行為決策的評(píng)估理論構(gòu)建研究

田向陽

·綜述·

行為決策的評(píng)估理論構(gòu)建研究

田向陽

中國健康教育中心，北京，100011。

本研究構(gòu)建了行為決策的評(píng)估理論，揭示人類行為發(fā)生、發(fā)展和改變的規(guī)律，為開展健康相關(guān)行為干預(yù)提供科學(xué)依據(jù)。本理論認(rèn)為，所有的人類行為都是個(gè)體為了生存和發(fā)展，在對(duì)內(nèi)、外部刺激進(jìn)行評(píng)估后所做出的主動(dòng)反應(yīng)。個(gè)體以基因遺傳、自我圖式、群體規(guī)范和直覺為參照系，對(duì)內(nèi)、外部刺激的重要性、安全性威脅和獲益性，以及個(gè)體所擁有的行為資源進(jìn)行感覺性評(píng)估和社會(huì)性評(píng)估，用以做出生理性反應(yīng)和社會(huì)性行為決策，并通過感受器、中樞神經(jīng)和效應(yīng)器，形成“刺激-評(píng)估-行為決策-行為”循環(huán)。開展行為干預(yù)時(shí)，應(yīng)通過與個(gè)體進(jìn)行討論和分析，幫助其發(fā)現(xiàn)和確認(rèn)刺激的重要性、安全性、獲益性及其擁有的行為資源。

刺激；感覺性評(píng)估；社會(huì)性評(píng)估；重要性評(píng)估；獲益性評(píng)估；安全性評(píng)估；資源評(píng)估；評(píng)估參照系

行為是健康的重要決定因素。在發(fā)達(dá)國家，歸因于吸煙、不健康的飲食習(xí)慣、靜坐生活方式等不健康行為的早死超過40%[1]。世界衛(wèi)生組織全球疾病負(fù)擔(dān)調(diào)查結(jié)果表明，2017年行為危險(xiǎn)因素對(duì)DALYs的貢獻(xiàn)占36.5%[2]。

多年來，國際上開展了大量有關(guān)行為的研究，建立了從不同側(cè)面解釋行為發(fā)生、發(fā)展和變化的理論模型，對(duì)理解和干預(yù)人類行為產(chǎn)生了重要影響，但也存在著各自的缺陷和不足。研究表明，應(yīng)用這些理論或其一部分開展健康相關(guān)行為干預(yù)取得的效果優(yōu)于不應(yīng)用理論的干預(yù)[3]，但這些效果很可能只是控制性研究條件下的“有效性”[4-5]，在實(shí)際的行為干預(yù)項(xiàng)目中，這些理論常常被發(fā)現(xiàn)是無效的[6-7]，或總體效果不明確[8]、不持久[9]。即使出現(xiàn)了行為改變，也往往容易回復(fù)到原來的狀態(tài)。出現(xiàn)這種現(xiàn)象，很可能是因?yàn)檫@些理論并未準(zhǔn)確抓住行為發(fā)生和改變的根源[8]。另外，現(xiàn)有的理論模式是通過對(duì)人類各種行為現(xiàn)象進(jìn)行觀察、歸納推理得出的結(jié)論，存在明顯的或然性，有可能遺漏重要信息，甚至得出片面或錯(cuò)誤的結(jié)論。

為了全面揭示人類行為發(fā)生、發(fā)展的根源和本質(zhì)規(guī)律，為健康相關(guān)行為干預(yù)提供理論依據(jù)，本文在大量文獻(xiàn)研究的基礎(chǔ)上，廣泛吸收社會(huì)學(xué)、心理學(xué)、神經(jīng)科學(xué)、行為科學(xué)、生物學(xué)、遺傳學(xué)、表觀遺傳學(xué)等學(xué)科的理論和最新研究成果，提出了行為改變的決策評(píng)估理論模型。

1 人體對(duì)內(nèi)、外部刺激的評(píng)估機(jī)制

1.1 “刺激-評(píng)估-行為決策-行為”循環(huán)

行為是人體對(duì)除生理發(fā)育變化外的內(nèi)、外部刺激的協(xié)調(diào)反應(yīng)[10]。人體感受器（眼、耳、鼻、舌、皮膚、黏膜、內(nèi)臟、血管、神經(jīng)）和中樞神經(jīng)（大腦和脊髓）需要隨時(shí)對(duì)內(nèi)外環(huán)境刺激進(jìn)行評(píng)估，并根據(jù)評(píng)估結(jié)果，做出應(yīng)對(duì)決策[11]，由效應(yīng)器產(chǎn)生相應(yīng)的生理反應(yīng)或行為（行動(dòng)）。生理反應(yīng)和行為結(jié)果作為反饋信息又會(huì)被傳回中樞神經(jīng)系統(tǒng)，進(jìn)行再評(píng)估和再?zèng)Q策，產(chǎn)生新的生理反應(yīng)或新的行為（行動(dòng)），形成持續(xù)運(yùn)行的“刺激-評(píng)估-行為決策-行為”循環(huán)，以保持人體內(nèi)部生理生化穩(wěn)定和與外環(huán)境之間的相對(duì)平衡[12]。為此，可把人的行為分為生理性行為（如呼吸、心跳、性沖動(dòng)等）和社會(huì)性行為（如學(xué)習(xí)、工作、人際交往等）兩類。人的生理性行為屬于非條件反射，較少或不受意識(shí)的控制，教育、勸說等外部干預(yù)可對(duì)生理性行為的幅度、強(qiáng)度、頻率和效率產(chǎn)生影響，但不能消除。社會(huì)性行為屬于條件反射，是在意識(shí)控制下，經(jīng)過主動(dòng)建構(gòu)學(xué)習(xí)，對(duì)人體對(duì)內(nèi)、外部刺激做出的反應(yīng)，是在生理性行為的基礎(chǔ)上，通過教育、勸說和環(huán)境干預(yù)而形成的[13-14]。

1.2 感覺性評(píng)估與社會(huì)性評(píng)估

人體感受器和中樞神經(jīng)系統(tǒng)對(duì)內(nèi)、外部刺激的性質(zhì)、頻率、強(qiáng)度等進(jìn)行的不間斷的監(jiān)測(cè)評(píng)估是行為決策的基礎(chǔ)和前提。人體隨時(shí)隨地接受環(huán)境刺激信號(hào)，并把信號(hào)通過傳入神經(jīng)實(shí)時(shí)傳輸?shù)街袠猩窠?jīng)，由中樞神經(jīng)對(duì)刺激進(jìn)行感覺性評(píng)估和社會(huì)性評(píng)估。

感覺性評(píng)估是指對(duì)人體通過感覺器官和中樞神經(jīng)對(duì)體內(nèi)生理生化平衡變化（如酸堿平衡失調(diào)、營養(yǎng)素缺乏、高血糖等）、環(huán)境理化改變（如冷熱溫度、干濕度、堅(jiān)硬度、尖銳度、柔軟度、酸甜苦辣味道、香臭氣味、顏色、亮度等的變化）等內(nèi)、外部刺激進(jìn)行的感知和分析判斷，評(píng)估的結(jié)果包括飽腹/饑餓感、口渴感、疼痛感、溫暖/寒冷、舒適/難受、悅耳/刺耳、漂亮/丑陋、可口/難吃、甜/苦、香/臭等[15]。感覺性評(píng)估一般是在無意識(shí)的情況下，由人體感受器和中樞神經(jīng)系統(tǒng)自動(dòng)進(jìn)行的。

社會(huì)性評(píng)估[16-17]是指?jìng)€(gè)體在意識(shí)的控制下，通過比較、權(quán)衡、分析推理和歸納總結(jié)，對(duì)感覺性評(píng)估結(jié)果和外環(huán)境刺激（視聽覺信息等）進(jìn)行評(píng)估，以做出是否采取行動(dòng)或采取什么行動(dòng)的決策。如個(gè)人會(huì)對(duì)饑餓感和進(jìn)食沖動(dòng)（感覺性評(píng)估結(jié)果）進(jìn)行評(píng)估，如果做出應(yīng)該立即進(jìn)食的決策，就會(huì)繼而對(duì)食物的可獲得性、食品或餐飲廣告、餐廳、擺放在某處的食品（外環(huán)境刺激）分別進(jìn)行評(píng)估，最終做出吃不吃、吃什么、怎么吃和在哪里吃的決定（社會(huì)性評(píng)估結(jié)果）。

2 人體對(duì)內(nèi)、外部刺激的評(píng)估內(nèi)容

為了做出行為決策，進(jìn)而采取行動(dòng)或改變自己的行為，個(gè)體主要會(huì)對(duì)內(nèi)、外部刺激的重要性、安全性威脅（危險(xiǎn)性）、獲益性和個(gè)體所擁有的資源4個(gè)方面進(jìn)行評(píng)估。

2.1 重要性評(píng)估

重要性評(píng)估是指人們關(guān)于內(nèi)、外部刺激對(duì)于自己來說是否重要的估計(jì)。既往的研究發(fā)現(xiàn)，大腦腹內(nèi)側(cè)前額葉皮質(zhì)、眶額葉皮質(zhì)和腹側(cè)紋狀體負(fù)責(zé)對(duì)內(nèi)、外部刺激的價(jià)值性評(píng)估[18-20]。最新的研究認(rèn)為，這種評(píng)估機(jī)制主要存在于丘腦室旁核（PVT）[21]。人們對(duì)環(huán)境刺激重要性的估計(jì)存在一定的規(guī)律。比如，人們?cè)谕瑫r(shí)面對(duì)多種選擇時(shí)，總是先進(jìn)行感覺性評(píng)估，然后再進(jìn)行社會(huì)性評(píng)估，解決強(qiáng)烈的饑餓感、劇烈的疼痛、嚴(yán)重的口渴、緊急的生命威脅等問題，以及漂亮的外觀、好聞的味道、親近的關(guān)系等，總是比其他事項(xiàng)更重要；人們傾向于把能引起強(qiáng)烈感官反應(yīng)的事物評(píng)估為更重要；人們習(xí)慣于認(rèn)為遠(yuǎn)水解不了近渴，更易于把在空間和時(shí)間上臨近的人和事物評(píng)估為重要[22]。

2.2 安全性評(píng)估

安全性評(píng)估是指對(duì)內(nèi)、外部刺激是否會(huì)對(duì)自己的生存、發(fā)展和生命安全構(gòu)成威脅的估計(jì)。人有自我防御本能，很多行為都是直接或間接地為了使自己更安全[23]。研究發(fā)現(xiàn)，人腦的下丘腦基底核（amygdala）、腹內(nèi)側(cè)前額葉皮質(zhì)（vmPFC）、背外側(cè)前額葉皮層（DLPFC）和前島葉（AI）負(fù)責(zé)個(gè)體對(duì)安全性/危險(xiǎn)性的認(rèn)知分析[24-28]。人體在受到內(nèi)、外部刺激，安全感受到嚴(yán)重威脅時(shí)，大腦顳葉海馬區(qū)會(huì)對(duì)刺激的性質(zhì)、種類、危險(xiǎn)性進(jìn)行快速評(píng)估，交感神經(jīng)系統(tǒng)快速啟動(dòng)，做出是“戰(zhàn)斗還是逃跑”（fight or flight）的決策。同時(shí)，藍(lán)斑（LC）-交感-腎上腺髓質(zhì)軸和下丘腦-垂體-腎上腺皮質(zhì)軸（HPA）自動(dòng)啟動(dòng)[29-31]，人體會(huì)出現(xiàn)心跳加速、呼吸增快、血糖和血脂增高等生理性行為的變化，以調(diào)動(dòng)人體的能量，應(yīng)對(duì)安全威脅，但可導(dǎo)致肌體耗能、組織分解、血管痙攣、組織缺血、致死性心律失常、高血壓、糖尿病等多種健康問題[32]。安全感受到持續(xù)性的嚴(yán)重威脅時(shí)，初期會(huì)出現(xiàn)焦慮、攻擊性或極端冒險(xiǎn)性行為，最后會(huì)發(fā)展為抑郁、疲勞和衰竭，導(dǎo)致哮喘、胃潰瘍、糖尿病、心臟病、惡性腫瘤等[33]?？梢?，長期持續(xù)性的不安全感在慢性非傳染性疾病和感染性疾病的發(fā)生中扮演者重要的角色。

從社會(huì)認(rèn)知層面，一般來說，人們傾向于認(rèn)為未知或信息知之甚少的事物更危險(xiǎn)；人們往往會(huì)把突然出現(xiàn)的外部刺激（如猛撲過來的惡犬）評(píng)估為更危險(xiǎn)，而常常低估緩慢呈現(xiàn)或延遲出現(xiàn)的外部刺激的危險(xiǎn)性，如10年后出現(xiàn)的癌癥、不戴安全帶有可能導(dǎo)致的車禍死亡、吸煙引起的癌癥死亡等；人們之所以傾向于模仿大多數(shù)人的行為[34-35]，是因?yàn)檎J(rèn)為大多數(shù)人的行為才是最安全的[36]；人們總是認(rèn)為別人開車打電話比自己開車打電話更危險(xiǎn)；人之所以有嫉妒心理，是因?yàn)槠渌麄€(gè)體的優(yōu)秀和強(qiáng)大，有可能威脅到自身生存和發(fā)展的安全[37-38]。人們總是拒絕改變，因?yàn)楦淖儸F(xiàn)狀會(huì)帶來不安全感；但人們并非總是規(guī)避風(fēng)險(xiǎn)的，人們常常為了求得更大的安全感而甘愿冒險(xiǎn)，正如中國成語所說：“不入虎穴，焉得虎子”。

2.3 獲益性評(píng)估

獲益性評(píng)估是指人們對(duì)內(nèi)、外部刺激是否可為自身帶來益處所進(jìn)行的評(píng)估。獲益包括生理上的滿足、物質(zhì)上的獲取或占有、精神心理上的愉悅、同伴或群體的認(rèn)同或支持、家人和朋友的鼓勵(lì)、樂觀的預(yù)期、安全保障等[39]。研究表明，人腦中存在專門的對(duì)預(yù)期獎(jiǎng)勵(lì)（獲益預(yù)期）進(jìn)行評(píng)估的腦區(qū)——腹內(nèi)側(cè)前額葉皮質(zhì)（vmPFC）和腹側(cè)紋狀體（VSTR）[40]，由其做出是否努力的決策。人們總是“無利不起早”，傾向于實(shí)施那些對(duì)自身有益或使自己獲益最大化的行為[41]；人們總是傾向于買漲不買落[42]；人傾向于把能使自己感官舒服的（止渴餓的、甜的、香的）、滿足生理需要的評(píng)估，認(rèn)為是有益的；人們往往經(jīng)受不住大獎(jiǎng)的誘惑，傾向于高估結(jié)局良好的小概率事件發(fā)生（如買獎(jiǎng)券中大獎(jiǎng)）的可能性[43]。值得注意的是，人們天生對(duì)損失更敏感，損失的痛苦常常大于獲益的快樂[44-45]。大腦的杏仁核專司個(gè)體的損失預(yù)期[46]。

2.4 資源評(píng)估

資源是指?jìng)€(gè)體可獲取的用于采取行動(dòng)或改變行為的體力、精力、知識(shí)、技能、經(jīng)驗(yàn)、環(huán)境條件、經(jīng)濟(jì)狀況、社會(huì)支持等，是促使行為產(chǎn)生和發(fā)展的保障[47]。一般來說，個(gè)人擁有的資源越多，自我評(píng)估的模式也會(huì)越積極，自我效能感越強(qiáng)，也越有可能采取某項(xiàng)行動(dòng)或改變某個(gè)行為。但自我評(píng)估模式不僅受到個(gè)體擁有的資源情況的影響，還會(huì)受到遺傳、個(gè)性心理特征、情緒、情境、他人勸說等因素的影響。研究表明，大腦豆?fàn)詈耍↙N）負(fù)責(zé)自我效能評(píng)估[48]。

3 評(píng)估的參照系

每個(gè)人都有自己特有的評(píng)估參照系[49-50]和評(píng)估框架[51]，當(dāng)接受到內(nèi)、外部刺激時(shí)，大腦相應(yīng)功能區(qū)會(huì)把刺激的性質(zhì)、強(qiáng)度與參照系中的標(biāo)準(zhǔn)或閾值進(jìn)行比較[52]，做出評(píng)估。

3.1 基因遺傳

個(gè)人對(duì)客觀事物進(jìn)行評(píng)估的參照系基本結(jié)構(gòu)和路徑與生俱來，持續(xù)終生。俗話說：江山易改，秉性難移。研究表明，人的大多數(shù)行為特征都具有高度的遺傳性，如人的利他性[53]和同情心[54]，基因可解釋其遺傳差異的30%~50%[55]。表觀遺傳學(xué)認(rèn)為，個(gè)體的祖輩或父輩的行為經(jīng)歷和自身從受精卵開始的經(jīng)歷，會(huì)通過染色體甲基化產(chǎn)生基因修飾，被作為遺傳印記，在后代身上表達(dá)出來[56-59]。

3.2 自我圖式（self-schema）

是指?jìng)€(gè)體在自身特有的遺傳傾向性的基礎(chǔ)上融合自己和他人替代性經(jīng)驗(yàn)而形成的個(gè)人價(jià)值體系。人們總是以自我為中心，根據(jù)自己的生理、心理和社會(huì)需要、親身經(jīng)歷和價(jià)值觀，對(duì)客觀事物做出評(píng)估[60]。如：利他主義者認(rèn)為捐助慈善事業(yè)比自己消費(fèi)更重要；環(huán)保主義者認(rèn)為商品的環(huán)境友好性比舒適性更重要[61]。核心價(jià)值觀分為2個(gè)維度：一是自我提升/自我超越維度，即個(gè)體認(rèn)為權(quán)力、成就、享樂重要，還是普救、慈善重要；二是開放/保守維度，即認(rèn)為講求自主、追求刺激更重要，還是服從、傳統(tǒng)、安全更重要[62]。

3.3 群體規(guī)范

群體規(guī)范是指一個(gè)群體或組織成文或不成文的、用以確定價(jià)值觀、信仰、態(tài)度和行為的規(guī)矩。文化、法律、宗教教規(guī)、風(fēng)俗習(xí)慣等均屬于群體規(guī)范的表現(xiàn)形式。群體規(guī)范常成為群體內(nèi)個(gè)體對(duì)內(nèi)、外部刺激進(jìn)行評(píng)估的重要參照標(biāo)準(zhǔn)[63]。人們常常聽從或參考他人的評(píng)估模式和評(píng)估結(jié)果（錨定效應(yīng)）[64]或根據(jù)自認(rèn)為的大多數(shù)人的意見做出評(píng)估[65]。

3.4 直覺

直覺是指不需進(jìn)行邏輯推理而瞬間形成的信念或判斷[66]。人類的很多直覺源自情緒、情感（如同情、恐懼、嫉妒、快樂等）[67]和潛意識(shí)推斷[68]。在需要進(jìn)行復(fù)雜評(píng)估、用于評(píng)估的信息不足而無法進(jìn)行準(zhǔn)確評(píng)估或需要緊急做出評(píng)估時(shí)，一般會(huì)進(jìn)行直覺性評(píng)估[69]，或根據(jù)自己的成見進(jìn)行評(píng)估[70]。

4 評(píng)估的特性

4.1 評(píng)估的有序性

一般來說，人們傾向于先進(jìn)行感覺性評(píng)估，然后再根據(jù)自己的評(píng)估資源進(jìn)行社會(huì)性評(píng)估。如人們雖然為了健康會(huì)控制進(jìn)食甜食（社會(huì)性評(píng)估和決策），但誘人的甜食呈現(xiàn)在面前時(shí)，人們的唾液還是會(huì)禁不住奔涌而出（感覺性評(píng)估）[71]。令人愉快的外部刺激會(huì)通過人體感受器影響（“欺騙”）評(píng)估機(jī)制，從而使個(gè)體做出錯(cuò)誤的行為決策。如甜食會(huì)使大腦產(chǎn)生愉快感，得出“應(yīng)該多進(jìn)食”的評(píng)估結(jié)論，導(dǎo)致甜食攝入過多，引發(fā)肥胖。

4.2 評(píng)估的情感性

人們并非總是理性的，情緒和情感顯著影響評(píng)估的過程和評(píng)估結(jié)果[72-73]。如：在有關(guān)情況不確定、不可知的情況下，人們更傾向于根據(jù)自己的情感和情緒進(jìn)行評(píng)估[74]；人們傾向于以貌取人，把漂亮的、好看的、悅耳的、柔軟的、光滑的、溫暖的、明亮的事物評(píng)價(jià)為有益的（很多時(shí)候恰恰相反）。人們的情緒和情感會(huì)影響對(duì)行為結(jié)果好壞的預(yù)期[75]。人們?cè)谛那榇蠛玫那闆r下，往往傾向于把行為結(jié)果估計(jì)為良好。人在害怕時(shí)會(huì)高估風(fēng)險(xiǎn)，而在憤怒時(shí)會(huì)低估風(fēng)險(xiǎn)[76]。

4.3 評(píng)估的情境性

情境是指不同個(gè)性心理特征的個(gè)體對(duì)環(huán)境的主觀感知和解釋[77]。

在不同的情境下，人們會(huì)對(duì)同一事物給出不同的評(píng)價(jià)結(jié)果[78]。如：在節(jié)日喜慶的氛圍中，人們更易于對(duì)事物給予積極正向的評(píng)估；而在悲傷低沉的氛圍中，則更傾向于對(duì)事物做出悲觀的估計(jì)。

4.4 評(píng)估的成熟性

人們可以通過學(xué)習(xí)提高評(píng)估能力（速度和準(zhǔn)確度），也可經(jīng)過多次重復(fù)后成為經(jīng)驗(yàn)，出現(xiàn)成熟，形成動(dòng)力定型，即固定的評(píng)估模式。動(dòng)態(tài)決策理論認(rèn)為，人們可通過評(píng)估行為經(jīng)驗(yàn)、結(jié)果、知識(shí)以及環(huán)境提示從而做出行為決策[79]。

5 對(duì)行為干預(yù)的參考意義

根據(jù)本研究構(gòu)建的理論，進(jìn)行行為干預(yù)時(shí)，應(yīng)幫助個(gè)體通過與其他行為的比較，認(rèn)識(shí)到推薦行為的重要性優(yōu)先。通過與個(gè)體的討論，確認(rèn)刺激的危險(xiǎn)性以及推薦行為在增加安全性方面的意義；通過對(duì)推薦行為及行為結(jié)果的分析，幫助個(gè)體發(fā)現(xiàn)能獲得的益處；通過與個(gè)體討論，幫助其找出實(shí)施推薦行為所擁有的資源。但本理論是否可有效應(yīng)用于行為干預(yù)，尚需進(jìn)行實(shí)踐驗(yàn)證。

6 結(jié)論

人體通過感受器和中樞神經(jīng)對(duì)內(nèi)、外部刺激持續(xù)進(jìn)行評(píng)估，并根據(jù)評(píng)估結(jié)果做出行為決策，進(jìn)而產(chǎn)生生理反應(yīng)或行為。行為結(jié)果作為反饋信息，供中樞神經(jīng)做出新的行為決策，形成“刺激-評(píng)估-決策循環(huán)-行為”循環(huán)。個(gè)體以基因遺傳、自我圖式、群體規(guī)范和直覺為參照系，對(duì)內(nèi)外刺激的重要性、獲益性、安全性和資源進(jìn)行感覺性評(píng)估和社會(huì)性評(píng)估。評(píng)估會(huì)受到情感、情境和成熟因素的影響。進(jìn)行行為干預(yù)時(shí)，應(yīng)重點(diǎn)幫助個(gè)體發(fā)現(xiàn)和確認(rèn)推薦行為的重要性、實(shí)施推薦行為可增加的安全感和益處以及其擁有的資源。本研究構(gòu)建的理論有效性尚需進(jìn)行實(shí)踐驗(yàn)證。

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A Study on Construction of Assessment Theory on Behavioral Decision-making

An assessment theory on behavioral decision-making is constructed to lay a scientific basis for behavioral intervention by revealing the origin and intrinsic rule of generating, development and change of human behavior. The theory proposes that all human behavior is the individual's active coping response to an assessment of internal and external stimuli in order to survive and develop. An individual makes sensual and rational assessment on importance, security, benefits of internal and external stimuli, and resources that can be utilized to respond, based on the reference framework of genetic endowment, self-schema, group norms, and intuition. The assessment founds the premise for decision-making of/and physiological responses and behavior/action, and through the sensor, central nervous system and effector a “stimulation - assessment - decision-making-behavior” circulation is established. When conducting behavioral intervention, discussion and analysis with individuals should be conducted to help them identify the importance, increased security, gains, and resources possessed to perform the coping behaviors.

Stimulus; Sensual assessment; Rational assessment; Importance assessment; Gains assessment; Security assessment; Resource assessment; Reference framework

10.16117/j.cnki.31-1974/r.202002016

田向陽（1967—），男，主任醫(yī)師，主要從事健康教育與健康促進(jìn)理論研究工作，healthtian@163.com。

2020-03-03。