本研究旨在發展青少年健康素養量表，再以此量表探討量表之健康知識、健康態度與健康行為的相關及預測因素。首先進行青少年健康素養量表之編製，由206位學生的預試及1,005位學生的正式施測，三個分量表之內部一致性信度係數Cronbach’s α分別為.85、.73及.91，總量表信度為.90。接著以探索式因素分析及驗證性因素分析研究工具之效度，再以卡方檢定、獨立樣本t檢定、單因子變異數分析比較不同背景青少年的健康素養之差異，最後使用階層迴歸分析釐清青少年健康素養三個層面「健康知識」、「健康態度」及「健康行為」的相關性，並以「健康知識」為調節變項區辨對「健康態度」與「健康行為」的關係。本研究發現青少年隨著年齡及年級增加而健康態度逐漸低落，大學生健康態度分數顯著低於國中學生，而女學生的健康行動分數顯著高於男學生；健康知識與健康態度對於健康行動具有顯著預測力。本研究提供青少年的健康素養現況及其預測因素作為各級學校及相關研究之參考，建議各級學校重視學生的健康素養並研發符合青少年生活情境的課程、教學及相關活動，以提升學生的健康素養，而如何提升女學生的健康知識及男學生的健康行為有待進一步探究與討論。

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1. 內政部（2017）。105年國民生活狀況意向調查性別分析。取自https://www.moi.gov.tw/stat/node.aspx?cate_sn=&belong_sn=6003&sn=6004 【Ministry of the Interior. (2017). Gender analysis of the 105-year national life status survey. Retrieved from https://www.moi.gov.tw/stat/node.aspx?cate_sn=&belong_sn=6003&sn=6004】
2. 王榮德、江東亮、陳為堅、詹長權（2015）。公共衛生學上冊（修訂五版）。臺北市：國立臺灣大學出版中心。 【Wang, R.-D., Jiang, D.-L., Chen, W.-J., & Zhan, C.-Q. (2015). Public health volume one (Rev. 5th ed.). Taipei, Taiwan: National Taiwan University Publishing Center.】
3. 台灣制度與經濟史學會（2019）。臺灣省五十一年來統計提要（1894-1945）。取自http://twstudy.iis.sinica.edu.tw/twstatistic50/【Taiwan Institute of Institutional and Economic History. (2019). A summary of the statistics of Taiwan Province in the past fifty-one years (1894-1945). Retrieved from http://twstudy.iis.sinica.edu.tw/twstatistic50/】
4. 佘曉清、林煥祥（主編）（2017）。PISA 2015臺灣學生的表現。臺北市：心理。 【She, H.-C., & Lin, H.-S. (Eds.). (2017). Taiwan student performance on PISA 2015. Taipei, Taiwan: Psychological.】
5. 吳明隆（2013）。SPSS統計應用學習實務：問卷分析與應用統計。臺北市：易習。 【Wu, M.-L. (2013). SPSS statistical application learning practice: Questionnaire analysis and application statistics. Taipei, Taiwan: Elearning.】
6. 吳美麗（2011）。探討以北海岸生物多樣性為主題進行體驗學習活動之教學及其成效。國教新知，58（2），2-13。doi:10.6701/TEEJ.201106_58(2).0001 【Wu, M.-L. (2011). Explore the teaching and effectiveness of experiential learning activities on the theme of biodiversity on the North Coast. New Knowledge of the State Religion, 58(2), 2-13. doi:10.6701/TEEJ.201106_58(2).0001】
7. 李宜致、吳偉立、李佳珂、林陽助（2012）。大學生健康知能與健康行為之研究。清雲學報，32（3），51-63。doi:10.7049/JCYU.201207.0051 【Li, Y.-Z., Wu, W.-L. Li, J.-K., & Lin, Y.-Z. (2012). Research on health awareness and healthy behavior of college students. Qingyun Journal, 32(3), 51-63. doi:10.7049/JCYU.201207.0051】
8. 李宜憲（2016）。人民生活品質與國家競爭力探討。取自https://pride.stpi.narl.org.tw/topic2/downloadSource/4b1141ad56970ef6015721b4eef72c90 【Li, Y.-X. (2016). Discussion on the quality of life of the people and national competitiveness. Retrieved from https://pride.stpi.narl.org.tw/topic2/downloadSource/4b1141ad56970ef6015721b4eef72c90】
9. 林煥祥（2009）。科學素養的評量。科學發展，438，66-69。 【Lin, H.-S. (2009). Assessment of scientific literacy. Scientific Development, 438, 66-69.】
10. 國家教育研究院（2014）。十二年國民基本教育課程體系發展指引。臺北市：作者。 【National Academy for Education Research. (2014). Guidelines for the development of the 12-year National Basic Education Curriculum System. Taipei, Taiwan: Author.】
11. 國家衛生研究院（2012）。兒童及青少年之長期發展研究報告（2001-2011）。取自http://iphs.nhri.org.tw/archives/?page_id=544 【National Health Research Institutes. (2012). Long-term development study report for children and adolescents (2001-2011). Retrieved from http://iphs.nhri.org.tw/archives/?page_id=544】
12. 國家衛生研究院（2016a）。2013年國民健康訪問調查結果報告。新北市：作者。 【National Health Research Institutes. (2016a). Report on the results of the 2013 National Health Visit Survey. National Research Institute publication, New Taipei, Taiwan: Author.】
13. 國家衛生研究院（2016b）。2013年國民健康訪問調查結果報告。取自http://nhis.nhri.org.tw/【National Health Research Institutes. (2016b). Report on the results of the 2013 National Health Visit Survey. Retrieved from http://nhis.nhri.org.tw/】
14. 國家衛生研究院（2017）。中華民國教育年報電子書105年版。取自https://www.naer.edu.tw/files/15-1000-13943,c1310-1.php?Lang=zh-tw 【National Health Research Institutes. (2017). The Republic of China Education Annual Report e-book 105 years. Retrieved from https://www.naer.edu.tw/files/15-1000-13943, c1310-1.php?Lang=zh-tw】
15. 郭淑珍、丁志音、陳怡君（2005）。民眾如何看待健康教育訊息：深度訪談嚼檳榔的計程車司機。台灣公共衛生雜誌，24（3），239-253。doi:10.6288/TJPH2005-24-03-09 【Guo, S.-C., Ting, C.-Y., & Chen, Y.-C. (2005). Lay perspectives of health education information: In-depth interviews with areca quid chewing taxi drivers. Taiwan Journal of Public Health, 24(3), 239-253. doi:10.6288/TJPH2005-24-03-09】
16. 陳秀雯（2009）。台灣成人健康知能、自我健康意識與服藥遵從行為（未出版碩士論文）。大仁科技大學，屏東縣。 【Chen, H.-W. (2009). Taiwan adult health awareness, self-health awareness and drug compliance behavior (Unpublished master’s thesis). Tajen University, Pingtung, Taiwan.】
17. 陳柏熹、黃馨瑩、陳郁欣、葉泰廷、蘇少祖（2015）。大學生基本素養測驗的發展及信度效度分析。教育科學研究期刊，60（3），95-126。doi:10.6209/JORIES.2015.60(3).04 【Chen, P.-H., Huang., H.-Y., Chen., Y.-H., Yeh., T.-T., & Su, S.-T. (2015). Evaluation of the psychometric properties of the general literacy test for university students. Journal of Research in Education Sciences, 60(3), 95-126. doi:10.6209/JORIES.2015.60(3).04】
18. 馮郁英（2014）。國中生健康素養評量編製及運用（未出版碩士論文）。國立臺南大學，臺南市。 【Feng, Y.-Y. (2014). Preparation and application of health literacy assessment for Chinese and middle school students (Unpublished master’s thesis). National Tainan University, Tainan, Taiwan.】
19. 黃莉芸、張鳳琴、苗迺芳（2017）。以健康信念模式探討台灣北部大學生接種人類乳突病毒疫苗之行為意圖及相關因素研究。台灣公共衛生雜誌，36（1），77-86。doi:10.6288/TJPH201736105095 【Huang, L.-Y., Chang., F.-C., & Miao, N.-F. (2017). Factors associated with university students’ intention to receive human papillomavirus vaccination in northern Taiwan: A heath belief model approach. Taiwan Journal of Public Health, 36(1), 77-86. doi:10.6288/TJPH201736105095】
20. 黃台珠（2014）。2012年臺灣公民科學素養概況。高雄市：國立中山大學通識教育中心公民推動研究中心。 【Huang, T.-C. (2014). Overview of Taiwan citizen science literacy in 2012. Kaohsiung, Taiwan: National Center for the Promotion of Citizens of the National Sun Yat-sen University.】
21. 臺灣教育促進學校（2014）。健保大富翁。取自https://hps.hphe.ntnu.edu.tw/topic/insurance/hygiene/video/detail/id-6 【Taiwan Education Promotion School. (2014). Health insurance monopoly. Retrieved from https://hps.hphe.ntnu.edu.tw/topic/insurance/hygiene/video/detail/id-6】
22. 劉婉柔（2013）。我國國中生健康素養指標之建構（未出版博士論文）。國立臺灣師範大學，臺北市。 【Liu, W.-R. (2013). The construction of health literacy indicators for Chinese middle school students (Unpublished doctoral dissertation). National Taiwan Normal University, Taipei, Taiwan.】
23. 劉潔心、廖梨伶、施淑芳、張子超、紀雪雲、Osborne, R.-H.（2014）。台灣學童健康素養測驗之發展與測量。台灣公共衛生雜誌，33（3），251-270。doi:10.6288/TJPH201433102105 【Liu, C.-H., Liao, L.-L., Shih, S.-F., Chang, T.-C., Chi, H.-Y., & Osborne, R.-H. (2014). Development and implementation of Taiwan’s child health literacy test. Taiwan Journal of Public Health, 33(3), 251-270. doi:10.6288/TJPH201433102105】
24. 衛福部國民健康署（2018）。學生健康行為調查。取自https://www.hpa.gov.tw/Pages/List.aspx?nodeid=113 【National Health Administration, Ministry of Health and Welfare. (2018). Investigation of student health behavior. Retrieved from https://www.hpa.gov.tw/Pages/List.aspx?nodeid=113】
25. 蘇哲能（2007）。建構「成人健康知能量表」：初探性研究（未出版碩士論文）。大仁科技大學，屏東縣。 【Su, C.-N. (2007). Development of a healthy literacy measurement: A preliminary study (Unpublished master’s thesis). Tajen University, Pingtung, Taiwan.】
26. Albert, D., & Steinberg, L. (2011). Judgment and decision making in adolescence. Journal of Research on Adolescence, 21(1), 211-224.
27. Begoray, D. L., & Kwan, B. (2011). A Canadian exploratory study to define a measure of health literacy. Health Promotion International, 27(1), 23-32. doi:10.1093/heapro/dar015
28. Braden, O., Gonçalves, D., Ricci-Cabello, I., Ziebland, S., & Valderas, J. (2014). An overview of self-administered health literacy instruments. PloS One, 9(12), e109110. doi:10.1371/journal.pone.0109110
29. Brenhouse, H. C., & Schwarz, J. M. (2016). Immunoadolescence: Neuroimmune development and adolescent behavior. Neuroscience & Biobehavioral Reviews, 70, 288-299. doi:10.1016/j.neubiorev.2016.05.035
30. Brown, S. L., Teufel, J. A., & Birch, D. A. (2007). Early adolescents perceptions of health and health literacy. Journal of School Health, 77(1), 7-15. doi:10.1111/j.1746-1561.2007.00156.x
31. Browne, M. W., & Cudeck, R. (1992). Alternative ways of assessing model fit. Sage Focus Editions, 154, 136-136. doi:10.4236/tel.2016.64070
32. Chari, R., Warsh, J., Ketterer, T., Hossain, J., & Sharif, I. (2014). Association between health literacy and child and adolescent obesity. Patient Education and Counseling, 94(1), 61-66. doi:10.1016/j.pec.2013.09.006
33. Chinn, D., & McCarthy, C. (2013). All Aspects of Health Literacy Scale (AAHLS): Developing a tool to measure functional, communicative and critical health literacy in primary healthcare settings. Patient Education and Counseling, 90(2), 247-253. doi:10.1016/j.pec.2012.10.019
34. Davis, T. C., Crouch, M. A., Long, S. W., Jackson, R. H., Bates, P., George, R. B., & Bairnsfather, L. E. (1991). Rapid assessment of literacy levels of adult primary care patients. Family Medicine, 23(6), 433-435.
35. De Leeuw, E. (2012). The political ecosystem of health literacies. Health Promotion International, 27(1), 1-4. doi:10.1093/heapro/das001
36. DeWalt, D. A., & Hink, A. (2009). Health literacy and child health outcomes: A systematic review of the literature. Pediatrics, 124(3), 265-274. doi:10.1542/peds.2009-1162B
37. Diaz‐Granados, J. L., & Graham, D. L. (2007). The effects of continuous and intermittent ethanol exposure in adolesence on the aversive properties of ethanol during adulthood. Alcoholism: Clinical and Experimental Research, 31(12), 2020-2027. doi:10.1111/j.1530-0277.2007.00534.x
38. Embretson, S. E., & Reise, S. P. (2013). Item response theory. Hillsdale, NJ: Erlbaum.
39. Felton, G. M., Parsons, M. A., & Bartoces, M. G. (1997). Demographic factors: Interaction effects on health‐promoting behavior and health related factors. Public Health Nursing, 14(6), 361-367.
40. Fleary, S. A., Joseph, P., & Pappagianopoulos, J. E. (2018). Adolescent health literacy and health behaviors: A systematic review. Journal of Adolescence, 62, 116-127. doi:10.1016/j.adolescence.2017.11.010
41. Guo, S., Armstrong, R., Waters, E., Sathish, T., Alif, S. M., Browne, G. R., & Yu, X. (2018). Quality of health literacy instruments used in children and adolescents: A systematic review. BMJ Open, 8(6), e020080.
42. Haun, J. N., Valerio, M. A., McCormack, L. A., Sørensen, K., & Paasche-Orlow, M. K. (2014). Health literacy measurement: An inventory and descriptive summary of 51 instruments. Journal of Health Communication, 19(2), 302-333. doi:10.1080/10810730.2014.936571
43. Hu, L.-T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1-55. doi:10.1080/10705519909540118
44. Juonala, M., Magnussen, C. G., Berenson, G. S., Venn, A., Burns, T. L., Sabin, M. A.,... Sun, C. (2011). Childhood adiposity, adult adiposity, and cardiovascular risk factors. New England Journal of Medicine, 365(20), 1876-1885. doi:10.1056/NEJMoa1010112
45. Kendler, K. S., Gardner, C. O., Annas, P., & Lichtenstein, P. (2008). The development of fears from early adolesence to young adulthood: A multivariate study. Psychological Medicine, 38(12), 1759-1769. doi:10.1017/S0033291708002936
46. Kwan, M., Bobko, S., Faulkner, G., Donnelly, P., & Cairney, J. (2014). Sport participation and alcohol and illicit drug use in adolescents and young adults: A systematic review of longitudinal studies. Addictive Behaviors, 39(3), 497-506. doi:10.1016/j.addbeh.2013.11.006
47. Lanza, S. T., & Vasilenko, S. A. (2015). New methods shed light on age of onset as a risk factor for nicotine dependence. Addictive Behaviors, 50, 161-164. doi:10.1016/j.addbeh.2015.06.024
48. Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 28(4), 563-575. doi:10.1111/j.1744-6570.1975.tb01393.x
49. McClory, A. J., & Spear, L. P. (2014). Effects of ethanol exposure during adolescence or in adulthood on Pavlovian conditioned approach in Sprague-Dawley rats. Alcohol, 48(8), 755-763. doi:10.1016/j.alcohol.2014.05.006
50. Nguyen, T. H., Park, H., Han, H. R., Chan, K. S., Paasche-Orlow, M. K., Haun, J., & Kim, M. T. (2015). State of the science of health literacy measures: Validity implications for minority populations. Patient Education and Counseling, 98(12), 1492-1512. doi:10.1016/j.pec.2015.07.013
51. Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259-267. doi:10.1093/heapro/15.3.259
52. Okan, O., Lopes, E., Bollweg, T. M., Bröder, J., Messer, M., Bruland, D.,... Pinheiro, P. (2018). Generic health literacy measurement instruments for children and adolescents: A systematic review of the literature. BMC Public Health, 18(1), 166. doi:10.1186/s12889-018-5054-0
53. Oraganisation for Economic Co-operation and Development. (2013). PISA 2015 draft science framework. Retrieved from https://www.oecd.org/pisa/pisaproducts/Draft%20PISA%202015%20Science%20Framework%20.pdf
54. Oraganisation for Economic Co-operation and Development. (2016). PISA 2015 Assessment and Analytical Framework (PISA): Science, reading, mathematic, financial literacy and collaborative problem solving (revised edition). Retrieved from https://www.oecd.org/pisa/pisa-for-development/PISA-D-Assessment-and-Analytical-Framework-Ebook.pdf
55. Parker, R. M., Baker, D. W., Williams, M. V., & Nurss, J. R. (1995). The test of functional health literacy in adults: A new instrument for measuring patients’ literacy skills. Journal of General Internal Medicine, 10(10), 537-541.
56. Parker, R. M., Williams, M. V., Weiss, B. D., Baker, D. W., Davis, T. C., Doak, C. C.,... Schwartzberg, J. G. (1999). Health literacy-report of the council on scientific affairs. Jama-Journal of the American Medical Association, 281(6), 552-557.
57. Patton, M. Q. (2002). Two decades of developments in qualitative inquiry: A personal, experiential perspective. Qualitative Social Work, 1(3), 261-283. doi:10.1177/1473325002001003636
58. Pleasant, A., McKinney, J., & Rikard, R. V. (2011). Health literacy measurement: A proposed research agenda. Journal of Health Communication, 16(S3), 11-21. doi:10.1080/10810730.2011.604392
59. Rubinelli, S., Schulz, P. J., & Nakamoto, K. (2009). Health literacy beyond knowledge and behaviour: Letting the patient be a patient. International Journal of Public Health, 54(5), 307-311. doi:10.1007/s00038-009-0052-8
60. Simonds, S. K. (1974). Health education as social policy. Health Education Monographs, 2(1), 1-10.
61. Squiers, L., Peinado, S., Berkman, N., Boudewyns, V., & McCormack, L. (2012). The health literacy skills framework. Journal of Health Communication, 17(S3), 30-54. doi:10.1080/10810730.2012.713442
62. Sykes, S., Wills, J., Rowlands, G., & Popple, K. (2013). Understanding critical health literacy: A concept analysis. BMC Public Health, 13(1), 150. doi:10.1186/1471-2458-13-150
63. Tirosh, A., Shai, I., Afek, A., Dubnov-Raz, G., Ayalon, N., Gordon, B.,... Rudich, A. (2011). Adolescent BMI trajectory and risk of diabetes versus coronary disease. New England Journal of Medicine, 364(14), 1315-1325. doi:10.1056/NEJMoa1006992
64. Veliz, P. T., Boyd, C. J., & McCabe, S. E. (2015). Competitive sport involvement and substance use among adolescents: A nationwide study. Substance Use & Misuse, 50(2), 156-165. doi:10.3109/10826084.2014.962049
65. Wang, H.-H., Chen, H.-T., Lin, H.-S., & Hong, Z.-R (2017). The effects of college students’ positive thinking, learning motivation and self-regulation through a self-reflection intervention in Taiwan. Higher Education Research & Development, 36(1), 201-216. doi:10.1080/07294360.2016.1176999
66. Weiss, B. D., Mays, M. Z., Martz, W., Castro, K. M., DeWalt, D. A., Pignone, M. P.,... Hale, F. A. (2005). Quick assessment of literacy in primary care: The newest vital sign. The Annals of Family Medicine, 3(6), 514-522. doi:10.1370/afm.405
67. World Health Organization. (1998). Health promotion glossary. Retrieved from http://whqlibdoc.who.int/hq/1998/WHO_HPR_HEP_98.1.pdf
68. World Health Organization. (2013). Health literacy: The solid facts. Retrieved from http://www.euro.who.int/pubrequest
69. Yu, X., Yang, T., Wang, S., & Zhang, X. (2012). Study on student health literacy gained through health education in elementary and middle schools in China. Health Education Journal, 71(4), 452-460. doi:10.1177/0017896911430548
70. Zhang, S.-C., Tao, F.-B., Wu, X.-Y., Tao, S.-M., & Fang, J. (2016). Low health literacy and psychological symptoms potentially increase the risks of non-suicidal self-injury in Chinese middle school students. BMC Psychiatry, 16(1), 327. doi:10.1186/s12888-016-1035-y

中文APA引文格式	吳枚瑛、洪瑞兒（2020）。探討高雄市青少年健康知識、態度及行為素養。教育科學研究期刊，65（3），187-223。doi:10.6209/JORIES.202009_65(3).0007
APA Format	Wu, M.-Y., & Hong, Z.-R. (2020). Exploration of Kaohsiung City Adolescents’ Health Knowledge, Attitudes, and Behavioral Literacy. Journal of Research in Education Sciences, 65(3), 187-223. 10.6209/JORIES.202009_65(3).0007

This study validated instruments for assessing the health awareness and health literacy of adolescents and explored the related and protective factors of adolescents’ health literacy in Taiwan. A total of 1,005 representative adolescents were stratified randomly selected from Kaohsiung City, and they completed two well-structured instruments for measuring their health awareness and health literacy. First, exploratory and confirmatory factor analyses and internal consistency were used to examine the instruments’ validities and reliabilities. Second, chi-square test, independent t-test, and one-way analysis of variance were conducted to compare the health awareness and health literacy levels of adolescents from different backgrounds. Finally, hierarchical regression analysis was employed to identify the relations between health knowledge, attitudes toward health, and healthy behaviors and their predictors. The initial results indicated that adolescents’ means of health attitude decreased with increasing age and improvement in grades. University students’ means of attitude toward health and health literacy were significantly lower than those of junior high school students. Male adolescents’ scores for health awareness and health knowledge were significantly higher than those of their female counterparts. On the other hand, female adolescents’ means of health actions were significantly higher than those of their male counterparts’. Additionally, adolescents’ means of health knowledge and attitudes toward health had significant and adjusted predictive power on their health behaviors. This study demonstrated the importance of developing and implementing situational tests and curricula and activities related to students’ everyday lives to improve their health literacy. Finally, further discussion on methods to improve adolescents’ health actions and female adolescents’ health knowledge is warranted.