{"created":"2023-06-19T09:22:54.940751+00:00","id":2194,"links":{},"metadata":{"_buckets":{"deposit":"a9e3feb1-8e92-442d-afc2-a75f65089118"},"_deposit":{"created_by":9,"id":"2194","owners":[9],"pid":{"revision_id":0,"type":"depid","value":"2194"},"status":"published"},"_oai":{"id":"oai:auhw.repo.nii.ac.jp:00002194","sets":["2:127"]},"author_link":[],"control_number":"2194","item_6_date_granted_11":{"attribute_name":"学位授与年月日","attribute_value_mlt":[{"subitem_dategranted":"2020-03-10"}]},"item_6_degree_grantor_9":{"attribute_name":"学位授与機関","attribute_value_mlt":[{"subitem_degreegrantor":[{"subitem_degreegrantor_language":"ja","subitem_degreegrantor_name":"青森県立保健大学"}],"subitem_degreegrantor_identifier":[{"subitem_degreegrantor_identifier_name":"21102","subitem_degreegrantor_identifier_scheme":"kakenhi"}]}]},"item_6_degree_name_8":{"attribute_name":"学位名","attribute_value_mlt":[{"subitem_degreename":"博士(健康科学)"}]},"item_6_description_23":{"attribute_name":"目次","attribute_value_mlt":[{"subitem_description":"第1章　序章\nI. 研究の背景とコンセプト \nII. 研究の目的と意義 \nIII. 中心命題（ the central thesis ）とリサーチクエスチョン\nIV. 本研究に用いた概念枠組み\nV. 研究で明らかにしたいこと\n1. 長命地域と短命地域の死亡統計， 健康関連指標からみた次世代の保健教育の必要性について\n2. 高校生の相互作用的･批判的ヘルスリテラシー， 健康情報リテラシー（ eHealth literacy）を身につける教育の必要性\n3. ヘルスリテラシーの担い手の役割\n4. 仮説と探索的研究課題の導出\nVI. 本論文の構成\nVII. 学術的な特色・新規性・独創的な点\nVIII. 結果の予測・期待される成果 \nIX. 用語の定義\n第2章　文献検討\nI. ヘルスリテラシー小史 \nII. 不十分なHealth Literacyがもたらす影響\nIII. ヘルスリテラシースクリーニングツール\nCommunicative and Critical Health Literacy ( CCHL ) 尺度\n2. 14-item Health literacy Scale ( HLS-14 )\n3. eHealth Literacy Scale ( eHEALS ) 日本語版\nIV. 国外における高校生のヘルスリテラシーに関する研究\n1. 方法\n2. 結果\n3. 考察\nV. 国内における高校生のヘルスリテラシーに関する研究\n1. 方法 \n2. 結果\n3. 考察\n4. 本研究の位置づけ， 学問的貢献度\n第3章　研究方法と対象\nI. 研究デザイン\nII. データ収集方法\n1. 調査対象\n2. 調査方法および調査期間\n3. 調査内容（ * 別添 質問紙調査用紙 生徒用/ 保護者用）\n【生徒用の調査用紙】\n【保護者用の調査用紙】\nIII. 分析方法\nIV. 倫理的配慮\n第4章　結果\nI. 調査の概要\n1. 回収状況(生徒)\n2. 回収状況(保護者)\n3. 調査結果\nII. 仮説I 高校生（ 青年期）の時期において，ヘルスリテラシーや生活習慣に地域差がない\n1） 高校生のHLスコアの3地域の比較\n2） 将来の生活習慣予測について\nIII． 仮説II 高校生のヘルスリテラシーと将来の生活習慣予測に関連が認められる\nIV． 仮説III 保護者世代（ 壮年期） において，ヘルスリテラシーや生活習慣に地域差がみられる\n1） 保護者世代（壮年期） のHLスコアについて\n（1） CCHL ( Communicative and Critical Health Literacy ) について\n（2） HLS-14（The14-item health literacy scale for Japanese adults）について\n（3） eHEALSについて\n2） 保護者世代（壮年期）の生活習慣について\nV. 仮説IV 保護者世代のヘルスリテラシーと生活習慣に関連が認められる . 4 7\nVI． 仮説Ⅴ 保護者のヘルスリテラシーと医療従事者とのコミュニケーションに関連が認められる\nVII． 探索的研究課題1）ヘルスリテラシーが高い人に影響している要因を明らかにする\n高校生\n保護者\nVIII． 探索的研究課題2）ヘルスリテラシーや生活習慣(生活習慣予測）の親子間の関連の大きさは？\n第5章　本研究の考察\nI. 本研究の限界点\nII. 仮説I 高校生（青年期）の時期において，ヘルスリテラシーや生活習慣に地域差がない\nIII. 仮説II 高校生のヘルスリテラシーと将来の生活習慣予測に関連が認められる\nIV. 仮説III 保護者世代（壮年期）において，ヘルスリテラシーや生活習慣に地域差がみられる\nV. 仮説IV 保護者世代のヘルスリテラシーと生活習慣に関連が認められる\nVI. 仮説V 保護者のヘルスリテラシーと医療従事者とのコミュニケーションに関連が認められる\nVII. 探索的研究課題1）ヘルスリテラシーが高い人に影響している要因を明らかにする（生徒\nVIII. 探索的研究課題1）ヘルスリテラシーが高い人に影響している要因を明らかにする（保護者）\nIX. 探索的研究課題2）ヘルスリテラシーや生活習慣(生活習慣予測）の親子間の関連の大きさは？\n第6章　結論・インプリケーション\n研究業績一覧\n謝辞\n文献\n資料","subitem_description_language":"ja","subitem_description_type":"TableOfContents"}]},"item_6_description_7":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"1.はじめに\n日本国内の長命地域と短命地域の間では,壮年期における生活習慣関連リスク及び死亡率に健康格差がみられる.米国のコホート研究では,ヘルスリテラシー(以下,HL)が低い人では,死亡リスクが高い等が報告され1,国策であるHealthy PeopleではHLの向上が目標に掲げられた.わが国でも,生涯を通じた健康の維持・増進という観点からは,健康な時期である青年期(高校生)でのHL教育は,早世を予防する上で重要と考えた.本研究の目的は,壮年期における死亡率の差が大きい長命地域(長野県・滋賀県)と短命地域(青森県)に居住する高校生とその保護者のHLの実態,親子間のHLの関連,HLを高める要因を明らかにし,高校生のHL教育について示唆を得ることである.\nII.研究方法と対象\n1.研究デザイン:観察研究,自記式質問紙による横断研究\n2.対象:高校2年生とその保護者青森県A市6校(公立4校,私立2校)計806人,長野県B・C市4校(公立;1校は生徒のみ)計978人,滋賀県D・E市3校(公立)計518人\n3.調査方法と期間:自記式質問紙調査,2018年7月3日～7月24日\n4.測定と解析方法:\n1)高校生と保護者のHL:CCHL(相互作用的HL,批判的HL)及びeHEALS日本語版は,高校生と保護者に用い,HLS-14は保護者のみに用いた.各HLスケールをスコア化し,Kruskal-Wallis及びHolm法で群間比較を行い,Spearmanの相関係数で親子の関連を調べた.\n2)HLを高める要因:【高校生】説明変数:個人特性(属性,将来の夢の有無,自己効力感,学習意欲),インターネット使用頻度,健康情報源,将来の生活習慣予測(自らが成人してからどのような生活習慣を送っているか;喫煙,運動,飲酒,体重管理),目的変数:HLスケール(CCHL,eHEALS日本語版)\n【保護者】説明変数:個人特性(年代,教育歴,職種),インターネット使用頻度,インターネットで検索している健康情報,健診受診状況,受療状況,現在の生活習慣(喫煙,運動,飲酒,体重管理),目的変数:HLスケール(CCHL,HLS-14,eHEALS日本語版)\n各HLスコアの中央値で,HL高値群と低値群の2群に分けた.説明変数は,質問への「いいえ」の回答を参照カテゴリ(オッズ比=1)とし,二項ロジスティック回帰分析(ステップワイズ法;地域で調整)を行った.IBM SPSS Statistics25を使用し,有意水準を5%(両側)とした.\nIII.結果\n1.高校生と保護者のHL青森県604人,長野県818人,滋賀県476人から有効回答があった.高校生のHLスコア(表1)では,短命地域(青森県)は長命地域(長野県・滋賀県)に比べ,CCHL(相互作用的HL,批判的HL,合計点)が有意に高かった.\n保護者では,CCHLスコアの平均17.0(標準偏差:3.7),HLS-14スコア44.8(5.9),eHEALSスコア22.4(6.9)で,群間で有意差はなかった.親子の関連では,青森県の親子間及び滋賀県の親子間のCCHL(批判的)で,弱い正の相関が認められた他,関連はなかった.\n2.HLを高める要因\n高校生のCCHL高値は,「インターネットの利用頻度が毎日」(オッズ比1.32;95%信頼区間1.03-1.68),「1か月以内の健康情報収集」(1.41;1.20-1.67),「将来の夢や目標を持っている」(1.40;1.18-1.66),「自分はやればできると思う」(2.26;1.91-2.67),「勉強は好きである」(1.36;1.12-1.66),「保健学習は好きである」(1.70;1.42-2.03),「将来,定期的な運動をする」(1.66;1.35-2.05),「将来,体重管理をする」(1.26;1.00-1.57)との間で関連(地域を調整後)が認められた.eHEALS高値は,「将来の夢や目標を持っている」(1.19;1.01-1.40),「自分はやればできると思う」(1.35;1.15-1.58),「保健学習は好きである」(1.67;1.42-1.96),「将来,喫煙はしない」(0.52;0.35-0.77),「将来,定期的な運動をする」(1.25;1.02-1.53),「将来,体重管理をする」(1.34;1.08-1.66)との間で関連が認められた.\nIv.考察\n青森県の高校生においてHLスコアが他の地域よりも高かったのは,同県では2005年頃より全県的な取り組みとして地域や学校,職域等で「短命県返上キャンペーン」を行っており,幼少期よりその影響を受けて健康意識が変化した可能性が考えられる.一方,保護者世代のHLには地域差が認められなかったが,生活習慣に関してはこれまでの報告と同様にハイリスクの状況にあることが確認された.また,HLスコアと望ましい生活習慣(運動と体重管理)との問に関連は認められたが,喫煙や飲酒との問には関連はなく,嗜好や常習性等のHLとは異なる要因がより重要と考えられた.今後,生活習慣に関連するリスクを包括的に評価できる客観性をもった尺度開発が必要であろう.なお,親子間のHLや生活習慣の関連は非常に弱く,高校生では学校教育方が家庭よりも影響が大きいと推察された.生涯を通じた健康の維持・増進には,学校全体の保健教育に加えて,生活習慣病予防のための健康情報が活用できるように,地域の人材や専門家等の協力を得て教育を行う仕組みづくりも重要である.","subitem_description_language":"ja","subitem_description_type":"Abstract"},{"subitem_description":"I．Objective\nThe health gaps in lifestyle-related risks and mortality in middle-aged adults have been recognized between the regions characterized by long and short life expectancies in Japan. A cohort study in the US reported higher risks of mortality in individuals with lower health literacy (HL)1. “Healthy People” program has indicated a target of improving HL as a national policy in the US. In Japan, education on HL in the teenage years (high school students) being still in their healthy period is also thought to be important for preventing premature death in their future from the view point of lifelong health maintenance and promotion.\nThis study aimed to compare the HL of high school students and their parents from the different regions with large disparities in mortality in middle-aged adults: Nagano and Shiga Prefectures characterized by the longest life expectancies, and Aomori Prefecture characterized by the shortest life expectancy in Japan. The study also aimed to examine the relations between the parents’ and children’s HL, identify the factors associated with higher HL, and obtain implications for more effective HL education for high school students.\nII．Subjects and Methods\n1．Research design: Cross-sectional observation study\n2．Subjects: Second-year students and their parents from six high schools in City A, Aomori Prefecture (4 public, 2 private; n = 806); four high schools in Cities B and C, Nagano Prefecture (all public; only students were surveyed for one school, = 978); and three high schools from Cities D and E, Shiga Prefecture (all public; n = 518).\n3．Survey methods and period: Self-administered questionnaire survey, July 3–24, 2018\n4．Measurements and analyses:\n1) High school students and their parents' HL: (1) Communicative and Critical Health Literacy Scale (CCHL: composed of communicative/interactive HL score, and critical HL score) and (2) Japanese version of the eHealth Literacy Scale (eHEALS) were measured in both students and parents, whereas (3) 14-item Health Literacy Scale for Japanese Adults (HLS-14) was measured in the parents only. These HL scales for each group were scored and compared by Kruskal–Wallis and Holm tests, and parent–child relationships were tested by Spearman’s correlation coefficient.\n2) Factors associated with higher HL: For the students, individual traits (basic demographic characteristics, whether or not they had a future dream, self -efficacy, and motivation for learning), frequency of internet use, health information resources, and predicted future lifestyle (what kind of lifestyle they expected to have after reaching their adult age; smoking, exercising, drinking, and weight management) were included as independent variables, whereas HL scale scores (CCHL and Japanese version of eHEALS) being used as dependent variables.\nFor parents, individual traits (age group, educational background, and occupation), frequency of internet use, health information searched for on the internet, whether they underwent health checkups, whether they were seeking health care, and current lifestyle (smoking, exercising, drinking, and weight management) were included as independent variables, whereas HL scale scores (CCHL, HLS-14, and Japanese version of eHEALS) were used as dependent variables.\nSubjects were divided into the high and low HL score groups by the median score. A binary logistic regression analysis (step-wise method, adjusted by region) was performed with a reference category (odds ratio = 1) which was assigned to the “No” as answer to the questions. IBM SPSS Statistics 25 was used for analysis, and p <0.05 (two-tailed) was considered statistically significant.\nIII．Results\n1．HL in high school students and their parents\nValid answers were received from 604 students in Aomori Prefecture, 818 students in Nagano Prefecture, and 476 students in Shiga Prefecture. The HL scores of students (Table 1) of the region with the shorter life expectancy (Aomori Prefecture) had significantly higher CCHL scores (communicative/interactive HL, critical HL, and total scores) compared with their counterparts from regions with longer life expectancies (Nagano and Shiga Prefectures).\nMean parents’ scores were 17.0 (SD:3.7) on the CCHL, 44.8(5.9) on the HLS-14, and 22.4 (6.9) on the eHEALS; no significant differences were seen across the groups. In terms of parent–child relationships, weak positive correlations were observed between parents' and children's CCHL scores (critical HL) in Aomori and Shiga Prefectures, but no other associations were observed.\n2．Factors associated with higher HL\nFactors associated with higher CCHL scores in high school students (after adjusting for regions) were daily use of the internet (OR: 1.32; 95% confidence interval: 1.03–1.68), having sought health information within the last month (1.41; 1.20–1.67), having dreams and goals for the future (1.40; 1.18–1.66), high self-efficacy (2.26; 1.91–2.67), enjoying studying (1.36; 1.12–1.66), enjoying learning about health (1.70; 1.42–2.03), intention to exercise regularly in the future (1.66; 1.35–2.05), and intention to manage weight in the future (1.26; 1.00–1.57). Factors associated with higher eHEALS scores were having dreams and goals for the future (1.19; 1.01–1.40), higher self-efficacy (1.35; 1.15–1.58), enjoying learning about health, (1.67; 1.42–1.96), intention not to smoke in the future (0.52; 0.35–0.77), intention to exercise regularly in the future (1.25; 1.02–1.53), and intention to manage weight in the future (1.34; 1.08–1.66).\nⅣ．Discussion\nHigh school students from the region with shorter life expectancies had higher CCHL scores, suggesting the possibility that exposure to the prefecture-wide campaigns in the communities, schools and worksites starting from 2005 to relieve the prefecture from a situation of the shortest life expectancies might have affected them toward better attitudes for health since they were still young children. On the other hands, no inter-regional differences in the parents’ HL scores were found, whereas the high risk behaviors in parents were observed in the region with shorter life expectancies as the previous surveys reported. Parents’ HL scores were associated with the preferable lifestyles (ie. exercise and wight control), but not with smoking or alcohol drinking which may be more affected by other factors such as palatability or recidivism than HL. These findings imply the need for developing a more appropriate new scale for comprehensive assessments of lifestyle-related risks. Notably, school education may have a greater influence on high school students than the family, because the associations of HL and lifestyle between the students and their parents were extremely weak. In addition to the general health education in schools, educational systems should be enhanced with the cooperation of experts and other human resources in the community, utilizing health information to prevent lifestyle-related diseases.","subitem_description_language":"en","subitem_description_type":"Abstract"}]},"item_6_dissertation_number_12":{"attribute_name":"学位授与番号","attribute_value_mlt":[{"subitem_dissertationnumber":"甲第50号"}]},"item_6_heading_22":{"attribute_name":"見出し","attribute_value_mlt":[{"subitem_heading_banner_headline":"青森県立保健大学大学院博士論文. 令和元年度","subitem_heading_language":"ja"}]},"item_6_identifier_registration":{"attribute_name":"ID登録","attribute_value_mlt":[{"subitem_identifier_reg_text":"10.24552/00002182","subitem_identifier_reg_type":"JaLC"}]},"item_6_version_type_18":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_access_right":{"attribute_name":"アクセス権","attribute_value_mlt":[{"subitem_access_right":"open access","subitem_access_right_uri":"http://purl.org/coar/access_right/c_abf2"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"笠原, 美香","creatorNameLang":"ja"},{"creatorName":"カサハラ, ミカ","creatorNameLang":"ja-Kana"}]},{"creatorNames":[{"creatorName":"Kasahara, Mika","creatorNameLang":"en"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2021-07-05"}],"displaytype":"detail","filename":"A50.pdf","filesize":[{"value":"9.5 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"A50","url":"https://auhw.repo.nii.ac.jp/record/2194/files/A50.pdf"},"version_id":"65f713cc-db34-4155-8c0a-f28fbd6216c0"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"doctoral thesis","resourceuri":"http://purl.org/coar/resource_type/c_db06"}]},"item_title":"高校生のヘルスリテラシーに関する研究～長命地域と短命地域の比較～","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"高校生のヘルスリテラシーに関する研究～長命地域と短命地域の比較～","subitem_title_language":"ja"}]},"item_type_id":"6","owner":"9","path":["127"],"pubdate":{"attribute_name":"公開日","attribute_value":"2021-07-05"},"publish_date":"2021-07-05","publish_status":"0","recid":"2194","relation_version_is_last":true,"title":["高校生のヘルスリテラシーに関する研究～長命地域と短命地域の比較～"],"weko_creator_id":"9","weko_shared_id":-1},"updated":"2023-12-08T02:52:33.407052+00:00"}