng)知識(shí)、技能的培訓(xùn);營養(yǎng)教育是一個(gè)長期的任務(wù),需要不斷堅(jiān)持。
[Abstract]:Background With the development of social economy and the improvement of people's living standards, nutrition-related diseases have an increasingly prominent impact on human health. Nutritional status in childhood not only affects their mental and physical development, but also affects their health status and labor productivity in adulthood. At present, primary and secondary school students still lack nutritional knowledge, do not eat breakfast, often eat unhealthy snacks and other issues. Through nutrition education, children can understand the concept of a reasonable diet, guide children to increase milk, eggs, meat, vegetables and fruits intake. Nutrition education formula In order to explore a suitable nutrition education model for rural primary schools in China, nine schools in Pingquan County, Hubei Wufeng County and Longyang District of Yunnan Province were set up from September 2014 to July 2016. Objective 1. To evaluate the effect of nutritional education on nutritional knowledge, attitude and behavior of primary school students. 2. To provide basic data and scientific advice for rural primary school nutritional education and accumulate experience. 3. Summarize the nutrition education model that can be popularized in rural primary schools in China. The research object is a two-year intervention study. The method of multi-stage stratified random cluster sampling is used for sampling. From September 2014 to July 2016, a teacher-student model of nutrition education was carried out in selected schools. All students in the school were selected as the subjects of education. All the nutrition teachers and the school's nutrition education leaders (hereinafter referred to as "school leaders") were assessed. In September 2014, June 2015 and June 2016, nutrition teachers and students were surveyed with questionnaires on nutrition knowledge, and school leaders were interviewed. The sample size of students was 1500 according to the sampling formula. Results 1 Nutrition education in primary schools started in two rounds of this study. Each round is a school year, from September 2014 to July 2015 for the first round, from 2015. From September to July 2016, the second round was held. Nutrition courses were taught once every two weeks, mostly in local classes, hygiene and general knowledge classes or safety classes. Rural pupils'correct answers to 10 nutritional knowledge points, such as health concept, protein source, calcium source, prevention of iron deficiency anemia, food composition of nutritional breakfast, choice of drinks, non-substitution of vegetables and fruits, nutritional characteristics of coarse grains, less pickles and pickles, and reasonable choice of snacks, were significantly improved. The average score of nutritional knowledge increased year by year in the past two years, and the growth rate in the second year was higher than that in the first year. The frequency of milk drinking, meat eating and eggs eating per week increased from 4.8, 3.8, and 4 to 5.3, 5.2, and 4.6, respectively, at baseline survey. There was significant difference before and after intervention (P 0.05). The proportion of drinking at least one glass of milk per day increased by 9.7 percentage points, and the proportion of eating at least one meat per day increased. The percentage of eating at least one egg per day increased by 9.7 percentage points, and the frequency of milk, meat and eggs per week increased year by year in the second year than in the first year. Nutrition education showed that the frequency of breakfast and the types of breakfast food in rural primary school students increased significantly, the frequency of breakfast increased from 6.3 times a week to 6.6 times a week in the baseline survey, and the types of breakfast food increased from 1.4 to 2 categories on average in the baseline survey. There was statistical significance before and after the intervention (P 0.05). The number of snacks per day decreased significantly, from 1.2 to 1.1 in the baseline survey. There was a statistically significant difference before and after the intervention (P 0.05). During the two years, the cumulative decline of 3.7 percentage points, the first year dropped by 7.8 percentage points, and in the second year, repeated, increased by 4.1 percentage points. There was a significant difference between the two groups (P 0.05). Among them, the cumulative percentage of daily sports activity time greater than or equal to 60 minutes increased by 9.6 percentage points, and the cumulative percentage of daily playing time longer than 30 minutes increased by 15.4 percentage points. There was no significant difference between before and after the intervention (P 0.05). The daily writing time decreased significantly from 72.5 minutes to 66.9 minutes. There was statistical significance before and after the intervention (P 0.05). The cumulative decrease of the proportion of daily writing time over 120 minutes was 8.1 percentage points, and the decrease in the second year was greater than that in the first year.2.5 nutritional status. After two years of nutritional education, the nutritional status of rural primary school students continued to improve, and more surveys showed that the nutritional status of students returned to normal range. (P 0.001). Conclusion Nutrition education can be carried out by teacher-student model, by training teachers to teach nutrition lessons, by means of student nutrition speech contest and teacher's teaching plan evaluation, etc. It can improve students'nutrition knowledge, dietary behavior and promote students' health. The effect of carrying out nutrition education for two years is better than that for one year. It is suggested that nutrition education should be popularized in an all-round way and students'nutrition quality should be improved; schools should incorporate nutrition education into their daily teaching plans and carry out systematic and comprehensive nutrition education for students; strengthen the training of teachers' nutrition knowledge and skills; nutrition education is a long-term task that needs to be persevered.
【學(xué)位授予單位】：中國疾病預(yù)防控制中心
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R153.2

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本文編號(hào)：2218259