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系統識別號 U0026-2508201514402800
論文名稱(中文) 臺灣觀光領隊人員自述健康問題之研究
論文名稱(英文) Self-reported health of tour managers in Taiwan
校院名稱 成功大學
系所名稱(中) 環境醫學研究所
系所名稱(英) Institute of Environmental and Occupational Health
學年度 103
學期 2
出版年 104
研究生(中文) 藍凡耘
研究生(英文) Fan-Yun Lan
學號 S76021127
學位類別 碩士
語文別 英文
論文頁數 55頁
口試委員 指導教授-郭浩然
口試委員-吳政龍
口試委員-曾妍娟
召集委員-蘇世斌
中文關鍵字 領隊  健康  旅遊醫學  職業 
英文關鍵字 tour manager  tour leader  tour escort  travel medicine  occupation  health 
學科別分類
中文摘要 ■ 目的
有鑑於旅行途中有明確傳染病、時差、和暈車暈船等健康風險,但有關具高度風險的「觀光領隊」的研究卻極為欠缺,本計畫探討臺灣觀光領隊的健康問題盛行狀況,以了解旅遊之健康風險在此高暴露族群中的表現。
■ 方法
本研究採橫斷式設計,暴露組為兼職或專任領隊、對照組為旅行社內勤行政人員。透過中華民國觀光領隊協會、一個商業同業公會、及一個旅行社主題旅遊部的協助,於2014年10月至2015年2月間,在觀光領隊聚會場合及旅行社辦公場所發送匿名問卷。問卷內容包括基本資料、醫療病史、頻繁症狀、以及職業安全衛生觀念。研究結果以SPSS第17版進行統計分析,藉單變項與多變項回歸計算職業暴露與健康風險之相關性。
■ 結果與討論
本研究共收案390名,其中包括內勤行政人員238名、兼職領隊95名、專任領隊57名。行政人員以女性為多(73.1%,領隊組為52.0%,p值< 0.001)。領隊組年紀較長(平均46.8歲,相較行政人員平均34.2歲,p值< 0.001)、教育程度較高(p值=0.011)、有較高的飲酒比率(p值=0.004)、且上班日較少的睡眠時間(平均5.8±1.3小時,相較行政人員平均6.9±1.2小時);身體質量指數(BMI)及抽菸比例則在二組無明顯差異。
至於自述健康狀況,經校正性別、年紀、教育程度、和飲酒後,觀光領隊自述罹患胃食道逆流比例較對照組為高(勝算比:3.8,95%信賴區間:1.2-11.7),下背痛亦然(勝算比:6.1,95%信賴區間:1.6-23.9)。更進一步進行趨勢檢定結果顯示,隨著加權工作年資的增加,自述消化性潰瘍/胃炎、胃食道逆流、及下背痛的比例亦增加(p值皆<0.05)。
比較在不同帶團區域的領隊,發現校正性別、年齡、教育程度、BMI、吸菸、飲酒、和多重區域帶團因素後,帶團至東北亞的領隊有較多近三個月咳嗽的症狀(勝算比:14.9,95%信賴區間:3.1-70.7)。
在職業安全衛生相關觀念方面,領隊比行政人員有較佳健康行為,包括定期健康檢查、查詢旅遊地疫情、和旅遊醫學門診諮詢情形(p值皆<0.05);然而即便領隊也僅有19.9%於出發前會至旅遊醫學門診諮詢。
■ 結論
本研究根據觀光領隊的自填問卷回覆,顯示觀光領隊胃食道逆流及下背痛的罹患比例較旅行業內勤人員為高。研究也發現隨著領隊工作年資增加,自述消化性潰瘍/胃炎、胃食道逆流、及下背痛等健康問題呈現出劑量-反應效應。此外,帶團至東北亞的領隊有較多自述三個月內咳嗽的症狀。
英文摘要 # Objective
Although travel is associated with obvious health hazards such as infection, circadian rhythm disruption, and vehicle sickness, there are few studies on the health conditions of tour managers, who are frequently exposed to these hazards. Therefore, we conducted a survey on health conditions of tour agency employees in Taiwan.
# Methods
We adopted a cross-sectional study design and recruited tour managers and office staff in tour agencies. With assistance of the Association of Tour Managers, Taiwan, a local trade association of travel agents, and a tour company, we sent anonymous questionnaires to the participants, which collected data on demographic characteristics, medical history, symptoms, and concepts of occupational health. The study period was from Oct. 2014 to Feb. 2015. We used logistic regression models to evaluate relationship between work exposure and health outcomes. The data were analyzed using software SPSS V17.0.
#Results and Discussion
There were a total of 390 respondents, including 238 office staff, 95 part-time tour managers, and 57 full-time tour managers. We found a female predominance in the office staff (73.1% versus 52.0%, p < 0.001). Tour managers were older (average 46.8 versus 34.2 years old, p < 0.001) and had higher education levels (p = 0.011). Tour managers had higher prevalence of alcohol consumption (p = 0.004) and slept less during a typical work day (average 5.8±1.3 versus 6.9±1.2 hours). There was no significant difference in the body mass index (BMI) and smoking history between the two groups. As to health outcomes, tour managers were more likely to have gastroesophageal reflux disease (GERD) (odds ratio [OR]: 3.8, 95% confidence interval [CI]: 1.2-11.7) and lower back pain (OR: 6.1, 95% CI : 1.6-23.9), after adjusting forsex, age, education level, and alcohol consumption. Furthermore, the prevalence of peptic ulcer/gastritis, GERD, and lower back pain increased as the weighted job tenure increased (all with p <0.05 for test for trend). In further analyses of data on tour managers, we found those who managed tours to North-East Asia reported more recent coughs (OR: 14.8, 95%CI: 3.1-70.7), after adjusting for effect of multiple tour-leading areas, sex, age, BMI, educational level, smoking, and alcohol consumption. As for concepts of occupational health, tour managers did better than office staff, regarding regular health check-up, seeking for health information before traveling, and seeking for advice from travel medicine specialists (all p<0.05), while only 19.9% tour managers sought for advice from travel medicine specialists.
#Conclusion
The study found higher prevalence of self-reported GERD and lower back pain among tour managers compared to office staff. We also found that as the duration of being a tour manager increased, peptic ulcer/gastritis, GERD, and lower back pain were more likely to be reported. In addition, tour managers managing tours to North-East Asia reported more coughs in the past three months.
論文目次 摘 要 i
Abstract   ii
誌 謝 iii
目 錄 iV
表 目 錄 Vi
本 文 1
I. Introduction 1
A. Background and motivation 1
B. Research questions 2
II. Literature review 2
A. Health problems among travelers 2
B. Health problems among flight attendants 4
1. Respiratory system 4
2. Malignancy 5
3. Mental conditions 5
4. Cardiovascular system 6
III. Significance 6
A. Objectives 6
B. Significance 6
IV. Materials and methods 7
A. Study structure and study design 7
1. Tour manager 7
2. Office staff in tour agencies 7
3. Questionnaire survey 7
4. Health outcome comparison 7
5. Other comparison  8
B. Statistical analysis 8
C. Ethical statement 8
V. Results   9
A. Respondent 9
B. Demographic data and personal factors 9
C. Health outcomes 10
1. Self-reported diseases 10
2. Self-reported symptoms in recent three months 10
D. Test for trend 11

1. Categorized by the proportion of working as a tour manager in the whole career 11
2. Categorized by adjusted job tenure of working as a tour manager 11
E. Comparison between main tour-leading areas 12
1. Demographic data and personal factors of tour managers with different tour-leading areas 12
2. Comparisons of self-reported health outcomes of tour managers with different tour-leading areas 12
F. Concepts of occupational health 13
1. Regular health check-up 14
2. Insights of health conditions 14
3. Health behaviors of traveling 14
VI. Discussion 14
A. Health problems amongst tour managers 15
B. Comparison between different tour-leading areas 19
C. Concept of occupational health amongst tour managers    20
D. Limitations of the study   22
E. Further efforts warranted 23
References 41
附 錄 - 旅遊從業人員健康狀況調查問卷 46
參考文獻 Abu Dabrh AM, Firwana B, Cowl CT, Steinkraus LW, Prokop LJ, Murad MH. 2014. Health assessment of commercial drivers: A meta-narrative systematic review. BMJ open 4:e003434.
Albert WJ, Everson D, Rae M, Callaghan JP, Croll J, Kuruganti U. 2014. Biomechanical and ergonomic assessment of urban transit operators. Work (Reading, Mass) 47:33-44.
Arjomandi M, Haight T, Redberg R, Gold WM. 2009. Pulmonary function abnormalities in never-smoking flight attendants exposed to secondhand tobacco smoke in the aircraft cabin. Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 51:639-646.
Arroyo MT, Forne M, de Argila CM, Feu F, Arenas J, de la Vega J, et al. 2004. The prevalence of peptic ulcer not related to helicobacter pylori or non-steroidal anti-inflammatory drug use is negligible in southern europe. Helicobacter 9:249-254.
Beatty AL, Haight TJ, Redberg RF. 2011. Associations between respiratory illnesses and secondhand smoke exposure in flight attendants: A cross-sectional analysis of the flight attendant medical research institute survey. Environmental health : a global access science source 10:81.
Bellack NR, Koehoorn MW, MacNab YC, Morshed MG. 2006. A conceptual model of water's role as a reservoir in helicobacter pylori transmission: A review of the evidence. Epidemiology and infection 134:439-449.
Bovenzi M, Hulshof CT. 1999. An updated review of epidemiologic studies on the relationship between exposure to whole-body vibration and low back pain (1986-1997). International archives of occupational and environmental health 72:351-365.
Bovenzi M. 2010. A longitudinal study of low back pain and daily vibration exposure in professional drivers. Industrial health 48:584-595.
Bowling TE, Cliff B, Wright JW, Blackshaw PE, Perkins AC, Lobo DN. 2008. The effects of bolus and continuous nasogastric feeding on gastro-oesophageal reflux and gastric emptying in healthy volunteers: A randomised three-way crossover pilot study. Clinical nutrition 27:608-613.
Buja A, Mastrangelo G, Perissinotto E, Grigoletto F, Frigo AC, Rausa G, et al. 2006. Cancer incidence among female flight attendants: A meta-analysis of published data. Journal of women's health 15:98-105.
Chang RCY, Kivela J, Mak AHN. 2011. Attributes that influence the evaluation of travel dining experience: When east meets west. Tourism Manage 32:307-316.
Chiang CY, Chen WC. 2014. The impression management techniques of tour leaders in group package tour service encounters. J Travel Tour Mark 31:747-762.
Chiodini JH, Anderson E, Driver C, Field VK, Flaherty GT, Grieve AM, et al. 2012. Recommendations for the practice of travel medicine. Travel medicine and infectious disease 10:109-128.
Coben RM, Weintraub A, DiMarino AJ, Jr., Cohen S. 1994. Gastroesophageal reflux during gastrostomy feeding. Gastroenterology 106:13-18.
Cuomo R, Andreozzi P, Zito FP, Passananti V, De Carlo G, Sarnelli G. 2014. Irritable bowel syndrome and food interaction. World journal of gastroenterology : WJG 20:8837-8845.
Driver CR, Valway SE, Morgan WM, Onorato IM, Castro KG. 1994. Transmission of mycobacterium tuberculosis associated with air travel. JAMA : the journal of the American Medical Association 272:1031-1035.
Ebbert JO, Croghan IT, Schroeder DR, Murawski J, Hurt RD. 2007. Association between respiratory tract diseases and secondhand smoke exposure among never smoking flight attendants: A cross-sectional survey. Environmental health : a global access science source 6:28.
Eisner MD, Blanc PD. 2002. Environmental tobacco smoke exposure during travel among adults with asthma. Chest 122:826-828.
Faucett J, Rempel D. 1994. Vdt-related musculoskeletal symptoms: Interactions between work posture and psychosocial work factors. American journal of industrial medicine 26:597-612.
Fiore DC, Hall S, Shoja P. 2010. Altitude illness: Risk factors, prevention, presentation, and treatment. American family physician 82:1103-1110.
Freedman DO, Weld LH, Kozarsky PE, Fisk T, Robins R, von Sonnenburg F, et al. 2006. Spectrum of disease and relation to place of exposure among ill returned travelers. The New England journal of medicine 354:119-130.
Gautret P, Gaudart J, Leder K, Schwartz E, Castelli F, Lim PL, et al. 2012. Travel-associated illness in older adults (>60 y). Journal of travel medicine 19:169-177.
Graham DY, Adam E, Reddy GT, Agarwal JP, Agarwal R, Evans DJ, Jr., et al. 1991. Seroepidemiology of helicobacter pylori infection in india. Comparison of developing and developed countries. Digestive diseases and sciences 36:1084-1088.
Greenwood Z, Black J, Weld L, O'Brien D, Leder K, Von Sonnenburg F, et al. 2008. Gastrointestinal infection among international travelers globally. Journal of travel medicine 15:221-228.
Hagmann S, Neugebauer R, Schwartz E, Perret C, Castelli F, Barnett ED, et al. 2010. Illness in children after international travel: Analysis from the geosentinel surveillance network. Pediatrics 125:e1072-1080.
Hamer DH, Connor BA. 2004. Travel health knowledge, attitudes and practices among united states travelers. Journal of travel medicine 11:23-26.
Hirschowitz BI, Lanas A. 2002. Atypical and aggressive upper gastrointestinal ulceration associated with aspirin abuse. Journal of clinical gastroenterology 34:523-528.
Holm S. 1979. A simple sequentially rejective multiple test procedure. Scandinavian journal of statistics:65-70.
Japan. Monthly weather report. Available: http://www.jma.go.jp/jma/indexe.html.
Khan K, Arino J, Hu W, Raposo P, Sears J, Calderon F, et al. 2009. Spread of a novel influenza a (h1n1) virus via global airline transportation. The New England journal of medicine 361:212-214.
Korea. Monthly weather report. Available: http://web.kma.go.kr/eng/index.jsp.
Lanciotti RS, Kosoy OL, Laven JJ, Panella AJ, Velez JO, Lambert AJ, et al. 2007. Chikungunya virus in us travelers returning from india, 2006. Emerging infectious diseases 13:764-767.
Leder K, Black J, O'Brien D, Greenwood Z, Kain KC, Schwartz E, et al. 2004. Malaria in travelers: A review of the geosentinel surveillance network. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 39:1104-1112.
Leder K, Newman D. 2005. Respiratory infections during air travel. Internal medicine journal 35:50-55.
Leder K, Steffen R, Cramer JP, Greenaway C. 2015. Risk assessment in travel medicine: How to obtain, interpret, and use risk data for informing pre-travel advice. Journal of travel medicine 22:13-20.
Levin KA. 2006. Study design iii: Cross-sectional studies. Evidence-based dentistry 7:24-25.
Lindkvist P, Wadstrom T, Giesecke J. 1995. Helicobacter pylori infection and foreign travel. The Journal of infectious diseases 172:1135-1136.
Lis AM, Black KM, Korn H, Nordin M. 2007. Association between sitting and occupational lbp. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 16:283-298.
Luoh HF, Tsaur SH. 2014. The effects of age stereotypes on tour leader roles. J Travel Res 53:111-123.
Malaty HM, El-Kasabany A, Graham DY, Miller CC, Reddy SG, Srinivasan SR, et al. 2002. Age at acquisition of helicobacter pylori infection: A follow-up study from infancy to adulthood. Lancet 359:931-935.
Mattson ME, Boyd G, Byar D, Brown C, Callahan JF, Corle D, et al. 1989. Passive smoking on commercial airline flights. JAMA : the journal of the American Medical Association 261:867-872.
McCormack GR, Virk JS. 2014. Driving towards obesity: A systematized literature review on the association between motor vehicle travel time and distance and weight status in adults. Preventive medicine 66:49-55.
McNeely E, Gale S, Tager I, Kincl L, Bradley J, Coull B, et al. 2014. The self-reported health of u.S. Flight attendants compared to the general population. Environmental health : a global access science source 13:13.
Namikawa K, Iida T, Ouchi K, Kimura M. 2010. Knowledge, attitudes, and practices of japanese travelers on infectious disease risks and immunization uptake. Journal of travel medicine 17:171-175.
Olsen SJ, Chang HL, Cheung TY, Tang AF, Fisk TL, Ooi SP, et al. 2003. Transmission of the severe acute respiratory syndrome on aircraft. The New England journal of medicine 349:2416-2422.
Paridou A, Velonakis E, Langner I, Zeeb H, Blettner M, Tzonou A. 2003. Mortality among pilots and cabin crew in greece, 1960-1997. International journal of epidemiology 32:244-247.
Peters HP, Wiersma JW, Koerselman J, Akkermans LM, Bol E, Mosterd WL, et al. 2000. The effect of a sports drink on gastroesophageal reflux during a run-bike-run test. International journal of sports medicine 21:65-70.
Pinkerton LE, Waters MA, Hein MJ, Zivkovich Z, Schubauer-Berigan MK, Grajewski B. 2012. Cause-specific mortality among a cohort of u.S. Flight attendants. American journal of industrial medicine 55:25-36.
Potasman I, Yitzhak A. 1998. Helicobacter pylori serostatus in backpackers following travel to tropical countries. The American journal of tropical medicine and hygiene 58:305-308.
Prombumroong J, Janwantanakul P, Pensri P. 2011. Prevalence of and biopsychosocial factors associated with low back pain in commercial airline pilots. Aviat Space Environ Med 82:879-884.
Rehrer NJ, van Kemenade M, Meester W, Brouns F, Saris WH. 1992. Gastrointestinal complaints in relation to dietary intake in triathletes. International journal of sport nutrition 2:48-59.
Repace J. 2004. Flying the smoky skies: Secondhand smoke exposure of flight attendants. Tobacco control 13 Suppl 1:i8-19.
Reynolds P, Cone J, Layefsky M, Goldberg DE, Hurley S. 2002. Cancer incidence in california flight attendants (united states). Cancer causes & control : CCC 13:317-324.
Savage R, Billing D, Furnell A, Netto K, Aisbett B. 2015. Whole-body vibration and occupational physical performance: A review. International archives of occupational and environmental health.
Schubauer-Berigan MK, Anderson JL, Hein MJ, Little MP, Sigurdson AJ, Pinkerton LE. 2015. Breast cancer incidence in a cohort of u.S. Flight attendants. American journal of industrial medicine 58:252-266.
Smith SD. 2006. Seat vibration in military propeller aircraft: Characterization, exposure assessment, and mitigation. Aviat Space Environ Med 77:32-40.
Space DR, Johnson RA, Rankin WL, Nagda NL. 1999. The airplane cabin environment- past, present and future research. Air quality and comfort in airliner cabins:189-214.
Spira AM. 2003. Assessment of travellers who return home ill. Lancet 361:1459-1469.
Taiwan. Monthly weather report. Available: http://www.cwb.gov.tw/V7/index_home.htm.
Taneja N. 2008. Spinal disabilities in military and civil aviators. Spine 33:2749-2753.
Toan do TT, Kien VD, Bao Giang K, Van Minh H, Wright P. 2014. Perceptions of climate change and its impact on human health: An integrated quantitative and qualitative approach. Global health action 7:23025.
Tokumaru O, Haruki K, Bacal K, Katagiri T, Yamamoto T, Sakurai Y. 2006. Incidence of cancer among female flight attendants: A meta-analysis. Journal of travel medicine 13:127-132.
Van Herck K, Van Damme P, Castelli F, Zuckerman J, Nothdurft H, Dahlgren AL, et al. 2004. Knowledge, attitudes and practices in travel-related infectious diseases: The european airport survey. Journal of travel medicine 11:3-8.
Wang KC, Hsieh AT, Chen WY. 2002. Is the tour leader an effective endorser for group package tour brochures? Tourism Manage 23:489-498.
Wang KC, Hsieh AT, Chou SH, Lin YS. 2007. Gptccc: An instrument for measuring group package tour service. Tourism Manage 28:361-376.
Wang KC, Jao PC, Chan HC, Chung CH. 2010. Group package tour leader's intrinsic risks. Ann Tourism Res 37:154-179.
WHO. 2015. International travel and health. Available: http://www.who.int/ith/other_health_risks/environmental_risks/en/.
中華民國交通部民用航空局. Available: http://www.caa.gov.tw/big5/content/index.asp?sno=8.
中華民國交通部觀光局. Available: http://taiwan.net.tw/.
王麗娟. 2003. 空服員之工作特性、工作壓力源與個人壓力反應. 桃園縣:國立中央大學.
張芸愷. 2006. 國際航線女性空服員工作壓力與身心健康之研究. 台中市:靜宜大學.
郭盈卿. 1999. 空服員之工作壓力、工作滿意、休閒滿意與工作倦怠之相關之研究. 高雄市:國立中山大學.
陳麗芬. 2004. 空服員之工作壓力與情緒智力之研究-以國內某國際性航空公司空服員為例. 台北市:國立台北護理學院.
賴家慶. 2011. 空服員休閒參與、工作壓力及幸福感之研究-以長榮航空公司為例. 台北市:國立臺灣師範大學.
簡杏霏. 2011. C航空公司空服員休閒參與對工作壓力與職業倦怠關係之研究. 屏東縣:大仁科技大學.
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