Epidemiology Commons^™

The Role Of Interspecies Recombination In The Evolution Of Antibiotic-Resistant Pneumococci, Joshua C. D'Aeth, Mark Pg Van Der Linden, Lesley Mcgee, Herminia De Lencastre, Paul Turner, Jae-Hoon Song, Stephanie W. Lo, Rebecca A. Gladstone, Gps Consortium, Sadia Shakoor

Department of Pathology and Laboratory Medicine

Multidrug-resistant Streptococcus pneumoniae emerge through the modification of core genome loci by interspecies homologous recombinations, and acquisition of gene cassettes. Both occurred in the otherwise contrasting histories of the antibiotic-resistant S. pneumoniae lineages PMEN3 and PMEN9. A single PMEN3 clade spread globally, evading vaccine-induced immunity through frequent serotype switching, whereas locally circulating PMEN9 clades independently gained resistance. Both lineages repeatedly integrated Tn916-type and Tn1207.1-type elements, conferring tetracycline and macrolide resistance, respectively, through homologous recombination importing sequences originating in other species. A species-wide dataset found over 100 instances of such interspecific acquisitions of resistance cassettes and flanking …

Post-Acute Sequelae Of Covid-19 And Polypharmacy: If You Think There’S Too Much Polypharmacy Now, Just Wait, Demetra Antimisiaris

The University of Louisville Journal of Respiratory Infections

The intersection of increased chronic disease burden worldwide with the COVID-19 pandemic was called the “perfect storm”. This article discusses yet another perfect storm: Post COVID-19 (acute and non-acute) syndrome, high chronic disease burdens, advanced age, and polypharmacy. The expected hyper polypharmacy that should result from the added disease and symptom burden due to post COVID-19 syndrome is discussed, as well as the importance of studying the incidence and characteristics to be able to address avoidable medication-related problems.

Baricitinib In The Treatment Of A Critical Patient With Covid-19 Pneumonia: A Case Report, Nishant Patel, Dylan Goldsmith, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

A 72-year-old male presented to the emergency department with a chief complaint of diarrhea after having tested positive for COVID-19 two days prior. He initially had minimal respiratory complaints, but was eventually transferred to the intensive care unit for acute hypoxic respiratory failure. In addition to dexamethasone, remdesivir, and antibiotics, the patient was treated with baricitinib, a Janus kinase inhibitor that was recently granted emergency use authorization by the Food and Drug Administration for treatment of hospitalized patients with COVID-19. He had an extensive and complicated hospital course and had to be placed on mechanical ventilation, ultimately undergoing tracheostomy. After …

Cognitive Complaints In Age-Related Chronic Conditions: A Systematic Review, Nikki L. Hill, Sakshi Bhargava, Monique J. Brown, Hyejin Kim, Iris Bhang, Kaitlyn Mullin, Kathleen Phillips, Jacqueline Mogle

Faculty Publications

Introduction

Cognitive complaints in older adults may be indicative of progressive cognitive decline including Alzheimer’s disease (AD), but also occur in other age-related chronic conditions, complicating identification of early AD symptoms. To better understand cognitive complaints in aging, we systematically reviewed the evidence to determine their prevalence and characterization among older adults with the most common age-related chronic conditions.

Methods

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the review protocol was prospectively registered with PROSPERO (ID: CRD42020153147). Searches were conducted in PubMed, CINAHL, PsycINFO, Web of Science, and …

Association Of Chronic Pain With Participation In Motor Skill Activities In Children With Cerebral Palsy, Haresh Rochani, Christopher M. Modlesky, Barbara Weissman, Joshua Vova, Gavin T. Colquitt

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Many children with cerebral palsy (CP) experience the secondary condition of pain, which is problematic because children with CP face barriers to participation in motor skill activities.^1,2 Motor performance in activities of daily living among children with CP is markedly lower than that among their age-matched peers.³ Because of the potential effect of pain on children with CP, we sought to examine the association between pain and activities requiring motor skill performance (ie, difficulty dressing or bathing and participation in sport) among a nationally representative sample of US children with CP.

Mathematical Modeling, Analysis, And Simulation Of The Covid-19 Pandemic With Behavioral Patterns And Group Mixing, Comfort Ohajunwa, Padmanabhan Seshaiyer

Spora: A Journal of Biomathematics

Due to the rise of COVID-19 cases, many mathematical models have been developed to study the disease dynamics of the virus. However, despite its role in the spread of COVID-19, many SEIR models neglect to account for human behavior. In this project, we develop a novel mathematical modeling framework for studying the impact of mixing patterns and social behavior on the spread of COVID-19. Specifically, we consider two groups, one exhibiting normal behavior who do not reduce their contacts and another exhibiting altered behavior who reduce their contacts by practicing non-pharmaceutical interventions such as social distancing and self-isolation. The dynamics …

Association Of Nonacute Opioid Use And Cardiovascular Diseases: A Scoping Review Of The Literature, Jade H. Singleton, Erin L. Abner, Peter D. Akpunonu, Anna M. Kucharska-Newton

Epidemiology and Environmental Health Faculty Publications

BACKGROUND

In this scoping review, we identified and reviewed 23 original articles from the PubMed database that investigated the relationship between nonacute opioid use (NOU) and cardiovascular outcomes.

METHODS AND RESULTS

We defined NOU to include both long-term opioid therapy and opioid use disorder. We summarized the association between NOU and 5 classes of cardiovascular disease, including infective endocarditis, coronary heart disease (including myocardial infarction), congestive heart failure, cardiac arrythmia (including cardiac arrest), and stroke. The most commonly studied outcomes were coronary heart disease and infective endocarditis. There was generally consistent evidence of a positive association between community prevalence of …

Identification Of Novel And Rare Variants Associated With Handgrip Strength Using Whole Genome Sequence Data From The Nhlbi Trans-Omics In Precision Medicine (Topmed) Program, Chloé Sarnowski, Han Chen, Mary L. Biggs, Sylvia Wassertheil-Smoller, Jan Bressler, Marguerite R. Irvin, Kathleen A. Ryan, David Karasik, Donna K. Arnett, L. Adrienne Cupples, David W. Fardo, Stephanie M. Gogarten, Benjamin D. Heavner, Deepti Jain, Hyun Min Kang, Charles Kooperberg, Arch G. Mainous, Braxton D. Mitchell, Alanna C. Morrison, Jeffrey R. O'Connell

Epidemiology and Environmental Health Faculty Publications

Handgrip strength is a widely used measure of muscle strength and a predictor of a range of morbidities including cardiovascular diseases and all-cause mortality. Previous genome-wide association studies of handgrip strength have focused on common variants primarily in persons of European descent. We aimed to identify rare and ancestry-specific genetic variants associated with handgrip strength by conducting whole-genome sequence association analyses using 13,552 participants from six studies representing diverse population groups from the Trans-Omics in Precision Medicine (TOPMed) Program. By leveraging multiple handgrip strength measures performed in study participants over time, we increased our effective sample size by 7-12%. Single-variant …

Can Community Gardens With Workshops Increase Gardening Behavior? A Navajo Wellness Collaboration, Kevin A. Lombard Phd, India J. Ornelas Phd, Desiree Deschenie, Felix Nez, Sonia Bishop, Katie Osterbauer Ms, Eileen Rillamas-Sun Phd, Shirley A.A. Beresford Phd

Journal of Health Disparities Research and Practice

This paper seeks to evaluate the potential efficacy of a community gardening intervention on the Navajo Nation to increase gardening and healthy eating behaviors, which are potentially important in preventing obesity and related health conditions. Rates of obesity are high among American Indians, including those living on Navajo Nation land. Eating fresh fruits and vegetables is part of healthy eating. However, availability and access to fresh fruits and vegetables are severely limited on the Navajo Nation, due to distance and cost. One way to increase both availability and consumption of fresh fruits and vegetables is through community gardening, yet …

Health Disparities And Covid-19 Pandemic: Increasing Clinical Research Participation Among African Americans, Kashica J. Webber-Ritchey, Abbi D. Lane-Cordova

Journal of Health Disparities Research and Practice

Health disparities in African Americans is a persistent issue. Higher rates and severity of the novel coronavirus-19 [COVID-19] among African Americans only widens health disparities. Effective COVID-19 treatment options are imperative, requiring representation of African Americans in clinical research. However, low participation and under-representation of African Americans is complex in nature. This article describes health disparities, the impact of COVID-19, and participation in clinical research among African Americans. We offer strategies for researchers to enhance the inclusion of African Americans. We also offer strategies in conducting clinical research during COVID-19.

Mental Health Services Provision In Primary Care And Emergency Department Settings: Analysis Of Blended Fee-For-Service And Blended Capitation Models In Ontario, Canada., Thyna Vu, Kelly K Anderson, Nibene H Somé, Amardeep Thind, Sisira Sarma

Epidemiology and Biostatistics Publications

Treating mental illnesses in primary care is increasingly emphasized to improve access to mental health services. Although family physicians (FPs) or general practitioners are in an ideal position to provide the bulk of mental health care, it is unclear how best to remunerate FPs for the adequate provision of mental health services. We examined the quantity of mental health services provided in Ontario's blended fee-for-service and blended capitation models. We evaluated the impact of FPs switching from blended fee-for-service to blended capitation on the provision of mental health services in primary care and emergency department using longitudinal health administrative data …

Evaluation Of Circulating Levels Of Interleukin-10 And Interleukin-16 And Dietary Inflammatory Index In Lebanese Knee Osteoarthritis Patients, Zeina El-Ali, Germine El-Kassas, Fouad M. Ziade, Nitin Shivappa Mbbs, Mph, Ph.D., James Hébert Scd, Nisrine Bissar

Faculty Publications

Objectives

To investigate plasma concentrations of Interleukin-16 (IL-16) and Interleukin-10 (IL-10) in Lebanese knee osteoarthritis (KOA) patients and to examine the association between the diet-associated inflammation and increased risk for KOA.

Methods

A total of 208 study participants were assigned to one of the 3 groups: Diagnosed Knee Osteoarthritis group (DKOA) (N = 78); Undiagnosed Knee Osteoarthritis group (UKOA) (N = 60) and controls matched on age, sex and sociodemographic characteristics (N = 70). UKOA represents KOA features before they are altered by therapeutic intervention and lifestyle modifications that follow the diagnosis. Energy-adjusted dietary inflammatory index (E-DII™) scores were calculated …

Diabetes, Anti-Diabetic Medication Use, And The Risk Of Ovarian Cancer, Chantaezia Joseph

Theses and Dissertations

Background- Although ovarian cancer is a rare disease, it is the 5th leading cause of cancer-related deaths among women in the United States. Diabetes is a serious chronic disease that plagues over 436 million adults worldwide and was ranked 7th in causes of death in the US in 2017. Epidemiologic evidence suggests that diabetes may lead to an increased risk of ovarian cancer due to shared risk factors such as sedentary behaviors, smoking and poor diet or through biological mechanisms related to hyperglycemia and obesity, but the epidemiologic evidence yields mixed results. Certain anti-diabetic medications may increase the risk …

Household Food Security, Lifestyle Factors, And Glycemic Control Among Youth And Young Adults With Diabetes, Lauren A. Reid

Theses and Dissertations

The purpose of this study was to assess the associations between household food insecurity (HFI) and glycemic control, physical activity, and diet quality in youth and young adults (YYA) with type 1 diabetes (T1D) and type 2 diabetes (T2D). Among older adults, HFI has been shown to complicate diabetes management due to the essential role of diet in diabetes management and the financial stress associated with HFI. Although HFI is more prevalent among YYA with diabetes than the general population, there are only a handful of studies that have focused on this population and, studies that include YYA with T2D …

Dysbiosis-Related Medications And The Association With Cognitive Decline, Cognitive Impairment, And Dementia, Nicholas Victor Resciniti

Theses and Dissertations

The main objectives of this dissertation were to quantitatively assess whether there is an association between medications (e.g., antibiotics, PPIs, antipsychotics) and cognitive performance over time, conduct a causal mediation analysis to evaluate the role of inflammation (C-reactive protein) in the association between medications and subsequent cognitive decline, and examine if dysbiosis-related medications (DRM) are associated with a greater risk of dementia for participants that were cognitively normal and had MCI at baseline.

The Health and Retirement Study (HRS) was used to conduct a secondary data analysis that used longitudinal data from 2004 to 2016. The HRS is an ongoing, …

Intersection Of Maternal Disability Status, Prescription Opioid Use Before And During Pregnancy, And Adverse Birth Outcomes, Chelsea Lynes Richard

Theses and Dissertations

Nationally, individuals with disability, like those with chronic health conditions, have higher rates of opioid use and misuse and are prescribed higher dosages than those without disability. Because opioid agonists and antagonists can cross the placenta rapidly, there is biological plausibility that they may have an impact on birth outcomes. Therefore, monitoring prescription opioid use, particularly among pregnant women, is of great public health importance. While evidence for the impact of opioid use on preterm birth and low birthweight are conflicting; findings are consistent that opioid use during pregnancy is associated with a higher risk of small for gestational age, …

Comparing Dietary Score Associations With Lipoprotein Particle Subclass Profiles: A Cross-Sectional Analysis Of A Middle-To Older-Aged Population, Seán R. Millar, Pilar Navarro, Janas M. Harrington, Nitin Shivappa Mbbs, Mph, Ph.D., James Hébert Scd, Ivan J. Perry, Catherine M. Phillips

Faculty Publications

Background and objectives: Lipoprotein particle concentrations and size are associated with increased risk for atherosclerosis and premature cardiovascular disease. Studies also suggest that certain dietary behaviours may be cardioprotective. Limited comparative data regarding any dietary score/index-lipoprotein particle subclass associations exist. Thus, our objective was to assess relationships between the Dietary Approaches to Stop Hypertension (DASH), Health Eating Index-2015 (HEI-2015), Mediterranean Diet (MD) and Energy-adjusted Dietary Inflammatory Index (E-DII™) scores and plasma lipids and lipoprotein profiles to test the hypothesis that healthier diet (better quality and more anti-inflammatory) would be associated with a more favourable lipoprotein profile.

Materials and methods: This …

Burden Of Transport-Related Injuries In The Eastern Mediterranean Region: A Systematic Analysis For The Global Burden Of Disease Study 2017, Gbd 2017 Emr Transport Injuries Collaborators, Saeid Safiri, Mark J M. Sullman, Timo Lajunen, Tetiana Hill, Amir Almasi-Hashiani, Maziar Moradi-Lakeh, Farshad Farzadfar, Sadaf G. Sepanlou, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age.
Methods: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs).
Results: In 2017, there …

A Review Of The Cardiac And Cardiovascular Effects Of Covid-19 In Adults And Children, Bibhuti B Das, S Kristen Sexon Tejtel, Shriprasad Deshpande, Lara S Shekerdemian

The Texas Heart Institute Journal

Symptomatic coronavirus disease 2019 (COVID-19) typically affects the respiratory system but can involve the cardiovascular system. Cardiac complications of COVID-19 can result directly from myocarditis or indirectly from numerous other mechanisms. Differentiating between primary and secondary cardiovascular involvement-our focus in this review-may help to identify the long-term effects of COVID-19 on the heart in adults and children.

Hubungan Jumlah Koloni Bakteri Di Udara Dalam Ruang Dengan Kejadian Sick Building Syndrome (Sbs) Pada Pegawai Di Arsip Nasional Republik Indonesia Tahun 2019, Rachma Aditria Suci, Ririn Arminsih Wulandari

Jurnal Nasional Kesehatan Lingkungan Global

Background. Sick Building Syndrome (SBS) is one of the problems that are often experienced by residents in office buildings. SBS can be caused due to indoor air quality and individual characteristics. This study aims to determine the relationship between the total amount of bacterial colonies in the air in indoor office with SBS at Arsip Nasional Republik Indonesia. Methods. Cross sectional study design was used, the independent variables was the total number of colonies. The confounding variables were temperature, relative humidity, lighting, age, gender, working period, history of allergies and smoking habits. Results. Statistical analysis gives the results of the …

Pengaruh Tekanan Panas Terhadap Tekanan Darah Tinggi Pada Pekerja Bagian Casting Dan Pressing Di Pt X Tahun 2019, Shendy Glenfano Salean, I Made Djaja

Jurnal Nasional Kesehatan Lingkungan Global

Background. Heat pressure is a combination of several factors such as air temperature, air humidity, air velocity which is a forming of heat pressure. Exposure to high heat pressure can cause an increase in heart rate and blood pressure, also known as hypertension. According to the WHO, hypertension causes the deaths of as many as 8 million deaths a year worldwide. According to Riskesdas (2018) in Indonesia hypertension has a high prevalence, which is equal to 25.8% in 2013 and then becomes 34.1% in 2018. Methods. This study used a cross-sectional study design. This study aims to see the relationship …

Analisis Risiko Kesehatan Pajanan Timbal Dalam Kangkung Air Pada Petani Kangkung Di Kelurahan Sukapura Jakarta Utara Tahun 2019, Fauzia Rachmidiani, Suyud Warno Utomo

Jurnal Nasional Kesehatan Lingkungan Global

Background. Fuel can emit lead heavy metal into the air and will fall to the ground and accumulate in the soil or water. Soil has the ability to retain most of the harmful elements it contains in a long time. Planting water spinach on the edge of a road that is heavily traversed by vehicles will affect lead levels in water spinach due to the absorption of lead from the environment. This study aims to estimate the level of health risk of water spinach farmers due to ingestion of lead in water spinach grown in Sukapura District, North Jakarta. Methods. …

Penyakit Berbasis Lingkungan, Phbs Dan Kondisi Lingkungan Di Lembaga Pemasyarakatan Perempuan Kelas Iia Jakarta, Nurunissa Pratiwi, Laila Fitria

Jurnal Nasional Kesehatan Lingkungan Global

Background. The environment-based disease is a disease phenomenon caused by human association with environmental factors. 3 environmental-based diseases observed in this study were ARI, diarrhea, and fungal infection skin diseases. The purpose of this study was to describe the health problems experienced by prisoners, environmental conditions and the application of clean and healthy behavior, and the relationship between variabels in the Class IIA, Jakarta. Methods. This study used a cross-sectional study with 96 respondents. Retrieval of data using a questionnaire interview technique. Results. The results of statistikal tests showed that there was a significant relationship between the incidence of ARI …

Faktor-Faktor Yang Mempengaruhi Kelayakan Gor Otista Jakarta Timur Menjadi Hunian Sementara Korban Bencana Banjir Ditinjau Dari Aspek Kesehatan Lingkungan Tahun 2019, Sulthana Labiba Khansa, Budi Hartono

Jurnal Nasional Kesehatan Lingkungan Global

Background. The aim of this study discusses the factors that influence the Otista Sports Hall proper for temporary shelter for flood victims in terms of environmental health aspects. This study discusses the form of temporary housing in addition to tents that are safer in terms of health that can be used at the location of refugee camps, one of which is Otista Sports Hall. Methods. This research method uses qualitative methods with descriptive observational univariate analysis. Data retrieval is done by observation and interview using the checklist. This research was conducted at GOR Otista, East Jakarta. Variables related to this …

Hubungan Higiene Sanitasi Makanan Dan Tingkat Kontaminasi Escherichia Coli Pada Makanan Di Lokawisata Baturaden Tahun 2018, Anindya Giodhani, Agustin Kusumayati

Jurnal Nasional Kesehatan Lingkungan Global

Background. Food is an important aspect of human life. However, diseases can also arise due to the ingredients present in food. Tourism places are one of the public places that are at risk as a place for disease transmission through the media, one of which is food. This study aims to determine the relationship between food sanitation hygiene and the level of Escherichia coli contamination in food at Baturaden Tourist Site. Methods. This study used a cross sectional study design. The data used are primary data consisting of laboratory test results of 42 food samples and the results of interviews …

Hubungan Status Pekerjaan Dengan Kadar Merkuri Dalam Rambut Masyarakat Di Wilayah Pertambangan Emas Skala Kecil (Pesk) Desa Mangkualam Dan Kramatjaya Kec. Cimanggu Kab. Pandeglang Banten Tahun 2018, Rizqiyah Rizqiyah, Ririn Arminsih Wulandari

Jurnal Nasional Kesehatan Lingkungan Global

Background. Mercury is one of the hazardous and toxic element in the form of persistent and bioaccumulative heavy silvery-white metal in the ecosystem, which causes particular threat to human and environmental health. One of the longterm biomarkers to assess mercury inside the body is hair. Methods. This study was an analytic observational study employing cross-sectional design with the main variable of residents’ employment status with hair mercury levels. Other variables measured were age, residence distance, frequent consumption of fish, fruits, and vegetables. The sampling technique was carried out by quota sampling with total of 43 respondents in each village. This …

Factors That Influence Enrollment In Syringe Services Programs In Rural Areas: A Qualitative Study Among Program Clients In Appalachian Kentucky, Umedjon Ibragimov, Katherine E. Cooper, Evan Batty, April M. Ballard, Monica Fadanelli, Skylar B. Gross, Emma M. Klein, Scott Lockard, April M. Young, Hannah L. F. Cooper

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Enrolling sufficient number of people who inject drugs (PWID) into syringe services programs (SSP) is important to curtail outbreaks of drug-related harms. Still, little is known about barriers and facilitators to SSP enrollment in rural areas with no history of such programs. This study's purpose was to develop a grounded theory of the role of the risk environment and individual characteristics of PWID in shaping SSP enrollment in rural Kentucky.

METHODS: We conducted one-on-one semi-structured interviews with 41 clients of 5 SSPs that were established in rural counties in Appalachian Kentucky in 2017-2018. Interviews covered PWID needs, the process …

Berat Badan Lahir Rendah (Bblr) Sebagai Determinan Terjadinya Ispa Pada Balita Analisis Data Sdki Tahun 2017, Desinta Ayu Lestari, Asri Adisasmita Prof

Jurnal Epidemiologi Kesehatan Indonesia

No abstract provided.

Hubungan Obesitas Dengan Kejadian Hipertensi Pada Lansia Di Posyandu Lansia Di Wilayah Kerja Puskesmas Pb Selayang Ii Kecamatan Medan Selayang, Medan, Hazella Rissa Valda Asari, Helda Helda

Jurnal Epidemiologi Kesehatan Indonesia

Populasi individu di seluruh dunia berusia 65 tahun dan lebih tua terus meningkat. Prevalensi hipertensi di Indonesia adalah 26,5%.Situasi hipertensi terus meningkat seiring dengan epidemiologinya yang meluas, yang berkontribusi terhadap meningkatnya beban global penyakit secara keseluruhan. Salah satu faktor hipertensi ialah obesitas. Studi Framingham menunjukkan bahwa baik pria maupun wanita mengalami peningkatan tekanan darah dengan peningkatan kelebihan berat badan. Mengetahui hubungan obesitas dengan hipertensi pada lansia. Desain potong lintang digunakan untuk penelitian yang dilaksanakan pada 9 posyandu lansia di wilayah kerja Puskesmas PB Selayang II pada bulan Agustus 2017. Populasi penelitian adalah lansia yang mengunjungi ke sembilan posyandu lansia di …

Hubungan Tingkat Pengetahuan Tentang Alat Kb Dengan Pemakaian Kontrasepsi Modern Pada Wanita Remaja Kawin Di Pulau Jawa (Analisis Sdki 2017), Priskatindea Priskatindea, Sudarto Ronoatmodjo

Jurnal Epidemiologi Kesehatan Indonesia

Prevalensi pemakaian metode KB modern pada wanita kawin usia remaja di Pulau Jawa tahun 2017 tergolong masih rendah, yakni 27,8%. Terbatasnya tingkat pengetahuan remaja mengenai pilihan kontrasepsi adalah salah satu hambatan pemakaian kontrasepsi pada remaja. Penelitian ini memiliki tujuan untuk mengetahui hubungan antara tingkat pengetahuan tentang alat/cara KB dengan pemakaian kontrasepsi modern pada wanita kawin usia remaja di Pulau Jawa. Penelitian ini menggunakan data sekunder dengan menganalisis hasil dari Survei Demografi dan Kesehatan Indonesia (SDKI) Tahun 2017. Sampel adalah 309 orang wanita berusia 15-19 tahun yang berdomisili di Pulau Jawa dengan status kawin. Pada hasil ditemukan sebanyak 62,4% responden memakai …