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s
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ac
k
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ng
,
.
.
(
Olubus
ay
o
A
k
inol
a)
173
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e
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y
[
8]
.
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e
v
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du
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ge
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a
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ge
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[
9
-
14]
a
m
o
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gs
t
a
do
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c
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s
[
15]
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us
e
o
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ps
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[
16]
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[
17]
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hi
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ubs
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us
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r
e
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t
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a
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s
[
18]
.
F
i
n
d
in
gs
f
r
o
m
t
h
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de
s
c
r
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pt
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v
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s
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ud
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d
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c
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t
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l
a
c
k
o
f
f
u
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r
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m
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e
a
l
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h
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ns
ur
a
n
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,
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s
f
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n
d
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r
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ve
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h
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[
18]
.
Oni
f
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de
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al
.
[
18]
e
s
t
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bli
s
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[
18]
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kpe
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[
13]
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s
s
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s
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p
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dd
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t
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t
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ge
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s
[
13]
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kpe
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g
[
13]
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gu
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de
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[
19]
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pr
o
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n
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Opo
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31%
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h
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pe
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[
13]
.
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i
t
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a
r
a
t
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f
33.
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dr
ug
us
e
a
m
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ude
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t
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[
13]
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ude
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s
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h
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s
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h
e
c
o
un
t
r
y
(
s
o
ut
h
we
s
t
a
n
d
s
o
ut
h
-
s
o
u
t
h
e
r
n
z
o
n
e
s
,
n
o
r
t
h
we
s
t
,
a
n
d
n
o
r
t
h
e
a
s
t
e
r
n
z
o
n
e
s
o
f
t
h
e
c
o
un
t
r
y
)
.
T
h
e
s
t
a
t
e
s
s
ur
v
e
y
e
d
f
r
o
m
e
a
c
h
z
o
ne
we
r
e
s
e
l
e
c
t
e
d
t
h
r
o
ugh
s
im
p
l
e
r
a
n
do
m
s
a
mp
l
i
ng
t
o
h
a
v
e
a
n
u
nbi
a
s
e
d
r
e
pr
e
s
e
n
t
a
t
i
o
n
o
f
M
HPs
i
n
t
h
e
c
o
un
t
r
y
.
Ho
s
pi
t
a
l
s
s
e
l
e
c
t
e
d
pe
r
z
o
n
e
we
r
e
f
e
de
r
a
l
n
e
ur
o
ps
y
c
hi
a
t
r
i
c
h
o
s
p
i
t
a
l
s
,
t
e
a
c
hi
n
g
h
o
s
p
i
t
a
l
s
,
a
n
d
s
t
a
t
e
n
e
ur
o
ps
y
c
hi
a
t
r
i
c
h
o
s
p
i
t
a
l
s
.
T
h
e
r
e
qu
i
r
e
d
s
a
m
p
l
e
s
i
z
e
wa
s
c
o
m
put
e
d
a
pr
i
o
r
i
us
i
ng
A
NO
V
A
f
i
xe
d
e
f
f
e
c
t
s
,
s
pe
c
i
a
l
m
a
i
n
e
f
f
e
c
t
s
,
a
n
d
i
n
t
e
r
a
c
t
i
o
ns
.
2.
1.
Com
p
l
ian
c
e
wit
h
e
t
h
ical
s
t
an
d
ar
d
s
E
t
hi
c
s
a
ppr
o
v
a
l
f
o
r
t
hi
s
s
t
ud
y
wa
s
o
b
t
a
i
n
e
d
f
r
o
m
W
a
l
de
n
U
ni
ve
r
s
i
t
y
I
ns
t
i
t
ut
i
o
n
a
l
R
e
vi
e
w
B
o
a
r
d
a
n
d
t
h
e
Na
t
i
o
n
a
l
He
a
l
t
h
R
e
s
e
a
r
c
h
E
t
hi
c
s
C
o
m
m
i
t
t
e
e
o
f
N
i
ge
r
i
a
(
NH
R
E
C
)
.
I
n
a
dd
i
t
i
o
n
,
i
nf
o
r
m
e
d
c
o
ns
e
n
t
s
we
r
e
o
b
t
a
i
n
e
d
f
r
o
m
M
HPs
w
h
o
r
e
s
po
n
de
d
to
t
h
e
s
ur
v
e
y
.
2.
2.
I
n
s
t
r
u
m
e
n
t
at
ion
an
d
op
e
r
at
ion
al
i
z
at
ion
of
c
on
s
t
r
u
c
t
s
T
h
e
i
ns
t
r
u
m
e
n
t
a
da
pt
e
d
i
n
t
hi
s
s
t
ud
y
i
s
t
h
e
s
u
bs
t
a
n
c
e
a
b
us
e
a
tt
i
t
ude
s
ur
v
e
y
(
S
AA
S
)
a
n
d
pe
r
m
i
s
s
i
o
n
to
a
da
pt
t
h
e
v
a
li
da
t
e
d
v
e
r
s
i
o
n
o
f
t
h
e
que
s
t
i
o
nn
a
i
r
e
wa
s
gr
a
n
t
e
d
by
t
h
e
c
o
p
y
r
i
g
h
t
h
o
l
de
r
.
I
n
a
dd
i
t
i
o
n
to
t
hi
s
i
ns
t
r
u
m
e
n
t
,
t
h
e
de
m
o
gr
a
phi
c
i
nf
o
r
m
a
t
i
o
n
o
f
t
h
e
pa
r
t
i
c
i
pa
n
t
s
s
e
r
v
e
d
a
s
t
h
e
i
n
de
pe
n
de
n
t
c
o
n
s
t
r
u
c
ts
o
f
t
h
e
s
t
udy
.
T
o
a
l
l
o
w
f
o
r
m
o
d
i
f
i
c
a
t
i
o
n
o
f
wo
r
di
n
g
s
,
f
o
r
po
s
s
i
ble
de
t
e
c
t
i
o
n
o
f
a
m
b
i
gu
i
t
y
,
a
n
d
t
o
i
de
n
t
i
f
y
wo
r
di
n
g
s
t
h
a
t
m
i
g
h
t
b
e
t
oo
s
e
n
s
i
t
i
ve
f
o
r
t
h
e
N
i
ge
r
i
a
n
c
u
l
t
ur
e
,
pr
e
l
im
i
na
r
y
t
e
s
t
i
n
g
o
f
t
h
e
S
AA
S
wa
s
c
o
n
duc
t
e
d
w
i
t
h
10
M
HPs
pr
a
c
t
i
c
i
ng
i
n
o
n
e
o
f
t
h
e
z
o
n
e
s
t
h
a
t
we
r
e
e
xc
l
ude
d
f
r
o
m
t
h
e
s
t
udy
(
n
o
r
t
h
c
e
n
t
r
a
l
z
o
ne
o
f
t
h
e
c
o
un
t
r
y
)
.
F
o
r
t
h
e
n
o
n
-
m
o
r
a
l
i
s
m
s
u
b
s
c
a
l
e
,
t
h
e
s
t
a
t
e
m
e
n
t
c
l
e
r
gy
me
n
s
hould
not
d
r
ink
in
publi
c
[
24]
wa
s
c
o
n
s
i
d
e
r
e
d
uni
d
i
r
e
c
t
i
o
n
a
l
a
n
d
wa
s
r
e
m
o
v
e
d
f
r
o
m
t
h
e
qu
e
s
t
i
o
nn
a
i
r
e
b
e
c
a
u
s
e
t
h
e
e
x
pe
c
t
e
d
r
o
l
e
a
n
d
c
o
n
duc
t
o
f
c
l
e
r
g
y
m
e
n
i
n
t
h
e
N
i
ge
r
i
a
n
s
o
c
i
e
t
y
w
a
s
t
o
a
b
s
t
a
i
n
b
o
t
h
pr
i
v
a
t
e
l
y
a
n
d
pu
bli
c
ly
f
r
o
m
il
li
c
i
t
dr
ug
u
s
e
.
B
e
c
a
us
e
h
e
r
o
i
n
a
n
d
c
a
nna
bi
s
a
r
e
c
o
ns
i
d
e
r
e
d
il
l
e
ga
l
u
n
de
r
t
h
e
N
i
ge
r
i
a
n
l
a
w
a
n
d
a
t
tr
a
c
t
t
h
e
s
a
m
e
pu
ni
s
hm
e
n
t
f
o
r
t
r
a
f
f
i
c
k
i
n
g
a
n
d
us
e
,
t
h
e
s
t
a
t
e
m
e
n
t
c
l
a
s
s
i
f
i
e
d
u
n
d
e
r
t
h
e
s
u
bs
c
a
l
e
o
f
n
o
n
-
m
o
r
a
l
i
s
m
,
the
la
w
s
go
v
e
r
ning
the
us
e
of
he
r
oin
s
hould
be
the
s
ame
[
24]
,
wa
s
r
e
m
o
v
e
d
f
r
o
m
t
h
e
que
s
t
i
o
nna
i
r
e
.
T
h
e
s
t
a
t
e
m
e
n
t
s
tobacc
o
s
mok
ing
s
hould
be
al
lo
w
e
d
in
high
s
c
hool
a
n
d
c
annabi
s
us
e
c
an
be
h
e
alt
hy
e
x
pe
r
im
e
ntat
ion
un
de
r
t
h
e
s
u
b
s
c
a
l
e
o
f
pe
r
m
i
s
s
i
ve
ne
s
s
[
24]
we
r
e
a
l
s
o
r
e
m
o
v
e
d
f
r
o
m
t
h
e
que
s
t
i
o
nn
a
i
r
e
b
e
c
a
u
s
e
t
h
e
y
we
r
e
c
o
n
s
i
de
r
e
d
t
oo
s
e
n
s
i
t
i
ve
i
n
t
h
e
N
i
ge
r
i
a
n
c
u
l
t
u
r
e
.
F
o
r
t
h
e
s
u
b
s
c
a
l
e
o
f
n
o
n
-
s
t
e
r
e
ot
y
pe
s
,
the
s
tat
e
me
n
t
c
hr
onic
s
ubs
tanc
e
de
pe
nde
nt
pe
ople
w
ho
r
e
f
us
e
tr
e
atme
nt
s
hould
be
legally
c
omm
it
ted
to
long
-
ter
m
c
ar
e
[
24]
,
wa
s
r
e
m
o
v
e
d
f
r
o
m
t
h
e
que
s
t
i
o
nn
a
i
r
e
b
e
c
a
u
s
e
o
f
t
h
e
a
b
s
e
n
c
e
o
f
a
ny
l
a
w
t
h
a
t
l
e
ga
ll
y
c
o
m
m
i
t
s
a
n
i
nd
i
v
i
dua
l
t
o
a
ny
f
o
r
m
o
f
s
u
b
s
t
a
n
c
e
de
pe
n
d
e
n
t
tr
e
a
t
m
e
n
t
i
n
t
h
e
c
o
un
tr
y
.
T
h
e
pr
e
li
m
i
na
r
y
t
e
s
t
i
n
g
o
f
t
h
e
que
s
t
i
o
nn
a
i
r
e
a
l
s
o
r
e
v
e
a
l
e
d
t
h
a
t
t
h
e
t
e
r
m
hippi
e
s
tyle
c
lot
hing
wa
s
n
o
t
a
c
o
m
m
o
nly
us
e
d
t
e
r
m
i
n
t
h
e
c
o
un
t
r
y
[
20]
.
T
h
e
r
e
f
o
r
e
,
t
h
e
s
t
a
t
e
m
e
n
t
pe
ople
w
ho
dr
e
s
s
in
hi
ppy
s
tyle
c
lot
hing
pr
obably
us
e
p
s
y
c
he
de
li
c
d
r
ug
u
n
de
r
t
h
e
s
u
b
s
c
a
l
e
o
f
n
o
n
-
s
t
e
r
e
ot
y
pe
w
a
s
r
e
m
o
v
e
d
f
r
o
m
t
h
e
que
s
t
i
o
nna
i
r
e
[
20]
.
B
e
c
a
us
e
t
hi
s
s
t
ud
y
wa
s
f
o
c
us
e
d
pr
i
m
a
r
i
ly
o
n
i
ll
i
c
i
t
dr
ug
us
e
a
n
d
n
o
t
a
l
c
o
h
o
l
,
que
s
t
i
o
ns
f
r
o
m
t
h
e
S
AA
S
we
r
e
m
o
d
i
f
i
e
d
w
i
t
h
pe
r
m
i
s
s
i
o
n
f
r
o
m
t
h
e
c
o
py
r
i
g
h
t
h
o
l
de
r
s
t
o
r
e
f
l
e
c
t
a
tt
i
t
ude
s
to
wa
r
d
i
ll
i
c
i
t
dr
ug
us
e
.
I
t
e
m
s
,
w
hi
c
h
r
e
f
l
e
c
t
e
d
b
o
t
h
“
alcoholis
m
or
d
r
ug
addiction”
,
we
r
e
m
a
d
e
t
o
r
e
a
d
“
dr
ug
ad
diction”
,
whi
c
h
i
nc
l
ude
d
f
a
c
t
o
r
2,
t
r
e
a
t
m
e
n
t
i
n
t
e
r
ve
n
t
i
o
n
s
u
b
s
c
a
l
e
(
i
t
e
m
s
8,
9,
10,
13)
a
n
d
f
a
c
t
or
4,
tr
e
a
t
m
e
n
t
o
p
t
i
mi
s
m
s
ubs
c
a
l
e
(
i
t
e
m
s
23,
24,
25)
.
I
t
e
m
s
f
r
o
m
f
a
c
t
o
r
1,
pe
r
m
i
s
s
i
ve
n
e
s
s
s
u
b
s
c
a
l
e
t
h
a
t
r
e
f
l
e
c
t
s
o
nly
“
us
e
of
alcohol”
we
r
e
m
a
de
t
o
r
e
a
d
“
dr
ug
us
e
”
(
i
t
e
m
s
5
&
7)
.
T
h
e
S
AA
S
wa
s
m
o
d
if
i
e
d
t
o
a
31
-
i
t
e
m
a
s
a
c
o
m
po
s
i
t
e
s
c
a
l
e
a
n
d
wa
s
a
do
p
t
e
d
f
o
r
t
hi
s
s
t
ud
y
a
s
s
h
o
wn
i
n
T
a
bl
e
1.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
S
S
N:
2252
-
8806
R
e
gional
V
ar
iat
ion
in
A
tt
it
ude
o
f
M
e
ntal
He
alt
h
P
r
of
e
s
s
ional
s
to
w
ar
d
s
T
ac
k
li
ng
,
.
.
(
Olubus
ay
o
A
k
inol
a)
175
T
a
bl
e
1.
S
ub
gr
o
up
o
f
A
tt
i
t
ude
s
I
de
n
t
i
f
i
e
d
by
t
h
e
S
AA
S
P
e
r
m
is
s
iv
e
ne
s
s
I
ndi
vi
dua
l
a
c
c
e
p
ta
nc
e
t
ha
t
il
li
c
it
d
r
ug us
e
i
s
a
c
o
nt
in
uum
of
t
y
pi
c
a
l
huma
n be
ha
v
i
o
r
.
T
h
e
s
ubgr
o
up
c
o
ns
is
ts
of
7 qu
e
s
ti
o
ns
(
Q
1
-
Q
7)
.
T
r
e
a
tm
e
nt
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.
F
i
ve
s
ur
v
e
y
s
w
e
r
e
r
e
m
o
v
e
d
b
e
c
a
us
e
t
h
e
y
we
r
e
o
ut
l
i
e
r
s
.
An
ot
h
e
r
s
ur
ve
y
wa
s
r
e
m
o
ve
d
whe
n
,
a
f
t
e
r
c
o
n
duc
t
i
n
g
r
e
s
i
dua
l
d
i
a
g
n
o
s
t
i
c
s
t
o
v
a
l
i
d
a
t
e
t
h
e
m
o
de
l
f
i
t
,
i
t
wa
s
t
a
k
e
n
t
o
b
e
a
uni
va
r
i
a
t
e
o
u
t
l
i
e
r
)
.
n
i
i
s
t
he
s
a
m
p
l
e
s
i
z
e
o
f
e
a
c
h
o
f
t
h
e
r
e
g
i
o
n
s
ur
v
e
y
e
d
(
NE
=
31.
5%
,
NW
=
20.
6
%
,
S
S
=
28
.
3%
,
a
n
d
S
W
=
1
9.
6%
)
a
n
d
R
i
i
s
t
h
e
s
u
m
r
a
n
k
s
f
o
r
e
a
c
h
gr
o
ups
.
3.
RE
S
UL
T
S
A
ND
AN
AL
YSI
S
T
wo
h
un
dr
e
d
a
n
d
ni
ne
t
y
t
wo
(
292
)
M
HPs
r
e
s
po
n
de
d
to
t
h
e
s
ur
ve
y
a
n
d
a
r
e
s
po
ns
e
r
a
t
e
o
f
81.
1%
wa
s
a
c
hi
e
ve
d.
Ho
we
v
e
r
,
whe
n
e
v
a
l
ua
t
i
n
g
t
h
e
r
e
s
po
n
s
e
s
f
o
r
o
u
t
l
i
e
r
s
a
n
d
m
i
s
s
i
ng
c
a
s
e
s
a
n
d
t
o
e
n
s
ur
e
t
h
e
s
ur
v
e
ys
we
r
e
c
o
m
p
l
e
t
e
d
a
c
c
ur
a
t
e
l
y
,
f
i
ve
s
ur
v
e
y
s
we
r
e
r
e
mo
v
e
d.
An
o
t
h
e
r
s
ur
ve
y
wa
s
r
e
m
o
v
e
d
w
h
e
n
,
a
f
t
e
r
c
o
n
duc
t
i
n
g
r
e
s
i
dua
l
d
i
a
g
n
o
s
t
i
c
s
to
v
a
li
da
t
e
t
h
e
m
o
de
l
f
i
t
,
i
t
wa
s
t
a
ke
n
t
o
b
e
a
u
ni
va
r
i
a
t
e
o
u
t
l
i
e
r
(
e
x
t
r
e
m
e
c
a
s
e
)
.
T
h
us
,
t
h
e
r
e
s
po
n
s
e
s
f
r
o
m
286
pa
r
t
i
c
i
pa
n
t
s
we
r
e
us
e
d
f
o
r
f
i
na
l
d
a
t
a
a
n
a
l
y
s
i
s
.
3.
1.
B
as
e
l
in
e
d
e
m
og
r
ap
h
ic
c
h
a
r
ac
t
e
r
is
t
ics
of
t
h
e
s
t
u
d
y
p
op
u
l
at
ion
J
us
t
o
v
e
r
h
a
l
f
(
51.
7%
[
n
=
148]
)
o
f
t
h
e
M
HPs
w
h
o
r
e
s
po
n
de
d
to
t
h
e
s
ur
v
e
y
we
r
e
m
a
l
e
.
T
h
e
m
a
j
o
r
i
t
y
(
63.
3%
[
n
=
181]
)
wa
s
a
ge
d
b
e
t
we
e
n
21
a
n
d
40
y
e
a
r
s
.
M
o
r
e
t
h
a
n
80%
(
n
=
235)
o
f
t
h
e
r
e
s
po
n
d
e
n
t
s
ha
d
un
de
r
gr
a
dua
t
e
de
gr
e
e
,
a
n
d
13.
3%
(
n
=
38)
a
n
d
4.
5%
(
n
=
13)
h
a
d
o
b
t
a
i
n
e
d
e
i
t
h
e
r
a
m
a
s
t
e
r
’
s
de
gr
e
e
or
P
h
D
a
t
t
h
e
t
i
m
e
o
f
t
h
e
s
ur
v
e
y
.
M
a
j
o
r
i
t
y
o
f
t
h
e
pa
r
t
i
c
i
pa
n
t
s
(
70.
6
%
[
n
=
202]
)
h
a
d
pr
a
c
t
i
c
e
d
f
o
r
l
e
s
s
t
h
a
n
16
y
e
a
r
s
.
J
us
t
o
v
e
r
h
a
lf
58%
(
n
=
166)
o
f
t
he
286
M
HPs
i
nc
l
ude
d
f
o
r
f
i
na
l
da
t
a
a
n
a
ly
s
i
s
w
e
r
e
ps
y
c
hi
a
t
r
i
c
n
ur
s
e
s
,
7
%
(n
=
2
0)
we
r
e
ps
y
c
h
o
l
o
g
i
s
t
s
,
18.
9%
(
n
=
5
4)
we
r
e
s
o
c
i
a
l
w
o
r
ke
r
s
,
2.
1%
(
n
=
6)
we
r
e
a
dd
i
c
t
i
o
n
c
o
un
s
e
l
o
r
s
,
1.
4%
(
n
=
4
)
we
r
e
pe
e
r
c
o
un
s
e
l
o
r
s
,
a
n
d
12.
6%
(
n
=
36)
we
r
e
ps
y
c
hi
a
t
r
i
s
t
s
.
Of
t
h
e
u
s
e
a
bl
e
qu
e
s
t
i
o
nn
a
i
r
e
,
31.
5%
(
n
=
90)
we
r
e
o
b
t
a
i
n
e
d
f
r
o
m
t
h
e
n
o
r
t
h
we
s
t
e
r
n
r
e
g
i
o
n
,
20.
6%
(
n
=
59)
we
r
e
f
il
l
e
d
by
M
HPs
f
r
o
m
t
h
e
n
o
r
th
e
a
s
t
e
r
n
r
e
g
i
o
n
.
A
ppr
o
xim
a
t
e
l
y
28%
(
n
=
81)
a
n
d
19.
6%
(
n
=
56)
we
r
e
f
r
o
m
t
h
e
s
o
ut
h
-
s
o
u
t
h
a
n
d
s
o
ut
h
we
s
t
e
r
n
r
e
g
i
o
n
o
f
t
h
e
c
o
un
tr
y
r
e
s
pe
c
t
i
v
e
ly
.
F
r
e
que
n
c
y
o
f
d
i
s
t
r
i
b
ut
i
o
n
a
n
d
de
m
o
gr
a
phi
c
s
pe
r
c
e
n
t
a
ge
s
a
r
e
pr
e
s
e
n
t
e
d
i
n
T
a
bl
e
3.
T
h
e
f
i
r
s
t
r
e
s
e
a
r
c
h
que
s
t
i
o
n
a
s
s
e
s
s
e
d
t
h
e
e
x
t
e
n
t
t
o
whi
c
h
N
i
ge
r
i
a
n
M
HPs
’
e
xhi
b
i
t
po
s
i
t
i
ve
v
e
r
s
u
s
n
e
g
a
t
i
v
e
a
t
t
i
t
ude
r
e
ga
r
d
i
n
g
t
h
e
i
r
pr
o
f
e
s
s
i
o
n
a
l
r
o
l
e
i
de
n
t
i
t
y
i
n
t
a
c
k
l
i
ng
i
ll
i
c
i
t
dr
ug
us
e
i
n
N
i
ge
r
i
a
.
A
tt
i
t
ude
s
o
f
m
u
l
t
i
d
i
s
c
i
p
li
na
r
y
M
HPs
we
r
e
a
s
s
e
s
s
e
d
us
i
ng
t
h
e
s
ubs
t
a
n
c
e
a
b
u
s
e
a
tt
i
t
ude
s
ur
v
e
y
(
S
AA
S
)
de
v
e
l
o
pe
d
b
y
C
ha
ppe
l
e
t
al.
[
24]
.
T
h
e
va
l
i
d
a
t
e
d
S
AA
S
a
do
pt
e
d
i
n
t
hi
s
s
t
ud
y
c
o
ns
i
s
t
s
o
f
31
que
s
t
i
o
ns
a
n
d
r
e
s
po
ns
e
s
we
r
e
b
a
s
e
d
o
n
a
f
o
ur
-
po
i
n
t
L
i
ke
r
t
s
c
a
l
e
t
o
a
v
o
i
d
n
e
u
t
r
a
l
r
e
s
po
ns
e
s
.
Al
l
que
s
t
i
o
ns
we
r
e
a
s
s
o
c
i
a
t
e
d
w
it
h
f
i
ve
-
a
tt
i
t
ud
i
n
a
l
s
u
b
s
c
a
l
e
f
a
c
t
o
r
s
a
n
d
t
h
e
s
e
i
nc
l
ude
:
1)
pe
r
m
i
s
s
i
ve
ne
s
s
,
2)
tr
e
a
t
m
e
n
t
i
n
t
e
r
v
e
n
t
i
o
n
,
3)
n
o
n
-
s
t
e
r
e
ot
y
pe
s
,
4)
t
r
e
a
t
m
e
n
t
o
p
t
i
mi
s
m
a
n
d
5)
n
o
n
-
m
o
r
a
l
i
s
m
(
T
a
bl
e
1)
.
M
HPs
w
h
o
r
e
s
po
n
de
d
to
t
h
e
s
ur
v
e
y
t
e
n
de
d
t
o
wa
r
d
t
h
e
n
o
n
-
pe
r
m
i
s
s
i
ve
a
n
d
s
t
e
r
e
ot
y
p
i
c
s
p
e
c
t
r
um
.
Alm
o
s
t
a
l
l
t
h
e
s
t
ud
y
pa
r
t
i
c
i
pa
n
t
s
,
93.
7%
(
n
=
268,
M
=
1.
94,
SD
=
0.
243)
di
s
a
gr
e
e
d
t
h
a
t
m
a
r
ij
ua
n
a
s
ho
ul
d
b
e
l
e
ga
li
z
e
d
a
n
d,
89.
2%
(
n
=
255,
M
=
1.
89,
SD
=
0.
311
)
b
e
li
e
v
e
d
t
h
a
t
t
h
e
pe
r
s
o
n
a
l
u
s
e
o
f
dr
ugs
s
h
o
ul
d
n
o
t
b
e
l
e
ga
l
e
v
e
n
i
n
t
h
e
c
o
nf
i
ne
s
o
f
t
h
e
h
o
m
e
s
o
f
i
nd
i
v
i
dua
l
s
us
e
il
li
c
i
t
dr
ugs
(
T
a
bl
e
4)
.
A
s
u
b
s
t
a
n
t
i
a
l
n
u
m
be
r
o
f
t
h
e
pa
r
t
i
c
i
pa
n
t
s
,
86%
(
n
=
246,
M
=
1.
14,
SD
=
0.
347)
e
x
pr
e
s
s
e
d
t
h
e
o
p
i
ni
o
n
t
h
a
t
pe
o
pl
e
w
h
o
s
m
o
ke
w
i
ll
in
du
l
ge
i
n
m
a
r
ij
ua
n
a
us
e
,
a
n
d
t
h
a
t
i
t
i
s
a
l
m
o
s
t
i
m
po
s
s
i
b
l
e
f
o
r
a
ddi
c
t
s
to
r
e
c
o
v
e
r
b
e
c
a
us
e
h
e
r
o
i
n
i
s
a
dd
i
c
t
i
n
g.
Al
t
h
o
ugh
t
h
e
pa
r
t
i
c
i
p
a
n
t
s
we
r
e
qui
t
e
m
o
r
a
l
i
s
t
i
c
,
m
a
j
o
r
i
t
y
,
73.
1%
(
n
=
209,
M
=
1.
73
,
SD
=
0.
444
)
we
r
e
a
ga
i
ns
t
a
n
gr
y
c
o
nf
r
o
n
t
a
t
i
o
n
w
h
e
n
t
r
e
a
t
i
n
g
dr
ug
-
us
i
n
g
c
l
i
e
n
t
s
.
R
e
s
po
n
s
e
s
o
n
t
r
e
a
t
m
e
n
t
i
n
t
e
r
v
e
n
t
i
o
n
a
n
d
t
r
e
a
t
m
e
n
t
opt
i
mi
s
m
we
r
e
f
a
i
r
l
y
h
o
m
o
ge
n
o
us
a
s
M
HP
s
d
i
s
p
l
a
y
e
d
po
s
i
t
i
vi
t
y
t
o
wa
r
d
s
uc
c
e
s
s
f
u
l
o
ut
c
o
m
e
o
f
dr
ug
de
p
e
n
de
nc
e
t
r
e
a
t
m
e
n
t
a
n
d
c
a
r
e
a
s
s
h
o
wn
i
n
T
a
bl
e
4.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
P
HS
I
S
S
N:
2252
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8806
R
e
gional
V
ar
iat
ion
in
A
tt
it
ude
o
f
M
e
ntal
He
alt
h
P
r
of
e
s
s
ional
s
to
w
ar
d
s
T
ac
k
li
ng
,
.
.
(
Olubus
ay
o
A
k
inol
a)
177
T
a
bl
e
3.
F
r
e
que
n
c
i
e
s
o
f
D
i
s
t
r
i
b
ut
i
o
n
f
o
r
R
e
s
po
n
de
n
t
s
’
De
m
o
gr
a
p
hi
c
s
by
P
r
o
f
e
s
s
i
o
n
V
a
r
ia
bl
e
s
P
s
y
c
hi
a
tr
is
t
%
(
n=
36)
N
ur
s
e
%
(
n=
166)
A
ddi
c
ti
o
n
C
o
uns
e
l
o
r
%
(
n=
6)
S
oc
ia
l
W
o
r
k
e
r
%
(
n=
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T
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n=
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R
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th
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19.4
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N
o
r
th
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t
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N
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t
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W
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ge
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33.3
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25.0
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31
-
35
16.7
12.7
16.7
25.9
35.0
50.0
17.8
36
-
40
22.2
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18.5
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0.0
13.3
41
-
45
19.4
14.5
0.0
11.1
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45
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E
duc
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s
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G
e
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M
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Y
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75.0
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11
-
15
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50.0
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25.0
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5.6
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20
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0.0
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T
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bl
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4.
F
r
e
que
n
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R
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s
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r
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S
tr
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S
tr
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ngl
y
D
is
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gr
e
e
D
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gr
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e
F
a
c
t
o
r
1:
P
e
r
mi
s
s
iv
e
n
e
s
s
1. M
a
r
ij
ua
na
s
ho
ul
d be
l
e
ga
li
z
e
d
8
10
199
69
2. P
e
r
s
o
na
l
us
e
of
d
r
ugs
s
ho
ul
d b
e
l
e
ga
l
in
t
he
c
o
n
f
in
e
s
of
o
n
e
’
s
ho
m
e
13
18
130
125
3.
D
a
il
y
us
e
of
o
ne
ma
r
ij
ua
na
c
ig
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r
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tt
e
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s
n
o
t
ne
c
e
s
s
a
r
il
y
ha
r
m
f
ul
9
17
62
198
4. I
t
c
a
n b
e
n
o
r
ma
l
f
or
a
t
e
e
na
g
e
r
t
o
e
x
pe
r
im
e
nt
w
it
h dr
ugs
47
15
149
75
5. L
i
f
e
l
o
ng a
bs
ti
ne
n
c
e
i
s
a
ne
c
e
s
s
a
r
y
g
o
a
l
in
th
e
t
r
e
a
tm
e
nt
of
pr
o
bl
e
ma
ti
c
dr
ug us
e
113
126
17
30
6.O
nc
e
a
p
e
r
s
o
n b
e
c
o
m
e
s
dr
ug
-
f
r
e
e
t
hr
o
ugh tr
e
a
tm
e
nt
, h
e
c
a
n
ne
ve
r
b
e
c
o
m
e
a
s
o
c
ia
l
us
e
r
32
42
89
123
7. P
a
r
e
nt
s
s
ho
ul
d
te
a
c
h t
h
e
ir
c
hi
ld
r
e
n h
o
w
t
o
us
e
d
r
ugs
11
90
153
32
F
a
c
t
o
r
2:
T
r
e
a
tm
e
nt
I
nt
e
r
ve
nt
i
o
n
8. F
a
mi
l
y
i
n
vol
v
e
m
e
nt
i
s
a
v
e
r
y
i
mp
o
r
ta
nt
pa
r
t
of
t
h
e
tr
e
a
tm
e
nt
of
d
r
ug
a
ddi
c
ti
o
n
81
199
2
4
9. T
h
e
b
e
s
t
w
a
y
t
o
t
r
e
a
t
dr
ug
-
d
e
p
e
nde
nt
p
e
o
pl
e
i
s
t
o
r
e
f
e
r
t
h
e
m
to
a
goo
d t
r
e
a
tm
e
nt
pr
o
g
r
a
m
148
131
6
1
10. G
r
o
up t
h
e
r
a
p
y
i
s
ve
r
y
i
mp
o
r
ta
nt
i
n t
he
tr
e
a
tm
e
nt
of
dr
ug a
d
di
c
ti
o
n
75
195
5
11
11. Ur
in
e
dr
ug s
c
r
e
e
ni
ng
c
a
n b
e
a
n i
mp
o
r
ta
nt
pa
r
t
of
t
r
e
a
tm
e
nt
of
dr
ug mi
s
us
e
186
58
3
39
12. L
o
ng
-
t
e
r
m
o
ut
pa
ti
e
nt
t
r
e
a
tm
e
nt
i
s
ne
c
e
s
s
a
r
y
f
or
t
h
e
t
r
e
a
tm
e
nt
of
d
r
ug
a
ddi
c
ti
o
n
121
115
14
36
13. P
a
r
a
pr
of
e
s
s
i
o
na
l
c
o
uns
e
l
o
r
s
c
a
n pr
ovi
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e
f
f
e
c
ti
ve
t
r
e
a
tm
e
nt
f
or
dr
ug mi
s
us
e
r
s
95
122
49
20
F
a
c
t
o
r
3:
N
o
n
-
S
t
e
r
e
o
t
y
p
e
s
14. P
e
o
pl
e
w
h
o
us
e
ma
r
ij
ua
na
us
ua
ll
y
d
o
n
o
t
r
e
s
pe
c
t
a
ut
h
o
r
it
y
198
36
4
48
15. S
mo
ki
ng
le
a
ds
t
o
ma
r
ij
ua
na
us
e
, w
hi
c
h, i
n t
ur
n l
e
a
ds
t
o
ha
r
d dr
ugs
96
150
18
22
16. M
a
r
ij
ua
na
us
e
l
e
a
ds
t
o
m
e
nt
a
l
il
ln
e
s
s
196
78
8
4
17.
H
e
r
o
in
is
s
o
a
ddi
c
ti
ng
th
a
t
n
o
o
ne
c
a
n
r
e
a
ll
y
r
e
c
ov
e
r
o
n
c
e
he
/s
h
e
be
c
o
me
s
a
n a
ddi
c
t
39
102
72
73
18. All he
r
o
in
us
e
l
e
a
ds
t
o
a
ddi
c
ti
o
n
150
77
16
43
19. W
e
e
k
e
nd us
e
r
s
of
dr
ugs
w
il
l
pr
o
gr
e
s
s
t
o
d
r
ug mi
s
us
e
201
52
13
20
20. A ho
s
pi
ta
l
is
t
he
b
e
s
t
pl
a
c
e
t
o
tr
e
a
t
a
dr
ug a
ddi
c
t
131
68
16
71
21. R
e
c
r
e
a
ti
o
na
l
dr
ug us
e
pr
e
c
e
d
e
s
dr
ug mi
s
us
e
157
92
3
34
F
a
c
t
o
r
4:
T
r
e
a
tm
e
nt
O
pt
im
is
m
22. Dr
ug a
ddi
c
ti
o
n i
s
a
t
r
e
a
ta
bl
e
i
l
ln
e
s
s
112
153
8
13
23.
A
dr
ug
-
de
p
e
nd
e
nt
p
e
r
s
o
n
w
ho
ha
s
r
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la
ps
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d
s
e
ve
r
a
l
t
im
e
s
pr
o
ba
bl
y
c
a
nn
o
t
b
e
t
r
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a
te
d
62
26
97
101
24. M
o
s
t
dr
ug
-
d
e
pe
nd
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nt
p
e
r
s
o
ns
a
r
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unpl
e
a
s
a
nt
t
o
w
or
k w
it
h
199
97
23
57
25.
A
dr
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-
de
pe
nd
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p
e
r
s
o
n
c
a
nn
o
t
be
h
e
lp
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d
unt
il
he
/s
he
ha
s
hi
t
“
r
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k b
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tt
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m”
41
39
104
102
F
a
c
t
o
r
5:
N
o
n
-
m
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r
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s
m
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I
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178
Q
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ti
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ns
S
tr
o
ngl
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A
gr
e
e
A
gr
e
e
S
tr
o
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y
D
is
a
gr
e
e
D
is
a
gr
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e
26. S
tr
e
e
t
pus
h
e
r
s
a
r
e
t
h
e
i
ni
ti
a
l
s
o
ur
c
e
of
d
r
ugs
f
or
y
oung a
dul
t
111
109
14
14
27. Dr
ug mi
s
us
e
i
s
s
o
da
nge
r
o
us
t
ha
t
it
c
a
n de
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oy
th
e
y
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ur
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o
unt
r
y
i
f
n
o
t
c
o
n
tr
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ll
e
d b
y
l
a
w
183
95
2
6
28. Angr
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c
o
n
f
r
o
nt
a
ti
o
n i
s
ne
c
e
s
s
a
r
y
i
n t
h
e
t
r
e
a
tm
e
nt
of
d
r
ug a
ddi
c
ts
27
50
10
199
29. Dr
ug mi
s
us
e
r
s
s
ho
ul
d
o
nl
y
b
e
t
r
e
a
t
e
d b
y
s
pe
c
ia
li
s
ts
i
n t
he
f
i
e
ld
144
94
36
12
30. Addic
ti
o
n t
o
dr
ug
is
a
s
s
o
c
ia
te
d w
i
th
a
w
e
a
k w
il
l
113
113
18
42
31. Us
in
g a
ny
ha
r
d d
r
ug s
hor
te
ns
o
n
e
’
s
l
i
f
e
s
pa
n
108
159
7
12
R
e
s
e
a
r
c
h
que
s
t
i
o
n
2
:
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s
t
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HPs
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.
[
25]
a
n
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ka
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.
[
1]
a
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gs
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[
26]
.
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[
27
-
29]
a
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[
30
-
32]
.
R
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a
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c
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n
duc
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by
Ga
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k
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al
.
[
33]
de
m
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t
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As
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[
34]
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38
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-
5
0
,
2
0
1
2
.
[
3
]
C.
E
.
G
rel
l
a,
et
a
l
.
,
“
Pe
r
ce
p
t
i
o
n
s
o
f
n
eed
a
n
d
h
el
p
rece
i
v
e
d
fo
r
s
u
b
s
t
an
ce
d
e
p
e
n
d
e
n
ce
i
n
a
n
at
i
o
n
a
l
p
ro
b
ab
i
l
i
t
y
s
u
rv
ey
,
”
P
s
ych
i
a
t
r
i
c
S
er
v
i
ces
,
v
o
l
.
6
0
,
p
p
.
1
0
6
8
–
1
0
7
4
,
2
0
0
9
.
[
4
]
G.
G
i
l
ch
ri
s
t
,
et
al.
,
“
St
aff
re
g
ard
t
o
w
ard
s
w
o
rk
i
n
g
w
i
t
h
s
u
b
s
t
an
c
e
u
s
e
rs
:
A
E
u
r
o
p
e
a
n
M
u
l
t
i
-
cen
t
re
s
t
u
d
y
,
”
A
d
d
i
c
t
i
o
n
,
v
o
l
.
1
0
6
,
p
p
.
1
1
1
4
-
1
1
2
5
,
2
0
1
1
.
[
5
]
L
.
M
c
Farl
i
n
g
,
et
a
l
.
,
“
St
i
g
m
a
as
a
b
arri
e
r
t
o
s
u
b
s
t
an
ce
ab
u
s
e
an
d
me
n
t
al
h
e
a
l
t
h
t
re
at
me
n
t
,
”
M
i
l
i
t
a
r
y
P
s
ych
o
l
o
g
y
,
v
o
l
/
i
s
s
u
e:
2
3
(1
),
p
p
.
1
-
5,
2
0
1
1
.
[
6
]
L
.
C.
V
.
Bo
e
k
el
,
et
a
l
.
,
“
H
e
al
t
h
c
ar
e
p
ro
f
e
s
s
i
o
n
a
l
s
’
re
g
ar
d
t
o
w
ar
d
s
w
o
r
k
i
n
g
w
i
t
h
p
at
i
e
n
t
s
w
i
t
h
s
u
b
s
t
an
ce
u
s
e
d
i
s
o
r
d
e
rs
:
C
o
m
p
ari
s
o
n
o
f
p
ri
m
ar
y
c
ar
e,
g
e
n
e
ra
l
p
s
y
c
h
i
at
ry
,
an
d
s
p
ec
i
a
l
i
s
t
ad
d
i
c
t
i
o
n
s
e
rv
i
ce
s
,
”
D
r
u
g
a
n
d
A
l
c
o
h
o
l
D
ep
en
d
e
n
ce
,
v
o
l
.
1
3
4
,
p
p
.
9
2
-
9
8
,
2
0
1
4
.
[
7
]
A.
Br
y
a
n
,
et
a
l
.
,
“
D
ru
g
-
r
el
at
ed
k
n
o
w
l
e
d
g
e,
at
t
i
t
u
d
e
s
an
d
b
e
l
i
e
fs
i
n
I
r
el
an
d
:
r
e
p
o
rt
o
f
a
n
at
i
o
n
-
w
i
d
e
s
u
rv
ey
,
”
D
u
b
l
i
n
,
I
r
e
l
a
n
d
,
T
h
e
H
e
al
t
h
R
e
s
e
ar
c
h
B
o
ard
,
2
0
0
0
.
[
8
]
O
.
A
.
A
y
o
r
i
n
d
e
,
et
a
l
.
,
“
Ps
y
ch
i
at
ri
c
r
e
s
e
arch
i
n
N
i
g
e
ri
a
:
Bri
d
g
i
n
g
t
rad
i
t
i
o
n
an
d
m
o
d
e
rn
i
zat
i
o
n
,
”
Th
e
B
r
i
t
i
s
h
Jo
u
r
n
a
l
o
f
P
s
ych
i
a
t
r
y,
v
o
l
/
i
s
s
u
e:
1
8
4
(6
),
p
p
.
5
3
6
-
5
3
8
,
2
0
0
4
.
[
9
]
S.
A
m
a
e
l
e,
“
A
l
t
e
r
n
at
i
v
e
me
as
u
r
e
s
fo
r
t
h
e
c
o
n
t
ro
l
o
f
d
ru
g
ab
u
s
e
i
n
N
i
g
e
ri
a
n
s
c
h
o
o
l
s
y
s
t
em
,
”
In
t
er
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
A
ca
d
em
i
c
R
es
e
a
r
c
h
,
v
o
l
/
i
s
s
u
e
:
4
(6
),
p
p
.
1
8
6
-
1
9
1
,
2
0
1
2
.
[
1
0
]
O
.
A
.
A
w
o
s
u
s
i
an
d
J
.
A
.
A
d
eg
b
o
y
eg
a,
“
K
n
o
w
l
ed
g
e
o
f
h
e
a
l
t
h
e
ff
ec
t
s
an
d
s
u
b
s
t
an
ce
u
s
e
a
m
o
n
g
s
t
u
d
en
t
s
o
f
t
e
rt
i
ary
i
n
s
t
i
t
u
t
i
o
n
s
i
n
So
u
t
h
w
e
s
t
e
r
n
,
N
i
g
e
r
i
a,
”
Jo
u
r
n
a
l
o
f
E
d
u
ca
t
i
o
n
a
n
d
P
r
a
ct
i
ce,
v
o
l
.
4
,
p
p
.
2
3
-
2
8
,
2
0
1
3
.
[
1
1
]
A
.
A
b
a
y
o
mi
,
et
a
l
.
,
“
P
s
y
c
h
o
s
o
c
i
al
co
rr
e
l
at
e
s
o
f
h
azar
d
o
u
s
al
co
h
o
l
u
s
e
a
m
o
n
g
u
n
d
e
r
g
rad
u
at
e
s
i
n
So
u
t
h
W
e
s
t
e
rn
N
i
g
e
r
i
a,
”
G
en
er
a
l
H
o
s
p
i
t
a
l
P
s
ych
i
a
t
r
y,
v
o
l
.
3
5
,
p
p
.
3
2
0
-
324,
2
0
1
3
.
[
1
2
]
C.
F.
E
s
s
i
en
,
“
D
ru
g
u
s
e
a
n
d
ab
u
s
e
a
mo
n
g
s
t
u
d
en
t
s
i
n
t
e
rt
i
ar
y
i
n
s
t
i
t
u
t
i
o
n
s
-
t
h
e
c
as
e
o
f
F
ed
e
ral
U
n
i
v
e
rs
i
t
y
o
f
T
e
ch
n
o
l
o
g
y
,
M
i
n
n
a,
”
Jo
u
r
n
a
l
o
f
R
es
e
a
r
c
h
i
n
N
a
t
i
o
n
a
l
D
evel
o
p
m
en
t
,
v
o
l
/
i
s
s
u
e:
8
(1
),
2010.
[
1
3
]
S.
N
.
E
k
p
e
n
y
o
n
,
“
D
ru
g
ab
u
s
e
i
n
N
i
g
e
r
i
an
s
ch
o
o
l
s
:
A
s
t
u
d
y
o
f
s
el
ec
t
e
d
s
eco
n
d
ar
y
i
n
s
t
i
t
u
t
i
o
n
s
i
n
Ba
y
el
s
a
s
t
at
e
,
So
u
t
h
-
S
o
u
t
h
,
N
i
g
e
r
i
a,
”
In
t
er
n
a
t
i
o
n
a
l
Jo
u
r
n
a
l
o
f
S
c
i
en
t
i
f
i
c
R
es
ea
r
c
h
i
n
E
d
u
c
a
t
i
o
n
,
v
o
l
/
i
s
s
u
e
:
5
(3
),
p
p
.
2
6
0
-
2
6
8
,
2
0
1
2
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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V
ar
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in
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(
Olubus
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181
[
1
4
]
K
.
A
.
O
s
h
i
k
o
y
a
an
d
A
.
A
l
l
i
,
“
Pe
r
ce
p
t
i
o
n
o
f
d
ru
g
ab
u
s
e
a
mo
n
g
s
t
N
i
g
e
ri
a
n
u
n
d
e
r
g
rad
u
at
e,
”
W
o
r
l
d
Jo
u
r
n
a
l
o
f
M
ed
i
ca
l
S
ci
e
n
ces
,
v
o
l
/
i
s
s
u
e:
1
(2
),
p
p
.
1
3
3
-
1
3
9
,
2
0
0
6
.
[
1
5
]
D
.
O
.
Fare
o
,
“
D
ru
g
ab
u
s
e
a
m
o
n
g
N
i
g
e
r
i
an
a
d
o
l
e
s
cen
t
s
t
rat
e
g
i
e
s
fo
r
co
u
n
s
el
i
n
g
,
”
Th
e
Jo
u
r
n
a
l
o
f
I
n
t
e
r
n
a
t
i
o
n
a
l
S
o
c
i
a
l
R
es
ea
r
c
h
,
v
o
l
/
i
s
s
u
e
:
5
(2
0
),
p
p
.
3
4
1
-
3
4
7
,
2
0
1
2
.
[
1
6
]
A
.
A
d
e
s
an
y
a
,
et
a
l
.
,
“
Ps
y
ch
o
a
c
t
i
v
e
s
u
b
s
t
an
ce
ab
u
s
e
a
mo
n
g
i
n
m
at
e
s
o
f
a
N
i
g
e
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i
an
p
ri
s
o
n
p
o
p
u
l
at
i
o
n
,
”
D
r
u
g
a
n
d
A
l
co
h
o
l
D
ep
en
d
en
ce,
v
o
l
/
i
s
s
u
e:
4
7
(1
),
p
p
.
3
9
-
4
4
,
1
9
9
7
.
[
1
7
]
A
.
O
.
P
el
a,
“
Recen
t
t
re
n
d
s
i
n
d
ru
g
u
s
e
a
n
d
ab
u
s
e
i
n
N
i
g
eri
a,
”
B
u
l
l
et
i
n
o
n
Na
r
co
t
i
c
s
,
v
o
l
/
i
s
s
u
e
:
4
1
(1
-
2
),
p
p
.
1
0
3
-
1
0
7
,
1
9
8
9
.
[
1
8
]
P.
O
.
O
n
i
fad
e,
et
a
l
.
,
“
A
d
e
s
c
ri
p
t
i
v
e
s
u
rv
ey
o
f
t
y
p
e
s
,
s
p
re
ad
,
an
d
c
h
ara
c
t
e
ri
s
t
i
c
s
o
f
s
u
b
s
t
an
ce
ab
u
s
e
t
re
at
me
n
t
ce
n
t
e
rs
i
n
N
i
g
e
r
i
a,
”
S
u
b
s
t
a
n
ce
A
b
u
s
e
Tr
e
a
t
m
en
t
,
P
r
even
t
i
o
n
a
n
d
P
o
l
i
cy,
v
o
l
/
i
s
s
u
e:
6
(2
5
),
2
0
1
1
.
[
1
9
]
J
.
Rh
o
d
e
s
an
d
L
.
J
as
o
n
,
“
Pre
v
en
t
i
n
g
s
u
b
s
t
an
ce
ab
u
s
e
a
mo
n
g
c
h
i
l
d
r
e
n
a
n
d
ad
o
l
e
s
ce
n
t
s
,
”
N
ew
Y
o
rk
,
N
Y
,
P
e
r
g
a
mo
n
Pre
s
s
,
1998
.
[
2
0
]
B.
O
.
J
am
e
s
an
d
J
.
O
.
O
m
o
ar
e
g
b
a,
“
N
i
g
e
ri
a
n
med
i
c
a
l
s
t
u
d
en
t
s
’
o
p
i
n
i
o
n
ab
o
u
t
i
n
d
i
v
i
d
u
al
s
w
h
o
u
s
e
an
d
ab
u
s
e
p
s
y
ch
o
a
c
t
i
v
e
s
u
b
s
t
an
ce
s
,
”
S
u
b
s
t
a
n
ce
A
b
u
s
e:
R
es
e
a
r
c
h
a
n
d
Tr
e
a
t
m
en
t
,
v
o
l
.
7
,
p
p
.
1
0
9
-
1
1
6
,
2
0
1
3
.
[
2
1
]
I
.
O
.
J
a
c
k
-
Id
e
,
et
a
l
.
,
“
Me
n
t
al
h
e
al
t
h
c
ar
e
p
o
l
i
cy
e
n
v
i
r
o
n
m
en
t
i
n
Ri
v
e
rs
s
t
at
e
:
E
x
p
e
r
i
e
n
ce
s
o
f
men
t
al
h
e
a
l
t
h
n
u
r
s
e
s
p
ro
v
i
d
i
n
g
me
n
t
al
h
e
al
t
h
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ar
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s
e
rv
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ce
s
i
n
n
e
u
r
o
p
s
y
ch
i
at
ri
c
h
o
s
p
i
t
al
,
Po
rt
H
arc
o
u
rt
,
N
i
g
e
ri
a,
”
In
t
er
n
a
t
i
o
n
a
l
J
o
u
r
n
a
l
o
f
M
en
t
a
l
H
ea
l
t
h
S
y
s
t
em
s
,
v
o
l
/
i
s
s
u
e:
7
(8
),
p
p
.
1
0
9
-
1
1
6
,
2
0
1
3
.
[
2
2
]
J
.
Cap
l
e
h
o
r
n
,
et
a
l
.
,
“
Me
as
u
ri
n
g
an
d
co
m
p
ari
n
g
t
h
e
at
t
i
t
u
d
e
s
an
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u
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2
3
]
K
.
H
u
m
p
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ey
s
,
et
a
l
.
,
“
Re
c
o
v
e
ri
n
g
s
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ce
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s
t
aff
mem
b
e
rs
’
b
el
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e
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ab
o
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ad
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i
c
t
i
o
n
,
”
J
o
u
r
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a
l
o
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u
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A
b
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s
e
Tr
e
a
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t
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l
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s
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e
:
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3
(1
),
p
p
.
7
5
-
7
8
,
1
9
9
6
.
[
2
4
]
J
.
N
.
C
h
ap
el
,
et
a
l
.
,
“
T
h
e
s
u
b
s
t
an
ce
ab
u
s
e
at
t
i
t
u
d
e
s
u
rv
ey
:
A
n
i
n
s
t
ru
me
n
t
fo
r
me
as
u
ri
n
g
at
t
i
t
u
d
e
s
,
”
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u
r
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a
l
o
f
S
t
u
d
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l
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o
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,
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o
l
.
4
6
,
p
p
.
4
8
-
5
2
,
1
9
8
5
.
[
2
5
]
S.
K
el
l
eh
e
r
an
d
P.
Co
t
t
e
r,
“
A
d
e
s
c
ri
p
t
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v
e
s
t
u
d
y
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n
eme
rg
en
cy
d
e
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art
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d
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rs
’
an
d
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e
s
’
k
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ed
g
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d
at
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co
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ce
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n
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ce
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s
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rs
,
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In
t
e
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t
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E
m
er
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en
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r
s
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g
,
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l
/
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s
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u
e:
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7
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),
p
p
.
3
-
14,
2
0
0
9
.
[
2
6
]
N
at
i
o
n
a
l
In
s
t
i
t
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e
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o
f
H
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&
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g
A
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ru
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n
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”
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d
a,
MD
,
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ID
A
,
2
0
1
0
.
[
2
7
]
J
.
E
.
B.
H
arri
s
,
et
a
l
.
,
“
Ch
an
g
i
n
g
me
n
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al
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o
f
at
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i
t
u
d
e
ch
an
g
e
,
”
S
ex
R
o
l
es
,
v
o
l
/
i
s
s
u
e:
3
5
(9
),
p
p
.
5
6
3
–
5
8
0
,
1
9
9
6
.
[
2
8
]
D
.
F.
M
cL
au
g
h
l
i
n
,
et
a
l
.
,
“T
h
e
p
e
r
ce
p
t
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o
n
s
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d
as
p
i
rat
i
o
n
s
i
l
l
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ci
t
d
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g
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s
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rs
h
o
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w
ard
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al
t
h
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ar
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s
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aff
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ar
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ece
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v
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,
”
Jo
u
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o
f
P
s
ych
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a
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c
a
n
d
M
en
t
a
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H
ea
l
t
h
Nu
r
s
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g
,
v
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l
.
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,
p
p
.
4
3
5
–
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1
,
2
0
0
0
.
[
2
9
]
M.
K
.
H
ag
e
,
et
a
l
.
,
“
Mo
d
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f
y
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n
g
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’
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s
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at
me
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rai
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,
”
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m
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ca
n
Jo
u
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l
.
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p
p
.
4
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–
47,
2
0
0
1
.
[
3
0
]
L
.
D
i
x
o
n
,
et
a
l
.
,
“
A
c
u
t
e
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ff
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t
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g
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n
s
ch
i
z
o
p
h
ren
i
c
p
at
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e
n
t
s
:
Cl
i
n
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a
l
o
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s
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at
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s
an
d
p
at
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'
s
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f
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rt
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,
”
S
ch
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B
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,
v
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l
.
1
6
,
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p
.
6
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-
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,
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9
9
0
.
[
3
1
]
W.
H
a
l
l
a
n
d
L.
D
eg
e
n
h
ard
t
,
“
Can
n
ab
i
s
u
s
e
an
d
p
s
y
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h
o
s
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s
:
A
r
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v
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of
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d
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p
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d
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d
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ce
,
”
A
u
s
t
r
a
l
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a
n
a
n
d
New
Zea
l
a
n
d
J
o
u
r
n
a
l
o
f
P
s
ych
i
a
t
r
y,
v
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l
/
i
s
s
u
e:
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4
(1
),
p
p
.
2
6
-
3
4
,
2
0
0
0
.
[
3
2
]
T
.
H
.
Mo
o
r
e
,
et
a
l
.
,
“
Can
n
ab
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s
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s
e
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d
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o
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ec
t
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men
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o
u
t
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o
me
s
:
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s
y
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t
em
at
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c
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v
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,
”
La
n
ce
t
,
v
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l
.
3
7
0
,
p
p
.
3
1
9
–
3
2
8
,
2
0
0
7
.
[
3
3
]
A
.
D
.
G
al
i
n
s
k
y
,
et
a
l
.
,
“
Pe
rs
p
e
c
t
i
v
e
-
t
ak
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n
g
a
n
d
s
e
l
f
-
o
t
h
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o
v
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l
ap
:
Fo
s
t
e
r
i
n
g
s
o
c
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l
b
o
n
d
s
an
d
faci
l
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t
at
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n
g
s
o
c
i
a
l
c
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o
rd
i
n
at
i
o
n
,
”
G
r
o
u
p
P
r
o
ces
s
es
a
n
d
In
t
e
r
g
r
o
u
p
R
el
a
t
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o
n
s
,
v
o
l
.
8
,
p
p
.
1
0
9
–
1
2
4
,
2
0
0
5
.
[
3
4
]
N
.
J
.
G
o
l
d
s
t
ei
n
an
d
R.
B.
Ci
a
l
d
i
n
i
,
“
T
h
e
s
p
y
g
l
as
s
s
e
l
f:
A
mo
d
el
o
f
v
i
c
ari
o
u
s
s
e
lf
-
p
e
r
ce
p
t
i
o
n
,
”
Jo
u
r
n
a
l
o
f
P
er
s
o
n
a
l
i
t
y
a
n
d
S
o
ci
a
l
P
s
ych
o
l
o
g
y,
v
o
l
/
i
s
s
u
e:
9
2
(3
),
p
p
.
4
0
2
–
4
1
7
,
2
0
0
7
.
[
3
5
]
W
.
R.
Mi
l
l
e
r
a
n
d
V
.
C.
Sa
n
c
h
e
z,
“
Mo
t
i
v
at
i
n
g
y
o
u
n
g
ad
u
l
t
s
fo
r
t
re
at
men
t
an
d
l
i
f
e
s
t
y
l
e
ch
an
g
e,
”
i
n
G
.
H
o
w
ard
(
E
d
.
),
“
I
s
s
u
e
s
i
n
a
l
c
o
h
o
l
u
s
e
a
n
d
m
i
s
u
s
e
b
y
y
o
u
n
g
ad
u
l
t
s
,
”
N
o
t
re
D
a
me
,
IN
,
U
n
i
v
e
rs
i
t
y
o
f
N
o
t
r
e
D
a
me
Pre
s
s
,
1993.
[
3
6
]
C.
M.
V
au
c
l
a
i
r
an
d
R.
Fi
s
c
h
e
r,
“
D
o
cu
l
t
u
ra
l
v
al
u
e
s
p
re
d
i
c
t
i
n
d
i
v
i
d
u
a
l
s
’
m
o
ra
l
at
t
i
t
u
d
e
s
?
A
c
r
o
s
s
-
c
u
l
t
u
ral
m
u
l
t
i
-
l
ev
el
ap
p
ro
ac
h
,
”
E
u
r
o
p
e
a
n
Jo
u
r
n
a
l
o
f
S
o
c
i
a
l
P
s
ych
o
l
o
g
y,
v
o
l
.
4
1
,
p
p
.
6
4
5
-
6
5
7
,
2
0
1
1
.
[
3
7
]
F.
C.
T
o
d
d
,
et
a
l
.
,
“
Barri
e
rs
t
o
o
p
t
i
m
a
l
c
ar
e
f
o
r
p
at
i
en
t
s
w
i
t
h
co
e
x
i
s
t
i
n
g
s
u
b
s
t
an
ce
u
s
e
an
d
men
t
al
h
e
a
l
t
h
d
i
s
o
r
d
ers
,
”
A
u
s
t
r
a
l
i
a
n
a
n
d
New
Zea
l
a
n
d
J
o
u
r
n
a
l
o
f
P
s
ych
i
a
t
r
y,
v
o
l
.
3
6
,
p
p
.
7
9
2
-
7
9
9
,
2
0
0
2
.
[
3
8
]
C.
Ch
u
an
d
A
.
G
al
an
g
,
“
H
o
s
p
i
t
al
n
u
rs
e
s
’
at
t
i
t
u
d
e
t
o
w
ar
d
p
at
i
e
n
t
s
w
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t
h
a
h
i
s
t
o
r
y
o
f
i
l
l
i
c
i
t
d
r
u
g
u
s
e
,
”
Th
e
Ca
n
a
d
i
a
n
Nu
r
s
e,
v
o
l
/
i
s
s
u
e:
1
0
9
(6
)
p
p
.
2
9
-
3
3
,
2
0
1
3
.
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