I
nte
rna
t
io
na
l J
o
urna
l o
f
P
u
bli
c
H
ea
lt
h Science
(
I
J
P
H
S)
Vo
l.
13
,
No
.
4
,
Dec
em
b
er
2
0
2
4
,
p
p
.
1
79
4
~
1
802
I
SS
N:
2
2
5
2
-
8
8
0
6
,
DOI
: 1
0
.
1
1
5
9
1
/ijp
h
s
.
v
1
3
i4
.
2
4
3
0
2
1794
J
o
ur
na
l ho
m
ep
a
g
e
:
h
ttp
:
//
ijp
h
s
.
ia
esco
r
e.
co
m
Risk a
na
ly
sis
of ado
lescent se
x
ua
l a
ctivity
in
co
lleg
e
Sura
ba
y
a
,
Indo
nesia
:
cros
s
-
s
ectiona
l study
E
ny
Q
urniy
a
wa
t
i
1
,
Z
ida
H
us
nin
a
2
,
J
a
y
a
nti
Dia
n E
k
a
Sa
ri
3
,
Asm
a
Azz
a
hra
4
,
I
zz
a
h Nur
Sh
a
brina
4
,
P
rim
a
K
a
rt
ika
4
,
Na
y
l
a
M
o
ha
m
ed
G
o
m
a
a
Na
s
r
5
1
D
e
p
a
r
t
me
n
t
o
f
E
p
i
d
e
m
i
o
l
o
g
y
,
B
i
o
s
t
a
t
i
st
i
c
s
,
P
o
p
u
l
a
t
i
o
n
S
t
u
d
y
a
n
d
H
e
a
l
t
h
P
r
o
mo
t
i
o
n
,
F
a
c
u
l
t
y
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
U
n
i
v
e
r
s
i
t
a
s
A
i
r
l
a
n
g
g
a
,
S
u
r
a
b
a
y
a
,
I
n
d
o
n
e
si
a
2
D
e
p
a
r
t
me
n
t
o
f
E
n
v
i
r
o
n
me
n
t
a
l
H
e
a
l
t
h
,
F
a
c
u
l
t
y
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
A
i
r
l
a
n
g
g
a
U
n
i
v
e
r
si
t
y
,
S
u
r
a
b
a
y
a
,
I
n
d
o
n
e
si
a
3
P
u
b
l
i
c
H
e
a
l
t
h
S
t
u
d
y
P
r
o
g
r
a
m,
F
a
c
u
l
t
y
o
f
H
e
a
l
t
h
,
M
e
d
i
c
i
n
e
,
a
n
d
Li
f
e
S
c
i
e
n
c
e
s (F
I
K
K
I
A
)
,
U
n
i
v
e
r
si
t
a
s A
i
r
l
a
n
g
g
a
,
S
u
r
a
b
a
y
a
,
I
n
d
o
n
e
si
a
4
F
a
c
u
l
t
y
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
A
i
r
l
a
n
g
g
a
U
n
i
v
e
r
si
t
y
,
S
u
r
a
b
a
y
a
,
I
n
d
o
n
e
si
a
5
D
e
p
a
r
t
me
n
t
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
F
a
c
u
l
t
y
o
f
P
u
b
l
i
c
a
n
d
E
n
v
i
r
o
n
m
e
n
t
a
l
H
e
a
l
t
h
,
B
a
h
r
i
U
n
i
v
e
r
s
i
t
y
,
K
h
a
r
t
o
u
m,
S
u
d
a
n
Art
icle
I
nfo
AB
S
T
RAC
T
A
r
ticle
his
to
r
y:
R
ec
eiv
ed
Dec
5
,
2
0
2
3
R
ev
is
ed
Feb
8
,
2
0
2
4
Acc
ep
ted
Feb
21
,
2
0
2
4
Ad
o
les
c
e
n
c
e
is
c
h
a
ra
c
teriz
e
d
b
y
a
c
ti
v
e
se
x
u
a
l
h
o
rm
o
n
e
s
th
a
t
c
a
n
lea
d
t
o
se
x
u
a
l
u
rg
e
s
wit
h
th
e
o
p
p
o
site
s
e
x
.
T
h
e
se
u
r
g
e
s,
i
n
tu
r
n
,
m
a
y
tr
i
g
g
e
r
r
isk
y
se
x
u
a
l
b
e
h
a
v
i
o
r.
Co
ll
e
g
e
stu
d
e
n
t
s,
in
a
tran
siti
o
n
a
l
p
e
rio
d
fro
m
a
d
o
les
c
e
n
c
e
to
e
a
rl
y
a
d
u
lt
h
o
o
d
,
e
x
h
i
b
it
d
i
v
e
rsity
i
n
a
d
d
re
ss
in
g
se
x
u
a
l
a
c
ti
v
it
y
.
Th
is
re
se
a
rc
h
a
im
ed
to
a
n
a
ly
z
e
th
e
risk
s a
ss
o
c
iate
d
with
a
d
o
les
c
e
n
t
se
x
u
a
l
a
c
ti
v
it
y
in
a
c
o
ll
e
g
e
in
S
u
ra
b
a
y
a
,
In
d
o
n
e
sia
.
Th
e
stu
d
y
u
ti
li
z
e
s
a
c
ro
ss
-
se
c
ti
o
n
a
l
d
e
sig
n
wit
h
a
c
c
id
e
n
tal
sa
m
p
li
n
g
o
f
a
c
ti
v
e
stu
d
e
n
ts
a
g
e
d
1
8
-
2
4
y
e
a
r
s
.
Th
e
to
tal
n
u
m
b
e
r
o
f
p
a
rti
c
ip
a
n
ts
in
t
h
is
stu
d
y
wa
s
2
2
1
p
e
o
p
le
wh
o
f
il
led
o
u
t
a
q
u
e
sti
o
n
n
a
ire
i
n
th
e
fo
rm
o
f
a
G
o
o
g
le
F
o
rm
,
d
istri
b
u
ted
t
h
ro
u
g
h
s
o
c
ial
m
e
d
ia.
Th
e
re
su
lt
s
sh
o
w
th
a
t
,
a
m
o
n
g
a
ll
th
e
fa
c
to
rs
id
e
n
t
ifi
e
d
,
d
a
t
in
g
sta
t
u
s
h
a
s
a
sig
n
ifi
c
a
n
t
re
latio
n
sh
i
p
w
it
h
P
R
1
1
.
6
8
8
(9
5
%
CI
5
.
0
4
8
-
2
7
.
0
6
1
)
i
n
e
n
g
a
g
i
n
g
i
n
risk
y
se
x
u
a
l
a
c
ti
v
it
i
e
s
a
m
o
n
g
a
d
o
les
c
e
n
ts.
Re
p
r
o
d
u
c
ti
v
e
h
e
a
lt
h
e
d
u
c
a
ti
o
n
a
t
th
e
u
n
iv
e
rsit
y
le
v
e
l
is
n
e
e
d
e
d
t
o
re
d
u
c
e
ris
k
y
se
x
u
a
l
a
c
ti
v
it
ies
a
m
o
n
g
st
u
d
e
n
ts.
K
ey
w
o
r
d
s
:
Ad
o
lescen
t
Datin
g
s
tatu
s
Hea
lth
r
is
k
s
Sex
u
al
ac
tiv
ity
Sex
u
ally
tr
an
s
m
itted
d
is
ea
s
es
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
:
E
n
y
Qu
r
n
iy
awa
ti
Dep
ar
tm
en
t o
f
E
p
id
em
io
l
o
g
y
,
B
io
s
tati
s
tics
,
Po
p
u
latio
n
Stu
d
y
an
d
Hea
lth
Pr
o
m
o
tio
n
Facu
lty
o
f
Pu
b
lic
Hea
lth
Facu
l
ty
,
Un
iv
er
s
itas
Air
lan
g
g
a
Su
r
ab
ay
a,
I
n
d
o
n
esia
E
m
ail: e
n
y
.
q
u
r
n
iy
awa
ti@
f
k
m
.
u
n
air
.
ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
Ad
o
lescen
ce
is
a
p
er
io
d
ch
ar
ac
ter
ized
b
y
p
h
y
s
ical
an
d
em
o
tio
n
al
ch
an
g
es,
in
clu
d
in
g
th
e
ac
tiv
atio
n
o
f
s
ex
u
al
h
o
r
m
o
n
es
th
at
lead
to
an
in
te
r
est
in
th
e
o
p
p
o
s
ite
s
ex
an
d
t
h
e
em
er
g
en
ce
o
f
s
e
x
u
al
u
r
g
es.
Du
r
in
g
ad
o
lescen
ce
,
s
ex
u
al
b
eh
a
v
io
r
ca
n
v
ar
y
f
r
o
m
s
ex
u
al
ab
s
tin
en
ce
,
an
d
s
ex
u
al
f
a
n
tasi
es,
to
p
h
y
s
ical
in
ter
ac
tio
n
s
s
u
ch
as
to
u
ch
in
g
an
d
k
is
s
in
g
,
as
well
as
ac
ts
in
v
o
lv
in
g
th
e
g
en
itals
.
I
n
ad
d
itio
n
to
p
h
y
s
ical
ch
a
n
g
es,
ad
o
lescen
ts
also
ex
p
e
r
ien
ce
e
m
o
tio
n
al
c
h
an
g
es
t
h
at
ca
n
af
f
ec
t
th
eir
b
eh
av
io
r
a
n
d
h
ea
lth
[
1
]
.
Am
o
n
g
th
e
ty
p
es
o
f
s
ex
u
al
b
eh
a
v
io
r
m
e
n
tio
n
ed
,
v
ag
in
al
in
ter
c
o
u
r
s
e
is
th
e
s
ex
u
al
co
n
d
u
ct
th
at
p
o
s
es
th
e
m
o
s
t
ad
v
er
s
e
r
is
k
to
ad
o
lescen
ts
.
Ad
d
itio
n
ally
,
t
h
er
e
is
also
a
r
is
k
o
f
lo
w
ac
ad
em
ic
ac
h
iev
em
e
n
t
[
2
]
,
r
is
k
y
s
ex
u
al
b
eh
av
io
r
,
s
u
b
s
tan
ce
ab
u
s
e,
an
d
an
tis
o
cial
b
eh
av
io
r
in
ad
u
lth
o
o
d
[
3
]
.
T
h
e
two
b
ig
g
est
d
an
g
er
s
ar
e
co
n
tr
ac
tin
g
a
s
ex
u
ally
tr
an
s
m
itted
illn
ess
an
d
b
ec
o
m
i
n
g
p
r
e
g
n
an
t a
g
ain
s
t y
o
u
r
will
[
4
]
.
Sex
u
ally
tr
an
s
m
itted
in
f
ec
tio
n
s
(
STI
s
)
r
em
ain
a
g
lo
b
al
p
u
b
lic
h
ea
lth
p
r
o
b
lem
.
Acc
o
r
d
in
g
t
o
esti
m
ates
f
r
o
m
th
e
C
en
ter
s
f
o
r
Dis
ea
s
e
C
o
n
tr
o
l
an
d
Pre
v
en
ti
o
n
(
C
DC
)
,
o
v
er
h
alf
o
f
th
e
2
6
m
illi
o
n
n
ew
ca
s
es
o
f
s
ex
u
ally
tr
an
s
m
itted
d
is
ea
s
es
th
at
o
cc
u
r
r
ed
in
th
e
US
in
2
0
1
8
wer
e
am
o
n
g
teen
a
g
er
s
b
etwe
en
th
e
ag
es
o
f
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
R
is
k
a
n
a
lysi
s
o
f a
d
o
lescen
t se
xu
a
l a
ctivity
in
co
lleg
e
S
u
r
a
b
a
ya
,
I
n
d
o
n
esia
:
…
(
E
n
y
Qu
r
n
iy
a
w
a
ti)
1795
1
5
a
n
d
2
4
[
5
]
.
T
h
e
r
is
k
f
o
r
1
5
-
1
9
y
ea
r
o
ld
s
is
o
f
ten
ass
o
ciat
ed
with
b
eh
av
io
r
s
,
s
u
ch
as
alc
o
h
o
l
u
s
e
an
d
u
n
s
af
e
s
ex
[
1
]
.
R
esear
ch
co
n
d
u
cted
i
n
I
n
d
o
n
esia
in
2
0
1
5
s
h
o
wed
t
h
at
5
8
.
2
%
o
f
ad
o
lescen
ts
ag
e
d
1
5
-
1
9
y
ea
r
s
h
ad
en
g
ag
ed
in
s
ex
u
al
in
ter
co
u
r
s
e
[
6
]
.
An
o
th
e
r
s
tu
d
y
f
o
u
n
d
th
at
th
e
p
er
ce
n
tag
e
o
f
h
ig
h
s
ch
o
o
l
s
tu
d
en
ts
wh
o
h
ad
en
g
ag
ed
in
s
ex
u
al
in
ter
co
u
r
s
e
was
7
.
7
%
in
2
0
1
2
a
n
d
i
n
cr
e
ased
to
9
%
in
2
0
1
8
[
7
]
.
Su
r
a
b
ay
a
is
th
e
s
ec
o
n
d
-
lar
g
est
m
etr
o
p
o
litan
city
in
I
n
d
o
n
esia,
lo
ca
te
d
in
E
ast
J
av
a.
Data
o
n
th
e
s
p
r
ea
d
o
f
h
u
m
an
im
m
u
n
o
d
ef
icien
cy
v
ir
u
s
(
HI
V
)
in
2
0
2
1
r
an
k
s
Su
r
ab
ay
a
as
th
e
th
ir
d
-
lar
g
est
in
E
ast
J
av
a
am
o
n
g
th
e
ag
e
g
r
o
u
p
1
5
-
1
9
y
ea
r
s
,
with
a
p
r
o
p
o
r
tio
n
o
f
7
.
9
%
(
1
0
o
u
t
o
f
1
2
6
ca
s
es).
Me
a
n
wh
ile,
t
h
e
ag
e
g
r
o
u
p
2
0
-
2
4
y
ea
r
s
r
an
k
s
f
i
r
s
t
with
a
p
r
o
p
o
r
tio
n
o
f
1
5
.
4
%
(
1
0
7
o
u
t
o
f
6
9
6
ca
s
es)
[
8
]
.
Su
r
ab
ay
a
b
o
asts
th
e
lar
g
est
n
u
m
b
er
o
f
u
n
iv
er
s
ities
in
E
ast
J
av
a.
I
n
2
0
2
0
,
t
h
er
e
wer
e
6
s
tate
u
n
iv
er
s
ities
an
d
7
0
p
r
iv
a
te
u
n
iv
er
s
ities
with
a
to
tal
o
f
2
5
7
,
6
3
0
s
tu
d
e
n
ts
.
Stu
d
en
ts
,
in
th
eir
tr
an
s
itio
n
p
er
io
d
f
r
o
m
ad
o
lescen
ce
to
ea
r
ly
ad
u
lth
o
o
d
,
n
atu
r
ally
e
x
h
ib
it
d
iv
er
s
ity
in
ad
d
r
ess
in
g
s
ex
u
al
ac
tiv
ity
.
T
h
e
s
o
cial
en
v
ir
o
n
m
en
t
is
h
ig
h
l
y
o
p
e
n
an
d
d
y
n
am
ic
in
t
h
e
a
g
e
o
f
g
lo
b
aliza
tio
n
,
with
life
s
ty
le
ch
an
g
es
b
ein
g
a
s
ig
n
if
ican
t
co
n
tr
i
b
u
tin
g
f
ac
to
r
.
T
h
e
c
o
m
b
in
atio
n
o
f
ty
p
ical
ad
o
lescen
t
d
ev
elo
p
m
e
n
t
with
a
d
y
n
am
ic
s
o
cial
an
d
cu
ltu
r
al
en
v
ir
o
n
m
e
n
t
p
r
esen
ts
ch
allen
g
es.
O
n
e
o
f
th
e
ex
ter
n
al
f
ac
to
r
s
clo
s
ely
in
f
lu
en
cin
g
ad
o
lescen
ts
is
th
e
in
ter
n
et
[
9
]
.
R
esear
ch
r
esu
lts
in
d
icate
th
at
ad
o
lescen
ts
wh
o
u
s
e
s
o
cial
m
ed
ia
ten
d
to
en
g
a
g
e
in
r
is
k
y
s
ex
u
al
ac
tiv
ities
[
1
0
]
.
I
n
r
esp
o
n
s
e
to
th
e
p
r
e
v
alen
t
c
ases
o
f
s
ex
u
al
v
io
len
ce
in
th
e
u
n
iv
er
s
ity
e
n
v
ir
o
n
m
en
t,
th
er
e
is
a
g
ap
in
r
u
les
s
p
ec
if
ically
ad
d
r
ess
in
g
s
ex
u
al
v
io
len
ce
in
h
ig
h
er
ed
u
ca
tio
n
,
c
o
n
tr
ib
u
tin
g
to
th
e
h
ig
h
r
ate
o
f
s
ex
u
al
v
io
len
ce
o
n
ca
m
p
u
s
es.
T
h
e
Min
is
ter
o
f
E
d
u
ca
tio
n
an
d
C
u
ltu
r
e
R
eg
u
latio
n
o
n
R
esear
c
h
,
T
ec
h
n
o
lo
g
y
,
an
d
Hig
h
er
E
d
u
ca
tio
n
Nu
m
b
e
r
3
0
o
f
2
0
2
1
,
ad
d
r
ess
in
g
th
e
h
an
d
lin
g
an
d
p
r
ev
e
n
tio
n
o
f
s
ex
u
al
ass
au
lt
in
u
n
iv
er
s
ity
s
ettin
g
s
,
was
r
elea
s
ed
b
y
th
e
Min
is
tr
y
o
f
E
d
u
ca
tio
n
an
d
C
u
ltu
r
e
[
1
1
]
.
I
t
is
b
eliev
e
d
t
h
at
o
n
e
o
f
th
e
m
o
s
t
cr
u
cial
way
s
to
co
m
b
at
s
ex
u
al
ass
au
lt
is
to
r
aise
awa
r
en
ess
o
f
wh
at
s
ex
u
al
co
n
s
e
n
t
en
tails
.
T
ee
n
ag
e
r
ep
r
o
d
u
ctiv
e
h
ea
lth
f
ac
es
ch
a
llen
g
es,
with
r
is
k
y
s
ex
u
al
b
eh
av
io
r
,
lead
i
n
g
to
v
ar
i
o
u
s
r
e
p
r
o
d
u
ctiv
e
s
y
s
tem
is
s
u
es
[
1
2
]
.
T
h
is
r
esear
ch
ai
m
ed
to
an
aly
ze
t
h
e
r
is
k
s
ass
o
ciate
d
with
th
e
s
ex
u
al
ac
tiv
i
ty
o
f
ad
o
lescen
ts
in
Su
r
ab
ay
a
u
n
iv
er
s
ities
.
T
h
e
s
tu
d
y
co
n
tr
ib
u
tes
to
th
e
ac
c
o
m
p
li
s
h
m
en
t
o
f
th
e
th
i
r
d
s
u
s
tain
ab
l
e
d
ev
elo
p
m
en
t g
o
al
(
SDG)
o
f
2
0
3
0
,
wh
ich
ai
m
s
to
lo
wer
m
ater
n
al
an
d
n
ew
b
o
r
n
m
o
r
tality
r
esu
ltin
g
f
r
o
m
tee
n
ag
er
s
h
a
v
in
g
r
is
k
y
s
ex
u
al
ex
p
er
ien
ce
s
.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
em
p
l
o
y
s
an
o
b
s
er
v
atio
n
al
m
eth
o
d
o
lo
g
y
,
a
c
r
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
d
esig
n
,
an
d
a
q
u
an
titativ
e
tech
n
iq
u
e.
I
t
was
co
n
d
u
cted
i
n
J
u
ly
-
Au
g
u
s
t
2
0
2
3
at
Su
r
ab
a
y
a
C
ity
C
o
lleg
e,
I
n
d
o
n
esia.
T
h
e
tar
g
et
p
o
p
u
latio
n
in
clu
d
ed
all
a
d
o
lescen
ts
atten
d
in
g
c
o
lleg
es
in
Su
r
a
b
ay
a
C
i
ty
.
T
h
e
s
am
p
le
was
s
elec
ted
th
r
o
u
g
h
ac
cid
e
n
tal
s
am
p
lin
g
with
in
th
is
p
o
p
u
latio
n
g
r
o
u
p
.
I
n
clu
s
io
n
c
r
iter
ia
r
eq
u
ir
ed
s
tu
d
en
ts
to
b
e
en
r
o
ll
ed
at
Su
r
a
b
ay
a
city
co
lleg
es
an
d
to
h
av
e
e
n
g
ag
e
d
in
s
ex
u
al
ac
tiv
ity
.
T
h
e
s
am
p
l
e
s
ize
was
d
eter
m
in
ed
u
s
in
g
th
e
Slo
v
in
f
o
r
m
u
la
b
ased
o
n
th
e
p
o
p
u
latio
n
(
N)
o
f
2
7
3
,
2
2
9
(
t
h
e
n
u
m
b
e
r
o
f
s
tu
d
en
ts
in
Su
r
ab
ay
a
U
n
iv
er
s
ities
)
r
esu
ltin
g
in
a
ca
lcu
lated
s
am
p
le
s
ize
o
f
1
0
0
p
ar
ticip
an
ts
with
a
1
0
% m
ar
g
i
n
o
f
er
r
o
r
.
=
N
1
+
(
)
2
(
1
)
T
h
e
in
s
tr
u
m
e
n
t
u
s
ed
in
t
h
is
s
tu
d
y
h
as
u
n
d
er
g
o
n
e
v
alid
ity
an
d
r
eliab
ilit
y
test
s
to
e
n
s
u
r
e
ac
cu
r
ate
an
d
p
r
ec
is
e
d
ata.
Valid
ity
was
ass
ess
ed
u
s
in
g
Pear
s
o
n
'
s
co
r
r
elatio
n
,
an
d
th
e
q
u
esti
o
n
s
in
th
is
in
s
tr
u
m
en
t
m
et
th
e
test
r
eq
u
ir
em
en
ts
,
with
a
v
alu
e
ab
o
v
e
0
.
2
1
0
(
Asy
g
.
2
-
tailed
)
.
T
h
e
r
eliab
ilit
y
o
f
th
is
in
s
tr
u
m
en
t
is
m
o
d
er
ate,
as
in
d
icate
d
b
y
a
C
r
o
n
b
ac
h
'
s
al
p
h
a
v
alu
e
o
f
0
.
5
1
2
.
Data
co
l
lectio
n
was
co
n
d
u
cted
u
s
in
g
an
o
n
lin
e
p
latf
o
r
m
,
s
p
ec
if
ically
Go
o
g
le
Fo
r
m
s
,
d
i
s
tr
ib
u
ted
v
ia
s
o
cial
m
ed
ia
p
latf
o
r
m
s
s
u
ch
as
W
h
atsAp
p
,
I
n
s
tag
r
am
,
a
n
d
T
witter
.
T
h
e
co
llected
d
ata
f
r
o
m
s
am
p
les
in
clu
d
e
m
ea
s
u
r
e
m
en
ts
o
f
in
d
ep
e
n
d
en
t
v
ar
iab
les
in
cl
u
d
in
g
a
g
e,
g
e
n
d
er
,
r
esid
en
ce
(
ca
teg
o
r
ized
as
liv
i
n
g
alo
n
e
in
a
b
o
ar
d
in
g
h
o
u
s
e,
co
n
tr
ac
t,
d
o
r
m
ito
r
y
,
o
r
liv
in
g
with
p
ar
en
ts
)
,
p
ar
en
ts
'
in
co
m
e
(
less
th
an
6
m
illi
o
n
an
d
m
o
r
e
th
a
n
o
r
e
q
u
al
to
6
m
illi
o
n
)
,
s
o
cial
m
ed
ia
u
s
e
(
co
n
s
id
er
ed
n
eg
ativ
e
if
th
e
d
u
r
atio
n
is
ex
c
ee
d
s
f
o
u
r
h
o
u
r
s
,
v
e
r
y
f
r
e
q
u
en
t
u
s
ag
e,
ac
ce
s
s
in
g
p
o
r
n
o
g
r
a
p
h
i
c
co
n
ten
t,
s
ee
k
in
g
p
leasu
r
e
o
r
s
p
en
d
in
g
ex
ce
s
s
iv
e
tim
e
an
d
p
o
s
itiv
e
u
s
ag
e)
,
r
elatio
n
s
h
ip
s
tatu
s
(
d
atin
g
o
r
ev
e
r
d
atin
g
an
d
n
e
v
er
d
atin
g
)
,
ag
e
o
f
f
ir
s
t sex
u
al
ac
tiv
ity
(
1
0
-
1
9
y
ea
r
s
an
d
2
0
-
2
4
y
ea
r
s
)
,
s
ex
u
al
co
n
s
en
t (
n
o
n
e
an
d
p
r
esen
t)
,
s
ex
u
ally
tr
an
s
m
itted
in
f
ec
tio
n
s
cr
iter
ia
(
s
y
m
p
to
m
atic
a
n
d
asy
m
p
to
m
atic)
.
T
h
e
d
ep
en
d
en
t
v
ar
iab
le
is
s
ex
u
al
ac
tiv
ity
,
ca
teg
o
r
ized
i
n
to
a
h
ig
h
-
r
is
k
c
ateg
o
r
y
en
co
m
p
ass
in
g
ac
tiv
ities
s
u
ch
as
k
is
s
in
g
lip
s
,
k
is
s
in
g
n
ec
k
s
,
h
u
g
g
in
g
,
g
r
o
p
in
g
b
r
ea
s
ts
,
an
d
g
e
n
itals
,
r
u
b
b
in
g
g
e
n
itals
,
an
d
s
ex
u
al
i
n
ter
co
u
r
s
e.
A
d
d
itio
n
ally
,
th
er
e
is
a
m
ild
ca
teg
o
r
y
o
f
s
ex
u
al
ac
tiv
ity
,
i
n
clu
d
in
g
h
o
ld
in
g
h
an
d
s
an
d
k
is
s
in
g
f
o
r
eh
ea
d
s
/ch
ee
k
s
.
Dete
r
m
in
atio
n
o
f
th
e
s
am
p
l
e
in
v
o
lv
e
d
s
elec
tin
g
r
esp
o
n
d
en
ts
wh
o
h
ap
p
e
n
ed
to
b
e
p
r
esen
t
o
r
av
ailab
le
an
d
m
et
th
e
r
esear
ch
r
eq
u
ir
em
en
ts
.
E
v
e
r
y
r
esp
o
n
d
en
t
wh
o
co
m
p
leted
th
e
q
u
esti
o
n
n
air
e
in
f
u
ll
a
n
d
s
atis
f
ied
th
e
in
clu
s
io
n
cr
iter
ia
was
in
clu
d
ed
as
a
r
esear
ch
s
am
p
le.
B
iv
ar
iate
an
aly
s
is
was
e
m
p
lo
y
ed
t
o
cr
ea
te
a
cr
o
s
s
tab
le
(
c
o
n
tin
g
e
n
cy
tab
le
)
illu
s
tr
atin
g
t
h
e
c
o
n
n
ec
tio
n
b
etwe
en
th
e
in
d
ep
e
n
d
en
t
an
d
d
ep
en
d
en
t
v
ar
ia
b
les.
T
h
e
lev
el
o
f
r
is
k
was
as
s
ess
e
d
b
y
ex
am
in
in
g
th
e
p
r
ev
ale
n
c
e
r
atio
(
PR
)
with
a
9
5
%
co
n
f
i
d
en
ce
in
ter
v
al.
T
h
is
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.
13
,
No
.
4
,
Dec
em
b
er
20
24
:
1
79
4
-
1
80
2
1796
s
tu
d
y
ad
h
er
e
d
to
th
e
p
r
in
ci
p
les
o
f
r
esear
ch
eth
ics,
in
clu
d
in
g
r
esp
ec
t
th
r
o
u
g
h
in
f
o
r
m
e
d
co
n
s
en
t,
an
d
o
b
tain
e
d
eth
ical
ap
p
r
o
v
al
f
r
o
m
th
e
E
t
h
ics
C
o
m
m
is
s
io
n
o
f
th
e
Facu
lty
o
f
Pu
b
lic
Hea
lth
,
Air
lan
g
g
a
Un
iv
er
s
ity
with
eth
ical
n
u
m
b
er
1
4
3
/EA
/KE
PK/2
0
2
3
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Resul
t
s
3
.
1
.
1
.
Cha
ra
ct
er
is
t
ics o
f
r
esp
o
nd
ent
s
T
ab
le
1
s
h
o
ws
th
e
ch
ar
ac
ter
is
tics
o
f
u
n
iv
er
s
ity
s
tu
d
en
ts
.
T
h
e
m
ajo
r
ity
o
f
s
tu
d
en
ts
en
g
a
g
ed
in
s
ex
u
al
ac
tiv
ity
f
ell
with
in
th
e
h
ig
h
-
r
is
k
ca
teg
o
r
y
.
T
h
ey
p
ar
ticip
ate
in
ac
tiv
ities
s
u
ch
as
k
is
s
in
g
lip
s
,
k
is
s
in
g
n
ec
k
,
h
u
g
g
in
g
,
g
r
o
p
i
n
g
b
r
ea
s
ts
an
d
g
en
itals
,
r
u
b
b
i
n
g
g
e
n
itals
,
an
d
s
ex
u
al
in
ter
co
u
r
s
e
(
6
3
.
8
%).
3
.
1
.
2
.
Ris
k
f
a
c
t
o
rs f
o
r
risk
y
s
ex
ua
l a
ct
iv
it
y
B
eh
av
io
r
al
r
elate
d
to
s
tu
d
en
t
s
ex
u
al
ac
tiv
ity
,
as
s
h
o
wn
in
T
ab
le
2
,
in
clu
d
e
h
o
ld
in
g
h
an
d
s
,
k
is
s
in
g
f
o
r
eh
ea
d
s
an
d
ch
ee
k
s
,
h
u
g
g
in
g
,
k
is
s
in
g
lip
s
,
k
is
s
in
g
n
ec
k
s
,
g
r
o
p
i
n
g
b
r
ea
s
ts
,
an
d
g
e
n
itals
,
r
u
b
b
in
g
g
en
itals
,
an
d
s
ex
u
al
in
ter
co
u
r
s
e.
C
o
n
s
eq
u
en
tly
,
b
ased
o
n
th
e
tab
le,
it
ca
n
b
e
co
n
clu
d
e
d
th
at
d
a
tin
g
s
tatu
s
h
o
ld
s
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
with
t
h
e
p
r
ev
alen
ce
r
atio
(
PR
)
o
f
1
1
.
6
8
8
w
h
ich
is
at
th
e
9
5
%
co
n
f
id
en
ce
in
ter
v
al
(
C
I
)
o
f
5
.
0
4
8
t
o
2
7
.
0
6
1
.
T
h
is
im
p
l
ies
th
at
th
e
r
esp
o
n
d
e
n
ts
'
d
atin
g
s
tatu
s
is
m
o
r
e
lik
ely
to
e
n
g
ag
e
in
h
ea
v
y
s
ex
u
al
ac
tiv
ity
.
T
ab
le
1
.
C
h
ar
ac
ter
is
tics
o
f
u
n
i
v
er
s
ity
ad
o
lescen
ts
in
Su
r
ab
a
y
a
C
ity
C
h
a
r
a
c
t
e
r
i
s
t
i
c
n
%
A
g
e
10
-
1
9
y
e
a
r
s
41
1
8
.
6
20
-
2
4
y
e
a
r
s
1
8
0
8
1
.
4
G
e
n
d
e
r
M
a
l
e
41
1
8
.
6
F
e
mal
e
1
8
0
8
1
.
4
P
l
a
c
e
o
f
r
e
si
d
e
n
c
e
Li
v
e
a
l
o
n
e
1
1
5
5
2
.
0
Li
v
i
n
g
w
i
t
h
p
a
r
e
n
t
s
1
0
6
4
8
.
0
R
e
v
e
n
u
e
<
6
mi
l
l
i
o
n
1
4
0
6
3
.
3
≥
6
mi
l
l
i
o
n
81
3
6
.
7
U
se
o
f
s
o
c
i
a
l
m
e
d
i
a
N
e
g
a
t
i
v
e
2
0
5
9
2
.
8
P
o
si
t
i
v
e
16
7
.
2
A
g
e
o
f
f
i
r
s
t
se
x
u
a
l
a
c
t
i
v
i
t
y
10
-
1
9
y
e
a
r
s
1
7
7
8
0
.
1
20
-
2
4
y
e
a
r
s
44
1
9
.
9
S
e
x
u
a
l
c
o
n
se
n
t
N
o
c
o
n
se
n
t
13
5
.
9
H
a
v
i
n
g
c
o
n
se
n
t
2
0
8
9
4
.
1
S
TI
c
r
i
t
e
r
i
a
S
y
mp
t
o
ma
t
i
c
82
3
7
.
1
A
sy
mp
t
o
ma
t
i
c
1
3
9
6
2
.
9
R
e
l
a
t
i
o
n
s
h
i
p
s
t
a
t
u
s
D
a
t
i
n
g
/
b
e
e
n
d
a
t
i
n
g
1
8
1
8
1
.
9
N
e
v
e
r
d
a
t
e
d
40
1
8
.
1
S
e
x
u
a
l
a
c
t
i
v
i
t
y
W
e
i
g
h
t
1
4
1
6
3
.
8
Li
g
h
t
w
e
i
g
h
t
80
3
6
.
2
T
ab
le
2
.
R
is
k
o
f
s
ex
u
al
ac
tiv
it
y
in
co
lleg
e
a
d
o
lescen
ts
C
h
a
r
a
c
t
e
r
i
s
t
i
c
S
e
x
u
a
l
A
c
t
i
v
i
t
y
P
R
(
9
5
%
C
I
)
W
e
i
g
h
t
n
(
%)
Li
g
h
t
w
e
i
g
h
t
n
(
%)
A
g
e
10
-
1
9
y
e
a
r
s
2
4
(
5
7
.
1
)
1
8
(
4
2
.
9
)
0
.
7
0
0
(
0
.
3
5
4
-
1
.
3
8
6
)
20
-
2
4
y
e
a
r
s
1
2
0
(
6
5
.
6
)
6
3
(
3
4
.
4
)
G
e
n
d
e
r
M
a
l
e
3
1
(
7
0
.
5
)
1
3
(
2
9
.
5
)
1
.
4
3
5
(
0
.
7
0
3
-
2
.
9
3
1
)
F
e
mal
e
1
1
3
(
6
2
.
4
)
6
8
(
3
7
.
6
)
P
l
a
c
e
o
f
r
e
si
d
e
n
c
e
Li
v
e
a
l
o
n
e
7
5
(
6
3
.
6
)
4
3
(
3
6
.
4
)
0
.
9
6
1
(
0
.
5
5
7
-
1
.
6
5
7
)
Li
v
i
n
g
w
i
t
h
p
a
r
e
n
t
s
6
9
(
6
4
.
5
)
3
8
(
3
5
.
5
)
P
a
r
e
n
t
s’
i
n
c
o
m
e
<
6
mi
l
l
i
o
n
9
0
(
6
2
.
9
)
5
3
(
3
7
.
1
)
0
.
8
8
1
(
0
.
4
9
9
-
1
.
5
5
5
)
≥
6
mi
l
l
i
o
n
5
4
(
6
5
.
9
)
2
8
(
3
4
.
1
)
U
se
o
f
s
o
c
i
a
l
m
e
d
i
a
N
e
g
a
t
i
v
e
1
3
4
(
6
4
.
4
)
7
4
(
3
5
.
6
)
1
.
2
6
8
(
0
.
4
6
3
-
3
.
4
6
9
)
P
o
si
t
i
v
e
1
0
(
5
8
.
8
)
7
(
4
1
.
2
)
A
g
e
o
f
f
i
r
s
t
se
x
u
a
l
a
c
t
i
v
i
t
y
10
-
1
9
y
e
a
r
s
1
1
6
(
6
4
.
4
)
6
4
(
3
5
.
6
)
1
.
1
0
0
(
0
.
5
6
0
-
2
.
1
6
2
)
20
-
2
4
y
e
a
r
s
2
8
(
6
2
.
2
)
1
7
(
3
7
.
8
)
S
e
x
u
a
l
c
o
n
se
n
t
N
o
c
o
n
se
n
t
8
(
6
1
.
5
)
5
(
3
8
.
5
)
0
.
8
9
4
(
0
.
2
8
3
-
2
.
8
3
0
)
H
a
v
i
n
g
c
o
n
se
n
t
1
3
6
(
6
4
.
2
)
7
6
(
3
5
.
8
)
S
TI
c
r
i
t
e
r
i
a
S
y
mp
t
o
ma
t
i
c
5
5
(
6
5
.
5
)
2
9
(
3
4
.
5
)
1
.
1
0
8
(
0
.
6
3
0
-
1
.
9
5
0
)
A
sy
mp
t
o
ma
t
i
c
8
9
(
6
3
.
1
)
5
2
(
3
6
.
9
)
R
e
l
a
t
i
o
n
s
h
i
p
s
t
a
t
u
s
D
a
t
i
n
g
/
b
e
e
n
d
a
t
i
n
g
1
3
6
(
7
3
.
9
)
4
8
(
2
6
.
1
)
1
1
.
6
8
8
(
5
.
0
4
8
–
2
7
.
0
6
1
)
*
N
e
v
e
r
d
a
t
e
d
8
(
1
9
.
5
)
3
3
(
8
0
.
5
)
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
R
is
k
a
n
a
lysi
s
o
f a
d
o
lescen
t se
xu
a
l a
ctivity
in
co
lleg
e
S
u
r
a
b
a
ya
,
I
n
d
o
n
esia
:
…
(
E
n
y
Qu
r
n
iy
a
w
a
ti)
1797
3
.
1
.
3
.
Sp
a
t
ia
l a
na
ly
s
is
T
h
is
s
tu
d
y
u
tili
ze
d
d
ata
co
llected
f
r
o
m
2
2
1
ac
tiv
e
s
tu
d
e
n
ts
ag
ed
1
8
-
2
4
y
ea
r
s
o
ld
s
t
u
d
y
in
g
at
u
n
iv
er
s
ities
in
Su
r
ab
ay
a
.
Fig
u
r
e
1
illu
s
tr
ates
th
e
d
is
tr
ib
u
tio
n
o
f
th
e
n
u
m
b
e
r
o
f
s
ex
u
al
ac
tiv
ity
ca
s
es
b
y
r
esp
o
n
d
en
ts
b
ased
o
n
th
e
lo
c
atio
n
o
f
th
eir
co
lleg
e
ca
m
p
u
s
es.
T
h
e
lig
h
t
p
u
r
p
le
c
o
lo
r
in
t
h
e
W
est
an
d
So
u
th
Su
r
ab
ay
a
ar
ea
s
in
d
icate
s
a
r
an
g
e
o
f
1
-
1
0
0
ca
s
es,
wh
er
ea
s
th
e
d
ar
k
p
u
r
p
le
c
o
lo
r
,
in
E
ast
Su
r
ab
ay
a,
r
e
p
r
esen
te
d
ca
s
es r
an
g
in
g
f
r
o
m
1
0
0
-
200.
Fig
u
r
e
1
.
Sp
atial
an
aly
s
is
o
f
d
atin
g
s
tatu
s
o
n
s
ex
u
al
ac
tiv
ity
o
f
u
n
i
v
er
s
ity
s
tu
d
en
ts
in
Su
r
ab
ay
a
R
eg
io
n
,
I
n
d
o
n
esia
3
.
2
.
Dis
cus
s
io
n
T
h
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
in
d
i
ca
te
th
at
teen
ag
er
s
wh
o
ar
e
in
a
r
elatio
n
s
h
ip
o
r
h
a
v
e
ev
er
b
ee
n
d
atin
g
ar
e
m
o
r
e
lik
ely
to
e
n
g
ag
e
i
n
h
ig
h
-
r
is
k
s
ex
u
al
ac
tiv
ities
.
T
h
u
s
,
it
m
ay
b
e
co
n
clu
d
ed
th
at
wh
en
s
tu
d
en
ts
f
o
r
m
co
n
n
ec
tio
n
s
with
in
d
iv
i
d
u
als
o
f
th
e
o
p
p
o
s
ite
s
ex
,
th
ey
ar
e
m
o
r
e
p
r
o
n
e
to
e
n
g
ag
in
g
in
h
ar
m
f
u
l
b
eh
av
io
r
s
.
Ad
o
lescen
ce
is
a
p
er
i
o
d
m
ar
k
ed
b
y
in
ten
s
e
in
tellectu
al,
p
s
y
ch
o
lo
g
ical,
a
n
d
p
h
y
s
ical
d
ev
el
o
p
m
en
t.
Du
r
in
g
th
is
tim
e,
teen
ag
er
s
m
ay
d
ev
elo
p
c
h
ar
ac
ter
is
tics
s
u
ch
as
in
ten
s
e
c
u
r
io
s
ity
,
a
p
ass
io
n
f
o
r
a
d
v
en
tu
r
e,
an
d
a
r
ea
d
in
ess
to
tak
e
o
n
ch
allen
g
es.
Ho
w
ev
er
,
tee
n
ag
er
s
wh
o
h
av
e
a
cc
ess
to
m
ea
n
s
o
f
s
atis
f
y
in
g
th
eir
d
esire
m
ay
ex
p
er
ien
ce
in
te
r
n
al
s
tr
u
g
g
les.
Ma
k
in
g
p
o
o
r
ju
d
g
m
en
ts
ca
n
lead
to
r
is
k
y
b
eh
av
io
r
am
o
n
g
teen
ag
er
s
,
s
u
ch
as
en
g
ag
in
g
in
u
n
s
af
e
s
ex
u
al
ac
ti
v
ity
.
Ad
o
lescen
ts
en
g
a
g
in
g
in
s
u
ch
b
eh
a
v
io
r
m
a
y
ex
p
er
ien
ce
b
o
th
p
h
y
s
ical
an
d
p
s
y
ch
o
lo
g
ical
co
n
s
eq
u
en
ce
s
[
1
3
]
.
Ad
o
lescen
ts
ar
e
m
o
r
e
s
u
s
ce
p
tib
le
th
an
o
th
er
a
g
e
g
r
o
u
p
s
to
p
ar
tak
e
in
h
ig
h
-
r
is
k
s
ex
u
al
p
r
ac
tices,
s
u
ch
as
u
n
p
r
o
tecte
d
in
ter
co
u
r
s
e
o
r
ch
an
g
in
g
p
a
r
tn
er
s
[
1
3
]
.
As
p
u
b
e
r
ty
p
r
o
g
r
ess
es,
with
in
cr
ea
s
ed
an
d
r
o
g
en
p
r
o
d
u
ctio
n
an
d
th
e
d
ev
elo
p
m
en
t
o
f
s
ec
o
n
d
ar
y
s
ex
u
al
tr
aits
,
s
ex
u
ality
b
eg
in
s
to
m
an
if
est.
T
h
is
p
er
io
d
is
m
ar
k
ed
b
y
a
r
is
e
in
a
f
f
ec
tiv
e
-
s
ex
u
al
b
eh
av
io
r
s
,
p
o
ten
tially
ar
o
u
s
in
g
s
ex
u
al
d
esire
an
d
s
tim
u
latin
g
r
o
m
a
n
tic
an
d
er
o
tic
ex
p
er
ien
ce
s
[
1
1
]
.
T
h
is
ca
n
r
esu
lt
in
in
cr
ea
s
ed
s
ex
u
al
ac
t
iv
ity
,
tak
in
g
f
o
r
m
s
s
u
ch
as
s
elf
-
er
o
ticis
m
o
r
s
ex
u
al
in
itiatio
n
.
I
n
th
is
s
tu
d
y
,
v
a
r
io
u
s
s
ex
u
al
b
eh
a
v
io
r
s
in
clu
d
in
g
h
o
ld
i
n
g
h
a
n
d
s
,
em
b
r
ac
in
g
,
k
is
s
in
g
lip
s
an
d
c
h
ee
k
s
,
an
d
e
n
g
ag
i
n
g
in
i
n
tim
ate
ac
tiv
ities
wer
e
o
b
s
er
v
ed
[
1
3
]
.
Am
o
n
g
s
tu
d
en
t
s
en
g
ag
in
g
in
f
r
eq
u
e
n
t
s
ex
u
al
ac
tiv
ities
,
6
3
.
8
%
r
ea
ch
ed
th
e
p
o
in
t
o
f
en
g
a
g
in
g
in
s
ex
u
al
b
e
h
av
io
r
.
T
h
is
f
in
d
i
n
g
alig
n
s
with
r
esear
ch
f
r
o
m
th
e
Un
iv
er
s
ity
o
f
Mic
h
ig
an
,
wh
ic
h
r
ep
o
r
ted
a
s
im
ilar
f
ig
u
r
e
o
f
6
3
%
[
1
4
]
.
Ho
wev
er
,
it
co
n
tr
asts
with
s
tu
d
ies
s
h
o
win
g
a
lo
wer
p
r
e
v
alen
ce
o
f
4
1
.
6
%
am
o
n
g
c
o
lleg
e
s
tu
d
e
n
ts
i
n
E
th
io
p
ia
[
1
5
]
an
d
o
n
ly
3
8
.
6
%
a
m
o
n
g
s
tu
d
en
t
s
f
r
o
m
two
Nig
er
ian
U
n
iv
er
s
ities
[
1
6
]
.
Dis
cr
ep
an
cies
in
r
is
k
e
d
u
ca
tio
n
,
in
f
o
r
m
atio
n
d
eliv
er
y
to
s
tu
d
en
ts
,
an
d
v
a
r
iatio
n
s
in
u
r
b
a
n
en
v
ir
o
n
m
e
n
ts
,
in
clu
d
in
g
l
eisu
r
e
p
lace
s
,
m
ay
co
n
tr
ib
u
te
to
th
ese
d
if
f
er
e
n
ce
s
,
alo
n
g
with
p
o
ten
tial so
cial
an
d
cu
ltu
r
al
d
is
tin
ctio
n
s
.
A
s
ig
n
if
ican
t
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
(
6
4
.
4
%)
r
e
p
o
r
te
d
h
av
i
n
g
th
eir
f
i
r
s
t
s
ex
u
al
ex
p
er
ien
c
e
b
etwe
en
th
e
ag
es
o
f
1
0
an
d
1
9
.
T
h
is
co
n
tr
asts
with
C
r
o
atian
u
n
i
v
er
s
ity
s
tu
d
en
ts
,
am
o
n
g
wh
o
m
t
h
e
m
ajo
r
ity
h
ad
t
h
eir
f
ir
s
t sex
u
al
ex
p
er
ien
ce
b
etwe
e
n
th
e
ag
es o
f
1
6
an
d
1
8
[
1
7
]
.
T
h
e
r
is
k
o
f
f
r
e
q
u
en
t sex
u
al
ac
tiv
ity
ap
p
ea
r
s
h
ig
h
er
am
o
n
g
Gen
er
atio
n
Z
s
tu
d
e
n
ts
b
o
r
n
b
etwe
en
1
9
9
5
-
2
0
1
5
,
p
lac
in
g
th
em
in
th
e
ag
e
r
an
g
e
o
f
8
-
2
8
y
ea
r
s
o
ld
[
1
8
]
.
T
h
e
y
o
u
n
g
e
r
ag
e
o
f
in
d
iv
id
u
als
ca
n
im
p
ac
t
em
o
tio
n
al
co
n
tr
o
l
p
r
o
ce
s
s
es
an
d
th
e
f
o
r
m
atio
n
o
f
a
g
g
r
ess
iv
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.
13
,
No
.
4
,
Dec
em
b
er
20
24
:
1
79
4
-
1
80
2
1798
b
eh
av
io
r
.
Ad
o
lescen
ts
s
en
s
iti
v
e
to
n
ew
id
ea
s
m
ay
ex
h
ib
it
d
ev
ian
t
b
eh
av
i
o
r
[
1
8
]
.
T
h
e
ag
e
o
f
f
ir
s
t
s
ex
u
al
ac
tiv
ity
,
in
cr
ea
s
in
g
ly
o
cc
u
r
in
g
at
a
y
o
u
n
g
ag
e,
r
ef
lects
em
o
tio
n
al
in
s
tab
ilit
y
im
p
ac
ti
n
g
d
ec
is
io
n
-
m
ak
in
g
o
n
r
is
k
y
b
eh
av
io
r
s
.
Desp
ite
th
es
e
co
n
d
itio
n
s
,
th
e
alar
m
in
g
in
cid
en
ce
o
f
s
ex
u
al
v
io
le
n
ce
,
p
ar
ticu
lar
ly
tar
g
etin
g
ad
o
lescen
ts
o
r
c
h
ild
r
en
,
ca
n
n
o
t
b
e
tak
e
n
lig
h
tly
.
R
ep
o
r
ts
i
n
d
icate
a
r
is
e
in
co
m
p
lain
ts
o
f
s
ex
u
al
v
io
len
c
e
ag
ain
s
t
ch
ild
r
en
,
r
ea
ch
i
n
g
4
,
5
9
6
ca
s
es
f
o
r
ap
p
r
o
x
im
ately
th
r
ee
m
o
n
th
s
i
n
2
0
2
0
[
1
9
]
.
At
a
n
ea
r
ly
a
g
e,
ch
ild
r
en
ar
e
ex
p
o
s
ed
t
o
s
ex
u
al
k
n
o
wl
ed
g
e
to
en
a
b
le
th
em
t
o
p
r
o
tect
th
em
s
elv
es
f
r
o
m
s
ex
u
al
cr
im
es,
h
o
wev
er
,
in
r
ea
lity
,
th
is
ef
f
o
r
t
is
th
war
ted
b
y
th
e
co
m
p
r
o
m
is
ed
m
o
r
ality
o
f
s
ex
o
f
f
e
n
d
er
s
[
2
0
]
.
Victim
s
wh
o
ex
p
e
r
ien
ce
p
s
y
ch
o
lo
g
ical
im
p
ac
t a
t a
y
o
u
n
g
ag
e
o
f
ten
e
x
h
ib
it lo
w
s
elf
-
co
n
f
id
en
ce
a
n
d
a
lack
o
f
s
elf
-
es
teem
.
I
f
v
ictim
s
d
o
n
o
t
r
ec
eiv
e
ap
p
r
o
p
r
iate
p
s
y
ch
o
lo
g
ical
tr
ea
tm
en
t,
p
r
o
m
p
tly
,
it
is
n
o
t
s
u
r
p
r
is
in
g
th
at
th
e
f
u
tu
r
e
s
ex
u
al
b
eh
av
io
r
b
ec
o
m
es
in
cr
ea
s
in
g
ly
u
n
c
o
n
tr
o
llab
le.
T
h
u
s
,
s
ex
u
al
ac
tiv
ity
d
u
r
in
g
ad
o
lescen
ce
ca
n
n
o
t
b
e
d
iv
o
r
ce
d
f
r
o
m
a
s
er
ies o
f
in
ter
v
en
tio
n
s
r
e
g
ar
d
i
n
g
s
ex
u
al
k
n
o
wled
g
e
s
in
ce
ch
i
ld
h
o
o
d
.
Ad
d
r
ess
in
g
th
e
p
h
en
o
m
en
o
n
o
f
s
ex
u
al
ac
tiv
ity
in
ad
o
lescen
ce
,
th
is
r
esear
ch
f
o
u
n
d
th
at
6
2
.
4
%
o
f
th
e
g
ir
ls
s
tu
d
ied
wer
e
s
ex
u
ally
a
ctiv
e
in
th
e
h
ea
v
y
ca
teg
o
r
y
.
Ho
wev
er
,
n
o
m
ea
n
in
g
f
u
l
co
n
n
ec
tio
n
was
f
o
u
n
d
b
etwe
en
s
ex
u
al
ac
tiv
ity
an
d
g
en
d
er
.
W
h
en
co
n
s
id
er
i
n
g
g
e
n
d
er
r
o
les
in
s
ex
u
al
ac
tiv
ity
,
th
e
f
ac
to
r
o
f
s
elf
-
esteem
is
d
ee
m
ed
to
h
av
e
an
in
f
lu
en
ce
.
I
n
th
e
ca
s
e
o
f
ad
o
lescen
t
b
o
y
s
with
h
ig
h
s
elf
-
esteem
,
th
er
e
is
a
ten
d
en
cy
f
o
r
th
ier
r
elatio
n
s
h
ip
s
to
b
e
d
i
r
ec
tly
p
r
o
p
o
r
tio
n
al
t
o
th
eir
s
ex
u
al
ac
tiv
ity
.
A
s
tu
d
y
co
n
f
ir
m
s
th
at
th
e
in
ten
tio
n
to
d
elay
p
r
em
ar
ital
s
ex
u
al
in
ter
c
o
u
r
s
e
i
n
m
e
n
i
s
s
till
ca
teg
o
r
ized
as
lo
w
co
m
p
ar
ed
to
f
em
ale
ad
o
lescen
ts
[
2
1
]
.
T
h
e
p
atr
iar
c
h
al
cu
ltu
r
e
,
wh
ic
h
v
iews
m
en
as
th
e
h
o
ld
er
s
o
f
p
o
wer
an
d
c
o
n
tr
o
l
o
v
er
wo
m
e
n
,
s
ee
m
s
to
b
e
s
til
l
d
ee
p
ly
im
p
r
e
g
n
ated
in
s
o
m
e
s
eg
m
en
ts
o
f
o
u
r
s
o
ciety
[
2
2
]
.
Gen
d
er
q
u
ality
h
as
n
o
t
y
et
b
ee
n
f
u
lly
r
ea
lized
,
as
ca
m
p
aig
n
s
ad
v
o
ca
tin
g
f
o
r
th
e
r
ig
h
ts
an
d
o
p
p
o
r
tu
n
ities
o
f
wo
m
en
,
e
s
p
ec
ially
r
eg
ar
d
in
g
s
ex
u
ality
is
s
u
es,
ar
e
s
till
p
r
ev
alen
t.
T
h
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
a
r
e
s
tu
d
en
ts
liv
in
g
al
o
n
e
in
Su
r
ab
ay
a
C
ity
,
in
clu
d
in
g
th
o
s
e
in
b
o
a
r
d
in
g
h
o
u
s
es,
r
en
te
d
h
o
u
s
es,
ap
a
r
tm
en
ts
,
d
o
r
m
ito
r
ies,
an
d
o
th
er
s
im
ilar
ac
co
m
m
o
d
atio
n
s
.
An
o
th
er
g
r
o
u
p
co
n
s
is
ts
o
f
s
tu
d
en
ts
wh
o
liv
e
with
th
eir
p
ar
en
ts
at
h
o
m
e.
T
h
e
r
esu
lts
in
d
icate
th
at
s
tu
d
en
ts
liv
in
g
in
b
o
ar
d
in
g
h
o
u
s
es
an
d
en
g
ag
in
g
in
h
ea
v
y
s
ex
u
al
ac
ti
v
ity
ac
co
u
n
te
d
f
o
r
6
3
.
6
%,
wh
ile
th
o
s
e
en
g
ag
in
g
i
n
lig
h
t
s
ex
u
al
ac
tiv
ity
wer
e
3
6
.
4
%.
R
esp
o
n
d
en
ts
liv
in
g
at
h
o
m
e
with
p
a
r
en
ts
an
d
en
g
a
g
in
g
i
n
h
ea
v
y
s
ex
u
al
ac
tiv
ity
wer
e
6
4
.
5
%,
with
3
5
.
5
%
e
n
g
ag
in
g
in
lig
h
t
s
ex
u
al
ac
tiv
ity
.
T
h
is
s
u
g
g
ests
th
at
n
o
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
a
n
d
r
esp
o
n
d
en
ts
liv
in
g
alo
n
e
ar
e
m
o
r
e
p
r
o
n
e
to
p
a
r
ticip
atin
g
in
h
az
ar
d
o
u
s
s
ex
u
al
b
eh
av
io
r
.
R
esear
ch
co
n
d
u
cted
b
y
Ma
r
ia
at
Vo
ca
tio
n
al
Hig
h
Sch
o
o
l
R
u
ten
g
C
ity
s
h
o
ws
th
at
ad
o
lescen
t
s
liv
in
g
in
b
o
ar
d
in
g
h
o
u
s
es
e
n
g
ag
e
in
p
r
em
ar
ital
s
ex
at
a
r
ate
o
f
7
8
.
3
%,
wh
ile
th
o
s
e
liv
in
g
at
h
o
m
e
with
p
ar
en
ts
en
g
ag
e
in
p
r
em
ar
ital
s
ex
at
a
r
ate
o
f
1
3
.
3
%
[
2
3
]
.
An
o
th
er
s
tu
d
y
i
n
Ma
lu
k
u
r
ev
ea
led
th
at
s
ex
u
al
d
r
iv
e,
s
o
cial
d
em
an
d
s
a
n
d
liv
in
g
in
a
n
u
n
s
u
p
e
r
v
is
ed
p
lac
e
ar
e
th
e
r
is
k
s
o
f
s
ex
u
al
b
eh
a
v
io
r
am
o
n
g
tee
n
s
in
b
o
ar
d
i
n
g
h
o
u
s
es
[
2
4
]
.
T
h
is
is
s
u
p
p
o
r
t
ed
b
y
r
esear
ch
o
n
teen
ag
er
s
in
C
am
b
o
d
ia,
wh
ich
f
o
u
n
d
th
at
liv
in
g
awa
y
f
r
o
m
h
o
m
e
an
d
b
ein
g
u
n
m
ar
r
ied
p
u
t
teen
ag
er
s
at
r
is
k
o
f
en
g
ag
in
g
in
two
p
r
em
a
r
ital
s
ex
en
c
o
u
n
ter
s
[
2
5
]
.
T
h
e
r
ese
ar
ch
f
u
r
th
e
r
s
tates
th
at
t
h
e
a
b
s
en
ce
o
f
p
a
r
en
tal
s
u
p
er
v
is
io
n
h
as a
s
ig
n
if
ica
n
t im
p
ac
t o
n
t
h
eir
s
ex
u
al
b
e
h
av
io
r
[
2
4
]
.
Acc
o
r
d
in
g
to
th
e
C
NB
C
I
n
d
o
n
esia
web
s
ite,
th
e
E
ast
J
av
a
Pro
v
in
cial
g
o
v
e
r
n
m
en
t
s
et
th
e
m
in
im
u
m
s
alar
y
f
o
r
2
0
2
3
in
E
ast
J
av
a
Pro
v
in
ce
,
with
Su
r
a
b
ay
a
h
a
v
in
g
th
e
h
ig
h
est
at
I
DR
4
,
5
2
5
,
4
7
9
[
2
6
]
.
T
h
is
im
p
lies
a
r
elativ
ely
h
ig
h
f
ig
u
r
e
co
n
s
id
er
in
g
t
h
e
a
v
er
ag
e
in
co
m
e
o
f
p
eo
p
le
in
Su
r
a
b
ay
a.
Par
en
ts
'
in
co
m
e
will
in
f
lu
en
ce
th
e
p
ar
e
n
tin
g
an
d
f
ac
ilit
ies
av
ailab
le
to
a
d
o
lescen
ts
d
u
r
in
g
th
eir
g
r
o
wth
.
I
n
th
is
s
tu
d
y
,
p
a
r
en
tal
in
co
m
e
was
ca
teg
o
r
ized
in
to
two
g
r
o
u
p
s
:
u
n
d
er
6
m
illi
o
n
an
d
ab
o
v
e
o
r
eq
u
al
to
6
m
illi
o
n
.
T
h
e
r
esu
l
ts
in
d
icate
th
at
th
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
'
p
ar
en
ts
h
av
e
in
co
m
es
u
n
d
er
6
m
i
llio
n
.
Ad
o
lescen
ts
with
p
ar
en
ts
ea
r
n
in
g
u
n
d
er
6
m
illi
o
n
ten
d
to
en
g
ag
e
in
h
e
av
y
s
ex
u
al
ac
tiv
ity
at
a
r
ate
o
f
6
2
.
9
%.
T
h
is
s
u
g
g
ests
th
at
p
ar
en
ts
'
in
co
m
e
is
ef
f
ec
tiv
e
in
t
h
e
h
ig
h
lev
el
o
f
h
ea
v
y
s
ex
u
al
ac
tiv
ity
a
m
o
n
g
ad
o
lescen
ts
.
T
h
ese
f
in
d
in
g
s
ar
e
co
n
s
is
ten
t
with
r
esear
ch
b
y
R
o
s
m
an
i
in
Ace
h
,
in
d
icatin
g
th
at
th
e
r
e
is
a
r
elatio
n
s
h
ip
b
etwe
en
th
e
r
o
le
o
f
p
ar
en
ts
.
L
im
ited
p
ar
en
tal
co
n
tr
o
l
o
v
er
c
h
ild
r
en
m
ig
h
t
s
tem
f
r
o
m
h
ec
tic
wo
r
k
s
ch
ed
u
les,
leav
in
g
p
ar
e
n
ts
with
f
ew
o
p
tio
n
s
f
o
r
m
an
ag
in
g
th
eir
k
id
s
'
ev
er
y
d
a
y
ac
tiv
ities
[
2
7
]
.
T
h
is
s
tu
d
y
r
e
v
ea
led
th
at
th
e
m
ajo
r
ity
(
6
4
.
4
%)
o
f
s
tu
d
en
ts
wh
o
u
s
e
s
o
cial
m
e
d
ia
f
o
r
n
eg
ativ
e
p
u
r
p
o
s
es
en
g
ag
e
in
h
ig
h
-
r
is
k
s
ex
u
al
ac
ti
v
ity
.
T
h
is
is
in
lin
e
with
r
esear
ch
f
r
o
m
An
n
a
wh
ic
h
s
tates
th
at
ac
ce
s
s
to
in
f
o
r
m
atio
n
m
ed
ia
in
y
o
u
n
g
er
s
am
p
les
h
as
a
lar
g
e
in
f
l
u
en
ce
with
th
e
r
is
k
o
f
r
is
k
y
s
ex
u
al
b
eh
av
i
o
r
in
ad
o
lescen
t
[
2
8
]
.
T
h
e
u
s
e
o
f
s
o
cial
m
ed
ia
d
ep
en
d
s
o
n
t
h
e
p
u
r
p
o
s
e
o
f
u
s
e.
Similar
to
an
o
th
e
r
s
tu
d
y
,
th
e
y
claim
th
at
u
s
in
g
s
o
cial
m
ed
ia
o
r
th
e
in
ter
n
et
is
eq
u
i
v
alen
t
to
cy
b
er
s
ex
,
in
ad
d
itio
n
to
b
ein
g
a
m
ea
n
s
o
f
co
m
m
u
n
icatio
n
[
2
9
]
.
Stu
d
en
ts
ar
e
at
d
if
f
e
r
en
t
r
is
k
s
o
f
en
g
a
g
in
g
in
s
ex
u
al
ac
tiv
ity
d
e
p
en
d
i
n
g
o
n
h
o
w
t
h
ey
u
s
e
an
d
ac
ce
s
s
s
o
cial
m
ed
ia
in
f
o
r
m
atio
n
.
An
ass
o
ciatio
n
b
etwe
en
s
o
cial
m
ed
ia
u
s
e
an
d
s
ex
u
al
b
eh
av
io
r
h
as
b
ee
n
f
o
u
n
d
in
s
tu
d
y
r
esu
lts
[
3
0
]
.
T
ee
n
s
ar
e
in
ex
tr
icab
ly
lin
k
ed
to
th
eir
s
m
ar
tp
h
o
n
es
an
d
s
o
cial
m
ed
ia
ac
co
u
n
ts
.
T
ee
n
ag
er
s
wh
o
f
ail
to
ex
er
ci
s
e
ca
u
tio
n
in
th
is
r
eg
ar
d
r
is
k
h
av
in
g
u
n
f
ilter
ed
ac
ce
s
s
to
all
m
ater
ial
o
n
t
h
e
in
ter
n
et
an
d
s
o
cial
m
ed
ia.
I
n
ad
d
itio
n
to
a
lo
t
o
f
f
alse
in
f
o
r
m
atio
n
th
at
is
p
o
s
ted
o
n
lin
e,
o
n
e
m
ay
ac
ce
s
s
v
ar
io
u
s
m
ater
ial
o
n
t
h
e
in
ter
n
et
an
d
s
o
cial
m
ed
ia,
in
clu
d
i
n
g
in
f
o
r
m
atio
n
th
at
co
u
l
d
n
eg
ati
v
ely
af
f
ec
t
its
u
s
er
s
[
3
1
]
.
T
ee
n
ag
e
r
s
wh
o
a
r
e
cu
r
io
u
s
ab
o
u
t
s
ex
u
ality
o
r
r
ep
r
o
d
u
ctiv
e
h
ea
lth
will
tu
r
n
to
m
ass
m
ed
ia,
p
ar
ticu
la
r
ly
th
e
in
ter
n
et,
f
o
r
in
f
o
r
m
atio
n
i
f
th
ey
d
o
n
o
t
r
ec
eiv
e
it
f
r
o
m
t
h
eir
p
ar
en
ts
o
r
o
th
er
clo
s
est
r
elativ
es
[
3
1
]
.
Sin
ce
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
R
is
k
a
n
a
lysi
s
o
f a
d
o
lescen
t se
xu
a
l a
ctivity
in
co
lleg
e
S
u
r
a
b
a
ya
,
I
n
d
o
n
esia
:
…
(
E
n
y
Qu
r
n
iy
a
w
a
ti)
1799
th
e
m
ed
ia
an
d
o
th
er
tr
i
g
g
er
in
g
elem
en
ts
ar
e
b
ec
o
m
in
g
m
o
r
e
wid
ely
av
ailab
le,
th
is
co
m
p
licates
th
e
is
s
u
e
o
f
d
an
g
er
o
u
s
s
ex
u
al
ac
tiv
ity
am
o
n
g
teen
ag
e
r
s
[
3
2
]
.
Acc
o
r
d
in
g
to
a
s
tu
d
y
,
s
ex
u
al
b
eh
a
v
io
r
an
d
in
f
o
r
m
atio
n
m
ed
ia
ex
p
o
s
u
r
e
ar
e
s
ig
n
if
ic
an
tly
co
r
r
elate
d
[
3
1
]
.
B
ased
o
n
th
e
s
tu
d
y
'
s
f
in
d
in
g
s
,
th
er
e
is
a
v
alu
e
o
f
(p
-
v
alu
e
0
.
0
1
1
)
co
r
r
elatio
n
b
etwe
en
teen
ag
e
s
ex
u
al
b
eh
av
i
o
r
an
d
m
ass
m
e
d
ia.
T
ee
n
ag
er
s
in
Am
er
ica
n
o
w
ch
o
o
s
e
Face
b
o
o
k
ab
o
v
e
o
th
e
r
s
o
cial
m
ed
ia
p
latf
o
r
m
s
as o
f
2
0
1
2
.
T
ee
n
ag
er
s
also
o
f
te
n
u
s
e
T
witter
,
I
n
s
tag
r
am
,
an
d
Sn
ap
ch
at
as
s
o
cial
m
ed
ia
p
latf
o
r
m
s
.
On
e
o
f
th
e
t
h
in
g
s
th
at
ex
p
o
s
es
k
id
s
to
p
o
r
n
o
g
r
a
p
h
y
is
th
is
m
ed
iu
m
.
T
ee
n
s
in
r
o
m
an
tic
r
elatio
n
s
h
i
p
s
ar
e
im
p
ac
te
d
b
y
s
o
cial
m
e
d
ia.
W
h
en
e
x
am
in
in
g
s
ex
u
al
m
ed
ia,
m
o
s
t
s
ch
o
lar
s
co
n
ce
n
tr
ate
o
n
t
h
e
d
etr
i
m
en
tal
im
p
ac
ts
o
f
th
e
m
e
d
iu
m
[
1
3
]
.
I
t'
s
q
u
ite
s
im
p
le
to
ac
ce
s
s
p
o
r
n
o
g
r
a
p
h
ic
web
s
ites
o
v
er
th
e
i
n
ter
n
et.
Yo
u
ca
n
u
s
e
th
e
in
ter
n
et
an
y
wh
er
e
[
3
3
]
.
Sex
u
al
co
n
s
en
t
is
th
e
m
ain
th
i
n
g
th
at
m
u
s
t
b
e
f
u
lf
illed
in
a
h
ea
lth
y
r
elatio
n
s
h
ip
w
h
en
h
av
in
g
s
ex
u
al
in
ter
co
u
r
s
e.
I
n
th
is
s
tu
d
y
,
6
4
.
2
%
o
f
s
tu
d
e
n
ts
ca
r
r
y
in
g
o
u
t
h
ea
v
y
ca
te
g
o
r
y
s
ex
u
al
ac
tiv
ities
u
s
ed
s
ex
u
al
co
n
s
en
t.
T
h
ese
f
in
d
in
g
s
ar
e
c
o
n
s
is
ten
t
with
th
r
ee
ea
r
lier
s
tu
d
ies
th
at
f
o
u
n
d
th
at
s
tu
d
e
n
ts
co
m
m
u
n
icate
th
eir
co
n
s
en
t
f
o
r
s
ex
u
al
ac
tiv
ity
th
r
o
u
g
h
d
i
r
ec
t
n
o
n
v
er
b
al
b
e
h
av
io
r
(
e.
g
.
,
to
u
c
h
in
g
,
u
n
d
r
ess
in
g
,
k
is
s
in
g
,
o
r
"f
o
r
ep
lay
"
)
a
n
d
p
ass
iv
e
b
eh
a
v
io
r
(
e.
g
.
,
ac
ce
p
tin
g
t
h
eir
p
ar
tn
er
'
s
ef
f
o
r
ts
,
s
ay
in
g
n
o
,
a
n
d
r
ec
ip
r
o
ca
tin
g
th
eir
p
ar
tn
er
'
s
ac
tio
n
s
)
[
3
4
]
–
[
3
6
]
.
R
eg
ar
d
less
o
f
th
e
len
g
th
o
r
i
n
ten
s
ity
o
f
a
p
er
s
o
n
'
s
r
elatio
n
s
h
ip
with
an
o
th
er
,
o
b
tain
in
g
c
o
n
s
en
t
is
alwa
y
s
th
e
m
o
s
t
im
p
o
r
ta
n
t
th
in
g
to
r
em
em
b
er
b
e
f
o
r
e
h
av
in
g
s
ex
.
C
o
n
s
en
t
m
u
s
t
b
e
f
r
ee
ly
g
iv
en
th
r
o
u
g
h
u
n
am
b
ig
u
o
u
s
wo
r
d
s
an
d
ac
tio
n
s
an
d
ca
n
n
o
t
b
e
ass
u
m
ed
[
1
1
]
.
Acc
o
r
d
in
g
to
s
ex
u
al
co
n
s
en
t
th
eo
r
y
,
co
n
s
en
t
ca
n
o
n
ly
ex
i
s
t
wh
en
a
p
er
s
o
n
ex
p
r
ess
es
v
er
b
ally
t
h
at
th
ey
ar
e
willin
g
to
h
av
e
s
ex
[
3
7
]
.
B
ec
au
s
e
r
ap
e
o
cc
u
r
s
o
n
co
lle
g
e
ca
m
p
u
s
es
m
o
r
e
f
r
e
q
u
en
tly
th
an
in
an
y
o
th
e
r
p
lace
,
v
er
b
al
p
er
m
is
s
io
n
is
th
e
s
o
le
ac
ce
p
tab
le
f
o
r
m
o
f
c
o
n
s
en
t
[
3
8
]
.
T
h
r
ee
co
n
ce
p
ts
o
f
c
o
n
s
en
t
h
av
e
b
ee
n
id
e
n
tifie
d
:
ex
p
licit
ag
r
ee
m
en
t,
"in
f
er
r
ed
"
willin
g
n
ess
,
an
d
i
n
ter
n
al
"v
o
liti
o
n
"
[
3
9
]
.
W
h
en
it
co
m
es
to
d
atin
g
,
s
tu
d
e
n
ts
s
aid
th
at
lo
n
g
-
ter
m
o
r
s
er
io
u
s
r
elatio
n
s
h
ip
s
ten
d
to
h
av
e
less
ex
p
licit
p
er
m
is
s
io
n
b
ef
o
r
e
s
ex
u
al
ac
tiv
ity
[
4
0
]
.
T
o
p
r
ev
en
t
co
n
f
lict,
wo
m
en
in
co
m
m
itted
r
elatio
n
s
h
ip
s
m
ay
also
co
n
s
en
t
to
h
av
e
s
ex
with
th
eir
s
p
o
u
s
es
[
4
1
]
.
C
o
lleg
e
s
tu
d
en
ts
wh
o
in
ter
n
alize
n
o
r
m
s
th
at
le
g
itimiz
e
wo
m
en
'
s
co
o
p
e
r
atio
n
an
d
p
ass
iv
ity
in
s
ex
u
al
en
g
a
g
em
en
t
m
a
y
b
e
less
lik
ely
to
r
ef
u
s
e
u
n
welc
o
m
e
s
e
x
u
al
b
eh
a
v
io
r
[
3
6
]
.
Sex
u
ally
tr
an
s
m
itted
in
f
ec
tio
n
s
ar
e
o
n
e
o
f
th
e
m
an
y
co
n
s
eq
u
en
ce
s
o
f
p
r
e
m
ar
ital
s
ex
u
al
ac
tiv
ity
am
o
n
g
ad
o
lescen
ts
.
T
h
e
r
is
e
o
f
s
h
o
r
t
r
elatio
n
s
h
ip
s
in
to
d
ay
'
s
teen
ag
er
s
cr
ea
tes
a
g
r
ea
t
o
p
p
o
r
tu
n
ity
f
o
r
th
em
to
ch
an
g
e
p
ar
t
n
er
s
.
C
o
n
tin
u
in
g
f
r
o
m
th
e
p
r
ev
io
u
s
d
is
cu
s
s
io
n
,
wo
m
en
'
s
lack
o
f
em
p
o
wer
m
en
t
to
co
m
m
u
n
icate
an
d
m
ak
e
d
ec
is
io
n
s
in
s
ex
u
al
ac
tiv
ity
with
th
eir
p
ar
tn
er
s
ca
n
also
b
e
o
n
e
o
f
th
e
ca
u
s
es
o
f
th
e
p
r
ev
ale
n
ce
o
f
u
n
s
af
e
s
ex
u
al
r
elatio
n
s
h
ip
s
.
T
h
is
s
tu
d
y
s
u
cc
ess
f
u
lly
id
en
tifie
d
ad
o
lescen
ts
with
STI
s
y
m
p
to
m
s
,
wh
ich
am
o
u
n
ted
to
3
7
%
o
f
all
r
esp
o
n
d
en
ts
.
Ho
wev
er
,
th
e
ab
s
en
ce
o
f
p
h
y
s
ical
s
y
m
p
t
o
m
s
s
h
o
u
ld
n
o
t
b
e
ig
n
o
r
ed
,
as
m
o
s
t
STI
s
f
o
u
n
d
wo
r
ld
wid
e
a
r
e
o
f
te
n
asy
m
p
t
o
m
atic
[
4
2
]
.
B
ased
o
n
th
e
c
h
an
ce
s
o
f
cu
r
e,
s
ex
u
ally
tr
a
n
s
m
itted
d
is
ea
s
es
ar
e
d
iv
id
ed
in
to
cu
r
a
b
le
d
is
ea
s
es
an
d
d
is
ea
s
es
th
at
ca
n
b
e
tr
ea
ted
f
o
r
s
ev
er
ity
.
T
h
e
cu
r
ab
le
s
ex
u
ally
tr
an
s
m
itted
in
f
ec
tio
n
s
s
u
ch
as
C
h
lam
y
d
ia,
Go
n
o
r
r
h
ea
,
a
n
d
Sy
p
h
ilis
ar
e
th
e
m
o
s
t
co
m
m
o
n
,
to
p
p
in
g
th
e
lis
t
with
an
i
n
cr
ea
s
e
o
f
3
9
%,
9
6
%,
an
d
1
6
7
%
o
v
e
r
th
e
last
d
e
ca
d
e
ac
co
r
d
in
g
to
s
tatis
tics
in
C
an
ad
a
[
4
3
]
.
B
ased
o
n
I
r
is
h
s
u
r
v
eillan
ce
d
ata,
th
er
e
was
an
in
cr
ea
s
e
in
th
e
tr
an
s
m
is
s
io
n
o
f
s
ex
u
ally
tr
an
s
m
itted
ca
s
es
in
2
0
2
2
wh
en
co
m
p
ar
ed
to
th
e
p
an
d
e
m
ic
wh
ich
h
ad
d
ec
r
ea
s
ed
.
T
h
is
tr
an
s
m
is
s
io
n
is
d
o
m
in
ate
d
b
y
th
e
ag
e
g
r
o
u
p
u
n
d
er
2
5
y
ea
r
s
o
ld
[
4
4
]
.
B
ase
d
o
n
th
e
r
esu
lts
o
f
r
esear
ch
o
n
s
af
e
s
ex
u
al
b
eh
av
io
r
with
co
n
d
o
m
u
s
e
co
n
d
u
cted
in
m
en
an
d
ad
o
lescen
ts
ag
ed
1
5
-
2
4
y
ea
r
s
in
I
n
d
o
n
esia,
s
h
o
w
lo
w
r
esu
lts
with
a
p
er
ce
n
tag
e
o
f
2
5
-
2
7
.
4
%
[
4
5
]
.
Hav
in
g
b
ee
n
in
a
r
o
m
a
n
tic
r
elatio
n
s
h
ip
p
r
o
v
id
es
th
e
g
r
ea
te
s
t
ex
p
lan
ato
r
y
p
o
wer
f
o
r
b
o
t
h
m
en
an
d
wo
m
en
am
o
n
g
all
th
e
f
ac
to
r
s
s
h
o
wn
to
b
e
ass
o
ciate
d
with
co
lleg
e
s
tu
d
en
ts
'
s
ex
u
al
a
ctiv
ity
.
Nu
m
er
o
u
s
r
esear
ch
s
tu
d
ies
h
av
e
d
em
o
n
s
tr
ated
th
at
d
atin
g
p
ar
ticu
lar
ly
co
m
m
itted
lo
v
e
r
elatio
n
s
h
i
p
s
is
a
s
ig
n
if
ican
t
p
r
ed
icto
r
o
f
s
ex
u
al
ac
tiv
ity
.
Hav
in
g
a
p
a
r
tn
er
ca
n
m
ak
e
it
m
o
r
e
lik
ely
th
at
y
o
u
will
p
ar
tak
e
in
p
r
iv
ate,
p
r
e
-
r
elatio
n
s
h
ip
ac
tiv
ities
lik
e
f
o
n
d
lin
g
an
d
k
is
s
in
g
,
wh
ich
co
u
l
d
lead
to
s
ex
.
T
ee
n
ag
e
r
s
wh
o
h
av
e
a
b
o
y
f
r
ien
d
o
r
g
ir
lf
r
ien
d
m
ay
also
b
e
in
tr
o
d
u
ce
d
t
o
a
n
ew
s
o
cial
cir
cle
with
m
o
r
e
lib
er
al
s
ex
u
al
n
o
r
m
s
;
r
esear
ch
h
as
in
d
icate
d
th
at
s
ex
u
ally
ac
tiv
e
t
ee
n
ag
er
s
ar
e
m
o
r
e
lik
el
y
to
h
a
v
e
s
u
p
p
o
r
tiv
e
p
ee
r
n
o
r
m
s
[
4
6
]
.
Hen
ce
,
th
er
e
is
an
in
cr
ea
s
ed
d
em
a
n
d
f
o
r
ed
u
ca
ti
o
n
r
e
g
ar
d
in
g
in
tim
ac
y
,
s
ex
u
al
r
is
k
,
an
d
s
af
ety
f
o
r
y
o
u
n
g
in
d
i
v
id
u
als
in
r
o
m
an
tic
r
elatio
n
s
h
ip
s
.
T
h
e
s
ig
n
if
ican
c
e
o
f
f
o
cu
s
in
g
e
d
u
ca
tio
n
al
in
iti
ativ
es
o
n
y
o
u
n
g
p
eo
p
le
in
r
o
m
an
tic
r
elatio
n
s
h
ip
s
is
s
h
o
wn
b
y
th
is
s
tu
d
y
.
T
h
er
e
ar
e
s
ev
er
al
lim
itatio
n
s
to
th
is
s
tu
d
y
.
Firstl
y
,
th
e
g
en
d
er
-
im
b
alan
ce
d
s
am
p
lin
g
m
ad
e
it
im
p
o
s
s
ib
le
to
d
r
aw
a
d
ef
in
i
tiv
e
p
ictu
r
e
o
f
th
e
c
o
n
n
ec
ti
o
n
b
etwe
en
ac
tu
al
s
ex
u
al
a
ctiv
ity
an
d
g
en
d
er
.
Seco
n
d
ly
,
as
th
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
in
th
is
s
u
r
v
ey
wer
e
co
n
ce
n
tr
ated
i
n
p
ar
ticu
lar
r
e
g
io
n
s
,
th
e
f
in
d
in
g
s
s
h
o
u
ld
n
o
t
b
e
ap
p
lied
to
all
Su
r
ab
ay
a
s
tu
d
en
ts
.
Fin
ally
,
it
is
ess
en
tial
to
co
n
s
id
er
th
e
p
o
ten
tial
f
o
r
b
ias
r
esu
ltin
g
f
r
o
m
u
n
d
er
r
e
p
o
r
tin
g
.
T
h
e
r
esear
ch
er
d
id
n
o
t
d
ir
ec
tly
o
b
s
er
v
e
th
e
p
h
y
s
ical
co
n
d
itio
n
o
f
th
e
r
esp
o
n
d
en
ts
,
s
o
th
e
d
ata
co
ll
ec
ted
wer
e
s
tatem
en
ts
f
r
o
m
r
esp
o
n
d
en
ts
.
I
n
s
tead
,
th
e
m
ea
s
u
r
em
en
t
o
f
s
ex
u
a
l
ac
tiv
ity
in
th
is
s
tu
d
y
is
b
ased
o
n
s
elf
-
r
ep
o
r
tin
g
a
n
d
p
ar
ti
cip
an
t
s
en
s
itiv
ity
,
p
ar
ticu
lar
l
y
in
th
e
asp
ec
t
o
f
s
y
m
p
to
m
s
o
f
STDs.
4.
CO
NCLU
SI
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.
13
,
No
.
4
,
Dec
em
b
er
20
24
:
1
79
4
-
1
80
2
1800
T
h
e
r
esu
lts
s
h
o
wed
t
h
at
am
o
n
g
th
e
f
ac
to
r
s
id
e
n
tifie
d
f
o
r
s
ex
u
al
ac
tiv
ity
am
o
n
g
u
n
iv
e
r
s
ity
s
tu
d
en
ts
in
Su
r
ab
ay
a,
d
atin
g
s
tatu
s
was
t
h
e
s
tr
o
n
g
est
f
ac
to
r
tr
ig
g
er
in
g
r
is
k
y
s
ex
u
al
ac
tiv
ity
am
o
n
g
u
n
iv
er
s
ity
s
tu
d
en
ts
.
R
is
k
y
s
ex
u
al
ac
tiv
ity
will
lea
d
to
th
e
co
n
s
eq
u
en
ce
s
o
f
s
ex
u
ally
tr
an
s
m
itted
in
f
ec
tio
n
s
.
T
h
is
s
tu
d
y
id
en
tifie
d
ad
o
lescen
ts
with
STI
s
y
m
p
to
m
s
in
3
7
%
o
f
th
e
r
esp
o
n
d
e
n
ts
.
Ad
d
itio
n
ally
,
we
s
h
o
we
d
th
e
f
r
eq
u
e
n
cy
o
f
s
o
cio
ec
o
n
o
m
ic
s
tatu
s
,
s
ex
u
al
co
n
s
en
t,
p
lace
o
f
r
esid
en
ce
,
a
n
d
tim
e
s
p
en
t
o
n
s
o
cial
m
e
d
ia
o
n
s
ex
u
al
ac
tiv
ity
.
T
o
p
r
o
m
o
te
s
ex
ed
u
ca
tio
n
f
o
r
u
n
i
v
er
s
ity
s
tu
d
en
ts
an
d
r
aise
k
n
o
wled
g
e
o
f
s
ex
u
al
d
an
g
er
s
an
d
s
af
ety
,
leg
is
lato
r
s
an
d
s
ex
ed
u
ca
to
r
s
n
ee
d
t
h
is
in
f
o
r
m
atio
n
to
cr
ea
t
e
wo
r
k
a
b
le
a
n
d
s
u
cc
ess
f
u
l
m
e
th
o
d
s
.
I
n
a
d
d
itio
n
to
o
f
f
er
in
g
a
s
ec
u
r
e
s
ettin
g
f
o
r
s
t
u
d
en
ts
,
co
lleg
e
co
u
n
s
elo
r
s
s
h
o
u
ld
b
e
ab
le
t
o
p
r
o
v
id
e
r
eliab
le
in
f
o
r
m
atio
n
o
n
a
wid
e
r
an
g
e
o
f
s
ex
u
al
d
if
f
icu
lt
ies.
Fo
r
s
p
ec
ialized
in
f
o
r
m
ati
o
n
o
n
s
af
e
s
ex
,
co
n
tr
ac
ep
tio
n
,
an
d
s
ex
u
al
h
ea
lth
,
co
lleg
e
co
u
n
s
elin
g
ce
n
ter
s
m
u
s
t
o
f
f
er
p
er
tin
en
t,
ea
s
ily
av
ailab
le
in
f
o
r
m
atio
n
an
d
r
eso
u
r
ce
s
alo
n
g
with
h
elp
f
u
l
r
ec
o
m
m
en
d
atio
n
s
.
ACK
NO
WL
E
DG
E
M
E
NT
S
T
h
e
au
th
o
r
s
wo
u
ld
lik
e
to
th
an
k
Un
iv
er
s
itas
Air
lan
g
g
a
f
o
r
p
r
o
v
id
i
n
g
r
esear
ch
f
u
n
d
in
g
wi
th
co
n
tr
ac
t
n
u
m
b
er
1
7
4
8
/UN3
.
1
.
1
0
/PT/2
0
2
3
.
RE
F
E
R
E
NC
E
S
[
1
]
A
.
B
.
B
o
z
z
i
n
i
,
A
.
B
a
u
e
r
,
J
.
M
a
r
u
y
a
m
a
,
R
.
S
i
m
õ
e
s
,
a
n
d
A
.
M
a
t
i
j
a
s
e
v
i
c
h
,
“
F
a
c
t
o
r
s
a
ss
o
c
i
a
t
e
d
w
i
t
h
r
i
s
k
b
e
h
a
v
i
o
r
s
i
n
a
d
o
l
e
sc
e
n
c
e
:
a
sy
st
e
ma
t
i
c
r
e
v
i
e
w
,
”
Br
a
zi
l
i
a
n
J
o
u
rn
a
l
o
f
Ps
y
c
h
i
a
t
r
y
,
v
o
l
.
4
3
,
n
o
.
2
,
p
p
.
2
1
0
–
2
2
1
,
2
0
2
1
,
d
o
i
:
1
0
.
1
5
9
0
/
1
5
1
6
-
4
4
4
6
-
2
0
1
9
-
0
8
3
5
.
[
2
]
D
.
La
n
a
r
i
,
L.
M
a
n
g
i
a
v
a
c
c
h
i
,
a
n
d
M
.
P
a
sq
u
a
l
i
n
i
,
“
A
d
o
l
e
sc
e
n
t
s
e
x
u
a
l
b
e
h
a
v
i
o
u
r
a
n
d
a
c
a
d
e
m
i
c
p
e
r
f
o
r
ma
n
c
e
o
f
I
t
a
l
i
a
n
s
t
u
d
e
n
t
s,”
G
e
n
u
s
,
v
o
l
.
7
6
,
n
o
.
1
,
p
p
.
1
–
1
8
,
2
0
2
0
.
[
3
]
L.
E.
P
r
e
n
d
e
r
g
a
st
,
J.
W
.
T
o
u
mb
o
u
r
o
u
,
B
.
J
.
M
c
M
o
r
r
i
s,
a
n
d
R
.
F
.
C
a
t
a
l
a
n
o
,
“
O
u
t
c
o
mes
o
f
e
a
r
l
y
a
d
o
l
e
sce
n
t
s
e
x
u
a
l
b
e
h
a
v
i
o
r
i
n
A
u
st
r
a
l
i
a
:
Lo
n
g
i
t
u
d
i
n
a
l
f
i
n
d
i
n
g
s
i
n
y
o
u
n
g
a
d
u
l
t
h
o
o
d
,
”
J
o
u
rn
a
l
o
f
A
d
o
l
e
sce
n
t
H
e
a
l
t
h
,
v
o
l
.
6
4
,
n
o
.
4
,
p
p
.
5
1
6
–
5
2
2
,
2
0
1
9
.
[
4
]
T.
N
i
g
u
ss
i
e
,
T.
Le
g
e
ss
e
,
L
.
A
b
e
b
e
,
S
.
G
e
t
a
c
h
e
w
,
a
n
d
D
.
A
l
e
ma
y
e
h
u
,
“
M
a
g
n
i
t
u
d
e
o
f
r
i
s
k
y
s
e
x
u
a
l
b
e
h
a
v
i
o
r
s,
d
e
t
e
r
mi
n
a
n
t
s,
a
n
d
c
o
n
se
q
u
e
n
c
e
s
a
m
o
n
g
h
i
g
h
s
c
h
o
o
l
a
n
d
p
r
e
p
a
r
a
t
o
r
y
s
c
h
o
o
l
s
t
u
d
e
n
t
s
i
n
M
i
z
a
n
A
ma
n
T
o
w
n
,
E
t
h
i
o
p
i
a
,
”
J
o
u
r
n
a
l
o
f
Mi
d
w
i
f
e
ry
a
n
d
Re
p
r
o
d
u
c
t
i
v
e
H
e
a
l
t
h
,
v
o
l
.
8
,
n
o
.
1
,
p
p
.
2
0
9
6
–
2
1
0
4
,
2
0
2
0
.
[
5
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
“
A
d
o
l
e
s
c
e
n
t
h
e
a
l
t
h
,
”
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
.
A
c
c
e
ss
e
d
:
A
p
r
.
1
5
,
2
0
2
3
.
[
O
n
l
i
n
e
.
]
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
w
w
w
.
w
h
o
.
i
n
t
/
h
e
a
l
t
h
-
t
o
p
i
c
s/
a
d
o
l
e
sce
n
t
-
h
e
a
l
t
h
#
t
a
b
=
t
a
b
_
1
[
6
]
O
.
O
k
t
r
i
y
a
n
t
o
a
n
d
A
.
A
l
f
i
a
s
a
r
i
,
“
D
a
t
i
n
g
a
n
d
p
r
e
m
a
r
i
t
a
l
s
e
x
u
a
l
i
n
i
si
a
t
i
o
n
o
n
a
d
o
l
e
sc
e
n
c
e
i
n
I
n
d
o
n
e
s
i
a
,
”
K
EM
A
S
J
u
rn
a
l
K
e
se
h
a
t
an
Ma
s
y
a
r
a
k
a
t
,
v
o
l
.
1
5
,
n
o
.
1
,
p
p
.
9
8
–
1
0
8
,
2
0
1
9
.
[
7
]
D
.
E.
S
a
r
i
a
n
d
D
.
R
o
k
h
a
n
a
w
a
t
i
,
“
T
h
e
c
o
r
r
e
l
a
t
i
o
n
b
e
t
w
e
e
n
a
g
e
o
f
f
i
r
st
d
a
t
i
n
g
a
n
d
se
x
u
a
l
b
e
h
a
v
i
o
r
o
f
a
d
o
l
e
s
c
e
n
t
s
a
n
d
y
o
u
n
g
a
d
u
l
t
s
i
n
I
n
d
o
n
e
s
i
a
,
”
J
o
u
r
n
a
l
o
f
H
e
a
l
t
h
T
e
c
h
n
o
l
o
g
y
Ass
e
ssm
e
n
t
i
n
M
i
d
w
i
f
e
ry
,
v
o
l
.
2
6
2
0
,
p
.
5
6
5
3
,
2
0
1
8
.
[
8
]
Ea
st
J
a
v
a
H
e
a
l
t
h
O
f
f
i
c
e
,
“
Ea
s
t
Ja
v
a
P
r
o
v
i
n
c
e
h
e
a
l
t
h
p
r
o
f
i
l
e
2
0
2
1
,
”
2
0
2
2
.
A
c
c
e
sse
d
:
A
p
r
.
1
5
,
2
0
2
3
.
[
O
n
l
i
n
e
.
]
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
g
h
d
x
.
h
e
a
l
t
h
d
a
t
a
.
o
r
g
/
o
r
g
a
n
i
z
a
t
i
o
n
s
/
e
a
st
-
j
a
v
a
-
p
r
o
v
i
n
c
i
a
l
-
h
e
a
l
t
h
-
o
f
f
i
c
e
-
i
n
d
o
n
e
s
i
a
[
9
]
M
.
M
.
A
l
i
,
L.
M
e
r
d
a
d
,
a
n
d
S
.
B
e
l
l
i
z
z
i
,
“
S
o
c
i
o
e
c
o
n
o
m
i
c
v
a
r
i
a
t
i
o
n
s
i
n
r
i
s
k
y
sex
u
a
l
b
e
h
a
v
i
o
r
a
mo
n
g
a
d
o
l
e
sc
e
n
t
s
i
n
1
4
s
u
b
-
S
a
h
a
r
a
n
A
f
r
i
c
a
c
o
u
n
t
r
i
e
s
w
h
o
r
e
p
o
r
t
e
v
e
r
h
a
v
i
n
g
h
a
d
se
x
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
f
o
r
Eq
u
i
t
y
i
n
H
e
a
l
t
h
,
v
o
l
.
2
0
,
n
o
.
1
,
p
p
.
1
–
7
,
2
0
2
1
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
9
3
9
-
0
2
0
-
0
1
3
5
2
-
8.
[
1
0
]
K
e
m
e
n
d
i
k
b
u
d
r
i
st
e
k
R
I
,
Re
g
u
l
a
t
i
o
n
o
f
t
h
e
M
i
n
i
s
t
e
r
o
f
E
d
u
c
a
t
i
o
n
,
C
u
l
t
u
re
,
Re
se
a
rc
h
a
n
d
T
e
c
h
n
o
l
o
g
y
o
f
t
h
e
Re
p
u
b
l
i
c
o
f
I
n
d
o
n
e
s
i
a
N
u
m
b
e
r
3
0
o
f
2
0
2
1
c
o
n
c
e
r
n
i
n
g
p
rev
e
n
t
i
o
n
a
n
d
h
a
n
d
l
i
n
g
o
f
se
x
u
a
l
v
i
o
l
e
n
c
e
i
n
h
i
g
h
e
r
e
d
u
c
a
t
i
o
n
i
n
s
t
i
t
u
t
i
o
n
s
v
o
l
.
5
.
B
N
.
2
0
2
1
/
N
o
.
1
0
0
0
,
j
d
i
h
.
k
e
m
d
i
k
b
u
d
.
g
o
.
i
d
:
3
5
h
l
m.,
2
0
2
1
,
p
.
6
.
[
1
1
]
B
.
C
.
d
e
S
o
u
s
a
,
R
.
S
.
D
o
s
S
a
n
t
o
s
,
K
.
C
.
S
a
n
t
a
n
a
,
R
.
S
o
u
z
a
s
,
Á
.
J
.
M
.
L
e
i
t
e
,
a
n
d
D
.
S
.
d
e
M
e
d
e
i
r
o
s
,
“
S
e
x
u
a
l
b
e
h
a
v
i
o
r
a
n
d
a
s
s
o
c
i
a
t
e
d
f
a
c
t
o
r
s
i
n
r
u
r
a
l
a
d
o
l
e
s
c
e
n
t
s
,
”
R
e
v
i
s
t
a
d
e
S
a
ú
d
e
P
ú
b
l
i
c
a
,
v
o
l
.
5
2
,
p
.
3
9
,
2
0
1
8
,
d
o
i
:
1
0
.
1
1
6
0
6
/
s
1
5
1
8
-
8
7
8
7
.
2
0
1
8
0
5
2
0
0
6
9
8
8
.
[
1
2
]
Ea
st
J
a
v
a
C
e
n
t
r
a
l
B
u
r
e
a
u
o
f
S
t
a
t
i
s
t
i
c
s
,
“
N
u
m
b
e
r
o
f
st
u
d
e
n
t
s
(
p
u
b
l
i
c
a
n
d
p
r
i
v
a
t
e
)
u
n
d
e
r
t
h
e
M
i
n
i
s
t
r
y
o
f
Ed
u
c
a
t
i
o
n
a
n
d
C
u
l
t
u
r
e
by
D
i
st
r
i
c
t
/
C
i
t
y
,
2
0
2
1
a
n
d
2
0
2
2
”
Ea
s
t
J
a
v
a
C
e
n
t
r
a
l
B
u
r
e
a
u
o
f
S
t
a
t
i
st
i
c
s
.
[
1
3
]
T.
V
e
n
t
e
,
M
.
D
a
l
e
y
,
E.
K
i
l
l
me
y
e
r
,
a
n
d
L.
K
.
G
r
u
b
b
,
“
A
ss
o
c
i
a
t
i
o
n
o
f
s
o
c
i
a
l
me
d
i
a
u
se
a
n
d
h
i
g
h
-
r
i
s
k
b
e
h
a
v
i
o
r
s
i
n
a
d
o
l
e
sce
n
t
s
:
C
r
o
ss
-
se
c
t
i
o
n
a
l
s
t
u
d
y
,
”
J
MIR P
e
d
i
a
t
r
i
c
s a
n
d
P
a
r
e
n
t
i
n
g
,
v
o
l
.
3
,
n
o
.
1
,
p
p
.
1
–
1
0
,
2
0
2
0
,
d
o
i
:
1
0
.
2
1
9
6
/
1
8
0
4
3
.
[
1
4
]
A
.
F
.
B
r
o
u
w
e
r
e
t
a
l
.
,
“
H
P
V
v
a
c
c
i
n
a
t
i
o
n
h
a
s
n
o
t
i
n
c
r
e
a
se
d
s
e
x
u
a
l
a
c
t
i
v
i
t
y
o
r
a
c
c
e
l
e
r
a
t
e
d
se
x
u
a
l
d
e
b
u
t
i
n
a
c
o
l
l
e
g
e
-
a
g
e
d
c
o
h
o
r
t
o
f
men
a
n
d
w
o
m
e
n
,
”
BM
C
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
9
,
n
o
.
1
,
p
.
8
2
1
,
D
e
c
.
2
0
1
9
,
d
o
i
:
1
0
.
1
1
8
6
/
s1
2
8
8
9
-
0
1
9
-
7
1
3
4
-
1.
[
1
5
]
T.
A
mare
,
T.
Y
e
n
e
a
b
a
t
,
a
n
d
Y
.
A
m
a
r
e
,
“
A
s
y
st
e
ma
t
i
c
r
e
v
i
e
w
a
n
d
m
e
t
a
-
a
n
a
l
y
s
i
s
o
f
e
p
i
d
e
m
i
o
l
o
g
y
o
f
r
i
sk
y
s
e
x
u
a
l
b
e
h
a
v
i
o
r
s
i
n
c
o
l
l
e
g
e
a
n
d
u
n
i
v
e
r
s
i
t
y
s
t
u
d
e
n
t
s i
n
E
t
h
i
o
p
i
a
,
2
0
1
8
,
”
J
o
u
r
n
a
l
o
f
En
v
i
r
o
n
m
e
n
t
a
l
a
n
d
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
0
1
9
,
p
.
4
8
5
2
1
3
0
,
2
0
1
9
,
d
o
i
:
1
0
.
1
1
5
5
/
2
0
1
9
/
4
8
5
2
1
3
0
.
[
1
6
]
A
.
I
.
A
j
a
y
i
,
K
.
O
.
I
smai
l
,
a
n
d
W
.
A
k
p
a
n
,
“
F
a
c
t
o
r
s
a
sso
c
i
a
t
e
d
w
i
t
h
c
o
n
si
s
t
e
n
t
c
o
n
d
o
m
u
se:
a
c
r
o
ss
-
se
c
t
i
o
n
a
l
s
u
r
v
e
y
o
f
t
w
o
N
i
g
e
r
i
a
n
u
n
i
v
e
r
si
t
i
e
s,”
B
MC
Pu
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
9
,
n
o
.
1
,
p
.
1
2
0
7
,
2
0
1
9
,
d
o
i
:
1
0
.
1
1
8
6
/
s
1
2
8
8
9
-
0
1
9
-
7
5
4
3
-
1.
[
1
7
]
M
.
M
a
j
e
r
,
B
.
P
u
š
k
a
r
i
ć
S
a
i
ć
,
V
.
M
u
s
i
l
,
R
.
M
u
ž
i
ć
,
N
.
P
j
e
v
a
č
,
a
n
d
V
.
J
u
r
e
ša,
“
S
e
x
u
a
l
b
e
h
a
v
i
o
u
r
a
n
d
a
t
t
i
t
u
d
e
s
a
mo
n
g
u
n
i
v
e
r
s
i
t
y
st
u
d
e
n
t
s
i
n
Z
a
g
r
e
b
,
”
E
u
r
o
p
e
a
n
J
o
u
rn
a
l
o
f
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
9
,
n
o
.
S
u
p
p
l
e
me
n
t
_
4
,
p
.
c
k
z
1
8
6
.
1
6
4
,
N
o
v
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
9
3
/
e
u
r
p
u
b
/
c
k
z
1
8
6
.
1
6
4
.
[
1
8
]
P
.
U
e
d
a
,
C
.
H
.
M
e
r
c
e
r
,
C
.
G
h
a
z
n
a
v
i
,
a
n
d
D
.
H
e
r
b
e
n
i
c
k
,
“
Tr
e
n
d
s
i
n
F
r
e
q
u
e
n
c
y
o
f
S
e
x
u
a
l
A
c
t
i
v
i
t
y
a
n
d
N
u
mb
e
r
o
f
S
e
x
u
a
l
P
a
r
t
n
e
r
s
a
mo
n
g
A
d
u
l
t
s
A
g
e
d
1
8
t
o
4
4
Y
e
a
r
s
i
n
t
h
e
U
S
,
2
0
0
0
-
2
0
1
8
,
”
J
A
MA
N
e
t
w
o
rk
O
p
e
n
,
v
o
l
.
3
,
n
o
.
6
,
p
p
.
1
–
1
5
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
0
1
/
j
a
ma
n
e
t
w
o
r
k
o
p
e
n
.
2
0
2
0
.
3
8
3
3
.
[
1
9
]
P
r
e
si
d
e
n
t
o
f
t
h
e
R
e
p
u
b
l
i
c
o
f
I
n
d
o
n
e
s
i
a
,
N
a
t
i
o
n
a
l
p
o
l
i
c
y
t
o
e
ra
d
i
c
a
t
e
c
r
i
m
i
n
a
l
a
c
t
s
o
f
s
e
x
u
a
l
v
i
o
l
e
n
c
e
.
2
0
2
3
.
A
c
c
e
sse
d
:
A
p
r
.
1
5
,
2
0
2
3
.
[
O
n
l
i
n
e
.
]
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
p
e
r
a
t
u
r
a
n
.
b
p
k
.
g
o
.
i
d
/
D
e
t
a
i
l
s
/
2
7
6
4
1
5
/
p
e
r
p
r
e
s
-
no
-
9
-
t
a
h
u
n
-
2
0
2
4
[
2
0
]
L.
R
u
m
b
l
e
,
R
.
F
.
F
e
b
r
i
a
n
t
o
,
M
.
N
.
L
a
r
a
sat
i
,
C
.
H
a
mi
l
t
o
n
,
B
.
M
a
t
h
e
w
s,
a
n
d
M
.
P
.
D
u
n
n
e
,
“
C
h
i
l
d
h
o
o
d
se
x
u
a
l
v
i
o
l
e
n
c
e
i
n
i
n
d
o
n
e
si
a
:
a
sy
st
e
mat
i
c
r
e
v
i
e
w
,
”
T
r
a
u
m
a
,
V
i
o
l
e
n
c
e
,
a
n
d
A
b
u
s
e
,
v
o
l
.
2
1
,
n
o
.
2
,
p
p
.
2
8
4
–
2
9
9
,
2
0
2
0
,
d
o
i
:
1
0
.
1
1
7
7
/
1
5
2
4
8
3
8
0
1
8
7
6
7
9
3
2
.
[
2
1
]
M
.
G
h
a
f
f
a
r
i
,
S
.
R
a
k
h
s
h
a
n
d
e
r
o
u
,
Z.
G
h
a
r
l
i
p
o
u
r
,
F
.
K
.
F
a
r
a
h
a
n
i
,
T.
R
a
me
z
a
n
i
,
a
n
d
F
.
I
z
a
d
k
h
a
h
,
“
S
t
u
d
e
n
t
s’
p
e
r
sp
e
c
t
i
v
e
o
n
f
a
c
t
o
r
s
i
n
f
l
u
e
n
c
i
n
g
p
r
e
m
a
r
i
t
a
l
se
x
u
a
l
i
n
t
e
r
c
o
u
r
se,
”
J
o
u
r
n
a
l
o
f
H
o
l
i
s
t
i
c
N
u
r
si
n
g
a
n
d
Mi
d
w
i
f
e
ry
,
v
o
l
.
3
0
,
n
o
.
2
,
p
p
.
1
1
1
–
1
1
9
,
2
0
2
0
,
d
o
i
:
1
0
.
3
2
5
9
8
/
j
h
n
m
.
3
0
.
2
.
1
1
1
.
[
2
2
]
A
.
P
u
r
w
a
n
t
i
,
G
e
n
d
e
r
-
b
a
se
d
v
i
o
l
e
n
c
e
.
B
a
n
t
u
l
:
B
I
LD
U
N
G
,
2
0
2
0
.
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
R
is
k
a
n
a
lysi
s
o
f a
d
o
lescen
t se
xu
a
l a
ctivity
in
co
lleg
e
S
u
r
a
b
a
ya
,
I
n
d
o
n
esia
:
…
(
E
n
y
Qu
r
n
iy
a
w
a
ti)
1801
[
2
3
]
M
.
S
.
B
a
n
u
l
,
“
R
e
l
a
t
i
o
n
s
h
i
p
b
e
t
w
e
e
n
r
e
si
d
e
n
c
e
a
n
d
a
c
c
e
ss
t
o
p
o
r
n
o
g
r
a
p
h
i
c
med
i
a
w
i
t
h
p
r
e
mar
i
t
a
l
se
x
b
e
h
a
v
i
o
r
o
f
a
d
o
l
e
s
c
e
n
t
s
i
n
S
M
K
K
o
t
a
R
u
t
e
n
g
(
i
n
I
n
d
o
n
e
si
a
:
H
u
b
u
n
g
a
n
t
e
m
p
a
t
t
i
n
g
g
a
l
d
a
n
a
k
ses
m
e
d
i
a
p
o
rn
o
g
ra
f
i
d
e
n
g
a
n
p
e
ri
l
a
k
u
sek
s
p
r
a
n
i
k
a
h
rem
a
j
a
d
i
S
M
K
K
o
t
a
R
u
t
e
n
g
)
”
M
a
l
a
h
a
y
a
t
i
N
u
r
si
n
g
J
o
u
r
n
a
l
,
v
o
l
.
4
,
n
o
.
1
1
,
p
p
.
3
0
7
7
–
3
0
8
9
,
2
0
2
2
,
d
o
i
:
1
0
.
3
3
0
2
4
/
m
n
j
.
v
4
i
1
1
.
7
5
8
7
.
[
2
4
]
S
.
M
a
e
l
i
ss
a
,
“
R
i
sk
o
f
t
e
e
n
a
g
e
r
s’
p
r
e
-
marit
a
l
se
x
u
a
l
b
e
h
a
v
i
o
r
i
n
b
o
a
r
d
i
n
g
h
o
u
s
e
s
,
”
P
I
C
N
H
S
,
v
o
l
.
1
,
n
o
.
1
,
p
p
.
2
5
-
3
4
,
D
e
c
.
2
0
2
0
.
[
2
5
]
V
.
M
a
i
a
n
d
S
.
K
i
t
t
i
s
u
k
s
a
t
h
i
t
,
“
F
a
c
t
o
r
s
i
n
f
l
u
e
n
c
i
n
g
p
r
e
-
m
a
r
i
t
a
l
se
x
u
a
l
i
n
t
e
r
c
o
u
r
se
a
m
o
n
g
u
n
marr
i
e
d
y
o
u
n
g
i
n
d
i
v
i
d
u
a
l
s
i
n
C
a
m
b
o
d
i
a
,
”
M
a
k
a
r
a
J
o
u
r
n
a
l
o
f
H
e
a
l
t
h
R
e
se
a
rc
h
,
v
o
l
.
2
3
,
n
o
.
3
,
p
p
.
1
4
3
–
1
4
9
,
2
0
1
9
,
d
o
i
:
1
0
.
7
4
5
4
/
ms
k
.
v
2
3
i
3
.
1
1
5
7
.
[
2
6
]
Y
o
l
a
n
d
a
,
R
i
k
a
,
a
n
d
M
i
y
a
,
“
C
o
mp
a
r
a
t
i
v
e
A
n
a
l
y
si
s
b
e
t
w
e
e
n
g
o
j
e
k
d
r
i
v
e
r
i
n
c
o
me
a
n
d
r
e
g
i
o
n
a
l
m
i
n
i
mu
m
w
a
g
e
(
U
M
R
)
i
n
S
u
r
a
b
a
y
a
C
i
t
y
,
”
2
0
2
0
.
A
c
c
e
se
d
:
A
p
r
.
1
5
,
2
0
2
3
[
O
n
l
i
n
e
]
.
A
v
a
i
l
a
b
l
e
:
h
t
t
p
:
/
/
r
e
p
o
si
t
o
r
y
.
s
t
i
e
ma
h
a
r
d
h
i
k
a
.
a
c
.
i
d
/
1
4
5
5
/
.
[
2
7
]
R
.
S
i
n
a
g
a
,
“
Th
e
r
e
l
a
t
i
o
n
s
h
i
p
b
e
t
w
e
e
n
t
h
e
r
o
l
e
o
f
p
a
r
e
n
t
s i
n
me
d
i
a
a
c
c
e
ss
t
o
a
d
o
l
e
sce
n
t
se
x
u
a
l
b
e
h
a
v
i
o
r
I
n
S
M
A
6
Ta
k
e
n
g
o
n
,
S
i
l
i
h
N
a
r
a
D
i
s
t
r
i
c
t
,
A
c
e
h
C
e
n
t
r
a
l
D
i
st
r
i
c
t
Y
e
a
r
2
0
2
0
,
”
M
i
d
w
i
f
e
r
y
,
v
o
l
.
9
,
n
o
.
2
,
p
p
.
6
5
0
-
6
5
4
,
S
e
p
.
2
0
2
1
.
[
2
8
]
A
.
V
a
n
n
u
c
c
i
,
E
.
G
.
S
i
mp
s
o
n
,
S
.
G
a
g
n
o
n
,
a
n
d
C
.
M
.
C
.
O
h
a
n
n
e
ssi
a
n
,
“
S
o
c
i
a
l
me
d
i
a
u
se
a
n
d
r
i
s
k
y
b
e
h
a
v
i
o
r
s
i
n
a
d
o
l
e
s
c
e
n
t
s
:
A
met
a
-
a
n
a
l
y
si
s
,
”
J
o
u
r
n
a
l
o
f
A
d
o
l
e
s
c
e
n
c
e
,
v
o
l
.
7
9
,
n
o
.
F
e
b
r
u
a
r
y
,
p
p
.
2
5
8
–
2
7
4
,
2
0
2
0
,
d
o
i
:
1
0
.
1
0
1
6
/
j
.
a
d
o
l
e
sc
e
n
c
e
.
2
0
2
0
.
0
1
.
0
1
4
.
[
2
9
]
C
.
A
.
U
k
w
u
e
z
e
a
n
d
E
.
C
.
A
b
a
n
e
me
,
“
S
e
x
t
i
n
g
:
a
se
l
f
p
o
r
t
r
a
y
a
l
t
r
e
n
d
a
m
o
n
g
y
o
u
t
h
s
o
n
s
o
c
i
a
l
me
d
i
a
?
,
”
S
o
c
i
a
l
sc
i
e
n
t
i
a
:
J
o
u
rn
a
l
o
f
S
o
c
i
a
l
S
c
i
e
n
c
e
s
a
n
d
H
u
m
a
n
i
t
i
e
s
,
v
o
l
.
6
,
n
o
.
1
,
2
0
2
1
.
[
3
0
]
E.
A
smi
n
a
n
d
J
.
M
a
i
n
a
s
e
,
“
T
h
e
u
s
e
o
f
mass
me
d
i
a
a
n
d
s
o
c
i
o
e
c
o
n
o
m
i
c
p
a
r
e
n
t
s
o
n
a
d
o
l
e
sc
e
n
t
s
e
x
u
a
l
b
e
h
a
v
i
o
r
”
Mo
l
u
c
c
a
M
e
d
i
c
a
,
p
p
.
2
4
–
2
8
,
2
0
2
0
,
d
o
i
:
1
0
.
3
0
5
9
8
/
mo
l
m
e
d
.
2
0
2
0
.
v
1
3
.
i
1
.
2
4
.
[
3
1
]
G
.
d
e
F
e
l
i
c
e
e
t
a
l
.
,
“
H
o
w
d
o
a
d
o
l
e
s
c
e
n
t
s
u
s
e
s
o
c
i
a
l
n
e
t
w
o
r
k
s
a
n
d
w
h
a
t
a
r
e
t
h
e
i
r
p
o
t
e
n
t
i
a
l
d
a
n
g
e
r
s
?
a
q
u
a
l
i
t
a
t
i
v
e
s
t
u
d
y
o
f
g
e
n
d
e
r
d
i
f
f
e
r
e
n
c
e
s
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
E
n
v
i
r
o
n
m
e
n
t
a
l
R
e
s
e
a
r
c
h
a
n
d
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
1
9
,
n
o
.
9
,
2
0
2
2
,
d
o
i
:
1
0
.
3
3
9
0
/
i
j
e
r
p
h
1
9
0
9
5
6
9
1
.
[
3
2
]
D
.
P
i
r
r
o
n
e
,
M
.
Z
o
n
d
e
r
v
a
n
-
Zw
i
j
n
e
n
b
u
r
g
,
E
.
R
e
i
t
z
,
R
.
J
.
J.
M
.
v
a
n
d
e
n
Ei
j
n
d
e
n
,
a
n
d
T
.
F
.
M
.
t
e
r
B
o
g
t
,
“
P
o
r
n
o
g
r
a
p
h
y
u
s
e
p
r
o
f
i
l
e
s
a
n
d
t
h
e
e
mer
g
e
n
c
e
o
f
s
e
x
u
a
l
b
e
h
a
v
i
o
r
s
i
n
a
d
o
l
e
sc
e
n
c
e
,
”
Ar
c
h
i
v
e
s
o
f
S
e
x
u
a
l
Be
h
a
v
i
o
r
,
v
o
l
.
5
1
,
n
o
.
2
,
p
p
.
1
1
4
1
–
1
1
5
6
,
2
0
2
2
,
d
o
i
:
1
0
.
1
0
0
7
/
s
1
0
5
0
8
-
0
2
1
-
0
2
1
4
0
-
3.
[
3
3
]
W
.
R
a
h
ma
d
h
a
n
i
a
n
d
W
.
L
a
o
h
a
s
i
r
i
w
o
n
g
,
“
G
e
n
d
e
r
o
f
b
a
b
y
a
n
d
p
o
s
t
p
a
r
t
u
m
d
e
p
r
e
ss
i
o
n
a
m
o
n
g
a
d
o
l
e
sc
e
n
t
mo
t
h
e
r
s
i
n
C
e
n
t
r
a
l
Ja
v
a
,
I
n
d
o
n
e
si
a
,
”
P
e
d
i
a
t
ri
c
s
a
n
d
Ad
o
l
e
sc
e
n
t
H
e
a
l
t
h
:
R
e
c
e
n
t
I
n
t
e
r
n
a
t
i
o
n
a
l
Re
s
e
a
r
c
h
,
v
o
l
.
1
3
,
n
o
.
1
,
p
p
.
1
5
7
–
1
7
0
,
2
0
2
2
.
[
3
4
]
M
.
W
i
l
l
i
s
a
n
d
R
.
S
m
i
t
h
,
“
S
e
x
u
a
l
c
o
n
se
n
t
a
c
r
o
ss
d
i
v
e
r
se
b
e
h
a
v
i
o
r
s
a
n
d
c
o
n
t
e
x
t
s
:
g
e
n
d
e
r
d
i
f
f
e
r
e
n
c
e
s
a
n
d
n
o
n
c
o
n
s
e
n
su
a
l
se
x
u
a
l
e
x
p
e
r
i
e
n
c
e
s
,
”
J
o
u
rn
a
l
o
f
I
n
t
e
rp
e
r
so
n
a
l
Vi
o
l
e
n
c
e
,
v
o
l
.
3
7
,
n
o
.
1
9
–
2
0
,
p
p
.
N
P
1
8
9
0
8
–
N
P
1
8
9
3
4
,
O
c
t
.
2
0
2
2
,
d
o
i
:
1
0
.
1
1
7
7
/
0
8
8
6
2
6
0
5
2
1
1
0
4
4
1
0
1
.
[
3
5
]
A
.
G
r
u
b
e
r
,
“
A
f
f
i
r
ma
t
i
v
e
C
o
n
s
e
n
t
,
”
2
0
2
2
.
A
c
c
e
ss
e
d
:
A
p
r
.
1
5
,
2
0
2
3
.
[
O
n
l
i
n
e
.
]
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s
:
/
/
sc
h
o
l
a
r
.
l
a
w
.
c
o
l
o
r
a
d
o
.
e
d
u
/
f
a
c
u
l
t
y
-
a
r
t
i
c
l
e
s/
1
5
8
9
/
[
3
6
]
P
.
J.
H
i
l
l
s,
M
.
P
l
e
v
a
,
E.
S
e
i
b
,
a
n
d
T.
C
o
l
e
,
“
U
n
d
e
r
s
t
a
n
d
i
n
g
H
o
w
u
n
i
v
e
r
si
t
y
st
u
d
e
n
t
s
u
se
p
e
r
c
e
p
t
i
o
n
s
o
f
c
o
n
se
n
t
,
w
a
n
t
e
d
n
e
ss,
a
n
d
p
l
e
a
s
u
r
e
i
n
La
b
e
l
i
n
g
R
a
p
e
,
”
Ar
c
h
i
v
e
s
o
f
S
e
x
u
a
l
B
e
h
a
v
i
o
r
,
v
o
l
.
5
0
,
n
o
.
1
,
p
p
.
2
4
7
–
2
6
2
,
2
0
2
1
,
d
o
i
:
1
0
.
1
0
0
7
/
s
1
0
5
0
8
-
0
2
0
-
0
1
7
7
2
-
1.
[
3
7
]
M
.
H
o
l
t
z
m
a
n
,
“
Lo
w
e
r
i
n
g
t
h
e
r
i
s
k
o
f
sex
u
a
l
a
ssa
u
l
t
:
w
h
a
t
c
a
m
p
u
ses
n
e
e
d
t
o
k
n
o
w
a
b
o
u
t
e
f
f
e
c
t
i
v
e
p
r
e
v
e
n
t
i
o
n
p
r
o
g
r
a
m
mi
n
g
,
”
C
h
a
n
g
e
:
T
h
e
Ma
g
a
zi
n
e
o
f
H
i
g
h
e
r L
e
a
rn
i
n
g
,
v
o
l
.
5
1
,
n
o
.
3
,
p
p
.
2
8
–
3
3
,
M
a
y
2
0
1
9
,
d
o
i
:
1
0
.
1
0
8
0
/
0
0
0
9
1
3
8
3
.
2
0
1
9
.
1
6
0
6
5
8
6
.
[
3
8
]
R
.
O
r
t
i
z
,
“
Ex
p
l
i
c
i
t
,
v
o
l
u
n
t
a
r
y
,
a
n
d
c
o
n
s
c
i
o
u
s:
a
ss
e
ssm
e
n
t
o
f
t
h
e
i
m
p
o
r
t
a
n
c
e
o
f
a
d
o
p
t
i
n
g
a
n
a
f
f
i
r
ma
t
i
v
e
c
o
n
s
e
n
t
d
e
f
i
n
i
t
i
o
n
f
o
r
sex
u
a
l
a
ss
a
u
l
t
p
r
e
v
e
n
t
i
o
n
p
r
o
g
r
a
mm
i
n
g
o
n
c
o
l
l
e
g
e
c
a
m
p
u
s
e
s,
”
J
o
u
r
n
a
l
o
f
H
e
a
l
t
h
C
o
m
m
u
n
i
c
a
t
i
o
n
,
v
o
l
.
2
4
,
n
o
.
9
,
p
p
.
7
2
8
–
7
3
5
,
S
e
p
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
8
0
/
1
0
8
1
0
7
3
0
.
2
0
1
9
.
1
6
6
6
9
3
9
.
[
3
9
]
C
.
H
o
l
mstr
ö
m,
L.
P
l
a
n
t
i
n
,
a
n
d
E.
El
mers
t
i
g
,
“
C
o
m
p
l
e
x
i
t
i
e
s
o
f
se
x
u
a
l
c
o
n
sen
t
:
y
o
u
n
g
p
e
o
p
l
e
’
s
r
e
a
s
o
n
i
n
g
i
n
a
S
w
e
d
i
s
h
c
o
n
t
e
x
t
,
”
Psy
c
h
o
l
.
S
e
x
.
,
v
o
l
.
1
1
,
n
o
.
4
,
p
p
.
3
4
2
–
3
5
7
,
O
c
t
.
2
0
2
0
,
d
o
i
:
1
0
.
1
0
8
0
/
1
9
4
1
9
8
9
9
.
2
0
2
0
.
1
7
6
9
1
6
3
.
[
4
0
]
M
.
W
i
l
l
i
s,
M
.
H
u
n
t
,
A
.
W
o
d
i
k
a
,
D
.
L.
R
h
o
d
e
s,
J
.
G
o
o
d
m
a
n
,
a
n
d
K
.
N
.
Jo
z
k
o
w
s
k
i
,
“
E
x
p
l
i
c
i
t
v
e
r
b
a
l
se
x
u
a
l
c
o
n
se
n
t
c
o
mm
u
n
i
c
a
t
i
o
n
:
e
f
f
e
c
t
s
o
f
g
e
n
d
e
r
,
r
e
l
a
t
i
o
n
sh
i
p
st
a
t
u
s,
a
n
d
t
y
p
e
o
f
se
x
u
a
l
b
e
h
a
v
i
o
r
,
”
I
n
t
e
rn
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
S
e
x
u
a
l
H
e
a
l
t
h
,
v
o
l
.
3
1
,
n
o
.
1
,
p
p
.
6
0
–
7
0
,
J
a
n
.
2
0
1
9
,
d
o
i
:
1
0
.
1
0
8
0
/
1
9
3
1
7
6
1
1
.
2
0
1
9
.
1
5
6
5
7
9
3
.
[
4
1
]
M
.
C
.
D
a
r
d
e
n
,
A
.
C
.
E
h
m
a
n
,
E
.
C
.
L
a
i
r
,
a
n
d
A
.
M
.
G
r
o
s
s
,
“
S
e
x
u
a
l
c
o
m
p
l
i
a
n
c
e
:
e
x
a
m
i
n
i
n
g
t
h
e
r
e
l
a
t
i
o
n
s
h
i
p
s
a
m
o
n
g
s
e
x
u
a
l
w
a
n
t
,
s
e
x
u
a
l
c
o
n
s
e
n
t
,
a
n
d
s
e
x
u
a
l
a
s
s
e
r
t
i
v
e
n
e
s
s
,
”
S
e
x
u
a
l
i
t
y
&
C
u
l
t
u
r
e
,
v
o
l
.
2
3
,
n
o
.
1
,
p
p
.
2
2
0
–
2
3
5
,
2
0
1
9
,
d
o
i
:
1
0
.
1
0
0
7
/
s
1
2
1
1
9
-
0
1
8
-
9
5
5
1
-
1.
[
4
2
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
“
S
e
x
u
a
l
l
y
t
r
a
n
sm
i
t
t
e
d
i
n
f
e
c
t
i
o
n
s
(
S
TI
s)
,
”
F
a
c
t
S
h
e
e
t
s
W
H
O
.
A
c
c
e
sse
d
:
A
p
r
.
1
5
,
2
0
2
3
.
[
O
n
l
i
n
e
.
]
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s:
/
/
w
w
w
.
w
h
o
.
i
n
t
/
n
e
w
s
-
r
o
o
m
/
f
a
c
t
-
sh
e
e
t
s/
d
e
t
a
i
l
/
se
x
u
a
l
l
y
-
t
r
a
n
s
mi
t
t
e
d
-
i
n
f
e
c
t
i
o
n
s
-
(
st
i
s)
.
[
4
3
]
A
.
D
h
a
n
o
a
,
F
.
Eh
s
a
n
,
K
.
H
u
x
t
e
r
,
C
.
L.
M
o
l
l
e
r
,
L.
N
o
l
e
t
-
M
u
l
h
o
l
l
a
n
d
,
a
n
d
R
.
D
a
h
a
l
,
“
Y
o
u
n
g
a
n
d
r
i
sk
y
:
se
x
u
a
l
b
e
h
a
v
i
o
u
r
s
a
m
o
n
g
g
e
n
e
r
a
t
i
o
n
Z
a
n
d
mi
l
l
e
n
n
i
a
l
s
,
”
Eu
r
e
k
a
,
v
o
l
.
5
,
n
o
.
1
,
p
p
.
1
–
9
,
D
e
c
.
2
0
2
0
,
d
o
i
:
1
0
.
2
9
1
7
3
/
e
u
r
e
k
a
2
8
7
4
9
.
[
4
4
]
H
e
a
l
t
h
P
r
o
t
e
c
t
i
o
n
S
u
r
v
e
i
l
l
a
n
c
e
C
e
n
t
r
e
,
“
I
n
c
r
e
a
se
d
S
TI
n
o
t
i
f
i
c
a
t
i
o
n
s i
n
I
R
e
l
a
n
d
si
n
c
e
t
h
e
C
O
V
I
D
-
1
9
p
a
n
d
e
mi
c
,
”
H
e
a
l
t
h
P
r
o
t
e
c
t
i
o
n
S
u
r
v
e
i
l
l
a
n
c
e
C
e
n
t
r
e
.
A
c
c
e
sse
d
:
A
p
r
.
1
5
,
2
0
2
3
.
[
O
n
l
i
n
e
.
]
A
v
a
i
l
a
b
l
e
:
h
t
t
p
s:
/
/
w
w
w
.
h
p
s
c
.
i
e
/
n
e
w
s
/
n
e
w
sarc
h
i
v
e
/
2
0
2
3
n
e
w
sar
c
h
i
v
e
/
t
i
t
l
e
-
2
3
0
8
9
-
e
n
.
h
t
ml
[
4
5
]
I
.
G
.
N
.
E
.
P
u
t
r
a
,
D
.
A
s
t
u
t
i
,
D
.
A
.
W
i
d
y
a
s
t
a
r
i
,
a
n
d
D
.
P
h
u
e
n
g
s
a
m
r
a
n
,
“
P
r
e
v
a
l
e
n
c
e
a
n
d
d
e
t
e
r
m
i
n
a
n
t
s
o
f
c
o
n
d
o
m
u
s
e
a
m
o
n
g
m
a
l
e
a
d
o
l
e
s
c
e
n
t
s
i
n
I
n
d
o
n
e
s
i
a
,
”
I
n
t
e
r
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
A
d
o
l
e
s
c
e
n
t
M
e
d
i
c
i
n
e
a
n
d
H
e
a
l
t
h
,
v
o
l
.
3
3
,
n
o
.
2
,
2
0
2
1
,
d
o
i
:
1
0
.
1
5
1
5
/
i
j
a
m
h
-
2018
-
0
1
4
1
.
[
4
6
]
Y
.
W
a
n
g
,
M
.
C
h
e
n
,
a
n
d
J.
H
.
Le
e
,
“
A
d
o
l
e
sce
n
t
s’
so
c
i
a
l
n
o
r
ms
a
c
r
o
ss
f
a
mi
l
y
,
p
e
e
r
,
a
n
d
s
c
h
o
o
l
set
t
i
n
g
s:
l
i
n
k
i
n
g
s
o
c
i
a
l
n
o
r
m
p
r
o
f
i
l
e
s
t
o
a
d
o
l
e
s
c
e
n
t
r
i
sk
y
h
e
a
l
t
h
b
e
h
a
v
i
o
r
s
,
”
J
o
u
r
n
a
l
o
f
Y
o
u
t
h
a
n
d
A
d
o
l
e
s
c
e
n
c
e
,
v
o
l
.
4
8
,
n
o
.
5
,
p
p
.
9
3
5
–
9
4
8
,
2
0
1
9
,
d
o
i
:
1
0
.
1
0
0
7
/
s
1
0
9
6
4
-
0
1
9
-
0
0
9
8
4
-
6.
B
I
O
G
RAP
H
I
E
S O
F
AUTH
O
RS
En
y
Q
u
r
n
iy
a
wa
ti
is a l
e
c
tu
re
r
a
n
d
re
se
a
rc
h
e
r
a
t
th
e
De
p
a
rtme
n
t
o
f
Ep
i
d
e
m
io
l
o
g
y
,
Bio
sta
ti
stics
,
P
o
p
u
lati
o
n
S
t
u
d
ies
a
n
d
He
a
lt
h
P
r
o
m
o
ti
o
n
,
F
a
c
u
lt
y
o
f
P
u
b
li
c
He
a
lt
h
,
U
n
iv
e
rsitas
Airlan
g
g
a
.
T
h
e
a
u
t
h
o
r
is
in
tere
ste
d
i
n
c
o
n
d
u
c
ti
n
g
re
se
a
rc
h
with
p
u
b
li
c
h
e
a
lt
h
issu
e
s
re
late
d
t
o
stu
n
ti
n
g
,
HIV
/AIDS,
Re
p
ro
d
u
c
t
iv
e
He
a
lt
h
,
M
a
tern
a
l
a
n
d
Ch
il
d
He
a
lt
h
,
e
p
id
e
m
io
lo
g
y
o
f
in
fe
c
ti
o
u
s
a
n
d
n
o
n
-
c
o
m
m
u
n
ica
b
l
e
d
ise
a
se
s.
S
o
m
e
o
f
th
e
b
o
o
k
ti
tl
e
s
th
a
t
h
a
v
e
b
e
e
n
writt
e
n
in
c
lu
d
e
In
tr
o
d
u
c
ti
o
n
t
o
He
a
lt
h
M
e
th
o
d
o
l
o
g
y
a
n
d
I
n
tr
o
d
u
c
ti
o
n
t
o
E
p
id
e
m
io
l
o
g
y
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
at
e
m
a
il
:
e
n
y
.
q
u
rn
i
y
a
wa
ti
@fk
m
.
u
n
a
ir
.
a
c
.
id
.
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.
13
,
No
.
4
,
Dec
em
b
er
20
24
:
1
79
4
-
1
80
2
1802
Zid
a
H
u
sn
in
a
is
a
lec
tu
re
r
a
n
d
re
se
a
rc
h
e
r
fro
m
t
h
e
De
p
a
rtme
n
t
o
f
En
v
iro
n
m
e
n
tal
He
a
lt
h
,
F
a
c
u
lt
y
o
f
P
u
b
li
c
He
a
l
th
,
Un
iv
e
rsitas
Airlan
g
g
a
.
M
y
re
se
a
rc
h
in
tere
sts
in
c
lu
d
e
e
n
v
iro
n
m
e
n
tal
p
o
ll
u
ti
o
n
,
tro
p
ica
l
in
fe
c
ti
o
u
s
d
ise
a
se
s,
fo
o
d
sa
fe
ty
a
n
d
f
o
o
d
c
o
n
tam
in
a
ti
o
n
,
a
n
d
o
th
e
r
t
o
p
ics
re
late
d
t
o
e
n
v
iro
n
m
e
n
tal
risk
a
ss
e
ss
m
e
n
t
u
n
d
e
r
e
n
v
ir
o
n
m
e
n
tal
e
p
id
e
m
io
l
o
g
y
fra
m
e
wo
rk
.
I
a
m
k
e
e
n
o
n
lea
rn
in
g
a
b
o
u
t
e
n
v
ir
o
n
m
e
n
tal
h
e
a
lt
h
fro
m
m
u
lt
ip
le
p
e
rsp
e
c
ti
v
e
s
a
n
d
e
x
p
lo
r
in
g
n
e
w
m
e
th
o
d
s
o
f
a
n
a
ly
sis
to
s
u
p
p
o
rt
th
e
re
se
a
rc
h
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
z
id
a
.
h
u
s
n
in
a
@fk
m
.
u
n
a
ir.
a
c
.
i
d
.
J
a
y
a
n
ti
Di
a
n
Ek
a
S
a
r
i
is
a
le
c
tu
re
r
a
t
th
e
P
u
b
l
ic
He
a
lt
h
S
tu
d
y
P
ro
g
ra
m
,
F
a
c
u
lt
y
o
f
He
a
lt
h
,
M
e
d
icin
e
,
a
n
d
Li
fe
S
c
ien
c
e
s
(F
IKK
IA),
Un
i
v
e
rsitas
Air
lan
g
g
a
,
In
d
o
n
e
sia
,
wh
o
h
a
s
b
e
e
n
a
c
ti
v
e
sin
c
e
2
0
1
5
.
T
h
e
a
u
th
o
r
is ac
ti
v
e
in
re
se
a
rc
h
a
n
d
c
o
m
m
u
n
it
y
se
rv
ice
a
c
ti
v
it
ies
in
t
h
e
field
o
f
p
u
b
li
c
h
e
a
lt
h
.
Th
e
a
u
th
o
r
is
in
tere
ste
d
i
n
p
u
b
li
c
h
e
a
lt
h
p
ro
b
lem
s
re
late
d
to
stu
n
ti
n
g
,
HIV
/AIDS,
Ad
o
les
c
e
n
t
Re
p
ro
d
u
c
ti
v
e
He
a
lt
h
,
Was
te
M
a
n
a
g
e
m
e
n
t
a
n
d
Co
m
m
u
n
it
y
Emp
o
we
rm
e
n
t.
T
h
e
a
u
t
h
o
r
h
a
s
se
v
e
ra
l
c
o
p
y
ri
g
h
ts
o
n
p
ro
d
u
c
t
s
p
ro
d
u
c
e
d
e
it
h
e
r
th
r
o
u
g
h
re
se
a
rc
h
a
c
ti
v
it
ies
o
r
c
o
m
m
u
n
it
y
se
rv
ice
.
S
o
m
e
o
f
t
h
e
b
o
o
k
ti
tl
e
s
th
a
t
h
a
v
e
b
e
e
n
writ
ten
in
c
lu
d
e
th
e
He
a
lt
h
P
ro
m
o
ti
o
n
Bo
o
k
,
th
e
C
o
m
m
u
n
ica
ti
o
n
S
c
ien
c
e
Bo
o
k
a
n
d
th
e
I
n
tr
o
d
u
c
ti
o
n
to
M
a
n
a
g
e
m
e
n
t
B
o
o
k
.
Th
e
a
u
th
o
r
is
v
e
ry
c
o
m
m
it
ted
to
c
o
n
ti
n
u
i
n
g
to
su
p
p
o
rt
th
e
a
c
h
iev
e
m
e
n
t
o
f
th
e
S
DG
s
th
ro
u
g
h
a
se
ries
o
f
a
c
t
iv
it
ies
a
ime
d
a
t
in
c
re
a
sin
g
t
h
e
le
v
e
l
o
f
p
u
b
l
ic
h
e
a
lt
h
t
h
ro
u
g
h
a
c
ti
v
it
ies
to
stre
n
g
th
e
n
c
o
m
m
u
n
it
y
c
a
p
a
c
it
y
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
jay
a
n
ti
d
ian
@fk
m
.
u
n
a
ir.
a
c
.
i
d
.
As
m
a
Az
z
a
h
r
a
is
a
n
u
n
d
e
rg
ra
d
u
a
te
stu
d
e
n
t
o
f
P
u
b
li
c
He
a
lt
h
F
a
c
u
lt
y
wit
h
a
field
o
f
Ep
id
e
m
io
l
o
g
y
a
t
Un
i
v
e
rsitas
Airlan
g
g
a
,
S
u
ra
b
a
y
a
,
In
d
o
n
e
sia
.
I
h
a
v
e
a
n
i
n
tere
st
in
st
u
d
y
in
g
th
e
fiel
d
o
f
d
ise
a
se
su
r
v
e
il
lan
c
e
,
e
sp
e
c
ially
i
n
t
h
e
c
a
se
o
f
d
ise
a
se
s
th
a
t
c
a
n
c
a
u
se
o
u
tb
re
a
k
s.
I
a
m
a
lso
in
tere
ste
d
in
e
x
p
l
o
ri
n
g
t
h
e
d
e
v
e
l
o
p
m
e
n
t
o
f
p
u
b
li
c
h
e
a
lt
h
sta
tu
s.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
sm
a
a
z
z
a
h
ra
0
1
@g
m
a
il
.
c
o
m
.
Iz
z
a
h
Nur
S
h
a
b
r
in
a
is
a
n
u
n
d
e
r
g
ra
d
u
a
te
d
st
u
d
e
n
t
wh
o
h
a
s
stu
d
ied
in
P
u
b
li
c
He
a
lt
h
F
a
c
u
lt
y
o
f
Un
i
v
e
rsitas
Airlan
g
g
a
,
In
d
o
n
e
sia
.
M
a
jo
r
in
g
i
n
e
p
id
e
m
io
l
o
g
y
,
I
h
a
v
e
stu
d
ied
a
b
o
u
t
t
h
e
e
m
e
rg
e
n
c
e
o
f
d
ise
a
se
s
re
late
d
t
o
p
e
o
p
le,
p
lac
e
,
a
n
d
ti
m
e
a
s
th
e
fa
c
to
rs.
I
a
m
a
lso
in
tere
ste
d
in
n
u
tri
ti
o
n
a
l
a
sp
e
c
t
w
h
ich
tak
e
s
a
ro
le
a
s
a
p
e
o
p
le'
s
d
e
t
e
rm
in
a
n
t
fa
c
to
r
o
f
d
ise
a
se
.
I
h
a
v
e
so
m
e
e
x
p
e
rie
n
c
e
s
in
c
o
m
m
u
n
it
y
se
rv
ice
p
ro
jec
ts
wh
ic
h
tak
e
s
a
n
a
c
ti
o
n
to
b
ri
d
g
in
g
t
h
e
c
o
m
m
u
n
it
y
with
so
m
e
sta
k
e
h
o
l
d
e
rs
fo
r
a
imin
g
g
o
o
d
p
u
b
l
ic
h
e
a
lt
h
m
a
n
a
g
e
m
e
n
t.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
izz
a
h
n
u
rsh
a
b
r
in
a
@g
m
a
il
.
c
o
m
.
Prim
a
K
a
r
tik
a
is
a
g
ra
d
u
a
te
with
a
b
a
c
h
e
lo
r'
s
d
e
g
re
e
in
P
u
b
li
c
He
a
lt
h
fro
m
Airlan
g
g
a
U
n
iv
e
rsit
y
,
S
u
ra
b
a
y
a
,
In
d
o
n
e
sia
,
wit
h
a
n
in
tere
st
i
n
e
p
id
e
m
io
lo
g
y
.
S
h
e
is
c
l
o
se
ly
re
late
d
to
stu
d
y
in
g
th
e
field
o
f
i
n
f
e
c
ti
o
u
s
in
fe
c
ti
o
n
s
a
n
d
n
o
n
-
c
o
m
m
u
n
ica
b
le
d
ise
a
se
s
th
a
t
o
c
c
u
r
in
so
c
iety
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
p
rima
k
a
rti
k
a
a
a
@g
m
a
il
.
c
o
m
.
Na
y
la
M
o
ha
m
ed
G
o
m
a
a
Na
s
r
is
a
lec
tu
re
r
a
n
d
re
se
a
rc
h
e
r
a
t
t
h
e
fa
c
u
lt
y
o
f
p
u
b
li
c
a
n
d
E
n
v
iro
n
m
e
n
tal
H
e
a
lt
h
Ba
h
ri
U
n
iv
e
rsit
y
,
K
h
a
rto
u
m
,
S
u
d
a
n
.
Th
e
a
u
th
o
r
is
in
tere
ste
d
in
c
o
n
d
u
c
ti
n
g
re
se
a
rc
h
with
re
late
d
to
G
e
n
e
ti
c
s
a
n
d
Bi
o
m
a
rk
e
rs
,
M
e
d
ica
l
En
t
o
m
o
l
o
g
y
,
P
a
ra
sito
lo
g
y
,
Ep
i
d
e
m
io
lo
g
y
,
a
n
d
Disa
ste
r
m
a
n
a
g
e
m
e
n
t
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
n
il
e
o
o
o
o
o
h
@g
m
a
il
.
c
o
m
o
r
n
a
y
la.
g
o
m
a
a
@m
e
d
.
u
n
i
d
e
b
.
h
u
.
Evaluation Warning : The document was created with Spire.PDF for Python.