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Factor a
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istere
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a
ti
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n
,
p
h
y
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c
a
l
a
c
ti
v
it
y
le
v
e
ls,
se
d
e
n
tary
b
e
h
a
v
i
o
r
,
so
c
ial
su
p
p
o
rt
(fr
o
m
fa
m
il
y
a
n
d
p
e
e
rs),
a
n
d
p
s
y
c
h
o
lo
g
ica
l
fa
c
to
rs
(d
e
p
re
ss
io
n
,
a
n
x
iety
,
a
n
d
stre
ss
).
An
th
r
o
p
o
m
e
tri
c
m
e
a
su
re
m
e
n
ts,
in
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lu
d
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g
h
e
ig
h
t
a
n
d
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t,
we
re
o
b
tai
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d
u
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g
a
S
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1
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sta
d
io
m
e
ter an
d
a
Tan
it
a
w
e
ig
h
in
g
sc
a
le,
wi
th
b
o
d
y
m
a
ss
in
d
e
x
(
BM
I
)
-
fo
r
-
a
g
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su
b
se
q
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e
n
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l
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lcu
late
d
.
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o
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f
1
8
1
p
a
rti
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ip
a
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ts
we
re
in
c
l
u
d
e
d
in
t
h
e
stu
d
y
.
T
h
e
re
su
lt
s
in
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ica
ted
t
h
a
t
th
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m
a
jo
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f
stu
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n
ts
m
e
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th
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o
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m
e
n
d
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p
h
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a
l
a
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u
i
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Ap
p
ro
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tel
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two
-
t
h
ird
s
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f
p
a
rti
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p
a
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las
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s
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v
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l
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w
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e
m
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jo
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x
h
ib
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ted
h
ig
h
lev
e
ls
o
f
se
d
e
n
tary
b
e
h
a
v
io
r.
Re
g
a
r
d
in
g
so
c
ial
su
p
p
o
rt,
o
n
l
y
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n
e
-
fift
h
o
f
stu
d
e
n
ts
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p
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in
g
a
d
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a
te
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m
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p
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rt,
w
h
il
e
h
a
lf
o
f
th
e
stu
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ts
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p
o
rted
a
d
e
q
u
a
te
p
e
e
r
su
p
p
o
r
t.
P
sy
c
h
o
lo
g
ica
l
a
ss
e
ss
m
e
n
ts
re
v
e
a
led
th
a
t
one
-
th
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o
f
p
a
rti
c
i
p
a
n
ts
e
x
h
i
b
it
e
d
n
o
rm
a
l
d
e
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re
ss
iv
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sy
m
p
t
o
m
s,
wh
e
re
a
s
n
e
a
rly
h
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lf
e
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h
i
b
it
e
d
s
y
m
p
to
m
s
o
f
a
n
x
iet
y
a
n
d
stre
ss
.
S
ig
n
ifi
c
a
n
t
a
ss
o
c
iatio
n
s
we
re
id
e
n
ti
fied
b
e
t
we
e
n
p
h
y
sic
a
l
a
c
ti
v
it
y
l
e
v
e
ls
a
n
d
se
v
e
ra
l
fa
c
to
rs,
in
c
l
u
d
i
n
g
a
g
e
,
g
e
n
d
e
r,
f
a
m
il
y
su
p
p
o
r
t,
p
e
e
r
su
p
p
o
r
t,
a
n
d
stre
ss
.
In
c
o
n
c
lu
si
o
n
,
wh
il
e
m
o
st
se
c
o
n
d
a
ry
b
o
a
r
d
in
g
sc
h
o
o
l
stu
d
e
n
ts
i
n
t
h
is
stu
d
y
m
e
t
th
e
re
c
o
m
m
e
n
d
e
d
d
a
il
y
a
m
o
u
n
t
o
f
p
h
y
sic
a
l
a
c
ti
v
it
y
,
h
ig
h
lev
e
ls
o
f
se
d
e
n
tary
b
e
h
a
v
i
o
r
a
n
d
v
a
ry
in
g
lev
e
ls
o
f
so
c
ial
su
p
p
o
rt
a
n
d
p
s
y
c
h
o
lo
g
ica
l
d
istres
s
h
ig
h
li
g
h
t
a
re
a
s th
a
t
wa
rra
n
t
fu
rt
h
e
r
in
terv
e
n
ti
o
n
.
K
ey
w
o
r
d
s
:
Ad
o
lescen
t
B
o
ar
d
in
g
s
ch
o
o
l
Ph
y
s
ical
ac
tiv
ity
Ps
y
ch
o
lo
g
ical
Sed
en
tar
y
T
h
is i
s
a
n
o
p
e
n
a
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c
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ss
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rticle
u
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d
e
r th
e
CC B
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SA
li
c
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se
.
C
o
r
r
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s
p
o
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A
uth
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r
:
Haz
izi
Ab
u
Saad
Dep
ar
tm
en
t o
f
Nu
tr
itio
n
,
Facu
lty
o
f
Me
d
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a
n
d
Hea
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Sc
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ce
s
,
Un
iv
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tr
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D
UCT
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O
N
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W
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ld
Hea
lth
Or
g
an
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n
(
W
HO)
r
ec
o
m
m
e
n
d
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th
at
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als
ag
ed
5
to
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7
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g
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6
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ate
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to
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v
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o
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o
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s
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ten
s
ity
ae
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o
b
ic
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d
aily
,
d
is
tr
ib
u
ted
th
r
o
u
g
h
o
u
t
t
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e
wee
k
.
Ad
d
itio
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ally
,
v
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o
r
o
u
s
-
in
ten
s
ity
ae
r
o
b
ic
ac
tiv
ities
,
as
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ex
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cises
th
at
s
tr
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g
th
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m
u
s
cles
an
d
b
o
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s
h
o
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b
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c
o
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p
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r
ated
at
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ast
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r
ee
d
a
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a
wee
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im
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s
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tar
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eh
av
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o
r
,
p
ar
ti
cu
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ly
r
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r
ea
tio
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al
s
cr
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n
tim
e,
is
also
em
p
h
asized
as
cr
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f
o
r
ad
o
lescen
ts
[
1
]
.
T
h
e
W
HO'
s
2
0
2
2
g
lo
b
al
s
tatu
s
r
ep
o
r
t
o
n
p
h
y
s
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ac
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p
r
esen
ted
ala
r
m
in
g
f
i
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d
in
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s
:
8
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ce
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ts
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d
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7
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o
f
ad
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lts
wo
r
l
d
wid
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d
o
n
o
t
m
ee
t
th
e
r
ec
o
m
m
en
d
e
d
p
h
y
s
ical
ac
tiv
ity
lev
els.
Am
o
n
g
ad
o
lesce
n
ts
,
g
ir
ls
wer
e
f
o
u
n
d
to
b
e
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s
ac
tiv
e
th
an
b
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s
,
with
in
ac
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r
ates o
f
8
5
% a
n
d
7
7
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6
%,
r
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.
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n
Ma
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p
h
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s
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in
ac
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is
a
g
r
o
win
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co
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r
n
,
p
a
r
ticu
lar
ly
am
o
n
g
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lescen
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.
A
s
tu
d
y
h
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h
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ted
th
at
Ma
lay
s
ia
h
as
h
ig
h
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r
ates
o
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p
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in
ac
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ass
o
ciate
d
m
o
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tality
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m
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8
8
0
6
F
a
cto
r
a
s
s
o
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w
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p
h
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l a
ctivity
leve
l a
mo
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s
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o
n
d
a
r
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…
(
A
h
ma
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‘
A
fifu
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d
-
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in
Hi
s
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mu
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d
in
)
1429
av
er
ag
es
[
2
]
.
Acc
o
r
d
in
g
to
th
e
Natio
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al
Hea
lth
an
d
M
o
r
b
id
ity
Su
r
v
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y
(
NHM
S)
2
0
1
2
,
o
n
ly
4
2
.
7
%
o
f
Ma
lay
s
ian
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o
lescen
ts
wer
e
p
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ically
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with
b
o
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s
(
5
4
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4
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b
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m
o
r
e
ac
tiv
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th
an
g
ir
ls
(
3
1
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1
%)
[
3
]
.
R
ec
en
t
d
ata
f
r
o
m
th
e
NHM
S
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o
lescen
t
h
ea
lth
s
u
r
v
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2
0
2
2
in
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icate
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th
at
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n
ly
2
1
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%
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f
ad
o
lescen
ts
in
Ma
lay
s
ia
ar
e
p
h
y
s
ically
ac
tiv
e
[
4
]
.
T
h
ese
f
in
d
in
g
s
u
n
d
e
r
s
co
r
e
th
e
u
r
g
e
n
t
n
ee
d
t
o
a
d
d
r
ess
in
s
u
f
f
icien
t
p
h
y
s
ical
ac
tiv
ity
a
m
o
n
g
Ma
lay
s
ian
y
o
u
th
.
Sed
en
tar
y
b
eh
av
io
r
r
e
f
er
s
to
an
y
wak
in
g
ac
tiv
ity
with
an
en
er
g
y
ex
p
e
n
d
itu
r
e
o
f
1
.
5
M
E
T
s
o
r
less
wh
ile
s
itti
n
g
,
r
ec
lin
in
g
,
o
r
l
y
i
n
g
d
o
wn
.
T
h
is
in
cl
u
d
es
ac
tiv
i
ties
s
u
ch
as
d
esk
-
b
ased
o
f
f
ice
wo
r
k
,
d
r
iv
in
g
,
an
d
watc
h
in
g
telev
is
io
n
,
an
d
is
also
r
elev
an
t
f
o
r
in
d
i
v
id
u
als
u
n
a
b
le
to
s
tan
d
,
s
u
ch
as
wh
ee
lch
air
u
s
er
s
[
5
]
.
L
o
ca
l
r
esear
ch
o
n
s
ed
en
tar
y
b
eh
a
v
io
r
r
em
ain
s
lim
ited
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b
u
t
p
r
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io
u
s
s
tu
d
ies
h
av
e
estab
lis
h
ed
an
a
s
s
o
ciatio
n
b
etwe
en
s
ed
en
tar
y
b
e
h
av
io
r
an
d
p
h
y
s
i
ca
l
ac
tiv
ity
lev
els
am
o
n
g
ad
o
lescen
ts
.
No
tab
ly
,
in
d
iv
i
d
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al
s
m
ay
ac
h
iev
e
th
e
r
ec
o
m
m
en
d
ed
lev
els
o
f
p
h
y
s
ical
ac
tiv
ity
,
y
et
th
e
y
ca
n
s
till
s
p
en
d
a
lar
g
e
p
o
r
tio
n
o
f
t
h
e
ir
d
ay
en
g
ag
ed
in
s
ed
en
tar
y
ac
tiv
ities
,
s
u
ch
as
s
itti
n
g
[6
]
.
A
s
y
s
tem
atic
r
ev
iew
b
y
Ma
et
a
l.
[
7
]
,
r
ev
ea
led
th
at
n
ea
r
ly
h
alf
o
f
ad
o
lescen
ts
wer
e
s
ed
en
tar
y
af
ter
s
ch
o
o
l
h
o
u
r
s
,
a
p
atter
n
wi
th
s
ig
n
if
ican
t
h
ea
lth
im
p
licati
o
n
s
.
I
n
a
s
tu
d
y
o
f
1
8
0
,
2
9
8
ad
o
lescen
ts
ag
e
d
1
2
–
1
5
y
ea
r
s
,
o
n
l
y
1
5
.
3
%
m
et
th
e
r
ec
o
m
m
en
d
ed
p
h
y
s
i
ca
l
ac
tiv
it
y
lev
el
(
at
least
6
0
m
in
u
tes
o
f
p
h
y
s
ical
ac
tiv
ity
p
er
d
ay
,
as
p
er
W
HO
g
u
id
elin
es).
Fu
r
th
er
m
o
r
e,
6
4
.
6
%
ex
h
ib
ited
lo
w
s
ed
en
tar
y
b
eh
av
io
r
(
d
ef
i
n
ed
as
2
h
o
u
r
s
o
r
less
o
f
s
itti
n
g
ac
tiv
ities
p
er
d
ay
,
ex
cl
u
d
in
g
s
ch
o
o
l
o
r
h
o
m
ewo
r
k
tim
e)
.
O
n
ly
9
.
1
% o
f
a
d
o
lescen
ts
m
et
b
o
th
th
e
p
h
y
s
ical
ac
tiv
ity
an
d
s
ed
en
tar
y
b
eh
a
v
io
r
r
ec
o
m
m
en
d
atio
n
s
[
7
]
.
I
n
Ma
lay
s
ia,
r
esear
ch
o
n
p
h
y
s
i
ca
l a
ctiv
ity
an
d
s
ed
en
tar
y
b
eh
av
io
r
o
f
te
n
ce
n
ter
s
o
n
g
en
er
al
s
ec
o
n
d
a
r
y
s
ch
o
o
l
s
tu
d
en
ts
,
n
eg
lectin
g
th
e
u
n
i
q
u
e
ch
ar
ac
ter
is
tics
o
f
b
o
ar
d
in
g
s
ch
o
o
l
s
tu
d
en
ts
,
wh
o
f
ac
e
d
is
tin
ct
ch
allen
g
es
an
d
life
s
ty
le
p
atter
n
s
.
B
o
ar
d
in
g
s
ch
o
o
l
s
tu
d
en
ts
liv
e
o
n
ca
m
p
u
s
f
o
r
ex
ten
d
ed
p
er
io
d
s
,
o
f
ten
with
less
p
ar
en
tal
in
v
o
lv
em
en
t
co
m
p
ar
ed
to
s
tu
d
e
n
ts
wh
o
liv
e
at
h
o
m
e.
T
h
eir
s
tr
u
ctu
r
e
d
d
ail
y
r
o
u
tin
es,
in
clu
d
i
n
g
s
p
ec
if
ic
tim
es
allo
ca
ted
f
o
r
cl
ass
es,
m
ea
ls
,
s
tu
d
y
,
an
d
e
x
tr
a
cu
r
r
icu
lar
ac
ti
v
ities
,
cr
ea
te
a
d
is
tin
ct
en
v
ir
o
n
m
e
n
t
f
o
r
p
h
y
s
ical
ac
tiv
ity
.
T
h
is
m
a
k
es
it
ess
en
tial
to
in
v
esti
g
ate
p
h
y
s
ical
ac
tiv
i
ty
lev
els
am
o
n
g
b
o
a
r
d
in
g
s
ch
o
o
l
s
tu
d
en
ts
,
as
th
eir
ex
p
er
ien
ce
s
d
if
f
er
s
ig
n
if
ican
tly
f
r
o
m
th
o
s
e
o
f
d
ay
s
ch
o
o
l
s
tu
d
en
ts
.
T
h
is
s
tu
d
y
aim
s
to
ass
e
s
s
th
e
p
h
y
s
ical
ac
tiv
ity
le
v
els
o
f
s
ec
o
n
d
ar
y
b
o
ar
d
in
g
s
ch
o
o
l
s
tu
d
en
ts
an
d
e
x
p
lo
r
e
th
e
p
o
ten
tial
ass
o
ciatio
n
s
b
etwe
en
th
ese
lev
els
an
d
v
ar
io
u
s
f
ac
to
r
s
s
u
ch
as
s
o
cio
-
d
em
o
g
r
ap
h
ics,
b
o
d
y
m
ass
in
d
ex
,
s
ed
en
tar
y
b
e
h
av
io
r
,
s
o
cial
s
u
p
p
o
r
t,
a
n
d
p
s
y
ch
o
lo
g
ical
asp
ec
ts
.
B
y
ex
am
in
in
g
th
ese
r
elatio
n
s
h
ip
s
,
th
e
s
tu
d
y
s
ee
k
s
to
p
r
o
v
id
e
v
alu
ab
le
in
s
ig
h
ts
i
n
to
th
e
f
ac
to
r
s
in
f
lu
en
ci
n
g
p
h
y
s
ical
ac
ti
v
ity
in
th
is
u
n
iq
u
e
p
o
p
u
latio
n
,
with
th
e
g
o
al
o
f
in
f
o
r
m
in
g
tar
g
eted
in
ter
v
e
n
tio
n
s
an
d
p
o
licies to
p
r
o
m
o
te
ad
o
lescen
t h
ea
lth
.
2.
M
E
T
H
O
D
2
.
1
.
Desig
n a
nd
s
a
m
ple size
T
h
is
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
was
co
n
d
u
cted
i
n
a
s
ec
o
n
d
ar
y
b
o
ar
d
i
n
g
s
ch
o
o
l
lo
ca
ted
in
Selan
g
o
r
,
Ma
lay
s
ia.
T
h
e
s
am
p
le
s
ize
wa
s
d
eter
m
in
ed
u
s
in
g
Dan
iel'
s
(
1
9
9
9
)
f
o
r
m
u
la
[
8
]
.
B
ased
o
n
th
e
NHM
S
2
0
2
2
[
4
]
p
r
ev
alen
ce
o
f
p
h
y
s
ically
ac
tiv
e
ad
o
lescen
ts
in
Ma
lay
s
ia
(
2
1
.
4
%),
th
e
r
eq
u
ir
e
d
s
am
p
le
s
ize
was
ca
lcu
lated
t
o
b
e
8
2
s
ec
o
n
d
a
r
y
b
o
ar
d
in
g
s
ch
o
o
l
s
tu
d
en
ts
.
T
h
is
ac
co
u
n
ted
f
o
r
a
m
ar
g
in
o
f
e
r
r
o
r
o
r
a
b
s
o
lu
te
p
r
ec
is
io
n
o
f
±
1
0
%
in
esti
m
atin
g
th
e
p
r
e
v
alen
ce
with
9
5
%
co
n
f
id
e
n
ce
,
wh
ile
also
co
n
s
id
er
in
g
a
p
o
t
en
tial
2
0
%
attr
itio
n
r
ate.
C
o
n
s
eq
u
en
tly
,
th
e
an
ticip
ated
9
5
%
co
n
f
id
e
n
ce
in
ter
v
a
l
r
an
g
ed
f
r
o
m
1
1
.
4
%
to
3
1
.
4
%.
T
h
e
s
am
p
le
s
ize
was c
o
m
p
u
ted
u
s
in
g
th
e
Scale
x
SP
ca
lcu
lato
r
Nain
g
et
a
l
.
[
9
]
in
co
n
j
u
n
ctio
n
with
Da
n
iel'
s
(
1
9
9
9
)
f
o
r
m
u
la.
2
.
2
.
P
a
rt
icipa
nts a
nd
re
cr
uitm
ent
A
m
u
ltis
tag
e
s
am
p
lin
g
tec
h
n
i
q
u
e
was
u
tili
ze
d
t
o
r
ec
r
u
it
p
a
r
ticip
an
ts
.
T
h
e
s
ch
o
o
l
c
o
n
s
is
ted
o
f
f
iv
e
s
tu
d
en
t
g
r
o
u
p
s
,
b
u
t
o
n
ly
Fo
r
m
s
1
,
2
,
an
d
4
wer
e
in
clu
d
ed
in
th
e
s
tu
d
y
.
Fo
r
m
5
s
tu
d
en
ts
we
r
e
ex
clu
d
e
d
d
u
e
t
o
th
eir
n
atio
n
al
ex
am
in
atio
n
s
ch
ed
u
les.
T
h
r
ee
clas
s
es
wer
e
r
a
n
d
o
m
ly
s
elec
ted
f
r
o
m
ea
ch
o
f
Fo
r
m
s
1
,
2
,
an
d
4
,
an
d
all
s
tu
d
en
ts
with
in
th
e
s
el
ec
ted
class
es we
r
e
in
v
ited
to
p
ar
ticip
ate
in
th
e
s
tu
d
y
.
2
.
3
.
Resea
rc
h
i
ns
t
rum
ent
s
A
s
elf
-
ad
m
in
is
ter
ed
q
u
esti
o
n
n
air
e
in
Ma
lay
was
u
s
ed
,
in
co
r
p
o
r
atin
g
v
alid
ated
an
d
r
eliab
le
in
s
tr
u
m
en
ts
:
i)
T
h
e
p
h
y
s
ical
ac
tiv
ity
q
u
esti
o
n
n
air
e
f
o
r
c
h
ild
r
en
(
PAQ
-
C
)
f
o
r
ass
ess
i
n
g
p
h
y
s
ical
ac
tiv
ity
lev
els;
ii)
T
h
e
Ad
o
lescen
t
s
e
d
en
tar
y
ac
tiv
ity
q
u
esti
o
n
n
air
e
,
d
ev
elo
p
e
d
b
y
Har
d
y
et
a
l
.
[
1
0
]
f
o
r
m
ea
s
u
r
in
g
s
ed
en
tar
y
b
eh
av
i
o
r
,
th
e
s
o
cial
s
u
p
p
o
r
t
s
ca
le
f
o
r
ex
er
cise
(
Ma
lay
Ver
s
io
n
,
v
alid
ated
b
y
Sab
o
et
a
l.
[
1
1
]
f
o
r
ev
alu
atin
g
s
o
cial
s
u
p
p
o
r
t f
r
o
m
f
r
ien
d
s
an
d
f
a
m
ily
;
an
d
iii)
T
h
e
d
ep
r
ess
io
n
,
an
x
iety
,
an
d
s
tr
ess
s
ca
le
-
2
1
I
tem
s
(
DASS
-
2
1
)
f
o
r
ass
ess
in
g
p
s
y
ch
o
lo
g
ical
f
ac
to
r
s
.
H
eig
h
t
a
n
d
weig
h
t
wer
e
also
m
ea
s
u
r
ed
to
ca
lc
u
late
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
an
d
B
MI
-
f
o
r
-
ag
e
Z
-
s
co
r
es.
Data
co
llectio
n
to
o
k
p
lace
o
n
-
s
ite
in
Dec
em
b
er
2
0
2
3
,
with
in
f
o
r
m
e
d
co
n
s
en
t
o
b
tain
ed
f
r
o
m
b
o
th
p
ar
ticip
an
ts
an
d
th
eir
p
ar
en
ts
o
r
g
u
ar
d
ian
s
.
2
.
4
.
St
a
t
is
t
ica
l
a
na
ly
s
is
Statis
t
ical
an
aly
s
is
was
p
er
f
o
r
m
ed
u
s
in
g
I
B
M
SP
SS
v
er
s
i
o
n
2
6
,
with
s
ig
n
if
ican
ce
lev
els
s
et
at
p
<0
.
0
5
.
Un
iv
ar
iate
a
n
aly
s
is
was
em
p
lo
y
ed
f
o
r
d
escr
ip
tiv
e
d
ata,
with
ca
teg
o
r
ical
v
ar
i
ab
les
p
r
esen
ted
as
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
4
2
8
-
1
4
3
5
1430
f
r
eq
u
e
n
cies
an
d
p
er
ce
n
ta
g
es,
an
d
co
n
tin
u
o
u
s
v
ar
iab
l
es
as
m
ea
n
s
an
d
s
tan
d
a
r
d
d
ev
iatio
n
s
.
Pear
s
o
n
co
r
r
elatio
n
an
d
c
h
i
-
s
q
u
ar
e
test
s
wer
e
u
s
ed
f
o
r
b
iv
ar
iate
an
aly
s
is
to
ex
am
in
e
t
h
e
ass
o
ciatio
n
s
b
et
wee
n
in
d
e
p
en
d
e
n
t
v
ar
iab
les
(
e.
g
.
,
s
o
cio
d
e
m
o
g
r
a
p
h
ic
f
ac
to
r
s
,
B
MI
,
s
ed
en
tar
y
b
eh
av
io
r
,
s
o
cial
s
u
p
p
o
r
t,
p
s
y
ch
o
lo
g
ical
f
ac
to
r
s
)
an
d
th
e
d
ep
en
d
en
t v
ar
ia
b
le
(
p
h
y
s
ical
ac
tiv
ity
lev
el)
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
A
t
o
ta
l
o
f
1
8
1
p
ar
t
ici
p
an
ts
w
e
r
e
in
v
o
l
v
e
d
i
n
t
h
e
s
t
u
d
y
,
w
it
h
a
m
ea
n
a
g
e
o
f
1
4
.
3
8
±
1
.
2
0
y
ea
r
s
.
T
ab
le
1
s
h
o
ws
th
e
d
is
tr
ib
u
tio
n
o
f
p
ar
ti
cip
an
ts
in
th
is
s
tu
d
y
.
T
h
e
m
aj
o
r
ity
o
f
p
ar
ticip
an
ts
wer
e
f
em
ale
(
6
3
.
5
%),
wh
ile
m
ales
ac
co
u
n
ted
f
o
r
3
6
.
5
%.
Nea
r
ly
7
5
%
o
f
p
ar
ticip
an
ts
'
p
ar
en
ts
h
ad
attain
ed
ter
tiar
y
e
d
u
ca
tio
n
,
in
d
icatin
g
a
r
elativ
ely
h
ig
h
lev
el
o
f
p
ar
en
t
al
ed
u
ca
tio
n
.
I
n
ter
m
s
o
f
f
am
i
ly
in
co
m
e,
4
0
.
8
%
o
f
p
a
r
ticip
a
n
ts
b
elo
n
g
ed
to
th
e
B
4
0
ca
teg
o
r
y
(
lo
w
in
co
m
e,
b
elo
w
R
M5
,
2
5
0
)
,
3
2
.
9
%
wer
e
in
th
e
M4
0
ca
te
g
o
r
y
(
m
i
d
d
l
e
in
co
m
e,
b
etwe
en
R
M5
,
2
5
0
an
d
R
M1
1
,
8
1
9
)
,
an
d
2
4
.
3
% we
r
e
in
th
e
T
2
0
ca
teg
o
r
y
(
h
ig
h
in
co
m
e,
a
b
o
v
e
R
M1
1
,
8
2
0
)
.
On
ly
4
.
4
%
o
f
p
ar
ticip
a
n
ts
d
id
n
o
t
m
ee
t
th
e
r
ec
o
m
m
e
n
d
ed
p
h
y
s
ical
ac
tiv
ity
g
u
id
elin
es,
w
h
ile
9
5
.
6
%
ex
ce
ed
ed
th
e
r
ec
o
m
m
e
n
d
atio
n
o
f
en
g
ag
in
g
in
at
least
4
2
0
m
in
u
tes
o
f
m
o
d
er
ate
-
to
-
v
ig
o
r
o
u
s
p
h
y
s
ical
ac
tiv
ity
(
MV
PA)
p
er
wee
k
.
T
h
is
in
d
icate
s
a
h
ig
h
lev
el
o
f
p
h
y
s
ical
ac
tiv
ity
am
o
n
g
th
e
s
tu
d
y
p
o
p
u
latio
n
.
B
y
co
m
p
ar
is
o
n
,
th
e
NHM
S
2
0
2
2
r
ep
o
r
ted
th
at
o
n
ly
2
1
.
4
%
o
f
Ma
lay
s
ian
ad
o
lescen
ts
ac
h
iev
ed
th
e
r
ec
o
m
m
e
n
d
ed
6
0
m
i
n
u
tes
o
f
d
aily
p
h
y
s
ical
a
ctiv
ity
.
Pre
v
io
u
s
r
esear
ch
s
u
p
p
o
r
ts
th
e
tr
en
d
th
at
ad
o
lescen
ts
g
en
er
ally
allo
ca
te
in
s
u
f
f
icien
t
tim
e
to
p
h
y
s
ical
ac
tiv
ity
[
1
2
]
,
[
1
3
]
.
Ho
wev
e
r
,
t
h
e
p
r
esen
t
s
tu
d
y
r
ev
ea
ls
a
s
tr
ik
in
g
co
n
t
r
ast
with
n
atio
n
al
d
ata,
s
h
o
win
g
th
at
b
o
ar
d
in
g
s
ch
o
o
l
ad
o
lescen
ts
d
e
m
o
n
s
tr
ate
s
ig
n
if
ican
tly
h
ig
h
er
lev
els
o
f
p
h
y
s
ical
ac
tiv
ity
.
T
h
e
s
tr
u
ct
u
r
ed
s
c
h
e
d
u
les
an
d
m
an
d
at
o
r
y
p
ar
ticip
atio
n
in
s
p
o
r
ts
an
d
r
ec
r
ea
tio
n
al
ac
tiv
ities
with
in
b
o
ar
d
in
g
s
ch
o
o
ls
ar
e
k
ey
f
ac
t
o
r
s
co
n
tr
i
b
u
tin
g
to
th
is
elev
at
ed
p
h
y
s
ical
ac
tiv
ity
.
T
h
e
a
v
ai
lab
ilit
y
o
f
s
ch
o
o
l
r
ec
r
ea
tio
n
al
f
ac
ilit
ies
also
p
la
y
s
a
cr
itical
r
o
le
in
in
v
o
lv
em
en
t
with
m
o
d
er
ate
to
v
ig
o
r
o
u
s
p
h
y
s
ical
ac
tiv
ity
am
o
n
g
a
d
o
lescen
ts
[
1
4
]
.
I
n
ter
m
s
o
f
B
MI
,
6
3
.
5
%
o
f
p
ar
ticip
an
ts
h
ad
a
n
o
r
m
al
we
ig
h
t,
wh
ile
2
1
.
5
%
wer
e
ca
teg
o
r
ized
as
o
v
er
weig
h
t
a
n
d
1
3
.
3
%
as
o
b
e
s
e.
A
s
m
all
p
r
o
p
o
r
tio
n
o
f
p
ar
t
icip
an
ts
(
1
.
7
%)
wer
e
u
n
d
e
r
weig
h
t.
T
h
ese
r
esu
lts
alig
n
with
NHM
S
2
0
2
2
d
ata,
wh
ich
in
d
icate
th
at
5
9
.
6
%
o
f
Ma
l
ay
s
ian
ch
ild
r
en
an
d
a
d
o
le
s
ce
n
ts
ag
ed
5
to
1
7
y
ea
r
s
h
ad
a
b
o
d
y
m
ass
in
d
ex
f
o
r
ag
e
z
-
s
co
r
e
(
B
AZ
)
i
n
th
e
n
o
r
m
al
r
a
n
g
e,
with
1
7
.
8
%
class
if
ied
as
o
v
er
weig
h
t
an
d
1
4
.
3
%
as
o
b
ese.
T
h
ese
f
in
d
in
g
s
ar
e
c
o
n
s
is
ten
t
with
p
r
ev
io
u
s
s
tu
d
ies,
wh
ich
r
ep
o
r
ted
s
im
ilar
B
AZ
d
is
t
r
ib
u
tio
n
s
am
o
n
g
a
d
o
lesce
n
ts
[
1
5
]
.
O
n
e
p
r
i
o
r
l
o
c
a
l
s
t
u
d
y
o
b
s
e
r
v
e
d
t
h
a
t
a
p
p
r
o
x
i
m
a
t
e
l
y
6
8
%
o
f
p
a
r
t
i
c
i
p
a
n
t
s
h
a
d
a
n
o
r
m
a
l
B
M
I
,
al
i
g
n
i
n
g
wit
h
t
h
e
c
u
r
r
e
n
t
s
t
u
d
y
'
s
f
i
n
d
i
n
g
s
.
T
h
a
t
s
t
u
d
y
a
ls
o
r
e
p
o
r
t
e
d
t
h
at
5
0
.
6
%
o
f
p
a
r
t
i
ci
p
a
n
t
s
h
a
d
a
n
o
r
m
a
l
B
A
Z
,
w
it
h
2
7
.
5
%
f
a
l
l
i
n
g
i
n
t
o
t
h
e
o
v
e
r
we
i
g
h
t
o
r
o
b
e
s
e
c
a
t
e
g
o
r
y
.
I
n
t
e
r
e
s
ti
n
g
ly
,
t
h
e
p
r
e
v
a
l
e
n
c
e
o
f
u
n
d
e
r
w
e
i
g
h
t
i
n
d
i
v
i
d
u
a
ls
w
as
s
li
g
h
t
l
y
h
i
g
h
e
r
i
n
t
h
e
p
r
e
v
i
o
u
s
s
tu
d
y
,
a
t
2
2
%
o
f
t
h
e
s
a
m
p
l
e
[
1
6
]
.
T
h
e
av
er
ag
e
tim
e
p
ar
ticip
a
n
ts
s
p
en
t
o
n
s
ed
en
tar
y
b
e
h
av
io
r
s
o
v
e
r
a
wee
k
(
7
d
ay
s
)
was
5
2
9
.
1
5
±
2
5
0
.
1
5
m
in
u
tes
p
er
d
ay
,
wh
ich
eq
u
ates
to
ap
p
r
o
x
im
ately
9
h
o
u
r
s
o
f
s
ed
en
tar
y
a
ctiv
ity
d
aily
.
Am
o
n
g
th
e
d
if
f
e
r
en
t
s
ed
e
n
tar
y
ac
tiv
iti
es,
th
e
h
ig
h
est
av
er
a
g
e
tim
e
was
s
p
en
t
o
n
s
o
cial
ac
tiv
ities
,
with
p
a
r
ticip
an
ts
en
g
ag
in
g
in
th
ese
ac
tiv
ities
f
o
r
1
,
3
3
0
.
4
2
±
9
9
5
.
3
4
m
in
u
tes
p
er
wee
k
.
T
h
e
tim
e
s
p
en
t
o
n
ed
u
ca
tio
n
al
an
d
cu
ltu
r
al
s
ed
en
tar
y
ac
tiv
ities
av
er
ag
e
d
4
6
1
.
2
6
±
3
0
2
.
2
1
m
in
u
tes
an
d
2
6
7
.
2
8
±
2
7
6
.
9
5
m
in
u
tes
p
er
wee
k
,
r
esp
ec
tiv
ely
.
I
n
co
n
tr
ast,
p
ar
ticip
an
ts
r
ep
o
r
ted
lo
wer
lev
e
ls
o
f
s
cr
ee
n
tim
e
an
d
tr
av
el
-
r
elate
d
s
ed
en
tar
y
ac
tiv
ities
,
with
av
er
ag
es
o
f
7
0
.
4
8
±
9
0
.
4
7
m
in
u
tes
an
d
4
0
.
6
3
±
1
0
8
.
7
6
m
in
u
tes
p
er
wee
k
,
r
e
s
p
ec
tiv
ely
.
Ov
er
all,
8
7
.
6
%
o
f
p
ar
ticip
an
t
s
wer
e
cla
s
s
if
ied
as
h
av
in
g
h
i
g
h
s
ed
en
ta
r
y
lev
els,
s
p
en
d
in
g
m
o
r
e
th
an
4
h
o
u
r
s
p
er
d
ay
o
n
s
ed
en
tar
y
ac
tiv
ities
,
wh
ile
o
n
l
y
1
2
.
4
% we
r
e
class
if
ied
as h
av
in
g
lo
w
s
ed
en
ta
r
y
lev
els.
I
n
co
m
p
ar
is
o
n
t
o
th
e
f
in
d
in
g
s
o
f
th
e
NHM
S
2
0
2
2
,
th
is
s
tu
d
y
r
e
v
ea
led
th
at
a
s
ig
n
i
f
ican
t
p
r
o
p
o
r
tio
n
(
6
6
.
7
%)
o
f
p
ar
ticip
a
n
ts
s
p
en
t
at
least
th
r
ee
h
o
u
r
s
p
er
d
ay
e
n
g
ag
ed
in
s
ed
e
n
tar
y
ac
tiv
ities
.
Pre
v
io
u
s
r
esear
ch
r
ep
o
r
ted
a
s
lig
h
tly
lo
wer
p
r
ev
alen
ce
o
f
s
ed
e
n
tar
y
b
eh
a
v
io
r
,
with
ap
p
r
o
x
im
ately
6
2
.
5
%
o
f
r
esp
o
n
d
e
n
ts
class
if
ied
as
s
ed
en
tar
y
[
6
]
.
C
o
n
v
er
s
ely
,
a
g
l
o
b
al
s
tu
d
y
i
n
d
icate
d
a
h
ig
h
er
p
r
e
v
alen
ce
o
f
lo
w
s
ed
e
n
tar
y
b
eh
a
v
io
r
,
with
6
4
.
6
%
o
f
r
esp
o
n
d
en
ts
f
allin
g
in
to
th
is
ca
teg
o
r
y
,
co
n
tr
asti
n
g
with
t
h
e
lo
wer
p
r
ev
alen
ce
(
1
2
.
4
%)
o
b
s
er
v
ed
in
th
e
cu
r
r
en
t
s
tu
d
y
[
7
]
.
T
h
e
elev
ated
s
ed
e
n
tar
y
b
eh
av
io
r
in
th
is
s
t
u
d
y
m
a
y
b
e
attr
ib
u
tab
le
to
th
e
b
o
ar
d
in
g
s
ch
o
o
l
en
v
ir
o
n
m
en
t,
wh
er
e
s
tu
d
en
ts
s
p
en
d
m
o
r
e
ti
m
e
s
o
cializin
g
with
p
ee
r
s
d
u
e
to
lim
ited
ac
ce
s
s
to
elec
tr
o
n
ic
d
ev
ices a
n
d
a
g
r
ea
ter
f
o
cu
s
o
n
ac
ad
em
ic
ac
tiv
ities
an
d
r
ev
is
io
n
.
Ad
eq
u
ate
s
u
p
p
o
r
t
f
r
o
m
b
o
th
p
ar
en
ts
an
d
p
e
er
s
is
k
n
o
wn
to
p
o
s
itiv
ely
in
f
lu
en
ce
a
d
o
lescen
t
s
'
p
h
y
s
ical
ac
tiv
ity
[
1
7
]
.
I
n
th
is
s
t
u
d
y
,
h
a
lf
o
f
th
e
p
ar
ticip
an
ts
r
ep
o
r
ted
r
ec
eiv
in
g
s
u
f
f
icie
n
t
s
u
p
p
o
r
t
f
o
r
p
h
y
s
ical
ac
tiv
ity
,
wh
ile
th
e
o
t
h
er
h
alf
i
n
d
icate
d
lo
w
lev
els
o
f
s
u
p
p
o
r
t
.
T
h
is
m
ay
r
e
f
lect
th
e
b
o
ar
d
in
g
s
ch
o
o
l
co
n
tex
t,
w
h
er
e
s
tu
d
en
ts
s
p
en
d
s
ig
n
if
ican
t
tim
e
with
p
ee
r
s
,
r
esu
ltin
g
in
h
i
g
h
er
lev
els
o
f
p
ee
r
s
u
p
p
o
r
t
co
m
p
ar
ed
t
o
p
ar
e
n
tal
s
u
p
p
o
r
t.
Pre
v
io
u
s
r
esear
ch
h
as
h
ig
h
lig
h
ted
th
at
s
u
p
p
o
r
t
f
r
o
m
f
r
ien
d
s
,
p
ar
en
ts
,
an
d
teac
h
er
s
o
f
ten
p
lay
s
a
m
o
r
e
s
u
b
s
tan
tial r
o
le
in
p
ar
ticip
atio
n
in
p
h
y
s
ical
ac
tiv
ity
[
1
8
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
F
a
cto
r
a
s
s
o
cia
ted
w
ith
p
h
ysica
l a
ctivity
leve
l a
mo
n
g
s
ec
o
n
d
a
r
y
…
(
A
h
ma
d
‘
A
fifu
’
d
-
d
in
Hi
s
a
mu
d
d
in
)
1431
T
ab
le
1
.
Me
an
±
SD a
n
d
d
is
tr
ib
u
tio
n
o
f
r
esp
o
n
d
en
ts
o
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1432
Nea
r
ly
h
alf
o
f
th
e
p
ar
ticip
a
n
ts
wer
e
co
n
s
id
er
ed
asy
m
p
t
o
m
atic
f
o
r
an
x
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(
4
4
.
0
%)
an
d
s
tr
ess
(
4
9
.
4
%),
wh
ile
m
o
r
e
t
h
an
h
alf
wer
e
asy
m
p
to
m
atic
f
o
r
d
e
p
r
e
s
s
io
n
(
6
2
.
6
%).
A
s
m
all
p
er
ce
n
tag
e
o
f
p
a
r
ticip
an
ts
r
ep
o
r
ted
ex
p
er
ien
cin
g
e
x
tr
e
m
e
lev
els
o
f
d
ep
r
ess
io
n
(
1
.
6
%)
an
d
s
tr
ess
(
0
.
6
%).
Ad
d
itio
n
ally
,
1
1
%
o
f
p
ar
ticip
an
ts
r
ep
o
r
ted
s
ev
er
e
a
n
x
iety
,
a
r
ate
h
ig
h
er
th
an
th
o
s
e
f
o
r
d
ep
r
ess
io
n
an
d
s
tr
ess
.
A
p
r
ev
io
u
s
s
tu
d
y
r
ep
o
r
te
d
th
e
p
r
ev
alen
ce
o
f
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
am
o
n
g
ad
o
lescen
ts
to
b
e
1
9
%,
wh
ic
h
is
lo
wer
th
an
th
e
3
7
.
4
%
f
o
u
n
d
in
th
e
c
u
r
r
en
t
s
t
u
d
y
[
1
9
]
.
Similar
ly
,
an
x
iety
p
r
ev
alen
ce
in
th
e
p
r
io
r
s
tu
d
y
was
h
ig
h
(
6
3
.
8
%),
alig
n
in
g
with
th
e
cu
r
r
en
t stu
d
y
'
s
f
in
d
in
g
s
o
f
5
4
%
[
2
0
]
.
Oliv
ei
r
a
et
a
l
.
[
2
1
]
r
ep
o
r
ted
th
at
a
p
p
r
o
x
im
ately
4
4
% o
f
ad
o
lescen
ts
h
ad
a
h
ig
h
p
er
ce
p
tio
n
o
f
s
tr
ess
,
co
n
s
is
ten
t
with
th
e
5
1
%
o
b
s
er
v
ed
i
n
th
is
s
tu
d
y
.
C
o
llectiv
ely
,
th
ese
f
in
d
in
g
s
s
u
g
g
est
th
at
a
s
u
b
s
tan
tial
p
r
o
p
o
r
tio
n
o
f
p
ar
tic
ip
an
ts
in
th
is
s
tu
d
y
ar
e
ex
p
e
r
ien
cin
g
s
y
m
p
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s
o
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ep
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d
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ap
p
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m
ately
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alf
af
f
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b
y
an
x
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a
n
d
s
tr
ess
an
d
o
n
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-
th
ir
d
a
f
f
ec
ted
b
y
d
ep
r
ess
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s
y
m
p
to
m
s
,
in
d
i
ca
tin
g
a
wo
r
s
en
in
g
s
itu
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n
a
m
o
n
g
t
h
ese
ad
o
lescen
ts
.
T
ab
le
2
p
r
esen
ts
th
e
r
elatio
n
s
h
ip
b
etwe
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s
o
cio
d
em
o
g
r
a
p
h
i
c
f
ac
to
r
s
an
d
wee
k
ly
p
h
y
s
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ac
tiv
ity
.
A
s
ig
n
if
ican
t
ass
o
ciatio
n
was
a
l
s
o
f
o
u
n
d
b
etwe
en
g
e
n
d
er
an
d
p
h
y
s
ical
ac
tiv
ity
lev
els
(
p
=
0
.
0
2
4
)
.
All
m
ale
p
ar
ticip
an
ts
(
1
0
0
%)
m
et
th
e
r
e
co
m
m
en
d
e
d
p
h
y
s
ical
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tiv
ity
lev
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m
p
ar
e
d
to
9
3
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o
f
f
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ales,
with
7
%
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f
f
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ales
f
allin
g
s
h
o
r
t
o
f
th
e
r
ec
o
m
m
en
d
atio
n
s
.
T
h
is
is
co
n
s
is
ten
t
with
p
r
ev
io
u
s
r
esear
c
h
lin
k
in
g
g
e
n
d
er
to
p
h
y
s
ical
ac
tiv
ity
lev
els,
wh
er
e
m
ale
s
tu
d
en
ts
ty
p
ically
ex
h
ib
it
h
ig
h
er
ac
ti
v
ity
lev
els
[
6
]
,
[
1
2
]
.
T
h
e
g
e
n
d
er
d
is
p
ar
ity
in
p
h
y
s
ical
ac
tiv
ity
m
ay
b
e
in
f
lu
e
n
ce
d
b
y
s
o
cio
c
u
ltu
r
al
f
ac
to
r
s
,
s
u
ch
as
th
e
a
s
s
o
ciatio
n
b
etwe
en
m
ascu
lin
ity
an
d
p
h
y
s
ical
ac
t
iv
ity
an
d
th
e
ten
d
en
c
y
f
o
r
f
em
ale
ad
o
lescen
ts
to
p
r
io
r
itize
ac
ad
em
ics
an
d
h
o
u
s
eh
o
ld
r
esp
o
n
s
ib
ilit
ies
o
v
e
r
p
h
y
s
ical
ex
er
cise.
A
s
ig
n
if
ican
t,
s
tr
o
n
g
n
eg
ativ
e
co
r
r
elatio
n
was
f
o
u
n
d
b
et
wee
n
ag
e
an
d
wee
k
ly
p
h
y
s
i
ca
l
ac
tiv
ity
(r
=
−0
.
7
6
,
p
<0
.
0
0
1
)
,
s
u
g
g
esti
n
g
th
at
as
ag
e
in
cr
ea
s
es,
tim
e
s
p
en
t
o
n
p
h
y
s
ical
ac
tiv
ity
d
ec
r
ea
s
es.
T
h
is
f
in
d
in
g
alig
n
s
with
p
r
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r
r
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c
h
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wh
ich
also
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en
tifie
d
a
s
ig
n
if
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t
ass
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n
b
etwe
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ag
e
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d
p
h
y
s
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ac
tiv
ity
en
g
ag
em
e
n
t
[
2
2
]
,
[
2
3
]
.
Fu
en
t
ea
lb
a
-
Ur
r
a
et
a
l
.
[
2
4
]
n
o
ted
t
h
at
th
e
tr
an
s
itio
n
f
r
o
m
ch
ild
h
o
o
d
to
a
d
o
lescen
ce
o
f
ten
r
esu
lts
in
a
d
ec
lin
e
in
b
o
th
th
e
f
r
e
q
u
en
c
y
an
d
d
u
r
atio
n
o
f
p
h
y
s
ical
ac
tiv
ity
.
No
s
ig
n
if
ican
t
ass
o
cia
tio
n
s
wer
e
f
o
u
n
d
b
etwe
en
p
a
r
en
ts
'
ed
u
ca
tio
n
al
le
v
els
an
d
p
h
y
s
ical
ac
tiv
ity
(p
=
0
.
4
1
0
)
.
T
h
is
f
in
d
in
g
is
co
n
s
is
ten
t
with
s
o
m
e
s
tu
d
ies
[
6
]
,
[
2
5
]
b
u
t
co
n
tr
asts
with
o
th
er
s
th
at
h
av
e
s
u
g
g
ested
a
s
ig
n
i
f
ican
t
im
p
a
ct
o
f
a
f
at
h
er
'
s
ed
u
ca
tio
n
o
n
ad
o
lescen
ts
'
p
h
y
s
ical
ac
tiv
ity
lev
els
[
2
6
]
.
T
h
ese
d
is
cr
ep
an
cies m
ay
b
e
attr
i
b
u
te
d
to
v
ar
iat
io
n
s
in
s
am
p
le
s
ize
an
d
p
o
p
u
latio
n
ch
ar
ac
ter
is
tics
.
S
i
m
i
l
a
r
l
y
,
n
o
s
i
g
n
i
f
i
c
a
n
t
r
e
l
a
t
i
o
n
s
h
i
p
w
a
s
f
o
u
n
d
b
e
t
w
e
e
n
h
o
u
s
e
h
o
l
d
i
n
c
o
m
e
a
n
d
w
e
e
k
l
y
p
h
y
s
i
c
a
l
a
c
t
i
v
i
t
y
(r
=
0
.
0
2
,
p
=
0
.
7
8
0
)
.
W
h
i
l
e
l
o
c
a
l
s
t
u
d
i
e
s
a
l
s
o
r
e
p
o
r
t
n
o
c
o
r
r
e
l
a
t
i
o
n
b
e
t
w
e
e
n
i
n
c
o
m
e
a
n
d
p
h
y
s
i
c
a
l
a
c
t
i
v
i
t
y
[
1
2
]
,
o
t
h
e
r
r
e
s
e
a
r
c
h
h
a
s
i
d
e
n
t
i
f
i
e
d
a
s
i
g
n
i
f
i
c
a
n
t
a
s
s
o
c
i
a
t
i
o
n
[
2
5
]
.
I
n
t
h
i
s
s
t
u
d
y
,
e
q
u
a
l
a
c
c
e
s
s
t
o
s
c
h
o
o
l
-
p
r
o
v
i
d
e
d
s
p
o
r
t
s
f
a
c
i
l
i
t
i
e
s
a
c
r
o
s
s
i
n
c
o
m
e
l
e
v
e
l
s
m
a
y
e
x
p
l
a
i
n
t
h
e
l
a
c
k
o
f
i
n
c
o
m
e
-
r
e
l
a
t
e
d
d
i
f
f
e
r
e
n
c
e
s
i
n
p
h
y
s
i
c
a
l
a
c
t
i
v
i
t
y
.
T
ab
le
3
s
h
o
ws
th
e
co
r
r
elatio
n
b
etwe
en
B
MI
-
f
o
r
-
a
g
e
Z
-
s
co
r
e
(
B
AZ
)
,
s
o
cio
lo
g
ical
f
ac
to
r
s
(
f
am
ily
an
d
p
ee
r
s
u
p
p
o
r
t,
d
ep
r
ess
io
n
,
a
n
x
iety
,
an
d
s
tr
ess
)
,
s
ed
en
tar
y
b
e
h
av
io
r
s
,
an
d
wee
k
ly
p
h
y
s
ical
ac
tiv
ity
(
m
in
u
tes).
B
MI
was
n
o
t
s
ig
n
if
ican
tly
as
s
o
ciate
d
with
wee
k
ly
p
h
y
s
ica
l
ac
tiv
ity
(
r
=
0
.
1
4
,
p
=
0
.
0
6
2
)
.
T
h
is
alig
n
s
with
p
r
io
r
r
esear
ch
,
wh
ich
o
f
te
n
f
i
n
d
s
n
o
d
ir
ec
t
r
elatio
n
s
h
ip
b
etw
ee
n
p
h
y
s
ical
ac
tiv
ity
an
d
B
MI
am
o
n
g
a
d
o
lescen
ts
[
1
2
]
.
Ho
we
v
er
,
s
o
m
e
s
tu
d
ies
s
u
g
g
est
th
at
o
b
ese
ad
o
lescen
t
s
m
ay
en
g
ag
e
in
m
o
r
e
p
h
y
s
ic
al
ac
tiv
ity
,
p
o
s
s
ib
ly
as
a
weig
h
t
-
lo
s
s
s
tr
ateg
y
[
2
7
]
.
T
h
e
u
s
e
o
f
s
elf
-
r
ep
o
r
ted
q
u
esti
o
n
n
air
es
m
a
y
h
a
v
e
co
n
tr
ib
u
ted
to
ov
er
esti
m
atio
n
in
p
h
y
s
ical
ac
tiv
ity
lev
els,
as
s
tu
d
ies
u
s
i
n
g
o
b
jectiv
e
m
ea
s
u
r
es
lik
e
ac
ce
ler
o
m
eter
s
h
av
e
s
h
o
wn
m
o
r
e
s
ig
n
if
ican
t a
s
s
o
ciatio
n
s
[
2
8
]
.
T
h
er
e
was
n
o
s
ig
n
if
ican
t
r
elat
io
n
s
h
ip
b
etwe
en
s
ed
en
tar
y
b
e
h
av
io
r
an
d
p
h
y
s
ical
ac
tiv
ity
(
r
=
−0
.
0
7
1
,
p
=
0
.
3
4
7
)
.
T
h
is
d
if
f
er
s
f
r
o
m
s
tu
d
ies
s
h
o
win
g
t
h
at
p
h
y
s
ical
an
d
s
ed
e
n
tar
y
b
eh
a
v
io
r
s
c
an
co
ex
is
t
[
6
]
.
I
t
is
p
o
s
s
ib
le
th
at
ad
o
lescen
ts
m
ay
en
g
ag
e
in
p
h
y
s
ical
ac
tiv
ity
wh
ile
s
till
s
p
en
d
in
g
s
ig
n
if
ican
t
am
o
u
n
ts
o
f
tim
e
in
s
ed
en
tar
y
ac
tiv
ities
.
T
ab
le
2
.
R
elatio
n
s
h
ip
b
etwe
en
s
o
cio
d
em
o
g
r
ap
h
ic
f
ac
to
r
s
with
wee
k
ly
p
h
y
s
ical
ac
tiv
ity
s
p
e
n
t (
m
in
u
tes)
V
a
r
i
a
b
l
e
s
M
e
e
t
r
e
c
o
mm
e
n
d
a
t
i
o
n
N
o
t
m
e
e
t
r
e
c
o
mm
e
n
d
a
t
i
o
n
r
n
(
%)
n
(
%)
p
A
g
e
-
0
.
7
6
a
<
0
.
0
0
1
a
*
S
e
x
M
a
l
e
0
(
0
.
0
)
6
6
(
1
0
0
.
0
)
0
.
0
2
4
b
*
F
e
mal
e
8
(
7
.
0
)
1
0
6
(
9
3
.
0
)
F
a
t
h
e
r
’
s e
d
u
c
a
t
i
o
n
l
e
v
e
l
S
e
c
o
n
d
a
r
y
o
r
l
o
w
e
r
2
(
4
.
5
)
4
2
(
9
5
.
5
)
1
.
0
0
0
b
Te
r
t
i
a
r
y
6
(
4
.
5
)
1
2
8
(
9
5
.
5
)
M
o
t
h
e
r
’
s e
d
u
c
a
t
i
o
n
l
e
v
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l
S
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c
o
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r
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o
r
l
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w
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r
3
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6
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4
1
(
9
3
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2
)
0
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4
1
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b
Te
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t
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a
r
y
5
(
3
.
7
)
1
2
8
(
9
6
.
3
)
H
o
u
s
e
h
o
l
d
i
n
c
o
me
st
a
t
u
s
0
.
0
2
a
0
.
7
8
0
a
N
o
t
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:
a
P
e
a
r
s
o
n
p
r
o
d
u
c
t
-
mo
me
n
t
c
o
r
r
e
l
a
t
i
o
n
;
b
F
i
s
h
e
r
’
s E
x
a
c
t
Te
st
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
F
a
cto
r
a
s
s
o
cia
ted
w
ith
p
h
ysica
l a
ctivity
leve
l a
mo
n
g
s
ec
o
n
d
a
r
y
…
(
A
h
ma
d
‘
A
fifu
’
d
-
d
in
Hi
s
a
mu
d
d
in
)
1433
So
cial
s
u
p
p
o
r
t
em
er
g
e
d
as
a
s
ig
n
if
ican
t
f
ac
to
r
in
f
lu
e
n
cin
g
p
h
y
s
ical
ac
tiv
ity
.
A
wea
k
p
o
s
itiv
e
r
elatio
n
s
h
ip
was
f
o
u
n
d
b
etw
ee
n
f
am
ily
s
u
p
p
o
r
t
an
d
wee
k
ly
p
h
y
s
ical
ac
tiv
ity
(
r
=
0
.
2
8
,
p
<0
.
0
0
1
)
,
an
d
a
m
o
d
er
ate
p
o
s
itiv
e
r
elatio
n
s
h
i
p
was
o
b
s
e
r
v
e
d
with
p
ee
r
s
u
p
p
o
r
t
(
r
=
0
.
3
9
,
p
<0
.
0
0
1
)
.
T
h
ese
f
in
d
in
g
s
ec
h
o
p
r
ev
io
u
s
r
esear
ch
,
wh
ich
h
i
g
h
lig
h
ts
th
e
im
p
o
r
tan
ce
o
f
s
o
ci
al
s
u
p
p
o
r
t
f
r
o
m
f
r
ie
n
d
s
an
d
f
am
ily
in
p
r
o
m
o
tin
g
p
h
y
s
ical
ac
tiv
ity
am
o
n
g
ad
o
l
escen
ts
[
2
9
]
.
Frie
n
d
s
,
in
p
ar
t
icu
lar
,
ca
n
en
c
o
u
r
a
g
e
p
h
y
s
ical
ac
tiv
ity
th
r
o
u
g
h
s
h
ar
ed
h
ab
its
an
d
p
ar
ticip
atio
n
in
ac
tiv
e
p
u
r
s
u
its
.
L
astl
y
,
a
wea
k
n
eg
ativ
e
r
elatio
n
s
h
ip
was
f
o
u
n
d
b
etwe
en
s
tr
ess
an
d
p
h
y
s
ical
ac
tiv
ity
(
r
=
−0
.
1
8
,
p
=
0
.
0
1
6
)
.
Hig
h
e
r
s
tr
ess
lev
els
wer
e
ass
o
ciate
d
with
r
ed
u
c
e
d
p
h
y
s
ical
ac
tiv
ity
,
s
u
p
p
o
r
tin
g
r
e
s
ea
r
ch
s
h
o
win
g
th
at
s
tr
ess
ca
n
d
im
in
is
h
ex
er
cise
en
g
ag
em
e
n
t
[
3
0
]
.
Alth
o
u
g
h
e
x
er
cise
is
k
n
o
wn
to
allev
iate
s
tr
ess
,
in
d
iv
id
u
als
o
f
ten
o
p
t f
o
r
s
ed
en
tar
y
ac
tiv
ities
d
u
r
in
g
s
tr
ess
f
u
l p
er
io
d
s
,
p
o
ten
tially
d
u
e
to
p
er
ce
i
v
ed
lack
o
f
tim
e
an
d
en
e
r
g
y
[
3
1
]
,
[
3
2
]
.
No
s
ig
n
if
ican
t
ass
o
ciatio
n
s
wer
e
f
o
u
n
d
b
etwe
en
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
(
r
=
−0
.
1
1
,
p
=
0
.
1
3
0
)
o
r
an
x
iety
s
y
m
p
to
m
s
(
r
=
−0
.
1
4
,
p
=
0
.
0
6
0
)
a
n
d
p
h
y
s
ical
ac
tiv
ity
,
alth
o
u
g
h
p
r
e
v
io
u
s
s
tu
d
ies
h
av
e
s
h
o
w
n
m
ix
e
d
r
esu
lts
r
eg
ar
d
in
g
t
h
ese
r
elatio
n
s
h
ip
s
.
T
ab
le
3
.
C
o
r
r
elatio
n
b
etwe
en
B
MI
-
f
o
r
-
ag
e
Z
-
s
co
r
e
(
B
AZ
)
,
s
o
cio
lo
g
ical
f
ac
to
r
s
(
f
am
ily
&
p
ee
r
s
s
u
p
p
o
r
t,
d
ep
r
ess
io
n
,
an
x
iety
&
s
tr
ess
)
,
s
ed
en
tar
y
b
e
h
av
io
r
s
with
wee
k
ly
p
h
y
s
ical
ac
tiv
ity
s
p
en
t (
m
i
n
u
tes)
V
a
r
i
a
b
l
e
W
e
e
k
l
y
p
h
y
s
i
c
a
l
a
c
t
i
v
i
t
y
sp
e
n
t
(
m
i
n
u
t
e
s)
r
p
-
v
a
l
u
e
B
A
Z
0
.
1
4
0
.
0
6
2
F
a
mi
l
y
s
u
p
p
o
r
t
0
.
2
8
<
0
.
0
0
1
*
P
e
e
r
s s
u
p
p
o
r
t
0
.
3
9
<
0
.
0
0
1
*
D
e
p
r
e
ss
i
o
n
-
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Hea
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Or
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4
2
0
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in
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h
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ly
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ig
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l
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h
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ically
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T
h
e
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tr
u
c
tu
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ir
o
n
m
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t,
ac
ce
s
s
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well
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eq
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ip
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f
ac
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an
d
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ch
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led
r
ec
r
ea
tio
n
al
ac
tiv
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in
b
o
ar
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g
s
ch
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o
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lik
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n
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ib
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te
to
th
is
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h
lev
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o
f
ac
tiv
ity
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Ho
wev
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,
d
esp
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h
p
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ic
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ac
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lev
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s
tu
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ti
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9
h
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s
p
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ay
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ed
en
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y
ac
tiv
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.
S
ig
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if
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ass
o
ciat
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etwe
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en
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p
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t,
a
n
d
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tr
ess
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h
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ca
l
ac
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lev
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So
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o
t
h
f
r
o
m
f
am
ily
an
d
p
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s
,
was
p
ar
ticu
lar
ly
in
f
lu
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tial,
with
h
ig
h
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lev
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o
f
s
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p
p
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co
r
r
esp
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n
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in
g
to
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ter
p
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ac
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.
Stre
s
s
,
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th
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t
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,
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ativ
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icatin
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ay
h
in
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ts
'
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ex
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W
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b
o
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n
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ter
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ca
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m
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.
ACK
NO
WL
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DG
M
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S
T
h
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au
th
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r
s
ex
ten
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ap
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to
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tici
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eir
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t,
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n
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v
alu
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tio
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s
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T
h
eir
p
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ticip
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was in
s
tr
u
m
e
n
tal
in
th
e
s
u
cc
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f
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l c
o
m
p
leti
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n
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f
th
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esear
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F
UNDING
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was c
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with
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h
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jo
u
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C
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a
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C
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to
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g
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ize
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th
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tio
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r
ed
u
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au
th
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s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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3
,
Sep
tem
b
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20
25
:
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4
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titu
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.
DATA AV
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[
HAS]
.
T
h
e
d
ata,
w
h
ich
co
n
tain
s
in
f
o
r
m
atio
n
th
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d
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e
to
ce
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tain
r
estrictio
n
s
.
RE
F
E
R
E
NC
E
S
[
1
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
“
P
h
y
s
i
c
a
l
a
c
t
i
v
i
t
y
.
F
a
c
t
s
h
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e
t
.
”
h
t
t
p
s
:
/
/
w
w
w
.
w
h
o
.
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n
t
/
n
e
w
s
-
r
o
o
m/
f
a
c
t
-
sh
e
e
t
s
/
d
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t
a
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l
/
p
h
y
si
c
a
l
-
a
c
t
i
v
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t
y
(
a
c
c
e
s
se
d
A
p
r
.
0
5
,
2
0
2
3
)
.
[
2
]
S
.
K
h
o
o
,
B
.
K
.
P
o
h
,
S
.
A
.
S
u
h
a
i
m
i
,
K
.
H
.
C
h
o
n
g
,
a
n
d
A
.
R
a
mi
r
e
z
V
a
r
e
l
a
,
“
P
h
y
s
i
c
a
l
a
c
t
i
v
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t
y
p
r
o
m
o
t
i
o
n
i
n
M
a
l
a
y
s
i
a
:
C
h
a
l
l
e
n
g
e
s
a
n
d
o
p
p
o
r
t
u
n
i
t
i
e
s
,
”
Fro
n
t
i
e
rs
i
n
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
8
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O
c
t
.
2
0
2
0
,
d
o
i
:
1
0
.
3
3
8
9
/
f
p
u
b
h
.
2
0
2
0
.
5
3
6
2
3
9
.
[
3
]
I
n
st
i
t
u
t
e
f
o
r
P
u
b
l
i
c
H
e
a
l
t
h
(
I
P
H
)
,
“
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c
h
n
i
c
a
l
r
e
p
o
r
t
n
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t
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o
n
a
l
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e
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m
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t
y
su
r
v
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y
(
N
H
M
S
)
2
0
2
2
:
A
d
o
l
e
s
c
e
n
t
h
e
a
l
t
h
su
r
v
e
y
,
M
a
l
a
y
si
a
.
”
h
t
t
p
s:
/
/
i
k
u
.
g
o
v
.
m
y
/
i
m
a
g
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s/
n
h
ms
-
2
0
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2
/
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p
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_
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(
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c
c
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sse
d
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.
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2
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)
.
[
4
]
I
n
st
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u
t
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f
o
r
P
u
b
l
i
c
H
e
a
l
t
h
(
I
P
H
)
,
“
T
h
e
n
a
t
i
o
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a
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h
e
a
l
t
h
a
n
d
m
o
r
b
i
d
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y
su
r
v
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y
:
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a
l
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l
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sc
h
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-
b
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d
st
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d
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t
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a
l
t
h
su
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v
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y
2
0
2
2
,
”
M
i
n
i
st
r
y
o
f
H
e
a
l
t
h
M
a
l
a
y
s
i
a
.
h
t
t
p
s:
/
/
i
k
u
.
g
o
v
.
my
/
n
h
ms
-
a
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-
2
0
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2
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(
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c
c
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sse
d
J
u
l
.
1
5
,
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0
2
3
)
.
[
5
]
W
o
r
l
d
H
e
a
l
t
h
O
r
g
a
n
i
z
a
t
i
o
n
,
WHO
g
u
i
d
e
l
i
n
e
s
o
n
p
h
y
si
c
a
l
a
c
t
i
v
i
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y
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n
d
se
d
e
n
t
a
r
y
b
e
h
a
v
i
o
u
r
.
2
0
2
0
.
[
6
]
K
.
J
h
a
,
R
.
S
.
B
l
u
m
e
n
t
h
a
l
,
a
n
d
G
.
S
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B
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RAP
H
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S O
F
AUTH
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a
d
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isa
m
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d
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re
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d
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Ba
c
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lo
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o
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c
ien
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(Ho
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s)
in
Nu
tri
ti
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n
a
n
d
Co
m
m
u
n
it
y
He
a
lt
h
fro
m
Un
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P
u
tra
M
a
lay
sia
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i
s
c
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rre
n
tl
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wo
rk
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s
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p
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tri
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C.
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tere
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l
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ti
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n
d
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o
m
m
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n
it
y
h
e
a
lt
h
.
H
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
fif
u
d
1
1
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m
a
il
.
c
o
m
.
H
a
z
izi
Abu
S
a
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d
is
a
n
As
so
c
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P
ro
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ss
o
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Co
m
m
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it
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tri
t
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th
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De
p
a
rtme
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t
o
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u
tri
ti
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a
c
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lt
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M
e
d
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e
a
n
d
He
a
lt
h
S
c
ien
c
e
s,
Un
iv
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i
P
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tra
M
a
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.
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wa
s
De
p
u
ty
Dire
c
to
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o
f
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p
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rts
Ac
a
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e
m
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U
n
iv
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P
u
tra
M
a
lay
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fro
m
2
0
1
3
-
2
0
2
0
.
Ha
z
izi’s
re
se
a
rc
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tea
m
h
a
s
b
e
e
n
in
v
o
lv
e
d
in
re
se
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rc
h
fo
c
u
sin
g
o
n
p
h
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a
l
a
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ti
v
it
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,
n
u
tri
ti
o
n
,
a
n
d
e
n
e
rg
y
b
a
lan
c
e
.
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is
a
m
e
m
b
e
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a
n
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p
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rt
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ra
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n
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ti
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m
m
it
tee
s
a
n
d
a
re
se
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c
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n
su
lt
a
n
t
in
n
u
tri
ti
o
n
,
p
h
y
sic
a
l
a
c
ti
v
it
y
,
a
n
d
o
b
e
sity
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
h
a
z
izi@u
p
m
.
e
d
u
.
m
y
.
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