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Vo
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14
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3
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Sep
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b
er
2
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Phys
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rv
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K
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s
:
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x
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Me
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ea
lth
Pu
b
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Sed
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s
ty
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Su
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T
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u
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CC B
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C
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s
p
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A
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:
Nad
ia
Sam
s
u
d
in
Facu
lty
o
f
So
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Scien
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s
an
d
L
ib
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Ar
ts
,
UC
SI
Un
iv
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s
ity
Ku
ala
L
u
m
p
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Ma
lay
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E
m
ail:
n
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s
am
s
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@
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n
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s
ity
.
ed
u
.
m
y
1.
I
NT
RO
D
UCT
I
O
N
Su
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e
is
o
n
e
o
f
th
e
m
o
s
t
p
r
ess
in
g
g
lo
b
al
p
u
b
lic
h
ea
lth
p
r
o
b
lem
s
,
r
esu
ltin
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in
m
o
r
e
th
a
n
7
0
0
,
0
0
0
lo
s
s
o
f
liv
es
ev
er
y
y
ea
r
[
1
]
.
Strik
in
g
ly
,
th
e
s
u
icid
e
r
ate
am
o
n
g
ad
o
lescen
ts
in
cr
ea
s
ed
b
etw
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n
2
0
1
8
an
d
2
0
2
0
[
2
]
.
Su
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e
is
an
ac
t
o
f
p
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r
p
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s
ef
u
l
s
elf
-
in
f
licted
in
ju
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ca
u
s
in
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d
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th
[
3
]
an
d
b
ein
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m
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f
r
eq
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tly
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b
s
er
v
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lea
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in
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ca
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wo
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ld
wid
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[
4
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.
L
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7
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[
5
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with
th
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1
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)
[
4
]
.
Ma
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ar
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m
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lik
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m
p
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s
u
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o
f
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s
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m
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m
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p
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s
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m
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r
eq
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tly
[
6
]
.
T
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ca
u
s
es
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f
s
u
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ar
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h
ig
h
ly
c
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m
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lex
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d
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f
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lin
k
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d
to
m
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tal
h
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d
is
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mu
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ab
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its
u
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d
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ly
in
g
m
ec
h
an
is
m
s
r
em
ain
s
u
n
clea
r
[
3
]
,
[
7
]
.
Me
n
tal
an
d
s
u
b
s
tan
c
e
-
u
s
e
d
is
o
r
d
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s
ar
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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6
I
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t J Pu
b
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Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
2
1
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3
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1222
ass
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m
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8
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.
Stu
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h
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t a
n
d
s
o
cial
s
u
p
p
o
r
t c
a
n
h
elp
th
em
lead
f
u
lf
illi
n
g
liv
es.
A
d
o
l
e
s
c
e
n
t
s
a
r
e
p
a
r
t
ic
u
l
a
r
l
y
v
u
l
n
e
r
a
b
l
e
t
o
m
e
n
t
a
l
h
e
a
l
t
h
is
s
u
es
,
w
it
h
s
u
i
c
i
d
al
t
h
o
u
g
h
t
s
i
n
c
r
e
a
s
i
n
g
s
i
g
n
i
f
i
c
a
n
t
l
y
d
u
r
i
n
g
t
h
i
s
d
e
v
el
o
p
m
e
n
t
a
l
p
e
r
i
o
d
[
1
1
]
.
A
d
o
l
es
c
e
n
c
e
i
s
m
a
r
k
e
d
b
y
t
r
a
n
s
i
t
i
o
n
s
a
c
r
o
s
s
m
u
l
t
i
p
l
e
d
o
m
a
i
n
s
,
i
n
c
l
u
d
i
n
g
e
d
u
c
a
t
i
o
n
,
s
o
c
i
a
l
r
e
la
t
i
o
n
s
h
i
p
s
,
i
d
e
n
ti
t
y
f
o
r
m
a
t
i
o
n
,
a
n
d
i
n
c
r
e
a
s
i
n
g
i
n
d
ep
e
n
d
e
n
c
e
[
1
2
]
,
[
1
3
]
T
h
e
s
e
t
r
a
n
s
it
i
o
n
s
c
a
n
c
r
e
at
e
f
ee
l
i
n
g
s
o
f
h
el
p
l
es
s
n
es
s
a
n
d
d
i
s
t
r
e
s
s
,
c
o
n
t
r
i
b
u
t
i
n
g
t
o
m
e
n
t
a
l
h
e
al
t
h
is
s
u
es
,
i
n
cl
u
d
i
n
g
s
u
i
c
i
d
al
t
h
o
u
g
h
t
s
a
n
d
b
e
h
a
v
i
o
r
s
.
S
u
i
c
i
d
e
is
t
h
e
s
e
c
o
n
d
m
o
s
t
c
o
m
m
o
n
c
a
u
s
e
o
f
d
e
a
t
h
a
m
o
n
g
a
d
o
l
e
s
c
e
n
t
s
i
n
E
u
r
o
p
e
[
1
4
]
.
A
r
e
c
e
n
t
m
e
t
a
-
a
n
a
l
y
s
is
r
e
p
o
r
t
e
d
t
h
e
p
r
e
v
al
e
n
c
e
o
f
s
u
i
c
i
d
a
l
i
d
e
a
ti
o
n
a
m
o
n
g
i
n
d
i
v
i
d
u
a
l
s
a
g
e
d
6
t
o
2
1
y
e
a
r
s
v
a
r
y
i
n
g
r
e
g
i
o
n
a
ll
y
f
r
o
m
1
4
.
3
%
t
o
2
2
.
6
%
[
1
5
]
,
w
h
i
l
e
a
g
l
o
b
a
l
a
n
a
l
y
s
is
f
o
u
n
d
t
h
e
p
r
e
v
a
l
e
n
c
e
o
f
s
u
i
c
i
d
al
i
d
e
a
t
i
o
n
,
p
l
a
n
n
i
n
g
,
a
n
d
a
t
t
e
m
p
t
s
t
o
b
e
1
8
%
,
9
.
9
%
,
a
n
d
6
%
,
r
e
s
p
e
c
t
i
v
e
l
y
[
1
6
]
.
H
o
w
e
v
e
r
,
t
h
e
s
e
f
i
g
u
r
e
s
l
i
k
el
y
u
n
d
e
r
e
s
t
i
m
a
te
t
h
e
t
r
u
e
s
e
v
e
r
i
t
y
d
u
e
t
o
t
h
e
c
h
a
l
l
e
n
g
es
i
n
i
d
e
n
ti
f
y
i
n
g
a
n
d
r
e
c
o
r
d
i
n
g
s
u
i
c
i
d
e
a
c
cu
r
a
t
e
l
y
[
7
]
.
B
i
o
l
o
g
i
ca
l
,
p
s
y
c
h
o
l
o
g
i
c
al
,
a
n
d
s
o
c
i
a
l
f
a
ct
o
r
s
c
o
n
t
r
i
b
u
t
e
t
o
a
d
o
l
e
s
c
e
n
t
s
u
i
ci
d
e
r
i
s
k
[
1
3
]
.
D
e
v
e
lo
p
m
e
n
t
a
l
c
h
a
r
a
c
t
e
r
is
t
i
cs
,
s
u
c
h
as
d
e
c
is
i
o
n
-
m
a
k
i
n
g
s
t
y
l
e
,
c
o
p
i
n
g
s
t
r
a
t
e
g
i
e
s
,
f
a
m
il
y
d
y
n
a
m
i
c
s
,
a
n
d
p
e
e
r
r
e
l
a
t
i
o
n
s
h
i
p
s
,
c
a
n
a
m
p
l
i
f
y
v
u
l
n
e
r
a
b
i
l
i
t
y
t
o
s
u
i
c
id
a
l
b
e
h
a
v
i
o
r
s
[
1
1
]
.
H
o
w
e
v
e
r
,
t
h
e
s
e
b
e
h
a
v
i
o
r
s
a
r
e
m
o
d
i
f
i
a
b
l
e
[
1
7
]
.
A
c
c
e
s
s
t
o
m
e
n
t
a
l
h
e
al
t
h
c
a
r
e
,
s
o
ci
a
l
s
u
p
p
o
r
t
,
a
n
d
c
o
m
m
u
n
i
t
y
a
c
ti
v
i
ti
e
s
c
a
n
s
e
r
v
e
as
p
r
o
t
e
c
ti
v
e
f
a
ct
o
r
s
[
1
8
]
,
[
1
9
]
.
A
m
o
n
g
t
h
e
s
e
,
s
p
o
r
ts
a
n
d
p
h
y
s
ic
a
l
a
c
t
i
v
i
t
y
(
PA
)
h
a
v
e
e
m
e
r
g
e
d
a
s
i
m
p
o
r
t
a
n
t
f
o
r
p
r
o
m
o
t
i
n
g
m
e
n
t
al
h
ea
l
t
h
a
n
d
p
r
e
v
e
n
t
i
n
g
s
u
i
c
i
d
e
[
2
0
]
,
[
2
1
]
.
E
a
r
l
y
r
e
s
e
ar
c
h
i
n
d
i
c
a
t
e
s
t
h
at
y
o
u
t
h
e
n
g
a
g
e
d
i
n
s
p
o
r
t
s
s
h
o
w
l
o
w
e
r
r
a
tes
o
f
s
u
i
c
i
d
e
-
r
e
la
t
e
d
b
e
h
a
v
i
o
r
s
c
o
m
p
a
r
e
d
t
o
n
o
n
-
p
a
r
t
i
c
i
p
a
n
ts
[
2
2
]
–
[
2
4
]
.
P
A
o
f
f
e
r
s
n
u
m
e
r
o
u
s
a
d
v
a
n
t
a
g
e
s
,
i
n
c
l
u
d
in
g
l
o
w
c
o
s
t
,
e
a
s
e
o
f
d
i
s
s
e
m
i
n
a
t
i
o
n
,
a
n
d
m
i
n
i
m
al
s
t
ig
m
a
[
2
5
]
.
S
u
b
s
t
a
n
t
i
al
e
v
i
d
e
n
ce
l
i
n
k
s
PA
t
o
t
h
e
r
e
d
u
c
t
i
o
n
o
f
s
u
i
c
i
d
e
r
is
k
f
a
c
t
o
r
s
s
u
c
h
a
s
d
e
p
r
ess
i
o
n
[
2
6
]
,
a
n
x
i
et
y
[
2
7
]
,
s
l
e
e
p
d
is
t
u
r
b
a
n
c
es
[
2
8
]
,
s
u
b
s
t
a
n
ce
a
b
u
s
e
[
2
9
]
,
a
n
d
p
s
y
c
h
o
t
i
c
s
y
m
p
t
o
m
s
[
3
0
]
.
P
a
r
t
i
c
i
p
at
i
o
n
i
n
te
a
m
s
p
o
r
t
s
h
as
b
e
e
n
i
d
e
n
ti
f
i
e
d
as
a
p
r
o
t
ec
t
i
v
e
f
a
ct
o
r
a
g
a
i
n
s
t
s
u
i
c
i
d
a
l
p
l
an
n
i
n
g
a
n
d
a
t
t
e
m
p
ts
a
m
o
n
g
h
i
g
h
s
c
h
o
o
l
s
t
u
d
e
n
t
s
[
3
0
]
–
[
3
3
]
.
P
A
p
r
o
m
o
t
e
s
t
h
e
r
e
l
ea
s
e
o
f
e
n
d
o
r
p
h
i
n
s
a
n
d
s
e
r
o
t
o
n
in
,
i
m
p
r
o
v
i
n
g
m
o
o
d
,
e
n
e
r
g
y
,
a
n
d
a
l
e
r
t
n
e
s
s
w
h
i
l
e
p
r
o
v
i
d
i
n
g
a
n
o
u
t
l
e
t
f
o
r
f
r
u
s
t
r
a
t
io
n
a
n
d
n
e
g
a
t
i
v
e
e
m
o
t
i
o
n
s
.
F
u
r
t
h
e
r
m
o
r
e
,
P
A
w
i
th
p
e
e
r
s
a
n
d
f
a
m
i
l
y
m
e
m
b
e
r
s
f
a
c
il
i
t
a
t
e
s
s
o
c
i
al
s
u
p
p
o
r
t
a
n
d
c
o
m
m
u
n
i
t
y
i
n
t
e
g
r
a
t
i
o
n
.
Desp
ite
th
ese
f
in
d
in
g
s
,
s
ev
er
al
u
n
r
eso
lv
ed
is
s
u
es
r
em
ain
.
T
h
e
s
p
ec
if
ic
m
ec
h
an
is
m
s
b
y
wh
ich
PA
in
f
lu
en
ce
s
s
u
icid
e
-
r
elate
d
b
eh
av
io
r
s
ar
e
n
o
t
f
u
lly
u
n
d
er
s
to
o
d
,
an
d
t
h
er
e
is
a
n
ee
d
to
id
en
t
if
y
th
e
f
o
r
m
s
o
f
PA
th
at
a
r
e
m
o
s
t
ef
f
ec
tiv
e
f
o
r
d
if
f
er
en
t
d
em
o
g
r
ap
h
ic
g
r
o
u
p
s
.
Ad
d
itio
n
ally
,
wh
ile
an
ass
o
ciatio
n
b
etwe
en
PA
an
d
s
u
icid
e
-
r
elate
d
b
eh
a
v
io
r
s
h
as
b
ee
n
estab
lis
h
ed
,
r
esear
ch
h
as
p
r
ed
o
m
in
an
tly
b
ee
n
cr
o
s
s
-
s
ec
tio
n
al,
lim
itin
g
th
e
ab
ilit
y
to
i
n
f
er
ca
u
s
ality
.
T
h
is
r
ev
iew
aim
s
to
ad
d
r
ess
th
ese
g
ap
s
b
y
ex
p
lo
r
in
g
cr
o
s
s
-
s
ec
tio
n
al
an
d
p
r
o
s
p
ec
tiv
e
ass
o
ciatio
n
s
b
etwe
en
PA
an
d
s
u
icid
e
-
r
elate
d
b
eh
av
io
r
s
,
p
a
r
ticu
lar
ly
f
o
cu
s
in
g
o
n
ad
o
lesc
en
ts
ag
ed
1
0
to
1
9
y
ea
r
s
.
I
t
also
i
n
v
esti
g
ates
th
e
i
m
p
ac
t
o
f
PA
in
ter
v
e
n
tio
n
s
o
n
th
is
p
o
p
u
latio
n
to
c
lar
if
y
th
e
p
o
ten
tial
o
f
PA
as
a
p
r
ev
en
tiv
e
s
tr
ateg
y
a
g
ain
s
t
s
u
icid
e.
T
h
e
f
o
llo
win
g
s
ec
tio
n
s
d
etail
th
e
m
eth
o
d
o
lo
g
y
em
p
lo
y
e
d
t
o
s
y
s
tem
atica
lly
r
ev
iew
th
e
liter
atu
r
e,
p
r
esen
t
t
h
e
r
esu
lts
o
f
s
tu
d
ies
ex
am
in
in
g
t
h
e
lin
k
b
etwe
en
PA
an
d
s
u
icid
al
b
eh
av
io
r
s
,
an
d
d
i
s
cu
s
s
th
e
im
p
licatio
n
s
o
f
t
h
ese
f
in
d
i
n
g
s
.
B
y
d
o
i
n
g
s
o
,
th
is
r
ev
iew
aim
s
to
co
n
t
r
ib
u
te
t
o
th
e
d
ev
elo
p
m
e
n
t
o
f
tar
g
eted
,
e
v
i
d
en
ce
-
b
ased
in
ter
v
e
n
tio
n
s
th
a
t
lev
er
ag
e
PA
as
a
k
e
y
c
o
m
p
o
n
en
t
in
ad
o
lescen
t
s
u
icid
e
p
r
ev
en
tio
n
ef
f
o
r
ts
.
2.
M
E
T
H
O
D
2
.
1
.
T
he
m
a
t
er
ia
ls
m
e
t
ho
do
l
o
g
y
f
o
r
s
uicid
e
re
s
ea
rc
h
W
e
a
p
p
l
ie
d
s
y
s
t
e
m
at
i
c
r
e
v
i
e
w
m
e
t
h
o
d
s
wi
t
h
m
o
d
i
f
i
ca
t
i
o
n
s
t
o
d
e
l
i
v
e
r
r
a
p
i
d
,
al
b
e
i
t
i
n
f
o
r
m
a
t
iv
e
,
r
e
s
u
l
ts
.
T
h
i
s
m
et
h
o
d
o
l
o
g
i
c
a
l
f
r
a
m
ew
o
r
k
d
r
a
w
s
o
n
e
x
i
s
t
i
n
g
m
e
t
h
o
d
s
o
f
e
v
i
d
e
n
c
e
s
y
n
t
h
e
s
i
s
r
e
l
at
e
d
t
o
p
r
a
c
t
i
ce
-
o
r
i
e
n
t
e
d
P
A
r
e
v
i
e
ws
b
y
P
u
b
l
i
c
H
ea
l
t
h
E
n
g
l
a
n
d
[
3
4
]
.
I
t
i
n
c
l
u
d
e
d
a
s
p
e
c
i
f
i
c
a
n
d
c
o
m
p
r
e
h
e
n
s
i
v
e
s
ea
r
c
h
,
s
y
n
t
h
e
s
is
,
a
n
d
t
r
a
n
s
l
at
i
o
n
o
f
t
h
e
li
t
e
r
a
t
u
r
e
r
e
le
v
a
n
t
t
o
t
h
e
r
o
l
e
o
f
PA
i
n
t
h
e
p
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e
v
e
n
t
i
o
n
o
f
a
d
o
l
es
c
e
n
t
s
u
i
cid
e
.
W
e
a
i
m
e
d
f
o
r
a
m
i
d
d
l
e
g
r
o
u
n
d
b
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t
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c
o
m
p
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n
s
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s
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o
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t
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t
i
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o
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a
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i
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r
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v
a
n
c
e
o
f
o
u
r
r
e
s
u
l
t
s
,
w
i
t
h
t
h
e
la
t
t
e
r
e
m
p
h
as
i
zi
n
g
c
l
in
i
c
a
l
a
c
ti
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ci
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p
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v
e
n
t
i
o
n
a
m
o
n
g
a
d
o
l
e
s
c
e
n
ts
.
2
.
2
.
Da
t
a
g
a
t
hering
Ou
r
d
ata
co
llectio
n
s
tr
ateg
y
was
m
eticu
lo
u
s
ly
d
esig
n
ed
to
en
s
u
r
e
a
th
o
r
o
u
g
h
c
o
v
er
a
g
e
o
f
th
e
to
p
ic.
T
ar
g
eted
s
ea
r
ch
es
wer
e
c
o
n
d
u
cted
u
s
in
g
SP
OR
T
Dis
cu
s
,
th
e
p
s
y
ch
o
lo
g
y
an
d
b
e
h
av
io
r
al
s
cien
ce
s
co
llectio
n
,
an
d
Go
o
g
le
Sch
o
lar
.
T
h
e
a
n
aly
s
is
f
o
cu
s
ed
o
n
p
ee
r
-
r
ev
iewe
d
jo
u
r
n
al
ar
ticles
p
u
b
lis
h
ed
b
et
wee
n
J
an
u
ar
y
2
0
1
8
an
d
Ma
r
ch
2
0
2
3
.
Sear
ch
ter
m
s
,
s
u
ch
as
s
p
o
r
t
o
r
p
h
y
s
ical
ac
tiv
ity
an
d
ad
o
lescen
t
o
r
y
o
u
th
o
r
teen
ag
e
a
n
d
s
u
icid
e,
wer
e
em
p
lo
y
ed
to
i
d
e
n
tify
th
e
m
o
s
t r
elev
an
t s
tu
d
ies.
Evaluation Warning : The document was created with Spire.PDF for Python.
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8
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P
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in
terven
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fo
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lescen
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eh
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(
R
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eter B
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R
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te
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i
a
:
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)
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r
ti
c
le
s
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o
t
p
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s
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d
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p
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r
-
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v
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d
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o
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ls
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)
Pu
b
l
i
c
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n
g
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;
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t
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a
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v
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es
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r
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t
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r
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C
o
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p
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p
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t
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p
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n
ti
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f
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a
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it
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e
s
e
a
r
c
h
p
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li
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d
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f
o
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e
2
0
1
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t
o
e
n
s
u
r
e
f
i
n
d
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n
g
s
w
e
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l
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v
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t
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h
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c
u
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n
t
c
o
n
t
e
x
t
.
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y
a
p
p
l
y
i
n
g
t
h
e
s
e
s
t
r
i
n
g
e
n
t
c
r
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t
e
r
i
a
,
we
e
n
s
u
r
e
d
t
h
e
s
e
l
e
ct
i
o
n
o
f
h
i
g
h
-
q
u
a
l
i
t
y
a
n
d
r
e
l
e
v
a
n
t
s
t
u
d
i
es
w
h
i
le
m
a
i
n
t
ai
n
i
n
g
t
h
e
in
t
e
g
r
i
t
y
a
n
d
f
o
c
u
s
o
f
t
h
e
r
e
s
e
a
r
c
h
p
r
o
c
e
s
s
.
2
.
3
.
Q
ua
lit
y
a
s
s
ura
nce
A
two
-
s
tep
ap
p
r
o
ac
h
was
ad
o
p
ted
to
e
n
h
an
ce
th
e
r
eliab
ilit
y
an
d
v
alid
ity
o
f
th
e
r
esear
ch
ev
id
en
ce
.
First,
th
e
Activ
e
L
iv
in
g
b
y
De
s
i
g
n
(
AL
B
D)
C
o
m
m
u
n
ity
Act
io
n
Mo
d
el
was
u
tili
ze
d
.
T
h
is
m
o
d
el
in
clu
d
es
f
iv
e
co
r
e
c
o
m
p
o
n
en
ts
:
p
r
e
p
ar
atio
n
,
p
r
o
m
o
tio
n
,
p
r
o
g
r
am
,
p
o
l
icy
,
an
d
p
h
y
s
ical
p
r
o
jects
.
I
t
p
r
o
v
id
es
a
s
tr
u
ctu
r
ed
f
r
am
ewo
r
k
to
ca
teg
o
r
ize
s
tu
d
i
es
with
in
m
ea
n
in
g
f
u
l
c
o
n
tex
ts
an
d
id
en
tif
y
r
esear
ch
g
ap
s
ef
f
ec
tiv
ely
.
Seco
n
d
,
th
e
q
u
ality
o
f
ea
ch
s
tu
d
y
was
ev
alu
ated
u
s
in
g
a
p
r
ed
ef
in
ed
r
u
b
r
ic
[
3
5
]
.
T
h
e
k
e
y
asp
ec
ts
as
s
ess
ed
in
clu
d
ed
th
e
s
tu
d
y
'
s
d
esig
n
,
co
n
s
id
er
atio
n
o
f
lo
n
g
itu
d
in
al
elem
e
n
ts
,
th
e
r
ig
o
r
o
f
cr
o
s
s
-
s
ec
tio
n
al
co
m
p
ar
is
o
n
s
,
f
r
eq
u
e
n
cy
o
f
d
ata
co
llectio
n
,
u
s
e
o
f
o
b
je
ctiv
e
m
ea
s
u
r
em
en
t
to
o
ls
,
an
d
ac
k
n
o
wled
g
m
en
t
o
f
p
r
ev
i
o
u
s
v
alid
atio
n
a
n
d
r
eliab
ili
ty
test
s
.
B
ased
o
n
th
es
e
cr
iter
ia,
s
tu
d
ies
wer
e
s
co
r
ed
o
n
a
s
ca
le
f
r
o
m
0
t
o
8
,
with
s
co
r
es
class
if
ied
as
lo
w
-
q
u
ality
(
0
–
2
)
,
m
o
d
e
r
ate
-
q
u
ality
(
3
–
6
)
,
o
r
h
ig
h
-
q
u
ality
(
7
–
8
)
.
T
o
m
ai
n
tain
ac
cu
r
ac
y
an
d
co
n
s
is
ten
cy
,
in
ter
-
r
ater
r
eliab
ilit
y
was
m
e
asu
r
ed
u
s
in
g
C
o
h
e
n
’
s
k
ap
p
a
with
r
eg
u
lar
ass
ess
m
en
ts
an
d
team
co
n
s
en
s
u
s
to
r
eso
lv
e
d
is
cr
ep
an
cies.
Fin
ally
,
th
e
s
y
s
tem
atic
r
ev
iew
was
co
n
d
u
cte
d
an
d
r
ep
o
r
ted
in
al
ig
n
m
en
t
with
th
e
p
r
ef
er
r
e
d
r
ep
o
r
tin
g
item
s
f
o
r
s
y
s
tem
atic
r
ev
iews
an
d
m
eta
-
an
aly
s
is
(
PR
I
S
MA
)
g
u
id
elin
es,
en
s
u
r
in
g
a
tr
an
s
p
ar
en
t a
n
d
m
eth
o
d
ical
ap
p
r
o
ac
h
t
o
th
e
r
esear
c
h
p
r
o
ce
s
s
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
Fro
m
th
e
s
ea
r
c
h
co
n
d
u
cte
d
o
n
s
tu
d
ies
r
ep
o
r
tin
g
a
n
ass
o
ciatio
n
b
etwe
en
PA
an
d
s
u
icid
al
i
d
ea
tio
n
in
ad
o
lescen
ts
,
we
s
elec
ted
s
ev
en
ar
ticles
as
s
h
o
wn
in
Fig
u
r
e
1
.
I
n
ter
es
tin
g
ly
,
we
f
o
u
n
d
th
at
elev
ated
s
ed
en
tar
y
b
eh
av
io
r
was
ass
o
ciate
d
with
in
cr
ea
s
ed
o
d
d
s
o
f
s
u
icid
al
th
o
u
g
h
ts
an
d
b
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s
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to
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tal
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alth
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r
th
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r
m
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ass
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etwe
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d
s
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f
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ch
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lly
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b
s
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ce
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s
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in
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th
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PA
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s
h
ap
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s
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tib
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f
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to
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All
s
tu
d
ies
in
d
icate
d
an
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tid
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t
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d
an
ti
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x
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f
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t
th
at
is
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lu
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with
p
h
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s
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ac
tiv
ity
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esp
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am
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n
g
y
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g
m
en
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r
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m
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h
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tal
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tate
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d
in
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id
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u
b
jectiv
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s
tat
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s
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in
all,
th
ese
r
esu
lts
g
iv
e
ev
id
en
ce
f
o
r
t
h
e
m
u
ltifa
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ial
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ter
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f
th
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s
h
ip
b
etwe
en
PA a
n
d
m
en
tal
h
ea
lth
d
u
r
in
g
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o
lescen
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o
n
s
eq
u
en
tly
,
th
ey
ad
v
o
c
ate
f
o
r
p
er
s
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n
alize
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th
er
ap
ies an
d
p
o
licies en
co
u
r
a
g
in
g
PA a
s
p
ar
t o
f
in
itiativ
es c
o
m
p
iled
to
a
v
er
t su
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e.
Af
t
er
s
c
r
e
en
in
g
a
n
d
s
e
le
cti
o
n
,
as
s
h
o
w
n
in
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ab
le
1
(
s
ee
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p
p
e
n
d
ix
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d
esc
r
i
b
es
t
h
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s
e
v
e
n
s
tu
d
ies
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n
r
el
ati
o
n
s
h
i
p
s
b
e
twe
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n
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a
n
d
s
u
i
ci
d
a
l
id
ea
t
i
o
n
o
r
b
e
h
av
io
r
s
[
3
2
]
,
[
3
6
]
–
[
4
1
]
.
On
e
s
t
u
d
y
e
x
am
i
n
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t
h
e
ass
o
cia
ti
o
n
b
etw
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p
o
r
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a
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p
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ti
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n
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ic
id
al
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t
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n
s
ex
u
al
m
i
n
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r
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ty
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t
h
[
4
2
]
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Qu
a
n
tit
ati
v
e
d
at
a
s
o
u
r
ce
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we
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e
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s
e
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h
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i
r
s
t
a
u
t
h
o
r
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wer
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f
r
o
m
th
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Un
ite
d
Sta
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s
tu
d
i
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s
tr
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1
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t
u
d
y
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a
n
d
G
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m
an
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t
u
d
y
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e
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a
m
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b
s
ta
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ial
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2
2
3
t
o
2
0
6
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3
5
7
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a
r
t
ici
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a
n
ts
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h
is
r
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n
s
is
ten
tly
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n
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er
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co
r
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two
p
r
im
ar
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em
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a
n
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es
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f
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d
t
h
e
d
an
g
er
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ass
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ciate
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with
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tar
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eh
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io
r
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t
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en
tial
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n
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er
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th
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ed
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tar
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io
r
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ar
e
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m
er
ely
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p
o
s
in
g
o
r
m
u
tu
ally
ex
clu
s
iv
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co
n
ce
p
ts
[
4
3
]
.
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n
co
m
p
ass
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y
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o
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ily
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v
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en
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en
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s
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ed
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tar
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e
h
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r
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ef
er
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to
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ac
tiv
i
ties
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o
r
m
ed
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h
ile
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itti
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r
r
ec
lin
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w
ith
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en
er
g
y
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p
en
d
itu
r
e
o
f
1
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5
m
etab
o
lic
eq
u
i
v
alen
ts
(
ME
T
s
)
o
r
less
[
4
4
]
.
Ph
y
s
ical
in
ac
tiv
ity
was
d
ef
in
e
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as
f
ailu
r
e
to
m
ee
t
r
ec
o
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m
en
d
ed
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u
id
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Fo
r
in
s
t
an
ce
,
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
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HO)
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ec
o
m
m
en
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s
th
at
ch
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r
en
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d
ad
o
lescen
ts
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g
ag
e
in
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6
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in
u
tes
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m
o
d
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r
ate
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to
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v
ig
o
r
o
u
s
p
h
y
s
ical
ac
tiv
ity
(
MV
PA)
d
aily
[
1
]
.
M
VPA
in
clu
d
es
ac
tiv
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with
ME
T
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alu
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b
etwe
en
3
an
d
5
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9
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wh
ile
v
ig
o
r
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u
s
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in
ten
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ity
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ex
ce
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6
ME
T
s
[
4
4
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Ad
o
lescen
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wh
o
m
et
th
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o
m
m
e
n
d
atio
n
s
wer
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as
p
h
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ically
ac
t
iv
e.
Nev
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th
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s
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ev
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in
d
iv
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h
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v
e
th
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ay
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p
en
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ten
d
e
d
p
e
r
io
d
s
o
f
s
ed
en
tar
y
ac
tiv
ity
.
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s
elf
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lo
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elin
ess
,
an
d
s
tr
ess
am
o
n
g
a
d
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lescen
ts
[
4
4
]
,
[
4
6
]
,
[
4
7
]
.
W
ith
o
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t
m
u
ch
p
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s
ical
m
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[
1
]
f
o
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lescen
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.
Ma
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s
m
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a
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I
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2252
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8
8
0
6
P
h
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l a
ctivity
in
terven
tio
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s
fo
r
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(
R
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P
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1225
T
ab
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2
.
R
ep
o
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tin
g
im
p
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m
m
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y
A
u
t
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s
P
h
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s
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v
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(
i
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st
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u
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)
S
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/
b
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a
v
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s
[
4
5
]
G
l
o
b
a
l
S
c
h
o
o
l
-
b
a
se
d
s
t
u
d
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v
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Y
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H
i
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s
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-
t
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me
S
B
si
g
n
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f
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a
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t
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y
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a
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sk
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su
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h
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s
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d
b
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v
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s
a
mo
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a
d
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l
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sc
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s
i
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LM
I
C
s.
I
n
a
d
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q
u
a
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P
A
h
a
s
a
st
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Th
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c
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b
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d
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P
A
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d
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B
a
m
p
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sk
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a
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o
n
,
p
l
a
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n
i
n
g
,
a
n
d
a
t
t
e
m
p
t
s.
A
c
t
i
v
e
l
i
f
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s
t
y
l
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p
r
o
mo
t
i
o
n
sh
o
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d
b
e
a
k
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y
c
o
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t
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f
su
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p
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t
i
o
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f
f
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s
i
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r
e
so
u
r
c
e
-
p
o
o
r
s
e
t
t
i
n
g
s
.
[
3
6
]
P
A
w
a
s
a
ss
e
sse
d
a
sk
i
n
g
r
e
sp
o
n
d
e
n
t
s
h
o
w
man
y
d
a
y
s
t
h
e
y
w
e
r
e
p
h
y
s
i
c
a
l
l
y
a
c
t
i
v
e
f
o
r
a
t
l
e
a
st
6
0
m
i
n
u
t
e
s
i
n
t
h
e
p
a
st
w
e
e
k
.
Y
e
s
I
n
su
f
f
i
c
i
e
n
t
s
l
e
e
p
w
a
s
a
sso
c
i
a
t
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d
w
i
t
h
a
n
i
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c
r
e
a
s
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d
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i
sk
o
f
su
i
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d
a
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t
i
o
n
,
w
h
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P
A
w
a
s
a
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d
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s
c
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t
s
i
n
t
h
e
st
u
d
y
.
[
3
8
]
M
V
P
A
No
N
o
s
i
g
n
i
f
i
c
a
n
t
a
ss
o
c
i
a
t
i
o
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w
a
s
i
d
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n
t
i
f
i
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d
b
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t
w
e
e
n
M
V
P
A
a
n
d
s
e
l
f
-
h
a
r
m
o
r
p
s
y
c
h
o
l
o
g
i
c
a
l
i
ss
u
e
s
i
n
e
i
t
h
e
r
g
e
n
d
e
r
.
[
3
2
]
F
o
u
r
mea
s
u
r
e
s
o
f
P
A
:
d
a
i
l
y
P
A
,
m
u
sc
l
e
-
st
r
e
n
g
t
h
e
n
i
n
g
a
c
t
i
v
i
t
y
,
p
h
y
s
i
c
a
l
e
d
u
c
a
t
i
o
n
,
a
n
d
s
p
o
r
t
s
t
e
a
m
p
a
r
t
i
c
i
p
a
t
i
o
n
.
No
S
B
l
i
n
k
e
d
t
o
a
d
o
l
e
s
c
e
n
t
s’
s
u
i
c
i
d
a
l
t
h
o
u
g
h
t
s
a
n
d
a
t
t
e
m
p
t
s.
S
u
i
c
i
d
a
l
t
h
o
u
g
h
t
s
w
e
r
e
a
ss
o
c
i
a
t
e
d
w
i
t
h
i
n
a
d
e
q
u
a
t
e
a
e
r
o
b
i
c
a
c
t
i
v
i
t
y
.
[
3
7
]
5
-
Li
k
e
r
t
sca
l
e
,
w
i
t
h
h
i
g
h
e
r
sc
o
r
e
s
i
n
d
i
c
a
t
i
n
g
mo
r
e
f
r
e
q
u
e
n
t
P
A
.
No
Th
e
g
r
e
a
t
e
r
p
o
s
i
t
i
v
e
me
n
t
a
l
h
e
a
l
t
h
med
i
a
t
e
d
t
h
e
su
i
c
i
d
e
-
p
r
e
v
e
n
t
i
o
n
b
e
n
e
f
i
t
s
o
f
P
A
.
[
3
9
]
Q
7
9
o
n
t
h
e
y
o
u
t
h
r
i
s
k
b
e
h
a
v
i
o
r
su
r
v
e
y
p
r
o
c
e
d
u
r
e
s (Y
R
B
S
)
q
u
e
s
t
i
o
n
n
a
i
r
e
s.
No
P
A
a
n
d
t
h
e
sc
h
o
o
l
e
n
v
i
r
o
n
m
e
n
t
r
e
d
u
c
e
a
d
o
l
e
sc
e
n
t
s
u
i
c
i
d
a
l
i
d
e
a
t
i
o
n
,
b
u
t
s
l
e
e
p
d
u
r
a
t
i
o
n
i
n
c
r
e
a
ses
i
t
(
t
h
o
u
g
h
m
o
r
e
r
e
sea
r
c
h
i
s
n
e
e
d
e
d
)
.
[
4
0
]
Te
a
m
s
p
o
r
t
s
p
a
r
t
i
c
i
p
a
t
i
o
n
f
r
o
m
Y
R
B
S
q
u
e
st
i
o
n
n
a
i
r
e
s.
No
Th
e
st
u
d
y
i
n
d
i
c
a
t
e
d
t
h
a
t
t
e
a
m
s
p
o
r
t
s
e
n
g
a
g
e
me
n
t
r
e
d
u
c
e
d
d
e
p
r
e
ss
i
o
n
a
n
d
s
u
i
c
i
d
a
l
i
d
e
a
t
i
o
n
i
n
a
l
l
g
r
o
u
p
s
e
x
c
e
p
t
LG
B
Q
a
d
o
l
e
sce
n
t
s.
L
o
w
t
o
m
o
d
e
r
a
t
e
l
e
v
e
ls
o
f
P
A
h
a
v
e
b
e
e
n
l
i
n
k
e
d
t
o
a
n
i
n
c
r
e
a
s
e
d
r
i
s
k
o
f
s
u
i
c
i
d
al
b
e
h
a
v
i
o
r
s
am
o
n
g
m
a
l
e
a
d
o
l
e
s
c
e
n
ts
,
a
f
i
n
d
i
n
g
c
o
n
s
i
s
te
n
t
w
i
t
h
p
r
e
v
i
o
u
s
r
es
e
a
r
c
h
[
4
8
]
.
H
o
w
e
v
e
r
,
L
a
R
o
c
ca
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T
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two
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g
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Stu
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in
d
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x
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d
in
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h
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leis
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tim
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tar
y
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
2
2
1
-
1
2
3
1
1226
ac
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s
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a
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a
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s
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e
m
a
y
n
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t e
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s
e
e
w
h
y
t
h
is
m
u
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t
b
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ca
s
e
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an
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d
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a
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m
a
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o
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t
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k
o
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c
r
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o
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n
o
t
b
e
d
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t
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r
m
i
n
e
d
.
4.
CO
NCLU
SI
O
N
T
h
is
r
ev
iew
h
ig
h
lig
h
ts
th
e
co
m
p
lex
r
elatio
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s
h
ip
b
etwe
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n
PA
an
d
s
u
icid
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r
elate
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id
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tio
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d
b
eh
av
io
r
s
in
ad
o
lescen
ts
,
em
p
h
asizin
g
th
e
im
p
o
r
tan
t
im
p
licatio
n
s
f
o
r
p
u
b
lic
h
ea
lth
s
tr
ateg
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an
d
f
u
tu
r
e
r
esear
ch
.
R
eg
u
lar
en
g
ag
em
e
n
t
in
PA,
e
s
p
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ially
in
team
s
p
o
r
ts
,
ap
p
ea
r
s
to
p
r
o
tect
ag
ain
s
t
s
u
icid
al
id
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tio
n
an
d
b
e
h
av
io
r
s
,
p
ar
ticu
lar
l
y
in
m
ale
ad
o
lescen
ts
.
PA
ca
n
r
e
d
u
ce
k
e
y
s
u
icid
e
r
is
k
f
ac
to
r
s
s
u
ch
as
d
ep
r
ess
io
n
,
an
x
iety
,
an
d
h
o
p
eless
n
ess
.
T
e
am
s
p
o
r
ts
o
f
f
er
ad
d
itio
n
al
b
en
ef
its
b
y
f
o
s
ter
in
g
s
o
cial
co
n
n
e
ctiv
ity
an
d
s
u
p
p
o
r
t
.
Ho
wev
er
,
th
e
p
r
o
tectiv
e
ef
f
ec
ts
o
f
PA
wer
e
n
o
t
u
n
if
o
r
m
ac
r
o
s
s
all
g
r
o
u
p
s
.
So
m
e
s
tu
d
ies
s
h
o
w
lim
ited
im
p
ac
t
f
o
r
f
e
m
ale
ad
o
lescen
ts
,
an
d
w
h
ile
PA
ca
n
r
e
d
u
ce
d
ep
r
ess
io
n
in
L
GB
T
Q
y
o
u
th
,
its
ef
f
ec
t
o
n
s
u
icid
al
id
ea
tio
n
in
th
is
g
r
o
u
p
is
less
clea
r
.
T
h
is
s
u
g
g
ests
th
at
co
n
tex
tu
al
f
ac
t
o
r
s
s
u
ch
as
th
e
in
clu
s
iv
ity
o
f
s
p
o
r
ts
s
ettin
g
s
p
lay
a
r
o
le
in
PA'
s
b
en
ef
its
.
De
s
p
it
e
th
ese
f
in
d
i
n
g
s
,
g
ap
s
r
e
m
ain
.
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s
t
s
tu
d
ies
ar
e
cr
o
s
s
-
s
ec
tio
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al,
lim
itin
g
th
e
u
n
d
er
s
tan
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i
n
g
o
f
ca
u
s
ality
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tu
r
e
lo
n
g
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al
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esear
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n
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to
clar
if
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h
o
w
PA
in
f
lu
en
ce
s
m
en
tal
h
ea
lth
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icid
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r
is
k
o
v
e
r
tim
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m
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ltifa
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p
r
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th
at
in
teg
r
ates
PA
p
r
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o
tio
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tal
h
ea
lth
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ca
tio
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an
d
s
o
cial
s
u
p
p
o
r
t
ca
n
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elp
r
e
d
u
ce
s
u
icid
e
r
ates
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d
en
h
an
c
e
ad
o
lescen
t
wellb
ein
g
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Desp
ite
th
ese
lim
itat
io
n
s
,
th
is
r
ev
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h
as
clea
r
ly
id
en
tifi
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a
s
tr
o
n
g
lin
k
b
etwe
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p
ar
ti
cip
atio
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in
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an
d
r
ed
u
ce
d
s
u
icid
al
id
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tio
n
an
d
b
eh
av
io
r
.
W
h
ile
ev
id
e
n
ce
d
i
r
ec
tly
lin
k
in
g
o
r
g
an
ized
s
p
o
r
ts
to
th
ese
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e
n
ef
its
is
s
o
m
ewh
at
lim
ited
,
th
e
p
o
ten
tial
ad
v
a
n
tag
es
o
f
s
o
cia
lly
f
o
cu
s
ed
s
p
o
r
ts
th
at
p
r
o
m
o
te
co
n
n
ec
tio
n
s
an
d
c
o
m
m
u
n
ity
ar
e
esp
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ially
p
er
s
u
asiv
e.
PA
p
r
o
v
id
es
u
n
i
q
u
e
p
o
ten
tial
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o
r
in
te
r
v
en
tio
n
wit
h
th
e
p
s
y
ch
o
lo
g
ical,
s
o
cial,
an
d
p
h
y
s
ical
b
en
ef
its
it e
n
tails
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I
t
im
p
r
o
v
es m
o
o
d
,
s
tr
en
g
t
h
en
s
r
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ien
ce
,
an
d
cr
ea
tes a
s
en
s
e
o
f
in
clu
s
io
n
wh
ich
tack
les th
e
ar
ea
s
th
at
d
r
iv
e
s
u
icid
al
id
ea
tio
n
an
d
ac
tio
n
s
.
I
n
ad
d
itio
n
,
PA
r
ep
r
esen
ts
a
r
elativ
ely
l
o
w
-
co
s
t
an
d
ea
s
ily
ac
ce
s
s
ib
le
in
ter
v
en
tio
n
with
alm
o
s
t
n
o
s
id
e
e
f
f
ec
ts
to
th
e
p
atien
t,
m
a
k
in
g
th
is
ap
p
r
o
ac
h
eg
alitar
ian
w
h
ile
d
ir
ec
tly
ad
d
r
ess
in
g
p
o
ten
tial
s
o
cio
ec
o
n
o
m
ic
d
is
p
ar
ities
b
etwe
en
y
o
u
n
g
p
eo
p
le.
T
h
is
s
tr
o
n
g
ly
s
u
p
p
o
r
ts
th
e
in
clu
s
io
n
o
f
s
o
cial
p
h
y
s
ical
a
ctiv
it
y
p
r
o
g
r
am
s
as
a
p
r
im
ar
y
in
ter
v
en
tio
n
f
o
r
th
e
p
r
ev
en
ti
o
n
an
d
m
an
a
g
em
en
t
o
f
s
u
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d
ea
tio
n
an
d
b
eh
a
v
io
r
.
T
ar
g
etin
g
PA
in
p
u
b
lic
h
ea
lth
an
d
e
d
u
ca
tio
n
al
p
r
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g
r
a
m
s
m
ak
es
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tr
o
n
g
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p
r
im
ar
y
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o
o
l to
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le
o
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e
o
f
t
h
e
m
o
s
t sig
n
if
ican
t m
en
tal
d
is
o
r
d
er
l
o
o
m
in
g
p
r
o
b
lem
am
o
n
g
y
o
u
th
.
F
UNDING
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M
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Au
th
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1227
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DATA AV
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NC
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[
1
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W
H
O
,
“
W
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[
2
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B.
-
R
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H
.
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[
3
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[
4
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[
5
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[
6
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A
.
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[
7
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C
.
R
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[
8
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M
.
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[
9
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A
.
J.
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[
1
1
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D
.
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.
H
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[
1
2
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C
.
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E.
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.
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[
1
3
]
J.
B
i
l
s
e
n
,
“
S
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:
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[
1
4
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U
N
I
C
EF,
“
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d
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[
1
5
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A
.
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R
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d
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B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
Ric
h
a
r
d
Pete
r
Ba
il
e
y
is
P
ro
f
e
ss
o
r
o
f
E
d
u
c
a
ti
o
n
a
n
d
De
p
u
ty
De
a
n
a
t
F
a
c
u
lt
y
o
f
S
o
c
ial
S
c
ien
c
e
s
a
n
d
Li
b
e
ra
l
Arts,
UCSI
Un
i
v
e
rsity
,
M
a
lay
sia
.
He
h
a
s
b
e
e
n
a
fu
ll
P
r
o
fe
ss
o
r
a
t
se
v
e
ra
l
Brit
ish
u
n
i
v
e
rsiti
e
s,
a
n
d
He
a
d
o
f
Re
se
a
rc
h
a
t
th
e
g
lo
b
a
l
sp
o
rts
NG
O
in
Be
rli
n
,
G
e
r
m
a
n
y
.
He
wo
rk
s
a
t
t
h
e
in
terfa
c
e
b
e
twe
e
n
sc
ien
c
e
a
n
d
p
h
i
lo
so
p
h
y
in
re
latio
n
to
h
e
a
lt
h
a
n
d
e
d
u
c
a
ti
o
n
a
n
d
h
a
s
c
a
rried
o
u
t
n
u
m
e
ro
u
s
p
r
o
jec
ts
i
n
t
h
is
a
re
a
.
Re
c
e
n
t
stu
d
ies
h
a
v
e
i
n
v
e
sti
g
a
ted
th
e
p
h
y
sic
a
l
a
n
d
m
e
n
tal
h
e
a
lt
h
o
u
tco
m
e
s
o
f
m
a
rti
a
l
a
rts,
t
h
e
p
h
il
o
so
p
h
ica
l
b
a
sis
o
f
e
x
ist
e
n
t
ial
p
sy
c
h
iatr
y
,
a
n
d
t
h
e
‘Ac
ti
v
e
S
c
h
o
o
ls’
c
o
n
c
e
p
t
o
f
h
e
a
lt
h
p
r
o
m
o
ti
o
n
.
His
X
(fo
rm
e
rly
Twit
ter)
fe
e
d
is
‘Co
a
c
h
i
n
g
S
c
ien
c
1
’,
a
n
d
Li
n
k
e
d
In
a
c
c
o
u
n
t
is
in
h
is
n
a
m
e
.
S
tan
fo
rd
U
n
iv
e
rsit
y
'
s
li
st
o
f
to
p
sc
ien
ti
sts
in
t
h
e
wo
r
ld
in
c
l
u
d
e
s
h
im
in
c
li
n
ica
l
m
e
d
icin
e
,
s
p
o
rts
sc
ien
c
e
s,
a
n
d
e
d
u
c
a
ti
o
n
.
H
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
rich
a
rd
.
b
a
il
e
y
@u
c
si
u
n
i
v
e
rsity
.
e
d
u
.
m
y
.
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