後疫情時代中部某醫學大學學生自覺COVID-19威脅與其飲食取得方式之關聯性

研究背景：COVID-19疫情自2019年末在中國武漢地區大爆發，且在短短幾個月內在全球間大流行。然而，在疫情大流行的三年期間，台灣曾出現多次疫情高峰，而中央流行疫情指揮中心也曾在2021年5月19日宣布將全國疫情警戒提升至第三級。為了避免群聚，教育機構在三級警戒期間也開始採取遠距教學，許多大學生也從宿舍返回家鄉，居住安排的改變以及政府在全國疫情二級及三級警戒期間對於餐飲業及用餐方式之相關政策規範可能會導致大學生在疫情期間的飲食取得方式隨之改變，此影響也可能會從疫情期間延續到後疫情時代甚至是解封之後。研究目的：本研究欲探討以下四個目的：(1)大學生自述之飲食取得方式及其在疾病降級前後之差異；(2)疾病降級與大學生飲食取得方式之關聯性；(3)大學生自覺COVID-19威脅與飲食取得方式之關聯性；(4)大學生飲食取得方式之相關因素及其在性別之差異。材料與方法：本研究係針對某一大學生世代進行兩次橫斷式研究（cross-sectional study），分別於兩次橫斷調查時間以中山醫學大學大學部之學生為研究對象進行線上問卷調查。第一次橫斷調查時間為2023年3月20日至2023年5月5日(n=1030)，第二次橫斷調查時間為2023年10月16日至2023年12月1日(n=1049)。本研究之依變項：飲食取得方式包括到餐廳用餐、外出購買食物、訂購外送及在家下廚。本研究亦使用SAS 9.4統計分析軟體進行敘述性統計、t檢定、ANOVA、卡方檢定、多元線性回歸分析以及多變項羅吉斯回歸分析。結果：(1)過去一個月與疫情期間相比，大學生自述疾病降級後，增加到餐廳用餐頻率之人數比例(45.76%)顯著高於降級前(30.68%)(P<.0001)；增加外出購買食物頻率之人數比例(36.61%)顯著高於降級前(29.81%)(P=0.0041)；減少訂購外送頻率之人數比例(24.12%)顯著高於降級前(16.31%)(P<.0001)。疾病降級後，大學生自述過去一個月與疫情前相比到餐廳用餐頻率不變的人數比例(59.87%)顯著高於降級前(57.86%)(P<.0001)；(2)在控制社會人口學變項及自覺COVID-19威脅之後，疾病降級後經常到餐廳用餐的可能性是疾病降級前的1.37倍，疾病降級後會訂購外送是疾病降級前的0.82倍；(3)在控制疾病降級以及社會人口學變項之後，自覺COVID-19威脅不論是自覺COVID-19易感受性亦或是自覺COVID-19嚴重度皆不影響大學生在後疫情時代之飲食取得方式；(4)男性、低年級、臨床科系、住學校宿舍或在外租屋者，經常到餐廳用餐的可能性較高；男性、住學校宿舍或在外租屋者，經常外出購買食物的可能性較高；女性、自己或同住者有COVID-19相關經驗者會訂購外送的可能性較高；女性、臨床科系、與家人同住者會在家下廚的可能性較高。此外，到餐廳用餐之相關因素在性別上的差異包含：疾病降級、年級；在家下廚之相關因素在性別上的差異包含：年級、居住安排、COVID-19疫苗接種狀況。結論：本研究發現，大學生之飲食取得方式與COVID-19降級有關，疾病降級後會增加到餐廳用餐並減少訂購外送的可能性，本研究也發現大學生在後疫情時代的飲食取得方式已不受自覺COVID-19威脅之影響。此外，大學生飲食取得方式及其相關因素均有性別差異。研究限制及重要建議：研究限制：本研究之研究對象為中山醫學大學大學部之學生，因此本研究之研究結果無法外推至台灣其他地區之大學生，亦無法外推到其他年齡層。此外，本研究請研究參與者自述過去一個月飲食取得方式及過去一個月分別與疫情期間及疫情前相比飲食取得方式之改變情形，因此可能會有回憶偏差(recall bias)。本研究為橫斷面研究，因此無法清楚了解變項之間的因果關係。由於研究參與者可自由決定是否參與本研究，因此會有選樣偏差(selection bias)。重要建議：建議可擴大研究範圍至(1)台灣其他縣市之大學生(2)不同年齡層，以探討不同縣市之大學生或是不同年齡層在飲食取得方式相關因素之差異。

Background:The COVID-19 pandemic, which erupted in Wuhan,China at the end of 2019, and rapidly spread globally within a few months. However,during the three-year of COVID-19 pandemic,the number of COVID-19 cases had peaked at several time point in Taiwan, and Central Epidemic Command Center had announced that the nationwide Level 3 alert for COVID-19 in May 19,2021.To avoid gathering, educational institutions started to adopt distance education during the Level 3 alert period,and many college students moved from their school dormitory to their hometown.The changing of the living arrangement and the government implemented preventing measures in restaurant industry during the Level 2 and Level 3 nationwide alert of COVID-19,which might influenced the food acquisition behavior among college students during the pandemic,and the effects might possibly persisting across times.Objectives:(1)Difference in changes of food acquisition behavior before and after COVID-19 de-escalation among college students.(2)The relationship between COVID-19 de-escalation and the food acquisition behaviors.(3)The relationship between perceived COVID-19 threat and the food acquisition behaviors among college students.(4)The related factors of food acquisition behaviors among college students,and the factors differents by genders.Methods:This study is a two cross-sectional surveys among a college students cohort.Our study conducted online questionnaires survey at two different time points,the first wave was conducted from March 20 to May 5, 2023 (n=1030), and the second wave was conducted from October 16 to December 1, 2023 (n=1049).The dependent variable in our study including four kinds of food acquisition:dining out,taking out food,ordering delivery services and home cooking.The data were analyzed using SAS 9.4 statistical software, and the statistical method such as descriptive statistics, t-tests, ANOVA, chi-square tests, multiple linear regression analysis, and multivariate logistic regression analysis were used for analysis.Results:(1) Compared to the pandemic period, after COVID-19 de-escalation,the proportion of the college students who self-reported increasing dining out during the past month (45.76%)was significantly higher than before COVID-19 de-escalation (30.68%)(P<.0001).The proportion of the college students who self-reported increasing taking out food during the past month (36.61%) was significantly higher than before COVID-19 downgrade (29.81%)(P=0.0041).The proportion of the college students who reported decreasing ordering delivery services during the past month (24.12%%)was significantly higher than before COVID-19 downgrade (16.31%)(P<.0001).Compared to Pre-pandemic, after COVID-19 de-escalation,the proportion of the college students who reported neither increasing nor decreasing dining out during the past month (59.87%) was significantly higher before COVID-19 de-escalation (57.86%)(P<.0001)；(2)After controlling sociodemographic variables and perceived COVID-19 threat, the likelihood of dining out after COVID-19 downgrade was 1.37 times higher than before the downgrade, and the likelihood of ordering food delivery services after COVID-19 downgrade was 0.82 times lower than before COVID-19 de-escalation；(3)After controlling for the COVID-19 de-escalation and sociodemographic variables, perceived COVID-19 threat did not affect the food acquisition behavior among college students in the post-pandemic era；(4)Male,lower grade,clinical student,living in the school dormitory or renting house off-campus are more likely to dine out.Male, living in the school dormitory or renting house off-campus are more likely to take out food.Female,the people or their coresidents who had covid-19 experience are more likely to order delivery services. Female,clinical students,and the people who live with their parents are more likely to cook at home. Additionally,the factors related to dining out difference on genders including: COVID-19 de-escalation and grade.The factors related to cooking at home were different on genders including:grade,living arrangement and COVID-19 vaccination status.Conclusions:This study found that the food acquisition behaviors among college students was related to COVID-19 de-escalation.Our study also found that the food acquisition behaviors of college students will nolonger be influenced by perceived COVID-19 threat in the post-pandemic era.Besides,the related factors of food acquisition behaviors also had gender differentiation.Limitation&Suggestions:Limitation:The study population of our study is undergraduated students in Chung Shang Medical University.Therfore,the results of our study can not be estimated to other counties or other age groups in Taiwan.Moreover,the participants reported their food acquisition in the past month and compare to covid-19 period and pre-covid-19,their responses may have recall bias. Furthermore,the participants can make their own decisions whether they participate in our research or not,it may have selection bias.Suggestions:It is recommended to expand the study scope to (1)The college students study in other counties in Taiwan, (2)Other age groups to explore the influence factors in different counties or age groups.