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Me
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.
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5
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r
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
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6
I
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t J Pu
b
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Hea
lth
Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
3
2
3
-
1
3
2
9
1324
in
d
icate
th
at
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ca
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8
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9
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Mo
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ac
tio
n
s
,
an
d
th
e
v
alu
es
th
ey
m
o
d
el.
T
h
e
y
m
u
s
t
p
r
o
v
i
d
e
cl
ea
r
,
ac
cu
r
ate,
a
n
d
a
g
e
-
ap
p
r
o
p
r
iate
g
u
id
an
ce
o
n
ex
p
ec
ted
b
e
h
av
io
r
s
wh
ile
p
r
io
r
itizin
g
th
eir
ch
ild
r
en
o
v
er
all
well
-
b
ein
g
[
1
0
]
,
[
1
1
]
.
Sex
ed
u
ca
tio
n
f
o
r
ea
r
ly
c
h
ild
h
o
o
d
is
o
f
ten
co
n
s
id
er
ed
ta
b
o
o
in
s
o
ciety
an
d
d
ee
m
ed
u
n
s
u
itab
le
f
o
r
y
o
u
n
g
ch
ild
r
en
,
alth
o
u
g
h
it
is
ess
en
tial
f
o
r
th
eir
d
ev
elo
p
m
e
n
t
[
1
2
]
.
I
n
teg
r
atin
g
s
ex
ed
u
ca
tio
n
with
p
ar
en
ts
is
ess
en
tial
f
o
r
en
s
u
r
in
g
th
e
ed
u
ca
tio
n
’
s
ef
f
ec
tiv
en
ess
,
as
it
h
elp
s
ch
ild
r
en
g
ain
a
b
etter
u
n
d
er
s
tan
d
in
g
an
d
r
ed
u
ce
s
th
e
r
is
k
o
f
m
is
in
ter
p
r
etatio
n
,
esp
ec
ially
am
o
n
g
m
o
th
er
s
.
B
u
ild
in
g
co
m
m
u
n
icatio
n
b
etwe
en
p
ar
en
ts
an
d
ch
ild
r
en
is
ess
en
tial,
s
tar
ti
n
g
with
th
e
in
tr
o
d
u
ctio
n
o
f
ch
ild
r
en
'
s
r
ep
r
o
d
u
ctiv
e
o
r
g
a
n
s
,
th
eir
f
u
n
ctio
n
s
,
an
d
h
o
w
to
ca
r
e
f
o
r
th
em
.
Par
e
n
ts
’
ab
ilit
y
to
u
n
d
er
s
tan
d
an
d
ed
u
ca
te
th
eir
ch
ild
r
en
ab
o
u
t
s
ex
u
ality
is
cr
u
cial
an
d
r
eq
u
ir
es
atten
tio
n
,
s
u
p
p
o
r
t,
a
n
d
f
ac
ilit
atio
n
[
1
3
]
,
[
1
4
]
.
Sev
er
al
f
ac
to
r
s
in
f
lu
en
ce
th
e
e
f
f
e
ctiv
en
ess
o
f
s
ex
u
al
ed
u
ca
tio
n
p
r
o
g
r
am
s
,
in
clu
d
in
g
f
am
ily
v
al
u
es,
th
e
q
u
ality
o
f
p
ar
en
tal
r
elatio
n
s
h
ip
s
,
th
e
av
a
ilab
ilit
y
o
f
ac
cu
r
ate
in
f
o
r
m
atio
n
an
d
k
n
o
wled
g
e
a
b
o
u
t
s
ex
u
ality
,
cu
ltu
r
al
an
d
n
o
r
m
ativ
e
in
f
lu
e
n
ce
s
,
an
d
th
e
im
p
ac
t
o
f
b
u
s
y
wo
r
k
s
ch
ed
u
les
[
1
5
]
–
[
1
7
]
.
Fu
r
th
er
r
esear
ch
is
n
ee
d
ed
o
n
p
r
o
v
id
in
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
to
y
o
u
n
g
c
h
ild
r
e
n
in
W
est
Su
m
atr
a
,
I
n
d
o
n
esia
.
T
h
is
s
tu
d
y
is
d
esig
n
ed
to
in
v
esti
g
ate
th
e
f
ac
to
r
s
in
f
lu
en
cin
g
m
ater
n
al
b
eh
av
io
r
in
d
eliv
er
in
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
to
y
o
u
n
g
ch
ild
r
e
n
in
2
0
2
1
a
n
d
t
o
p
r
o
v
id
e
i
n
s
ig
h
ts
f
o
r
d
ev
elo
p
in
g
s
tr
ateg
ies o
r
p
r
o
g
r
am
s
aim
ed
a
t im
p
r
o
v
in
g
m
ater
n
al
b
eh
a
v
io
r
in
th
is
co
n
tex
t.
2.
M
E
T
H
O
D
T
h
is
r
esear
ch
s
tu
d
y
is
an
a
n
aly
tical
o
b
s
er
v
atio
n
al
s
tu
d
y
t
h
at
u
tili
ze
s
a
cr
o
s
s
-
s
ec
tio
n
al
d
esig
n
.
I
t
was
co
n
d
u
cte
d
in
W
est
Su
m
atr
a
Pro
v
in
ce
f
r
o
m
Ma
y
to
Octo
b
er
2
0
2
1
,
in
v
o
lv
in
g
a
t
o
tal
p
o
p
u
latio
n
o
f
4
2
9
,
9
0
0
ch
ild
r
en
ag
ed
3
to
6
y
ea
r
s
liv
i
n
g
in
th
e
r
eg
i
o
n
.
W
e
d
eter
m
in
ed
th
e
s
am
p
le
s
ize
u
s
in
g
th
e
L
em
esh
o
w
m
eth
o
d
,
with
a
9
0
%
co
n
f
id
en
ce
in
ter
v
al
an
d
a
1
0
%
m
ar
g
in
o
f
er
r
o
r
.
A
s
am
p
le
o
f
2
5
7
p
ar
tici
p
an
ts
was
s
elec
ted
th
r
o
u
g
h
clu
s
ter
s
am
p
lin
g
.
Data
wer
e
co
llected
u
s
in
g
an
o
n
lin
e
q
u
esti
o
n
n
air
e
an
d
v
o
lu
n
tar
y
s
am
p
lin
g
.
A
s
u
m
m
ar
y
o
f
th
e
d
is
tr
ib
u
tio
n
o
f
m
o
t
h
er
ch
a
r
ac
ter
is
tics
is
p
r
o
v
id
ed
i
n
T
ab
le
1
.
T
h
e
s
tu
d
y
in
clu
d
e
d
m
o
t
h
er
s
with
ch
ild
r
en
ag
e
d
3
to
6
y
ea
r
s
r
esid
in
g
i
n
th
e
p
r
o
v
in
ce
o
f
W
est
Su
m
atr
a
,
I
n
d
o
n
esia
.
W
e
ex
clu
d
ed
in
d
iv
i
d
u
als
wh
o
d
id
n
o
t
c
o
m
p
lete
th
e
q
u
esti
o
n
n
air
e
in
f
u
ll.
Data
co
llectio
n
o
cc
u
r
r
e
d
th
r
o
u
g
h
th
e
co
m
p
leti
o
n
o
f
o
n
lin
e
q
u
esti
o
n
n
air
es,
w
h
ich
h
a
d
u
n
d
er
g
o
n
e
test
in
g
to
en
s
u
r
e
v
alid
ity
an
d
r
eliab
ilit
y
.
T
h
e
d
ep
en
d
en
t
v
ar
i
ab
le
f
o
cu
s
ed
o
n
m
o
th
er
s
'
b
eh
av
io
r
s
in
d
eliv
er
in
g
r
e
p
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
to
th
eir
y
o
u
n
g
c
h
ild
r
en
.
I
n
d
e
p
en
d
en
t
v
a
r
iab
les
en
co
m
p
ass
ed
k
n
o
wled
g
e
,
attitu
d
es,
in
f
o
r
m
atio
n
ex
p
o
s
u
r
e,
an
d
f
am
ily
s
u
p
p
o
r
t.
W
e
co
n
d
u
ct
ed
b
o
th
u
n
iv
a
r
iate
an
d
b
iv
a
r
iate
an
aly
s
es
u
s
in
g
th
e
C
hi
-
s
q
u
ar
e
s
tatis
tical
test
.
Un
iv
ar
iate
an
aly
s
is
d
eter
m
in
ed
th
e
d
is
tr
ib
u
tio
n
a
n
d
f
r
eq
u
e
n
cy
o
f
th
e
d
ata,
wh
ile
b
iv
ar
iate
an
aly
s
is
em
p
lo
y
ed
th
e
C
hi
-
s
q
u
a
r
e
te
s
t
to
in
v
esti
g
ate
th
e
r
elatio
n
s
h
ip
b
etwe
en
th
e
d
ep
en
d
e
n
t
an
d
in
d
e
p
en
d
e
n
t
v
ar
iab
les.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
3
.
1
.
Respo
nd
ent
s
’
cha
ra
ct
er
is
t
ics
T
h
e
m
ajo
r
ity
o
f
r
esp
o
n
d
e
n
ts
in
th
is
s
tu
d
y
wer
e
y
o
u
n
g
a
d
u
lts
an
d
h
ig
h
l
y
ed
u
ca
ted
i
n
d
iv
id
u
als.
Sp
ec
if
ically
,
7
8
.
6
%
wer
e
ag
ed
b
etwe
en
2
1
an
d
4
0
,
an
d
7
9
.
8
%
h
ad
a
h
ig
h
er
ed
u
ca
tio
n
b
ac
k
g
r
o
u
n
d
.
R
eg
ar
d
in
g
em
p
lo
y
m
e
n
t statu
s
,
5
8
.
0
% o
f
t
h
e
r
esp
o
n
d
en
ts
wer
e
u
n
e
m
p
lo
y
ed
,
as sh
o
wn
in
T
ab
le
1
.
B
iv
ar
iate
an
aly
s
is
r
ev
ea
led
a
s
ig
n
if
ican
t
co
r
r
elatio
n
b
et
wee
n
b
eh
av
io
r
an
d
attitu
d
e
s
to
war
d
f
ac
ilit
atin
g
ea
r
ly
ch
ild
h
o
o
d
r
e
p
r
o
d
u
ctiv
e
h
ea
lt
h
ed
u
ca
tio
n
f
o
r
ch
ild
r
en
ag
ed
3
to
6
y
ea
r
s
in
W
est
Su
m
atr
a
Pro
v
in
ce
.
R
esp
o
n
d
en
ts
with
a
p
o
s
itiv
e
attitu
d
e
wer
e
1
.
7
tim
es
m
o
r
e
lik
ely
to
d
eliv
er
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
.
Mo
r
e
o
v
er
,
a
s
ig
n
if
ican
t
ass
o
ciatio
n
was
f
o
u
n
d
b
etwe
en
m
o
th
er
s
'
b
eh
av
io
r
an
d
th
eir
ex
p
o
s
u
r
e
to
in
f
o
r
m
atio
n
ab
o
u
t
ea
r
ly
ch
il
d
h
o
o
d
r
ep
r
o
d
u
ctiv
e
h
ea
lth
e
d
u
ca
tio
n
.
R
esp
o
n
d
e
n
ts
with
g
r
ea
ter
ex
p
o
s
u
r
e
to
in
f
o
r
m
atio
n
wer
e
6
.
4
tim
es
m
o
r
e
lik
ely
to
p
r
o
v
id
e
th
e
ed
u
c
atio
n
.
I
n
ad
d
itio
n
,
a
s
ig
n
if
ican
t
co
r
r
elatio
n
ex
is
ts
b
etwe
en
f
am
ily
s
u
p
p
o
r
t
an
d
a
m
o
th
er
'
s
b
eh
av
io
r
in
f
ac
ilit
atin
g
ea
r
ly
ch
ild
h
o
o
d
r
e
p
r
o
d
u
cti
v
e
h
ea
lth
ed
u
ca
tio
n
.
R
esp
o
n
d
en
ts
r
ec
eiv
in
g
f
am
ily
s
u
p
p
o
r
t
ar
e
7
.
6
tim
es
m
o
r
e
lik
ely
to
p
r
o
v
id
e
th
is
ed
u
ca
tio
n
.
T
h
ese
b
iv
ar
iate
r
esu
lts
ar
e
p
r
esen
ted
in
T
a
b
le
2
.
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
Ma
tern
a
l b
eh
a
vio
r
in
p
r
o
vid
er o
f rep
r
o
d
u
ctive
h
e
a
lth
ed
u
c
a
t
io
n
to
ea
r
ly
ch
ild
h
o
o
d
(
Melis
a
Yen
ti
)
1325
T
ab
le
1
.
Dis
tr
ib
u
tio
n
o
f
m
o
th
e
r
c
h
ar
ac
ter
is
tics
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
F
%
A
g
e
g
r
o
u
p
16
-
2
0
y
e
a
r
s
o
l
d
5
1
.
9
21
-
4
0
y
e
a
r
s
o
l
d
2
0
2
7
8
.
6
41
-
6
0
y
e
a
r
s
o
l
d
50
1
9
.
5
Ed
u
c
a
t
i
o
n
Lo
w
52
2
0
.
2
H
i
g
h
2
0
5
7
9
.
8
P
r
o
f
e
ssi
o
n
W
o
r
k
1
0
8
4
2
.
0
D
o
e
s
n
o
t
w
o
r
k
1
4
9
5
8
.
0
To
t
a
l
2
5
7
1
0
0
.
0
T
ab
le
2
.
B
iv
ar
iate
a
n
aly
s
is
o
f
m
o
th
er
'
s
b
eh
av
io
r
in
p
r
o
v
id
in
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
in
ea
r
ly
ch
ild
h
o
o
d
V
a
r
i
a
b
l
e
n
B
e
h
a
v
i
o
r
O
R
(
9
0
%
C
I
)
p
-
v
a
l
u
e
W
e
l
l
N
o
t
e
n
o
u
g
h
f
%
f
%
K
n
o
w
l
e
d
g
e
Lo
w
1
2
8
59
46
.
1
69
53
.
9
1
,
4
3
2
0
.
1
9
0
W
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l
l
1
2
9
71
50
.
6
58
45
.
0
A
t
t
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t
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e
N
e
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en
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T
h
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allen
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o
f
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r
is
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f
r
o
m
s
o
cieta
l
tab
o
o
s
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d
t
h
e
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en
s
itiv
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atu
r
e
o
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th
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p
ic,
lea
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i
n
d
ir
e
ct
d
is
cu
s
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io
n
s
wh
er
e
p
ar
en
ts
o
f
ten
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s
e
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lan
g
ter
m
s
as
a
s
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b
s
titu
te
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o
r
f
o
r
m
al
lan
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m
a
k
e
th
e
co
n
v
er
s
atio
n
m
o
r
e
co
m
f
o
r
tab
le
[
1
8
]
.
T
h
e
lac
k
o
f
awa
r
en
ess
ab
o
u
t
th
e
im
p
o
r
tan
ce
o
f
s
ex
u
al
ed
u
ca
tio
n
am
o
n
g
s
o
m
e
p
ar
e
n
ts
m
ay
jeo
p
ar
d
ize
th
e
ir
ch
ild
r
e
n
’
s
s
ex
u
al
well
-
b
ein
g
[
1
9
]
.
T
h
is
s
tu
d
y
f
o
u
n
d
n
o
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
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m
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r
’
s
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eh
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d
th
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k
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n
to
ch
ild
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e
n
a
g
ed
3
-
6
.
T
h
ese
f
in
d
in
g
s
c
o
n
tr
ad
ict
th
e
s
tu
d
y
o
f
Mu
r
d
in
in
g
s
ih
et
a
l.
[
2
0
]
wh
ich
id
en
tifie
d
a
r
elatio
n
s
h
ip
b
etwe
en
b
eh
a
v
io
r
a
n
d
k
n
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wled
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(
p
=
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1
o
r
p
-
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alu
e
<0
.
0
5
)
in
m
o
th
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s
p
r
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v
id
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g
r
ep
r
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ctiv
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lth
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ca
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ild
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.
3
.
3
.
M
o
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her’
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T
h
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is
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
b
etwe
en
a
m
o
th
e
r
'
s
b
eh
av
io
r
an
d
attitu
d
e
in
p
r
o
v
id
i
n
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
to
ch
ild
r
en
a
g
ed
3
-
6
.
R
esp
o
n
d
en
t
wh
o
ex
h
ib
its
g
o
o
d
b
eh
av
io
r
in
d
eliv
er
in
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
e
d
u
ca
tio
n
f
o
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ea
r
ly
ch
ild
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o
o
d
ar
e
p
r
i
m
ar
ily
th
o
s
e
w
h
o
h
o
ld
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p
o
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itiv
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attitu
d
e
t
o
war
d
r
ep
r
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d
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ctiv
e
h
ea
lth
.
Sp
ec
if
i
ca
lly
,
7
6
r
esp
o
n
d
en
ts
(
5
0
.
6
%)
with
a
p
o
s
itiv
e
attitu
d
e,
co
m
p
ar
e
d
to
5
4
r
esp
o
n
d
en
ts
(
4
3
.
2
%)
with
a
n
eg
ativ
e
attitu
d
e,
d
em
o
n
s
tr
ate
b
etter
b
eh
av
io
r
in
th
is
r
eg
ar
d
.
R
esp
o
n
d
en
ts
with
a
p
o
s
itiv
e
attitu
d
e
a
r
e
1
.
7
tim
es
m
o
r
e
lik
el
y
to
p
r
o
v
id
e
r
e
p
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
.
T
h
ese
f
i
n
d
in
g
s
ali
g
n
wi
th
th
e
s
t
u
d
y
o
f
M
u
r
d
in
i
n
g
s
ih
et
a
l
.
[
2
0
]
wh
ic
h
id
en
tifie
d
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
(
p
=
0
.
0
0
1
o
r
p
-
v
al
u
e
<
0
.
0
5
)
b
et
we
en
att
it
u
d
es
a
n
d
m
at
er
n
a
l
b
e
h
a
v
i
o
r
i
n
p
r
o
v
id
in
g
r
e
p
r
o
d
u
cti
v
e
h
ea
lt
h
ed
u
ca
ti
o
n
.
Ma
n
y
m
o
th
er
s
r
ec
o
g
n
ize
th
e
im
p
o
r
tan
ce
o
f
r
ep
r
o
d
u
ctiv
e
h
ea
lth
in
f
o
r
m
atio
n
f
o
r
th
ei
r
ch
ild
r
en
,
b
u
t
th
ey
o
f
ten
f
ee
l
h
esit
an
t
to
in
itiate
o
r
e
n
g
ag
e
in
d
is
cu
s
s
io
n
s
o
n
th
ese
to
p
ics.
Nev
er
t
h
el
ess
,
p
ar
en
ts
with
a
p
o
s
itiv
e
attitu
d
e
ar
e
m
o
r
e
lik
ely
to
p
r
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v
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e
r
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p
r
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d
u
ctiv
e
h
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lth
ed
u
ca
tio
n
to
th
eir
ch
il
d
r
en
.
R
esear
ch
h
as
s
h
o
wn
th
at
th
e
m
ajo
r
ity
o
f
p
ar
en
ts
s
u
p
p
o
r
t
th
e
im
p
o
r
tan
ce
o
f
d
is
cu
s
s
in
g
s
ex
u
al
an
d
r
ep
r
o
d
u
ctiv
e
h
ea
lth
(
SR
H)
to
p
ics
to
teen
ag
er
s
[
2
1
]
.
Fu
r
th
e
r
m
o
r
e
,
p
ar
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n
ts
with
h
ig
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e
r
lev
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to
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p
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war
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in
SR
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cu
s
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io
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s
with
th
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co
m
p
ar
ed
t
o
th
o
s
e
with
lo
wer
lev
els
o
f
ed
u
ca
tio
n
[
1
0
]
.
T
o
f
o
s
ter
a
p
o
s
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e
atti
tu
d
e,
in
cr
ea
s
in
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ec
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p
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in
p
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h
ea
lth
ed
u
ca
tio
n
in
ea
r
ly
ch
ild
h
o
o
d
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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6
I
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Hea
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Sci
,
Vo
l.
14
,
No
.
3
,
Sep
tem
b
er
20
25
:
1
3
2
3
-
1
3
2
9
1326
3
.
4
.
I
nfo
r
m
a
t
io
n
e
x
po
s
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A
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
ex
is
ts
b
etwe
en
a
m
o
th
er
'
s
b
eh
av
io
r
an
d
h
e
r
ex
p
o
s
u
r
e
to
i
n
f
o
r
m
a
tio
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ac
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atin
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ly
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ild
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ep
r
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lth
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c
h
ild
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en
a
g
ed
3
to
6
y
ea
r
s
.
R
esp
o
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en
ts
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o
ex
h
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it
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b
eh
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v
io
r
in
d
eli
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g
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ca
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ar
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im
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s
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av
e
ex
p
o
s
u
r
e
to
in
f
o
r
m
atio
n
ab
o
u
t
r
e
p
r
o
d
u
cti
v
e
h
ea
lth
,
s
p
ec
if
ically
1
2
3
r
esp
o
n
d
en
ts
(
5
6
.
9
%),
co
m
p
a
r
ed
to
o
n
ly
s
ev
en
r
esp
o
n
d
en
ts
(
1
7
.
1
%)
with
o
u
t
s
u
ch
ex
p
o
s
u
r
e.
T
h
o
s
e
ex
p
o
s
ed
to
in
f
o
r
m
atio
n
h
av
e
6
.
4
tim
es
g
r
ea
ter
lik
elih
o
o
d
o
f
p
r
o
v
id
i
n
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
.
T
h
ese
f
in
d
i
n
g
s
alig
n
with
r
esear
c
h
b
y
Nu
r
s
al
et
a
l.
[
2
2
]
w
h
ich
d
em
o
n
s
tr
ated
a
s
ig
n
if
ican
t
r
e
latio
n
s
h
ip
(
p
=
0
.
0
0
1
o
r
p
-
v
alu
e
<0
.
0
5
)
b
etwe
en
in
f
o
r
m
a
tio
n
ex
p
o
s
u
r
e
a
n
d
m
ater
n
al
b
eh
a
v
io
r
in
d
eliv
er
in
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
.
E
x
p
o
s
u
r
e
to
in
f
o
r
m
atio
n
ca
n
s
ig
n
if
ican
tly
en
h
an
ce
an
in
d
iv
i
d
u
al’
s
k
n
o
wled
g
e.
As
in
d
iv
id
u
al
r
ec
eiv
e
in
ter
v
en
tio
n
aim
ed
at
in
cr
ea
s
i
n
g
th
eir
u
n
d
er
s
tan
d
in
g
,
t
h
eir
e
x
p
er
tis
e
in
th
e
ar
ea
im
p
r
o
v
es
[
2
0
]
.
T
h
is
in
c
r
ea
s
e
in
k
n
o
wled
g
e
ca
n
b
e
f
ac
ilit
ate
d
th
r
o
u
g
h
v
ar
io
u
s
m
ea
n
s
,
s
u
c
h
as
b
o
o
k
s
,
r
ea
d
i
n
g
m
a
g
az
in
e
s
,
an
d
u
tili
zin
g
t
h
e
in
ter
n
et
as
a
v
alu
ab
le
r
eso
u
r
ce
[
2
3
]
.
Ma
s
s
m
ed
ia
also
p
lay
s
a
p
iv
o
tal
r
o
le
i
n
h
elp
in
g
in
d
i
v
id
u
als
s
tay
u
p
d
ated
o
n
r
ele
v
an
t
to
p
ics.
B
y
p
r
o
v
i
d
in
g
p
r
o
p
e
r
r
e
p
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
th
r
o
u
g
h
m
ass
m
e
d
ia,
it
is
p
o
s
s
ib
le
to
d
is
p
el
m
y
th
s
an
d
m
is
in
f
o
r
m
ati
o
n
ab
o
u
t r
ep
r
o
d
u
ctiv
e
h
ea
lth
[
2
4
]
.
T
h
e
in
ter
n
et,
in
p
a
r
ticu
lar
,
h
a
s
b
ec
o
m
e
a
k
ey
to
o
l
f
o
r
en
h
a
n
cin
g
k
n
o
wled
g
e
o
f
r
ep
r
o
d
u
ct
iv
e
h
ea
lth
.
W
ith
wid
esp
r
ea
d
in
ter
n
et
ac
ce
s
s
,
it
s
er
v
es
as
an
alter
n
a
tiv
e
m
eth
o
d
f
o
r
d
eliv
er
i
n
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
,
in
clu
d
in
g
f
o
r
m
ater
n
al
ed
u
ca
tio
n
[
2
5
]
.
Par
en
ts
,
esp
ec
ially
m
o
th
er
s
,
s
h
o
u
ld
ac
tiv
ely
s
ee
k
in
f
o
r
m
atio
n
o
n
h
o
w
to
f
ac
ili
tate
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
c
atio
n
f
o
r
y
o
u
n
g
c
h
ild
r
en
in
way
s
th
at
ar
e
b
o
th
en
g
ag
in
g
an
d
ea
s
y
to
u
n
d
er
s
tan
d
[
2
2
]
.
As
m
o
th
e
r
s
ar
e
ex
p
o
s
ed
to
m
o
r
e
in
f
o
r
m
ati
o
n
,
t
h
eir
a
b
ilit
y
to
im
p
lem
en
t r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
i
n
ea
r
ly
c
h
ild
h
o
o
d
i
m
p
r
o
v
es.
3
.
5
.
F
a
m
ily
s
up
po
rt
A
s
ig
n
if
ican
t
r
elatio
n
s
h
i
p
ex
is
ts
b
etwe
en
a
m
o
th
e
r
'
s
b
eh
av
io
r
a
n
d
f
am
ily
s
u
p
p
o
r
t
in
d
eliv
er
in
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
e
d
u
ca
tio
n
to
ch
ild
r
en
a
g
ed
3
-
6
y
ea
r
s
.
R
e
s
p
o
n
d
en
ts
ex
h
i
b
itin
g
g
o
o
d
b
e
h
av
io
r
in
d
eliv
er
in
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
f
o
r
y
o
u
n
g
ch
ild
r
e
n
a
r
e
p
r
ed
o
m
in
an
tly
th
o
s
e
wh
o
r
ec
eiv
e
f
am
ily
s
u
p
p
o
r
t
o
n
r
ep
r
o
d
u
ctiv
e
h
ea
lth
,
with
1
2
1
r
esp
o
n
d
en
ts
(
5
9
.
9
%),
co
m
p
a
r
ed
to
o
n
ly
n
in
e
r
esp
o
n
d
en
ts
(
1
4
.
4
%)
wh
o
lack
s
u
ch
s
u
p
p
o
r
t.
R
esp
o
n
d
en
ts
wh
o
r
ec
eiv
e
f
am
ily
s
u
p
p
o
r
t
in
p
r
o
v
id
i
n
g
r
e
p
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
ar
e
m
o
r
e
lik
ely
to
ex
h
ib
it
g
o
o
d
m
ater
n
al
b
eh
av
io
r
i
n
d
eliv
er
in
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
e
d
u
ca
tio
n
to
ea
r
ly
ch
ild
h
o
o
d
,
as
o
p
p
o
s
ed
to
r
esp
o
n
d
en
ts
wh
o
d
o
n
o
t
h
a
v
e
f
a
m
ily
s
u
p
p
o
r
t
in
p
r
o
v
id
in
g
r
e
p
r
o
d
u
ctiv
e
h
ea
lth
e
d
u
ca
tio
n
.
R
esp
o
n
d
en
ts
wh
o
r
ec
ei
v
e
f
am
ily
s
u
p
p
o
r
t
ar
e
7
.
6
tim
es
m
o
r
e
lik
ely
to
d
em
o
n
s
tr
ate
p
o
s
itiv
e
m
ater
n
al
b
e
h
av
io
r
in
d
eliv
er
in
g
r
ep
r
o
d
u
ctiv
e
h
e
alth
ed
u
ca
tio
n
.
T
h
is
r
esu
lt
is
alig
n
with
r
esear
ch
b
y
Nu
r
s
al
et
a
l.
[
2
2
]
wh
ich
f
o
u
n
d
a
s
ig
n
if
ican
t
r
elatio
n
s
h
ip
(
p
=
0
.
0
0
4
o
r
p
-
v
alu
e
<0
.
0
5
)
b
etwe
en
f
am
ily
s
u
p
p
o
r
t
an
d
m
ater
n
al
b
eh
av
io
r
in
p
r
o
v
id
in
g
r
ep
r
o
d
u
ctiv
e
h
ea
l
th
ed
u
ca
tio
n
[
2
2
]
.
Acc
u
r
ate
ed
u
ca
tio
n
a
b
o
u
t
s
ex
u
ality
is
n
ec
ess
ar
y
f
o
r
c
h
ild
r
e
n
an
d
ad
o
lescen
ts
to
u
n
d
er
s
ta
n
d
h
o
w
to
p
r
ac
tice
h
ea
lth
y
s
ex
u
al
b
eh
a
v
io
r
[
2
6
]
.
Pro
v
id
in
g
p
a
r
en
ts
with
r
ep
r
o
d
u
ctiv
e
h
ea
lt
h
k
n
o
wled
g
e
is
ess
en
tial,
en
ab
lin
g
th
em
to
e
n
g
ag
e
in
o
p
en
a
n
d
i
n
f
o
r
m
ed
d
is
cu
s
s
io
n
s
ab
o
u
t
s
ex
u
ality
with
th
eir
ch
ild
r
en
[
2
7
]
.
T
h
ese
co
n
v
er
s
atio
n
s
a
r
e
m
o
r
e
c
o
m
m
o
n
ly
i
n
itiated
b
y
m
o
th
er
s
,
wh
o
ar
e
g
en
er
ally
clo
s
er
t
o
ch
ild
r
e
n
,
an
d
th
e
y
ten
d
t
o
d
is
cu
s
s
s
ex
u
al
h
ea
lth
m
o
r
e
f
r
eq
u
e
n
tly
an
d
ex
te
n
s
iv
ely
th
an
f
ath
er
s
[
2
8
]
.
Ho
wev
e
r
,
s
ev
er
al
f
ac
to
r
s
th
at
b
ec
o
m
e
b
ar
r
ie
r
s
h
in
d
er
th
e
d
is
cu
s
s
io
n
,
in
clu
d
in
g
th
e
lack
o
f
k
n
o
wled
g
e
,
f
ac
e
u
n
ce
r
tai
n
ty
,
an
d
co
n
f
u
s
io
n
r
eg
ar
d
in
g
s
ex
ed
u
ca
tio
n
,
in
ad
eq
u
ate
s
k
ills
,
an
d
p
o
o
r
f
ath
er
-
ch
ild
r
elatio
n
s
h
ip
s
[
1
9
]
,
[
2
9
]
.
Fath
er
s
,
in
p
ar
ticu
lar
,
n
ee
d
s
u
p
p
o
r
t
to
att
en
d
tr
ain
in
g
s
ess
io
n
s
th
at
in
cr
ea
s
e
th
eir
s
elf
-
ef
f
icac
y
in
c
o
m
m
u
n
icatin
g
with
th
eir
ch
ild
r
en
ab
o
u
t
s
ex
u
al
h
ea
lth
to
p
ics
c
o
m
f
o
r
tab
ly
an
d
co
n
f
id
en
tly
,
wh
ic
h
,
i
n
tu
r
n
,
h
elp
s
th
eir
k
id
s
talk
m
o
r
e
o
p
en
ly
a
b
o
u
t su
c
h
is
s
u
es
[
2
8
]
.
E
q
u
ip
p
in
g
p
ar
e
n
ts
with
ac
cu
r
ate
an
d
co
m
p
r
e
h
en
s
iv
e
s
ex
u
a
l
an
d
r
ep
r
o
d
u
ctiv
e
h
ea
lth
in
f
o
r
m
atio
n
,
alo
n
g
with
ef
f
ec
tiv
e
co
m
m
u
n
i
ca
tio
n
s
tr
ateg
ies
an
d
tech
n
i
q
u
es,
is
v
ital
f
o
r
im
p
r
o
v
in
g
ad
o
l
escen
t
s
ex
u
al
well
-
b
ein
g
[
2
7
]
.
Par
en
ts
wh
o
p
a
r
ticip
ated
in
tr
ain
in
g
p
r
o
g
r
am
s
d
e
m
o
n
s
tr
ated
im
p
r
o
v
ed
co
m
m
u
n
icatio
n
s
k
ills
wh
en
d
is
cu
s
s
in
g
s
ex
u
ality
with
th
eir
ch
ild
r
en
[
3
0
]
.
T
h
is
s
tu
d
y
h
as
two
p
o
ten
tial
lim
itatio
n
s
.
First,
th
e
u
s
e
o
f
an
o
n
lin
e
q
u
esti
o
n
n
ai
r
e
m
ay
h
av
e
in
tr
o
d
u
ce
d
p
o
ten
tial
s
elec
tio
n
b
ias
b
y
ex
clu
d
in
g
in
d
iv
id
u
als
with
lo
wer
s
o
cio
-
ec
o
n
o
m
ic
s
tatu
s
,
d
u
e
to
lim
ited
I
n
ter
n
et
ac
ce
s
s
.
T
h
e
s
ec
o
n
d
lim
itatio
n
is
th
at
th
e
q
u
esti
o
n
n
air
e
co
m
p
r
is
ed
o
n
ly
clo
s
ed
-
e
n
d
ed
q
u
esti
o
n
s
,
wh
ich
m
ay
h
av
e
r
estricte
d
th
e
d
ep
th
o
f
r
esp
o
n
s
e.
4.
CO
NCLU
SI
O
N
T
h
e
p
r
ev
ale
n
ce
o
f
s
ex
u
al
v
io
l
en
ce
ag
ain
s
t
ch
ild
r
en
in
W
est
Su
m
atr
a
h
as
b
ee
n
o
n
th
e
r
is
e.
Desp
ite
th
e
im
p
o
r
tan
ce
o
f
s
ex
ed
u
ca
t
io
n
f
o
r
ea
r
ly
c
h
ild
h
o
o
d
,
it
r
e
m
ain
s
a
s
o
cieta
l
tab
o
o
a
n
d
i
s
o
f
ten
c
o
n
s
id
er
ed
in
ap
p
r
o
p
r
iate
f
o
r
y
o
u
n
g
ch
ild
r
en
.
A
s
ig
n
if
ican
t
r
elatio
n
s
h
i
p
ex
is
ts
b
etwe
en
m
ater
n
al
b
eh
av
io
r
in
p
r
o
v
id
i
n
g
r
ep
r
o
d
u
ctiv
e
h
ea
lth
ed
u
ca
tio
n
an
d
f
ac
t
o
r
s
s
u
ch
as
attitu
d
es,
i
n
f
o
r
m
atio
n
ex
p
o
s
u
r
e,
an
d
f
am
ily
s
u
p
p
o
r
t
in
W
est
Su
m
atr
a.
T
o
a
d
d
r
ess
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s
itu
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n
,
s
tr
en
g
th
e
n
in
g
f
am
ily
s
u
p
p
o
r
t
th
r
o
u
g
h
f
am
il
y
co
u
n
s
elo
r
tr
ain
in
g
p
r
o
g
r
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s
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[
4
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I
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