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Dec
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20
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I
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Vo
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14
,
No
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4
,
Dec
em
b
er
20
25
:
1
6
4
7
-
1
6
5
7
1648
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RE
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Study
des
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1
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2
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2
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[
1
6
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,
t
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3
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[
1
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,
[
1
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.
W
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[
1
9
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A
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3.
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
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0
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I
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b
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ab
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3
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
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me
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e
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me
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4.
DIS
CU
SS
I
O
N
4
.
1
.
P
re
v
a
lence
o
f
s
ub
s
t
a
nce
s
us
ed
by
s
t
ud
ent
s
Fin
d
in
g
s
f
r
o
m
th
is
s
tu
d
y
in
d
ic
ated
th
at
th
e
m
o
s
t
co
m
m
o
n
ly
u
s
ed
s
u
b
s
tan
ce
b
y
s
tu
d
en
ts
in
th
e
last
3
0
d
ay
s
o
r
last
1
2
m
o
n
t
h
s
is
alco
h
o
l
(
4
4
.
4
%),
wh
ich
co
n
cu
r
s
w
ith
p
u
b
lis
h
ed
liter
atu
r
e
f
r
o
m
B
o
ts
wan
a
[
2
5
]
.
T
h
is
p
r
ev
alen
ce
f
i
g
u
r
e
is
co
m
p
ar
a
b
le
to
p
u
b
lis
h
ed
liter
atu
r
e
f
r
o
m
u
n
iv
e
r
s
ities
in
B
o
ts
wan
a
an
d
So
u
th
Af
r
ica
,
wh
er
e
alco
h
o
l
was
d
o
cu
m
en
te
d
to
b
e
th
e
m
o
s
t
co
m
m
o
n
ly
u
s
ed
s
u
b
s
tan
ce
at
a
p
r
ev
alen
ce
r
ate
o
f
3
1
.
9
%
an
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
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lic
Hea
lth
Sci
I
SS
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2252
-
8
8
0
6
P
r
ev
a
len
ce
,
p
a
tter
n
s
,
a
n
d
a
s
s
o
cia
ted
fa
cto
r
s
fo
r
s
u
b
s
ta
n
ce
u
s
e
a
mo
n
g
u
n
ivers
ity
…
(
P
h
o
o
fo
lo
K
a
mo
h
elo
)
1653
3
7
.
1
%
r
esp
ec
tiv
ely
[
2
6
]
,
[
2
7
]
.
T
h
e
p
r
ev
alen
ce
r
ates
o
f
th
is
s
tu
d
y
ar
e
also
in
lin
e
with
f
in
d
in
g
s
f
r
o
m
Nig
er
ia
(
4
3
.
5
%)
[
2
8
]
.
As
f
o
r
cig
ar
ette
s
m
o
k
in
g
,
th
e
p
r
ev
alen
ce
was
6
%
in
th
e
la
s
t
3
0
d
ay
s
.
I
t
was
lo
wer
th
an
u
n
iv
er
s
ity
s
tu
d
en
ts
in
B
o
ts
wan
a
(
1
2
%)
a
n
d
So
u
th
Af
r
ica
(
2
0
%)
[
2
9
]
,
[
3
0
]
.
Ho
we
v
er
,
th
e
f
in
d
i
n
g
s
wer
e
co
n
s
is
ten
t
with
Af
r
ican
liter
atu
r
e
f
r
o
m
No
r
th
-
ea
s
ter
n
E
th
io
p
i
a
(
7
.
9
%)
[
3
1
]
,
Ken
y
a
(
8
.
9
%)
[
3
2
]
,
a
n
d
E
g
y
p
t
(
8
.
9
%)
[
3
3
]
.
T
h
e
p
r
ev
alen
ce
o
f
d
a
g
g
a
am
o
n
g
s
tu
d
en
ts
in
th
is
s
tu
d
y
wa
s
6
%.
T
h
is
f
in
d
in
g
is
co
n
s
id
er
ab
ly
less
co
m
p
ar
ed
to
th
e
p
r
ev
ale
n
ce
o
f
2
4
%
o
f
life
tim
e
m
ar
iju
an
a
u
s
e
am
o
n
g
u
n
i
v
er
s
ity
s
tu
d
en
ts
in
n
eig
h
b
o
u
r
in
g
S
o
u
th
Af
r
ica
[
3
4
]
.
H
en
ce
,
it
is
also
less
co
m
p
ar
ed
to
th
e
8
%
am
o
n
g
ca
n
n
a
b
is
u
s
e
am
o
n
g
s
tu
d
e
n
ts
in
a
u
n
iv
er
s
ity
in
Ken
y
a
[
3
5
]
.
Var
iatio
n
s
in
th
e
p
r
ev
alen
c
e
o
f
alco
h
o
l
,
cig
ar
ette
s
m
o
k
in
g
,
an
d
ca
n
n
a
b
is
lar
g
ely
r
ef
lect
d
if
f
er
en
ce
s
in
r
esear
ch
m
eth
o
d
o
lo
g
ies,
p
a
r
ticu
lar
ly
s
am
p
lin
g
.
C
u
ltu
r
al
n
o
r
m
s
a
n
d
in
s
titu
tio
n
al
e
n
v
ir
o
n
m
en
ts
ac
r
o
s
s
co
u
n
tr
ies
also
s
h
ap
e
th
ese
o
u
tco
m
es.
T
o
g
eth
er
,
m
et
h
o
d
o
lo
g
ical
an
d
co
n
tex
t
u
al
f
ac
to
r
s
m
u
s
t
b
e
co
n
s
id
er
ed
wh
en
in
ter
p
r
etin
g
an
d
co
m
p
ar
in
g
p
r
e
v
alen
ce
d
ata.
4
.
2
.
P
re
v
a
lence
t
re
nd
s
T
h
e
f
in
d
in
g
s
s
h
o
wed
th
at
alco
h
o
l,
cig
ar
ette
s
m
o
k
in
g
,
an
d
ca
n
n
ab
is
u
s
e
wer
e
th
e
m
o
s
t
co
m
m
o
n
s
u
b
s
tan
ce
s
u
s
ed
am
o
n
g
th
e
s
a
m
p
le
o
f
s
tu
d
en
ts
,
wh
ich
was
c
o
n
s
is
ten
t
with
s
tu
d
ies
co
n
d
u
cted
in
o
th
er
Af
r
ican
co
u
n
tr
ies
s
u
ch
as
So
u
th
Af
r
i
ca
,
Ken
y
a,
T
an
za
n
ia
[
3
6
]
-
[
3
8
]
.
T
h
e
tr
en
d
is
s
im
ilar
g
lo
b
al
ly
,
wh
er
e
alco
h
o
l,
cig
ar
ette
s
m
o
k
in
g
,
a
n
d
ca
n
n
ab
is
ar
e
am
o
n
g
s
t
t
h
e
m
o
s
t
c
o
m
m
o
n
s
u
b
s
tan
ce
s
o
f
c
h
o
ice
b
y
lear
n
e
r
s
[
3
9
]
.
Alco
h
o
l
was
th
e
m
o
s
t
co
m
m
o
n
ly
u
s
ed
s
u
b
s
tan
ce
in
th
is
s
tu
d
y
.
T
h
is
is
ex
p
lain
ed
b
y
th
e
wid
e
ac
ce
s
s
ib
ilit
y
o
f
alc
o
h
o
l,
its
leg
al
s
tatu
s
,
an
d
i
ts
ac
ce
p
tab
ilit
y
in
m
an
y
s
o
cie
ties
[
4
0
]
,
in
clu
d
i
n
g
L
eso
th
o
.
Mo
r
eo
v
er
,
th
is
ca
n
also
b
e
attr
ib
u
ted
to
in
f
o
r
m
al
alco
h
o
l v
en
d
o
r
s
th
at
o
f
f
er
alco
h
o
l a
t
an
af
f
o
r
d
ab
le
p
r
ice.
T
h
e
ac
ce
s
s
ib
ili
ty
co
u
ld
also
b
e
th
e
r
ea
s
o
n
f
o
r
ci
g
ar
ette
u
s
e
in
th
is
s
tu
d
y
.
Alth
o
u
g
h
ca
n
n
ab
is
u
s
e
h
as
b
ee
n
r
ep
o
r
te
d
as
o
n
e
o
f
th
e
co
m
m
o
n
ly
u
s
ed
d
r
u
g
s
in
th
e
s
tu
d
y
,
it
is
n
o
t
s
u
r
p
r
is
in
g
th
at
it
is
u
n
d
er
r
ep
o
r
ted
b
ec
a
u
s
e
it
ca
r
r
ies
cu
ltu
r
al
s
tig
m
a
an
d
is
illeg
al
f
o
r
r
ec
r
ea
tio
n
al
u
s
e
in
L
eso
th
o
.
A
u
n
iq
u
e
f
i
n
d
in
g
in
th
is
s
tu
d
y
is
th
at
n
o
n
e
o
f
th
e
s
am
p
led
s
tu
d
en
ts
r
ep
o
r
ted
t
h
e
u
s
e
o
f
co
ca
in
e,
ec
s
tasy
,
h
er
o
in
,
n
y
a
o
p
e,
cr
ac
k
,
o
r
an
y
o
th
er
d
r
u
g
s
,
wh
ich
s
u
p
p
o
r
ts
th
e
v
iew
th
at
s
u
b
s
tan
ce
u
s
e
is
s
o
cially
in
f
lu
en
ce
d
[
4
1
]
,
a
n
d
th
at
,
b
ec
au
s
e
th
e
u
s
e
o
f
th
ese
s
u
b
s
tan
c
es
is
n
o
t
th
e
‘
in
’
th
in
g
,
th
e
y
d
o
n
o
t
en
g
a
g
e
in
it
.
On
th
e
o
th
e
r
h
a
n
d
,
it
c
o
u
ld
b
e
b
ec
au
s
e
th
ey
ar
e
n
o
t
ea
s
ily
a
cc
ess
ib
le
an
d
/o
r
af
f
o
r
d
a
b
le
to
u
n
iv
er
s
ity
s
tu
d
en
ts
in
L
eso
th
o
o
r
wid
ely
u
s
ed
i
n
t
h
e
g
en
er
al
p
o
p
u
latio
n
.
4
.
3
.
P
a
t
t
er
ns
o
f
s
ub
s
t
a
nce
us
e
T
h
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
in
d
icate
th
at
th
er
e
wer
e
n
o
s
tati
s
tically
s
ig
n
if
ican
t
ass
o
ciatio
n
s
b
etwe
en
s
u
b
s
tan
ce
u
s
e
an
d
a
g
e,
p
lace
o
f
r
esid
en
ce
,
co
u
r
s
es
en
r
o
ll
ed
in
,
an
d
m
ar
ital
s
tatu
s
.
Gen
d
er
was
th
e
o
n
ly
ch
ar
ac
ter
is
tic
th
at
was
s
tatis
ti
ca
lly
s
ig
n
if
ican
tly
ass
o
ciate
d
with
all
th
r
ee
s
u
b
s
tan
ce
s
,
i.e
.
cig
ar
ette,
alco
h
o
l
,
an
d
d
ag
g
a.
T
h
is
c
o
u
ld
b
e
attr
i
b
u
ted
t
o
th
e
f
ac
t
th
at
th
e
s
tu
d
y
p
ar
ticip
an
ts
h
ad
s
im
ilar
ch
ar
a
cter
is
tics
o
r
u
n
e
v
en
s
am
p
le
s
ize
,
wh
er
e
m
o
r
e
s
in
g
le
p
ar
ticip
an
ts
(
8
7
.
1
%)
p
a
r
ticip
ated
as
co
m
p
ar
ed
to
m
ar
r
ied
(
1
1
.
6
%)
an
d
d
iv
o
r
ce
d
(
1
.
3
%)
.
4
.
4
.
Ag
e
o
f
ini
t
ia
t
i
o
n
Glo
b
al
d
ata
r
ep
o
r
ts
th
at
s
u
b
s
ta
n
ce
u
s
e
o
f
ten
s
tar
ts
b
etwe
en
th
e
ag
es o
f
1
4
an
d
1
5
y
ea
r
s
[
4
2
]
,
wh
ich
is
th
e
ad
o
lescen
ce
p
er
i
o
d
o
f
tr
a
n
s
itio
n
in
wh
ich
in
d
i
v
id
u
als
s
ee
m
to
b
e
m
o
r
e
im
p
u
ls
iv
e,
r
ec
k
less
,
an
d
n
o
n
-
co
n
f
o
r
m
in
g
th
a
n
d
u
r
in
g
o
th
er
d
ev
elo
p
m
e
n
tal
s
tag
es
o
f
th
eir
liv
es
[
4
3
]
.
Alth
o
u
g
h
u
s
in
g
d
r
u
g
s
at
an
y
ag
e
ca
n
lead
to
ad
d
ictio
n
,
th
e
p
r
o
b
le
m
is
th
at
th
e
ea
r
lier
t
h
at
d
r
u
g
u
s
e
b
eg
in
s
,
th
e
m
o
r
e
lik
ely
i
t
will
p
r
o
g
r
ess
an
d
escalate
in
to
m
o
r
e
s
er
io
u
s
ab
u
s
e
[
4
4
]
.
T
h
e
s
tu
d
y
f
in
d
in
g
s
r
ev
ea
led
th
at
ab
o
u
t
h
alf
(
5
1
.
1
%)
o
f
th
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y
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ly
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ity
.
T
h
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p
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ted
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W
elsh
[
4
5
]
,
wh
o
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ted
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at
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v
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ity
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ith
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[
4
6
]
,
[
4
7
]
.
B
ei
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m
al
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b
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v
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ws
[
4
8
]
.
I
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Evaluation Warning : The document was created with Spire.PDF for Python.
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4
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Dec
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20
25
:
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s
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l
[
4
9
]
.
4
.
6
.
Rea
s
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ns
f
o
r
s
ub
s
t
a
nce
u
s
e
Similar
to
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u
b
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r
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tu
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v
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tu
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ts
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in
clu
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ical,
m
en
tal,
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s
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th
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ep
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m
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tal
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ain
,
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d
p
h
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ical
s
tr
en
g
th
[
5
0
]
,
[
5
1
]
.
T
h
e
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f
s
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ce
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ailab
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ce
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s
ib
ilit
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[
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2
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d
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with
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in
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m
[
5
3
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-
[
5
5
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in
d
icatin
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t
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So
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ce
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as
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m
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to
escap
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f
r
o
m
life
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tr
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r
s
[
5
6
]
.
5.
CO
NCLU
SI
O
N
T
o
th
e
b
est
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f
o
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wled
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ce
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s
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am
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g
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n
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ity
s
tu
d
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ts
in
Ma
s
er
u
,
L
eso
th
o
.
T
h
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s
tu
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p
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v
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tex
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-
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h
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l,
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k
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s
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n
o
r
m
aliza
tio
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n
d
p
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n
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m
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Gen
d
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s
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s
itiv
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r
ev
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n
tio
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s
tr
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n
d
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m
p
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ased
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tio
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s
ar
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tly
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e
d
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th
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b
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elf
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ts
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ld
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ter
p
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eted
ca
u
tio
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s
ly
,
as st
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ias m
ay
o
b
s
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e.
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h
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l,
cig
ar
ettes,
a
n
d
d
ag
g
a
m
ay
ac
t
as
g
atew
ay
s
to
h
a
r
d
e
r
d
r
u
g
u
s
e.
As
d
ig
ital
ac
ce
s
s
ex
p
an
d
s
in
L
eso
th
o
,
th
e
d
r
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g
lan
d
s
ca
p
e
an
d
av
ailab
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y
tr
e
n
d
s
ar
e
lik
ely
to
s
h
if
t,
m
ak
i
n
g
tim
ely
p
r
ev
en
tio
n
s
tr
ateg
ies
ess
en
tial;
u
n
iv
er
s
ities
s
h
o
u
ld
ad
o
p
t
p
r
o
ac
tiv
e
p
o
licies
to
an
t
icip
ate
em
er
g
in
g
th
r
ea
ts
.
A
co
o
r
d
in
ated
a
p
p
r
o
ac
h
in
v
o
lv
in
g
g
o
v
e
r
n
m
en
t,
ac
a
d
e
m
ic
in
s
titu
tio
n
s
,
an
d
co
m
m
u
n
ities
is
n
ee
d
ed
to
r
estrict
s
u
b
s
tan
ce
ac
ce
s
s
n
ea
r
s
tu
d
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ts
,
wh
ile
f
u
tu
r
e
r
esear
c
h
s
h
o
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ld
ex
a
m
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e
lo
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g
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in
al
p
atter
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s
an
d
t
h
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k
s
to
ac
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d
em
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p
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f
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m
an
ce
an
d
m
e
n
tal
h
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lth
,
co
m
p
lem
e
n
ted
b
y
q
u
alitativ
e
s
tu
d
ies
th
at
ca
p
tu
r
e
s
tu
d
en
ts
’
liv
ed
ex
p
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s
to
in
f
o
r
m
r
esp
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n
s
iv
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ter
v
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s
.
T
h
is
s
tu
d
y
is
s
u
b
ject
to
s
ev
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al
m
eth
o
d
o
lo
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itatio
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s
.
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th
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s
tu
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y
r
elied
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n
s
elf
-
r
ep
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ted
d
ata,
wh
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m
a
y
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e
s
u
b
ject
t
o
s
o
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d
esira
b
ilit
y
an
d
r
ec
al
l
b
ias.
Seco
n
d
ly
,
t
h
e
r
esu
lts
m
ay
n
o
t
b
e
wid
ely
g
en
er
aliza
b
le
d
u
e
to
th
e
s
p
e
cif
ic
ch
ar
ac
ter
is
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o
f
th
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am
p
led
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n
i
v
er
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ity
p
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latio
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L
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s
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tio
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al
d
esig
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th
e
a
b
ilit
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to
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elatio
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ip
s
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ap
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ter
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tics
an
d
s
u
b
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tan
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.
F
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U
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