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研究生: 杭極敏
Hang, Chi-Ming
論文名稱: 提升國小高年級學生鈣質攝取之教育介入成效探討
The Effects of A Calcium Intake Promoting Nutrition Education Program For Fifth Graders of Taiwan
指導教授: 林薇
Lin, Wei
學位類別: 博士
Doctor
系所名稱: 人類發展與家庭學系
Department of Human Development and Family Studies
論文出版年: 2009
畢業學年度: 97
語文別: 中文
論文頁數: 181
中文關鍵詞: 鈣質攝取國小高年級學生社會生態模式營養教育
英文關鍵詞: calcium intake, elementary student,, social-ecological model, nutrition education
論文種類: 學術論文
相關次數: 點閱:191下載:20
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  • 本研究的目的乃在發展適用於台灣地區國小高年級學童之提升鈣質攝取量教育介入計畫並評估其成效。以社會生態模式的架構,綜合健康信念模式和社會認知理論中飲食行為形成重要影響因子,發展教學策略及設計課程設計,計四單元,每單元40分鐘。在台灣地區北、中、南三區中每區之都市及鄉村中選取1所國民小學,每所學校以五年級一個班級為實驗組、一個班級為控制組,共計實驗組6班(N=178)、控制組6班(N=174),於實驗教學前、教學後一星期及教學後一個月分別對實驗組與控制組學生進行前測、後測及後後測評量,以了解教育介入之成效。成效評量項目包括以鈣質攝取頻率表評估之鈣質攝取量,及鈣質攝取行為之相關因素。研究結果發現:(1)實驗組學生於教育介入後,鈣質食物攝取量、鈣質相關之知識、對鈣質食物的喜好、知覺利益、「口味不合時會吃」的自我效能顯著提升,知覺障礙顯著降低,且除鈣質食物攝取量及預防骨質疏鬆症的知覺利益外,在其他項目也有短期延宕效果。(2)介入成效不因學生性別而有差異,對不同地區學生教學成效亦多無顯著差異,只有在知識方面,雖然都有提升,但是對鄉村地區學生的成效更優於城市地區的學生,而「家人都不吃時會吃」的自我效能的提升則只有對鄉村地區的學生有顯著成效。雖然介入後學童鈣質食物攝取量較控制組為高,但改變幅度不大,且並未達到學童的建議攝取量。探究原因,除因教學時間短較難在行為上產生大幅改變外,環境中食物供應-包括學校午餐和家庭供應,仍是無法掌握的因素。故欲提升學童鈣質攝取量至建議量,除加強學童之營養教育外,可能尚須有教育、農業或衛生政策上的配合,例如降價供應學校午餐乳製品等積極性改善學童飲食環境的措施。

    The purpose of this study was to assess the effects of a calcium intake promoting nutrition education program on fifth graders. The program was based on the concept of Social-Ecological Model and also major components of the Health Belief Model and the Social Cognitive Theory. Fifth-grade students from six elementary schools in northern, central, southern areas of Taiwan participated the study. The intervention group (N=178) was provided with a nutrition education program which included four 40-min classroom sessions and 2 parent’s newsletters. The control group (N=174) was not provided with any nutrition education program. The outcomes of the intervention were measured by questionnaires administered one week before (pre-test), a week after (post-test) and four weeks after (follow-up test) the intervention. The results indicated that: the intervention group’s knowledge, preference, self-efficiency and perceived benefits increased, as the perceived barriers decreased. As a result, the calcium intake increased. Although the calcium intake of the intervention group was significantly higher than the control group at the end of the intervention, it was still far below the DOH recommended level. Other than the intervention period was short and insufficient for significant improvement in behavior, school lunch’s failure to meet the recommended standard and the uncertainty of sufficient calcium-rich foods offered at home meals may all be reasons for the discrepancy. Therefore, besides school curriculum, related health and agriculture policies to increase the availability of calcium-rich foods, both in school and family, may be essential to solve the problem of calcium inadequacy of school children.

    目錄 --------------------------------------------------- I 表次 --------------------------------------------------- III 圖次 --------------------------------------------------- VII 第一章 緒論 第一節 研究動機 --------------------------------------- 1 第二節 研究目的------------------------------------------ 2 第三節 研究問題------------------------------------------ 3 第四節 名詞界定------------------------------------------ 3 第五節 研究限制------------------------------------------ 5 第二章 文獻探討 第一節 鈣質簡介------------------------------------------- 7 第二節 國小學童鈣質攝取之現況------------------------------ 17 第三節 營養教育理論--------------------------------------- 18 第四節 提升鈣質攝取相關研究-------------------------------- 27 第三章 研究方法 第一節 研究設計與架構理論---------------------------------43 第二節 研究對象----------------------------------------- 44 第三節 研究工具----------------------------------------- 44 第四節 實施步驟----------------------------------------- 53 第五節 資料處理與分析------------------------------------ 56 第四章 結果與討稐 第一節 受試者學生背景資料---------------------------------57 第二節 鈣質攝取行為影響因素評估--------------------------- 59 第三節 鈣質攝取量成效評估 ----------------------------- 81 第四節 家長及老師回饋 ------------------------------------ 90 第五章 結論與建議 第一節 結論----------------------------------------------93 第二節 建議--------------------------------------------- 94 參考文獻------------------------------------------------ 97 附錄 附錄一 教育介入教學活動、教師手冊、學生手冊及家長單張審 查專家名單-------------------------------------- 107 附錄二 國小高年級提升鈣質攝取營養教育介入教師手冊--------- 109 附錄三 教學光碟--------------------------------------- 151 附錄四 學生手冊--------------------------------------- 159 附錄五 家長單張--------------------------------------- 165 附錄六 國小五年級學童教育介入成效評量問卷各變項的計分方 式與相對題號對照表------------------------------ 167 附錄七 教育介入成效評量問卷審查專家名單------------------- 168 附錄八 教育介入成效評量問卷-------------------------------169 附錄九 國小五年及教育介入評估原始資料鍵入編碼代號說明------- 181 表次 表2-1.1 國人膳食營養素鈣質參考攝取量表--------------------- 13 表2-1.2 食物中鈣質含量----------------------------------- 14 表2-1.3 鈣質來源食物分類表-------------------------------- 15 表2-3.1 改變階段與改變歷程-------------------------------- 22 表2-3.2 改變歷程的介入方法-------------------------------- 22 表2-3.3 社會認知理論的主要概念及應用----------------------- 24 表2-4.1 影響鈣質攝取因素之相關研究------------------------- 31 表2-4.2 國內外鈣質攝取教育介入相關研究--------------------- 36 表3-3.1 國小高年級提升鈣質攝取營養教育介入之重點因子--------- 45 表3-3.2 國小學童鈣質飲食營養教育課程課堂教學部分之教學目 標、教學內容、理論及模式與教學方法------------------ 46 表3-3.3 國小高年級學生提升鈣質攝取家長宣導教育單張內容------- 49 表3-4.1 教育介入實驗設計--------------------------------- 55 表3-4.2 實驗教學活動時間表-------------------------------- 55 表4-1.1 實驗組與控制組學生背景資料之分佈情形與比較--------- 58 表4-2.1 實驗組與控制組個人因素、人際因素、環境因素各項目 之前測、後測及後後測之得分------------------------ 59 表4-2.2 組別 × 性別二因子共變數分析國小高年級提升鈣質攝 取教育介入之結果--------------------------------- 61 表4-2.3 實驗組與控制組個人因素、人際因素、環境因素各項目 之後測及後後測調整後平均得分及F值----------------- 62 表4-2.4 知識--後測組別 × 地區二因子共變數分析摘要表-------- 64 表4-2.5 知識--後後測組別 × 地區二因子共變數分析摘要表------ 64 表4-2.6 知識--後測單純主要效果共變數分析摘要表------------- 64 表4-2.7 知識--後後測單純主要效果共變數分析摘要表----------- 65 表4-2.8 實驗組學校不同地區之知識前測、後測與後後測得分及事後比較- ------------------------------------------------65 表4-2.9 實驗組前測、後測及後後測知識各題答對人數與百分比 分布-------------------------------------------- 66 表4-2.10 喜好--後測組別 × 地區二因子共變數分析摘要表-------- 67 表4-2.11 喜好--後後測組別 × 地區二因子共變數分析摘要表------ 67 表4-2.12 實驗組前測、後測、後後測各項食物喜好人數分布和百 分比-------------------------------------------- 69 表4-2.13 知覺利益-長高--後測組別 × 地區二因子共變數分析摘 要表-------------------------------------------- 70 表4-2.14 知覺利益-長高--後後測組別 × 地區二因子共變數分析 摘要表------------------------------------------ 70 表4-2.15 知覺利益-預防骨質疏鬆症--後測組別 × 地區二因子共 變數分析摘要表----------------------------------- 71 表4-2.16 知覺利益-預防骨質疏鬆症--後後測之組別 × 地區二因 子共變數分析摘要表-------------------------------- 71 表4-2.17 知覺障礙-因味道而不吃--後測組別 × 地區二因子共變 數分析摘要表------------------------------------- 72 表4-2.18 知覺障礙-因味道而不吃--後後測之組別 × 地區二因子 共變數分析摘要表--------------------------------- 72 表4-2.19 知覺障礙-因身體不適而不吃--後測組別 × 地區二因子 共變數分析摘要表--------------------------------- 72 表4-2.20 知覺障礙-因身體不適而不吃--後後測組別 × 地區二因 子共變數分析摘要表-------------------------------- 72 表4-2.21 口味不合會吃--後測之組別 × 地區二因子共變數分析 摘要表------------------------------------------ 74 表4-2.22 口味不合會吃--後後測組別 × 地區二因子共變數分析 摘要表------------------------------------------ 74 表4-2.23 家人都不吃時會吃--後測組別 × 地區二因子共變數分 析摘要表---------------------------------------- 75 表4-2.24 家人都不吃時會吃--後後測之組別 × 地區二因子共變 數分析摘要表------------------------------------- 75 表4-2.25 家人都不吃時會吃--後後測單純主要效果共變數分析摘 要表-------------------------------------------- 75 表4-2.26 實驗組學校不同地區之家人都不吃時會吃前測、後測與 後後測得分及事後比較------------------------------ 75 表4-2.27 家裡沒準備時會吃--後測組別 × 地區二因子共變數分 析摘要表---------------------------------------- 76 表4-2.28 家裡沒準備時會吃--後後測組別 × 地區二因子共變數 分析摘要表--------------------------------------- 76 表4-2.29 有其他食物時會吃--後測組別 × 地區二因子共變數分 析摘要表---------------------------------------- 76 表4-2.30 有其他食物時會吃--後後測組別 × 地區二因子共變數 分析摘要表--------------------------------------- 77 表4-2.31 朋友都不吃時會吃--後測組別 × 地區二因子共變數分析 摘要表-------------------------------------------77 表4-2.32 朋友都不吃時會吃--後後測組別 × 地區二因子共變數分 析摘要表---------------------------------------- 77 表4-2.33 長輩鼓勵--後測組別 × 地區二因子共變數分析摘要表----- 78 表4-2.34 長輩鼓勵--後後測組別 × 地區二因子共變數分析摘要表---- 78 表4-2.35 手足同儕鼓勵--後測組別 × 地區二因子共變數分析摘要表---79 表4-2.36 手足同儕鼓勵--後後測組別 × 地區二因子共變數分析摘要表- 79 表4-2.37 老師鼓勵--後測組別 × 地區二因子共變數分析摘要表------ 79 表4-2.38 老師鼓勵--後後測組別 × 地區二因子共變數分析摘要表---- 79 表4-2.39 廣告明星影響--後測組別 × 地區二因子共變數分析摘要表-- 80 表4-2.40 廣告明星影響--後後測組別 × 地區二因子共變數分析摘要表--80 表4-2.41 家中有而吃--後測組別 × 地區二因子共變數分析摘要表-- 80 表4-2.42 家中有而吃--後後測組別 × 地區二因子共變數分析摘要表-- 81 表4-2.43 學校有而吃--後測組別 × 地區二因子共變數分析摘要表-- 81 表4-2.44 學校有而吃--後後測組別 × 地區二因子共變數分析摘要表---81 表4-3.1 實驗組與控制組前測、後測及後後測鈣質攝取量及以重複量 數單因子變異數分析結果---------------------------- 82 表4-3.2 鈣質攝取量--後測之組別 × 性別 二因子共變數分析摘 要表-------------------------------------------- 82 表4-3.3 鈣質攝取量--後後測之組別 × 性別二因子共變數分析摘 要表-------------------------------------------- 82 表4-3.4 鈣質攝取量--後測之組別 × 地區 二因子共變數分析摘 要表------------------------------------------ 83 表4-3.5 鈣質攝取量--後後測之組別 × 地區二因子共變數分析摘 要表-------------------------------------------- 83 表4-3.6 控制前測後實驗組與控制組鈣質攝取量之後測及後後測 調整平均數-------------------------------------- 83 表4-3.7 實驗組前測、後測、後後測各項食物平均一日鈣質攝取量及佔 每日總鈣量的百分比及以重複量數單因子變異數分析結果---- 85 表4-3.8 實驗組主要鈣質食物(奶類、連骨吃的魚類、豆腐豆干類 及深色蔬菜類)攝食頻率、攝食量及鈣質量-------------- 87 表4-3.9 國小高年級提升鈣質攝取教育介入組別 × 地區別二因子 共變數分析結果總摘要表---------------------------- 89 圖次 圖2-3.1 健康信念模式------------------------------------- 20 圖2-3.2 理性行動論--------------------------------------- 20 圖2-3.3 計畫行為理論------------------------------------- 21 圖2-3.4 健康行動過程取向--------------------------------- 23 圖2-3.5 Precede-Proceed 計畫模式------------------------ 25 圖2-3.6 社會生態模式------------------------------------- 26 圖2-4.1 鈣質攝取之影響因素及教育介入----------------------- 30 圖 3-1.1 提升鈣攝取教育介入研究架構------------------------- 43 圖3-4.1 研究實施步驟之流程圖------------------------------ 54

    1. 中文參考文獻
    行政院衛生署 (民87)。台灣地區食品營養成分資料庫,台北市:行政院衛生署。
    行政院衛生署(民92)。國人膳食營養素參考攝取量及其說明,台北市:行政院衛生署。
    行政院衛生署 (2001)。巿售包裝食品營養標示規範,台北市:行政院衛生署。2006年8月10日取自http://www.doh.gov.tw/ufile/Doc/巿售包裝食品營養標示規範.doc
    朱禹禎(2007)。鈣質與鐵質攝取之飲食頻率問卷發展-青少年信度與效度研究。國立臺灣師範大學人類發展與家庭學系碩士論文。
    李寧遠、朱裕誠、張志平、謝明哲、高美丁 (1991)。民國七十五年至七十七年台灣地區膳食營養狀況調查。中華營誌,16,39-60。
    李蕙蓉、林薇及徐近平(2004)。修定「學校午餐食物內容及營養基準」及建立食譜範例。教育部委託計畫成果報告。
    林薇、劉貴雲、杭極敏、高美丁及楊小淇(2005)。傑克與碗豆,奇幻冒險健康當家-兒童期營養參考手冊,台北市:行政院衛生署。
    林薇(2006)。「台灣地區國中生乳製品攝取相關影響因素探討與教育介入—生態模式用運用」。行政院衛生署94年度科技計畫研究總報告。
    林薇、周麗端、杭極敏(2009)。「台灣地區國小高年級鈣質攝取相關影響因素探討與教育介入—應用precede-proceed 計畫模式」。行政院衛生署96-98年度科技計畫研究總報告(DOH97-TD-F-113-96005)。
    林淑靜(2003)。國小學童乳品攝取及其相關因素研究。國立台北護理學院醫護教育研究所碩士論文。
    教育部 (2006)。教育部全球資訊網。2007年6月11日,取自http://www.edu.tw/EDU_WEB/EDU_MGT/STATISTICS/EDU7220001/bbs/
    remote.hts
    陳師瑩、林佳蓉、高美丁、杭極敏、潘文涵 ( 2004)。學童服用膳食補充品的狀況與相關因素。國小學童營養調查結果學術研討會,台北市:中研院生醫所。
    陳慧君、蕭寧馨(2005)。大骨湯之礦物質含量。中華營誌,30,28-35
    陳懿禎(譯)(2007)。Thierry Souccar 作。牛奶,謊言與內幕。台北市:商周出版
    黃伯超、游素玲、李淑美、高美丁、李寧遠、洪清霖、吳宗賢、楊志良 (1983)。民國六十九年至七十年台灣地區膳食營養狀況調查。中華營誌,8,1-20。
    黃伯超、游素玲 (1993)。營養學精要 (11版) 。台北市:健康文化事業。
    潘文涵、葉乃華、張新儀、高美丁、魏燕蘭 (2004)。以24小時飲食回顧法評估國小學童膳食營養狀況。國小學童營養調查結果學術研討會,台北市:中研院生醫所。
    潘文涵、章雅惠、陳正義、吳幸娟、曾明淑、高美丁 (1999)。以二十四小時飲食回顧法評估國人膳食營養狀況。中華營誌,24,11-39。
    蔡敬民、黃淑惠、王克揚、丁海惠 (1994)。不同的蛋白質、鈣和磷攝取比例對老年雌鼠骨質流失現象之影響。中華營誌,19,233-245

    2. 英文參考文獻
    Abrams, S.A., Grusak, M.A., Stuff, J.E., & O’Brien, K.O. (1997). Calcium and magnesium balance in 9- to 14-year old children. American Journal of Clinical Nutrition, 66, 1172-1177.
    Achterberg, A.& Miller,C.(2004).Is one theory better than another in nutrition education? A viewpoint: More is better. Journal of Nutrition Education and behavior, 36,40-42
    Ackley, S., Barrett-Connor, E., & Suarez, L. (1983). Dairy products, calcium, and blood pressure. American Journal of Clinical Nutrition, 38, 457-461.
    ADA. (1999), Dietary guidance for healthy children aged 2 to 11 years--Position of ADA. Journal of the American Dietetic Association, 99, 93-101.
    Alaimo K, McDowell M.A, Briefel R.R, Bischof A.M, Caughman C.R, Loria C.M, Johnson C.L: “Dietary intake of vitamins,minerals and fiber of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988–91.” Hyattsville, MD: National Center for Health Statistics, Advance Data from Vital and Health Statistics: No.258
    Allen, L.H. (1982).Calcium bioavailability and absorption: A review. American Journal of Clinical Nutrition 35,783-808
    Alles-White, M. L., & Welch, P. (1985). Factor affecting the formation of food preferences in preschool children. Early Child Development and Care, 21, 265-276.
    Angus, R.M., Sambrook, P.N., Pocock, N.A., & Eisman, J.A. (1989). A simple method for assessing calcium intake in Caucasian women. Journal of the American Dietetic Association, 89(2), 209-214.
    Azadbakht, L., Mirmiran, P., Esmaillzadeh,A., & Azizi, F.(2005). Dairy consumption is inversely associated with the prevalence of the metabolic syndrome in Tehranian adults. American Journal of Clinical Nutrition 82,523-530
    Baranowski,T., Perry,C.L. & Parcel,G.S.(1997). How individuals ,environments,and health behavior interact:social cognitive theory.In K.Glanz,F.M.,Lewis & Rimer, B.K.(Eds),Health behavior and health education(2nd ed.,pp157). San CA:Jossey-Bass
    Baranowski,T.,Cullen, k.W.,& Baranowski,J.(1999).psychosocial correlates of dietary intake: Advancing intervention. Annual Review of Public Health.19:17-40
    Barr, S.I. (1994). Associations of social and demographic variables with calcium intake of high school students. Journal of the American Dietetic Association, 94, 260-266.
    Birch, L. L., McPhee, L., Shoba, B. C., Pirok, E., & Steinberg, L. (1987). What kind of exposure reduces children’s food neophobia? Looking vs tasting. Appetite, 1, 171-178.
    Boudreau,D., Livingston, K., Snyder, K., & Seip, R.(1999) Evaluation of a Calcium Education Model Designed for Second and Fifth Grade Girls and Their Parents. Journal of the American Dietetic Association,99 (S9), A56
    Caine-Bish,N. & Gordon, K.L.(2006).Calcium and kids: a pilot program developed to increase calcium intakes in third- through sixth-grade children. Journal of nutrition education and behavior 38,199-200.
    Chen, S.Y., Lin, J.R., Kao, M.D., Hang, C. M., Cheng, L.,& Pan, W. H.(2007)Dietary supplement usage among elementary school children in Taiwan: their school performance and emotional status. Asia Pacific Journal of Clinical Nutrition, 16 (S2), 554-563
    Constans, T., Delarue, J., Rivol, M., Theret, V., & Lamisse, F.(1994) Effects of nutrition education on calcium intake in the elderly. Journal of the American Dietetic Association, 94 (4), 447-448
    Contento,I.R., Blach,G.I.,Bronner,Y.L.,Lytle,L.A.,Maloney,S.K.,Olson,C.M., & Swadener,S.S. (1995). Nutrition education for school-age children. Journal of nutrition education,27(6),278-311
    Contento,I.R.(2007) Nutrition education: linking research, theory, and practice.(pp65). Boston NY:Jones and BartlettPublishers,Inc
    Conner, M., & Armitage, C. J. ( 2002). The social psychology of food (1st ed.,pp6) . Buckingham, MK: Open University Press
    Delmas P.D..(1992). Clinical use of biochemical markers of bone remodeling in osteoporosis. Bone, 13, S17-S21
    Devine, A., Criddle, R.A., Dick, I.M., Kerr, D.A., & Prince, R.I.(1995). A longitudinal study of the effect of sodium and calcium intakes on regional bone density in postmenopausal women. American Journal of Clinical Nutrition , 62,740-745
    Du, X.O., Greenfield, H., Fraser, D.R., Ge, K.Y., Liu, Z.H., & He, W. (2002). Milk consumption and bone mineral content in Chinese adolescent girls. Bone, 30, 521-528.
    Duarte-Gardea, M.O., & Acosta, M.I.(2006)Nutrition education enhances calcium intake in Mexican American pregnant women. Journal of the American Dietetic Association,106(8), A74
    Economos, C., Palombo, R., Wilde, A., & Storper, B.(1997)Osteoporosis Prevention in Adolescents Via Interactive Theater - Program Evaluation By Gender. Journal of the American Dietetic Association, 97 (S9), A22
    Fishbein, L. (2004). Multiple sources of dietary calcium-some aspects of itsessentiality. Regulatory Toxicology and Pharmacology, 39(2), 67-80
    Fisher, J.O., Mitchell, D.C., Smiciklas-Wright, H., & Birch, L.L.(2001). Maternal milk consumption predicts the tradeoff between milk and soft drinks in young girls’ diets. Journal of Nutrition,131,246-250.
    Fleming, K.H. & Heimbach, J. T. (1994) Consumption of calcium in the U.S.:food sources and intake levels. Journal of Nutrition, 124(8 Suppl):1426S–1430S.
    Gielen,A.C., & McDonald,E.M.(1997). The precede-proceed planning model.In K.Glanz,F.M.,Lewis & Rimer, B.K.(Eds), Health behavior and health education(2nd ed.,pp361). San CA:Jossey-Bass
    Goulding, A., Rockell, J. E. P., Black, R. Grant, A.M, Jones, I. & Williams, S. M. (2004). Children Who avoid drinking cow’s milk are at increased risk for prepubertal bone fractures. Journal of the American Dietetic Association, 104,250-253
    Green, L.W., & Kreuter, M.W. (1991). Health promotion planning - An educational and environmental approach. Mountain View, CA: Mayfield Publishing Company.
    Gueguen, L., & Pointillart, A. (2000). The bioavailability of dietary calcium. Journal of the American College Nutrition, 19(2), 119S-136S
    Hang, C. M., Lin, W., Yang, H. C., & Pan,W. H.( 2007). The relationship between snack intake and its availability of 4th-6th graders in Taiwan. Asia Pacific Journal of Clinical Nutrition, 16(S2),547-553
    Hazavehei, S. M., Taghdisi, M. H., & Saidi, M.(2007)Application of the health belief modek for ostroporosis prevention among middle school girl students, Garmsar, Iran. Education For Health,20(1),1-11
    Hajjar, I. M., Grim, C. E., Kotchen, T. A.(2003)Dietary Calcium Lowers the Age-Related Rise in Blood Pressure in the United States: The NHANES III Survey. Journal of Clinical Hypertens, 5, 122-126
    Health Canada (2002). Dietary sources of calcium (based on usual serving size).Retrieved December 6, 2005, from the World Wide Web:http://www.hc-sc.gc.ca/fn-an/nutriton/prenatal/national_guildeline_directrices_nationals-07-tablel_e.html.
    Heaney, R.P., Recker, R.P., and Hinders, SM. (1988) Variability of calcium absorption. American Journal of Clinical Nutrtioni, 47, 262-264
    Heaney, R.P. (2002). The importance of calcium intake for lifelong skeletal health. Calcified Tissue International, 70, 70-73.
    Hearn M.D., Baranowski T., , Baranowski J., Doyle C.,Smith M.,Lin L.S., Resnicow K.(1998)Environmental influences on dietary behavior among children: Availability and accessibility of fruit and vegetables enable consumption. J Health Edu. 29:26-32
    Hirota, T, Kusu, T. & Hirota, K. (2005).Improvement of nutrition stimulates bone mineral gain in Japanese school children and adolescents. Osteoporos Int 16, 1057–1064
    Jensen, J.K., Gustafson, D., Boushey, C.J., Auld, G., Bock, M.A., Bruhn, C.M., Gabel, K., Misner, S., Novotny, R., Peck, L., & Reed, M. (2004). Development of a food frequency questionnaire to estimate calcium intake of Asian, Hispanic, and White youth. Journal of the American Dietetic Association, 104(5), 762-770.
    Johnston, C.C., Miller, J.Z., Slemenda, C.W., Reister, T.K., Hui, S., Christian J.C., & Peacock, M. (1992). Calcium supplementation and increases in bone mineral density in children. The New England Journal of Medicine, 327, 82-87.
    Jorde, R.and Bønaa,K.H.(2000).Calcium from dairy products, vitamin D intake, and blood pressure: the Tromsø study.Am. Journal of Clinical Nutrition,, 71, 1530 - 1535.
    Lee, S., & Reicks, M. (2003). Environmental and behavioral factors are associated with the calcium intake of low-income adolescent girls. Journal of the American Dietetic Association, 103(11), 1526-1529.
    Larson, M.I., Story, M., Wall, M., & Neumark-Sztainer, D.(2006). Calcium and dairy intakes of sdolescent are associated with their home environment, taste preferences, personal healthy beliefs, and meal patterns. Journal of the American Medical Association, 106(11), 841-844.
    Lloyd, T., Andon, M.B., Rollings, N., Marktel, J.K., Landis, R., demers, L.M., Eggli, D.F., Kieselhorst, K., & Kulin, H.E. (1993). Calcium supplementation and bone mineral density in adolescentgirls. Journal of the American Medical Association, 270, 841-844.
    Lipkin, M., & Newmark, H.L. (1999). Vitamin D, calcium and prevention of breast cancer: a review. Journal of the American College of Nutrition, 18, 392S-397S.
    Margen, S., Chu, J.Y., Kaufmann, N.A., and Calloway, D.H. (1974) Studies in calcium metabolism I. The calciuretic effect of dietary protein. American Journal of Clinical Nutrition, 27, 584-589
    McCarron, D.A., & Reusser, M.E. (2001). Are low intakes of calcium and potassium important causes of cardiovascular disease? American Journal of Hypertension, 14, 206S-212S.
    McPherson, R.S., Montgomery, D.H., & Nichaman, M.Z. (1995). Nutritional status of children: What do we know? Journal of Nutrition Education, 27(5), 225-234.
    Mirmiran, P., Esmaillzadeh,A., & Azizi, F. (2005). Dairy consumption and body mass index: an inverse relationship. International Journal of Obesity,29,115-121.
    Montano,D.E.,Kasprzyk,D. & Taplin,S.A.(1997). The theory of reasoned action and the theory of planned behavior.In K.Glanz,F.M.,Lewis & Rimer, B.K.(Eds),Health behavior and health education(2nd ed.,pp87,92). San CA: Jossey-Bass
    Moormen, P.G. & Terry, P. (2004)Consumption of dairy products and the risk of breast cancer: a review of the literature. American Journal of Clinical Nutrition, 80, 5-14
    Mothersbaugh, D.L., Herrmann, R.O., & Warland, R.H. (1993). Perceived time pressure and recommended dietary practices: the moderating effect of knowledge of nutrition. The Journal of Consumer Affairs, 27,106-126.
    Morton JM, Bruhn CM(2006) Development of a Multi-Sensorial Nutrition Education Program for Children and Their Parents: Bone Appetit! and the Calcium Cooking Class Program. Journal of the American Dietetic Association, 106 ( S8), A48)
    Mullen, P.D., Hersey, J.C., & Iveson, D.C. (1987). Health behavior models compared. Social Science & Medicine, 24(11), 973-981.
    Nieves, J.W., Golden, A.L., Siris, E., Kelsey, J.L., & Linsay, R. (1995). Teenage and current calcium intake are related to bone mineral density of the hip and forearm in women aged 30-39 years. American Journal of Epidemiology, 141, 342-351.
    Nicklas,T.A.(2003). Calcium intake trends and health consequences from childhood through adulthood.Journal of the American College of Nutrition, 22, 340–356
    NIH Consensus Development Panel on Calcium Intake. (1994). Optimal calcium intake. Journal of American Medical Association, 272, 1942-1948.
    Novotny, R., Han, J-S., & Biernacke, I. (1999). Motivators and barriers to consuming calcium-rich foods among Asian adolescents in Hawaii. Journal of Nutrition Education, 31, 99-104.
    Novotny, R., Boushey, C., Bock, M A., Peck, L., Auld, G., Bruhn, C.M., Gustafson, D., Gabel, K., Jensen, J. K., Scottie Misner, S., & Read, M.,(2003). Calcium Intake of Asian, Hispanic and White Youth. Journal of the American College of Nutrition, 22, 64–70.
    Pereira, M. A., Jacobs, Jr. D. R., Van Horn, L., Slattery, M. L., Kartashov, A. I., &  Ludwig, D. S. (2002). Dairy consumption, obesity, and the insulin resistance syndrome in young adults: The CARDIA Study. Journal of the American Dietetic Association, 287, 2081-2089.
    Perry,C.L.,Klepp,K. I.,Ha;per, A.,Dudovitz,B.,Golden,D.,Griffin,G.,& Smyth,M.(1987). Promotion healthy eating and physical activity patterns aming adliescent: A pilot study of‘Slice of Life’.Health education Research,2(2),93-103
    Prentice, A. (2004). Diet, nutrition and the prevention of osteoporosis. Public Health Nutrition, 7(1A), 227-243.
    Prochaska,J.O.,Redding,C.A., & Evers,K.E.(1977) The transtheoretical model and stages of change.In K.Glanz,F.M.,Lewis & Rimer, B.K.(Eds),Health behavior and health education(2nd ed.,pp62-64,69). San CA:Jossey-Bass
    USDA(2007)Alternate menu planning approaches-calorie and nutrient standards. Retrieved December 10, 2007, from the World Wide Web:http://www.fns.usda.gov/cnd/Governance/Policy-Memos/2008/SP%2003-2008-OS.pdf
    USDA(n.d.) The special supplemental nutrition program for women, infants and children. Retrieved December 10, 2007, from the World Wide Web: http://www.fns.usda.gov/wic/WIC-Fact-Sheet.pdf
    Reed, D.B., Meeks, P.M., Nguyen, L., Cross, E.W., & Garrison, M.E.B. (1998). Assessment of nutrition education needs related to increasing dietary calcium intake in low-income Vietnamese mothers using focus group discussion. Journal of Nutrition Education, 30,155-163.
    Robinson,C.H. & Lawler,M.R.(1997)Normal and therapeutic nutrition.(16th ed.)NY:Macmilln Publishing CO. p.322
    Schwarzer, R. (1992). Self-efficacy in the adoption and maintenance of health behaviors: Theoretical approaches and a new model. In R. Schwarzer (Ed.), Self-efficacy: Thought control of action (pp. 217–243). Washington, DC: Hemisphere.
    Shapses, S.,A,.Robins, S. P., Schwartz, E. I., & Chowdhury, H. (1995) Short-term changes in calcium but not protein intakes alter the rate of bone resorption in healthy subjects as assessed by urinary pyridinium cross-link excretion. Journal of Nutrution, 125, 2814-2821
    Skinner, J. D., Bounds, W., Carruth, B. R., & Ziegler, P. (2003) Longitudinal calcium intake is negatively related to children’s body fat indexes. Journal of the American Dietetic Association, 103,1626-1631
    Shirazi,K.K., Niknami, S., Wallace, L., Hidarnia, A., Rahimi, E., & Faghihzadeh, S.(2006)Changes in self-efficacy and decisional balance following an intervention to increase consumption of calcium-rich foods. Social Behavior And Personality,34(8),1007-1016
    Slemenda, C.W., Reister, T.K., Peacock, M., & Johnston, C.C. (1993). Bone growth in children following the cessation of calcium supplementation. Journal of Bone and Mineral Research, 8, S154.
    Strecher,V.J. Rosenstock,I.M.(1997). The health belief model. In K.Glanz,F.M.,Lewis & Rimer, B.K.(Eds), Health behavior and health education(2nd ed.,pp48). San CA:Jossey-Bass
    Stuewe, R.L., Niemi, R.(1998) Using Professional Sports Teams to Educate Elementary Students About the Importance of Calcium in the Diet. Journal of the American Dietetic Association, 98(9), A41
    Subar, A.F., Thompson, F.E., Smith, A.F., Jobe, J.B., Ziegler, R.G., Potischman, N., Schatzkin, A., Hartman, A., Swanson, C., Kruse,L., Hayes, R.B., Lewis, D.R., & Harlan, L.C. (1995). Improving food frequency questionnaires: a qualitative approach using cognitive interviewing. Journal of the American Dietetic Association, 95(7), 781-788.
    Sullivan, S.A., & Birch, L. L. (1994). Infant dietary experience and acceptance of solid foods. Pediatrics, 93(2), 271-277.
    Teegarden, D., Lyle, R.M., Proulx, W.R., Johnston, C.C., & Weaver, C.M. (1999). Previous milk consumption is associated with greater bone density in young women. American Journal of Clinical Nutrition, 69, 1014-1017.
    Trevisan, M., Krogh, V., Farinaro, E., Panico, S., & Mancini, M. (1988). Calcium rich foods and blood pressure: findings from the Italian National Research Council Study (The Nine Community Study). American Journal of Epidemiology, 127(6), 1155-1163.
    Tsai, K.S. (1997). Osteoporotic fracture rate, bone mineral density, and bone metabolism. Journal of Formos Medical Association, 96(10), 802-805.
    Tsai, K.S., Twu, S.J., Chieng, P.U., Yang, R.S., & Lee, T.K. (1996). Prevalence of vertebral fractures in Chinese men and women in urban Taiwanese communities. Calcified Tissue International, 59, 249-53.
    Turner, L.W., Hunt, S.B.,、DiBrezzo, R., & Joner, C.(2004)Design and Implementation of an ostroporosis prevention program using the health belief model. American Journal of Health Studies,19(2), 115-121
    Tussing, L., & Chapman-Novakofski, K.(2005)Doing the Math for Calcium! See It, Do It, Teach It!. Journal of the American Dietetic Association,105(1), 92-97
    Walker RM and Linkswiler HM,1972 Calcium retention in the adult human male as affected by protein intake. J Nutr 102:1297-1302Willett, W. (1998). Nutritional epidemiology. New York: Oxford University Press.
    Witteman, J.C.M., Willett, W.C., Stampfer, M.J., Colditz, G.A., Sacks, F.M., & Speizer, F.E. et al. (1989). A prospective study of nutritional factors and hypertension among US women. Circulation, 80(5), 1320-1327.
    Willett, W. (1998). Nutritional epidemiology. New York: Oxford University Press
    Wright, J. D., Wang, C. Y., Kennedy-Stephenson, J., & Ervin, R. B. (2003). Dietary intake of ten key nutrients for public health, United States: 1999–2000. National Center for Health Statistics, Advance Data from Vital and Health Statistics: No.334
    Wu, S.J, Pan,W.H., Yeh, N.H., Chang, H.Y.(2007)Dietary nutrient intakes and food sources: results from the Nutrition and Health Survey in Taiwan Elementary School children 2001-2002. Asia Pacific Journal Clinical Nutrition, 16(S2), 518-533.
    Zemel, M. B., & Miller, S. L. (2004) Dietary calcium and dairy modulation of adiposity and obesity risk. Nutrition Reviews, 62, 125-131.

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