题名

青少年於新冠肺炎疫情下的健康狀況:探討兒童時期洗手習慣類型與其影響

并列篇名

Adolescent Health Status During COVID-19 Pandemic: Investigating the Patterns and Influences of Childhood Hand washing Habits

DOI

10.7014/SRMA.2022100003

作者

張齡尹(Ling-Yin Chang);林佳霈(Chia-Pei Lin);陳映璇(Ying-Hsuan Chen);林宇旋(Yu-Hsuan Lin);江東亮(Tung-liang Chiang)

关键词

兒童洗手習慣 ; 健康狀況 ; 新冠肺炎疫情 ; 長期世代追蹤研究 ; childhood handwashing habits ; health status ; COVID-19 pandemic ; longitudinal cohort study

期刊名称

調查研究-方法與應用

卷期/出版年月

49期(2022 / 10 / 01)

页次

91 - 133

内容语文

繁體中文

中文摘要

本研究使用臺灣出生世代研究的調查資料進行分析,探討兒童時期洗手習慣類型及其對新冠肺炎疫情下青少年健康狀況的影響。分析樣本為在自變項與依變項皆無遺漏值者,共計17,996名青少年。本結果顯示,近八成的青少年在疫情期間之健康狀況為「好」。另外,70.73%的樣本在5.5歲時有洗手習慣;8歲時有洗手習慣者則高達92.04%。長期而言,兒童時期的洗手習慣有四類:「早期養成(66.93%)」、「晚期養成(25.11%)」、「習慣消退(3.08%)」及「不曾養成(4.17%)」。控制社會人口學特性與5.5歲時的健康狀況後發現,洗手習慣類型與青少年疫情期間之健康狀況的關係具劑量效應關係;相較「早期養成」組,洗手習慣類型為「晚期養成」或「不曾養成」之青少年,在疫情期間有良好健康狀況的可能性較低,且以「不曾養成」對健康的負面影響更大。綜合而言,本研究結果發現,兒童時期之洗手習慣對後續健康的重要性。建議政府持續推廣並發展有效的衛生教育及介入措施,協助兒童建立良好洗手習慣,以促進健康。

英文摘要

The coronavirus disease 2019 (COVID-19) pandemic attributable to infection with SARS-CoV-2 has emerged as a global public health challenge. The most recent data show that there have been over 5 billion confirmed cases and more than 6 million deaths worldwide as of the end of April 2022. In response to COVID-19, the World Health Organization and Centers for Disease Control and Prevention have recommended that the public implement preventive strategies, including handwashing, to reduce SARS-CoV-2 transmission and the associated long-term sequelae. The long-term association between handwashing habits and adolescent health status during the pandemic, however, has never been examined. This study used data from the Taiwan Birth Cohort Study (TBCS) to investigate the patterns of handwashing habits during childhood and the subsequent influences on adolescent health status during the COVID-19 pandemic. TBCS is the first nationwide representative study of children in Taiwan that aimed to investigate the trajectories of children’s health and examine factors that contribute to their health development. By 2020, ten waves of the survey had been completed when children were at 6 months, 18 months, 3 years, 5.5, 7, 8, 9, 12, 13, and 15 years of age. The response rates of each wave ranged from 87.8% to 94.9%. A total of 17,996 participants who completed the 5.5-year, 8-year, and 15-year surveys and had no missing values on focal study variables were included for the current analysis. The study results show that about 80% of adolescents had good health status during the COVID-19 pandemic. Additionally, the rates of handwashing habits among children were 70.73% at five years old and increased to 92.0% at eight years old. Based on data of handwashing habits collected in the 5.5-year and 8-year surveys, we further identified four patterns of handwashing habits during childhood, namely "early formation (66.93%)," "late formation (25.11%), "arrested formation (3.08%)," and "non-formation (4.17%)." After controlling for sociodemographic factors and health status at five years old, we found significant associations between patterns of handwashing habits and health status during the COVID-19 pandemic. Specifically, the odds ratio (OR) of having good health status during the COVID-19 pandemic was significantly lower among adolescents who had "late formation" (OR=0.79, 95% CI=0.72-0.86) or "non-formation" (OR=0.69, 95% CI =0.58 -0.82) patterns of handwashing habits during childhood than those with the "early formation" pattern, with the negative effects on health status being most evident for those with the "non-formation" pattern. Sensitivity analyses were further conducted to test whether different classifications for the patterns of handwashing habits would influence study results. Similar results were obtained when we combined "late formation" and "arrested formation" into "inconsistent formation." That is, compared to adolescents who had an "early formation" pattern of handwashing habits during childhood, those had "inconsistent formation" and "non-formation" patterns were less likely to have good health status during the COVID-19 pandemic. Our findings highlight the importance and the long-term effects of childhood handwashing habits on health status among adolescents. The government should continue developing and implementing effective handwashing interventions to help promote health. Future studies could link TBCS data with the National Health Insurance Research Database to further understand the benefits of handwashing on disease mortality and health care utilization. More research is also needed to investigate factors associated with handwashing habits and the underlying mechanisms linking handwashing habits and health.

主题分类 社會科學 > 社會科學綜合
参考文献
  1. 江宛霖, Wan-Lin,江東亮, Tung-Liang(2019)。生命早期經驗與非傳染性疾病防治:歷史備忘錄。台灣公共衛生雜誌,38(2),118-123。
    連結:
  2. Adriaanse, M. A.,Gollwitzer, P. M.,De Ridder, D. T.,de Wit, J. B.,Kroese, F. M.(2011).Breaking Habits with Implementation Intentions: A Test of Underlying Processes.Personality and Social Psychology Bulletin,37(4),502-513.
  3. Allegranzi, B.,Memish, Z. A.,Donaldson, L.,Pittet, D.(2009).Religion and Culture: Potential Undercurrents Influencing Hand Hygiene Promotion in Health Care.American Journal of Infection Control,37(1),28-34.
  4. Alwin, D. F.(2012).Integrating Varieties of Life Course Concepts.The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences,67(2),206-220.
  5. Anderson, P.(2002).Assessment and Development of Executive Function (EF) during Childhood.Child Neuropsycholgy,8(2),71-82.
  6. Ataee, R. A.,Ataee, M. H.,Tavana, A. Mehrabi,Salesi, M.(2017).Bacteriological Aspects of Hand Washing: A Key for Health Promotion and Infections Control.International Journal of Preventive Medicine,8(16)
  7. Aunger, R.,Schmidt, W. P.,Ranpura, A.,Coombes, Y.,Maina, P. M.,Matiko, C. N.,Curtis, V.(2010).Three Kinds of Psychological Determinants for Hand-washing Behaviour in Kenya.Social Science & Medicine,70(3),383-391.
  8. Azor-Martinez, E.,Yui-Hifume, R.,Muñoz-Vico, F. J.,Jimenez-Noguera, E.,Strizzi, J. M.,Martinez-Martinez, I.,Garcia-Fernandez, L.,Seijas-Vazquez, M. L.,Torres-Alegre, P.,Fernández-Campos, M. A.,Gimenez-Sanchez, F.(2018).Effectiveness of a Hand Hygiene Program at Child Care Centers: A Cluster Randomized Trial.Pediatrics,142(5),e20181245.
  9. Baker, A. D.,Gilley, J.,James, J.,Kimani, M.(2012).High Five to Healthy Living: A Health Intervention Program for Youth at an Inner City Community Center.Journal of Community Health,37(1),1-9.
  10. Baur, L. A.,Garnett, S. P.(2018).Early Childhood—a Critical Period for Obesity Prevention.Nature Reviews Endocrinology,15(1),5-6.
  11. Ben-Shlomo, Y.,Kuh, D.(2002).A Life Course Approach to Chronic Disease Epidemiology: Conceptual Models, Empirical Challenges and Interdisciplinary Perspectives.International Journal of Epidemiology,31(2),285-293.
  12. Bouton, M. E.(2000).A Learning Theory Perspective on Lapse, Relapse, and the Maintenance of Behavior Change.Health Psychology,19(1),57-63.
  13. Bowen, A.,Agboatwalla, M.,Luby, S.,Tobery, T.,Ayers, T.,Hoekstra, R. M.(2012).Association Between Intensive Handwashing Promotion and Child Development in Karachi, Pakistan: A Cluster Randomized Controlled Trial.Archives of Pediatrics and Adolescent Medicine,166(11),1037-1044.
  14. Bundy, D. A. P.(ed.),de Silva, N(ed.),Horton, S.(ed.),Jamison, D. T.(ed.),Patton, G. C.(ed.)(2017).Disease Control Priorities, Third Edition (Volume 8): Child and Adolescent Health and Development.Washington DC:The International Bank for Reconstruction and Development/The World Bank.
  15. Burdzovic Andreas, J.,Brunborg, G. S.(2021).Self-reported Mental and Physical Health Among Norwegian Adolescents Before and During the COVID-19 Pandemic.JAMA Netw Open,4(8),e2121934.
  16. Chang, L. Y.,Chang, H. Y.,Wu, W. C.,Lin, L. N.,Wu, C. C.,Yen, L. L.(2018).Dual Trajectories of Sleep Duration and Cigarette Smoking during Adolescence: Relation to Subsequent Internalizing Problems.Journal of Abnormal Child Psychology,46(8),1651-1663.
  17. Chang, L. Y.,Lin, Y. H.,Lin, S. J.,Chiang, T. L.(2021).Cohort Profile: Taiwan Birth Cohort Study (TBCS).International Journal of Epidemiology,50(5),1430-1431.
  18. Chiang, W. L.,Chiang, T. L.(2021).Mediating Effects of Early Health on the Relationship Between Early Poverty and Long-term Health Outcomes of Children: A Birth Cohort Study.BMJ Open,11(12),e052237.
  19. Curtis, V. A.,Danquah, L. O.,Aunger, R. V.(2009).Planned, Motivated and Habitual Hygiene Behaviour: An Eleven Country Review.Health Education Research,24(4),655-673.
  20. Davies, E.,Read, J.,Shevlin, M.(2021).The Impact of Adverse Childhood Experiences and Recent Life Events on Anxiety and Quality of Life in University Students.Higher Education,1,1-14.
  21. Diefenbacher, S.,Pfattheicher, S.,Keller, J.(2020).On the Role of Habit in Self-Reported and Observed Hand Hygiene Behavior.Applied Psychology: Health and Well-Being,12(1),125-143.
  22. Dorvil, S. R.,Vu, M.,Haardörfer, R.,Windle, M.,Berg, C. J.(2021).Experiences of Adverse Childhood Events and Racial Discrimination in Relation to Depressive Symptoms in College Students.College Student Journal,45(3),295-308.
  23. Duijster, D.,Monse, B.,Dimaisip-Nabuab, J.,Djuharnoko, P.,Heinrich-Weltzien, R.,Hobdell, M.,Kromeyer-Hauschild, K.,Kunthearith, Y.,Mijares-Majini, M. C.,Siegmund, N.,Soukhanouvong, P.,Benzian, H.(2017).Fit for School’—A School-based Water, Sanitation and Hygiene Programme to Improve Child Health: Results from a Longitudinal Study in Cambodia, Indonesia and Lao PDR.BMC Public Health,17(1),302.
  24. Ejemot-Nwadiaro, R. I.,Ehiri, J. E.,Arikpo, D.,Meremikwu, M. M.,Critchley, J. A.(2015).Hand Washing Promotion for Preventing Diarrhoea.Cochrane Database of Systematic Reviews,2015(9),Cd004265.
  25. Eurosurveillance Editorial Team(2020).Note from the editors: World Health Organization Declares Novel Coronavirus (2019-nCoV) Sixth Public Health Emergency of International Concern.Eurosurveillance,25(5),200131e.
  26. Gaeta, M. L.,Cavazos, J.,Cabrera, M. D. R.,Rosário, P.(2018).Fostering Oral Hygiene Habits and Self-Regulation Skills: An Intervention With Preschool Children.Family & Community Health,41(1),47-54.
  27. Gaillard, R.,Wright, J.,Jaddoe, V. W. V.(2019).Lifestyle Intervention Strategies in Early Life to Improve Pregnancy Outcomes and Long-term Health of Offspring: a Narrative Review.Journal of Developmental Origins of Health and Disease,10(3),314-321.
  28. Goldfield, G. S.,Harvey, A.,Grattan, K.,Adamo, K. B.(2012).Physical Activity Promotion in the Preschool Years: a Critical Period to Intervene.International Journal of Environmental Research and Public Health,9(4),1326-1342.
  29. Gomes, A.,Fraga, S.,Ramos, E.(2011).Hand Washing and Diarrhoea in Adolescents.Journal of Public Health,19(5),401-407.
  30. Grytten, J.,Rossow, I.,Holst, D.,Steele, L.(1988).Longitudinal Study of Dental Health Behaviors and Other Caries Predictors in Early Childhood.Community Dentistry and Oral Epidemiology,16(6),356-359.
  31. Guo, N.,Ma, H.,Deng, J.,Ma, Y.,Huang, L.,Guo, R.,Zhang, L.(2018).Effect of Hand Washing and Personal Hygiene on Hand Food Mouth Disease: A Community Intervention Study.Medicine (Baltimore),97(51),e13144.
  32. Hallal, P. C.,Wells, J. C.,Reichert, F. F.,Anselmi, L.,Victora, C. G.(2006).Early Determinants of Physical Activity in Adolescence: Prospective Birth Cohort Study.British Medical Journal,332(7548),1002-1007.
  33. Howie, E. K.,McVeigh, J. A.,Smith, A. J.,Zabatiero, J.,Bucks, R. S.,Mori, T. A.,Straker, L. M.(2020).Physical Activity Trajectories from Childhood to Late Adolescence and Their Implications for Health in Young Adulthood.Preventive Medicine,139,106224.
  34. John, C. C.,Black, M. M.,Nelson, C. A. 3rd.(2017).Neurodevelopment: The Impact of Nutrition and Inflammation During Early to Middle Childhood in Low-Resource Settings.Pediatrics,139(Supplement_1),S59-S71.
  35. Johns Hopkins Coronavirus Resource Center, 2022, “COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University.” https://coronavirus.jhu.edu/map.html (Date visited: May 16, 2022).
  36. Jokela, M.,Power, C.,Kivimäki, M.(2009).Childhood Problem Behaviors and Injury Risk Over the Life Course.Journal of Child Psychology and Psychiatry,50(12),1541-1549.
  37. Jordao, L. M. R.,Malta, D. C.,Freire, M. D. M.(2018).Clustering Patterns of Oral and General Health-risk Behaviours in Brazilian Adolescents: Findings from a National Survey.Community Dentistry and Oral Epidemiology,46(2),194-202.
  38. Kandel, N.,Lamichane, J.(2016).Strategy of Making Hand Washing a Routine Habit: Principles of 5Es and 3Rs.Journal of Nepal Medical Association,55(203),40-44.
  39. Kidman, R.,Piccolo, L. R.,Kohler, H. P.(2020).Adverse Childhood Experiences: Prevalence and Association with Adolescent Health in Malawi.American Journal of Preventive Medicine,58(2),285-293.
  40. Kim, Y.,Kim, H.(2020).Association between Hand Washing and Oral Health Status and Behaviors among Korean Adolescents: The 12th Korea Youth Risk Behavior Survey in 2016.American Journal of Nursing Studies,1(1),1004.
  41. Kuh, D.,Ben-Shlomo, Y.,Lynch, J.,Hallqvist, J.,Power, C.(2003).Life Course Epidemiology.Journal of Epidemiology and Community Health,57(10),778-783.
  42. Lally, P.,Gardner, B.(2013).Promoting Habit Formation.Health Psychology Review,7(Supplement_1),S137-S158.
  43. Lally, P.,Van Jaarsveld, C. H. M.,Potts, H. W. W.,Wardle, J.(2010).How are Habits Formed: Modelling Habit Formation in the Real World.European Journal of Social Psychology,40(6),998-1009.
  44. Lally, P.,Wardle, J.,Gardner, B.(2011).Experiences of Habit Formation: A Qualitative Study.Psychology, Health & Medicine,16(4),484-489.
  45. Liddelow, C.,Ferrier, A.,Mullan, B.(2021).Understanding the Predictors of Hand Hygiene Using Aspects of the Theory of Planned Behaviour and Temporal Self-Regulation Theory.Psychology & Health,1-18.
  46. Lin, Y. C.,Wu, J. C.,Chiou, S. T.,Chiang, T. L.(2015).Healthy Living Practices in Families and Child Health in Taiwan.International Journal of Public Health,60(6),691-698.
  47. Liu, X.,Hou, W.,Zhao, Z.,Cheng, J.,van Beeck, E. F.,Peng, X.,Jones, K.,Fu, X.,Zhou, Y.,Zhang, Z.,Richardus, J. H.,Erasmus, V.(2019).A Hand Hygiene Intervention to Decrease Hand, Foot and Mouth Disease and Absence Due to Sickness among Kindergarteners in China: A Cluster-randomized Controlled Trial.Journal of Infection,78(1),19-26.
  48. Lynch, J. W.,Kaplan, G. A.,Salonen, J. T.(1997).Why do Poor People Behave Poorly? Variation in Adult Health Behaviours and Psychosocial Characteristics by Stages of the Socioeconomic Lifecourse.Social Science & Medicine,44(6),809-819.
  49. Männikkö, N.,Ruotsalainen, H.,Miettunen, J.,Kääriäinen, M.(2020).Associations between Childhood and Adolescent Emotional and Behavioral Characteristics and Screen Time of Adolescents.Issues in Mental Health Nursing,41(8),700-712.
  50. Mbakaya, B. C.,Lee, P. H.,Lee, R. L.(2017).Hand Hygiene Intervention Strategies to Reduce Diarrhoea and Respiratory Infections among School Children in Developing Countries: A Systematic Review.International Journal of Environmental Research and Public Health,14(4),371.
  51. Mercuur, R.,Dignum, V.,Jonker, C. M.(2019).Do Habits Fade Out? Discerning Between Two Theories Using Agent-Based Simulation.Advances in Social Simulation. ESSA 2019 (Proceedings of the 15th Simulation Conference: 23-27 September 2019),Cham:
  52. Miller, P. M.,Smith, G. T.,Goldman, M. S.(1990).Emergence of Alcohol Expectancies in Childhood: A Possible Critical Period.Journal of Studies on Alcohol and Drugs,51(4),343-349.
  53. Mitchell, A. E.,Kulasinghe, K.,Morawska, A.(2021).Establishing Healthy Personal Hygiene Habits with Young Children in Australia: A Cross-Sectional Mixed Methods Study.Behaviour Change,1-14.
  54. Mohebbi, S. Z.,Virtanen, J. I.,Murtomaa, H.,Vahid-Golpayegani, M.,Vehkalahti, M. M.(2008).Mothers as Facilitators of Oral Hygiene in Early Childhood.International Journal of Paediatric Dentistry,18(1),48-55.
  55. Monette, S.,Seguin, L.,Gauvin, L.,Nikiema, B.(2007).Validation of a Measure of Maternal Perception of the Child’s Health Status.Child: Care, Health and Development,33(4),472-481.
  56. Mortimer, J. T.(ed.),Shanahan, M. J.(ed.)(2003).Handbook of the Life Course.New York:Springer.
  57. Nicholson, J. A.,Naeeni, M.,Hoptroff, M.,Matheson, J. R.,Roberts, A. J.,Taylor, D.,Wright, R. L.(2014).An Investigation of the Effects of a Hand Washing Intervention on Health Outcomes and School Absence Using a Randomised Trial in Indian Urban Communities.Tropical Medicine & International Health,19(3),284-292.
  58. Orbell, S.,Verplanken, B.(2010).The Automatic Component of Habit in Health Behavior: Habit as Cue-contingent Automaticity.Health Psychology,29(4),374-383.
  59. Park, Y. J.,Choe, Y. J.,Park, O.,Park, S. Y.,Kim, Y. M.,Kim, J.,Jeong, E. K.(2020).Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020.Emerging Infectious Diseases,26(10),2465-2468.
  60. Reyes Fernández, B.,Knoll, N.,Hamilton, K.,Schwarzer, R.(2016).Social-cognitive Antecedents of Hand Washing: Action Control Bridges the Planning-behaviour Gap.Psychology & Health,31(8),993-1004.
  61. Stewardson, A.,Allegranzi, B.,Sax, H.,Kilpatrick, C.,Pittet, D.(2011).Back to the Future: Rising to the Semmelweis Challenge in Hand Hygiene.Future Microbiology,6(8),855-876.
  62. Szabó, Á.,Towers, A.,Newcombe, D.,Sheridan, J.(2021).Alcohol Use Trajectories Across the Life Course: Influences of Childhood Predictors and Consequences for Late-life Health.Drug Alcohol Depend,224,108713.
  63. Telama, R.,Yang, X.,Viikari, J.,Välimäki, I.,Wanne, O.,Raitakari, O.(2005).Physical Activity from Childhood to Adulthood: A 21-year Tracking Study.American Journal of Preventive Medicine,28(3),267-273.
  64. United Nations, 2015, “The Global Strategy for Women’s, Children, and Adolescents’ Health (2016-2030).” http://globalstrategy.everywomaneverychild.org/ (Date visited: May 16, 2022).
  65. United Nations Population Fund, 2020. “Adolescents and Young People & Coronavirus Disease (COVID-19) UPDATED.” https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_Preparedness_and_Response_-_UNFPA_Interim_Technical_Briefs_Adolescents_and_Young_People_23_March_2020.pdf (Date visited: May 16, 2022).
  66. van’t Riet, J,Sijtsema, S. J.,Dagevos, H.,De Bruijn, G. J.(2011).The Importance of Habits in Eating Behaviour. An Overview and Recommendations for Future Research.Appetite,57(3),585-596.
  67. Wang, D.,Jiang, Q.,Yang, Z.,Choi, J. K.(2021).The Longitudinal Influences of Adverse Childhood Experiences and Positive Childhood Experiences at Family, School, and Neighborhood on Adolescent Depression and Anxiety.Journal of Affective Disorders,1(292),542-551.
  68. Wee, J. H.,Park, M. W.,Min, C.,Park, I. S.,Park, B.,Choi, H. G.(2020).The Association between High Hygiene scores and Allergic Rhinitis in Korean Adolescents.International Forum of Allergy & Rhinology,10(8),1024-1030.
  69. Whitby, M.,McLaws, M. L.,Ross, M. W.(2006).Why Healthcare Workers don’t Wash Their Hands: a Behavioral Explanation.Infection Control & Hospital Epidemiology,27(5),484-492.
  70. Wigen, T. I.,Wang, N. J.(2015).Does Early Establishment of Favorable Oral Health Behavior Influence Caries Experience at Age 5 years?.Acta Odontologica Scandinavica,73(3),182-187.
  71. Willmott, M.,Nicholson, A.,Busse, H.,MacArthur, G. J.,Brookes, S.,Campbell, R.(2016).Effectiveness of Hand Hygiene Interventions in Reducing Illness Absence Among Children in Educational Settings: A Systematic Review and Meta-analysis.Archives of Disease in Childhood,101(1),42-50.
  72. Wolf, J.,Hunter, P. R.,Freeman, M. C.,Cumming, O.,Clasen, T.,Bartram, J.,Prüss-Ustün, A.(2018).Impact of Drinking Water, Sanitation and Handwashing With Soap on Childhood Diarrhoeal Disease: Updated Meta-analysis and Meta-regression.Tropical Medicine & International Health,23(5),508-525.
  73. Wood, W.,Neal, D. T.(2007).A New Look at Habits and the Habit-goal Interface.Psychological Review,114(4),843-863.
  74. Wood, W.,Neal, D. T.(2009).The Habitual Consumer.Journal of Consumer Psychology,19(4),579-592.
  75. World Health Organization, 2009, “WHO Guidelines on Hand Hygiene in Health Care: a Summary.” in Geneva: World Health Organization, https://apps.who.int/iris/handle/10665/70126 (Date visited: February 15, 2022).
  76. Wyer, R. S., Jr.(ed.),Srull, T. K.(ed.)(1994).Handbook of Social Cognition.Hillsdale. NJ:Erlbaum.
  77. Zhang, C.,Ye, M.,Fu, Y.,Yang, M.,Luo, F.,Yuan, J.,Tao, Q.(2020).The Psychological Impact of the COVID-19 Pandemic on Teenagers in China.Journal of Adolescent Health,67(6),747-755.
  78. 丁志音, Chih-Yin,江東亮, Tung-liang(1996)。以健康行為型態分類台灣地區之成人口群—群聚分析之應用。中華衛誌,15(3),175-187。
  79. 王郁茗, Yu-Ming,徐畢卿, Bih-Ching(2005)。生命歷程流行病學。台灣醫學,9(5),687-695。
  80. 黃芳誼, Fang-Yi(2016)。從生命歷程觀點評析健康研究。新社會政策,45,54-64。
  81. 臺大醫院,高雄榮民總醫院,財團法人醫院評鑑暨醫療品質策進會, and Joint Commission of Taiwan(2012).手部衛生工作手冊.
  82. 趙雁南, YanNan,黃頌恩, Sung-An,邱乾順, Chien-Shun,蔡韶慧, Shaur-Huei,林千惠, Chien-Hui,李品慧, Pin-Huei(2008)。2007 年 11 月台中市某國小水源性桿菌性痢疾流行事件調查。疫情報導,24(10),769-779。
  83. 劉嘉興, Jia-Xing,彭仁君, Jen-Jiun,廖東南, Tong-Nan,游昌憲, Chang-Hsien(2012)。台東縣國小學童蟯蟲感染率與可能的影響因子。台灣醫檢會報,27(2),79-85。
  84. 衛生福利部疾病管制署,2020,5 月5 日世界手部衛生日,指揮中心教導正確洗手(http://at.cdc.tw/85NI8q,取用日期:2020 年2 月 15 日)。(Taiwan Center for Disease Control, Ministry of Welfare, ROC (Taiwan), May 5th, 2020, WorldHandHygiene Day. Central Epidemic Command Center Illustrates the Correct Way of Handwashing.” http://at.cdc.tw/85NI8q (Date visited: February 15, 2020).)