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th
eir
ev
o
lv
in
g
n
ee
d
s
,
em
p
h
asizin
g
th
e
im
p
o
r
tan
ce
o
f
in
f
o
r
m
ed
an
d
f
o
r
war
d
-
lo
o
k
in
g
p
o
licy
d
ev
elo
p
m
en
t.
Facto
r
s
s
u
ch
as
liv
in
g
co
n
d
itio
n
s
,
s
o
cial
welf
ar
e
p
r
o
v
is
io
n
,
an
d
ac
ce
s
s
to
h
ea
lth
ca
r
e
p
lay
a
ce
n
tr
al
r
o
le
in
s
h
ap
in
g
o
ld
er
ad
u
lts
’
q
u
ality
o
f
life
.
T
h
is
b
r
o
ad
er
p
er
s
p
ec
tiv
e
u
n
d
er
s
co
r
es
th
e
n
ee
d
f
o
r
th
o
r
o
u
g
h
s
tu
d
ies
an
d
s
tr
ateg
ic
p
o
licy
in
itiativ
es
to
ad
d
r
ess
th
e
ch
allen
g
es
an
d
o
p
p
o
r
tu
n
ities
p
r
esen
ted
b
y
p
o
p
u
latio
n
ag
in
g
.
W
ith
in
th
is
co
n
tex
t,
life
s
atis
f
ac
tio
n
em
er
g
es
as
a
m
u
ltid
im
en
s
io
n
al
an
d
v
ital
asp
ec
t
o
f
well
-
b
ein
g
in
later
life
.
I
t
r
ef
lects
a
p
er
s
o
n
al
ev
alu
atio
n
o
f
v
ar
io
u
s
life
d
o
m
ain
s
,
in
clu
d
in
g
p
h
y
s
ical
h
ea
lth
,
m
en
tal
an
d
em
o
tio
n
al
well
-
b
ein
g
,
s
o
cial
co
n
n
ec
tio
n
s
,
an
d
th
e
ac
h
iev
em
en
t
o
f
p
er
s
o
n
al
g
o
als.
E
n
h
an
cin
g
life
s
atis
f
ac
tio
n
am
o
n
g
o
ld
er
ad
u
lts
is
cr
u
cial,
as
it
is
d
ir
ec
tly
lin
k
ed
to
o
v
er
all
q
u
ality
o
f
life
an
d
s
u
cc
ess
f
u
l
ag
in
g
.
T
h
e
d
eter
m
in
an
ts
o
f
life
s
atis
f
ac
tio
n
in
th
is
d
em
o
g
r
ap
h
ic
ar
e
m
u
ltifa
ce
ted
,
en
co
m
p
ass
in
g
h
ea
lth
s
tatu
s
,
f
in
an
cial
s
ec
u
r
ity
,
s
o
cial
p
ar
ticip
atio
n
,
an
d
a
s
en
s
e
o
f
p
u
r
p
o
s
e.
T
ailo
r
ed
s
u
p
p
o
r
t
s
y
s
tem
s
,
h
ea
lth
ca
r
e
in
ter
v
en
tio
n
s
,
an
d
s
o
cial
p
r
o
g
r
am
s
tar
g
etin
g
th
ese
d
eter
m
in
an
ts
ca
n
s
ig
n
if
ican
tly
co
n
tr
ib
u
te
to
s
u
s
tain
in
g
h
ig
h
lev
els
o
f
life
s
atis
f
ac
tio
n
.
Pre
v
io
u
s
r
esear
ch
d
em
o
n
s
tr
ated
th
at
life
s
atis
f
ac
tio
n
am
o
n
g
o
ld
er
ad
u
lts
was
in
f
lu
en
ce
d
b
y
a
co
m
p
lex
in
ter
p
lay
o
f
in
ter
co
n
n
ec
ted
f
ac
to
r
s
.
Ho
u
s
eh
o
ld
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
—
in
clu
d
in
g
in
co
m
e,
wea
lth
,
an
d
ass
ets
,
p
lay
ed
a
s
ig
n
if
ican
t
r
o
le,
with
s
tu
d
ies
r
ev
ea
lin
g
p
o
s
itiv
e
ass
o
ciatio
n
s
b
etwe
en
s
o
cio
-
ec
o
n
o
m
ic
f
ac
to
r
s
an
d
life
s
atis
f
ac
tio
n
[
4
]
.
Ph
y
s
ical
an
d
m
en
tal
h
ea
lth
also
r
ep
r
esen
ted
cr
u
cial
d
im
en
s
io
n
s
,
with
ag
e
-
r
elate
d
d
ec
lin
es
in
p
h
y
s
ical
f
u
n
ctio
n
in
g
n
eg
ativ
ely
im
p
ac
tin
g
o
v
er
all
s
atis
f
ac
tio
n
[
4
]
,
[
5
]
.
Mo
r
eo
v
er
,
th
e
r
ec
ip
r
o
ca
l
r
elatio
n
s
h
ip
b
etwe
en
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
an
d
h
ea
lth
was
well
-
d
o
cu
m
en
ted
,
as
ec
o
n
o
m
ic
r
eso
u
r
ce
s
in
f
lu
en
ce
d
h
ea
lth
o
u
tco
m
es
[
6
]
,
[
7
]
.
Activ
e
p
ar
ticip
atio
n
in
s
o
cial
ac
tiv
ities
f
u
r
th
er
em
er
g
ed
as
a
k
ey
d
r
iv
er
o
f
m
en
tal
h
ea
lth
an
d
life
s
atis
f
ac
tio
n
,
f
o
s
ter
in
g
s
o
cial
co
n
n
ec
ted
n
ess
an
d
a
s
en
s
e
o
f
p
u
r
p
o
s
e
[
8
]
,
[
9
]
.
Alth
o
u
g
h
p
r
io
r
s
tu
d
ies
o
f
f
er
ed
v
alu
ab
le
in
s
ig
h
ts
in
to
th
e
d
eter
m
in
an
ts
o
f
life
s
atis
f
ac
tio
n
in
later
life
,
s
ev
er
al
lim
itatio
n
s
r
em
ain
ed
.
Mo
s
t
r
esear
ch
—
b
o
th
g
lo
b
ally
an
d
in
T
h
ailan
d
—
r
elied
o
n
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
s
,
lim
itin
g
th
e
ab
ilit
y
to
ass
ess
tem
p
o
r
al
d
y
n
am
ics
o
r
ca
u
s
al
r
elatio
n
s
h
ip
s
.
Ma
n
y
f
o
cu
s
ed
o
n
s
in
g
le
d
o
m
ain
s
,
s
u
ch
as
h
ea
lth
o
r
ec
o
n
o
m
ic
s
tatu
s
,
with
o
u
t
ac
co
u
n
tin
g
f
o
r
th
eir
co
m
b
in
ed
ef
f
ec
ts
with
s
o
cial
en
g
ag
em
en
t.
Mo
r
eo
v
er
,
lo
n
g
itu
d
in
al
s
tu
d
ies
in
th
e
T
h
ai
co
n
tex
t
wer
e
s
ca
r
ce
,
an
d
n
o
n
e
ap
p
lied
cr
o
s
s
-
lag
g
ed
s
tr
u
ctu
r
al
eq
u
atio
n
m
o
d
elin
g
to
ex
am
in
e
th
e
r
ec
ip
r
o
ca
l
r
elatio
n
s
h
ip
s
am
o
n
g
h
ea
lth
,
s
o
cial,
an
d
ec
o
n
o
m
ic
f
ac
to
r
s
an
d
life
s
atis
f
ac
tio
n
.
T
h
is
s
tu
d
y
ad
d
r
ess
es
th
ese
g
ap
s
b
y
in
teg
r
atin
g
m
u
ltip
le
d
o
m
ain
s
u
s
in
g
h
ig
h
-
q
u
ality
lo
n
g
itu
d
in
al
d
ata
to
ex
p
lo
r
e
th
e
s
tab
ilit
y
an
d
cr
o
s
s
-
lag
g
ed
ef
f
ec
ts
o
f
k
ey
d
eter
m
in
an
ts
o
f
life
s
atis
f
ac
tio
n
am
o
n
g
o
ld
er
T
h
ai
ad
u
lts
.
T
h
e
in
tr
icate
in
ter
r
elatio
n
s
h
ip
s
am
o
n
g
th
ese
f
ac
to
r
s
h
ig
h
lig
h
t
th
e
n
ec
ess
ity
o
f
a
co
m
p
r
eh
en
s
iv
e
ap
p
r
o
ac
h
to
s
tu
d
y
in
g
life
s
atis
f
ac
tio
n
in
o
ld
er
ad
u
lts
.
T
h
is
s
tu
d
y
s
ee
k
ed
to
ass
ess
an
d
ex
p
lo
r
e
th
e
f
ac
to
r
s
in
f
lu
en
cin
g
life
s
atis
f
ac
tio
n
am
o
n
g
o
ld
er
ad
u
lts
in
T
h
ailan
d
,
f
o
cu
s
in
g
o
n
th
e
in
ter
p
lay
b
etwe
en
p
h
y
s
ical
h
ea
lth
,
m
en
tal
h
ea
lth
,
s
o
cial
en
g
ag
em
en
t,
an
d
s
o
cio
-
ec
o
n
o
m
ic
co
n
d
itio
n
s
.
Giv
en
th
e
co
m
p
lex
ity
o
f
ag
in
g
-
r
elate
d
ch
an
g
es,
a
lo
n
g
itu
d
in
al
ap
p
r
o
ac
h
is
ess
en
tial
to
ca
p
tu
r
e
h
o
w
life
s
atis
f
ac
tio
n
,
h
ea
lth
,
an
d
s
o
cio
-
ec
o
n
o
m
ic
f
ac
to
r
s
ev
o
lv
e
o
v
er
tim
e.
T
o
ad
d
r
ess
th
is
n
ee
d
,
th
e
p
r
esen
t
s
tu
d
y
em
p
lo
y
ed
a
cr
o
s
s
-
lag
g
ed
s
tr
u
ctu
r
al
eq
u
atio
n
m
o
d
el
to
ex
am
in
e
r
ec
ip
r
o
ca
l
an
d
tem
p
o
r
al
r
elatio
n
s
h
ip
s
ac
r
o
s
s
two
tim
e
p
o
in
ts
.
B
y
lev
er
ag
in
g
h
ig
h
-
q
u
ality
lo
n
g
itu
d
in
al
d
ata,
th
e
s
tu
d
y
aim
ed
to
g
en
er
ate
d
ee
p
er
in
s
ig
h
ts
in
to
th
e
d
y
n
am
ic
in
ter
ac
tio
n
s
am
o
n
g
th
ese
v
ar
iab
les,
th
er
eb
y
co
n
tr
ib
u
tin
g
to
a
m
o
r
e
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
th
e
ag
in
g
p
r
o
ce
s
s
in
T
h
ailan
d
.
T
h
ese
f
in
d
in
g
s
wer
e
ex
p
ec
ted
to
b
e
v
alu
ab
le
f
o
r
p
o
licy
m
ak
er
s
an
d
r
elev
an
t
o
r
g
an
izatio
n
s
in
d
ev
elo
p
in
g
ef
f
ec
tiv
e
s
tr
ateg
ies
an
d
in
ter
v
en
tio
n
s
to
s
u
p
p
o
r
t
th
e
well
-
b
ein
g
o
f
o
ld
er
ad
u
lts
in
th
e
y
ea
r
s
to
co
m
e.
2.
M
E
T
H
O
D
T
h
is
s
ec
tio
n
d
escr
ib
es
th
e
s
tu
d
y
’
s
th
eo
r
etica
l
f
o
u
n
d
atio
n
,
h
y
p
o
th
eses
,
d
ata
s
o
u
r
ce
,
an
d
an
aly
tical
ap
p
r
o
ac
h
,
f
o
cu
s
in
g
o
n
th
e
u
s
e
o
f
cr
o
s
s
-
lag
g
ed
s
tr
u
ctu
r
al
eq
u
atio
n
m
o
d
elin
g
to
ass
ess
s
tab
ilit
y
an
d
r
ec
ip
r
o
ca
l
r
elatio
n
s
h
ip
s
am
o
n
g
k
ey
v
ar
iab
les o
v
er
tim
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
6
8
6
-
1
6
9
9
1688
2
.
1
.
T
heo
re
t
ica
l
f
ra
m
ewo
rk
T
h
e
ex
p
lo
r
atio
n
o
f
life
s
atis
f
ac
tio
n
am
o
n
g
o
ld
er
ad
u
lts
was
o
f
p
ar
am
o
u
n
t
im
p
o
r
tan
ce
in
in
f
o
r
m
in
g
n
atio
n
al
p
o
licy
m
ak
er
s
.
T
h
is
s
tu
d
y
f
o
cu
s
ed
o
n
f
o
u
r
k
ey
d
im
en
s
io
n
s
th
at
wer
e
an
ticip
ated
to
im
p
ac
t
life
s
atis
f
ac
tio
n
,
b
o
th
d
ir
ec
tly
an
d
in
d
ir
ec
tly
.
T
h
ese
d
im
en
s
io
n
s
in
clu
d
ed
s
o
cio
-
ec
o
n
o
m
ic
f
ac
to
r
s
,
p
ar
ticip
atio
n
in
s
o
cial
ac
tiv
ity
,
an
d
th
e
in
f
lu
en
ce
o
f
p
h
y
s
ical
an
d
m
en
tal
h
ea
lth
.
T
o
g
ain
a
d
ee
p
er
u
n
d
er
s
tan
d
in
g
o
f
th
e
d
y
n
am
ics
o
f
th
ese
v
ar
iab
les
o
v
er
tim
e,
th
is
s
tu
d
y
em
p
lo
y
ed
a
cr
o
s
s
-
lag
g
ed
p
an
el
m
o
d
el,
wh
ich
allo
wed
f
o
r
th
e
ex
am
in
atio
n
o
f
r
ec
ip
r
o
ca
l
an
d
tem
p
o
r
al
r
elatio
n
s
h
ip
s
b
etwe
en
v
ar
iab
les
ac
r
o
s
s
m
u
ltip
le
tim
e
p
o
in
ts
f
r
o
m
th
e
lo
n
g
itu
d
in
al
d
ata.
A
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
th
ese
asp
ec
ts
,
in
clu
d
in
g
th
eir
s
tab
ilit
y
an
d
cr
o
s
s
-
lag
g
ed
ef
f
ec
ts
,
was r
ef
lecte
d
in
th
e
p
r
o
p
o
s
ed
m
o
d
el
as
s
h
o
wn
in
Fig
u
r
e
1
,
p
r
o
v
id
in
g
v
alu
ab
le
in
s
ig
h
ts
in
to
th
e
lo
n
g
-
ter
m
f
ac
to
r
s
in
f
lu
en
cin
g
life
s
atis
f
ac
tio
n
am
o
n
g
o
ld
er
ad
u
lts
.
Fig
u
r
e
1
.
Pro
p
o
s
ed
m
o
d
el
2
.
2
.
H
y
po
t
hes
es
2
.
2
.
1
.
P
hy
s
ica
l a
nd
m
ent
a
l hea
lt
h
a
f
f
ec
t
life
s
a
t
is
f
a
ct
io
n
L
if
e
s
atis
f
ac
tio
n
was
s
h
ap
ed
b
y
life
ev
en
ts
[
1
0
]
,
[
1
1
]
an
d
f
lu
ctu
ated
d
u
r
in
g
tr
an
s
itio
n
al
p
h
ases
[
1
2
]
.
I
t
f
o
llo
wed
an
in
v
er
ted
U
-
s
h
ap
e
ac
r
o
s
s
th
e
life
s
p
an
,
r
em
ain
in
g
lo
w
b
ef
o
r
e
ag
e
6
0
,
p
ea
k
in
g
tem
p
o
r
ar
ily
,
an
d
d
ec
lin
in
g
in
later
y
ea
r
s
d
u
e
to
h
ea
lth
d
eter
io
r
atio
n
[
1
3
]
.
R
esear
ch
s
h
o
wed
th
at
d
ec
lin
in
g
p
h
y
s
ical
h
ea
lth
was
ass
o
ciate
d
with
ag
in
g
,
n
eg
ativ
ely
af
f
ec
tin
g
life
s
atis
f
ac
tio
n
[
4
]
,
[
5
]
.
Stu
d
ies
in
C
h
in
a
an
d
Vietn
am
f
o
u
n
d
a
p
o
s
itiv
e
r
elatio
n
s
h
ip
b
etwe
en
h
ea
lth
an
d
life
s
atis
f
ac
tio
n
[
1
4
]
,
[
1
5
]
.
R
esear
ch
in
I
n
d
ia
id
en
tifie
d
s
tr
o
n
g
ass
o
ciatio
n
s
b
etwe
en
s
elf
-
r
ated
h
ea
lth
,
f
u
n
ctio
n
al
h
ea
lth
,
m
en
tal
well
-
b
ein
g
,
an
d
life
s
atis
f
ac
tio
n
[
1
3
]
.
Ho
wev
er
,
f
in
d
in
g
s
f
r
o
m
Fin
lan
d
,
Po
lan
d
,
an
d
Sp
ain
s
u
g
g
ested
th
at
h
ea
lth
h
ad
an
in
d
ir
ec
t
ef
f
ec
t
o
n
life
s
atis
f
ac
tio
n
[
1
6
]
.
R
ec
en
t
s
tu
d
ies
h
av
e
em
p
lo
y
ed
cr
o
s
s
-
lag
g
ed
p
an
el
m
o
d
els
to
ex
am
in
e
th
e
r
ec
ip
r
o
ca
l
an
d
tem
p
o
r
al
r
elatio
n
s
h
ip
s
b
etwe
en
life
s
atis
f
ac
tio
n
,
p
h
y
s
ical
h
ea
lth
,
an
d
m
en
tal
h
ea
lth
o
v
er
tim
e.
Fo
r
in
s
tan
ce
,
r
esear
ch
h
as d
em
o
n
s
tr
ated
th
at
wh
ile
h
ea
lth
an
d
life
s
atis
f
ac
tio
n
ca
n
im
p
ac
t e
ac
h
o
th
er
lo
n
g
itu
d
in
ally
,
th
e
ef
f
ec
t
o
f
life
s
atis
f
ac
tio
n
o
n
h
ea
lth
b
ec
o
m
es
n
eg
lig
ib
le
wh
en
with
in
-
p
er
s
o
n
s
tab
ilit
y
is
ac
co
u
n
ted
f
o
r
,
s
u
g
g
esti
n
g
th
at
h
ea
lth
m
ay
h
av
e
a
m
o
r
e
s
u
b
s
tan
tial im
p
ac
t o
n
life
s
atis
f
ac
tio
n
th
an
v
ice
v
er
s
a
[
1
7
]
.
Ad
d
itio
n
ally
,
s
tu
d
ies
h
av
e
f
o
u
n
d
b
id
ir
ec
tio
n
al
ass
o
ciatio
n
s
b
etwe
en
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
an
d
life
s
atis
f
ac
tio
n
,
in
d
icatin
g
th
at
ch
an
g
es
N
et
In
co
m
e
(
w3
)
Asset
(
w3
)
D
ebt
(
w3
)
So
cial
Ac
tiv
it
y
(
w3
)
P
h
y
s
ica
l H
ea
lt
h
Scores
(
w3
)
Men
t
a
l H
ea
lt
h
Scores
(
w3
)
Lif
e
Sat
is
f
action
(
w3
)
N
et
In
co
m
e
(
w4
)
Asset
(
w4
)
D
ebt
(
w4
)
So
cial
Ac
tiv
it
y
(
w4
)
Ph
y
s
ical
H
e
alt
h
Sco
re
s
(
w4
)
Me
n
ta
l Health
Scores
(
w4
)
Lif
e
Sa
tis
f
act
ion
(
w4
)
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
C
r
o
s
s
-
la
g
g
ed
p
a
n
el
in
s
ig
h
ts
in
to
h
ea
lth
,
s
o
cia
l,
a
n
d
ec
o
n
o
mic
in
life sa
tis
fa
ctio
n
(
P
a
ch
itja
n
u
t S
ir
ip
a
n
ich
)
1689
in
m
en
tal
h
ea
lth
ca
n
in
f
lu
en
ce
life
s
atis
f
ac
tio
n
an
d
v
ice
v
er
s
a
[
1
8
]
.
B
y
em
p
lo
y
in
g
a
cr
o
s
s
-
lag
g
ed
p
an
el
ap
p
r
o
ac
h
,
we
aim
ed
to
ass
ess
th
e
r
ec
ip
r
o
ca
l
an
d
tem
p
o
r
al
r
elatio
n
s
h
ip
s
b
etwe
en
h
ea
lth
an
d
life
s
atis
f
ac
tio
n
ac
r
o
s
s
two
wav
es.
T
h
u
s
,
we
p
r
o
p
o
s
ed
h
y
p
o
th
esis
1
:
H
ea
lth
in
f
lu
en
ce
d
life
s
atis
f
ac
tio
n
o
v
er
tim
e,
wh
ile
life
s
atis
f
ac
tio
n
also
p
lay
ed
a
r
o
le
in
s
h
ap
in
g
f
u
tu
r
e
h
ea
lth
o
u
tco
m
es,
d
em
o
n
s
tr
atin
g
a
d
y
n
am
ic
an
d
b
id
ir
ec
tio
n
al
ass
o
ciatio
n
.
2
.
2
.
2
.
H
o
us
eho
ld
s
o
cio
-
ec
o
no
m
ic
a
f
f
ec
t
hea
lt
h
Hea
lth
y
ag
in
g
was
in
f
lu
en
ce
d
b
y
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
[
SES]
th
r
o
u
g
h
o
u
t
life
[
6
]
.
L
o
wer
SES
was
ass
o
ciate
d
with
p
o
o
r
er
h
ea
lth
,
h
ig
h
er
m
o
r
b
id
ity
,
an
d
p
r
em
atu
r
e
m
o
r
tality
[
1
9
]
.
I
t w
as a
ls
o
r
elate
d
to
p
o
o
r
s
elf
-
r
ated
h
ea
lth
,
ch
r
o
n
ic
d
is
ea
s
e
[
2
0
]
,
lo
wer
q
u
ality
o
f
life
[
2
1
]
,
ca
r
d
io
v
ascu
lar
d
is
ea
s
es,
r
ed
u
ce
d
m
u
s
cle
s
tr
en
g
th
,
lo
w
r
esp
ir
ato
r
y
f
u
n
ctio
n
[
2
2
]
,
h
ig
h
er
m
o
r
tality
[
2
3
]
,
an
d
d
is
ab
ilit
y
[
2
4
]
.
L
o
w
h
o
u
s
eh
o
ld
SES
co
n
tr
ib
u
ted
to
u
n
h
ea
lth
y
b
eh
av
io
r
s
an
d
p
o
o
r
h
ea
lth
o
u
tco
m
es
[
2
5
]
.
Hig
h
er
in
co
m
e
im
p
r
o
v
ed
n
u
tr
itio
n
,
h
o
u
s
in
g
,
an
d
h
ea
lth
ca
r
e
[
2
6
]
.
Stru
ctu
r
al
eq
u
atio
n
m
o
d
elin
g
[
SEM
]
s
h
o
wed
SES
s
ig
n
if
ican
tly
af
f
ec
ted
p
h
y
s
ical
b
u
t
n
o
t
p
s
y
ch
o
lo
g
ical
h
ea
lth
[
7
]
.
So
cial
p
ar
ticip
atio
n
h
elp
ed
m
itig
ate
th
e
n
eg
ativ
e
ef
f
ec
ts
o
f
lo
w
SES
[
2
6
]
.
Me
an
wh
ile,
h
ig
h
er
SES
en
ab
led
b
etter
h
ea
lth
ca
r
e
ac
ce
s
s
,
q
u
ality
ca
r
e,
an
d
h
ea
lth
awa
r
en
ess
,
f
o
s
ter
in
g
p
o
s
itiv
e
h
ea
lth
b
eh
av
io
r
s
an
d
im
p
r
o
v
ed
s
elf
-
p
er
ce
p
tio
n
[
2
7
]
-
[
2
9
]
.
T
h
r
o
u
g
h
p
r
ev
io
u
s
s
tu
d
ies,
we
f
o
u
n
d
th
at
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
was
p
o
s
itiv
ely
ass
o
ciate
d
with
h
ea
lth
an
d
h
ad
s
ig
n
if
ican
t
ef
f
ec
ts
o
n
b
o
th
p
h
y
s
ical
an
d
m
en
tal
well
-
b
ein
g
in
o
ld
er
ad
u
lts
.
Ho
wev
er
,
th
ese
ef
f
ec
ts
m
ay
ev
o
lv
e
o
v
er
tim
e,
in
f
lu
en
cin
g
h
ea
lth
o
u
tco
m
es
at
d
if
f
er
en
t
life
s
tag
es.
T
o
ex
am
in
e
th
is
tem
p
o
r
al
d
im
en
s
io
n
,
we
p
r
o
p
o
s
e
h
y
p
o
th
esis
2
:
S
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
p
o
s
itiv
ely
im
p
ac
ts
o
ld
er
ad
u
lts
’
h
ea
lth
an
d
co
n
tr
ib
u
tes to
lo
n
g
-
ter
m
ch
an
g
es in
p
h
y
s
ical
an
d
m
en
tal
well
-
b
ein
g
.
2
.
2
.
3
.
So
cia
l
a
ct
iv
it
y
pa
rt
icipa
t
io
n
a
f
f
ec
t
s
m
ent
a
l hea
lt
h a
nd
life
s
a
t
is
f
a
ct
i
on
Old
er
ad
u
lts
wh
o
p
ar
ticip
ated
in
s
o
cial
ac
tiv
ity
ex
p
er
ien
ce
d
s
lo
wer
co
g
n
itiv
e
d
ec
lin
e
an
d
b
etter
m
en
tal
h
ea
lth
[
8
]
.
So
cial
en
g
ag
em
en
t
was
ass
o
ciate
d
with
f
ewe
r
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
,
th
o
u
g
h
its
im
p
ac
t
v
ar
ied
b
y
ac
tiv
ity
ty
p
e
[
3
0
]
.
Activ
e
p
ar
ticip
atio
n
im
p
r
o
v
ed
m
en
tal
well
-
b
ein
g
,
r
ed
u
ce
d
d
ep
r
ess
io
n
,
an
d
en
h
an
ce
d
life
s
atis
f
ac
tio
n
[
3
1
]
.
Ma
in
tain
in
g
an
ac
tiv
e
life
s
ty
le
s
u
p
p
o
r
ted
s
elf
-
esteem
an
d
a
p
o
s
itiv
e
s
elf
-
co
n
ce
p
t,
co
n
tr
ib
u
tin
g
to
m
en
tal
h
ea
lth
in
later
life
.
B
ased
o
n
ac
tiv
ity
an
d
r
o
le
ac
cu
m
u
latio
n
th
eo
r
ies,
b
o
th
p
ar
ticip
atio
n
an
d
th
e
n
u
m
b
er
o
f
ac
tiv
ities
wer
e
cr
u
cial
to
m
en
tal
well
-
b
ein
g
[
3
2
]
.
Stu
d
ies
f
o
u
n
d
th
at
in
v
o
lv
em
en
t
in
r
elig
io
u
s
g
r
o
u
p
s
,
clu
b
s
,
p
o
liti
ca
l
o
r
g
an
izatio
n
s
,
an
d
v
o
lu
n
teer
in
g
h
ad
p
o
s
itiv
e
ef
f
ec
ts
o
n
m
en
tal
h
ea
lth
[
3
0
]
,
[
3
3
]
,
[
3
4
]
.
So
cial
ac
tiv
ity
in
clu
d
ed
h
o
b
b
y
clu
b
s
,
g
ath
er
in
g
s
,
r
elig
io
u
s
ev
en
ts
,
v
o
lu
n
teer
in
g
,
an
d
s
en
io
r
co
m
m
u
n
ity
ce
n
ter
s
[
3
5
]
.
L
if
e
s
atis
f
ac
tio
n
in
cr
ea
s
ed
wh
en
o
ld
er
ad
u
lts
en
g
ag
ed
in
s
o
cial
ac
tiv
ity
,
as
th
ese
p
r
o
v
id
ed
p
u
r
p
o
s
e
an
d
r
esil
ien
ce
.
I
n
f
o
r
m
al
ac
tiv
ities
with
f
r
ien
d
s
o
r
f
am
ily
en
h
an
ce
d
well
-
b
ein
g
[
3
6
]
.
R
e
s
e
a
r
c
h
c
o
n
s
i
s
t
e
n
t
l
y
s
h
o
w
e
d
t
h
a
t
a
c
t
i
v
e
p
a
r
t
i
c
i
p
a
t
i
o
n
i
m
p
r
o
v
e
d
l
i
f
e
s
a
t
i
s
f
a
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[
3
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s
o
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ical,
m
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tal,
an
d
ec
o
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o
m
ic
s
atis
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ac
tio
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)
.
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n
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[
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t
a
l
s
c
o
r
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:
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–
5]
M
e
n
t
a
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t
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To
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d
a
y
[
To
t
a
l
s
c
o
r
e
:
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–
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Li
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a
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i
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a
c
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To
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d
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g
o
o
d
[
To
t
a
l
s
c
o
r
e
:
3
–
3
0
]
2.
4
.
Sta
t
is
t
ica
l
m
o
del
-
ba
s
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t
heo
ry
T
h
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s
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d
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lti
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m
ain
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-
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tr
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r
al
eq
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n
m
o
d
el
(
SEM
)
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r
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ip
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o
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s
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m
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s
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r
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en
t
p
o
in
ts
—
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av
e
3
(
w3
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an
d
W
av
e
4
(
w4
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—
co
v
er
in
g
f
o
u
r
k
ey
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o
m
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s
:
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o
n
o
m
ic
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n
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in
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m
e,
ass
et
,
d
eb
t)
,
s
o
cial
(
s
o
cial
ac
tiv
ity
)
,
h
ea
lth
(
p
h
y
s
ical
h
ea
lth
,
m
en
tal
h
ea
lth
)
,
an
d
well
-
b
ein
g
(
life
s
atis
f
ac
tio
n
)
.
T
h
e
m
o
d
el
s
im
u
ltan
eo
u
s
ly
esti
m
ated
th
r
ee
ty
p
es
o
f
ef
f
ec
ts
.
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s
tab
ilit
y
(
au
to
r
eg
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ess
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ef
f
ec
ts
m
ea
s
u
r
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e
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ten
t
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wh
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ea
ch
v
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r
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ain
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s
is
ten
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tim
e.
T
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f
ec
ts
wer
e
m
o
d
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as
au
to
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r
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s
in
wh
ich
a
v
ar
iab
le
at
W
av
e
4
was
p
r
ed
icted
b
y
its
o
wn
v
alu
e
at
W
av
e
3
,
ex
p
r
ess
ed
as:
4
=
+
3
+
wh
er
e
X
t
is
th
e
v
alu
e
o
f
v
ar
iab
le
X
at
wav
e
t
,
β
XX
r
ep
r
esen
ts
th
e
au
to
r
eg
r
ess
iv
e
co
ef
f
icien
t
r
ef
lectin
g
tem
p
o
r
al
s
tab
ilit
y
,
an
d
is
th
e
d
is
tu
r
b
an
ce
ter
m
.
Hig
h
er
v
alu
es o
f
in
d
icate
s
tr
o
n
g
er
p
er
s
is
ten
ce
o
f
th
e
co
n
s
tr
u
ct
o
v
er
tim
e.
Seco
n
d
,
cr
o
s
s
-
lag
g
ed
ef
f
ec
ts
ca
p
tu
r
ed
th
e
d
ir
ec
tio
n
al
in
f
lu
en
ce
s
b
etwe
en
d
if
f
er
en
t
co
n
s
tr
u
cts
ac
r
o
s
s
wav
es,
allo
win
g
f
o
r
th
e
ex
am
in
atio
n
o
f
r
ec
ip
r
o
ca
l
ca
u
s
atio
n
.
T
h
ese
wer
e
m
o
d
eled
as:
4
=
+
3
+
3
+
,
wh
er
e
r
ep
r
esen
ts
th
e
cr
o
s
s
-
lag
co
ef
f
icien
t
f
r
o
m
3
to
4
an
d
4
=
+
3
+
3
+
,
,
whe
r
e
r
e
pr
e
s
e
n
ts
the
c
r
oss
−
lag
c
oe
ff
ic
ie
n
t
fr
om
3
to
4
.
Sig
n
if
ican
t
v
alu
es
f
o
r
b
o
th
an
d
p
r
o
v
id
e
ev
id
en
ce
f
o
r
r
ec
ip
r
o
ca
l r
elatio
n
s
h
ip
s
.
Fo
r
ex
am
p
le:
4
=
+
,
3
+
,
3
+
,
3
+
4
=
+
,
3
+
,
3
+
W
h
er
e
LS
r
ep
r
esen
ts
life
s
atis
f
ac
tio
n
,
PH
an
d
MH
d
en
o
te
p
h
y
s
ical
an
d
m
en
tal
h
ea
lth
s
co
r
es
at
wav
e
t,
t
=
3
,
an
d
4
.
I
f
b
o
th
,
an
d
,
.
T
h
ese
ar
e
s
ig
n
if
ican
t
;
th
is
in
d
icate
s
d
y
n
am
ic
r
ec
ip
r
o
city
b
etwe
en
p
h
y
s
ical
h
ea
lth
an
d
life
s
atis
f
ac
tio
n
.
T
h
ir
d
,
s
y
n
ch
r
o
n
o
u
s
co
r
r
elatio
n
s
m
ea
s
u
r
ed
th
e
ass
o
ciatio
n
s
b
etwe
en
v
ar
iab
les
with
in
th
e
s
am
e
wav
e,
ca
p
tu
r
in
g
co
n
tem
p
o
r
an
eo
u
s
r
elatio
n
s
h
ip
s
b
ey
o
n
d
th
e
lo
n
g
itu
d
in
al
p
ath
way
s
.
I
n
SEM
m
atr
ix
n
o
tatio
n
,
th
e
m
o
d
el
ca
n
b
e
ex
p
r
ess
ed
as:
4
=
+
3
+
,
wh
er
e
=
[
,
,
,
,
,
,
]
,
B
is
a
co
ef
f
icien
t
m
atr
ix
co
n
tain
in
g
b
o
th
s
tab
ilit
y
co
ef
f
icien
ts
(
β
ii
)
an
d
cr
o
s
s
-
lag
g
ed
co
ef
f
icien
ts
(
β
ij
,
i
j
)
,
an
d
ϵ
is
th
e
r
esid
u
al
er
r
o
r
v
ec
to
r
.
Diag
o
n
al
elem
en
ts
o
f
B
r
ep
r
esen
t
s
tab
ilit
y
p
ath
s
,
wh
er
ea
s
o
f
f
-
d
iag
o
n
al
elem
en
ts
r
ep
r
esen
t
cr
o
s
s
-
lag
g
ed
p
ath
s
.
T
h
e
th
eo
r
etica
l
f
o
u
n
d
atio
n
o
f
th
is
m
o
d
el
in
teg
r
ates
s
ev
er
al
p
er
s
p
ec
tiv
es.
C
r
o
s
s
-
lag
g
ed
p
an
el
th
eo
r
y
[
3
9
]
p
r
o
v
id
es
th
e
f
r
am
ewo
r
k
f
o
r
ass
ess
in
g
r
ec
ip
r
o
ca
l
an
d
d
ir
ec
tio
n
al
in
f
lu
en
ce
s
b
etwe
en
co
n
s
tr
u
cts
o
v
er
tim
e.
T
h
e
s
tab
ilit
y
–
co
n
tin
u
ity
p
er
s
p
ec
tiv
e
[
4
0
]
p
o
s
its
th
at
p
s
y
ch
o
lo
g
ical
an
d
b
eh
av
io
r
al
co
n
s
tr
u
cts
ex
h
ib
it
m
o
d
er
ate
to
h
ig
h
r
an
k
-
o
r
d
er
s
tab
ilit
y
ac
r
o
s
s
th
e
life
co
u
r
s
e.
T
h
e
lif
e
co
u
r
s
e
p
er
s
p
ec
tiv
e
em
p
h
asizes
th
e
d
y
n
am
ic
in
ter
d
ep
en
d
en
ce
o
f
ec
o
n
o
m
ic,
s
o
cial,
h
ea
lth
,
an
d
well
-
b
ein
g
tr
ajec
to
r
ies
o
v
er
tim
e.
Fin
ally
,
dyn
am
ic
s
y
s
tem
s
th
eo
r
y
o
f
f
er
s
a
co
n
ce
p
tu
al
ap
p
r
o
ac
h
f
o
r
in
ter
p
r
etin
g
th
e
in
ter
p
lay
b
etwe
en
s
tab
ilit
y
(
as
r
ef
lecte
d
in
au
to
r
eg
r
ess
iv
e
ef
f
ec
ts
)
an
d
ch
an
g
e
(
as
r
ef
lecte
d
in
cr
o
s
s
-
lag
g
ed
ef
f
ec
ts
)
,
th
er
eb
y
in
f
o
r
m
in
g
th
e
an
aly
s
is
o
f
b
o
th
p
er
s
is
ten
t a
n
d
ev
o
lv
in
g
in
f
lu
en
ce
s
o
n
life
s
atis
f
ac
tio
n
.
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
C
r
o
s
s
-
la
g
g
ed
p
a
n
el
in
s
ig
h
ts
in
to
h
ea
lth
,
s
o
cia
l,
a
n
d
ec
o
n
o
mic
in
life sa
tis
fa
ctio
n
(
P
a
ch
itja
n
u
t S
ir
ip
a
n
ich
)
1691
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
T
h
is
s
ec
tio
n
p
r
esen
ts
th
e
f
in
d
in
g
s
o
f
th
e
cr
o
s
s
-
lag
g
ed
p
an
el
m
o
d
el,
ex
am
in
in
g
th
e
r
elatio
n
s
h
ip
s
b
etwe
en
s
o
cio
-
ec
o
n
o
m
ic
f
ac
to
r
s
,
h
ea
lth
v
ar
iab
les,
s
o
cial
ac
tiv
ity
,
an
d
life
s
atis
f
ac
tio
n
ac
r
o
s
s
W
av
e
I
I
I
an
d
W
av
e
I
V.
T
h
e
an
aly
s
is
ex
p
lo
r
ed
b
o
th
d
ir
ec
t
an
d
in
d
ir
ec
t
ef
f
ec
ts
,
id
en
tify
in
g
r
ec
ip
r
o
ca
l
an
d
tem
p
o
r
al
r
elatio
n
s
h
ip
s
as
well
as
cr
o
s
s
-
wav
e
in
f
lu
en
ce
s
o
v
er
tim
e.
T
h
is
ap
p
r
o
ac
h
p
r
o
v
id
ed
a
co
m
p
r
eh
en
s
iv
e
u
n
d
er
s
tan
d
in
g
o
f
s
tab
ilit
y
,
b
id
ir
ec
tio
n
al
ef
f
ec
ts
,
an
d
d
y
n
am
ic
in
ter
p
lay
am
o
n
g
h
ea
lth
,
well
-
b
ein
g
,
an
d
s
o
cio
-
ec
o
n
o
m
ic
f
ac
to
r
s
.
3
.
1
.
M
ea
s
urem
ent
i
nv
a
ria
nce
T
h
e
r
esu
lts
p
er
tain
in
g
to
th
e
r
elate
d
f
it
s
tatis
tics
o
f
m
ea
s
u
r
em
en
t
in
v
ar
ian
ce
,
as
well
as
th
e
f
itn
ess
in
d
ices
o
f
th
e
alter
n
ativ
e
m
o
d
el
[
f
in
al
m
o
d
el]
an
d
ag
e
g
r
o
u
p
m
o
d
els,
wer
e
ex
am
in
ed
.
T
o
ass
ess
th
e
m
o
d
er
atin
g
r
o
le
o
f
th
e
v
ar
iab
le
'
ag
e
g
r
o
u
p
'
in
o
ld
er
ad
u
lts
’
life
s
atis
f
ac
tio
n
,
it
is
ess
en
tial
to
in
itially
co
m
p
ar
e
th
e
f
itn
ess
in
d
ices
b
etwe
en
th
e
alter
n
ativ
e
m
o
d
el
an
d
th
e
ag
e
g
r
o
u
p
m
o
d
el.
T
h
e
m
o
d
el
f
itn
ess
in
d
ices
u
s
ed
in
th
e
cu
r
r
en
t
s
tu
d
y
wer
e
g
o
o
d
n
ess
o
f
f
it
in
d
ex
(
GFI
)
,
ad
ju
s
ted
g
o
o
d
n
ess
o
f
f
it
in
d
ex
(
AGFI
)
,
co
m
p
ar
ativ
e
f
it
in
d
ex
(
C
FI
)
,
an
d
r
o
o
t
m
ea
n
s
q
u
ar
e
er
r
o
r
o
f
ap
p
r
o
x
im
atio
n
(
R
MSE
A
)
.
As
s
h
o
wn
in
T
ab
le
2
,
th
e
f
itn
ess
in
d
ices
o
f
th
e
alter
n
ativ
e
m
o
d
el
an
d
th
e
ag
e
g
r
o
u
p
m
o
d
el
wer
e
d
if
f
er
en
t,
im
p
ly
in
g
th
at
th
e
ag
e
o
f
o
ld
er
ad
u
lts
co
u
ld
b
e
m
o
d
er
ated
by
th
eir
life
s
atis
f
ac
tio
n
.
3
.
2
.
M
o
del
f
it
nes
s
ind
ices
T
h
e
p
r
o
p
o
s
ed
m
o
d
el
in
clu
d
ed
th
r
ee
co
n
s
tr
u
cted
v
ar
iab
les:
p
h
y
s
ical
h
ea
lth
,
m
en
tal
h
ea
lth
,
an
d
life
s
atis
f
ac
tio
n
,
alo
n
g
s
id
e
f
o
u
r
o
b
s
er
v
ed
v
ar
iab
les:
n
et
in
co
m
e,
ass
ets
,
d
eb
t
,
an
d
s
o
cial
ac
tiv
ity
.
Ho
wev
er
,
af
ter
in
v
esti
g
atin
g
th
e
s
ig
n
if
ican
t
f
ac
to
r
s
,
it
was
f
o
u
n
d
th
at
life
s
atis
f
ac
tio
n
was
u
n
af
f
ec
ted
b
y
ce
r
tain
p
r
ed
icto
r
s
.
As
a
r
esu
lt,
an
alter
n
ativ
e
m
o
d
el
was
d
ev
elo
p
ed
,
alo
n
g
with
an
ag
e
g
r
o
u
p
m
o
d
el,
to
ex
am
in
e
h
o
w
th
e
r
elatio
n
s
h
ip
s
am
o
n
g
all
f
ac
to
r
s
v
ar
y
b
y
ag
e
g
r
o
u
p
.
T
h
ese
m
o
d
els,
in
co
r
p
o
r
atin
g
cr
o
s
s
-
lag
g
ed
p
an
el
an
aly
s
is
to
ass
ess
r
ec
ip
r
o
ca
l a
n
d
tem
p
o
r
al
r
elatio
n
s
h
ip
s
o
v
er
tim
e,
wer
e
d
ep
icted
in
Fig
u
r
es 2
an
d
3
.
T
ab
le
2
p
r
esen
ts
th
e
m
o
d
el
f
itn
ess
in
d
ices,
p
r
o
v
id
in
g
a
co
m
p
r
eh
en
s
iv
e
ev
alu
atio
n
o
f
h
o
w
well
th
e
m
o
d
els
alig
n
with
th
e
o
b
s
er
v
ed
d
ata.
Fo
r
th
e
alter
n
ativ
e
m
o
d
el,
th
e
in
d
ices
wer
e
GFI
=
0
.
9
6
1
,
AGFI
=
0
.
9
2
8
,
C
FI
=
0
.
9
1
1
,
an
d
R
MSE
A
=
0
.
0
6
2
.
Fo
r
th
e
ag
e
g
r
o
u
p
m
o
d
el,
th
e
f
itn
ess
in
d
ices
wer
e
GFI
=
0
.
9
4
4
,
AGFI
=
0
.
9
0
1
,
C
FI
=
0
.
9
0
2
,
an
d
R
MSE
A
=
0
.
0
4
8
,
with
n
o
tab
le
im
p
r
o
v
em
en
ts
in
C
FI
[
Δ
C
FI
=
0
.
0
0
9
]
an
d
R
MSE
A
[
Δ
R
MSE
A
=
0
.
0
1
4
]
.
T
h
ese
r
esu
lts
in
d
icate
d
th
at
b
o
th
th
e
alter
n
ativ
e
m
o
d
el
an
d
th
e
ag
e
g
r
o
u
p
m
o
d
el
f
it
well
with
th
e
em
p
ir
ical
d
ata.
T
h
ese
r
esu
lts
d
em
o
n
s
tr
ated
th
at
b
o
th
th
e
alter
n
ativ
e
m
o
d
el
an
d
th
e
ag
e
g
r
o
u
p
m
o
d
el
f
itted
well
with
th
e
em
p
ir
ical
d
ata.
An
o
th
er
im
p
o
r
tan
t
p
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x
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T
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Fig
u
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s
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d
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3
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3
.
1
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F
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s
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I
I
I
[
w3
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T
h
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is
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I
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,
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h
o
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d
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b
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[
1
4
]
,
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5
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.
Ad
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ally
,
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ican
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ag
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in
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[
3
6
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,
[
3
8
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Ph
y
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ical
h
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ad
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,
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e
with
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in
d
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g
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f
r
o
m
[
2
9
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
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0
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I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
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b
er
20
25
:
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6
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1692
Fig
u
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ativ
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u
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3
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p
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f
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n
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u
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o
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A
l
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r
n
at
i
v
e
m
o
de
l
A
ge
gr
o
u
p
m
o
de
l
:
age
=
45-
59
(
n
=
101
)
A
ge
gr
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u
p
m
o
de
l
:
age
=
60
an
d
o
v
e
r
(
n
=
460
)
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
C
r
o
s
s
-
la
g
g
ed
p
a
n
el
in
s
ig
h
ts
in
to
h
ea
lth
,
s
o
cia
l,
a
n
d
ec
o
n
o
mic
in
life sa
tis
fa
ctio
n
(
P
a
ch
itja
n
u
t S
ir
ip
a
n
ich
)
1693
3
.
3
.
3
.
Cro
s
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la
g
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ef
f
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t
s
bet
wee
n
Wa
v
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I
a
nd
Wa
v
e
I
V
Stab
ilit
y
:
T
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s
is
r
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s
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g
s
tab
ilit
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ac
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o
s
s
k
ey
v
ar
iab
les
o
v
er
tim
e.
So
cial
ac
tiv
ity
r
em
ain
e
d
co
n
s
is
ten
t
,
with
W
av
e
I
I
I
h
av
in
g
a
s
ig
n
if
ica
n
t
ef
f
ec
t
o
n
W
av
e
I
V
[
p
ath
co
ef
f
ici
en
t
=
0
.
3
4
9
,
p
<0
.
0
0
1
]
.
L
ik
ewise,
m
en
tal
h
ea
lth
d
em
o
n
s
tr
ated
co
n
tin
u
ity
,
as
m
en
tal
h
ea
lth
at
W
av
e
I
I
I
s
tr
o
n
g
ly
in
f
lu
en
ce
d
m
en
tal
h
ea
lth
at
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
2
9
1
,
p
<0
.
0
0
1
]
.
Ph
y
s
ical
h
ea
lth
ex
h
ib
ited
th
e
h
ig
h
est
s
tab
ilit
y
,
with
s
u
b
s
tan
tial
co
n
tin
u
ity
b
etwe
en
W
av
e
I
I
I
an
d
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
7
4
5
,
p
<0
.
0
0
1
]
,
em
p
h
asizin
g
its
p
er
s
is
ten
ce
as
a
cr
itical
f
ac
to
r
o
v
er
tim
e.
L
if
e
s
atis
f
ac
tio
n
also
m
ain
tain
ed
s
tr
o
n
g
s
tab
ilit
y
,
with
W
av
e
III
s
ig
n
if
ica
n
tly
af
f
ec
ti
n
g
W
av
e
I
V
[
p
ath
co
ef
f
icie
n
t
=
0
.
3
3
6
,
p
<0
.
0
0
1
]
,
r
ef
lectin
g
s
im
ilar
f
in
d
in
g
s
f
r
o
m
[
1
1
]
,
[
1
3
]
.
R
ec
ip
r
o
ca
l
an
d
tem
p
o
r
al
r
elatio
n
s
h
ip
s
:
T
h
e
an
aly
s
is
r
ev
ea
led
r
ec
ip
r
o
ca
l
an
d
tem
p
o
r
al
r
elatio
n
s
h
ip
s
am
o
n
g
m
en
tal
h
ea
lth
,
life
s
atis
f
ac
tio
n
,
an
d
p
h
y
s
ical
h
ea
lth
.
W
ith
in
ea
ch
wav
e,
m
en
tal
h
ea
lth
h
ad
a
s
ig
n
if
ican
t
ef
f
ec
t
o
n
life
s
atis
f
ac
tio
n
,
wh
ile
ac
r
o
s
s
wav
es,
life
s
atis
f
ac
tio
n
at
W
av
e
I
I
I
in
f
lu
en
ce
d
m
en
tal
h
ea
lth
at
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
1
8
1
,
p
<0
.
0
0
1
]
,
co
n
f
ir
m
in
g
m
u
tu
al
in
f
lu
en
ce
[
1
7
]
.
L
ik
ewise,
m
en
tal
an
d
p
h
y
s
ical
h
ea
lth
ex
h
ib
ited
b
id
ir
ec
tio
n
al
ef
f
ec
ts
.
Fo
r
W
av
e
I
I
I
,
p
h
y
s
ical
h
ea
lth
co
n
tr
ib
u
ted
to
m
en
tal
well
-
b
ein
g
,
an
d
ac
r
o
s
s
wav
es,
m
en
tal
h
ea
lth
at
W
av
e
I
I
I
p
o
s
itiv
ely
af
f
ec
ted
p
h
y
s
ical
h
ea
lth
at
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
1
3
7
,
p
<0
.
0
0
1
]
,
s
u
p
p
o
r
tin
g
a
life
co
u
r
s
e
p
er
s
p
ec
tiv
e
[
2
0
]
,
[
2
3
]
.
T
h
ese
f
in
d
in
g
s
u
n
d
er
s
co
r
e
th
e
d
y
n
am
ic
an
d
in
ter
d
ep
en
d
en
t
n
atu
r
e
o
f
p
s
y
ch
o
lo
g
ical
an
d
p
h
y
s
ical
well
-
b
ein
g
o
v
er
tim
e.
No
tab
ly
,
b
o
th
m
en
tal
h
ea
lth
an
d
p
h
y
s
ical
h
ea
lth
f
u
n
ctio
n
ed
as m
o
d
er
ato
r
s
in
W
av
e
I
I
I
an
d
W
av
e
I
V,
b
r
id
g
in
g
th
e
r
elatio
n
s
h
ip
s
b
etwe
en
s
o
cio
-
ec
o
n
o
m
ic
f
ac
to
r
s
[
ass
ets,
n
et
in
co
m
e]
an
d
life
s
atis
f
ac
tio
n
.
I
n
ad
d
itio
n
,
p
h
y
s
ical
h
ea
lth
co
n
tr
ib
u
ted
in
d
ir
ec
tly
to
life
s
atis
f
ac
tio
n
th
r
o
u
g
h
its
im
p
ac
t o
n
m
en
tal
h
ea
lth
,
a
m
ec
h
an
is
m
th
at
is
also
n
o
ted
in
th
e
wo
r
k
o
f
[
7
]
.
3
.
4
.
E
x
plo
ring
cr
o
s
s
-
la
g
g
ed
a
s
s
o
cia
t
io
ns
in a
g
e
g
ro
up
m
o
dels
influencing
life
s
a
t
is
f
a
ct
io
n
T
h
is
s
tu
d
y
co
n
s
id
er
ed
ag
e
g
r
o
u
p
s
as
a
m
o
d
er
ato
r
,
lead
in
g
to
an
an
aly
s
is
th
at
ex
am
in
ed
cr
o
s
s
-
lag
g
ed
ass
o
ciatio
n
s
s
ep
ar
ately
f
o
r
ea
ch
ag
e
g
r
o
u
p
.
B
y
ap
p
ly
in
g
ag
e
-
s
p
ec
if
ic
m
o
d
els,
th
e
r
esear
ch
ex
p
lo
r
ed
h
o
w
h
ea
lth
,
s
o
cial,
an
d
ec
o
n
o
m
ic
f
ac
to
r
s
in
f
lu
en
ce
d
life
s
atis
f
ac
tio
n
o
v
er
tim
e.
3
.
4
.
1
.
T
he
a
g
e
g
ro
up
4
5
–
59
y
ea
rs
T
h
e
cr
o
s
s
-
lag
g
ed
p
an
el
m
o
d
el
f
o
r
th
e
ag
e
g
r
o
u
p
4
5
–
59
y
ea
r
s
d
em
o
n
s
tr
ated
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
s
am
o
n
g
s
o
cio
-
ec
o
n
o
m
ic
f
ac
to
r
s
,
h
ea
lth
v
ar
iab
les,
s
o
cial
ac
tiv
ity
,
an
d
life
s
atis
f
ac
tio
n
with
in
an
d
ac
r
o
s
s
tim
e
p
o
in
ts
[
W
av
e
I
I
I
an
d
W
av
e
I
V]
as sh
o
wn
in
Fig
u
r
e
s
3
an
d
4
.
−
Fin
d
in
g
s
with
in
W
av
e
I
I
I
[
w3
]
On
ly
m
en
tal
h
ea
lth
ex
er
ted
a
s
ig
n
if
ican
t
in
f
lu
en
ce
o
n
life
s
atis
f
ac
tio
n
,
wh
er
ea
s
th
e
o
th
er
f
ac
to
r
s
d
id
n
o
t
d
em
o
n
s
tr
ate
s
tatis
tically
s
ig
n
if
ican
t
ef
f
ec
ts
.
Sp
ec
if
ically
,
p
h
y
s
ical
h
ea
lth
was
n
o
t
s
ig
n
if
ican
tly
ass
o
ciate
d
with
eith
er
life
s
atis
f
ac
tio
n
o
r
m
en
tal
h
ea
lth
.
L
ik
ewise,
n
et
in
co
m
e
an
d
ass
ets
d
id
n
o
t
ex
h
ib
it
s
ig
n
if
ican
t
ass
o
ciatio
n
s
with
h
ea
lth
v
ar
iab
les.
Fu
r
th
er
m
o
r
e,
s
o
cial
ac
tiv
ity
also
f
ailed
to
d
em
o
n
s
tr
ate
a
s
ig
n
if
ican
t
ef
f
ec
t
o
n
life
s
atis
f
ac
tio
n
.
−
Fin
d
in
g
s
w
ith
in
W
av
e
I
V
[
w4
]
At
W
av
e
I
V,
it
is
in
ter
esti
n
g
to
n
o
te
th
at
with
in
th
e
s
am
e
wav
e,
n
o
f
ac
to
r
s
wer
e
s
ig
n
if
ican
tly
ass
o
ciate
d
with
life
s
atis
f
ac
tio
n
.
I
n
s
tead
,
th
e
ex
p
lan
ato
r
y
v
ar
iab
les,
n
am
ely
ass
ets
an
d
p
h
y
s
ical
h
ea
lth
,
h
ad
a
s
ig
n
if
ican
t
im
p
ac
t
o
n
m
en
tal
h
ea
lth
[
p
ath
co
ef
f
icien
t
=
-
0
.
1
9
4
,
p
=
0
.
0
1
6
an
d
p
ath
co
ef
f
icien
t
=
0
.
2
1
9
,
p
=
0
.
0
1
1
,
r
esp
ec
tiv
ely
]
,
s
u
g
g
esti
n
g
co
m
p
lex
s
o
cio
-
ec
o
n
o
m
ic
d
y
n
am
ics
as
d
escr
ib
ed
by
[
1
6
]
.
T
h
is
f
in
d
in
g
s
u
g
g
ests
th
at
ass
et
o
wn
er
s
h
ip
m
ay
b
e
r
elate
d
to
f
in
an
cial
o
r
p
s
y
ch
o
lo
g
ical
s
tr
ess
in
th
is
a
g
e
g
r
o
u
p
,
h
ig
h
lig
h
tin
g
th
e
n
ee
d
f
o
r
f
u
r
th
er
in
v
esti
g
atio
n
to
ex
p
lo
r
e
th
e
u
n
d
er
ly
in
g
m
ec
h
an
is
m
s
d
r
iv
in
g
th
is
r
elatio
n
s
h
ip
.
Similar
to
W
av
e
I
I
I
,
n
et
in
co
m
e
co
n
tin
u
ed
to
r
ef
lect
a
n
o
n
-
s
ig
n
if
ican
t
ef
f
ec
t
o
n
p
h
y
s
ical
h
ea
lth
,
in
d
icatin
g
a
p
er
s
is
ten
t
lack
o
f
ass
o
ciatio
n
b
etwe
en
ec
o
n
o
m
ic
r
eso
u
r
ce
s
an
d
h
ea
lth
o
u
tco
m
es.
Ad
d
itio
n
ally
,
s
o
cial
ac
tiv
ity
at
W
av
e
I
V
r
em
ain
ed
u
n
r
elate
d
to
m
en
tal
h
ea
lth
.
Stab
ilit
y
:
So
cial
ac
tiv
ity
,
p
h
y
s
ical
h
ea
lth
,
an
d
m
en
tal
h
ea
lth
m
ain
tain
ed
s
ig
n
if
ican
t
s
tab
ilit
y
ac
r
o
s
s
wav
es,
h
ig
h
lig
h
tin
g
th
eir
last
in
g
p
r
esen
ce
o
v
er
tim
e.
So
cial
ac
tiv
ity
d
em
o
n
s
tr
ated
s
tr
o
n
g
co
n
tin
u
ity
,
with
W
av
e
I
I
I
h
av
in
g
a
s
ig
n
if
ican
t
ef
f
ec
t
o
n
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
3
6
5
,
p
<0
.
0
0
1
]
,
in
d
icatin
g
co
n
s
is
ten
t
lev
els
o
f
s
o
cial
en
g
ag
em
en
t.
L
ik
ewise,
p
h
y
s
ical
h
ea
lth
ex
h
ib
ited
s
u
b
s
tan
tial
s
tab
ilit
y
,
as
W
av
e
I
I
I
h
ad
a
s
tr
o
n
g
in
f
lu
en
ce
o
n
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
6
5
4
,
p
<0
.
0
0
1
]
.
Me
n
tal
h
ea
lth
also
r
etain
ed
s
ig
n
if
ican
t
s
tab
ilit
y
,
with
W
av
e
I
I
I
s
co
r
es
af
f
ec
tin
g
W
av
e
I
V
s
co
r
es
[
p
ath
co
ef
f
icien
t
=
0
.
3
7
4
,
p
<0
.
0
0
1
]
,
r
ein
f
o
r
cin
g
th
e
p
er
s
is
ten
ce
o
f
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
ac
r
o
s
s
tim
e.
L
if
e
s
atis
f
ac
tio
n
also
d
em
o
n
s
tr
ated
h
ig
h
tem
p
o
r
al
s
tab
ilit
y
,
with
W
av
e
I
I
I
af
f
ec
tin
g
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
7
6
7
,
p
<0
.
0
0
1
]
,
u
n
d
er
s
co
r
in
g
its
r
o
le
as
a
co
n
s
is
ten
t m
ea
s
u
r
e
o
f
s
u
b
jectiv
e
well
-
b
ein
g
.
R
ec
ip
r
o
ca
l
an
d
tem
p
o
r
al
r
elatio
n
s
h
ip
s
:
T
h
e
f
in
d
in
g
s
f
o
r
th
e
ag
e
g
r
o
u
p
4
5
–
5
9
y
ea
r
s
af
f
ir
m
ed
th
e
s
tr
o
n
g
s
tab
ilit
y
o
f
s
o
cial
ac
tiv
ity
,
p
h
y
s
ical
h
ea
lth
,
m
en
tal
h
ea
lth
,
an
d
life
s
atis
f
ac
tio
n
ac
r
o
s
s
wav
es,
with
s
ig
n
if
ican
t
cr
o
s
s
-
lag
ef
f
ec
ts
d
em
o
n
s
tr
atin
g
th
eir
in
ter
co
n
n
ec
ted
n
atu
r
e.
Sp
ec
if
ically
,
m
en
tal
h
ea
lth
n
o
t
o
n
ly
m
ain
tain
ed
its
o
wn
s
tab
ilit
y
b
u
t
also
in
f
lu
en
ce
d
f
u
tu
r
e
p
h
y
s
ical
h
ea
lth
,
wh
ile
life
s
atis
f
ac
tio
n
s
er
v
ed
as
a
p
r
ed
icto
r
o
f
s
u
b
s
eq
u
en
t
m
en
tal
h
ea
lth
.
T
h
ese
r
esu
lts
h
ig
h
lig
h
ted
th
e
d
y
n
am
ic
r
elatio
n
s
h
ip
s
b
etwe
en
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
6
8
6
-
1
6
9
9
1694
p
s
y
ch
o
lo
g
ical,
p
h
y
s
ical,
an
d
s
u
b
jectiv
e
well
-
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g
o
v
er
tim
e,
em
p
h
asizin
g
th
e
lo
n
g
-
ter
m
im
p
o
r
tan
ce
o
f
m
en
tal
h
ea
lth
an
d
life
s
atis
f
ac
tio
n
as d
r
iv
er
s
o
f
o
v
er
all
well
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ein
g
,
co
n
s
is
ten
t w
ith
th
e
f
in
d
in
g
s
o
f
[
4
1
]
.
Fig
u
r
e
4
.
Stan
d
a
r
d
ized
r
eg
r
ess
io
n
co
ef
f
icien
ts
–
Fin
al
m
o
d
el:
ag
e
g
r
o
u
p
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o
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el
[
4
5
-
5
9
y
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r
s
]
3
.
4
.
2
.
T
he
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g
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g
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up
6
0
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rs a
nd
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v
er
T
h
e
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in
al
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o
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el
f
o
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in
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6
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an
d
o
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h
ig
h
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ig
n
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ican
t
r
elatio
n
s
h
ip
s
am
o
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g
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o
cial
ac
tiv
ity
,
s
o
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-
ec
o
n
o
m
ic,
h
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d
well
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ar
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les
ac
r
o
s
s
W
av
e
I
I
I
an
d
W
av
e
I
V
(
Fig
u
r
e
s
3
an
d
5)
.
Me
n
tal
h
ea
lth
co
n
tin
u
ed
to
s
er
v
e
as
a
cr
u
cial
m
ed
iato
r
b
etwe
en
p
h
y
s
ical
h
ea
lth
an
d
life
s
atis
f
ac
tio
n
in
b
o
th
W
av
e
I
I
I
an
d
W
av
e
I
V.
Ph
y
s
ical
h
ea
lth
p
o
s
itiv
ely
in
f
lu
en
ce
d
m
en
tal
h
ea
lth
[
p
ath
co
ef
f
icien
t
=
0
.
1
3
6
,
p
<0
.
0
0
1
f
o
r
W
av
e
I
I
I
,
an
d
p
ath
co
ef
f
icien
t
=
0
.
1
7
0
,
p
<0
.
0
0
1
f
o
r
W
av
e
I
V]
,
wh
ich
in
tu
r
n
h
ad
a
s
ig
n
if
ican
tly
s
tr
o
n
g
est
ef
f
ec
t
o
n
life
s
atis
f
ac
tio
n
[
p
ath
co
ef
f
icien
t
=
0
.
3
0
1
,
p
<0
.
0
0
1
f
o
r
W
av
e
I
I
I
,
an
d
p
ath
co
ef
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icien
t
=
0
.
2
1
9
,
p
<0
.
0
0
1
f
o
r
W
av
e
I
V]
,
co
n
s
is
ten
t w
ith
s
tu
d
ies b
y
[
2
6
]
,
[
3
4
]
.
So
cial
ac
tiv
ity
an
d
p
h
y
s
ical
h
ea
lth
em
er
g
ed
as
k
ey
co
n
tr
ib
u
to
r
s
to
life
s
atis
f
ac
tio
n
in
b
o
th
wav
es,
wh
ile
f
in
an
cial
f
ac
to
r
s
p
lay
ed
a
lim
ited
r
o
le.
So
cial
en
g
ag
em
en
t sig
n
if
ican
tly
in
f
lu
en
ce
d
life
s
atis
f
ac
tio
n
,
with
s
tr
o
n
g
er
ef
f
ec
ts
o
b
s
er
v
ed
at
W
av
e
I
I
I
[
p
ath
co
ef
f
icien
t
=
0
.
1
7
2
,
p
<0
.
0
0
1
]
co
m
p
ar
ed
to
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
0
9
7
,
p
=
0
.
0
2
4
]
,
co
n
s
is
ten
t
with
f
in
d
in
g
s
f
r
o
m
[
9
]
,
[
3
3
]
.
Ph
y
s
ical
h
ea
lth
d
em
o
n
s
tr
ated
a
co
n
s
is
ten
t
p
o
s
itiv
e
im
p
ac
t
o
n
life
s
atis
f
ac
tio
n
,
with
s
ig
n
if
ican
t
ef
f
ec
ts
at
b
o
th
W
av
e
I
I
I
[
p
ath
co
ef
f
icien
t
=
0
.
1
4
4
,
p
<0
.
0
0
1
]
an
d
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
1
5
4
,
p
<0
.
0
0
1
]
.
I
n
co
n
tr
ast,
f
in
an
cial
f
ac
to
r
s
h
ad
m
in
im
al
in
f
lu
en
ce
;
wh
ile
ass
ets
at
W
av
e
I
I
I
h
ad
a
p
o
s
itiv
e
ef
f
ec
t
o
n
m
en
tal
h
ea
lth
[
p
ath
co
ef
f
icien
t
=
0
.
0
9
8
,
p
=
0
.
0
3
3
]
,
th
eir
d
ir
ec
t
im
p
ac
t
o
n
f
u
tu
r
e
o
u
tco
m
es
was
lim
ited
.
Net
in
co
m
e,
o
n
th
e
o
th
er
h
an
d
,
h
ad
n
o
s
ig
n
if
ican
t
lo
n
g
-
ter
m
ass
o
ciatio
n
with
eith
er
p
h
y
s
ical
o
r
m
en
tal
h
ea
lth
in
th
is
ag
e
g
r
o
u
p
.
Sev
er
al
k
ey
v
ar
iab
les
d
em
o
n
s
tr
ated
s
tr
o
n
g
s
tab
ilit
y
ac
r
o
s
s
wav
es.
Ph
y
s
ical
h
ea
lth
,
m
en
tal
h
ea
lth
,
life
s
atis
f
ac
tio
n
,
an
d
s
o
cial
ac
tiv
ity
all
r
etain
ed
s
ig
n
if
ican
t
co
n
tin
u
ity
f
r
o
m
W
av
e
I
I
I
to
W
av
e
I
V,
as
in
d
icate
d
b
y
th
eir
r
esp
ec
tiv
e
p
ath
co
ef
f
icien
ts
[
p
h
y
s
ical
h
ea
lth
=
0
.
7
5
7
,
p
<0
.
0
0
1
;
m
en
tal
h
ea
lth
=
0
.
2
7
9
,
p
<0
.
0
0
1
;
s
o
cial
ac
tiv
ity
=
0
.
3
4
2
,
p
<0
.
0
0
1
]
.
L
if
e
s
atis
f
ac
tio
n
at
W
av
e
I
I
I
s
ig
n
if
ican
tly
af
f
ec
ted
life
s
atis
f
ac
tio
n
at
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
1
8
1
,
p
<0
.
0
0
1
]
.
T
h
ese
f
in
d
in
g
s
h
ig
h
lig
h
t
th
e
lo
n
g
-
ter
m
s
tab
ilit
y
o
f
th
ese
v
ar
iab
les
o
v
er
tim
e,
em
p
h
asizin
g
th
eir
f
o
u
n
d
atio
n
al
r
o
les in
o
v
er
all
well
-
b
ein
g
.
Fu
r
th
er
m
o
r
e,
life
s
atis
f
ac
tio
n
at
W
av
e
I
I
I
h
ad
a
p
o
s
itiv
e
ef
f
ec
t
o
n
m
en
tal
h
ea
lth
at
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
1
7
6
,
p
<0
.
0
0
1
]
,
d
em
o
n
s
tr
atin
g
a
r
ec
ip
r
o
ca
l
an
d
tem
p
o
r
al
r
elatio
n
s
h
ip
in
wh
ich
im
p
r
o
v
em
en
ts
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
C
r
o
s
s
-
la
g
g
ed
p
a
n
el
in
s
ig
h
ts
in
to
h
ea
lth
,
s
o
cia
l,
a
n
d
ec
o
n
o
mic
in
life sa
tis
fa
ctio
n
(
P
a
ch
itja
n
u
t S
ir
ip
a
n
ich
)
1695
in
s
u
b
jectiv
e
well
-
b
ein
g
co
n
tr
ib
u
ted
to
en
h
an
ce
d
m
en
tal
h
ea
lth
o
v
er
tim
e.
Ad
d
itio
n
ally
,
m
en
tal
h
ea
lth
at
W
av
e
I
I
I
s
ig
n
if
ican
tly
im
p
ac
ted
p
h
y
s
ical
h
ea
lth
at
W
av
e
I
V
[
p
ath
co
ef
f
icien
t
=
0
.
1
2
9
,
p
<0
.
0
0
1
]
,
s
u
p
p
o
r
tin
g
th
e
r
o
le
o
f
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
in
s
u
s
tain
in
g
p
h
y
s
ical
h
ea
lth
o
v
er
tim
e
[
5
]
,
[
2
2
]
.
Fig
u
r
e
5
.
Stan
d
a
r
d
ized
r
eg
r
ess
io
n
co
ef
f
icien
ts
–
f
in
al
m
o
d
el:
ag
e
g
r
o
u
p
m
o
d
el
[
6
0
y
ea
r
s
an
d
o
v
er
]
T
h
e
o
v
er
all
m
o
d
el
r
esu
lts
in
d
icate
d
th
at
m
en
tal
h
ea
lth
was
th
e
m
o
s
t
co
n
s
is
ten
t
an
d
in
f
lu
en
tial
f
ac
to
r
af
f
ec
tin
g
life
s
atis
f
ac
tio
n
ac
r
o
s
s
b
o
th
wav
es,
co
n
s
is
ten
t
with
p
r
io
r
lo
n
g
itu
d
in
al
s
tu
d
ies
th
at
id
en
tifie
d
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
as a
k
ey
d
eter
m
in
an
t o
f
q
u
ality
o
f
life
in
later
ad
u
lth
o
o
d
[
1
4
]
,
[
3
5
]
.
T
h
is
h
ig
h
lig
h
ted
th
e
ce
n
tr
al
r
o
le
o
f
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
in
s
h
ap
in
g
in
d
iv
id
u
als’
p
er
ce
p
tio
n
s
o
f
q
u
ality
o
f
life
an
d
th
eir
ab
ilit
y
to
ad
ap
t
to
h
ea
lth
an
d
s
o
cial
ch
an
g
es.
I
ts
s
tr
o
n
g
im
p
ac
t
m
ay
h
av
e
s
tem
m
ed
f
r
o
m
h
o
w
p
o
s
itiv
e
m
en
tal
s
tates
en
h
an
ce
d
r
esil
ien
ce
,
co
p
in
g
,
an
d
s
o
cial
co
n
n
ec
tio
n
s
—
k
ey
elem
en
ts
o
f
s
u
b
jectiv
e
well
-
b
ein
g
th
at
h
ad
b
ee
n
em
p
h
asized
in
p
r
io
r
th
eo
r
etica
l
an
d
em
p
ir
ical
wo
r
k
[
1
4
]
,
[
3
5
]
.
Ph
y
s
ical
h
ea
lth
also
s
h
o
wed
a
p
er
s
is
ten
t
co
n
tr
ib
u
tio
n
,
r
ein
f
o
r
cin
g
th
e
im
p
o
r
tan
ce
o
f
m
ain
tain
in
g
f
u
n
ctio
n
al
ab
ilit
y
an
d
in
d
ep
en
d
en
ce
f
o
r
d
aily
en
g
ag
em
en
t
an
d
m
en
tal
s
tab
ilit
y
,
in
lin
e
with
ea
r
lier
f
in
d
in
g
s
th
at
f
u
n
ctio
n
al
lim
itatio
n
s
s
tr
o
n
g
ly
p
r
ed
icted
d
ec
lin
es
in
well
-
b
ein
g
[
1
3
]
,
[
3
4
]
.
So
cial
ac
tiv
ity
,
th
o
u
g
h
with
a
s
m
aller
ef
f
ec
t
s
ize,
s
u
p
p
o
r
ted
life
s
atis
f
ac
tio
n
b
y
r
ed
u
cin
g
is
o
latio
n
an
d
f
o
s
ter
in
g
em
o
tio
n
al
s
u
p
p
o
r
t
an
d
b
elo
n
g
in
g
,
wh
ich
ec
h
o
ed
p
r
ev
io
u
s
s
tu
d
ies
h
ig
h
lig
h
tin
g
s
o
cial
en
g
ag
em
en
t
as
a
p
r
o
tectiv
e
f
ac
to
r
ag
ain
s
t
lo
n
elin
ess
an
d
p
s
y
ch
o
lo
g
ical
d
is
tr
ess
in
o
ld
er
p
o
p
u
latio
n
s
[
3
0
]
,
[
3
6
]
.
I
n
co
n
tr
ast,
s
o
cio
-
ec
o
n
o
m
ic
in
d
icato
r
s
s
u
ch
as
ass
ets
an
d
in
co
m
e
h
ad
wea
k
er
o
r
in
co
n
s
is
ten
t
d
ir
ec
t
ef
f
ec
ts
,
a
f
in
d
in
g
co
n
s
is
ten
t
with
r
esear
ch
s
u
g
g
esti
n
g
th
at
,
b
ey
o
n
d
m
ee
tin
g
b
asic
n
ee
d
s
,
f
in
an
cial
r
eso
u
r
ce
s
o
f
ten
in
f
lu
en
ce
d
well
-
b
ein
g
in
d
ir
ec
tly
th
r
o
u
g
h
h
ea
lth
an
d
s
o
cial
p
ath
way
s
r
ath
er
th
an
d
ir
ec
t e
f
f
ec
ts
[
2
9
]
.
Ag
e
-
s
tr
atif
ied
an
aly
s
is
r
ev
ea
led
d
is
tin
ct
p
atter
n
s
,
b
r
o
ad
ly
alig
n
in
g
with
ev
id
en
ce
th
at
th
e
s
alien
ce
o
f
d
if
f
er
en
t
life
s
atis
f
ac
tio
n
d
eter
m
in
an
ts
s
h
if
ted
with
ag
e
[
3
7
]
,
[
3
8
]
.
Am
o
n
g
ad
u
lts
ag
ed
4
5
–
5
9
,
m
en
tal
h
ea
lth
was
th
e
k
ey
d
r
iv
er
o
f
life
s
atis
f
ac
tio
n
,
p
o
s
s
ib
ly
d
u
e
to
m
id
life
s
tr
ess
o
r
s
lik
e
wo
r
k
an
d
f
am
ily
o
b
lig
atio
n
s
th
at
o
v
er
s
h
ad
o
wed
th
e
b
en
ef
its
o
f
in
co
m
e
o
r
s
o
cial
ac
tiv
ity
,
a
p
h
en
o
m
en
o
n
o
b
s
er
v
ed
in
o
th
er
m
id
life
well
-
b
ein
g
s
tu
d
ies
[
1
4
]
,
[
3
7
]
,
[
3
8
]
.
T
h
e
n
eg
ativ
e
lin
k
b
etwe
en
ass
ets
an
d
m
en
tal
h
ea
lth
in
W
av
e
I
V
m
ay
h
av
e
r
ef
lecte
d
f
in
an
cial
s
tr
ain
o
r
d
eb
t
-
r
elate
d
s
tr
ess
,
p
ar
allelin
g
f
in
d
in
g
s
th
at
ass
et
o
wn
er
s
h
ip
co
u
ld
b
e
ass
o
ciate
d
with
f
in
an
cial
an
x
iety
u
n
d
er
ce
r
tain
ec
o
n
o
m
ic
co
n
d
itio
n
s
[
2
9
]
.
Fo
r
ad
u
lts
ag
ed
6
0
an
d
o
ld
er
,
b
o
th
p
h
y
s
ical
an
d
m
en
tal
h
ea
lth
r
em
ain
ed
s
tr
o
n
g
p
r
ed
icto
r
s
o
f
life
s
atis
f
ac
tio
n
,
co
n
s
is
ten
t
with
p
r
io
r
r
esear
ch
s
h
o
win
g
th
at
h
ea
lth
-
r
elate
d
ca
p
ac
ities
b
ec
am
e
m
o
r
e
cr
itical
f
o
r
m
ain
tain
in
g
q
u
ality
o
f
life
in
later
life
[
2
6
]
,
[
3
4
]
.
Me
n
tal
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