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rna
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l J
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urna
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P
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ea
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I
J
P
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Vo
l.
14
,
No
.
4
,
Dec
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b
er
20
25
,
p
p
.
1
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7
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~
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Factors
inf
l
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he p
ra
ctice
of
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st self
-
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x
a
mina
tion
a
mo
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in
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9
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Sep
2
4
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2
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v
3
,
2
0
2
5
Bre
a
st
c
a
n
c
e
r
is
th
e
se
c
o
n
d
lea
d
i
n
g
c
a
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se
o
f
c
a
n
c
e
r
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late
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m
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m
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g
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m
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In
d
o
n
e
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y
d
e
tec
ti
o
n
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r
o
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v
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e
t
m
a
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les
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t
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c
ti
c
e
b
re
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st
se
lf
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x
a
m
in
a
ti
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n
(B
S
E).
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i
d
e
n
c
e
o
n
p
e
rso
n
a
l
b
a
rriers
a
m
o
n
g
y
o
u
n
g
wo
m
e
n
re
m
a
in
s
li
m
it
e
d
.
To
a
n
a
l
y
z
e
k
n
o
wle
d
g
e
,
p
e
rc
e
iv
e
d
su
sc
e
p
ti
b
il
it
y
,
a
n
d
b
a
rri
e
rs
to
BS
E
p
ra
c
ti
c
e
a
m
o
n
g
late
a
d
o
les
c
e
n
ts
in
S
a
latig
a
,
Ce
n
tral
Ja
v
a
.
A
c
ro
ss
-
se
c
ti
o
n
a
l
stu
d
y
wa
s
c
o
n
d
u
c
ted
in
F
e
b
ru
a
ry
2
0
2
3
a
m
o
n
g
6
7
fe
m
a
le
stu
d
e
n
ts
a
g
e
d
1
8
–
2
1
y
e
a
rs
li
v
i
n
g
in
a
u
n
i
v
e
rsity
d
o
rm
it
o
ry
.
Da
ta we
re
c
o
ll
e
c
ted
u
sin
g
a
se
lf
-
a
d
m
in
istere
d
q
u
e
stio
n
n
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ire b
a
se
d
o
n
t
h
e
He
a
lt
h
Be
li
e
f
M
o
d
e
l
a
n
d
a
n
a
ly
z
e
d
with
d
e
sc
rip
ti
v
e
sta
t
isti
c
s
a
n
d
lo
g
isti
c
re
g
re
ss
io
n
.
M
o
st
re
sp
o
n
d
e
n
ts
(7
0
.
1
%
)
h
a
d
re
c
e
iv
e
d
B
S
E
in
fo
rm
a
ti
o
n
,
m
a
in
ly
fr
o
m
so
c
ial
m
e
d
ia
(
3
5
.
8
%
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a
n
d
sc
h
o
o
l
(
3
2
.
8
%
).
Ba
rrier
s
in
c
lu
d
e
d
p
e
rc
e
iv
in
g
BS
E
a
s
u
n
imp
o
rtan
t
(
3
7
.
3
%
)
,
lac
k
o
f
k
n
o
wle
d
g
e
(3
5
.
8
%
),
b
e
li
e
f
th
a
t
it
wa
s
u
n
n
e
c
e
ss
a
ry
with
o
u
t
il
l
n
e
ss
(3
8
.
8
%
),
a
n
d
fe
e
li
n
g
t
o
o
y
o
u
n
g
(2
0
.
9
%
)
.
Lo
g
isti
c
re
g
re
ss
io
n
i
d
e
n
t
ifi
e
d
fo
u
r
p
re
d
icto
rs
o
f
n
o
n
-
p
ra
c
ti
c
e
:
lac
k
o
f
k
n
o
wle
d
g
e
(OR
=
0
.
0
0
3
,
9
5
%
CI:
0
.
0
0
0
–
0
.
2
4
3
,
p
=
0
.
0
1
0
),
b
e
li
e
f
B
S
E
is
o
n
l
y
n
e
e
d
e
d
wit
h
sy
m
p
to
m
s
(OR
=
0
.
0
2
2
,
9
5
%
CI:
0
.
0
0
2
–
0
.
3
1
2
,
p
=
0
.
0
0
5
),
lac
k
o
f
p
ri
v
a
c
y
(O
R
=
0
.
0
2
6
,
9
5
%
CI:
0
.
0
0
1
–
0
.
9
4
6
,
p
=
0
.
0
4
6
),
a
n
d
t
ime
c
o
n
stra
in
ts
(OR
=
0
.
0
6
4
,
9
5
%
CI:
0
.
0
0
6
–
0
.
7
0
1
,
p
=
0
.
0
2
4
).
M
isc
o
n
c
e
p
ti
o
n
s,
li
m
it
e
d
k
n
o
wle
d
g
e
,
a
n
d
so
c
ial
c
o
n
stra
i
n
t
s
we
re
th
e
m
a
in
b
a
rriers
to
BS
E
p
ra
c
ti
c
e
a
m
o
n
g
a
d
o
les
c
e
n
t
g
irl
s.
Ad
d
re
ss
in
g
th
e
se
re
q
u
ire
s
sc
h
o
o
l
-
b
a
se
d
p
ro
g
ra
m
s,
in
teg
ra
ti
o
n
o
f
B
S
E
in
t
o
re
p
ro
d
u
c
ti
v
e
h
e
a
lt
h
c
u
rricu
la,
a
n
d
c
o
m
m
u
n
it
y
c
a
m
p
a
ig
n
s,
wh
il
e
n
u
rsin
g
p
ra
c
ti
c
e
sh
o
u
ld
fo
c
u
s
o
n
e
n
h
a
n
c
i
n
g
se
lf
-
e
ffica
c
y
a
n
d
n
o
rm
a
li
z
in
g
BS
E.
K
ey
w
o
r
d
s
:
B
r
ea
s
t c
an
ce
r
B
r
ea
s
t self
-
ex
am
in
atio
n
I
n
d
o
n
esia
Pra
ctice
T
ee
n
ag
e
g
ir
ls
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
Kr
is
tian
i D
esimin
a
T
au
h
o
Dep
ar
tm
en
t o
f
Nu
r
s
in
g
,
Facu
lt
y
o
f
Hea
lth
Scien
ce
s
,
Un
iv
e
r
s
itas
Kr
is
ten
Saty
a
W
ac
an
a
Salatig
a,
I
n
d
o
n
esia
E
m
ail:
k
r
is
tian
i.ta
u
h
o
@
u
k
s
w.
ed
u
1.
I
NT
RO
D
UCT
I
O
N
C
an
ce
r
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ch
ar
ac
ter
ized
b
y
th
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n
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g
r
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d
d
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io
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o
f
a
b
n
o
r
m
al
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lls
in
th
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o
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y
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wh
ich
ca
n
in
v
a
d
e
s
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r
r
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n
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g
b
o
d
y
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s
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es.
T
h
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ca
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ce
r
ce
lls
c
an
g
r
o
w
f
u
r
th
er
an
d
s
p
r
ea
d
to
o
th
e
r
b
o
d
y
p
ar
ts
,
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esu
ltin
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in
d
ea
th
.
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o
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ll
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will
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eg
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to
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r
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ig
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p
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f
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[
1
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[
2
]
.
Glo
b
ally
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2
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2
[
3
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2
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9
[
4
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.
Mo
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,
h
o
wev
er
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h
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co
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cr
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ca
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2
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an
d
2
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d
6
5
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8
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n
ew
ca
s
es r
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o
r
ted
in
2
0
2
0
al
o
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e
[
5
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
5
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6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
7
7
9
-
1
7
87
1780
At
th
e
p
r
o
v
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cial
lev
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th
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H
ea
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Of
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ates
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n
o
wled
g
e
,
m
is
co
n
ce
p
tio
n
s
,
an
d
s
o
cio
-
cu
ltu
r
al
b
ar
r
ier
s
to
B
SE
[
7
]
-
[
9
]
.
Desp
ite
th
ese
co
n
tr
ib
u
tio
n
s
,
m
o
s
t
ex
is
ti
n
g
r
esear
ch
f
o
cu
s
es
o
n
ad
u
lt
wo
m
e
n
o
r
ev
alu
ates
s
h
o
r
t
-
ter
m
in
ter
v
en
tio
n
s
,
leav
in
g
a
cr
itical
g
ap
in
u
n
d
er
s
tan
d
in
g
a
d
o
lescen
t
-
s
p
ec
if
ic
b
ar
r
ier
s
.
Ad
d
r
ess
in
g
th
is
g
ap
is
ess
en
tial,
s
in
ce
ad
o
lescen
ce
is
a
f
o
r
m
ativ
e
s
tag
e
f
o
r
estab
lis
h
in
g
life
lo
n
g
h
ea
lth
b
e
h
av
i
o
r
s
.
C
u
ltu
r
al
an
d
s
o
cial
co
n
tex
ts
f
u
r
th
er
co
m
p
licate
ad
o
lescen
t e
n
g
ag
em
en
t in
p
r
e
v
en
tiv
e
h
ea
lth
.
I
n
m
an
y
So
u
th
ea
s
t
Asi
an
co
m
m
u
n
ities
,
tab
o
o
s
s
u
r
r
o
u
n
d
in
g
t
h
e
f
em
al
e
b
o
d
y
an
d
f
atalist
ic
b
elief
s
ab
o
u
t
illn
ess
—
s
u
ch
as
p
er
ce
iv
in
g
ca
n
ce
r
as
d
esti
n
y
—
d
is
co
u
r
ag
e
o
p
en
d
is
cu
s
s
io
n
an
d
p
r
e
v
en
tiv
e
ac
tio
n
.
T
h
ese
b
elief
s
m
ay
lo
we
r
p
er
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
,
r
ed
u
ce
m
o
tiv
atio
n
,
an
d
r
ein
f
o
r
ce
em
b
ar
r
ass
m
en
t
o
r
av
o
id
an
ce
o
f
B
SE,
ev
en
wh
en
awa
r
en
ess
ex
is
ts
[
1
0
]
.
Hea
lth
b
eh
av
io
r
th
eo
r
ies
p
r
o
v
i
d
e
a
v
alu
ab
le
f
r
am
ewo
r
k
to
u
n
d
er
s
tan
d
wh
y
awa
r
en
ess
d
o
es
n
o
t
alwa
y
s
tr
an
s
late
in
to
p
r
ev
en
tiv
e
ac
tio
n
.
T
h
e
h
ea
lth
b
elief
m
o
d
el
(
H
B
M)
,
o
n
e
o
f
t
h
e
m
o
s
t
wid
ely
ap
p
lied
f
r
am
ewo
r
k
s
in
ca
n
ce
r
p
r
e
v
en
tio
n
r
esear
ch
,
em
p
h
asizes
p
er
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
,
s
ev
er
ity
,
p
er
ce
iv
e
d
b
en
ef
its
,
p
er
ce
i
v
e
d
b
ar
r
ier
s
,
c
u
es
to
ac
tio
n
,
an
d
s
elf
-
ef
f
icac
y
i
n
s
h
ap
in
g
h
ea
lth
b
e
h
av
io
r
[
1
1
]
.
Pre
v
io
u
s
s
tu
d
ies
h
av
e
s
h
o
wn
th
at
lo
w
p
er
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
(
“f
e
elin
g
to
o
y
o
u
n
g
”)
,
lo
w
p
er
ce
iv
ed
b
en
e
f
its
(
“BS
E
is
u
n
n
ec
ess
ar
y
with
o
u
t
s
y
m
p
to
m
s
”)
,
an
d
v
a
r
io
u
s
s
o
ci
o
-
cu
ltu
r
al
b
ar
r
ier
s
ar
e
s
ig
n
if
ic
an
t
p
r
ed
icto
r
s
o
f
p
o
o
r
B
SE
p
r
ac
tice
am
o
n
g
y
o
u
n
g
wo
m
en
[
1
2
]
.
Gr
o
u
n
d
i
n
g
th
is
s
tu
d
y
in
th
e
HB
M
f
r
am
ewo
r
k
al
lo
ws
f
o
r
a
d
ee
p
er
an
aly
s
is
o
f
h
o
w
p
er
s
o
n
al
an
d
/o
r
s
o
cial
b
ar
r
ier
s
s
h
ap
e
ad
o
lescen
t g
ir
ls
’
d
ec
is
io
n
s
to
en
g
ag
e
,
o
r
n
o
t e
n
g
ag
e
,
i
n
B
SE.
Pre
v
io
u
s
s
t
u
d
ies
o
n
B
SE
h
av
e
p
r
ed
o
m
i
n
an
tly
ex
a
m
in
ed
g
e
n
e
r
al
f
ac
to
r
s
s
u
ch
as
k
n
o
wled
g
e,
awa
r
en
ess
,
an
d
attitu
d
es
[
1
3
]
-
[
1
5
]
.
Ho
wev
er
,
th
ese
s
tu
d
ies
h
av
e
n
o
t
ex
p
lo
r
ed
th
e
s
p
ec
if
ic
p
er
s
o
n
al
o
b
s
tacle
s
th
at
p
r
ev
en
t
y
o
u
n
g
wo
m
en
f
r
o
m
p
r
ac
ticin
g
B
SE.
T
h
is
g
ap
is
cr
itical,
g
iv
en
th
at
a
d
o
lescen
ce
is
a
f
o
r
m
ativ
e
s
tag
e
f
o
r
d
ev
elo
p
in
g
life
lo
n
g
h
ea
lth
b
eh
av
io
r
s
.
Mo
r
eo
v
e
r
,
l
o
ca
l
d
ata
f
r
o
m
C
en
tr
al
J
av
a
in
d
icate
th
at
Salatig
a
h
as
o
n
e
o
f
th
e
lo
west
r
ates
o
f
b
r
ea
s
t
ex
am
in
atio
n
s
b
y
h
ea
lth
wo
r
k
er
s
(
1
2
.
9
%)
[
6
]
.
Yet,
n
o
p
r
io
r
r
esear
ch
h
as
ex
p
l
o
r
ed
wh
y
y
o
u
n
g
wo
m
en
in
th
is
s
ettin
g
u
n
d
er
u
tili
ze
s
elf
-
ex
am
in
atio
n
.
F
o
cu
s
in
g
o
n
ad
o
lescen
t
g
i
r
ls
in
Salatig
a,
th
is
s
tu
d
y
u
n
iq
u
ely
c
o
n
tr
ib
u
tes
to
th
e
liter
atu
r
e
b
y
h
i
g
h
lig
h
tin
g
co
n
tex
t
-
s
p
ec
if
ic
p
er
s
o
n
al
an
d
s
o
cial
b
ar
r
ier
s
,
p
r
o
v
id
in
g
ev
id
en
ce
t
o
in
f
o
r
m
te
en
ag
e
h
e
alth
ed
u
ca
tio
n
an
d
p
o
licy
i
n
I
n
d
o
n
esia.
T
o
ad
d
r
ess
th
e
lack
o
f
ad
o
lescen
t
-
f
o
cu
s
ed
r
esear
ch
in
So
u
th
ea
s
t
Asi
a,
th
is
s
tu
d
y
in
v
esti
g
ates
f
ac
to
r
s
i
n
f
lu
en
cin
g
B
SE
p
r
ac
tice
am
o
n
g
teen
ag
e
g
ir
ls
in
Salatig
a
C
ity
,
I
n
d
o
n
esia.
B
y
i
d
en
tify
in
g
p
e
r
s
o
n
al,
co
g
n
iti
v
e,
an
d
s
o
cio
-
c
u
ltu
r
al
b
ar
r
ie
r
s
,
t
h
e
f
in
d
in
g
s
ai
m
to
in
f
o
r
m
a
d
o
lescen
t h
ea
lth
e
d
u
c
atio
n
s
tr
ateg
ies an
d
co
n
t
r
ib
u
te
to
b
r
ea
s
t c
an
ce
r
p
r
ev
e
n
tio
n
ef
f
o
r
ts
in
I
n
d
o
n
esia.
2.
M
E
T
H
O
D
T
h
i
s
r
es
e
a
r
c
h
u
s
e
d
a
n
i
n
s
ti
t
u
t
i
o
n
-
b
a
s
e
d
c
r
o
s
s
-
s
e
ct
i
o
n
a
l
s
t
u
d
y
ap
p
r
o
a
c
h
.
T
h
e
s
t
u
d
y
w
a
s
c
o
n
d
u
ct
e
d
a
t
Sa
t
y
a
W
a
c
a
n
a
C
h
r
i
s
t
i
a
n
U
n
i
v
e
r
s
i
t
y
i
n
S
a
l
a
t
i
g
a
C
i
t
y
,
C
e
n
t
r
a
l
J
a
v
a
,
I
n
d
o
n
e
s
i
a
.
T
h
e
p
o
p
u
l
a
t
i
o
n
c
o
m
p
r
i
s
e
d
f
e
m
a
l
e
s
t
u
d
e
n
t
s
a
g
e
d
1
8
–
2
1
y
e
a
r
s
a
t
S
a
t
y
a
W
ac
a
n
a
C
h
r
i
s
t
i
a
n
U
n
i
v
e
r
s
it
y
(
S
W
C
U
)
,
S
a
l
at
i
g
a
,
w
h
o
r
e
s
i
d
e
d
i
n
u
n
i
v
e
r
s
i
t
y
d
o
r
m
i
t
o
r
i
es
.
A
t
o
t
a
l
o
f
6
7
r
e
s
p
o
n
d
e
n
t
s
w
e
r
e
r
e
c
r
u
i
t
e
d
u
s
i
n
g
p
u
r
p
o
s
i
v
e
s
a
m
p
l
i
n
g
.
T
h
i
s
t
e
c
h
n
i
q
u
e
w
a
s
c
h
o
s
en
b
e
c
a
u
s
e
a
c
c
e
s
s
t
o
p
a
r
t
i
c
i
p
a
n
ts
r
e
q
u
i
r
e
d
p
e
r
m
is
s
i
o
n
f
r
o
m
u
n
i
v
e
r
s
i
t
y
a
n
d
d
o
r
m
i
t
o
r
y
a
d
m
i
n
i
s
t
r
at
o
r
s
,
a
n
d
t
h
e
s
t
u
d
y
a
i
m
e
d
t
o
t
a
r
g
e
t
a
s
p
e
c
i
f
i
c
s
u
b
g
r
o
u
p
o
f
l
a
t
e
a
d
o
l
esc
e
n
t
s
.
M
o
r
e
o
v
e
r
,
d
o
r
m
i
t
o
r
y
r
es
id
e
n
t
s
r
e
p
r
e
s
e
n
t
e
d
a
u
n
i
q
u
e
p
o
p
u
l
a
t
i
o
n
f
r
o
m
d
i
v
e
r
s
e
r
e
g
i
o
n
s
a
c
r
o
s
s
I
n
d
o
n
e
s
i
a
,
c
o
n
t
r
ib
u
t
i
n
g
v
a
r
i
e
d
c
u
l
t
u
r
a
l
b
a
c
k
g
r
o
u
n
d
s
,
k
n
o
w
l
e
d
g
e
l
e
v
e
ls
,
a
n
d
m
o
ti
v
a
t
i
o
n
s
t
h
a
t
m
i
g
h
t
a
f
f
e
c
t
B
S
E
p
r
a
ct
i
c
e
.
N
e
v
e
r
t
h
ele
s
s
,
t
h
e
d
o
r
m
i
t
o
r
y
-
b
a
s
e
d
s
a
m
p
l
e
l
i
m
i
ts
g
e
n
e
r
a
li
z
a
b
i
li
t
y
,
s
i
n
c
e
a
d
o
l
e
s
c
e
n
t
s
l
i
v
i
n
g
w
i
t
h
f
a
m
il
i
es
o
r
i
n
d
e
p
e
n
d
e
n
t
l
y
m
a
y
h
a
v
e
d
i
f
f
e
r
e
n
t
e
x
p
e
r
i
e
n
c
e
s
.
A
p
u
r
p
o
s
i
v
e
s
a
m
p
li
n
g
t
e
c
h
n
i
q
u
e
w
a
s
a
p
p
li
e
d
t
o
i
n
c
l
u
d
e
r
esp
o
n
d
e
n
t
s
w
h
o
m
e
t
t
h
e
f
o
l
l
o
w
in
g
c
r
i
t
e
r
i
a
:
f
e
m
a
l
e
s
t
u
d
e
n
ts
a
g
e
d
1
8
–
2
1
y
e
a
r
s
,
n
o
t
d
i
a
g
n
o
s
e
d
w
i
t
h
b
r
e
as
t
t
u
m
o
r
s
,
a
n
d
w
i
ll
i
n
g
t
o
p
a
r
t
ic
i
p
a
t
e
i
n
t
h
e
s
t
u
d
y
.
F
e
m
a
l
e
s
t
u
d
e
n
ts
d
i
a
g
n
o
s
e
d
w
i
th
b
r
e
a
s
t
t
u
m
o
r
s
,
a
g
e
d
b
e
l
o
w
1
5
o
r
a
b
o
v
e
2
5
y
e
a
r
s
,
o
r
u
n
w
i
l
l
i
n
g
t
o
p
a
r
t
i
c
i
p
a
te
w
e
r
e
e
x
c
l
u
d
e
d
f
r
o
m
t
h
i
s
s
t
u
d
y
.
G
i
v
e
n
t
h
e
l
i
m
i
t
e
d
p
o
p
u
l
a
t
i
o
n
s
i
z
e
i
n
t
h
e
d
o
r
m
i
t
o
r
y
a
n
d
t
h
e
v
o
l
u
n
t
a
r
y
p
a
r
t
i
c
i
p
a
ti
o
n
o
f
r
e
s
p
o
n
d
e
n
t
s
,
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3.
RE
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L
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D
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I
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o
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3
.
1
.
T
he
cha
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ct
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t
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f
t
he
re
s
po
nd
e
nts
T
h
e
r
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ts
in
th
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s
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d
y
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cited
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T
ab
le
1
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ag
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s
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with
th
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1
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s
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3
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3
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h
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t
r
esp
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n
d
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ts
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s
(
1
3
.
4
%).
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t
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als
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b
e
s
ee
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in
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ab
le
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th
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m
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r
esp
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d
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Pro
test
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t
C
h
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tian
s
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4
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th
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least
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Mu
s
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1
.
3
%).
R
esp
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n
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en
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ito
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m
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f
r
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m
v
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s
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g
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s
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ated
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m
Kalim
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Me
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e
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t f
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r
esp
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n
d
e
n
ts
in
th
is
s
tu
d
y
ca
m
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f
r
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m
Su
lawe
s
i (
2
.
0
%).
Tab
le 1
.
Ch
a
ra
c
teristics
o
f
re
sp
o
n
d
e
n
ts
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
F
r
e
q
u
e
n
c
y
(
n
=
6
7
)
P
e
r
c
e
n
t
a
g
e
(
%)
A
g
e
(
y
.
o
)
18
17
2
5
.
4
19
9
1
3
.
4
20
12
1
7
.
9
21
29
4
3
.
3
R
e
l
i
g
i
o
n
I
sl
a
m
2
1
.
3
C
h
r
i
st
i
a
n
51
64
.
5
C
a
t
h
o
l
i
c
14
34
.
2
O
r
i
g
i
n
P
a
p
u
a
3
4
.
5
Ea
st
N
u
s
a
T
e
n
g
g
a
r
a
15
1
0
.
1
M
a
l
u
k
u
13
8
.
7
K
a
l
i
m
a
n
t
a
n
16
1
0
.
7
S
u
ma
t
r
a
10
6
.
7
S
u
l
a
w
e
si
3
2
.
0
Ja
v
a
7
4
.
7
T
h
is
r
esear
ch
p
r
esen
ts
ag
e
as
o
n
e
o
f
th
e
d
em
o
g
r
ap
h
ic
ch
ar
a
cter
is
tics
o
f
r
esp
o
n
d
en
ts
b
ec
au
s
e
B
SE
i
s
r
ec
o
m
m
en
d
ed
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b
e
ca
r
r
ied
o
u
t
f
r
o
m
ad
o
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ce
.
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SE
is
m
o
r
e
ef
f
ec
tiv
e
wh
e
n
a
wo
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a
n
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1
5
y
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r
s
o
l
d
b
ec
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s
e,
at
th
at
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e,
w
o
m
en
a
r
e
alr
ea
d
y
at
r
is
k
o
f
d
ev
elo
p
in
g
b
r
ea
s
t
ca
n
ce
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.
Yo
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n
g
a
g
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is
o
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ten
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ter
ized
b
y
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er
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cy
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av
e
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h
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g
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er
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n
d
e
n
th
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s
iasm
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e
ek
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f
o
r
m
atio
n
,
r
ec
eiv
e
in
f
o
r
m
atio
n
,
an
d
in
cr
ea
s
e
k
n
o
wled
g
e
ac
tiv
ely
,
s
o
n
ew
s
k
ills
s
u
ch
as
B
SE
p
r
a
ctice
s
s
h
o
u
ld
b
e
lea
r
n
ed
an
d
p
r
ac
ticed
f
r
o
m
ea
r
ly
ad
o
lescen
ce
.
T
h
is
h
ig
h
d
esire
an
d
en
th
u
s
iasm
ca
n
m
ak
e
y
o
u
n
g
wo
m
en
b
eh
a
v
e
well
in
B
SE.
I
n
ad
d
itio
n
,
y
o
u
n
g
er
wo
m
en
ar
e
p
u
r
s
u
in
g
f
o
r
m
al
ed
u
ca
tio
n
.
T
h
ey
ar
e
in
v
o
lv
e
d
in
m
o
r
e
s
o
cial
ac
tiv
ities
an
d
ar
e
m
o
r
e
ex
p
o
s
ed
to
s
o
c
ial
m
ed
ia,
s
u
ch
as
watc
h
in
g
t
elev
is
io
n
,
Face
b
o
o
k
,
W
h
atsA
p
p
,
an
d
Yo
u
T
u
b
e.
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
.
4
,
Dec
em
b
er
20
25
:
1
7
7
9
-
1
7
87
1782
Hen
ce
,
th
ey
ar
e
m
o
r
e
ex
p
o
s
ed
to
in
f
o
r
m
atio
n
r
elate
d
to
wo
m
en
'
s
h
ea
lth
p
r
o
b
lem
s
co
m
p
a
r
ed
to
o
l
d
er
wo
m
e
n
[
1
6
]
.
An
o
th
er
th
in
g
th
at
ca
n
c
au
s
e
y
o
u
n
g
er
wo
m
en
to
h
av
e
b
etter
B
SE
b
eh
av
io
r
is
th
at
y
o
u
n
g
e
r
wo
m
en
p
ay
m
o
r
e
atten
tio
n
t
o
th
eir
p
h
y
s
ica
l a
p
p
ea
r
an
ce
a
n
d
h
ea
lth
th
an
o
ld
er
wo
m
en
[
1
7
]
.
R
elig
io
n
an
d
th
e
r
esp
o
n
d
en
ts
'
ar
ea
o
f
o
r
ig
in
in
t
h
eir
d
em
o
g
r
ap
h
ic
s
tatu
s
ar
e
f
ac
to
r
s
r
elate
d
to
th
eir
b
elief
s
r
eg
ar
d
i
n
g
th
e
p
r
ac
tice
o
f
B
SE.
A
p
r
ev
io
u
s
s
tu
d
y
s
h
o
wed
th
at
w
o
m
en
b
eliev
e
th
at
th
e
b
r
ea
s
ts
ar
e
a
s
en
s
itiv
e
o
r
g
an
an
d
an
im
p
o
r
t
an
t
s
y
m
b
o
l
o
f
a
wo
m
a
n
,
s
o
th
ey
s
h
o
u
ld
n
o
t
b
e
ch
ec
k
e
d
f
r
eq
u
en
tly
.
C
ar
r
y
in
g
o
u
t
b
r
ea
s
t
ex
am
in
atio
n
s
is
also
c
o
n
s
id
er
ed
ta
b
o
o
.
I
f
a
wo
m
an
ex
p
er
ien
ce
s
b
r
ea
s
t
ca
n
ce
r
,
th
e
n
s
h
e
m
u
s
t
ac
ce
p
t
h
er
f
ate
b
ec
au
s
e
s
h
e
is
d
esti
n
ed
to
d
o
s
o
[
1
3
]
.
Of
co
u
r
s
e,
th
is
will
b
e
a
s
ig
n
if
ican
t
o
b
s
tacle
in
i
m
p
lem
en
tin
g
B
SE
p
r
ac
tices in
th
e
co
m
m
u
n
ity
.
C
u
ltu
r
al
an
d
r
elig
io
u
s
b
ac
k
g
r
o
u
n
d
s
s
h
ap
e
k
n
o
wled
g
e
an
d
attitu
d
es
to
war
d
B
SE.
I
n
m
an
y
co
m
m
u
n
ities
,
cu
ltu
r
al
n
o
r
m
s
t
h
at
r
eg
ar
d
t
h
e
b
r
ea
s
t
as
a
p
r
iv
at
e
o
r
s
en
s
itiv
e
ar
ea
an
d
r
elig
io
u
s
ly
f
r
am
ed
f
atalist
ic
b
elief
s
(
e.
g
.
,
illn
ess
as
d
esti
n
y
)
ca
n
d
is
co
u
r
ag
e
o
p
en
d
is
cu
s
s
io
n
ab
o
u
t
b
r
ea
s
t
h
ea
lth
an
d
r
ed
u
ce
p
er
ce
iv
ed
n
ec
ess
ity
o
f
s
elf
-
s
cr
ee
n
in
g
,
ev
en
wh
en
f
ac
tu
al
in
f
o
r
m
atio
n
is
av
ailab
le
[
1
8
]
,
[
1
9
]
.
T
h
ese
s
o
cio
-
cu
ltu
r
al
f
ac
to
r
s
o
p
er
ate
th
r
o
u
g
h
m
u
ltip
le
p
ath
way
s
:
th
ey
lim
it
ex
p
o
s
u
r
e
to
n
o
r
m
ativ
e
h
ea
lth
co
n
v
er
s
atio
n
s
,
in
cr
ea
s
e
s
h
am
e
o
r
em
b
ar
r
ass
m
en
t
ab
o
u
t
to
u
c
h
in
g
o
r
ex
am
in
in
g
o
n
e'
s
b
o
d
y
,
an
d
lo
wer
p
er
ce
iv
ed
s
elf
-
ef
f
icac
y
to
p
er
f
o
r
m
B
SE
co
r
r
ec
tly
.
E
m
p
ir
ical
s
tu
d
ies
a
m
o
n
g
y
o
u
n
g
wo
m
en
an
d
co
m
m
u
n
ity
s
am
p
les
h
a
v
e
r
e
p
ea
ted
ly
s
h
o
wn
th
at
s
h
am
e,
tab
o
o
,
an
d
lo
w
s
elf
-
ef
f
icac
y
ar
e
s
ig
n
if
ican
t c
o
r
r
elate
s
o
f
lo
wer
B
SE
u
p
tak
e,
in
d
ep
en
d
e
n
t o
f
f
o
r
m
al
k
n
o
wled
g
e
lev
els
[
2
0
]
,
[
2
1
]
.
I
m
p
o
r
tan
tly
,
in
ter
v
en
tio
n
s
tu
d
ies
in
d
i
ca
te
th
at
cu
ltu
r
ally
s
en
s
itiv
e
ed
u
ca
tio
n
—
esp
ec
ially
p
r
o
g
r
a
m
s
th
at
ex
p
licitly
ad
d
r
ess
r
elig
io
u
s
/f
atalist
ic
b
elief
s
an
d
b
u
ild
p
r
ac
tical
s
k
ills
an
d
co
n
f
i
d
en
ce
(
s
elf
-
ef
f
icac
y
)
—
ca
n
im
p
r
o
v
e
b
o
th
in
ten
t
an
d
ac
tu
al
B
SE
p
r
ac
tice
am
o
n
g
wo
m
en
[
2
2
]
.
T
h
er
ef
o
r
e
,
wh
e
n
in
te
r
p
r
etin
g
th
e
p
r
esen
t
f
in
d
in
g
s
,
th
e
r
o
le
o
f
cu
ltu
r
al
an
d
r
elig
io
u
s
b
ac
k
g
r
o
u
n
d
s
h
o
u
l
d
b
e
ac
k
n
o
wle
d
g
ed
as
a
p
o
ten
tial
m
ed
iato
r
b
etwe
en
i
n
f
o
r
m
atio
n
ex
p
o
s
u
r
e
a
n
d
p
r
ev
e
n
tiv
e
b
eh
a
v
io
r
.
3
.
2
.
T
he
info
rma
t
io
n so
urce
re
g
a
rding
B
SE
re
ce
iv
ed
by
re
s
po
nd
ent
s
B
ase
d
o
n
T
ab
le
2
,
th
e
in
f
o
r
m
a
tio
n
o
n
B
SE
o
b
tain
e
d
b
y
y
o
u
n
g
wo
m
en
in
th
is
s
tu
d
y
m
ain
ly
ca
m
e
f
r
o
m
s
o
cial
m
ed
ia
(
3
5
.
8
%),
f
o
llo
we
d
b
y
s
ch
o
o
l
(
3
2
.
8
%),
a
n
d
2
9
.
9
%
d
id
n
o
t
g
et
an
y
in
f
o
r
m
atio
n
.
Fo
r
m
al
an
d
in
f
o
r
m
al
ed
u
ca
tio
n
in
f
o
r
m
atio
n
co
n
t
r
ib
u
tes
to
B
SE
p
r
ac
tice
b
eh
av
io
r
[
2
3
]
.
T
h
is
r
esear
ch
s
h
o
ws
th
at
as
m
an
y
as
7
0
.
1
%
o
f
y
o
u
n
g
wo
m
e
n
h
av
e
r
ec
ei
v
e
d
in
f
o
r
m
atio
n
ab
o
u
t
th
e
p
r
ac
tic
e
o
f
B
SE,
an
d
m
o
s
tly
g
et
th
is
i
n
f
o
r
m
atio
n
th
r
o
u
g
h
s
o
cial
m
ed
ia.
Tab
le 2
.
Re
c
e
p
ti
o
n
o
f
in
f
o
rm
a
ti
o
n
re
g
a
rd
in
g
BS
E
p
ra
c
ti
c
e
s
R
e
c
e
p
t
i
o
n
o
f
i
n
f
o
r
m
a
t
i
o
n
F
r
e
q
u
e
n
c
y
(
n
=
6
7
)
P
e
r
c
e
n
t
a
g
e
(
%)
Y
e
s
47
7
0
.
1
F
r
o
m s
o
c
i
a
l
me
d
i
a
24
3
5
.
8
F
r
o
m sc
h
o
o
l
22
3
2
.
8
N
o
20
2
9
.
9
To
t
a
l
67
1
0
0
.
0
B
SE
in
f
o
r
m
atio
n
ca
n
co
m
e
f
r
o
m
o
th
er
p
eo
p
le,
s
u
ch
as
s
ee
in
g
h
ea
lth
in
f
o
r
m
atio
n
o
n
telev
is
io
n
,
r
ea
d
i
n
g
b
o
o
k
s
o
r
n
ews a
b
o
u
t w
o
m
en
'
s
b
r
ea
s
t h
ea
lth
,
an
d
s
o
cial
m
ed
i
a
[
2
4
]
.
So
cial
m
ed
ia
is
a
p
latf
o
r
m
f
o
r
teen
ag
er
s
to
ac
ce
s
s
in
f
o
r
m
atio
n
a
b
o
u
t
B
SE.
T
h
e
u
s
e
o
f
s
o
cial
m
ed
ia
in
in
cr
ea
s
in
g
k
n
o
wled
g
e
is
v
er
y
ef
f
ec
tiv
e
b
ec
a
u
s
e
it
ca
n
b
e
r
ea
d
wh
e
r
ev
er
an
d
wh
en
ev
er
th
e
y
ar
e.
Ap
ar
t
f
r
o
m
th
at,
th
e
p
r
esen
tatio
n
o
f
h
ea
lth
in
f
o
r
m
atio
n
v
ia
I
n
s
tag
r
am
is
d
o
m
in
ate
d
b
y
im
ag
es,
p
h
o
to
s
,
o
r
v
id
e
o
s
,
m
ak
in
g
it
ea
s
ier
f
o
r
p
e
o
p
le
to
r
ec
eiv
e
h
ea
lth
in
f
o
r
m
atio
n
[
2
5
]
.
So
cial
m
ed
ia
i
n
f
lu
en
ce
d
h
ea
lth
p
r
o
m
o
ti
o
n
ef
f
o
r
ts
to
in
cr
ea
s
e
u
n
d
er
s
tan
d
in
g
an
d
s
u
p
p
o
r
t
t
h
e
p
u
b
lic
in
h
ea
lth
y
b
e
h
av
io
r
.
So
cial
m
ed
i
a
h
as p
o
s
itiv
ely
co
n
tr
i
b
u
ted
to
h
ea
lth
p
r
o
m
o
tio
n
ef
f
o
r
ts
[
2
6
]
.
3.
3
.
T
he
f
a
ct
o
rs t
ha
t
influence
t
he
pra
ct
ice
o
f
B
SE
T
h
e
f
in
d
in
g
s
in
d
icate
th
at
b
ar
r
ier
s
to
B
SE
am
o
n
g
ad
o
lescen
t
g
ir
ls
ar
e
m
u
ltifa
ce
ted
,
s
p
an
n
in
g
p
s
y
ch
o
lo
g
ical,
s
o
cial,
c
o
g
n
iti
v
e,
an
d
p
er
ce
p
t
u
al
d
o
m
ai
n
s
as
s
h
o
wn
in
Fig
u
r
e
1
.
Fro
m
th
e
p
s
y
ch
o
l
o
g
ical
p
er
s
p
ec
tiv
e,
em
b
ar
r
ass
m
en
t
(
1
9
.
4
%)
a
n
d
f
ea
r
o
f
th
e
r
esu
lts
(
2
2
.
4
%)
wer
e
cited
as
b
ar
r
ier
s
.
Alth
o
u
g
h
n
o
t
t
h
e
m
o
s
t
d
o
m
in
an
t,
th
ese
f
a
cto
r
s
h
ig
h
lig
h
t
th
e
r
o
le
o
f
em
o
tio
n
a
l
r
esp
o
n
s
es
an
d
s
tig
m
a
in
h
i
n
d
er
in
g
B
SE
p
r
ac
tice.
Pre
v
io
u
s
r
esear
ch
h
as
h
ig
h
li
g
h
ted
th
at
f
ea
r
o
f
ca
n
ce
r
d
ia
g
n
o
s
is
an
d
s
h
am
e
ass
o
ciate
d
with
d
is
cu
s
s
in
g
o
r
to
u
ch
in
g
th
e
b
r
ea
s
t
ar
e
co
m
m
o
n
p
s
y
c
h
o
lo
g
ical
o
b
s
tacle
s
[
2
7
]
,
[
2
8
]
.
T
h
ese
f
in
d
in
g
s
s
u
g
g
est
th
at
n
u
r
s
in
g
in
ter
v
en
tio
n
s
s
h
o
u
ld
p
r
o
v
id
e
tech
n
ical
k
n
o
wled
g
e
an
d
a
d
d
r
ess
em
o
tio
n
al
r
ea
d
in
ess
.
C
u
l
t
u
r
a
ll
y
s
e
n
s
i
t
i
v
e
c
o
u
n
s
e
l
i
n
g
a
n
d
p
e
e
r
-
s
u
p
p
o
r
t
i
n
i
t
i
a
ti
v
e
s
c
o
u
l
d
b
e
e
f
f
e
c
t
i
v
e
in
n
o
r
m
a
l
i
z
i
n
g
B
S
E
a
n
d
r
e
d
u
c
i
n
g
t
h
e
s
t
i
g
m
a
t
h
a
t
a
d
o
l
e
s
c
e
n
ts
m
a
y
as
s
o
ci
a
t
e
w
i
t
h
i
t
.
R
eg
ar
d
in
g
s
o
cial
f
ac
to
r
s
,
lack
o
f
p
r
iv
ac
y
(
2
8
.
4
%)
an
d
b
ein
g
to
o
b
u
s
y
(
2
6
.
9
%)
em
er
g
ed
as
n
o
tab
le
b
ar
r
ier
s
.
T
h
ese
f
in
d
i
n
g
s
s
u
g
g
est
th
at
en
v
ir
o
n
m
en
tal
co
n
d
it
io
n
s
an
d
d
aily
r
o
u
tin
es
ar
e
e
s
s
en
tial
in
s
h
ap
in
g
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
6
F
a
cto
r
s
in
flu
en
cin
g
th
e
p
r
a
ctice
o
f b
r
ea
s
t self
-
ex
a
min
a
tio
n
a
mo
n
g
teen
a
g
e
…
(
K
r
is
tia
n
i
Desimin
a
Ta
u
h
o
)
1783
ad
o
lescen
ts
'
ab
ilit
y
to
en
g
ag
e
in
B
SE.
Stu
d
ies
co
n
d
u
cted
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
in
lo
w
-
an
d
m
id
d
le
-
in
co
m
e
co
u
n
tr
ies
h
av
e
s
h
o
wn
th
at
a
s
u
p
p
o
r
tiv
e
en
v
ir
o
n
m
en
t,
wh
et
h
er
at
h
o
m
e,
s
ch
o
o
l,
o
r
d
o
r
m
ito
r
y
s
ettin
g
s
,
p
lay
s
a
v
ital
r
o
le
in
en
ab
lin
g
a
d
o
lescen
ts
to
ad
o
p
t
s
elf
-
ca
r
e
p
r
ac
tices
[2
9]
.
Nu
r
s
es
wo
r
k
in
g
in
s
ch
o
o
l
h
ea
lth
p
r
o
g
r
am
s
o
r
co
m
m
u
n
ity
-
b
ased
in
itiativ
e
s
ca
n
ad
v
o
ca
te
f
o
r
s
af
e
an
d
p
r
i
v
ate
s
p
ac
es
f
o
r
h
ea
lth
p
r
ac
tices
wh
ile
in
teg
r
atin
g
B
SE
ed
u
ca
tio
n
in
to
r
o
u
tin
e
s
ch
o
o
l
ac
tiv
ities
.
T
im
e
-
m
an
ag
em
en
t
ed
u
ca
tio
n
an
d
em
b
ed
d
in
g
B
SE
in
to
ad
o
le
s
ce
n
ts
'
d
aily
h
ea
lth
r
o
u
ti
n
es c
o
u
ld
f
u
r
th
er
r
ed
u
ce
th
e
p
er
ce
p
tio
n
o
f
"b
u
s
y
n
ess
"
as a
b
ar
r
ier
.
R
eg
ar
d
in
g
c
o
g
n
itiv
e
b
ar
r
ie
r
s
,
3
5
.
8
%
o
f
r
esp
o
n
d
en
ts
r
e
p
o
r
ted
f
ee
lin
g
th
at
B
SE
was
u
n
im
p
o
r
tan
t
,
2
3
.
9
%
f
elt
in
co
m
p
eten
t,
an
d
3
5
.
8
%
cited
a
lack
o
f
k
n
o
wle
d
g
e
ab
o
u
t
th
e
p
r
o
ce
d
u
r
e.
T
h
e
s
e
r
esu
lts
in
d
icate
a
s
ig
n
if
ican
t
g
ap
i
n
awa
r
en
ess
an
d
s
elf
-
ef
f
icac
y
r
elate
d
to
B
SE
p
r
ac
tices.
Nu
m
er
o
u
s
s
tu
d
ies
co
n
f
ir
m
th
at
k
n
o
wled
g
e
g
a
p
s
an
d
p
o
o
r
s
k
ills
ar
e
s
u
b
s
tan
tial
p
r
ed
icto
r
s
o
f
lo
w
ad
h
er
e
n
ce
t
o
B
SE
[
9
]
,
[
3
0
]
.
Nu
r
s
in
g
p
r
ac
tice
s
h
o
u
l
d
th
er
ef
o
r
e
em
p
h
asize
s
tr
u
ctu
r
ed
ed
u
ca
tio
n
al
in
ter
v
e
n
t
io
n
s
th
at
ex
p
lain
th
e
b
en
ef
its
o
f
B
SE
an
d
p
r
o
v
id
e
h
an
d
s
-
o
n
d
em
o
n
s
tr
atio
n
s
.
Sc
h
o
o
l
-
b
ased
wo
r
k
s
h
o
p
s
led
b
y
n
u
r
s
es,
s
u
p
p
o
r
ted
with
v
is
u
a
l
aid
s
an
d
p
r
ac
tice
m
o
d
els,
co
u
ld
en
h
a
n
ce
c
o
m
p
eten
ce
a
n
d
co
n
f
i
d
en
ce
a
m
o
n
g
a
d
o
lescen
ts
,
r
e
d
u
cin
g
th
e
k
n
o
wled
g
e
d
ef
icit
co
n
tr
ib
u
tin
g
to
n
o
n
-
c
o
m
p
lian
c
e.
Fin
ally
,
p
er
ce
p
tu
al
f
ac
to
r
s
ap
p
ea
r
ed
as
th
e
m
o
s
t
f
r
eq
u
e
n
tly
cit
ed
b
ar
r
ie
r
s
.
Sp
ec
if
ically
,
2
0
.
9
%
b
eliev
ed
th
ey
wer
e
s
till
to
o
y
o
u
n
g
,
3
7
.
3
%
r
ep
o
r
ted
t
h
ey
wo
u
l
d
o
n
l
y
p
er
f
o
r
m
B
SE
wh
en
s
y
m
p
to
m
s
wer
e
p
r
esen
t,
an
d
3
8
.
8
%
b
eliev
ed
B
SE
was
u
n
n
ec
ess
ar
y
in
th
e
ab
s
en
ce
o
f
i
lln
ess
.
T
h
ese
m
is
co
n
ce
p
tio
n
s
s
u
g
g
est
th
at
m
an
y
ad
o
lescen
ts
lin
k
B
SE
o
n
ly
with
ex
is
tin
g
h
ea
lth
p
r
o
b
lem
s
,
r
ath
er
th
an
r
ec
o
g
n
izin
g
its
r
o
le
in
ea
r
ly
d
etec
tio
n
.
R
ec
en
t
em
p
ir
i
ca
l
s
tu
d
ies
in
c
o
m
p
ar
ab
le
p
o
p
u
latio
n
s
r
e
p
o
r
t
l
o
w
lev
els
o
f
ac
cu
r
ate
k
n
o
wled
g
e
an
d
p
r
ac
tice
o
f
B
SE
an
d
f
r
eq
u
en
t
d
elay
s
in
ca
r
e
-
s
ee
k
in
g
u
n
til
s
y
m
p
to
m
s
a
r
e
n
o
ticed
,
in
d
icatin
g
a
p
r
e
d
o
m
in
an
tly
s
y
m
p
to
m
-
d
r
iv
en
(
r
ea
ctiv
e
)
ap
p
r
o
ac
h
to
b
r
ea
s
t
h
ea
lth
r
ath
er
th
an
a
p
r
ev
en
tiv
e
o
n
e
[
1
3
]
,
[
3
1
]
,
[
3
2
]
.
Fro
m
a
n
u
r
s
in
g
s
tan
d
p
o
in
t,
th
is
h
ig
h
lig
h
ts
th
e
im
p
o
r
tan
ce
o
f
r
ef
r
a
m
in
g
h
ea
lt
h
ed
u
ca
tio
n
m
ess
ag
es
to
f
o
cu
s
o
n
ea
r
ly
d
etec
tio
n
an
d
em
p
o
wer
m
e
n
t.
Nu
r
s
es
ca
n
in
teg
r
ate
m
ess
ag
es
ab
o
u
t
p
r
ev
en
tiv
e
h
ea
lth
in
to
ad
o
lescen
t
h
ea
lth
p
r
o
m
o
tio
n
p
r
o
g
r
a
m
s
,
em
p
h
asizin
g
th
at
b
r
ea
s
t
ca
n
ce
r
ca
n
o
cc
u
r
in
y
o
u
n
g
wo
m
en
an
d
th
at
ea
r
ly
d
et
ec
tio
n
s
ig
n
if
ican
tly
im
p
r
o
v
es
o
u
tco
m
es.
Ov
er
all,
t
h
e
r
esu
lts
d
e
m
o
n
s
tr
ate
t
h
at
w
h
ile
p
s
y
ch
o
lo
g
ical
a
n
d
s
o
cial
i
n
f
lu
en
ce
s
e
x
is
t,
th
e
p
r
ed
o
m
i
n
an
t b
a
r
r
ier
s
ar
e
r
o
o
te
d
in
c
o
g
n
itiv
e
lim
itatio
n
s
an
d
m
is
p
er
ce
p
tio
n
s
ab
o
u
t th
e
im
p
o
r
tan
ce
an
d
p
u
r
p
o
s
e
o
f
B
SE.
Ad
d
r
ess
in
g
th
ese
m
is
co
n
ce
p
tio
n
s
an
d
p
r
o
v
id
in
g
p
r
a
ctica
l k
n
o
wled
g
e
ar
e
cr
itical
in
p
r
o
m
o
tin
g
r
eg
u
lar
B
SE
p
r
ac
tice
am
o
n
g
ad
o
lescen
t g
ir
ls
.
Fig
u
r
e
1
.
Facto
r
s
th
at
in
f
lu
en
c
e
B
SE
p
r
ac
tice
am
o
n
g
tee
n
ag
e
g
ir
ls
3
.
4
.
M
ultiv
a
ria
ble
lo
g
is
t
ic
re
g
re
s
s
io
n a
na
ly
s
is
o
f
do
m
ina
nt
ba
rr
iers t
o
bs
e
pra
ct
ice
T
ab
le
3
p
r
esen
ts
th
e
m
u
ltiv
ar
iab
le
lo
g
is
tic
r
eg
r
ess
io
n
an
aly
s
is
r
esu
lts
ex
am
in
in
g
f
ac
to
r
s
ass
o
ciate
d
with
b
r
ea
s
t
s
elf
-
ex
am
i
n
a
tio
n
(
B
SE)
p
r
ac
tice
am
o
n
g
ad
o
lesce
n
t
g
ir
ls
.
Fo
u
r
f
ac
to
r
s
wer
e
f
o
u
n
d
to
b
e
s
tatis
tically
s
ig
n
if
ican
t
p
r
e
d
icto
r
s
.
Ad
o
lescen
ts
wh
o
p
er
ce
iv
e
d
th
at
B
SE
s
h
o
u
ld
o
n
ly
b
e
p
er
f
o
r
m
ed
wh
en
s
y
m
p
t
o
m
s
ar
e
p
r
esen
t
wer
e
s
ig
n
if
ican
tly
less
lik
ely
to
p
r
ac
tice
B
SE
(
OR
=
0
.
0
2
2
,
9
5
%
C
I
:
0
.
0
0
2
–
0
.
3
1
2
,
p
=
0
.
0
0
5
)
.
Similar
ly
,
lack
o
f
k
n
o
wled
g
e
s
tr
o
n
g
ly
r
e
d
u
ce
d
th
e
li
k
elih
o
o
d
o
f
p
r
ac
tic
in
g
B
SE
(
OR
=
0
.
0
0
3
,
9
5
%
C
I
:
0
.
0
0
0
–
0
.
2
4
3
,
p
=
0
.
0
1
0
)
.
So
cial
f
ac
t
o
r
s
also
p
la
y
ed
an
im
p
o
r
ta
n
t
r
o
le:
b
ein
g
t
o
o
b
u
s
y
(
OR
=
0
.
0
6
4
,
9
5
%
C
I
:
0
.
0
0
6
–
0
.
7
0
1
,
p
=
0
.
0
2
4
)
an
d
lac
k
o
f
p
r
iv
ac
y
(
OR
=
0
.
0
2
6
,
9
5
%
C
I
:
0
.
0
0
1
–
0
.
9
4
6
,
p
=
0
.
0
4
6
)
b
o
th
s
ig
n
i
f
ican
tly
h
in
d
er
e
d
th
e
p
r
ac
tice
o
f
B
SE.
T
h
ese
f
in
d
in
g
s
h
ig
h
lig
h
t
th
at
m
is
p
er
ce
p
tio
n
ab
o
u
t
s
y
m
p
to
m
s
,
lim
ited
k
n
o
wled
g
e,
an
d
s
o
cial
co
n
s
tr
ain
ts
ar
e
ad
o
lescen
t g
ir
l
s
'
m
o
s
t c
r
i
tica
l b
ar
r
ier
s
to
B
SE
p
r
ac
tice.
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
.
4
,
Dec
em
b
er
20
25
:
1
7
7
9
-
1
7
87
1784
Tab
le 3
.
M
u
l
ti
v
a
riab
le
lo
g
isti
c
re
g
re
ss
io
n
a
n
a
l
y
sis o
f
b
a
rriers
to
B
S
E
p
ra
c
ti
c
e
(fin
a
l
m
o
d
e
l)
V
a
r
i
a
b
l
e
B
SE
O
R
(
Ex
p
(
B
)
)
9
5
%
C
I
f
o
r
O
R
p
-
v
a
l
u
e
B
u
s
y
n
e
ss
-
2
.
7
4
3
1
.
2
1
8
0
.
0
6
4
0
.
0
0
6
–
0
.
7
0
1
0
.
0
2
4
N
o
s
y
mp
t
o
ms
-
3
.
8
1
0
1
.
3
5
0
0
.
0
2
2
0
.
0
0
2
–
0
.
3
1
2
0
.
0
0
5
La
c
k
o
f
k
n
o
w
l
e
d
g
e
-
5
.
8
1
7
2
.
2
4
7
0
.
0
0
3
0
.
0
0
0
–
0
.
2
4
3
0
.
0
1
0
La
c
k
o
f
p
r
i
v
a
c
y
-
3
.
6
3
1
1
.
8
2
4
0
.
0
2
6
0
.
0
0
1
–
0
.
9
4
6
0
.
0
4
6
T
h
e
f
in
d
i
n
g
s
o
f
th
is
s
tu
d
y
n
o
t
o
n
ly
i
d
en
tify
s
tatis
tical
ass
o
c
iatio
n
s
b
u
t
also
p
r
o
v
id
e
i
n
s
ig
h
ts
in
to
th
e
u
n
d
er
ly
i
n
g
f
ac
to
r
s
s
h
ap
in
g
ad
o
lescen
ts
’
en
g
ag
em
e
n
t
in
b
r
e
ast
s
elf
-
ex
am
in
atio
n
.
T
o
b
etter
u
n
d
er
s
tan
d
t
h
ese
r
esu
lts
,
th
e
f
o
llo
win
g
s
ec
tio
n
d
is
cu
s
s
es
th
e
b
ar
r
ier
s
with
in
b
r
o
ad
er
p
s
y
ch
o
lo
g
ical,
cu
ltu
r
al,
an
d
th
eo
r
etica
l
co
n
tex
ts
,
an
d
h
ig
h
lig
h
ts
p
r
ac
tical
im
p
li
ca
tio
n
s
f
o
r
a
d
o
lescen
t h
ea
lth
p
r
o
m
o
tio
n
.
˗
Per
ce
iv
ed
b
ar
r
ie
r
s
T
h
is
s
tu
d
y
f
o
u
n
d
th
at
a
d
o
le
s
ce
n
t
g
ir
ls
in
Salatig
a
f
ac
e
d
m
u
ltip
le
b
ar
r
ier
s
to
B
SE,
s
p
an
n
in
g
p
s
y
ch
o
lo
g
ical,
c
o
g
n
itiv
e,
p
er
c
ep
tu
al,
an
d
s
o
cial
d
o
m
ain
s
.
Misco
n
ce
p
tio
n
s
,
s
u
ch
as
b
eliev
i
n
g
th
at
B
SE
is
o
n
ly
n
ec
ess
ar
y
wh
en
s
y
m
p
to
m
s
ap
p
ea
r
(
3
8
.
8
%)
o
r
p
er
ce
iv
in
g
th
em
s
elv
es
as
to
o
y
o
u
n
g
(
2
0
.
9
%)
,
wer
e
am
o
n
g
th
e
m
o
s
t
f
r
eq
u
en
tl
y
cited
b
ar
r
ier
s
.
T
h
ese
f
in
d
in
g
s
ec
h
o
p
r
io
r
r
esear
ch
s
h
o
win
g
th
at
y
o
u
n
g
wo
m
en
o
f
te
n
lin
k
p
r
ev
en
tiv
e
b
e
h
av
io
r
o
n
ly
to
v
is
ib
le
s
y
m
p
to
m
s
,
r
e
f
lectin
g
a
r
ea
ctiv
e
r
ath
e
r
th
a
n
p
r
o
ac
tiv
e
ap
p
r
o
ac
h
to
b
r
ea
s
t
h
ea
lth
[
3
1
]
,
[
3
2
]
.
C
o
g
n
itiv
e
b
a
r
r
ier
s
s
u
ch
as
la
ck
o
f
k
n
o
wled
g
e
(
3
5
.
8
%)
an
d
f
ee
lin
g
s
o
f
in
c
o
m
p
eten
ce
(
2
3
.
9
%)
f
u
r
th
er
lim
ited
B
SE
u
p
ta
k
e,
u
n
d
er
s
co
r
in
g
th
e
n
ee
d
f
o
r
tailo
r
ed
h
ea
lth
ed
u
ca
tio
n
.
I
n
ter
esti
n
g
ly
,
alth
o
u
g
h
a
r
elativ
ely
h
ig
h
p
r
o
p
o
r
tio
n
o
f
r
esp
o
n
d
en
ts
r
ep
o
r
ted
th
e
p
er
ce
p
tio
n
o
f
"h
a
v
in
g
n
o
illn
ess
"
in
t
h
e
d
escr
ip
tiv
e
f
in
d
in
g
s
,
th
is
f
ac
to
r
d
id
n
o
t
em
er
g
e
as
a
s
ig
n
if
ican
t
p
r
ed
icto
r
o
f
B
SE
p
r
ac
tice
in
th
e
lo
g
is
tic
r
eg
r
ess
io
n
m
o
d
el.
On
e
p
o
s
s
ib
le
ex
p
lan
atio
n
is
th
e
o
v
er
lap
b
etwe
en
th
is
p
er
ce
p
t
io
n
an
d
o
th
er
r
elate
d
b
ar
r
ier
s
,
p
ar
ticu
lar
ly
th
e
b
elief
th
at
B
SE
s
h
o
u
l
d
o
n
ly
b
e
p
er
f
o
r
m
ed
wh
en
s
y
m
p
to
m
s
ar
e
p
r
esen
t.
W
h
en
en
te
r
ed
s
im
u
ltan
eo
u
s
ly
in
th
e
m
u
ltiv
a
r
iate
m
o
d
el,
th
e
e
f
f
ec
t
o
f
"h
av
in
g
n
o
illn
ess
"
m
ay
h
av
e
b
ee
n
s
u
p
p
r
ess
ed
b
y
t
h
e
s
tr
o
n
g
er
p
r
ed
ictiv
e
p
o
wer
o
f
"
n
o
s
y
m
p
to
m
s
.
"
T
h
is
r
esu
lt
i
n
d
icate
s
th
at
ad
o
lescen
ts
'
d
ec
is
io
n
s
to
p
er
f
o
r
m
B
SE
ar
e
m
o
r
e
d
ir
ec
tly
i
n
f
lu
en
ce
d
b
y
s
y
m
p
to
m
-
o
r
ien
te
d
th
in
k
in
g
r
ath
er
th
an
a
g
e
n
er
al
p
e
r
ce
p
tio
n
o
f
b
ein
g
h
ea
lth
y
.
An
o
th
er
ex
p
lan
atio
n
is
th
at
t
h
e
r
esp
o
n
s
e
d
is
tr
ib
u
tio
n
f
o
r
t
h
is
f
ac
to
r
m
ay
h
av
e
b
ee
n
to
o
h
o
m
o
g
en
e
o
u
s
to
d
if
f
er
en
tiate
b
etwe
en
th
o
s
e
wh
o
p
r
ac
ticed
B
SE
an
d
th
o
s
e
wh
o
d
id
n
o
t,
lim
itin
g
its
p
r
ed
ictiv
e
u
tili
ty
in
th
e
r
eg
r
ess
io
n
m
o
d
el
.
˗
C
u
ltu
r
al
in
f
lu
en
ce
s
C
u
ltu
r
al
an
d
r
elig
io
u
s
co
n
tex
ts
s
ig
n
if
ican
tly
s
h
ap
ed
ad
o
lesce
n
t
p
er
ce
p
tio
n
s
.
I
n
m
an
y
So
u
t
h
ea
s
t
Asi
a
n
co
m
m
u
n
ities
,
th
e
f
em
ale
b
o
d
y
is
co
n
s
id
er
ed
a
ta
b
o
o
s
u
b
ject,
an
d
f
atalist
ic
b
elief
s
,
s
u
ch
as
v
iewin
g
illn
ess
as
d
esti
n
y
,
d
is
co
u
r
ag
e
p
r
ev
e
n
tiv
e
p
r
ac
tices
[
1
0
]
,
[
1
8
]
.
Ou
r
f
in
d
in
g
s
s
u
g
g
est
th
at
em
b
ar
r
ass
m
e
n
t
(
1
9
.
4
%)
an
d
lack
o
f
p
r
i
v
ac
y
(
2
8
.
4
%)
r
ef
lect
t
h
ese
b
r
o
ad
e
r
cu
ltu
r
al
co
n
s
tr
ain
ts
.
Su
ch
s
o
cio
-
cu
ltu
r
al
b
a
r
r
ier
s
r
estrict
o
p
en
d
is
cu
s
s
io
n
s
ab
o
u
t
b
r
ea
s
t
h
ea
lth
an
d
lo
wer
s
elf
-
ef
f
icac
y
,
e
v
en
am
o
n
g
ad
o
lescen
ts
with
s
o
m
e
k
n
o
wled
g
e
o
f
B
SE.
I
n
ter
v
en
tio
n
s
m
u
s
t th
er
ef
o
r
e
b
e
cu
ltu
r
ally
s
en
s
itiv
e
an
d
d
esig
n
ed
to
ch
allen
g
e
s
tig
m
a
a
n
d
f
atalism.
˗
T
h
eo
r
etica
l
in
teg
r
atio
n
with
th
e
HB
M
T
h
e
r
esu
lts
ca
n
b
e
i
n
ter
p
r
ete
d
th
r
o
u
g
h
th
e
HB
M.
L
o
w
p
er
ce
iv
ed
s
u
s
ce
p
tib
ilit
y
was
e
v
id
en
t
i
n
ad
o
lescen
ts
wh
o
f
elt
“to
o
y
o
u
n
g
”
to
b
e
at
r
is
k
.
L
o
w
p
er
ce
iv
ed
b
en
ef
its
wer
e
r
ef
lecte
d
in
t
h
e
b
elief
th
at
B
SE
is
u
n
n
ec
ess
ar
y
with
o
u
t
s
y
m
p
to
m
s
.
Per
ce
iv
ed
b
ar
r
ier
s
,
in
clu
d
in
g
lac
k
o
f
p
r
iv
ac
y
,
em
b
ar
r
ass
m
en
t,
an
d
tim
e
co
n
s
tr
ain
ts
,
d
ir
ec
tly
h
in
d
er
e
d
p
r
ac
tice.
Fin
ally
,
r
ed
u
ce
d
s
elf
-
ef
f
icac
y
was
ap
p
ar
en
t
i
n
f
ee
lin
g
s
o
f
in
c
o
m
p
ete
n
ce
an
d
u
n
ce
r
tain
ty
a
b
o
u
t
p
er
f
o
r
m
in
g
B
SE
co
r
r
ec
tly
.
T
h
ese
f
i
n
d
in
g
s
alig
n
with
p
r
e
v
io
u
s
m
eta
-
an
aly
s
es
s
h
o
win
g
th
at
p
er
ce
iv
ed
s
ev
er
ity
,
b
en
ef
its
,
an
d
s
elf
-
ef
f
icac
y
ar
e
s
tr
o
n
g
er
p
r
ed
icto
r
s
o
f
B
SE
b
eh
a
v
io
r
th
a
n
awa
r
en
ess
alo
n
e
[
3
3
]
.
Gr
o
u
n
d
in
g
th
e
r
esu
lts
in
HB
M
h
ig
h
lig
h
ts
th
e
m
u
ltifa
cto
r
ial
n
atu
r
e
o
f
ad
o
lesc
en
t
h
ea
lth
b
e
h
av
io
r
an
d
u
n
d
er
s
co
r
es th
e
im
p
o
r
tan
c
e
o
f
in
ter
v
en
tio
n
s
th
at
ad
d
r
ess
b
o
th
co
g
n
itiv
e
an
d
cu
ltu
r
al
d
i
m
en
s
io
n
s
.
˗
I
m
p
licatio
n
s
f
o
r
p
r
ac
tice
T
h
e
f
in
d
i
n
g
s
h
av
e
s
ev
er
al
p
r
ac
tical
im
p
licatio
n
s
.
Peer
-
led
ed
u
ca
tio
n
an
d
m
en
to
r
i
n
g
ca
n
h
elp
n
o
r
m
aliz
e
B
SE
am
o
n
g
ad
o
lescen
t
s
,
r
ed
u
ce
em
b
ar
r
ass
m
en
t,
an
d
b
u
ild
m
o
tiv
atio
n
.
Dig
ital
h
ea
lth
p
latf
o
r
m
s
an
d
s
o
cial
m
ed
ia
,
alr
ea
d
y
cited
as m
ajo
r
i
n
f
o
r
m
atio
n
s
o
u
r
ce
s
in
th
is
s
tu
d
y
,
s
h
o
u
ld
b
e
h
ar
n
ess
ed
f
o
r
cu
ltu
r
ally
ap
p
r
o
p
r
iate
h
ea
lth
ca
m
p
aig
n
s
.
Sch
o
o
l
-
b
ased
in
ter
v
en
tio
n
s
m
u
s
t
in
teg
r
at
e
s
tr
u
ctu
r
ed
B
SE
tr
ain
in
g
in
to
r
ep
r
o
d
u
ctiv
e
h
ea
lt
h
cu
r
r
icu
la.
Nu
r
s
es
p
lay
a
ce
n
tr
al
r
o
le
in
th
ese
s
tr
ateg
ies:
th
ey
ca
n
d
eliv
er
c
u
ltu
r
ally
s
en
s
itiv
e
ed
u
ca
tio
n
,
s
tr
en
g
th
en
ad
o
lescen
ts
’
s
elf
-
ef
f
icac
y
,
an
d
co
llab
o
r
ate
with
te
ac
h
er
s
an
d
c
o
m
m
u
n
ity
h
ea
lth
wo
r
k
er
s
to
s
u
s
tain
awa
r
en
ess
an
d
p
r
ac
tice.
4.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
id
en
tifie
d
s
ev
er
al
f
a
cto
r
s
th
at
in
f
lu
en
ce
th
e
p
r
ac
tice
o
f
B
SE
am
o
n
g
teen
ag
e
g
ir
ls
in
Salatig
a
C
ity
,
I
n
d
o
n
esia.
Alth
o
u
g
h
7
0
.
1
%
o
f
r
esp
o
n
d
e
n
ts
h
ad
r
ec
ei
v
ed
in
f
o
r
m
atio
n
ab
o
u
t
B
SE
,
m
ain
ly
f
r
o
m
s
o
cial
m
ed
ia
an
d
s
ch
o
o
l
,
m
a
n
y
s
till
p
er
ce
iv
ed
th
e
p
r
ac
tice
as
u
n
n
ec
ess
ar
y
u
n
less
s
y
m
p
to
m
s
ap
p
ea
r
ed
.
T
h
is
r
esu
lt
h
ig
h
lig
h
ts
a
g
a
p
b
etwe
en
k
n
o
wled
g
e
an
d
p
r
ev
e
n
tiv
e
b
eh
a
v
i
o
r
.
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
6
F
a
cto
r
s
in
flu
en
cin
g
th
e
p
r
a
ctice
o
f b
r
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t self
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a
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(
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Desimin
a
Ta
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)
1785
T
h
e
m
o
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t
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ig
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if
ican
t
b
ar
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was
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e
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at
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SE
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im
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tan
t
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y
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r
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k
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ile
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th
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ited
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s
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T
h
is
s
tu
d
y
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ig
h
lig
h
ts
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n
ee
d
f
o
r
s
ch
o
o
l
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b
ased
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ter
v
en
tio
n
s
th
at
in
teg
r
ate
s
tr
u
ctu
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ed
B
SE
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u
ca
tio
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to
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e
p
r
o
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u
ctiv
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h
ea
lth
c
u
r
r
icu
la,
s
u
p
p
o
r
ted
b
y
p
r
ac
tical
d
em
o
n
s
tr
atio
n
s
an
d
tr
ai
n
in
g
f
o
r
s
ch
o
o
l
h
ea
lth
p
er
s
o
n
n
el.
C
o
llab
o
r
atio
n
with
lo
ca
l
h
ea
lth
au
t
h
o
r
ities
an
d
co
m
m
u
n
ity
ca
m
p
aig
n
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s
in
g
s
o
c
ial
m
ed
ia
an
d
p
ee
r
m
o
d
elin
g
ar
e
also
r
ec
o
m
m
en
d
ed
to
ad
d
r
ess
m
is
co
n
ce
p
tio
n
s
an
d
en
h
an
ce
ad
o
lescen
t
en
g
ag
em
e
n
t.
Fu
tu
r
e
r
esear
ch
s
h
o
u
ld
em
p
lo
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u
alitativ
e
ap
p
r
o
ac
h
es,
ex
p
an
d
to
m
o
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e
d
iv
e
r
s
e
ad
o
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t
p
o
p
u
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n
s
,
an
d
ev
alu
ate
th
e
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f
ec
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en
e
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o
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s
ch
o
o
l
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an
d
co
m
m
u
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ity
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ased
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ter
v
en
ti
o
n
s
.
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h
is
s
tu
d
y
h
as
s
e
v
e
r
al
l
im
ita
ti
o
n
s
th
at
s
h
o
u
l
d
b
e
c
o
n
s
i
d
e
r
e
d
wh
e
n
i
n
t
er
p
r
et
in
g
t
h
e
f
i
n
d
i
n
g
s
.
F
ir
s
t,
t
h
e
s
tu
d
y
em
p
lo
y
e
d
a
c
r
o
s
s
-
s
e
cti
o
n
al
d
esi
g
n
,
w
h
i
ch
lim
its
t
h
e
a
b
il
it
y
t
o
d
ete
r
m
i
n
e
c
a
u
s
al
r
e
la
tio
n
s
h
i
p
s
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etw
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n
k
n
o
w
le
d
g
e
,
a
ttit
u
d
es
,
a
n
d
B
S
E
b
e
h
a
v
i
o
r
.
Sec
o
n
d
,
t
h
e
s
am
p
l
e
was
r
est
r
i
cte
d
t
o
y
o
u
n
g
wo
m
e
n
r
es
id
in
g
in
a
s
t
u
d
e
n
t
d
o
r
m
it
o
r
y
i
n
a
s
i
n
g
le
cit
y
,
w
h
i
ch
m
a
y
n
o
t
r
e
p
r
ese
n
t
t
h
e
b
r
o
a
d
e
r
a
d
o
les
ce
n
t
p
o
p
u
la
ti
o
n
i
n
I
n
d
o
n
es
ia
wi
th
m
o
r
e
d
i
v
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r
s
e
c
u
lt
u
r
al
,
s
o
c
io
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o
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o
m
i
c,
an
d
e
d
u
ca
t
i
o
n
al
b
a
c
k
g
r
o
u
n
d
s
.
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d
d
iti
o
n
a
ll
y
,
s
el
f
-
r
e
p
o
r
te
d
q
u
esti
o
n
n
ai
r
es
m
ay
b
e
s
u
b
j
ec
t
t
o
r
es
p
o
n
s
e
b
i
as,
p
a
r
ti
cu
la
r
l
y
s
o
ci
al
d
esi
r
a
b
il
it
y
b
i
as,
as p
a
r
ti
ci
p
a
n
ts
m
ig
h
t
p
r
o
v
i
d
e
a
n
s
we
r
s
th
at
th
e
y
b
el
ie
v
e
a
r
e
ex
p
e
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ed
r
at
h
e
r
t
h
a
n
t
h
e
ir
ac
tu
al
b
e
h
a
v
i
o
r
o
r
p
er
c
ep
t
io
n
.
T
h
e
s
t
u
d
y
d
i
d
n
o
t
in
cl
u
d
e
q
u
al
itat
iv
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d
a
ta
th
a
t
co
u
l
d
h
a
v
e
e
n
r
ic
h
e
d
t
h
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u
n
d
e
r
s
ta
n
d
i
n
g
o
f
d
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ep
e
r
p
e
r
s
o
n
al
o
r
cu
lt
u
r
al
b
eli
ef
s
i
n
f
l
u
e
n
c
in
g
B
S
E
p
r
a
cti
ce
s
.
I
n
s
u
m
m
ar
y
,
th
is
s
tu
d
y
h
ig
h
lig
h
ts
th
at
ad
o
lescen
t g
ir
l in
Sala
tig
a
f
ac
e
s
ig
n
if
i
ca
n
t p
er
s
o
n
al,
co
g
n
itiv
e,
an
d
s
o
cio
-
cu
ltu
r
al
b
ar
r
ier
s
to
b
r
ea
s
t
s
elf
-
ex
am
in
atio
n
.
Mi
s
co
n
ce
p
tio
n
s
,
lo
w
p
er
ce
iv
e
d
s
u
s
ce
p
tib
ilit
y
,
an
d
cu
ltu
r
al
tab
o
o
s
r
em
ai
n
th
e
s
tr
o
n
g
est
o
b
s
tacle
s
,
wh
ich
ar
e
co
n
s
is
ten
t
with
co
n
s
tr
u
cts
o
f
th
e
Hea
lth
B
elief
Mo
d
el.
T
h
ese
f
in
d
i
n
g
s
em
p
h
asize
th
e
n
ee
d
f
o
r
tailo
r
e
d
,
c
u
ltu
r
ally
s
e
n
s
itiv
e
in
ter
v
en
tio
n
s
t
h
at
s
tr
en
g
th
en
s
elf
-
ef
f
icac
y
an
d
n
o
r
m
alize
B
SE
as
a
p
r
e
v
en
tiv
e
h
ea
lth
b
eh
av
i
o
r
.
Peer
-
led
ed
u
ca
tio
n
,
s
ch
o
o
l
-
b
ased
p
r
o
g
r
a
m
s
,
an
d
t
h
e
in
teg
r
atio
n
o
f
d
ig
ital
h
ea
lth
p
latf
o
r
m
s
r
ep
r
esen
t
p
r
o
m
is
in
g
s
tr
ateg
ies
to
r
ea
ch
ad
o
lescen
ts
m
o
r
e
ef
f
ec
tiv
ely
.
Nu
r
s
es,
as
tr
u
s
ted
h
ea
lth
p
r
o
f
ess
io
n
als,
ar
e
p
iv
o
tal
in
p
r
o
m
o
tin
g
ad
o
lescen
t
h
ea
lth
liter
ac
y
a
n
d
s
h
ap
in
g
p
o
s
itiv
e
p
r
ev
en
tiv
e
p
r
ac
tices.
ACK
NO
WL
E
DG
M
E
N
T
S
W
e
th
an
k
Un
iv
er
s
itas
Kr
is
ten
Saty
a
W
ac
an
a
o
f
Salatig
a
C
ity
f
o
r
th
e
a
p
p
r
o
v
al
o
f
t
h
e
au
th
o
r
s
to
co
n
d
u
ct
th
is
s
tu
d
y
.
T
h
is
p
u
b
licatio
n
is
s
u
p
p
o
r
ted
b
y
Saty
a
W
ac
an
a
C
h
r
is
tian
Un
iv
er
s
ity
th
r
o
u
g
h
th
e
W
r
iter
s
C
am
p
2
0
2
5
p
r
o
g
r
a
m
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
n
o
f
u
n
d
i
n
g
was
in
v
o
l
v
ed
in
th
e
r
esear
ch
p
r
o
c
ess
,
b
u
t
r
ec
eiv
e
d
f
u
n
d
in
g
f
o
r
th
e
ar
ticle
tr
an
s
latio
n
,
p
r
o
o
f
r
ea
d
in
g
,
an
d
ar
ticle
p
r
o
ce
s
s
in
g
c
h
ar
g
e
(
A
PC
)
f
r
o
m
Un
iv
e
r
s
itas
Kr
is
ten
Saty
a
W
ac
an
a
o
f
Salatig
a
C
ity
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
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Vi
Su
P
Fu
Kr
is
tian
i D
esimin
a
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h
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✓
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Dar
y
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Ab
eb
e
Alem
u
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s
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Ma
g
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Pau
lin
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C
:
C
o
n
c
e
p
t
u
a
l
i
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a
t
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:
M
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t
h
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:
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f
t
w
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r
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Va
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l
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d
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t
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o
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Fo
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Fo
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mal
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n
a
l
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i
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:
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n
v
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Fu
:
Fu
n
d
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n
g
a
c
q
u
i
si
t
i
o
n
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
.
4
,
Dec
em
b
er
20
25
:
1
7
7
9
-
1
7
87
1786
CO
NF
L
I
C
T
O
F
I
N
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E
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S
T
ST
A
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M
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NT
Au
th
o
r
s
s
tate
n
o
co
n
f
lict o
f
in
t
er
est.
E
T
H
I
CAL AP
P
RO
V
AL
T
h
is
r
esear
ch
was
eth
ically
ap
p
r
o
v
e
d
b
y
th
e
E
th
ics
C
o
m
m
ittee
o
f
Un
iv
er
s
itas
Kr
is
ten
Saty
a
W
ac
an
a
with
th
e
n
u
m
b
er
2
9
8
/PE/KE
PK.U
KSW
/2
0
2
0
.
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
d
ata
th
at
s
u
p
p
o
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t
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e
f
in
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n
g
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o
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th
is
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tu
d
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e
a
v
ailab
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f
r
o
m
th
e
co
r
r
esp
o
n
d
in
g
a
u
th
o
r
,
[
KDT
]
,
u
p
o
n
r
ea
s
o
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ab
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r
eq
u
est.
RE
F
E
R
E
NC
E
S
[
1
]
Y
.
F
e
n
g
e
t
a
l
.
,
“
B
r
e
a
s
t
c
a
n
c
e
r
d
e
v
e
l
o
p
me
n
t
a
n
d
p
r
o
g
r
e
ssi
o
n
:
R
i
sk
f
a
c
t
o
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J.
K
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,
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[
5
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T
h
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M
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[
6
]
C
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O
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T
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7
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8
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[
9
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R
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E.
Ti
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,
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1
0
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.
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K
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,
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1
1
]
N
.
B
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h
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F
.
M
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,
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o
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1
2
]
M
.
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o
s
n
j
a
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,
I
.
A
j
z
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n
,
a
n
d
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.
S
c
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s
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o
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[
1
3
]
T
.
K
.
D
e
w
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,
K
.
M
a
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s
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r
,
R
.
A
.
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.
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,
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n
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.
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o
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i
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2.
[1
4]
N
.
G
.
D
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n
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g
d
e
,
T
.
G
.
D
e
m
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e
,
a
n
d
A
.
B
.
D
i
r
i
b
a
,
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n
o
w
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d
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r
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c
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d
d
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A
b
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a
,
E
t
h
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i
a
,
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r
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a
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1
4
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/
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C
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.
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2
7
9
5
5
7
.
[
1
5
]
R
.
H
.
U
d
o
h
,
M
.
Ta
h
i
r
u
,
M
.
A
n
s
u
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M
e
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a
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,
V
.
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a
w
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F
.
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.
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q
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a
h
,
a
n
d
D
.
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u
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p
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e
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,
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W
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k
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o
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)
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o
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c
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m
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e
d
u
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iv
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o
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d
h
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r
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c
h
e
lo
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d
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re
e
in
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rsin
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fro
m
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r
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ste
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lt
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ip
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d
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c
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ly
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o
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c
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ti
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s
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p
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m
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with
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h
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wit
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sp
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n
th
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y
,
sh
e
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tatio
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n
d
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rit
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v
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o
f
th
e
m
a
n
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rip
t.
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h
e
c
a
n
b
e
c
o
n
tac
ted
at
e
m
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il
:
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a
ry
.
d
a
ry
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k
sw
.
e
d
u
.
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Ale
m
u
Ansh
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b
o
is
a
n
a
ss
istan
t
p
ro
fe
ss
o
r
sp
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c
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g
in
Re
p
ro
d
u
c
ti
v
e
He
a
lt
h
a
n
d
M
a
tern
i
ty
Nu
rsi
n
g
a
t
Wac
h
e
m
o
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y
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h
io
p
ia
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a
n
d
a
P
h
.
D.
sc
h
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lar
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Ep
id
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m
io
lo
g
y
a
n
d
P
u
b
li
c
He
a
lt
h
a
t
Ce
n
tral
Un
iv
e
rsity
o
f
Tam
il
N
a
d
u
,
In
d
ia.
He
h
o
l
d
s
a
BS
c
in
M
id
wife
r
y
a
n
d
a
n
M
S
c
in
Re
p
ro
d
u
c
ti
v
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a
lt
h
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n
d
M
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tern
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fr
o
m
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d
is
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a
b
a
Un
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rsity
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is
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e
e
p
ly
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m
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ted
t
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a
lt
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ro
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se
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g
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t.
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h
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ra
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re
p
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tab
le
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with
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n
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in
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e
x
o
f
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n
a
d
d
it
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o
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h
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h
e
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t
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h
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m
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in
c
l
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h
e
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t
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c
a
n
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