ArticlePDF Available

Abstract and Figures

Web-based tailored intervention programs show considerable promise in effecting health-promoting behaviors and improving health outcomes across a variety of medical conditions and patient populations. This meta-analysis compares the effects of tailored versus nontailored web-based interventions on health behaviors and explores the influence of key moderators on treatment outcomes. Forty experimental and quasi-experimental studies (N = 20,180) met criteria for inclusion and were analyzed using meta-analytic procedures. The findings indicated that web-based tailored interventions effected significantly greater improvement in health outcomes as compared with control conditions both at posttesting, d = .139 (95% CI = .111, .166, p <.001, k = 40) and at follow-up, d = .158 (95% CI = .124, .192, p < .001, k = 21). The authors found no evidence of publication bias. These results provided further support for the differential benefits of tailored web-based interventions over nontailored approaches. Analysis of participant/descriptive, intervention, and methodological moderators shed some light on factors that may be important to the success of tailored interventions. Implications of these findings and directions for future research are discussed.
Content may be subject to copyright.
e Florida State University
DigiNole Commons
School of Library and Information Studies Faculty
Publications School of Library and Information Studies
6-1-2013
A Meta-Analysis of Web-Delivered, Tailored
Health Behavior Change Interventions
Mia A. Lustria
Florida State University, mlustria@fsu.edu
Seth M. Noar
University of North Carolina at Chapel Hill
Juliann Cortese
Florida State University
Stephanie K. Van Stee
University of Kentucky
Robert L. Glueckauf
Florida State University
See next page for additional authors
Follow this and additional works at: hp://diginole.lib.fsu.edu/slis_faculty_publications
Part of the Health Information Technology Commons, and the Library and Information Science
Commons
is Article is brought to you for free and open access by the School of Library and Information Studies at DigiNole Commons. It has been accepted
for inclusion in School of Library and Information Studies Faculty Publications by an authorized administrator of DigiNole Commons. For more
information, please contact lib-ir@fsu.edu.
Recommended Citation
Lustria, M. L. A., Noar, S. M., Cortese, J., van Stee, S., Glueckauf, R. L., & Lee, J. (2013). A meta-analysis of web-delivered tailored
health behavior change interventions. Journal of Health Communication, 18(9), 1039-1069. doi:10.1080/10810730.2013.768727
Authors
Mia A. Lustria, Seth M. Noar, Juliann Cortese, Stephanie K. Van Stee, Robert L. Glueckauf, and Junga Lee
is article is available at DigiNole Commons: hp://diginole.lib.fsu.edu/slis_faculty_publications/13
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
1
!
!
A!Meta'Analysis!of!Web'Delivered,!Tailored!Health!Behavior!Change!Interventions1!
,
1),
,
!+$,:+;$,&<,:=*#5+$3,>7<?<,@,
AB7--(,-.,:+05$5),$'2,8'.-5C$#+-',A#=2+"*,
D-(("E",-.,D-CC='+B$#+-',F,8'.-5C$#+-'3,G(-5+2$,A#$#",H'+9"5*+#),
IJ@,D-(("E+$#",:--K3,4$(($7$**""3,G:,L@LMN%@IMM,
>7-'"O,PQRMS,NJJ%N@LT,
C(=*#5+$U.*=<"2=,,
,
A"#7,!<,V-$53,>7<?<,
AB7--(,-.,W-=5'$(+*C,$'2,!$**,D-CC='+B$#+-',
H'+9"5*+#),-.,V-5#7,D$5-(+'$,$#,D7$K"(,6+((,
LNL,D$55-((,6$((,PD1,LLNRS3,D7$K"(,6+((3,VD,,@TRXX%LLNR,
'-$5U"C$+(<='B<"2=,
,
W=(+$'',D-5#"*"3,>7<?<,
AB7--(,-.,D-CC='+B$#+-',
D-(("E",-.,D-CC='+B$#+-',F,8'.-5C$#+-'3,G(-5+2$,A#$#",H'+9"5*+#),
@XN,D7$CK+-'*,/$)3,4$(($7$**""3,G:,L@LMN%@NNJ,
YB-5#"*"U.*=<"2=,,
,
A#"K7$'+",Z<,[$',A#""3,!<&<,
?"K$5#C"'#,-.,D-CC='+B$#+-'3,H'+9"5*+#),-.,Z"'#=B\),
@@T,]5"7$',1=+(2+'E3,:"^+'E#-'3,Z_,JMRMN%MMJ@,
,*\9$'*@U=\)<"2=,,
,
`-0"5#,:<,](="B\$=.3,>7<?<,
?"K$5#C"'#,-.,!"2+B$(,6=C$'+#+"*,F,A-B+$(,AB+"'B"*,
D-(("E",-.,!"2+B+'"3,G(-5+2$,A#$#",H'+9"5*+#),
IIIR,/<,D$((,A#<3,A=+#",ILIM,:3,4$(($7$**""3,G:,L@LMN%JLMM,
`-0"5#<](="B\$=.UC"2<.*=<"2=,,
,
W='E$,:""3,>7<?<,
AK-5#*,!"2+B+'",:$0-5$#-5)3,_-'*"+,H'+9"5*+#),
A"-=(3,A-=#7,Z-5"$,
Y='E$NILUEC$+(<B-C,
!
!
!
!
I,!"#$%#$%&'%()*"+,-$%.,#/#'&0%1&')$2,#3*%+4%&'%&,*#205%6"+$5%4#'&0%&'7%754#'#*#85%4+,9:%*"5%;5,$#+'%+4%<52+,7:%"&$%=55'%
3)=0#$"57%#'%*"5%>+),'&0%+4%?5&0*"%@+99)'#2&*#+'%ABCDEF%A2+3G,#/"*%!&G0+,%H%I,&'2#$FJ%K05&$5%7+%'+*%7#$*,#=)*5%6#*"+)*%
*"5%&)*"+,$L%35,9#$$#+'J%@#*&*#+'M%:=*#5+$3,!<,:<,&<3,V-$53,A<,!<3,D-5#"*"3,W<3,9$',A#""3,A<3,](="B\$=.3,`<,:<3,F,:""3,W<,P@MILS<,
&,C"#$%$'$()*+*,-.,a"0%2"(+9"5"2,#$+(-5"2,7"$(#7,0"7$9+-5,B7$'E",+'#"59"'#+-'*<,>+),'&0%+4%?5&0*"%@+99)'#2&*#+':%
DNPXS3,IMLX%IMNX<,2-+OIM<IMQMbIMQIMTLM<@MIL<TNQT@T,
@,D-55"*K-'2+'E,$=#7-5<,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
2
A!Meta'Analysis!of!Web'Delivered,!Tailored!Health!Behavior!Change!Interventions!
,
,
,
,
Abstract!
BackgroundO,/"0%0$*"23,#$+(-5"2,+'#"59"'#+-',K5-E5$C*,*7-a,B-'*+2"5$0(",K5-C+*",+',
".."B#+'E,7"$(#7%K5-C-#+'E,0"7$9+-5*,$'2,+CK5-9+'E,7"$(#7,-=#B-C"*,$B5-**,$,9$5+"#),-.,
C"2+B$(,B-'2+#+-'*,$'2,K$#+"'#,K-K=($#+-'*<,,PurposeO,47+*,C"#$%$'$()*+*,B-CK$5"*,#7",
".."B#*,-.,#$+(-5"2,9"5*=*,'-'%#$+(-5"23,a"0%0$*"2,+'#"59"'#+-'*,-',7"$(#7,0"7$9+-5*3,$'2,
"^K(-5"*,#7",+'.(="'B",-.,\"),C-2"5$#-5*,-',#5"$#C"'#,-=#B-C"*<,MethodsO,G-5#),
"^K"5+C"'#$(,$'2,c=$*+%"^K"5+C"'#$(,*#=2+"*,PO,d,@M3IQMS,C"#,B5+#"5+$,.-5,+'B(=*+-',$'2,
a"5",$'$();"2,=*+'E,C"#$%$'$()#+B,K5-B"2=5"*<,ResultsO,47",.+'2+'E*,+'2+B$#"2,#7$#,a"0%
0$*"23,#$+(-5"2,+'#"59"'#+-'*,".."B#"2,*+E'+.+B$'#(),E5"$#"5,+CK5-9"C"'#,+',7"$(#7,
-=#B-C"*,$*,B-CK$5"2,#-,B-'#5-(,B-'2+#+-'*,0-#7,$#,K-*#%#"*#+'E3,7%d,<ILX,PXRe,D8,d,<III3,
<INN3,3P<MMI3,Q,d,JMS,$'2,$#,.-((-a%=K3,7%d,<IRQ,PXRe,D8,d,<I@J3,<IX@3,3P<MMI3,Q,d,@IS<,V-,
"9+2"'B",-.,K=0(+B$#+-',0+$*,a$*,.-='2<,ConclusionsO,47"*",5"*=(#*,K5-9+2"2,.=5#7"5,
*=KK-5#,.-5,#7",2+.."5"'#+$(,0"'".+#*,-.,#$+(-5"2,a"0%0$*"2,+'#"59"'#+-'*,-9"5,'-'%#$+(-5"2,
$KK5-$B7"*<,&'$()*+*,-.,K$5#+B+K$'#b2"*B5+K#+9"3,+'#"59"'#+-'3,$'2,C"#7-2-(-E+B$(,
C-2"5$#-5*,*7"2,*-C",(+E7#,-',.$B#-5*,#7$#,C$),0",+CK-5#$'#,#-,#7",*=BB"**,-.,#$+(-5"2,
+'#"59"'#+-'*<,8CK(+B$#+-'*,-.,#7"*",.+'2+'E*,$'2,2+5"B#+-'*,.-5,.=#=5",5"*"$5B7,$5",
2+*B=**"2<,!
KeywordsO,R'*5,'5*:%65=S=&$57:%*&#0+,#'/:%#'*5,85'*#+':%"5&0*"%=5"&8#+,%2"&'/5
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
3
INTRODUCTION,
8#,7$*,0""',$,B-CC-',C+*B-'B"K#+-',-.,K=0(+B,7"$(#7,K5-E5$C*,#7$#,7"$(#7,
C"**$E"*,$'2,C-2"*,-.,2"(+9"5),B$',.+#,$((,K-K=($#+-'*3,C"2+B$(,B-'2+#+-'*,-5,
B+5B=C*#$'B"*,PZ5"=#"53,A#5"B7"53,F,]($**C$'3,IXXXf,A=##-'3,1$(B73,F,:"."095"3,IXXRS<,&,
E5-a+'E,0-2),-.,5"*"$5B7,*7-a*,#7$#,K5"*"'#+'E,E"'"5$(,7"$(#7,+'.-5C$#+-',a+#7-=#,
B-'*+2"5+'E,+'2+9+2=$(,'""2*,-5,K"5*-'$(,5"("9$'B",C$),(+C+#,*=0*#$'#+$((),#7","^#"'#,-.,
7"$(#7,0"7$9+-5,B7$'E",PD$+$#$,g=.."5"),F,AB7=(;3,@MMXf,]$'*,"#,$(<3,@MMXf,:$C0"5#3,
:-+*"(("3,F,!$B2-'$(23,@MMXf,:=*#5+$3,D-5#"*"3,V-$53,F,](="B\$=.3,@MMXf,V"9+(("3,!+($#3,F,
hi6$5$3,@MMXf,V"9+(("3,hi6$5$3,F,!+($#3,@MMX$3,@MMX0f,V-$53,6$55+'E#-'3,F,&(25+B73,@MMXf,
A#5"B7"5,"#,$(<3,@MMQf,A=EE*,F,!B8'#)5"3,@MMXf,4",>-"(3,1-(C$'3,`"=0*$"#3,F,2",[5+"*3,@MMXf,
/$'E0"5E3,@MMQS<,,
4$+(-5+'E,+*,$,C=(#+%2+C"'*+-'$(,B-CC='+B$#+-',*#5$#"E),#7$#,+'9-(9"*,2"9"(-K+'E,
+'2+9+2=$(+;"2,C"**$E"*,0$*"2,-',K5"%$**"**C"'#,-.,\"),+'2+9+2=$(%2+.."5"'B",9$5+$0("*,-5,
B7$5$B#"5+*#+B*,(+'\"2,#-,#7",='2"5()+'E,C-2"(,-.,0"7$9+-5,B7$'E",PZ5"=#"53,G$55"((3,
h("9+#B73,F,15"''$'3,@MMMf,:=*#5+$3,"#,$(<3,@MMXS<,V=C"5-=*,*#=2+"*,7$9",.-='2,#7$#,
B-CK$5"2,#-,'-'%#$+(-5"2,C$#"5+$(*3,#$+(-5"2,7"$(#7,C"**$E"*,B-CC$'2,E5"$#"5,$##"'#+-'3,
$5",K5-B"**"2,C-5",+'#"'#()3,B-'#$+',("**,5"2='2$'#,+'.-5C$#+-'3,$'2,$5",K"5B"+9"2,C-5",
K-*+#+9"(),0),7"$(#7,B-'*=C"5*,P1$'2=5$3,IXXQf,15=E3,h"'"C$3,F,D$CK0"((3,@MMLf,Z5"=#"53,
D$0=5'$)3,D7"'3,F,?-'(+'3,@MMJf,Z5"=#"5,F,/5$)3,@MMLf,&<,D<,!$5B=*,"#,$(<3,@MMRf,AC""#*3,
15=E3,F,2",[5+"*3,@MMQf,/+((+$C*%>+"7-#$3,AB7'"+2"53,>+;$55-3,!-a$23,F,A$(-9")3,@MMLS<,,
4$+(-5+'E,a-5\*,0),+'B5"$*+'E,#7",K"5*-'$(,5"("9$'B",-.,7"$(#7,C"**$E"*,P6$a\+'*3,
Z5"=#"53,`"*'+B-a3,G+*70"+'3,F,?+Y\*#5$3,@MMQS<,&BB-52+'E,#-,#7",j($0-5$#+-',:+\"(+7--2,
!-2"(3,a7"',+'2+9+2=$(*,K"5B"+9",+'.-5C$#+-',#-,0",K"5*-'$((),5"("9$'#3,#7+*,C$),"'7$'B",
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
4
#7"+5,C-#+9$#+-',#-,"($0-5$#",-',#7",C"**$E"3,$'2,+'B5"$*",#7"+5,*"'*+#+9+#),#-,$5E=C"'#,
*#5"'E#7,P>"##),F,D$B+-KK-3,IXTXS<,&(#"5'$#+9"()3,+.,#7",$5E=C"'#*,K5"*"'#"2,$5",K"5B"+9"2,
#-,0",*#5-'E3,K"5B"+9"2,K"5*-'$(,5"("9$'B",B$',+'B5"$*",K"5*=$*+-'<,47=*3,#$+(-5+'E,C$),
K($),$',+CK-5#$'#,$(0"+#,+'2+5"B#,5-(",+',B5"$#+'E,$',+2"$(,"'9+5-'C"'#,.-5,K"5*=$*+-',$'23,
K-#"'#+$(()3,7"$(#7,0"7$9+-5,B7$'E",P?+Y\*#5$3,@MMRf,6$a\+'*3,"#,$(<3,@MMQf,`+C"5,F,Z5"=#"53,
@MMNS<,,
D-CK=#+'E,#"B7'-(-E+"*,7$9",B-'#5+0=#"2,*+E'+.+B$'#(),#-,#7",("9"(,-.,*-K7+*#+B$#+-',
-.,#$+(-5+'E<,A=B7,*)*#"C*,B$',.$B+(+#$#",#7"-5)%0$*"2,$**"**C"'#,#-,*=KK-5#,#$+(-5+'E,-',$,
'=C0"5,-.,\"),K"5*-'$(,B7$5$B#"5+*#+B*<,!-5"-9"53,C=(#+K(",+'#"5$B#+9",C-2$(+#+"*,B$',
"'7$'B",#7",2"(+9"5),-.,7"$(#7,C"**$E"*<,,8',$,C"#$%$'$()*+*,-.,TR,5$'2-C+;"2,B-'#5-(("2,
#5+$(*3,>-5#'-),"#,$(<,P@MMQS,.-='2,#7$#,B-CK=#"5%#$+(-5"2,+'#"59"'#+-'*,("2,#-,K-*#%
#5"$#C"'#,B7$'E"*,-',$,'=C0"5,-.,#7"-5"#+B$(()%5"("9$'#,$'#"B"2"'#,9$5+$0("*,P"<E<3,*"(.%
"..+B$B)3,\'-a("2E"3,$##+#=2"*3,K"5B"+9"2,'-5C*3,0"7$9+-5$(,+'#"'#+-'*3,$'2,5"$2+'"**,#-,
B7$'E"S,7)K-#7"*+;"2,#-,+CK5-9",B-'2+#+-'*,.-5,0"7$9+-5,B7$'E",P1$'2=5$3,IXXQf,G+*70"+',
F,D$KK"(($3,@MMNf,>5-B7$*\$,F,?+D("C"'#"3,IXQJS<,,Z5"0*,$'2,>5-B7$*\$,P@MIMS,
$EE5"E$#"2,#7",5"*=(#*,-.,QQ,#$+(-5"2,B-CK=#"5%3,K5+'#%,-5,#"("K7-'"%0$*"2,7"$(#7,
+'#"59"'#+-'*,#$5E"#+'E,.-=5,7"$(#7,0"7$9+-5*,P+<"<3,*C-\+'E,B"**$#+-'3,K7)*+B$(,$B#+9+#)3,
7"$(#7),"$#+'E3,$'2,05"$*#,*B5""'+'ES,$'2,.-='2,$,*+E'+.+B$'#,C"$',".."B#,*+;",PE,d,M<ITS,
$B5-**,#7"*",+'#"59"'#+-'*<,47"*",.+'2+'E*,7$9",0""',B-55-0-5$#"2,+',$,'=C0"5,-.,
*)*#"C$#+B,5"9+"a*3,*7-a+'E,2+.."5"'#+$(,K-*+#+9",".."B#*,.-5,B-CK=#"5%#$+(-5"2,
+'#"59"'#+-'*,-','=#5+#+-',$'2,2+"#$5),0"7$9+-5*,PZ5-";"3,/"5\C$'3,F,15=E3,@MMNf,1<,6<,
!$5B=*,"#,$(<3,@MMTf,V"9+(("3,!+($#3,"#,$(<3,@MMXf,V"9+(("3,hi6$5$3,"#,$(<3,@MMX$3,@MMX0S3,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
5
*C-\+'E,B"**$#+-'3,$'2,-#7"5,5+*\,0"7$9+-5*,P`"9"5",F,?='0$53,@MMIf,`+C"5,F,]($**C$'3,
IXXQf,A#5"B7"53,IXXXf,A#5"B7"53,/$'E3,?"55)3,/+(2"'7$=*3,F,W-7'*-'3,@MM@S<,,
/"0%0$*"23,B-CK=#"5%#$+(-5"2,+'#"59"'#+-'*,7$9",C=(#+K(",$29$'#$E"*,-9"5,*+'E("%
C-2"3,*#$#+B,+'#"59"'#+-'*O,PIS,a+2"5,$BB"**,#-,"^K"5#,B$5",$'2,.""20$B\f,P@S,$0+(+#),#-,
#-EE(",0"#a""',C-2$(+#+"*,$'2,.-5C$#*,#-,*=+#",2+.."5"'#,("$5'+'E,*#)("*,$'2,(+#"5$B),("9"(*f,
PLS,-K#+-',#-,B-CC='+B$#",*)'B75-'-=*(),$'2,$*)'B75-'-=*(),#7=*,"'$0(+'E,B-'9"'+"'#,
*B7"2=(+'E,-.,+'#"5$B#+-'*,$'2,2"(+9"5),-.,5"C+'2"5*,$'2,C"**$E"*f,PJS,$,a+2",$55$),-.,
+'#"5$B#+9",B-CK-'"'#*,#-,"'7$'B",=*"5,"^K"5+"'B"*,$'2,*=KK-5#,*\+((*,2"9"(-KC"'#3,
0"7$9+-5bE-$(,C-'+#-5+'E3,$'2,K5-E5"**,#5$B\+'E,P"<E<3,"%Y-=5'$(*3,*+C=($#+-'*3,E$C"*3,"#B<S,
P:=*#5+$3,"#,$(<3,@MMXf,>-5#'-)3,"#,$(<3,@MMQS<,,
&*,*=B73,#7",K5-B"**,#-,2"9"(-K,#$+(-5"2,+'#"59"'#+-'*,B$',0",C-5",B-CK("^,#7$',
a7$#,a-=(2,0",+'9-(9"2,+',#7",2"9"(-KC"'#,-.,+'#"59"'#+-'*,2"(+9"5"2,9+$,#5$2+#+-'$(,
C-2"*,P"<E<3,K5+'#S<,&22+#+-'$(()3,#7",C=(#+%C-2$(3,+'#"5$B#+9",'$#=5",-.,a"0%0$*"2,#$+(-5"2,
+'#"59"'#+-'*,C$\"*,+#,2+..+B=(#,#-,#"$*",-=#,C-2"5$#-5*,-.,"..+B$B),B-CK$5"2,#-,#5$2+#+-'$(3,
*+'E("%C-2",$KK5-$B7"*<,D-'*"c="'#()3,"..+B$B),B$',0",+'.(="'B"2,0),$,'=C0"5,-.,.$B#-5*O,
P$S,#7",'$#=5",-.,#7",+'#"59"'#+-',P+<"<3,7"$(#7,.-B=*,$'2,'=C0"5,$'2,#)K"*,-.,#$5E"#,7"$(#7,
0"7$9+-5*Sf,P0S,C-2"*,-.,2"(+9"5)f,PBS,*#=2),B7$5$B#"5+*#+B*f,P2S,K$5#+B+K$'#,K-K=($#+-'f,P"S,
'=C0"5,-.,+'#"59"'#+-',B-'#$B#*f,$'2,P.S,$KK(+B$#+-',-.,#7"-5)%0$*"2,$**"**C"'#,P:=*#5+$3,
"#,$(<3,@MMXf,V-$53,"#,$(<3,@MMXS<,,,
/7+(",K5"9+-=*,C"#$%$'$()*"*,7$9","^$C+'"2,a"0%0$*"2,+'#"59"'#+-'*3,'-'",-.,
#7"*",7$9",.-B=*"2,*K"B+.+B$((),-',a"0%750#85,57,#$+(-5"2,K5-E5$C*<,47+*,*#=2)3,#7"5".-5"3,
.+((*,$,E$K,+',#7",(+#"5$#=5",E+9"',#7",($5E",$'2,5$K+2(),E5-a+'E,'=C0"5,-.,*#=2+"*,-',a"0%
2"(+9"5"2,#$+(-5"2,K5-E5$C*,P"<E<3,:=*#5+$3,"#,$(<3,@MMXf,V-$53,"#,$(<3,@MMXS<,>-5#'-),"#,$(<,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
6
P@MMQS,.-B=*"2,#7"+5,C"#$%$'$()*+*,-',B-CK=#"5%2"(+9"5"2,+'#"59"'#+-'*3,"^$C+'+'E,$'),
+'#"59"'#+-',2"(+9"5"2,9+$,B-CK=#"5,$'2,"^$C+'+'E,*7-5#%#"5C,".."B#*,-'()<,Z5"0*,"#,$(<,
P@MIMS,.-B=*"2,#7"+5,C"#$%$'$()*+*,-',B-CK=#"5%#$+(-5"2,K5-E5$C*,2"(+9"5"2,9+$,$'),
B7$''"(3,a+#7,C-*#,+'#"59"'#+-'*,PTReS,2"(+9"5+'E,K5+'#%0$*"2,5"K-5#*,$'2,-'(),IX,*#=2+"*,
P@@eS,2"(+9"5+'E,B-'#"'#,9+$,B-CK=#"5*,-5,#7",a"0<,/"00,"#,$(<,P@MIMS,"^$C+'"2,#7",05-$2,
a"0%0$*"2,+'#"59"'#+-',(+#"5$#=5",$'2,.-B=*"2,#7"+5,$'$()*+*,K5+C$5+(),-',#7",=*",-.,#7"-5),
$'2,0"7$9+-5,B7$'E",#"B7'+c="*<,,
47",B=55"'#,C"#$%$'$()*+*,.-B=*"*,-',a"0%0$*"23,B-CK=#"5%#$+(-5"2,7"$(#7,
+'#"59"'#+-',*#=2+"*3,$'2,"^$C+'"*,0-#7,*7-5#,$'2,(-'E"5%#"5C,".."B#*,-.,*=B7,
+'#"59"'#+-'*,-',0"7$9+-5$(,-=#B-C"*<,G-((-a+'E,C"#$%$'$()*"*,#7$#,7$9",.-B=*"2,-',
#$+(-5+'E,0=#,*-("(),-5,K5+C$5+(),-',K5+'#%0$*"2,B-'#"'#,2"(+9"5),PZ5"0*3,"#,$(<3,@MIMf,V-$53,
1"'$B3,F,6$55+*3,@MMTf,A-7(,F,!-)"53,@MMTS3,#7",B=55"'#,*#=2),"^$C+'"*,#7",K-#"'#+$(,-.,
#$+(-5+'E,*#5$#"E+"*,=*+'E,#7",a"0,$*,#7",K5+C$5),2"(+9"5),C"B7$'+*C<,AK"B+.+B$(()3,+#,
$**"**"*,#7","..+B$B),-.,a"0%0$*"23,B-CK=#"5%#$+(-5"2,7"$(#7,0"7$9+-5,B7$'E",+'#"59"'#+-',
*#=2+"*,=*+'E,C"#$%$'$()#+B,K5-B"2=5"*<,!-5"-9"53,#7+*,*#=2),B-CK$5"*,#7","..+B$B),-.,
#$+(-5"2,a"0%0$*"2,7"$(#7,0"7$9+-5,B7$'E",+'#"59"'#+-'*,#-,*#$'2$52,-5,E"'"5+B,
$KK5-$B7"*,$'2,"^K(-5"*,*"9"5$(,*"#*,-.,C-2"5$#-5*,#7$#,C$),+CK$B#,#7",".."B#*,-.,
#$+(-5+'E<,,,
47",*K"B+.+B,C-2"5$#-5*,$'2,5"*"$5B7,c="*#+-'*,#"*#"2,$5",$*,.-((-a*O,
I< K&,*#2#3&'*TU5$2,#3*#85%2"&,&2*5,#$*#2$O,6$9",-=#B-C"*,-.,#$+(-5"2,a"0%0$*"2,
0"7$9+-5$(,+'#"59"'#+-'*,9$5+"2,a+#7,5"E$52,#-,E"'2"53,$E"3,K-K=($#+-',#)K"3,B-='#5),
$'2,0"7$9+-5,*#=2+"2k,,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
7
@< R'*5,85'*#+'T*&#0+,#'/%2"&,&2*5,#$*#2$O,6$9",-=#B-C"*,-.,#$+(-5"2,a"0%0$*"2,0"7$9+-5$(,
+'#"59"'#+-'*,9$5+"2,a7"',2+.."5+'E,#$+(-5+'E,*#5$#"E+"*,7$9",0""',$KK(+"2k,47"*",
+'B(=2",#$+(-5+'E,*#5$#"E+"*,*=B7,$*,.5"c="'B),-.,#$+(-5+'E,$**"**C"'#,$'2,=*"5,B-'#5-(<,
L< 15*"+7+0+/#2&0%2"&,&2*5,#$*#2$O,6$9",-=#B-C"*,-.,#$+(-5"2,a"0%0$*"2,0"7$9+-5$(,
+'#"59"'#+-'*,9$5+"2,a+#7,5"E$52,#-,*#=2),2"*+E'3,#)K",-.,B-CK$5+*-',B-'2+#+-'3,("'E#7,
-.,.-((-a%=K3,$'2,*#=2),5"#"'#+-'k,
!j46h?,
V5&,2"%V*,&*5/G%
/",B-'2=B#"2,B-CK5"7"'*+9",*"$5B7"*,-.,#7",1570#'5,$'2,K$G2ROI.,2$#$0$*"*,.-5,
K-#"'#+$((),"(+E+0(",*#=2+"*,+',K""5%5"9+"a"2,Y-=5'$(*,$'2,0--\,B7$K#"5*,K=0(+*7"2,.5-C,
W$'=$5),IXXX,#-,?"B"C0"5,@MMX<,&',+'+#+$(,*B$',-.,#7",(+#"5$#=5",5"9"$("2,#7$#,*#=2+"*,
K5"2$#+'E,IXXX,2+2,'-#,C""#,#7",.=((,B5+#"5+$,.-5,B-CK=#"5%#$+(-5"23,a"0%2"(+9"5"2,
+'#"59"'#+-'*3,#7=*,#7+*,)"$5,a$*,*"#,$*,#7",*#$5#+'E,K-+'#,.-5,-=5,*"$5B7<,A"$5B7,c="5+"*,
a"5",.-5C=($#"2,=*+'E,2+.."5"'#,B-C0+'$#+-'*,-.,#7",.-((-a+'E,#"5C*O,lB-CK=#"5m3,l/"0m3,
l8'#"5'"#m3,l#$+(-5"2m3,l7"$(#7m,$'2,l+'#"59"'#+-'<m,&((,K-#"'#+$((),"(+E+0(",$5#+B("*,a"5",
"^$C+'"2,#-,2"#"5C+'",#7","^#"'#,-.,5"("9$'B"<,/",$(*-,"^$C+'"2,5"9+"a,$5#+B("*,$'2,
5"."5"'B",(+*#*,-.,*"("B#"2,$5#+B("*,PZ5-";"3,"#,$(<3,@MMNf,:=*#5+$3,"#,$(<3,@MMXf,V-$53,"#,$(<3,
@MMTf,>-5#'-)3,"#,$(<3,@MMQf,`+B7$52*,"#,$(<3,@MMTf,A=EE*,F,!B8'#)5"3,@MMXf,!$5(""',6<,9$',
2"',1"5E3,AB7--'"*3,F,[(+"($'23,@MMTf,/"+'*#"+'3,@MMNS,#-,"'*=5",-=5,*"$5B7,K5-B"**,a$*,
"^7$=*#+9"<,/",-'(),+'B(=2"2,a-5\,K=0(+*7"2,+',K""5%5"9+"a"2,Y-=5'$(*3,0--\*3,-5,0--\,
B7$K#"5*<,,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
8
8'+#+$(,*"$5B7"*,5"*=(#"2,+',Q@R,$0*#5$B#*,#7$#,a"5","^$C+'"2,.-5,5"("9$'B"<,A#=2+"*,
a"5",*B5""'"2,+',*"9"5$(,*#$E"*,=*+'E,"^K(+B+#,+'B(=*+-',$'2,"^B(=*+-',B5+#"5+$,P*"",G+E=5",
ISO,
K=0(+*7"2,.5-C,W$'=$5),IXXX,#-,?"B"C0"5,@MMX,+',j'E(+*7%($'E=$E"3,K""5%5"9+"a"2,
Y-=5'$(*,
5$'2-C+;"2,B-'#5-(("2,#5+$(*,-5,c=$*+%"^K"5+C"'#$(,*#=2+"*,
"..+B$B),*#=2+"*,-.,-'(+'",7"$(#7,+'#"59"'#+-'*3,#7$#O,
o 7$2,$#,("$*#,-'",a"0%0$*"2,B-CK-'"'#,P2"(+9"5"2,-9"5,#7",8'#"5'"#3,"<E<3,=*+'E,"%
C$+(3,a"0*+#"3,"#B<S,
o =*"2,$,B-CK=#"5,$(E-5+#7C,.-5,#$+(-5+'E,
o "9$(=$#"2,$#,("$*#,-'",7"$(#7,0"7$9+-5,-5,B(+'+B$(,-=#B-C",C"$*=5",,
o K5+C$5+(),#$5E"#"2,K$#+"'#*,-5,E"'"5$(,7"$(#7,B-'*=C"5*,$'2,Vh4,B$5"E+9"5*,-5,
K5-9+2"5*,
n8VAj`4,G8]H`j,Io
, D+#$#+-'*,a"5","9$(=$#"2,$'2,+'"(+E+0(",*#=2+"*,P+<"<3,*#=2+"*,$0-=#,-'(+'",7"$(#7,
+'.-5C$#+-',*""\+'E3,$'2,a"0%0$*"2,B-'#+'=+'E,C"2+B$(,"2=B$#+-'f,-5,2=K(+B$#"2,
K=0(+B$#+-'*S,a"5","^B(=2"2,P'WJQQS<,&0*#5$B#*,-.,#7",5"C$+'+'E,K-#"'#+$((),"(+E+0(",*#=2+"*,
a"5",(-B$#"2,$'2,B(-*"(),"^$C+'"2,.-5,5"("9$'B",P'WLLTS<,A#=2+"*,#7$#,2+2,'-#,7$9",$,a"0,
B-CK-'"'#,-5,2+2,'-#,.-B=*,-',K$#+"'#*,P'WIL@S3,-5,a"5",5"9+"a,$5#+B("*,P'WJMS,a"5",
*=0*"c="'#(),"^B(=2"2<,A+'B",a",a"5",+'#"5"*#"2,+',B-2+'E,$'2,B-CK$5+'E,*#=2+"*,$B5-**,$,
a+2",5$'E",-.,B7$5$B#"5+*#+B*3,a",$(*-,B-'*+2"5"2,#7",B-CK5"7"'*+9"'"**,-.,5"K-5#+'E,+',
*"("B#+'E,$5#+B("*<,,/",$(*-,"^B(=2"2,*#=2+"*,#7$#O,P$S,2+2,'-#,=*",B-CK=#"5%0$*"2,
$**"**C"'#,$'2,#$+(-5+'E,P'WIRS3,P0S,2+2,'-#,C"$*=5",$'),0"7$9+-5$(,-=#B-C"*,P'WLIS3,-5,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
9
PBS,a"5",'-#,5$'2-C+;"2,B-'#5-(("2,#5+$(*,-5,7$2,'-,C"$'+'E.=(,B-CK$5+*-',E5-=K*,P'WQMf,
#7"*",+'B(=2"2,."$*+0+(+#),*#=2+"*3,K5-K-*$(*3,=*$0+(+#),*#=2+"*3,$'2,c=$(+#$#+9",*#=2+"*S<,&*,$,
5"*=(#3,$,.+'$(,*"#,-.,LX,$5#+B("*,PIIeS,C"#,B5+#"5+$,PG+E=5",IS<,1"B$=*",-'",$5#+B(",5"K-5#"2,
2$#$,.5-C,@,*#=2+"*3,#7",.+'$(,*"#,-.,*#=2+"*,+',#7",C"#$%$'$()*+*,a$*,Q,d,JM,P4$0(",IS<,,
n8VAj`4,4&1:j,Io,
(,*#205%@+7#'/%&'7%R'*5,2+75,%<50#&=#0#*G%
&5#+B("*,a"5","9$(=$#"2,.-5,"(+E+0+(+#),0),#a-,+'2"K"'2"'#,B-2"5*<,j(+E+0(",*#=2+"*,
a"5",B-2"2,-',#7",.-((-a+'E,9$5+$0("*O,2"C-E5$K7+B,$'2,*$CK(",B7$5$B#"5+*#+B*f,
+'#"59"'#+-',B7$5$B#"5+*#+B*,P+<"<3,7"$(#7,B-'#"'#3,#$+(-5+'E,B5+#"5+$,$'2,*#5$#"E+"*3,$'2,
C-2$(+#+"*b2"(+9"5),C-2"Sf,$'2,C"#7-2-(-E+B$(,B7$5$B#"5+*#+B*,P+<"<3,5"B5=+#C"'#,
K5-B"2=5"3,B-CK$5+*-',B-'2+#+-'*3,+'#"59"'#+-',("'E#73,+'#"59"'#+-',2-*"3,("'E#7,-.,.-((-a,
=K3,$'2,*#=2),5"#"'#+-'S<,hK"5$#+-'$(,2".+'+#+-'*,a"5",*=CC$5+;"2,+',$,B-2"0--\,#-,"'*=5",
#7$#,B$#"E-5+;$#+-',a$*,B-'*+*#"'#(),$'2,$BB=5$#"(),$KK(+"2,#75-=E7-=#,#7",B-2+'E,K5-B"**<,
4a-,B-2"5*,#"*#"2,$'2,C-2+.+"2,#7+*,B-2"0--\,=*+'E,$',+#"5$#+9",K5-B"**,-.,2$#$,5"9+"a3,
B-'*=(#$#+-'3,$'2,B-'*"'*=$(,9$(+2$#+-'<,,
8'#"5B-2"5,5"(+$0+(+#),a$*,B$(B=($#"2,.-5,"$B7,B7$5$B#"5+*#+B,=*+'E,Z5+KK"'2-5..p*,
$(K7$,P6$)"*,F,Z5+KK"'2-5..3,@MMTf,Z5+KK"'2-5..3,@MMJS3,a7+B7,B$',B$(B=($#",5"(+$0+(+#),.-5,
B$#"E-5+B$(,$'2,B-'#+'=-=*,9$5+$0("*<,Z5+KK"'2-5..p*,$(K7$,5$'E"2,.5-C,$,(-a,-.,M<X@,#-,$,
7+E7,-.,I<M3,a+#7,$,C"$',$(K7$,-.,M<XXQ<,,>"5B"'#$E",-.,$E5""C"'#,.-5,"$B7,B-2+'E,B$#"E-5),
a$*,$(*-,B$(B=($#"2,0),2+9+2+'E,#7",'=C0"5,-.,$E5""2,=K-',B-2+'E,+'*#$'B"*,0),#7",#-#$(<,
>"5B"'#$E",-.,$E5""C"'#,5$'E"2,.5-C,$,(-a,-.,QT<Re,#-,$,7+E7,-.,IMMe3,a+#7,$,C"$',
K"5B"'#,$E5""C"'#,-.,XX<Ne,PC-*#,B$#"E-5+"*,7$2,IMMe,$E5""C"'#S<,47"*",B-"..+B+"'#*,
+'2+B$#"2,9"5),E--2,$E5""C"'#,0"#a""',#7",B-2"5*<,,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
10
X4452*%V#Y5%XZ*,&2*#+'%&'7%@&02)0&*#+'%
47",*#$'2$52+;"2,C"$',2+.."5"'B",*#$#+*#+B,P+<"<3,#7",2+.."5"'B",+',#5"$#C"'#,$'2,
B-'#5-(,C"$'*,2+9+2"2,0),#7",K--("2,*#$'2$52,2"9+$#+-'S,a$*,=*"2,$*,#7",".."B#,*+;",
+'2+B$#-5,PD$5(*-',F,AB7C+2#3,IXXXf,:+K*"),F,/+(*-'3,@MMIS<,1"B$=*",#7+*,".."B#,*+;",+'2"^,
7$*,0""',*7-a',#-,0",=Ka$52(),0+$*"2,a7"',0$*"2,=K-',*C$((,*$CK(",*+;"*,P6"2E"*,F,
h(\+'3,IXQRS3,#7",5"B-CC"'2"2,*#$#+*#+B$(,B-55"B#+-',.-5,#7+*,0+$*,a$*,$KK(+"2,P:+K*"),F,
/+(*-'3,@MMIS<,j.."B#,*+;"*,a"5",B$(B=($#"2,.5-C,2$#$,5"K-5#"2,+',#7",$5#+B("*,P"<E<3,*%#"*#3,
*=CC$5),*#$#+*#+B*S,=*+'E,$KK5-K5+$#",.-5C=($*,P:+K*"),F,/+(*-'3,@MMIf,`-*"'#7$(3,IXXIS<,
&2Y=*#"2,*#$#+*#+B*,a"5",=*"2,+',B$(B=($#+'E,".."B#,*+;"*,#-,"'*=5",#7$#,$'),0$*"(+'",
2+.."5"'B"*,+',E5-=K*,a"5",#$\"',+'#-,$BB-='#<,/7"',$2Y=*#"2,*#$#+*#+B*,a"5",'-#,5"K-5#"23,
0=#,0$*"(+'",2$#$,a"5",$9$+($0("3,a",$2Y=*#"2,.-5,0$*"(+'",2+.."5"'B"*,+',B-CK=#+'E,".."B#,
*+;"*<,,
8',C-*#,B$*"*3,-'(),-'",B-CK$5+*-',B-'2+#+-',"^+*#"2,$'2,a$*,=*"2,a7"',
B-CK=#+'E,".."B#,*+;","*#+C$#"*<,8',$,."a,B$*"*3,0-#7,'-,#5"$#C"'#,B-'#5-(,$'2,'-'%#$+(-5"2,
a"0*+#",B-'#5-(,B-'2+#+-'*,"^+*#"2<,A+'B",#7",E-$(,-.,#7",*#=2),a$*,#-,"^$C+'",#7",5"($#+9",
+CK$B#,-.,*&#0+,57%K5-E5$C*3,+',#7"*",B$*"*,#7",'-'%#$+(-5"2,B-'2+#+-',a$*,B7-*"',P-9"5,#7",
'-%#5"$#C"'#,B-'#5-(,B-'2+#+-'S<,&22+#+-'$(()3,("**,#7$',7$(.,-.,#7",*#=2+"*,PQ,d,IXS,5"K-5#"2,
7$9+'E,B-(("B#"2,K-*##"*#,2$#$,-'()<,>-*##"*#,$'2,K-*##"*#+'E,5"."5,#-,#7",$2C+'+*#5$#+-',-.,
2"K"'2"'#,C"$*=5"*,B(-*"(),$.#"5,#7",#"5C+'$#+-',-.,#5"$#C"'#<,8',#7-*",B$*"*3,".."B#,*+;"*,
a"5",B-CK=#"2,.5-C,#7$#,*+'E(",#+C",K-+'#<,47",-9"5$((,2$#$*"#,+'B(=2"2,JM,*#=2+"*3,a+#7,
"$B7,*#=2),K5"*"'#+'E,2$#$,.-5,#7",K-*##"*#+'E,K7$*",$#,$,C+'+C=C<,47",-#7"5,*"#,-.,*#=2+"*,
PQ,d,@IS,5"K-5#"2,7$9+'E,B-(("B#"2,2$#$,.5-C,-'",-5,C-5",.-((-a%=K,K"5+-2*,$.#"5,
K-*##"*#+'E<,8',-52"5,#-,C$^+C+;",#7",=*",-.,#7",2$#$,5"K-5#"23,$,*"B-'2,2$#$*"#,a$*,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
11
B5"$#"2,P=*+'E,#7"*",@I,*#=2+"*S,$'2,a",B-2"2,#7",(-'E"*#,.-((-a%=K,#+C",K-+'#,#7$#,a$*,
5"K-5#"2<,8',#7+*,a$)3,a",a"5",$0(",#-,$**"**,#7",+CK$B#,-.,#$+(-5"2,K5-E5$C*,$#,K-*##"*#+'E,
$'2,$#,$,(-'E"5%#"5C,.-((-a%=K,K7$*"<,6"5"$.#"53,.-5,B($5+#)3,a",a+((,5"."5,#-,#7"*",#a-,
2$#$*"#*,$*,#7-*","^$C+'+'E,3+$**5$*#'/,$'2,4+00+6S)3,".."B#*3,5"*K"B#+9"()<,
G=5#7"53,E+9"',#7$#,-'(),-'",".."B#,*+;",K"5,-=#B-C",B-=(2,0",+'B(=2"2,+',#7",C"#$%
$'$()*+*3,a7"',$5#+B("*,5"K-5#"2,#a-,*+C+($5,-=#B-C",C"$*=5"*,P"<E<3,#a-,2+.."5"'#,
C"$*=5"*,-.,2+"#$5),B7$'E"S3,".."B#,*+;"*,a"5",B$(B=($#"2,.-5,0-#7,$'2,*=0*"c="'#()3,
$9"5$E"2,#-E"#7"5<,A+C+($5()3,a7"',$5#+B("*,5"K-5#"2,-=#B-C"*,-',C=(#+K(",7"$(#7,
0"7$9+-5*3,".."B#,*+;"*,a"5",B$(B=($#"2,.-5,"$B7,0"7$9+-5,$'2,#7"',$9"5$E"2,#-E"#7"5<,8',
$22+#+-'3,+',-52"5,#-,\""K,".."B#,*+;"*,B-'*+*#"'#,$'2,+'#"5K5"#$0("3,$((,*#=2+"*,+',a7+B7,#7",
#$+(-5"2,B-'2+#+-',-=#K"5.-5C"2,#7",B-CK$5+*-',B-'2+#+-',a"5",E+9"',$,K-*+#+9",*+E',PqS3,
a7"5"$*,$,'"E$#+9",*+E',P%S,+'2+B$#"2,#7$#,#7",5"9"5*",-.,#7+*,a$*,#5="<,,
15*&S('&0G*#2%(33,+&2"%
j.."B#,*+;"*,a"5",a"+E7#"2,0),#7"+5,+'9"5*",9$5+$'B",$'2,B-C0+'"2,=*+'E,*#$'2$52,
.+^"2,".."B#*,C"#$%$'$()#+B,K5-B"2=5"*,P:+K*"),F,/+(*-'3,@MMIS<,47",[,*#$#+*#+B,a$*,=*"2,#-,
"^$C+'",a7"#7"5,*+E'+.+B$'#,7"#"5-E"'"+#),-0#$+'"2,$C-'E,#7",".."B#,*+;"*<,j.."B#,*+;"*,.-5,
7)K-#7"*+;"2,B$#"E-5+B$(,C-2"5$#-5*,a"5",B$(B=($#"2,$(-'E,a+#7,#7"+5,XRe,B-'.+2"'B",
+'#"59$(*3,$'2,#7-*",".."B#,*+;"*,a"5",*#$#+*#+B$((),B-CK$5"2,=*+'E,#7"%[=%%*#$#+*#+B<,
&22+#+-'$(()3,+',#7",B$*",-.,B-'#+'=-=*,P+<"<3,+'#"59$(%("9"(S,C-2"5$#-5,9$5+$0("*3,
B-55"($#+-'*,a"5",B$(B=($#"2,0"#a""',K$5#+B=($5,C-2"5$#-5,9$5+$0("*,$'2,".."B#,*+;"*<,&((,
$'$()*"*,a"5",B-'2=B#"2,=*+'E,D-CK5"7"'*+9",!"#$%&'$()*+*,*-.#a$5"3,["5*+-',@<@<MJN3,
$'2,A>AA,["5*+-',IT<,
, ,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
12
`jAH:4A,
47",Q,d,JM,*#=2+"*,+'B(=2"2,+',#7",C"#$%$'$()*+*,7$2,$,B=C=($#+9",O,d,@M3IQM,
PC"2+$',O,K"5,*#=2),d,IXNf,5$'E",O,d,L3JTTS3,$'2,a"5",K=0(+*7"2,.5-C,W$'=$5),IXXX,#-,
?"B"C0"5,@MMX3,a+#7,$,C"2+$',K=0(+B$#+-',)"$5,-.,@MMN<,4$0("*,@,$'2,L,K5-9+2",
*=CC$5+"*,-.,#7","(+E+0(",*#=2+"*<,47+5#)%.+9",*#=2+"*,PQQeS,+'B(=2"2,B-C0+'"2,
C$("b."C$(",*$CK("*3,a7"5"$*,#7",5"C$+'+'E,*#=2+"*,.-B=*"2,-',."C$("*,-'(),PQ%d,R3,I@eS<,
&C-'E,#7",B-C0+'"2,C$("b."C$(",*#=2+"*3,#7",C"$',K5-K-5#+-',-.,."C$("*,a$*,NJe<,,
!"$',$E",$B5-**,#7",*#=2+"*,a$*,LJ<LN,PA?,d,IR<NXS<,G+'$(()3,Q,d,@@,*#=2+"*,PRReS,+'9-(9"2,
H<A<,*$CK("*3,a7"5"$*,Q,d,IQ,PJReS,+'9-(9"2,*$CK("*,.5-C,*"9"5$(,-#7"5,B-='#5+"*<,
n8VAj`4,4&1:jA,@,F,Lo,
!$Y-5+#),-.,#7",*#=2+"*,PQ,d,@X,f,TLeS,a"5",*+'E("%0"7$9+-5,*#=2+"*3,#7",5"C$+'2"5,
P@TeS,#$5E"#"2,C=(#+K(",0"7$9+-5*<,47",C-*#,.5"c="'#(),*#=2+"2,0"7$9+-5*,a"5",K7)*+B$(,
$B#+9+#),PJ@e,-.,$((,0"7$9+-5*S3,.-((-a"2,0),'=#5+#+-'b2+"#,P@ReS3,$'2,*C-\+'Eb#-0$BB-,
PIQeS<,6-a"9"53,C$'),-.,#7"*",0"7$9+-5*,a"5",*#=2+"2,+',#7",B-'#"^#,-.,C=(#+K(",0"7$9+-5,
+'#"59"'#+-'*<,G-5,"^$CK("3,-.,#7",@L,*#=2+"*,#7$#,+'B(=2"2,K7)*+B$(,$B#+9+#),$*,$,.-B=*3,
IIb@L,PJTeS,a"5",*+'E("%0"7$9+-5,*#=2+"*,.-B=*+'E,-'(),-',K7)*+B$(,$B#+9+#)<,47",
5"C$+'2"5,"^$C+'"2,K7)*+B$(,$B#+9+#),K(=*,-#7"5,7"$(#7,0"7$9+-5*<,,
G+'$(()3,Q,d,IQ,*#=2+"*,PJReS,5"K-5#"2,'-,"^K(+B+#,#7"-5),E=+2+'E,#7",+'#"59"'#+-',
"..-5#<,47",5"C$+'+'E,@@,*#=2+"*,"$B7,5"K-5#"2,-'",-5,C-5",#7"-5+"*,=*"2,#-,E=+2",#7",
+'#"59"'#+-'<,47",C-*#,B-CC-',#7"-5+"*,=*"2,a"5"O,45$'*#7"-5"#+B$(,!-2"(3,A-B+$(,
D-E'+#+9",47"-5)3,$'2,#7",6"$(#7,1"(+".,!-2"(<,h#7"5,#7"-5+"*,=*"23,0=#,C=B7,("**,-.#"'3,
a"5"O,47"-5),-.,`"$*-'"2,&B#+-'3,47"-5),-.,>($''"2,1"7$9+-53,>5"B$=#+-',&2-K#+-',
>5-B"**,!-2"(3,$'2,A-B+$(,D-CK$5+*-',47"-5),P*"",4$0(",LS<,,
% %
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
13
X44#2&2G%+4%R'*5,85'*#+'$%%
47",.+5*#,c="*#+-',"^$C+'"2,a$*,#7",-9"5$((,C$E'+#=2",-.,".."B#<,,47",a"+E7#"2,
C"$',".."B#,*+;",.-5,#7",K-*##"*#,".."B#*,-.,+'#"59"'#+-'*,a$*,7%d,<ILX,PXRe,D-'.+2"'B",
8'#"59$(,nD8od,<III3,<INN3,3P<MMI3,Q,d,JMS<,47=*3,#$+(-5"23,a"0%0$*"2,+'#"59"'#+-'*,7$2,$,
*+E'+.+B$'#(),E5"$#"5,+CK$B#,-',7"$(#7,0"7$9+-5,-=#B-C"*,#7$',#7",B-CK$5+*-'bB-'#5-(,
B-'2+#+-'*,P*"",G+E=5",@S<,,
n8VAj`4,G8]H`j,@o,
/",#7"',B$(B=($#"2,#7",$9"5$E",".."B#,*+;",.-5,@I,*#=2+"*,a+#7,.-((-a%=K,
$2C+'+*#5$#+-'*,-.,#7",2"K"'2"'#,C"$*=5"*<,47",a"+E7#"2,C"$',".."B#,*+;",-.,*#=2+"*,
B-CK$5+'E,#7",.-((-a%=K,".."B#*,-.,#$+(-5"2,9"5*=*,'-'%#$+(-5"2,a"0%0$*"2,+'#"59"'#+-'*,
a$*,7%d,<IRQ,PXRe,D8,d,<I@J3,<IX@3,3P<MMI3,Q,d,@IS<,6"'B"3,#7",2+.."5"'#+$(,K-*+#+9",".."B#*,-.,
#$+(-5"2,a"0%0$*"2,9"5*=*,'-'%#$+(-5"2,a"0%0$*"2,+'#"59"'#+-'*,a"5",C$+'#$+'"2,-9"5,#7",
(-'E"5,#"5C3,a+#7,'-,-0*"59$0(",2"B$),+',".."B#*,-9"5,#+C",P*"",G+E=5",LS<,4-,"'*=5",#7$#,
#7"*",*+C+($5,".."B#,*+;"*,a"5",'-#,2=",#-,#7",2+.."5"'#+$(,C$\"%=K,-.,*#=2+"*,+',#7",#a-,
*"K$5$#",$'$()*"*,PJM,*#=2+"*,9"5*=*,@I,*#=2+"*S3,a","^$C+'"2,#7",+CC"2+$#",K-*##"*#,
".."B#*,-.,#7",@I,*#=2+"*<,47",C"$',".."B#,*+;",a$*,.-='2,#-,0"3,7%d,<ILR,PXRe,D8,d,<IMM3,
<INX3,3P<MMI3,Q,d,@IS3,$,9$(=",$(C-*#,+2"'#+B$(,#-,#7",7,d,<ILX,5"K-5#"2,$0-9"<,,
,n8VAj`4,G8]H`j,Lo,
8',-52"5,#-,"^$C+'",#7",K-**+0+(+#),-.,K=0(+B$#+-',0+$*3,.$+(%*$.",V,9$(="*,a"5",
B$(B=($#"2,$'2,#7",#5+C,$'2,.+((,K5-B"2=5",a$*,$KK(+"2,P:+K*"),F,/+(*-'3,@MMIS<,h5a+'p*,
PIXQLS,C"#7-2,#-,B$(B=($#",.$+(%*$.",V,+'2+B$#"2,#7$#,TI,*#=2+"*,a+#7,'-'%*+E'+.+B$'#,
.+'2+'E*,a-=(2,'""2,#-,"^+*#,#-,5"2=B",#7",2,d,<ILX,K-*##"*#,".."B#,#-,$,#5+9+$(,".."B#,-.,2,d,
<MR3,a7+(",JN,'-'%*+E'+.+B$'#,*#=2+"*,a-=(2,'""2,#-,"^+*#,#-,5"2=B",#7",2,d,<IRQ,.-((-a%=K,
".."B#,#-,$,#5+9+$(,".."B#,-.,2,d,<MR<,G=''"(,K(-#*,-.,#7"*",".."B#*,a"5",$(*-,"^$C+'"2<,A=B7,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
14
K(-#*,a"5",.-='2,#-,0",c=+#",*)CC"#5+B$(,$'2,#7",#5+C,$'2,.+((,$'$()*+*,*=EE"*#"2,'-,
$2Y=*#C"'#,#-,#7"*",C"$',".."B#,*+;"*,P?=9$(,F,4a""2+"3,@MMMS<,47"*",5"*=(#*,+'2+B$#",'-,
"9+2"'B",-.,K=0(+B$#+-',0+$*,$C-'E,#7",B=55"'#,*"#,-.,*#=2+"*<,
V"^#3,7"#"5-E"'"+#),-.,#7",a"+E7#"2,C"$',".."B#,*+;"*,a$*,"^$C+'"2<,A#$#+*#+B$(,
#"*#+'E,+'2+B$#"2,*+E'+.+B$'#,7"#"5-E"'"+#),$#,K-*##"*#+'E,P[E\,d,INQ<ML3,3P<MMI3,RB,d,TN<TXS3,
$*,a"((,$*,$#,.-((-a%=K,P[BC,d,TN<MX3,3P<MMI3,RB,d,TL<T@S3,*=EE"*#+'E,#7",K5"*"'B",-.,
C-2"5$#-5,9$5+$0("*<,47",'"^#,*"#,-.,$'$()*"*,"^K(-5"2,#7",+'.(="'B",-.,#7",&%3,#+,#,
2"#"5C+'"2,C-2"5$#-5*,-',B7$'E"*,+',7"$(#7,0"7$9+-5,-=#B-C"*<,1"B$=*",#7",K-*##"*#,
".."B#*,2$#$*"#,+'B(=2"2,$((,JM,*#=2+"*3,#7"*",2$#$,a"5",=*"2,+',#7",C-2"5$#-5,$'$()*"*,
0"(-a,P"^B"K#,+',-'",B$*",$*,'-#"2,0"(-aS<,
1+75,&*+,%!5$*#'/%
K&,*#2#3&'*TU5$2,#3*#85%9+75,&*+,$J,>$5#+B+K$'#b2"*B5+K#+9",C-2"5$#-5*,a"5",
E"'2"5,PK5-K-5#+-',-.,."C$("*,+',#7",*$CK("*S3,$E"3,#$5E"#,K-K=($#+-'3,B-='#5),$'2,7"$(#7,
0"7$9+-5<,47",B-55"($#+-',0"#a""',E"'2"5,PK5-K-5#+-',."C$("S,$'2,".."B#,*+;",a$*,,,PLXS,d,%
<@X3,3d<IM3,a7"5"$*,#7",B-55"($#+-',0"#a""',$E",$'2,".."B#,*+;",a$*,,,PLRS,d,%<MR3,3d<QM<,47+*,
+'2+B$#"2,#7$#,'"+#7"5,-.,#7"*",K$5#+B+K$'#,9$5+$0("*,a$*,*+E'+.+B$'#(),$**-B+$#"2,a+#7,
+'#"59"'#+-',-=#B-C"*<,`"*=(#*,-.,#7",5"C$+'+'E,C-2"5$#-5,$'$()*"*,+'2+B$#"2,#7$#,
+'#"59"'#+-'*,7$2,*+E'+.+B$'#(),E5"$#"5,".."B#*,a7"',.-B=*"2,-',E"'"5$(,K-K=($#+-',E5-=K*,
P5"."55+'E,#-,+'2+9+2=$(*,'-#,*B5""'"2,.-5,$'),K$5#+B=($5,B75-'+B,+(('"**,-5,-#7"5,2+*"$*",
.$B#-5S,$'2,a7"',.-B=*"2,-',H<A<,*$CK("*,P9"5*=*,'-'%H<A<,*$CK("*S,P0-#7,3r<MRS,P*"",
4$0(",JS<,V-,*+E'+.+B$'#,2+.."5"'B"*,a"5",.-='2,a7"',B-CK$5+'E,C+^"2,#-,."C$("%-'(),
*$CK("*3,*+'E(",9"5*=*,C=(#+K(",0"7$9+-5,+'#"59"'#+-'*3,$'2,a7"',B-CK$5+'E,7"$(#7,
0"7$9+-5*,#$5E"#"2,0),#7",+'#"59"'#+-',P3s<MRS<,
n8VAj`4,4&1:j,Jo,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
15
R'*5,85'*#+'%9+75,&*+,$J%8'#"59"'#+-',C-2"5$#-5*,.-B=*"2,-',.5"c="'B),-.,#$+(-5+'E,
$**"**C"'#,$'2,=*"5,B-'#5-(,P*"",4$0(",RS<,/","9$(=$#"2,a7"#7"5,B-'2=B#+'E,#7",#$+(-5+'E,
$**"**C"'#,$#,0$*"(+'",-'(),-5,C=(#+K(",#+C"*,#75-=E7-=#,#7",+'#"59"'#+-',a$*,5"($#"2,#-,
"..+B$B)<,A+'B",#7+*,*#5$#"E),B$',-'(),7$9",$',+CK$B#,-9"5,#+C"3,a",=*"2,#7",Vd@I,.-((-a%=K,
2$#$,.-5,#7+*,K$5#+B=($5,$'$()*+*<,`"*=(#*,2"C-'*#5$#"2,'-,*+E'+.+B$'#,2+.."5"'B",$C-'E,
*#=2+"*,#7$#,$2C+'+*#"5"2,C=(#+K(",$**"**C"'#*,-9"5,#7",B-=5*",-.,#7",+'#"59"'#+-',#-,
B5"$#",#$+(-5"2,C"**$E"*,P'WIMS,B-CK$5"2,#-,#7-*",#7$#,"CK(-)"2,$,*+'E(",#$+(-5+'E,
$**"**C"'#,$#,0$*"(+'",P'WIIS<,&22+#+-'$(()3,a","^$C+'"2,a7"#7"5,#7",$C-='#,-.,=*"5,
B-'#5-(,P"<E<3,a7"#7"5,#7",#$+(-5"2,+'#"59"'#+-',+'9-(9"2,*=0*#$'#+$(,"^K"5#,E=+2$'B",-5,a$*,
($5E"(),*"(.%E=+2"2S,+'.(="'B"2,-=#B-C"*3,0=#,-=5,$'$()*"*,5"9"$("2,'-,*+E'+.+B$'#,
2+.."5"'B"*,P3s<MRS,P*"",4$0(",RS<,
n8VAj`4,4&1:j,Ro,
15*"+7+0+/#2&0%9+75,&*+,$J%!"#7-2-(-E+B$(,C-2"5$#-5*,a"5",*#=2),2"*+E'3,#)K",-.,
B-CK$5+*-',B-'2+#+-'3,("'E#7,-.,.-((-a%=K3,$'2,*#=2),5"#"'#+-',P*"",4$0(",NS<,h=5,$'$()*+*,
*7-a"2,#7$#,5$'2-C+;"2,B-'#5-(("2,#5+$(*,-0#$+'"2,*+E'+.+B$'#(),E5"$#"5,".."B#,*+;"*,P7%W%<IN3,
3P<MMI3,Q,d,LIS,#7$',c=$*+%"^K"5+C"'#$(,2"*+E'*,P7%d,<MT3,3P<MR3,Q,d,XS<,/+#7,5"E$52,#-,
B-CK$5+*-',B-'2+#+-'3,C-*#,*#=2+"*,=*"2,"+#7"5,$,'-'%#$+(-5"2,a"0*+#",PQdIQS,-5,$,'-,
#5"$#C"'#,B-'#5-(,PQdIQS,B-CK$5+*-'<,G-=5,*#=2+"*,B-CK$5"2,#$+(-5"2,a"0*+#"*,#-,'-'%
#$+(-5"2,K5+'#,C$#"5+$(*<,&'$()*+*,-.,B-CK$5+*-',B-'2+#+-'*,5"9"$("2,#7$#,#$+(-5"2,a"0*+#"*,
*+E'+.+B$'#(),-=#K"5.-5C"2,'-'%#$+(-5"2,a"0*+#"*,-',7"$(#7,0"7$9+-5,-=#B-C"*,P7%W%<IQQ3,
3P<MMIS<,A#=2+"*,#7$#,B-CK$5"2,#$+(-5"2,a"0*+#"*,#-,'-%#5"$#C"'#,B-'#5-(,B-'2+#+-'*,
$B7+"9"2,*+E'+.+B$'#(),*C$(("5,".."B#,*+;"*3,7%W%<MT3,3P<MI3,$*,2+2,*#=2+"*,#7$#,B-CK$5"2,
#$+(-5"2,a"0*+#"*,#-,'-'%#$+(-5"2,K5+'#,C$#"5+$(*3,7,d,<MQ3,3,d,<LR3,Q,d,J,P*"",4$0(",NS<,&(*-3,
#7",B-55"($#+-',0"#a""',.-((-a%=K,#+C",K-+'#,$'2,".."B#,*+;",a$*,,,PLXS,d,<MMJ3,3d<XQ3,.-5,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
16
K-*##"*#,".."B#*3,$'2,,,P@MS,d,%<ITN3,3d<RM3,.-5,.-((-a%=K,".."B#*<,47+*,*=EE"*#*,#7$#,("'E#7,-.,
.-((-a%=K,2+2,'-#,*+E'+.+B$'#(),+'.(="'B",+'#"59"'#+-',-=#B-C"*<,47",B-55"($#+-',0"#a""',
*#=2),5"#"'#+-',$'2,".."B#,*+;",a$*,,,PLXS,d,<MIT3,3d<X@3,+'2+B$#+'E,#7$#,5"#"'#+-',2+2,'-#,
+'.(="'B",*#=2),-=#B-C"*<,,
n8VAj`4,4&1:j,No,
?8ADHAA8hV,
D-CK$5"2,#-,*+'E("%C-2",#$+(-5"2,+'#"59"'#+-'*3,a"0%0$*"2,#$+(-5"2,+'#"59"'#+-'*,
C$),+'B(=2",-#7"5,C-2$(+#+"*,P+<"<3,9+2"-3,$=2+-3,2+*B=**+-',.-5=C*3,B7$#3,"#B<S,#7$#,K5-9+2",
E5"$#"5,+'#"5$B#+9+#),$'2,2+.."5"'#,\'-a("2E"3,*\+((*,0=+(2+'E3,$'2,*"(.%C$'$E"C"'#,#--(*,
P"<E<3,0(--2,E(=B-*",C-'+#-5+'E,#--(*f,"("B#5-'+B,Y-=5'$(+'E3,"#B<S<,47",C=(#+%C-2$(,$'2,
+'#"5$B#+9",'$#=5",-.,a"0%0$*"2,#$+(-5"2,+'#"59"'#+-'*,C$),+CK5-9",#7"+5,".."B#+9"'"**,0),
"'7$'B+'E,K$#+"'#,K$5#+B+K$#+-',$'2,"'E$E"C"'#3,0=#,#7",B-'.(="'B",-.,C-2$(+#+"*,$'2,
."$#=5"*,C$\"*,+#,2+..+B=(#,#-,#"$*",-=#,#7",2+.."5"'#+$(,".."B#*,-.,#7"*",B-CK-'"'#*,-',
+'#"59"'#+-',"..+B$B)<,
47+*,C"#$%$'$()*+*,+*,#7",.+5*#,#-,"^K(-5",#7","..+B$B),-.,B-CK=#"5%#$+(-5"23,a"0%
0$*"2,7"$(#7,0"7$9+-5,B7$'E",+'#"59"'#+-'*,$B5-**,$,a+2",5$'E",-.,7"$(#7,.-B+<,,8',
K$5#+B=($53,a","^$C+'"2,#7","..+B$B),-.,#$+(-5"23,a"0%0$*"2,$KK5-$B7"*,-',7"$(#7,0"7$9+-5,
-=#B-C"*,$'2,"^K(-5"2,C-2"5$#-5*,-.,+'#"59"'#+-',"..+B$B)<,47+*,$'$()*+*,-.,JM,*#=2+"*,
PB=C=($#+9",O,d,@M3IQMS,5"9"$("2,#7$#,#7"*",+'#"59"'#+-'*,+CK$B#"2,7"$(#7,0"7$9+-5,
-=#B-C"*,$#,K-*##"*#+'E,Pa"+E7#"2,C"$',".."B#,*+;",-.,7,d,<ILXS<,,&'$()*+*,-.,.-((-a%=K,
".."B#*,-.,#$+(-5"2,+'#"59"'#+-'*,a$*,$(*-,K5-C+*+'E,P".."B#,*+;","*#+C$#",-.,7,d,<IRQS<,
&(#7-=E7,C$+'#"'$'B",-.,0"7$9+-5,B7$'E",7$*,(-'E,0""',$,C$Y-5,B7$(("'E",.-5,7"$(#7,
B-CC='+B$#+-',K5-E5$C*,P`-#7C$'3,@MMMS3,#7",5"*=(#*,+'2+B$#"2,#7$#,#$+(-5"2,
+'#"59"'#+-'*,C$),7"(K,+'2+9+2=$(*,C$+'#$+',B7$'E"*,-9"5,#+C"<,&,='+c=",$29$'#$E",-.,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
17
a"0%0$*"2,2"(+9"5),+*,#7",B$K$B+#),#-,#$+(-5,+'#"59"'#+-'*,#-,#$5E"#,K-K=($#+-',
B7$5$B#"5+*#+B*,P"<E<3,*K"B+.+B,5+*\,.$B#-5*S<,D-CK$5"2,#-,+'#"59"'#+-'*,5"c=+5+'E,.$B"%#-%.$B",
B-'#$B#,a+#7,#7",7"$(#7B$5",K5-9+2"53,#$+(-5"2,a"0%0$*"2,K5-E5$C*,C$),.$B+(+#$#",a+2"5,
$BB"**,$'2,"'B-=5$E",*"(.%B$5"3,a7+B7,C$),+CK5-9","..+B$B),$'2,C$+'#"'$'B",-.,E$+'*,-9"5,
#+C"<,47+*,B$',0"'".+#,+'2+9+2=$(*,a7-,(+9",+',5=5$(,$5"$*3,$5","B-'-C+B$((),2+*$29$'#$E"23,
-5,7$9",*+E'+.+B$'#,C-0+(+#),+CK$+5C"'#*<,4-,#7+*,K-+'#3,6"$(#7),>"-K(",@M@M,PH<A<,
?"K$5#C"'#,-.,6"$(#7,$'2,6=C$',A"59+B"*3,@MIIS,*#5-'E(),"'2-5*"*,#7",a+2"*K5"$2,
2"K(-)C"'#,-.,+'#"5$B#+9"3,B-CC='+B$#+-',#"B7'-(-E+"*,E"$5"2,#-a$52*,C$\+'E,7"$(#7,
"2=B$#+-',$'2,*"59+B"*,C-5",$BB"**+0(",#-,$'2,"'E$E+'E,.-5,#7",K=0(+B<,
1+75,&*+,$%+4%X44#2&2G%
/",$(*-,"^$C+'"2,#7",".."B#*,-.,$,*"#,-.,K$5#+B+K$'#b2"*B5+K#+9"3,+'#"59"'#+-'3,$'2,
C"#7-2-(-E+B$(,C-2"5$#-5*,-',+'#"59"'#+-',"..+B$B)<,G5-C,#7",9+"aK-+'#,-.,0=+(2+'E,$,
B=C=($#+9",*B+"'B",-.,#$+(-5+'E3,*=B7,$'$()*"*,$5",B5+#+B$(,+',$29$'B+'E,#7",.+"(2p*,
='2"5*#$'2+'E,-.,7-a,#$+(-5+'E,"^"5#*,+#*,".."B#*,P6$a\+'*3,"#,$(<3,@MMQf,V-$53,"#,$(<3,@MMXS<,,
`"*=(#*,+'2+B$#"2,#7$#,#$+(-5"23,a"0%0$*"2,+'#"59"'#+-'*,7$9",0""',C-*#,*=BB"**.=(,
a7"',#$5E"#+'E,E"'"5$(,K-K=($#+-'*,B-CK$5"2,#-,*K"B+.+B,K$#+"'#,E5-=K*,P"<E<3,B75-'+B$((),+((,
K$#+"'#*,-5,C+'-5*S<,8'#"59"'#+-'*,#$5E"#+'E,E"'"5$(,7"$(#7,B-'*=C"5*,a"5",($5E"(),
K5"9"'#+9",+','$#=5",$'2,2+2,'-#,5"c=+5",*=KK-5#,.-5,B-CK("^,#$*\*,+'9-(9"2,+',C$'$E+'E,
B75-'+B,B-'2+#+-'*<,47"*",.+'2+'E*,2-,'-#,'"B"**$5+(),+CK(),#7$#,a"0%0$*"2,#$+(-5"2,
$KK5-$B7"*,a-=(2,0",("**,".."B#+9",.-5,B75-'+B$((),+((,K$#+"'#*<,`$#7"53,#7"*",.+'2+'E*,C$),
+'2+B$#",#7$#,#7"*",K$#+"'#*,C$),*=.."5,.5-C,$,7-*#,-.,B-'2+#+-'*,#7$#,B$',C$\",+#,K7)*+B$(()3,
"C-#+-'$((),$'2,C"'#$((),2+..+B=(#,#-,.=((),"'E$E",+',#7"*",+'#"59"'#+-'*,P"<E<3,9+*+-',-5,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
18
C-0+(",+CK$+5C"'#*,B$',$.."B#,#7",$0+(+#),#-,B-CK=#"5,"c=+KC"'#S<,,&*,*=B73,#7"*",
(+C+#$#+-'*,C=*#,0",B-'*+2"5"2,a7"',2"*+E'+'E,a"0%0$*"2,+'#"59"'#+-'*,.-5,#7"*",E5-=K*<,
47+*,*#=2),$(*-,.-='2,#7$#,a"0%0$*"2,#$+(-5"2,+'#"59"'#+-'*,B-'2=B#"2,+',H<A<,
*"##+'E*,#"'2"2,#-,0",C-5",*=BB"**.=(,B-CK$5"2,#-,#7-*",($='B7"2,"(*"a7"5"<,1"(+".*,$0-=#,
7"$(#73,2+*"$*",$'2,#5"$#C"'#,7$9",0""',.-='2,#-,2+9"5E",$B5-**,5$B+$(,$'2,"#7'+B,C+'-5+#),
E5-=K*,PD7"'E,"#,$(<3,@MIMf,]5-"'"9"(23,A-''$23,:""3,&*B73,F,A7"$3,@MMNf,W"$'%>+"55","#,$(<3,
@MIMf,V-"(3,@MIMf,A7+5"3,@MM@S<,`"*"$5B7,7$*,*7-a',#7$#,+'2+9+2=$(+*C%B-(("B#+9+*C3,+',
$22+#+-',#-,-#7"5,B=(#=5$(%5"($#"2,B-'*#5=B#*,P+<"<3,7"$(#7,(-B=*,-.,B-'#5-(,-5,0"(+".,+',a7-,
=(#+C$#"(),7$*,5"*K-'*+0+(+#),.-5,-'"p*,7"$(#7S3,K($),$',+CK-5#$'#,5-(",+',$',+'2+9+2=$(p*,
7"$(#7,2"B+*+-'%C$\+'E,$'2,7"$(#7,0"7$9+-5*,$'2,7$*,0""',.-='2,#-,"^K($+',*-C",$C-='#,
-.,9$5+$'B",+',K5"."5"'B"*,.-5,7"$(#7,C"**$E+'E,P?=##$3,@MMTS<,,,
47"5",+*,$(*-,(+C+#"2,"9+2"'B",5"E$52+'E,7-a,B=(#=5$(,2+.."5"'B"*,C+E7#,+'.(="'B",
#7",&2253*&'25,-.,#$+(-5"2,$KK5-$B7"*<,?$9+*,P@MMQS,B-CK$5"2,#7",5"$B#+-'*,-.,&C"5+B$',
P5"K5"*"'#+'E,+'2+9+2=$(+*#+B,B=(#=5"*S,$'2,W$K$'"*",P5"K5"*"'#+'E,B-(("B#+9+*#+B,B=(#=5"*S,
+'2+9+2=$(*,#-,B=(#=5$(()%#$+(-5"2,C"**$E"*<,47",*#=2),.-='2,*+E'+.+B$'#,2+.."5"'B"*,
0"#a""',B=(#=5$(,-5+"'#$#+-'*,+',#"5C*,-.,5"K-5#"2,"'E$E"C"'#3,K"5B"+9"2,$##5$B#+9"'"**,
$'2,'-9"(#),-.,#7",+'.-5C$#+-',K5"*"'#"2,+',#7",#$+(-5"2,B-'2+#+-'<,/7+(",W$K$'"*",
K$5#+B+K$'#*,a"5",C-5",(+\"(),#-,5"%5"$2,#7",#$+(-5"2,+'.-5C$#+-'3,#7"),a"5",05$$,(+\"(),#-,
.+'2,+#,=*".=(,#-,B7$'E",#7"+5,2+"#$5),0"7$9+-5*,B-CK$5"2,#-,#7-*",a7-,a"5",*7-a',#7",
E"'"5+B,C"**$E"*<,,
4=5'+'E,#-,-=#B-C",B5+#"5+$3,#7",5"*=(#*,+'2+B$#"2,#7$#,#$+(-5"2,a"0%0$*"2,
+'#"59"'#+-'*,#$5E"#+'E,$,*+'E(",7"$(#7,0"7$9+-5,a"5",'-#,*+E'+.+B$'#(),C-5","..+B$B+-=*,
#7$',#7-*",#$5E"#+'E,C=(#+K(",7"$(#7,0"7$9+-5*<,8#,+*,+CK-5#$'#,#-,'-#",#7$#,".."B#,*+;"*,-.,
+'#"59"'#+-'*,#$5E"#+'E,C=(#+K(",7"$(#7,0"7$9+-5*,a"5",B$(B=($#"2,0),$9"5$E+'E,$((,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
19
0"7$9+-5$(,-=#B-C"*,0"B$=*","$B7,*#=2),B-=(2,-'(),B-'#5+0=#",-'",".."B#,*+;",#-,#7",C"#$%
$'$()*+*<,47",($B\,-.,*+E'+.+B$'#,2+.."5"'B"*,*=EE"*#*,#7$#,#7",".."B#*,-.,a"0%0$*"2,
+'#"59"'#+-'*,C$),'-#,$##"'=$#",$B5-**,C=(#+K(",7"$(#7,0"7$9+-5,"'2K-+'#*<,47"*",.+'2+'E*,
$5",($5E"(),B-'*+*#"'#,a+#7,5"B"'#,5"*"$5B7,PZ5"0*3,"#,$(<3,@MIMf,>5-B7$*\$3,@MMQS<,,
`"E$52+'E,$'$()*"*,-.,#$+(-5+'E,*#5$#"E+"*3,.+'2+'E*,*7-a,#7$#,#7",.5"c="'B),-.,
#$+(-5+'E,$**"**C"'#*,2+2,'-#,*+E'+.+B$'#(),$.."B#,+'#"59"'#+-',"..+B$B)<,&,5"B"'#,C"#$%
$'$()*+*,"^$C+'+'E,(-'E%#"5C,".."B#*,-.,#$+(-5"2,+'#"59"'#+-'*,.-='2,#7$#,2)'$C+B,#$+(-5+'E,
+*,C-5","..+B$B+-=*,#7$',*#$#+B,#$+(-5+'E,.-5,$((,+'#"59"'#+-'*,"CK(-)+'E,"+#7"5,*+'E(",-5,
C=(#+K(",2"(+9"5),C-2"*,PZ5"0*3,"#,$(<3,@MIMS<,,/",.-='2,#7$#,*#=2+"*,"CK(-)+'E,$,*+'E(",
$**"**C"'#,a"5",*(+E7#(),C-5",".."B#+9",#7$',#7-*","CK(-)+'E,C=(#+K(",$**"**C"'#*,-9"5,
#+C"3,#7-=E7,'-#,*+E'+.+B$'#(),*-<,,,
HK-',B(-*"5,"^$C+'$#+-'3,C-*#,*#=2+"*,=*+'E,$,*+'E(",#$+(-5+'E,$**"**C"'#,a"5",
05+".3,#$5E"#"2,0"7$9+-5*3,*=B7,$*,("9"(*,-.,K7)*+B$(,$B#+9+#)3,.5=+#,$'2,9"E"#$0(",+'#$\"3,
*$#=5$#"2,.$#,+'#$\",$'2,$0*#+'"'B",.5-C,*C-\+'E,$'2,$(B-7-(,B-'*=CK#+-'3,$'2,a"5",
"9$(=$#"2,a+#7+',*7-5#"5,.-((-a%=K,K"5+-2*<,A#=2+"*,"CK(-)+'E,C=(#+K(",$'2,+#"5$#+9",
#$+(-5+'E,$**"**C"'#,a"5",#)K+B$((),(-'E"5,#"5C3,.-B=*"2,-',C-5",B-CK("^,B-'2+#+-'*,P+<"<3,
C$'$E"C"'#,-.,B75-'+B,2+*"$*"*,*=B7,$*,$*#7C$,$'2,$5#75+#+*S3,$'2,#)K+B$((),#$5E"#"2,"+#7"5,
K$#+"'#,-5,7+E7,5+*\,K-K=($#+-',E5-=K*,P"<E<3,"*#$0(+*7"2,*C-\"5*3,-0"*",$2=(#*3,2+$0"#+B*S<,
47+*,B-'.(="'B",-.,.$B#-5*,C$),7$9",C$2",+#,C-5",2+..+B=(#,#-,$B7+"9",+'#"59"'#+-',E-$(*,
$'2,#7=*3,+'$29"5#"'#(),$##"'=$#"2,#7",K-#"'#+$(,0"'".+#*,-.,C=(#+K(",#$+(-5+'E,$**"**C"'#*<,,
!-5"-9"53,+#,a$*,='B("$5,.5-C,C-*#,5"K-5#*,7-a,C=(#+K("3,+#"5$#+9",$**"**C"'#*,
a"5",$B#=$((),$2C+'+*#"5"2,$'2,7-a,#7"*",+'.-5C"2,#7",2"9"(-KC"'#,-.,#$+(-5"2,7"$(#7,
C"**$E"*<,4+C+'E,-.,l5"%$**"**C"'#m,C$),0",+CK-5#$'#,"*K"B+$((),+',B$*"*,a7"5",7"$(#7,
C"**$E"*,$5",#$+(-5"2,$BB-52+'E,#-,5"$2+'"**,#-,B7$'E"<,8',#7+*,B$*"3,#7",$**=CK#+-',+*,#7$#,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
20
#7",K$5#+B+K$'#,a+((,7$9",='2"5E-'",C"$'+'E.=(,B7$'E"*,0".-5",#7"),B$',0",5"%$**"**"2,
$'2,C-#+9$#"2,#-,C-9",-',#-,#7",'"^#,*#$E",-.,B7$'E"<,,
V"^#3,'-,*+E'+.+B$'#,2+.."5"'B"*,a"5",-0#$+'"2,a7"',B-CK$5+'E,".."B#,*+;"*,-.,*"(.%
E=+2"2,$'2,"^K"5#%E=+2"23,a"0%0$*"2,#$+(-5"2,+'#"59"'#+-'*<,A"(.%E=+2"2,+'#"59"'#+-'*,
5"c=+5",C-5",$B#+9","'E$E"C"'#,.5-C,K$5#+B+K$'#*,$'2,5"(),7"$9+(),-',#7",K$#+"'#,#-,
l25+9"m,#7"+5,K5-E5"**,#75-=E7,#7",7"$(#7,K5-E5$C<,j^K"5#%E=+2"2,+'#"59"'#+-'*3,-',#7",
-#7"5,7$'23,5"c=+5",E5"$#"5,+'9-(9"C"'#,.5-C,7"$(#7B$5",K5$B#+#+-'"5*,#-,2+5"B#,K$#+"'#*,
#75-=E7,#7",K5-E5$C,$'2,K5-9+2",C-5",+CC"2+$#",.""20$B\<,`"*=(#*,+'2+B$#"2,#7$#,a7+(",
$22+#+-'$(,.""20$B\,.5-C,"^K"5#*,B$',+CK5-9","..+B$B)3,+'#"59"'#+-'*,a+#7,("**,"^K"5#,+'K=#,
B$',0",Y=*#,$*,".."B#+9"<,47=*3,a"0%0$*"2,#$+(-5"2,$KK5-$B7"*,.-5,*"(.%C$'$E"C"'#,B$',0",
=*".=(,"9"',a7"',*=KK-5#,.5-C,7"$(#7B$5","^K"5#*,C$),'-#,0",5"$2+(),$9$+($0("<,
47",C-*#,B-CK"((+'E,.+'2+'E,7"5",+*,#7$#,#$+(-5"2,a"0*+#"*,a"5",*+E'+.+B$'#(),C-5",
".."B#+9",#7$','-'%#$+(-5"2,a"0*+#"*,+',$B7+"9+'E,0"7$9+-5$(,-=#B-C"*,P7%d,<IQQS<,47+*,
*=KK-5#*,"$5(+"5,C"#$%$'$()*"*,,#7$#,7$9",.-='2,#7$#,#$+(-5+'E,B$',0",$',".."B#+9",*#5$#"E),
.-5,7"$(#7,0"7$9+-5,B7$'E",PZ5"0*3,"#,$(<3,@MIMf,V-$53,"#,$(<3,@MMTf,>-5#'-)3,"#,$(<3,@MMQf,A-7(,
F,!-)"53,@MMTS<,47+*,+*,not%#-,*$),#7$#,$((,#$+(-5"2,a"0*+#"*,a+((,0",*+C+($5(),"..+B$B+-=*<,
47"5",+*,E5"$#,9$5+$0+(+#),+',7-a,#$+(-5+'E,a$*,B$55+"2,-=#<,47"5",a$*,*+E'+.+B$'#,
7"#"5-E"'"+#),$C-'E,#7+*,*"#,-.,*#=2+"*,0"B$=*",#7",a"0,$((-a*,.-5,$,9$5+"#),-.,."$#=5"*3,
$'2,.-5C$#*3,$'2,("9"(*,-.,+'#"5$B#+9+#)<,47+*,C$),7"(K,"^K($+',a7),*#=2+"*,B-CK$5+'E,
#$+(-5"2,a"0*+#"*,#-,'-,#5"$#C"'#,B-'#5-(,B-'2+#+-'*,"^7+0+#"2,*+E'+.+B$'#(),*C$(("5,
a"+E7#"2,C"$',".."B#,*+;"*,P7,d,<MTIS,#7$',#7-*",B-CK$5+'E,#$+(-5"2,#-,'-'%#$+(-5"2,
a"0*+#"*,P7,d,<IQQS<,47+*,+*,B-='#"5%+'#=+#+9"3,$*,-'",a-=(2,"^K"B#,#7",0&,/5$*%".."B#,#-,0",
"^7+0+#"2,a7"',$,#5+$(,B-CK$5"*,$',+'#"59"'#+-',#-,l'-#7+'Em,P+<"<3,'-,#5"$#C"'#,B-'#5-(S<,,
47+*,+*,(+\"(),#-,0",$,C"#7-2-(-E+B$(,$5#+.$B#,-.,#7"*",*#=2+"*<,,8#,+*,K-**+0(",#7$#,+',-52"5,#-,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
21
.$B+(+#$#",C-5",5+E-5-=*,#"*#+'E3,C-5",".."B#+9",C"**$E"*,a"5",E"'"5$#"2,+',*#=2+"*,
B-CK$5+'E,#$+(-5"2,$'2,'-'%#$+(-5"2,a"0*+#"*,#7$',#7-*",*#=2+"*,a+#7,-'(),'-,#5"$#C"'#,
B-'#5-(,E5-=K*<,h'",("**-',7"5",+*,#7$#,5"*"$5B7"5*,*7-=(2,'-#,#7+'\,-.,#$+(-5+'E,$*,$,lC$E+B,
0=(("#m,$'2,*7-=(2,.-((-a,$,B$5".=(,K5-B"**,-.,2"9"(-KC"'#,P"<E<3,Z5"=#"5,"#,$(<3,@MMMS,0$*"2,
-',B-CK5"7"'*+9",.-5C$#+9",a-5\<,
]#9#*&*#+'$%
h'",(+C+#$#+-',-.,#7",*#=2)3,a7+B7,+*,B-CC-',a7"',$**"**+'E,C-2"5$#-5*,+',C"#$%
$'$()*"*3,+*,#7$#,9$5+$0("*,C$),*-C"#+C"*,0",B-'.-='2"2,a+#7,-#7"5,9$5+$0("*,$'2,#7+*3,+',
#=5'3,C$),5"*=(#,+',B-='#"5%+'#=+#+9",.+'2+'E*,P:+K*")3,@MMLS<,V"9"5#7"("**3,+#,+*,B5+#+B$(,#7$#,
#$+(-5+'E,5"*"$5B7"5*,B-'#+'=",#-,"^$C+'",='2"5,a7$#,B+5B=C*#$'B"*,$'2,.-5,a7$#,
B-'2+#+-'*,a"0%0$*"2,#$+(-5"2,7"$(#7,0"7$9+-5,B7$'E",+'#"59"'#+-'*,B$',0",C-*#,".."B#+9"<,
47+*,B$',0",$B7+"9"2,#75-=E7,'"a,K5+C$5),*#=2+"*,$*,a"((,$*,C"#$%$'$()*"*<,47",E5-a+'E,
a"0%#$+(-5+'E,(+#"5$#=5",K5-9+2"*,$',-KK-5#='+#),#-,B-'2=B#,C"#$%5"E5"**+-',$'$()*+*3,
a7+B7,C$),0"##"5,B-'#5-(,.-5,l$5#+.$B#m,9$5+$0("*,$'2,7"(K,$29$'B",-=5,='2"5*#$'2+'E,-.,
C"B7$'+*C*,+',#$+(-5+'E<,,,
R930#2&*#+'$%&'7%I)*),5%U#,52*#+'$%
8',*=C3,#7+*,*#=2),K5-9+2"*,"9+2"'B",.-5,#7",-9"5$((,"..+B$B),-.,a"0%0$*"2,#$+(-5"2,
$KK5-$B7"*,.-5,0-#7,*7-5#,$'2,(-'E"5%#"5C,0"7$9+-5,B7$'E",+'#"59"'#+-'*,<,
/"0%0$*"2,#$+(-5"2,+'#"59"'#+-'*,#$5E"#+'E,E"'"5$(,K-K=($#+-',E5-=K*,a"5",
*+E'+.+B$'#(),C-5",".."B#+9",#7$',#7-*",#$5E"#+'E,*K"B+.+B,K$#+"'#,E5-=K*,-5,C+'-5*<,/"0%
0$*"2,#$+(-5"2,+'#"59"'#+-'*,+',#7",H<A<,a"5",.-='2,#-,7$9",*+E'+.+B$'#(),E5"$#"5,".."B#,*+;"*,
#7$',#7-*",B-'2=B#"2,"(*"a7"5"<,,8'#"5"*#+'E()3,#7+*,$'$()*+*,.-='2,'-,*+E'+.+B$'#,2+.."5"'B",
+',".."B#,*+;"*,.-5,*#=2+"*,#$5E"#+'E,*+'E(",9*<,C=(#+K(",7"$(#7,0"7$9+-5*<,A+'B",a",$9"5$E"2,
".."B#,*+;"*,$B5-**,9$5+-=*,0"7$9+-5*,+',C=(#+K("%0"7$9+-5,#$+(-5"2,+'#"59"'#+-'*3,#7+*,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
22
*=EE"*#*,#7$#,#7",($##"5,C$),0","c=$((),".."B#+9",$*,+'#"59"'#+-'*,#$5E"#+'E,-'(),$,*+'E(",
0"7$9+-5<,,
D-='#"5,#-,K5"9+-=*,C"#$%$'$()*"*3,a",.-='2,#7$#,5$'2-C+;"2,B-'#5-(("2,#5+$(*,
B-CK$5+'E,$,a"0%0$*"2,#$+(-5"2,+'#"59"'#+-',a+#7,$,C"$'+'E.=(,B-CK$5+*-',E5-=K,P"<E<3,$,
'-'%#$+(-5"2,-5,a$+#(+*#,B-'#5-(,B-'2+#+-'S,a"5",*+E'+.+B$'#(),C-5",".."B#+9",#7$',c=$*+%
"^K"5+C"'#$(,*#=2+"*,a+#7,'-,#5"$#C"'#,B-'#5-(,E5-=K*<,
h9"5$((3,#7+*,*#=2),5$+*"*,$,'=C0"5,-.,+CK-5#$'#,c="*#+-'*,#7$#,'""2,.=5#7"5,
"^K(-5$#+-',#-,"'$0(",=*,#-,-K#+C+;",#7",=*",-.,a"0%0$*"2,#$+(-5+'E,+',0"7$9+-5,B7$'E",
+'#"59"'#+-'*<,`"*"$5B7"5*,*7-=(2,0","'B-=5$E"2,#-,K5-9+2",0"##"5,2"*B5+K#+-'*,-.,#7"+5,
#$+(-5+'E,B5+#"5+$,$'2,#$B#+B*,=*"2,.-5,C"**$E",2"*+E'3,C-2"*,-.,2"(+9"5),$'2,B-CK-'"'#*,-.,
#7",+'#"59"'#+-'3,+'B(=2+'E,'=C0"5,$'2,+'#"'*+#),-.,+'#"59"'#+-',B-'#$B#*,K"5,#$+(-5"2,
B-CK-'"'#,P*"",6$55+'E#-',F,V-$53,@MI@S<,A=B7,2"*B5+K#+-'*,a+((,.$B+(+#$#",C-5",$BB=5$#",
B-2+'E,$'2,#"*#+'E,-.,K-**+0(",C-2"5$#-5*,-.,"..+B$B),$'2,a+((,7"(K,B($5+.),*-C",-.,#7",
+**="*,5$+*"2,7"5"<,,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
23
REFERENCES
&'3,:<,D<3,Z($##3,D<3,>"55)3,D<,:<3,:"+'3,j<,1<3,6"''5+\=*3,?<,W<3,>$((-'"'3,H<,j<3,<,<,<,j7(+'E"53,j<,><,
P@MMQS<,47",`"$(H,-'(+'",B"**$#+-',+'#"59"'#+-',.-5,B-(("E",*C-\"5*O,&,5$'2-C+;"2,
B-'#5-(("2,#5+$(<,K,585'*#85%157#2#'5:%^_P@S3,IXJ%IXX<,2-+O,
IM<IMINbY<)KC"2<@MMQ<MJ<MII,
1$'2=5$3,&<,PIXXQS<,6"$(#7,K5-C-#+-',.5-C,#7",K"5*K"B#+9",-.,*-B+$(,B-E'+#+9",#7"-5)<,
K$G2"+0+/G%&'7%?5&0*":%DEPJS3,N@L%NJX<,2-+O,IM<IMQMbMQQTMJJXQMQJMTJ@@,
15=E3,W<3,h"'"C$3,&<3,F,D$CK0"((3,!<,P@MMLS<,>$*#3,K5"*"'#3,$'2,.=#=5",-.,B-CK=#"5%#$+(-5"2,
'=#5+#+-',"2=B$#+-'<,(95,#2&'%>+),'&0%+4%@0#'#2&0%O)*,#*#+':%__PJ,A=KK(S3,IM@QA%
IMLJA<,,
1=(("53,?<,1<3,1-5($'23,`<3,/--2$((3,/<,]<3,6$((3,W<,`<3,6+'"*3,W<,!<3,1=55+*%/--2$((3,><3,<,<,<,A$0$3,:<,
P@MMQS<,`$'2-C+;"2,#5+$(*,-',D-'*+2"5,47+*3,$,#$+(-5"23,8'#"5'"#%2"(+9"5"2,*C-\+'E,
K5"9"'#+-',K5-E5$C,.-5,$2-("*B"'#*<,?5&0*"%X7)2&*#+'%H%`5"&8#+,:%EaP@S3,@NM%@QI<,
2-+O,IM<IITTbIMXMIXQIMN@QQXQ@,
D$+$#$,g=.."5")3,!<3,F,AB7=(;3,><,W<,P@MMXS<,A"(.%C$'$E"C"'#,-.,B75-'+B,(-a,0$B\,K$+'O,&',
"^K(-5$#+-',-.,#7",+CK$B#,-.,$,K$#+"'#%B"'#"5"2,a"0*+#"<,K&*#5'*%X7)2&*#+'%&'7%
@+)'$50#'/:%__PIS3,@T%L@<,2-+O,IM<IMINbY<K"B<@MMX<MI<MIN,
D$5(*-'3,Z<,?<3,F,AB7C+2#3,G<,:<,PIXXXS<,8CK$B#,-.,"^K"5+C"'#$(,2"*+E',-',".."B#,*+;"O,
G+'2+'E*,.5-C,#7",5"*"$5B7,(+#"5$#=5",-',#5$+'+'E<,>+),'&0%+4%(330#57%K$G2"+0+/G:%
N^PNS3,QRI%QN@<,2-+O,IM<IMLTbMM@I%XMIM<QJ<N<QRI,
D7"'E3,D<,j<3,85a+'3,1<3,!$=5+"((-3,?<3,6"CC+'E"53,:<3,>$KK"5#3,&<3,F,Z+C0$((3,&<,1<,P@MIMS<,
6"$(#7,2+*K$5+#+"*,$C-'E,2+.."5"'#,"#7'+B,$'2,5$B+$(,C+22(",$'2,7+E7,*B7--(,*#=2"'#*,
+',*=',"^K-*=5",0"(+".*,$'2,\'-a("2E"<,>+),'&0%+4%(7+05$25'*%?5&0*":%^_PIS3,IMN%IMX<,
2-+O,IM<IMINbY<Y$2-7"$(#7<@MMX<I@<M@Q,
D7+$=;;+3,j<3,]5""'3,4<,D<3,:-523,A<3,47=C3,D<3,F,]-(2*#"+'3,!<,P@MMRS<,&,7+E7%5+*\,25+'\+'E,
K5"9"'#+-',a"0,*+#",.-5,B-(("E",*#=2"'#*<,>+),'&0%+4%(95,#2&'%@+005/5%?5&0*":%aEPNS3,
@NL%@TJ<,2-+O,IM<L@MMbW&D6<RL<N<@NL%@TJ,
?$9+*3,A<,P@MMQS<,47",+'.(="'B",-.,B-(("B#+9+*#+B,$'2,+'2+9+2=$(+*#+B,9$(=",-5+"'#$#+-'*,-',#7",
$BB"K#$'B",-.,+'2+9+2=$(()%#$+(-5"2,+'#"5'"#,B-CC='+B$#+-'*<,R'*5,4&25M%!"5%>+),'&0%
4+,%X7)2&*#+':%@+99)'#*G:%&'7%;&0)5$:%NPIS<,`"#5+"9"2,.5-C,
http://bcis.pacificu.edu/journal/article.php?id=160,
?+Y\*#5$3,&<,P@MMRS<,/-5\+'E,C"B7$'+*C*,-.,B-CK=#"5%#$+(-5"2,7"$(#7,"2=B$#+-'O,j9+2"'B",
.5-C,*C-\+'E,B"**$#+-'<,?5&0*"%X7)2&*#+'%<5$5&,2":%BCPRS3,R@T%RLX<,2-+O,
IM<IMXLb7"5bB)7MIJ,
?='#-'3,]<,G<3,F,`-0"5#*-'3,4<,><,P@MMQS<,&,#$+(-5"2,+'#"5'"#%K(=*%"C$+(,+'#"59"'#+-',.-5,
+'B5"$*+'E,K7)*+B$(,$B#+9+#),$C-'E,"#7'+B$(()%2+9"5*",a-C"'<,K,585'*#85%157#2#'5:%
^_PNS3,NMR%NII<,2-+O,IM<IMINbY<)KC"2<@MMQ<IM<MMJ,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
24
?=##$3,!<,W<,P@MMTS<,D-CC='+B$#+'E,$0-=#,B=(#=5",$'2,7"$(#7O,47"-5+;+'E,B=(#=5"%B"'#"5"2,
$'2,B=(#=5$(,*"'*+#+9+#),$KK5-$B7"*<,@+99)'#2&*#+'%!"5+,G:%D_PLS3,LMJ%L@Q<,2-+O,
IM<IIIIbY<IJNQ%@QQR<@MMT<MM@XT<^,
?=9$(3,A<3,F,4a""2+"3,`<,P@MMMS<,45+C,$'2,.+((O,&,*+CK(",.=''"(%K(-#t0$*"2,C"#7-2,-.,#"*#+'E,
$'2,$2Y=*#+'E,.-5,K=0(+B$#+-',0+$*,+',C"#$%$'$()*+*<,`#+95*,#2$:%abP@S3,JRR%JNL<,2-+O,
IM<IIIIbY<MMMN%LJIu<@MMM<MMJRR<^,
G+*70"+'3,!<3,F,D$KK"(($3,W<,V<,P@MMNS<,47",5-(",-.,#7"-5),+',2"9"(-K+'E,".."B#+9",7"$(#7,
B-CC='+B$#+-'*<,>+),'&0%+4%@+99)'#2&*#+':%abP*IS3,AI%AIT<,2-+O,IM<IIIIbY<IJNM%
@JNN<@MMN<MM@QM<^,
G5"''3,!<3,!$(+'3,A<3,15-a'3,`<,:<3,]5""53,_<3,G-^3,W<3,]5""53,W<3,F,AC)B;"\3,A<,P@MMRS<,D7$'E+'E,
#7",#+2"O,$',8'#"5'"#b9+2"-,"^"5B+*",$'2,(-a%.$#,2+"#,+'#"59"'#+-',a+#7,C+22("%
*B7--(,*#=2"'#*<,(330#57%O),$#'/%<5$5&,2":%DNPIS3,IL%@I<,2-+O,
IM<IMINbY<$K'5<@MMJ<MJ<MML,
]$'*3,Z<,!<3,`+*+B$3,><,!<3,A#5-(($3,:<,h<3,G-=5'+"53,:<3,Z+5#$'+$3,H<3,HK"E=+3,?<3,<,<,<,&B7$5))$3,A<,
P@MMXS<,j.."B#+9"'"**,-.,2+.."5"'#,C"#7-2*,.-5,2"(+9"5+'E,#$+(-5"2,'=#5+#+-',
"2=B$#+-',#-,(-a,+'B-C"3,"#7'+B$((),2+9"5*",$2=(#*<,R'*5,'&*#+'&0%>+),'&0%+4%
`5"&8#+,&0%O)*,#*#+'%&'7%K"G$#2&0%(2*#8#*G:%b3,@J<,2-+O,IM<IIQNbIJTX%RQNQ%N%@J,
]5-"'"9"(23,><,/<3,A-''$23,A<,A<3,:""3,&<,Z<3,&*B73,?<,&<3,F,A7"$3,W<,j<,P@MMNS<,`$B+$(,2+.."5"'B"*,
+',$##+#=2"*,#-a$52,+''-9$#+9",C"2+B$(,#"B7'-(-E)<,>+),'&0%+4%c5'5,&0%R'*5,'&0%
157#2#'5:%BDPNS3,RRX%RNL<,2-+O,IM<IIIIbY<IR@R%IJXT<@MMN<MMJRL<^,
6$E"C$'3,><,&<3,/$(\"53,A<,V<3,F,>=(("'3,D<,6<,P@MMRS<,4$+(-5"2,9"5*=*,*#$'2$52,8'#"5'"#%
2"(+9"5"2,+'#"59"'#+-'*,#-,K5-C-#",K7)*+B$(,$B#+9+#),+',-(2"5,a-C"'<,>+),'&0%+4%
c5,#&*,#2%K"G$#2&0%!"5,&3G:%BNPIS3,@Q%LL<,,
6$55+'E#-'3,V<,]<3,F,V-$53,A<,!<,P@MI@S<,`"K-5#+'E,*#$'2$52*,.-5,*#=2+"*,-.,#$+(-5"2,
+'#"59"'#+-'*<,?5&0*"%X7)2&*#+'%<5$5&,2":%B_P@S3,LLI%LJ@<,2-+O,IM<IMXLb7"5bB)5IMQ,
6$a\+'*3,`<,><3,Z5"=#"53,!<3,`"*'+B-a3,Z<3,G+*70"+'3,!<3,F,?+Y\*#5$3,&<,P@MMQS<,H'2"5*#$'2+'E,
#$+(-5+'E,+',B-CC='+B$#+'E,$0-=#,7"$(#7<,?5&0*"%X7)2&*#+'%<5$5&,2":%BEPLS3,JRJ%JNN<,
2-+O,IM<IMXLb7"5bB)'MMJ,
6$)"*3,&<,G<3,F,Z5+KK"'2-5..3,Z<,P@MMTS<,&'*a"5+'E,#7",B$((,.-5,$,*#$'2$52,5"(+$0+(+#),
C"$*=5",.-5,B-2+'E,2$#$<,@+99)'#2&*#+'%15*"+7$%&'7%15&$),5$:%DPIS3,TT%QX<,2-+O,
IM<IMQMbIXLI@JRMTMXLLNNNJ,
6"2E"*3,:<,[<3,F,h(\+'3,8<,PIXQRS<,V*&*#$*#2&0%95*"+7$%4+,%95*&S&'&0G$#$<,h5($'2-O,&B$2"C+B,
>5"**<,
6=$'E3,&<3,1$5;+3,G<3,6=^(")3,`<3,?"')"53,]<3,`-75($B73,1<3,W$)'"3,Z<3,F,V"$(3,1<,P@MMNS<,47",
".."B#*,-',*$#=5$#"2,.$#,K=5B7$*"*,-.,K5-9+2+'E,8'#"5'"#,*7-KK"5*,a+#7,K=5B7$*"%
*K"B+.+B,2+"#$5),$29+B"O,&,5$'2-C+;"2,#5+$(<,K]+V%@0#'#2&0%!,#&0$:%DPRS3,"@@<,2-+O,
IM<ILTIbY-=5'$(<KB#5<MMIMM@@,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
25
6=5(+'E3,`<3,D$##3,!<3,?",1-'+3,!<3,G$+5(")3,1<,/<3,6=5*#3,4<3,!=55$)3,><3,<,<,<,1$5\7==*3,:<,P@MMTS<,
H*+'E,8'#"5'"#,$'2,C-0+(",K7-'",#"B7'-(-E),#-,2"(+9"5,$',$=#-C$#"2,K7)*+B$(,
$B#+9+#),K5-E5$CO,`$'2-C+;"2,B-'#5-(("2,#5+$(<,>+),'&0%+4%157#2&0%R'*5,'5*%<5$5&,2":%
\P@S3,"T<,2-+O,IM<@IXNbYC+5<X<@<"T,
W"$'%>+"55"3,><3,G+*B"(($3,Z<3,]5+EE*3,W<3,W-*"K73,W<,[<3,!-55-a3,]<3,D$55-((3,W<3,<,<,<,Z+5*7'"53,W<,W<,
P@MIMS<,`$B"b"#7'+B+#)%0$*"2,B-'B"5'*,-9"5,='2"5*#$'2+'E,B$'B"5,2+$E'-*+*,$'2,
#5"$#C"'#,K($'<,>+),'&0%+4%*"5%O&*#+'&0%157#2&0%($$+2#&*#+':%DCBPLS3,IQJ%IQX<,,
W-*"K73,D<,:<,!<3,>"#"5*-'3,j<3,6$9*#$23,A<3,W-7'*-'3,D<,D<3,6-"5$=.3,A<3,A#5+'E"53,A<3,<,<,<,A#5"B7"53,
[<,P@MMTS<,&,a"0%0$*"23,#$+(-5"2,$*#7C$,C$'$E"C"'#,K5-E5$C,.-5,=50$',&.5+B$'%
&C"5+B$',7+E7,*B7--(,*#=2"'#*<,(95,#2&'%>+),'&0%+4%<5$3#,&*+,G%&'7%@,#*#2&0%@&,5%
157#2#'5:%D_aPXS3,QQQ%QXR<,2-+O,IM<IINJb5BBC<@MMNMQ%I@JJhD,
Z5"0*3,><3,>5-B7$*\$3,W<,h<3,F,`-**+3,W<,A<,P@MIMS<,&,C"#$%$'$()*+*,-.,B-CK=#"5%#$+(-5"2,
+'#"59"'#+-'*,.-5,7"$(#7,0"7$9+-5,B7$'E"<,K,585'*#85%157#2#'5:%aDPL%JS3,@IJ%@@I<,
2-+O,IM<IMINbY<)KC"2<@MIM<MN<MMJ,
Z5"=#"53,!<,/<3,D$0=5'$)3,D<,&<3,D7"'3,W<,W<3,F,?-'(+'3,!<,W<,P@MMJS<,j.."B#+9"'"**,-.,
+'2+9+2=$(()%#$+(-5"2,B$("'2$5*,+',K5-C-#+'E,B7+(27--2,+CC='+;$#+-',+',=50$',
K=0(+B,7"$(#7,B"'#"5*<,(95,#2&'%>+),'&0%+4%K)=0#2%?5&0*":%\^PIS3,I@@%I@T<,,
Z5"=#"53,!<,/<3,G$55"((3,?<3,h("9+#B73,:<3,F,15"''$'3,:<,P@MMMS<,!&#0+,#'/%"5&0*"%95$$&/5$M%
@)$*+9#Y#'/%2+99)'#2&*#+'%6#*"%2+93)*5,%*52"'+0+/G%!$7a$73,V<W<O,:$a5"'B",
j5(0$=C,&**-B+$#"*<,
Z5"=#"53,!<,/<3,A#5"B7"53,[<,W<3,F,]($**C$'3,1<,PIXXXS<,h'",*+;",2-"*,'-#,.+#,$((O,#7",B$*",.-5,
#$+(-5+'E,K5+'#,C$#"5+$(*<,(''&0$%+4%`5"&8#+,&0%157#2#'5:%BDPJS3,@TN%@QL<,2-+O,
IM<IMMTb1GM@QXRXRQ,
Z5"=#"53,!<,/<3,F,/5$)3,`<,W<,P@MMLS<,4$+(-5"2,$'2,#$5E"#"2,7"$(#7,B-CC='+B$#+-'O,
*#5$#"E+"*,.-5,"'7$'B+'E,+'.-5C$#+-',5"("9$'B"<,(95,#2&'%>+),'&0%+4%?5&0*"%`5"&8#+,:%
B_%V)330%E3,A@@T%@L@<,,
Z5+KK"'2-5..3,Z<,P@MMJS<,@+'*5'*%('&0G$#$M%('%R'*,+7)2*#+'%*+%R*$%15*"+7+0+/G<,h$\*3,D&O,
A$E",>=0(+B$#+-'*<,
Z5-";"3,/<3,/"5\C$'3,&<3,F,15=E3,W<,P@MMNS<,&,*)*#"C$#+B,5"9+"a,-.,5$'2-C+;"2,#5+$(*,-',#7",
".."B#+9"'"**,-.,B-CK=#"5%#$+(-5"2,"2=B$#+-',-',K7)*+B$(,$B#+9+#),$'2,2+"#$5),
0"7$9+-5*<,(''&0$%+4%`5"&8#+,&0%157#2#'5:%EDPLS3,@MR%@@L<,2-+O,
IM<I@MTb*IRL@JTXN$0CLIMLv@,
Z)K5+3,Z<3,:$'E(")3,W<,?<3,A$='2"5*3,W<,1<3,D$*7"((%AC+#73,!<,:<3,F,6"50+*-'3,><,P@MMQS<,
`$'2-C+;"2,B-'#5-(("2,#5+$(,-.,a"0%0$*"2,$(B-7-(,*B5""'+'E,$'2,05+".,+'#"59"'#+-',
+',K5+C$5),B$5"<,(,2"#85$%+4%R'*5,'&0%157#2#'5:%DbNPRS3,RLM%RLN<,2-+O,
IM<IMMIb$5B7+'#"5'C"2<@MMT<IMX,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
26
Z)K5+3,Z<3,F,!B&'$(()3,6<,!<,P@MMRS<,`$'2-C+;"2,B-'#5-(("2,#5+$(,-.,$,a"0%0$*"2,K5+C$5),
B$5",+'#"59"'#+-',.-5,C=(#+K(",7"$(#7,5+*\,0"7$9+-5*<,K,585'*#85%157#2#'5:%^DPL%JS3,
TNI%TNN<,2-+O,IM<IMINbY<)KC"2<@MMR<MT<MIM,
Z)K5+3,Z<3,A$='2"5*3,W<,1<3,/+((+$C*3,A<,!<3,!B]""3,`<,h<3,:$'E(")3,W<,?<3,D$*7"((%AC+#73,!<,:<3,F,
]$(($E7"53,A<,W<,P@MMJS<,/"0%0$*"2,*B5""'+'E,$'2,05+".,+'#"59"'#+-',.-5,7$;$52-=*,
25+'\+'EO,&,2-=0("%0(+'2,5$'2-C+;"2,B-'#5-(("2,#5+$(<,(77#2*#+':%\\PIIS3,IJIM%IJIT<,
2-+O,IM<IIIIbY<ILNM%MJJL<@MMJ<MMQJT<^,
:$C0"5#3,A<,?<3,:-+*"(("3,D<,]<3,F,!$B2-'$(23,!<,j<,P@MMXS<,&',+'%2"K#7,"^K(-5$#+-',-.,
+'.-5C$#+-'%*""\+'E,0"7$9+-5,$C-'E,+'2+9+2=$(*,a+#7,B$'B"5O,>$5#,I,%,
H'2"5*#$'2+'E,2+.."5"'#+$(,K$##"5'*,-.,$B#+9",+'.-5C$#+-',*""\+'E<,@&'25,%O),$#'/:%
EBPIS3,II%@L<,2-+O,IM<IMXTbMI<VDD<MMMMLJLLT@<@JRIT<02,
:+K*")3,!<,/<,P@MMLS<,47-*",B-'.-='2"2,C-2"5$#-5*,+',C"#$%$'$()*+*O,]--23,0$23,$'2,=E()<,
(''&0$%+4%*"5%(95,#2&'%(2&759G%+4%K+0#*#2&0%&'7%V+2#&0%V2#5'25:%aN_PIS3,NX%QI<,2-+O,
IM<IITTbMMM@TIN@M@@RMTXI,
:+K*")3,!<,/<3,F,/+(*-'3,?<,1<,P@MMIS<,K,&2*#2&0%95*&S&'&0G$#$%d(330#57%$+2#&0%,5$5&,2"%
95*"+7$e%47-=*$'2,h$\*3,D&O,A&]j,>=0(+B$#+-'*,,
:-5+E3,Z<,`<3,`+##"53,><,:<3,:$=5"'#3,?<,?<3,F,>($'#3,Z<,P@MMQS<,47",+'#"5'"#%0$*"2,$5#75+#+*,*"(.%
C$'$E"C"'#,K5-E5$CO,&,-'"%)"$5,5$'2-C+;"2,#5+$(,.-5,K$#+"'#*,a+#7,$5#75+#+*,-5,
.+05-C)$(E+$<,(,*",#*#$%@&,5%&'7%<5$5&,2":%a\PTS3,IMMX%IMIT<,2-+O,IM<IMM@b$5#<@LQIT,
:=*#5+$3,!<,:<,&<3,D-5#"*"3,W<3,V-$53,A<,!<3,F,](="B\$=.3,`<,:<,P@MMXS<,D-CK=#"5%#$+(-5"2,7"$(#7,
+'#"59"'#+-'*,2"(+9"5"2,-9"5,#7",a"0O,`"9+"a,$'2,$'$()*+*,-.,\"),B-CK-'"'#*<,
K&*#5'*%X7)2&*#+'%&'7%@+)'$50#'/:%_^P@S3,IRN%ITL<,2-+O,IM<IMINbY<K"B<@MMQ<MQ<M@L,,
!$'E='\=*=C-3,`<,4<3,15=E3,W<3,2",Z-'+'E3,6<,W<3,9$',2"5,:"+3,W<3,F,`$$#3,6<,P@MMTS<,AB7--(%
0$*"2,8'#"5'"#%#$+(-5"2,.5=+#,$'2,9"E"#$0(","2=B$#+-',B-C0+'"2,a+#7,05+".,
B-='*"((+'E,+'B5"$*"*,B7+(25"'i*,$a$5"'"**,-.,+'#$\",("9"(*<,K)=0#2%?5&0*"%O)*,#*#+':%
DCPMLS3,@TL%@TX<,2-+O,IM<IMITbAILNQXQMMMT@JNNTI,
!$5B=*3,&<,D<3,!$*-'3,!<3,/-(."3,><3,`+C"53,1<,Z<3,:+K\=*3,8<3,A#5"B7"53,[<,W<3,<,<,<,15+E7#3,!<,&<,
P@MMRS<,47","..+B$B),-.,#$+(-5"2,K5+'#,C$#"5+$(*,+',K5-C-#+'E,B-(-5"B#$(,B$'B"5,
*B5""'+'EO,5"*=(#*,.5-C,$,5$'2-C+;"2,#5+$(,+'9-(9+'E,B$(("5*,#-,#7",V$#+-'$(,D$'B"5,
8'*#+#=#"i*,D$'B"5,8'.-5C$#+-',A"59+B"<,>+),'&0%+4%?5&0*"%@+99)'#2&*#+':%DCPA=KK(,
IS3,QL%IMJ<,2-+O,IM<IMQMbIMQIMTLMRMM@RTTRJ,
!$5B=*3,1<,6<3,:"a+*3,1<,&<3,/+((+$C*3,?<,!<3,?='*+E"53,A<3,W$\+B+B3,W<,!<3,/7+#"(")3,W<,&<3,<,<,<,>$5+*+3,
&<,G<,P@MMTS<,&,B-CK$5+*-',-.,8'#"5'"#,$'2,K5+'#%0$*"2,K7)*+B$(,$B#+9+#),
+'#"59"'#+-'*<,(,2"#85$%+4%R'*5,'&0%157#2#'5:%Db_PXS3,XJJ%XJX<,2-+O,
IM<IMMIb$5B7+'#"<INT<X<XJJ,
!BZ$)3,6<,]<3,Z+'E3,?<3,j$\+'3,j<,]<3,A""(")3,W<,`<3,F,]($*E-a3,`<,j<,P@MMIS<,47",?+$0"#"*,
V"#a-5\,8'#"5'"#%0$*"2,K7)*+B$(,$B#+9+#),+'#"59"'#+-'O,&,5$'2-C+;"2,K+(-#,*#=2)<,
U#&=5*5$%@&,5:%B^PQS3,IL@Q%ILLJ<,2-+O,IM<@LLTb2+$B$5"<@J<Q<IL@Q,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
27
V$K-(+#$'-3,!<,&<3,G-#7"5+'E7$C3,!<3,4$#"3,?<3,AB+$C$''$3,D<3,:"*(+"3,j<3,ha"'3,V<3,<,<,<,!$5B=*3,
1<,P@MMLS<,j9$(=$#+-',-.,$',8'#"5'"#%0$*"2,K7)*+B$(,$B#+9+#),+'#"59"'#+-'O,&,
K5"(+C+'$5),+'9"*#+E$#+-'<,(''&0$%+4%`5"&8#+,&0%157#2#'5:%BaP@S3,X@%XX<,2-+O,
IM<I@MTb*IRL@JTXN$0C@RM@vMJ,
V"9+(("3,:<,!<3,!+($#3,&<,W<3,F,hi6$5$3,1<,P@MMXS<,D-CK=#"5%#$+(-5"2,a"+E7#,5"2=B#+-',
+'#"59"'#+-'*,#$5E"#+'E,$2=(#*O,$,'$55$#+9",*)*#"C$#+B,5"9+"a<,?5&0*"%K,+9+*#+'%
>+),'&0%+4%()$*,&0#&%BCPIS3,JQ%RT<,,
V"9+(("3,:<,!<3,hi6$5$3,1<3,F,!+($#3,&<,W<,P@MMX$S<,D-CK=#"5%#$+(-5"2,2+"#$5),0"7$9+-=5,B7$'E",
+'#"59"'#+-'*O,$,*)*#"C$#+B,5"9+"a<,?5&0*"%X7)2&*#+'%<5$5&,2":%B^PJS3,NXX%T@M<,2-+O,
IM<IMXLb7"5bB)KMMN,
V"9+(("3,:<,!<3,hi6$5$3,1<3,F,!+($#3,&<,W<,P@MMX0S<,D-CK=#"5%#$+(-5"2,K7)*+B$(,$B#+9+#),0"7$9+-5,
B7$'E",+'#"59"'#+-'*,#$5E"#+'E,$2=(#*O,$,*)*#"C$#+B,5"9+"a<,R'*5,'&*#+'&0%>+),'&0%+4%
`5"&8#+,&0%O)*,#*#+'%&'7%K"G$#2&0%(2*#8#*G:%b3,LM<,2-+O,IM<IIQNbIJTX%RQNQ%N%LM,
V-$53,A<,!<3,1"'$B3,D<,V<3,F,6$55+*3,!<,A<,P@MMTS<,?-"*,#$+(-5+'E,C$##"5k,!"#$%$'$()#+B,5"9+"a,
-.,#$+(-5"2,K5+'#,7"$(#7,0"7$9+-5,B7$'E",+'#"59"'#+-'*<,K$G2"+0+/#2&0%`)005*#':%
DEEPJS3,NTL%NXL<,2-+O,IM<IMLTbMMLL%@XMX<ILL<J<NTL,
V-$53,A<,!<3,6$55+'E#-'3,V<,]<3,F,&(25+B73,`<,A<,P@MMXS<,47",5-(",-.,C"**$E",#$+(-5+'E,+',#7",
2"9"(-KC"'#,-.,K"5*=$*+9",7"$(#7,B-CC='+B$#+-',C"**$E"*<,8',D<,A<,1"B\,Pj2<S3,
@+99)'#2&*#+'%f5&,=++Q%EE,PKK<,TL%ILLS<,V"a,_-5\O,:$a5"'B",j5(0$=C&**-B+$#"*3,
8'B<,
V-"(3,:<,4<,P@MIMS<,&',"#7'+Bb5$B+$(,B-CK$5+*-',-.,B$=*$(,0"(+".*,$'2,#5"$#C"'#,K5"."5"'B"*,
.-5,#7",*)CK#-C*,-.,2"K5"**+-',$C-'E,K$#+"'#*,a+#7,2+$0"#"*<,U#&=5*5$%X7)2&*+,:%
EbPRS3,QIN%Q@T<,2-+O,IM<IITTbMIJRT@ITIMLQMIJR,
V-5C$'3,D<,?<3,!$(")3,h<3,:+3,u<3,F,A\+''"53,6<,&<,P@MMQS<,H*+'E,#7",8'#"5'"#,#-,$**+*#,*C-\+'E,
K5"9"'#+-',$'2,B"**$#+-',+',*B7--(*O,&,5$'2-C+;"23,B-'#5-(("2,#5+$(<,?5&0*"%
K$G2"+0+/G:%B_PNS3,TXX%QIM<,2-+O,IM<IMLTb$MMILIMR,
h"'"C$3,&<3,15=E3,W<3,?+Y\*#5$3,&<3,/""52#3,8<3,F,[5+"*3,6<,P@MMQS<,j..+B$B),$'2,=*",-.,$',
8'#"5'"#%2"(+9"5"2,B-CK=#"5%#$+(-5"2,(+."*#)(",+'#"59"'#+-'3,#$5E"#+'E,*$#=5$#"2,.$#,
+'#$\"3,K7)*+B$(,$B#+9+#),$'2,*C-\+'E,B"**$#+-'O,&,5$'2-C+;"2,B-'#5-(("2,#5+$(<,
(''&0$%+4%`5"&8#+,&0%157#2#'5:%EaP@S3,I@R%ILR<,2-+O,IM<IMMTb*I@INM%MMQ%XM@L%I,
h"'"C$3,&<3,4$'3,G<3,F,15=E3,W<,P@MMRS<,A7-5#%#"5C,"..+B$B),-.,$,a"0%0$*"2,B-CK=#"5%#$+(-5"2,
'=#5+#+-',+'#"59"'#+-'O,!$+',".."B#*,$'2,C"2+$#-5*<,(''&0$%+4%`5"&8#+,&0%157#2#'5:%
B\PIS3,RJ%NL<,2-+O,IM<I@MTb*IRL@JTXN$0C@XMIvQ,
h5a+'3,`<,]<,PIXQLS<,&,.$+(%*$.",V,.-5,".."B#,*+;",+',C"#$%$'$()*+*<,>+),'&0%+4%X7)2&*#+'&0%&'7%
`=5"&8#+,&0%V*&*#$*#2$:%NP@S3,IRT%IRX<,2-+O,IM<LIM@bIMTNXXQNMMQMM@IRT,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
28
>$(C"53,A<3,]5$7$C3,]<3,F,j((+-##3,j<,P@MMRS<,j.."B#*,-.,$,a"0%0$*"2,7"$(#7,K5-E5$C,-',.+.#7,
E5$2",B7+(25"'p*,K7)*+B$(,$B#+9+#)3,\'-a("2E"3,$##+#=2"*,$'2,0"7$9+-5<,(95,#2&'%
>+),'&0%+4%?5&0*"%X7)2&*#+':%EbP@S3,QN%XL<,2-+O,IM<IMQMbIXL@RMLT<@MMR<IMNMQINJ,
>"##)3,`<,j<3,F,D$B+-KK-3,W<,4<,PIXTXS<,8**=",+'9-(9"C"'#,B$',+'B5"$*",-5,2"B5"$*",K"5*=$*+-',
0),"'7$'B+'E,C"**$E"%5"("9$'#,B-E'+#+9",5"*K-'*"*<,>+),'&0%+4%K5,$+'&0#*G%&'7%
V+2#&0%K$G2"+0+/GJ:%E_PIMS3,IXIR%IX@N<,,
>-5#'-)3,?<,1<3,AB-##%A7"(2-'3,:<,&<,W<3,W-7'*-'3,1<,4<3,F,D$5")3,!<,><,P@MMQS<,D-CK=#"5%
2"(+9"5"2,+'#"59"'#+-'*,.-5,7"$(#7,K5-C-#+-',$'2,0"7$9+-5$(,5+*\,5"2=B#+-'O,&,C"#$%
$'$()*+*,-.,TR,5$'2-C+;"2,B-'#5-(("2,#5+$(*3,IXQQ%@MMT<,K,585'*#85%157#2#'5:%^_PIS3,
L%IN<,2-+O,IM<IMINbY<)KC"2<@MMQ<M@<MIJ,
>5-B7$*\$3,W<,h<,P@MMQS<,!=(#+K(",7"$(#7,0"7$9+-5,5"*"$5B7,5"K5"*"'#*,#7",.=#=5",-.,
K5"9"'#+9",C"2+B+'"<,K,585'*#85%157#2#'5:%^bPLS3,@QI%@QR<,2-+O,
IM<IMINbY<)KC"2<@MMQ<MI<MIR,
>5-B7$*\$3,W<,h<3,F,?+D("C"'#"3,D<,D<,PIXQJS<,!"5%*,&'$*"5+,5*#2&0%&33,+&2"%M%@,+$$#'/%
*,&7#*#+'&0%=+)'7&,#5$%+4%*"5,&3G<,6-C"a--23,8((O,?-a,W-'"*%85a+'<,
`"9"5"3,?<3,F,?='0$53,><,W<,P@MMIS<,`"9+"a,-.,B-CK=#"5%E"'"5$#"2,-=#K$#+"'#,7"$(#7,
0"7$9+-5,+'#"59"'#+-'*O,B(+'+B$(,"'B-='#"5*,w+',$0*"'#+$w<,>+),'&0%+4%*"5%(95,#2&'%
157#2&0%R'4+,9&*#2$%($$+2#&*#+':%NPIS3,N@%TX<,2-+O,IM<IILNbY$C+$<@MMI<MMQMMN@,
`+B7$52*3,Z<,D<3,j'2"5(+'3,D<,&<3,1"B\3,D<3,!BAa""'")3,W<,D<3,W-'"*3,4<,D<3,F,`-0"5*-'3,><,Z<,
P@MMTS<,4$+(-5"2,0+-0"7$9+-5$(,+'#"59"'#+-'*O,&,(+#"5$#=5",5"9+"a,$'2,*)'#7"*+*<,
<5$5&,2"%&'7%!"5+,G%4+,%O),$#'/%K,&2*#25:%BDPJS3,@TI%@QR<,2-+O,
IM<IQXIbMQQXTIQMTTQ@J@QM@X,
`+C"53,1<,Z<3,F,]($**C$'3,1<,PIXXQS<,4$+(-5+'E,B-CC='+B$#+-'*,.-5,K5+C$5),B$5",*"##+'E*<,
15*"+7$%+4%R'4+,9&*#+'%#'%157#2#'5:%E_P@S3,ITI%ITT<,,
`+C"53,1<,Z<3,F,Z5"=#"53,!<,/<,P@MMNS<,&29$'B+'E,#$+(-5"2,7"$(#7,B-CC='+B$#+-'O,&,
K"5*=$*+-',$'2,C"**$E",".."B#*,K"5*K"B#+9"<,>+),'&0%+4%@+99)'#2&*#+':%abP*IS3,
AIQJ%A@MI<,2-+O,IM<IIIIbY<IJNM%@JNN<@MMN<MM@QX<^,
`+##"50$'23,:<,!<3,D-^3,?<,W<3,/$(\"53,:<,A<3,Z-9$#B7"93,1<3,!BZ'+E7#3,:<3,>$#"(3,Z<3,<,<,<,A=#K7"'3,W<,
P@MMLS<,&',8'#"5'"#,+'#"59"'#+-',$*,$2Y='B#+9",#7"5$K),.-5,K"2+$#5+B,"'B-K5"*+*<,
>+),'&0%+4%@+'$)0*#'/%&'7%@0#'#2&0%K$G2"+0+/G:%_DPRS3,XIM%XIT<,2-+O,IM<IMLTbMM@@%
MMN^<TI<R<XIM,
`-*"'#7$(3,`<,PIXXIS<,15*&S&'&0G*#2%3,+257),5$%4+,%$+2#&0%,5$5&,2",P5"9+*"2,"2<S<,V"a0=5),
>$5\3,D&O,A$E"<,
`-#7"5#3,Z<3,A#5"B7"53,[<,W<3,?-)("3,:<,&<3,D$K($'3,/<,!<3,W-)B"3,W<,A<3,W+C+*-'3,6<,1<3,<,<,<,`-#73,!<,&<,
P@MMNS<,/"0%0$*"2,a"+E7#,C$'$E"C"'#,K5-E5$C*,+',$',+'#"E5$#"2,7"$(#7,B$5",
*"##+'EO,$,5$'2-C+;"23,B-'#5-(("2,#5+$(<,.=5$#*G:%D^P@S3,@NN%@T@<,2-+O,
IM<IMLQb-0)<@MMN<LJ,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
29
`-#7C$'3,&<,W<,P@MMMS<,4-a$52,$,#7"-5)%0$*"2,$'$()*+*,-.,0"7$9+-5$(,C$+'#"'$'B"<,?5&0*"%
K$G2"+0+/G:%D\PI,A=KK(S3,NJ%NX<,,
A"9"5*-'3,6<,6<3,]-52-'3,W<,A<3,?$'$7"53,1<,]<3,F,&\"5*3,:<,P@MMQS<,D7"aG5""<B-CO,j9$(=$#+-',
-.,$,a"0%0$*"2,B"**$#+-',K5-E5$C,.-5,*C-\"("**,#-0$BB-,=*"5*<,O#2+*#'5%H%!+=&22+%
<5$5&,2":%DCP@S3,LQI%LXI<,2-+O,IM<IMQMbIJN@@@MMTMIQ@JXQJ,
A7+5"3,V<,P@MM@S<,j.."B#*,-.,5$B"3,"#7'+B+#)3,E"'2"53,B=(#=5"3,(+#"5$B)3,$'2,*-B+$(,C$5\"#+'E,-',
K=0(+B,7"$(#7<,>+),'&0%+4%c5'75,SV352#4#2%157#2#'5:%aP@S3,JQ%RJ<,,
A(--#C$\"53,A<,!<3,D7+'$K$a3,!<,W<3,AB7=+#3,&<,W<3,A"+2"((3,W<,D<3,F,[$',!"B7"("'3,/<,P@MMXS<,
G"$*+0+(+#),$'2,".."B#+9"'"**,-.,-'(+'",K7)*+B$(,$B#+9+#),$29+B",0$*"2,-',$,K"5*-'$(,
$B#+9+#),C-'+#-5O,5$'2-C+;"2,B-'#5-(("2,#5+$(<,>+),'&0%+4%157#2&0%R'*5,'5*%<5$5&,2":%
DDPLS3,"@T<,2-+O,IM<@IXNbYC+5<IILX,
AC""#*3,4<3,15=E3,W<3,F,2",[5+"*3,6<,P@MMQS<,j.."B#*,-.,#$+(-5+'E,7"$(#7,C"**$E"*,-',K7)*+B$(,
$B#+9+#)<,?5&0*"%X7)2&*#+'%<5$5&,2":%BEPLS3,JM@%JIL<,2-+O,IM<IMXLb7"5bB)(IMI,
A-7(3,A<,W<3,F,!-)"53,&<,P@MMTS<,4$+(-5"2,+'#"59"'#+-'*,#-,K5-C-#",C$CC-E5$K7),*B5""'+'EO,
&,C"#$%$'$()#+B,5"9+"a<,K,585'*#85%157#2#'5:%^aPJS3,@R@%@NI<,2-+O,
IM<IMINbY<)KC"2<@MMT<MN<MMX,
AK+##$"(*3,6<3,?",1-=52"$=27=+Y3,8<3,15=E3,W<3,F,[$'2"($'-##"3,D<,P@MMTS<,j.."B#+9"'"**,-.,$',
-'(+'",B-CK=#"5%#$+(-5"2,K7)*+B$(,$B#+9+#),+'#"59"'#+-',+',$,5"$(%(+.",*"##+'E<,?5&0*"%
X7)2&*#+'%<5$5&,2":%BBPLS3,LQR%LXN<,2-+O,IM<IMXLb7"5bB)(MXN,
AK+##$"(*3,6<3,?",1-=52"$=27=+Y3,8<3,F,[$'2"($'-##"3,D<,P@MMTS<,j9$(=$#+-',-.,$,a"0*+#"%
2"(+9"5"2,B-CK=#"5%#$+(-5"2,+'#"59"'#+-',.-5,+'B5"$*+'E,K7)*+B$(,$B#+9+#),+',#7",
E"'"5$(,K-K=($#+-'<,K,585'*#85%157#2#'5:%^^PLS3,@MX%@IT<,2-+O,
IM<IMINbY<)KC"2<@MMN<II<MIM,
A#5"B7"53,[<,W<,PIXXXS<,D-CK=#"5%#$+(-5"2,*C-\+'E,B"**$#+-',C$#"5+$(*O,&,5"9+"a,$'2,
2+*B=**+-'<,K&*#5'*%X7)2&*#+'%&'7%@+)'$50#'/:%EbP@S3,IMT%IIT<,2-+O,IM<IMINbAMTLQ%
LXXIPXQSMMI@Q%I,
A#5"B7"53,[<,W<3,!BD(=5"3,W<,1<3,&("^$'2"53,]<,:<3,D7$\5$0-5#)3,1<3,V$+53,[<,V<3,Z-'\"(3,W<,!<3,<,<,<,
>-C"5("$=3,h<,G<,P@MMQS<,/"0%0$*"2,*C-\+'E%B"**$#+-',K5-E5$C*O,`"*=(#*,-.,$,
5$'2-C+;"2,#5+$(<,(95,#2&'%>+),'&0%+4%K,585'*#85%157#2#'5:%E^PRS3,LTL%LQI<,2-+O,
IM<IMINbY<$C"K5"<@MMT<I@<M@J,
A#5"B7"53,[<,W<3,A7+..C$'3,A<3,F,/"*#3,`<,P@MMRS<,`$'2-C+;"2,B-'#5-(("2,#5+$(,-.,$,a"0%0$*"2,
B-CK=#"5%#$+(-5"2,*C-\+'E,B"**$#+-',K5-E5$C,$*,$,*=KK("C"'#,#-,'+B-#+'",K$#B7,
#7"5$K)<,(77#2*#+':%DCCPRS3,NQ@%NQQ<,2-+O,IM<IIIIbY<ILNM%MJJL<@MMR<MIMXL<^,
A#5"B7"53,[<,W<3,/$'E3,D<3,?"55)3,6<3,/+(2"'7$=*3,Z<3,F,W-7'*-'3,D<,P@MM@S<,4$+(-5"2,
+'#"59"'#+-'*,.-5,C=(#+K(",5+*\,0"7$9+-5*<,?5&0*"%X7)2&*#+'%<5$5&,2":%D_PRS3,NIX%
N@N<,2-+O,IM<IMXLb7"5bIT<R<NIX,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
30
A=EE*3,:<,A<3,F,!B8'#)5"3,D<,P@MMXS<,&5",a",#7"5",)"#k,&',"^$C+'$#+-',-.,-'(+'",#$+(-5"2,
7"$(#7,B-CC='+B$#+-'<,?5&0*"%X7)2&*#+'%H%`5"&8#+,:%EbP@S3,@TQ%@QQ<,2-+O,
IM<IITTbIMXMIXQIMTLMLLMX,
A=##-'3,A<,!<3,1$(B73,]<,8<3,F,:"."095"3,`<,D<,PIXXRS<,A#5$#"E+B,c="*#+-'*,.-5,B-'*=C"5%0$*"2,
7"$(#7,B-CC='+B$#+-'*<,K)=0#2%?5&0*"%<53+,*$:%DDCPNS3,T@R%TLL<,,
Aa$5#;3,:<,6<,]<3,V-"((3,W<,/<3,AB75-"2"53,A<,/<3,F,&5)3,?<,[<,P@MMNS<,&,5$'2-C+*"2,B-'#5-(,
*#=2),-.,$,.=((),$=#-C$#"2,+'#"5'"#,0$*"2,*C-\+'E,B"**$#+-',K5-E5$CC"<,!+=&22+%
@+'*,+0:%DaPIS3,T%I@<,2-+O,IM<@LMTb@MTJTXMM,
4$#"3,?<,G<3,W$B\9-')3,j<,6<3,F,/+'E3,`<,`<,P@MMNS<,&,5$'2-C+;"2,#5+$(,B-CK$5+'E,7=C$',"%
C$+(,B-='*"(+'E3,B-CK=#"5%$=#-C$#"2,#$+(-5"2,B-='*"(+'E3,$'2,'-,B-='*"(+'E,+',$',
8'#"5'"#,a"+E7#,(-**,K5-E5$C<,(,2"#85$%+4%R'*5,'&0%157#2#'5:%DbbPIRS3,IN@M%IN@R<,
2-+O,IM<IMMIb$5B7+'#"<INN<IR<IN@M,
4",>-"(3,G<3,1-(C$'3,D<3,`"=0*$"#3,&<3,F,2",[5+"*3,6<,P@MMXS<,j..+B$B),-.,$,*+'E(",B-CK=#"5%
#$+(-5"2,"%C$+(,.-5,*C-\+'E,B"**$#+-'O,`"*=(#*,$.#"5,N,C-'#7*<,?5&0*"%X7)2&*#+'%
<5$5&,2":%B^PNS3,XLM%XJM<,2-+O,IM<IMXLb7"5bB)KMLN,
H<A<,?"K$5#C"'#,-.,6"$(#7,$'2,6=C$',A"59+B"*<,P@MII3,V-9<,IQS<,6"$(#7,D-CC='+B$#+-',
$'2,6"$(#7,8'.-5C$#+-',4"B7'-(-E),,`"#5+"9"2,hB#-0"5,T3,@MIM3,.5-C,
http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=18,
[$',?"',1"5E3,!<,6<3,`-'2$)3,6<,Z<3,>""#"5*3,&<,W<3,:",D"**+"3,A<3,[$',?"5,]+"*"'3,G<,W<3,
15""29"(23,G<,D<3,F,[(+"#,[(+"($'23,4<,><,!<,P@MMNS<,H*+'E,+'#"5'"#,#"B7'-(-E),#-,2"(+9"5,
$,7-C"%0$*"2,K7)*+B$(,$B#+9+#),+'#"59"'#+-',.-5,K$#+"'#*,a+#7,57"=C$#-+2,$5#75+#+*O,
&,5$'2-C+;"2,B-'#5-(("2,#5+$(<,(,*",#*#$%@&,5%&'7%<5$5&,2":%aaPNS3,XLR%XJR<,2-+O,
IM<IMM@b$5#<@@LLX,
9$',2"',1"5E3,!<,6<3,AB7--'"*3,W<,/<3,F,[(+"($'23,4<,><,!<,[<,P@MMTS<,8'#"5'"#%0$*"2,K7)*+B$(,
$B#+9+#),+'#"59"'#+-'*O,&,*)*#"C$#+B,5"9+"a,-.,#7",(+#"5$#=5"<,>+),'&0%+4%157#2&0%
R'*5,'5*%<5$5&,2":%\PLS3,TI%QN<,2-+O,IM<@IXNbYC+5<X<L<"@N,
["57"+Y2"'3,!<3,1$\^3,W<,D<3,&\\"5C$'*3,`<3,9$',2"',6--E"'3,6<3,]-2a+'3,V<,!<3,`-**"53,/<3,<,<,<,
9$',/""(3,D<,P@MMJS<,/"0%0$*"2,#$5E"#"2,'=#5+#+-',B-='*"((+'E,$'2,*-B+$(,*=KK-5#,
.-5,K$#+"'#*,$#,+'B5"$*"2,B$52+-9$*B=($5,5+*\,+',E"'"5$(,K5$B#+B"O,5$'2-C+;"2,
B-'#5-(("2,#5+$(<,>+),'&0%+4%157#2&0%R'*5,'5*%<5$5&,2":%bPJS3,"JJ<,2-+O,
IM<@IXNbYC+5<N<J<"JJ,
/$'E0"5E3,A<,D<,P@MMQS<,&',8'#"5'"#%0$*"2,2+$0"#"*,*"(.%B$5",+'#"59"'#+-',#$+(-5"2,#-,*"(.%
"..+B$B)<,?5&0*"%X7)2&*#+'%<5$5&,2":%BEPIS3,ITM%ITX<,2-+O,IM<IMXLb7"5bB)CMIJ,
/$''"53,!<3,!$5#+'%?+"'"53,j<3,15$='%G$75($'2"53,D<3,1$="53,]<3,F,!$5#+'3,1<,/<,P@MMXS<,
j.."B#+9"'"**,-.,$B#+9"%-'(+'"3,$',+'2+9+2=$((),#$+(-5"2,K7)*+B$(,$B#+9+#),+'#"59"'#+-'3,
+',$,5"$(%(+.",*"##+'EO,`$'2-C+;"2,B-'#5-(("2,#5+$(<,>+),'&0%+4%157#2&0%R'*5,'5*%
<5$5&,2":%DDPLS3,"@L<,2-+O,IM<@IXNbYC+5<IITX,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
31
/"003,:<,4<3,W-*"K73,W<3,_$52(")3,:<3,F,!+B7+"3,A<,P@MIMS<,H*+'E,#7",8'#"5'"#,#-,K5-C-#",7"$(#7,
0"7$9+-5,B7$'E"O,&,*)*#"C$#+B,5"9+"a,$'2,C"#$%$'$()*+*,-.,#7",+CK$B#,-.,#7"-5"#+B$(,
0$*+*3,=*",-.,0"7$9+-5,B7$'E",#"B7'+c="*3,$'2,C-2",-.,2"(+9"5),-',"..+B$B)<,>+),'&0%+4%
157#2&0%R'*5,'5*%<5$5&,2":%DBPIS3,"J<,2-+O,IM<@IXNbYC+5<ILTN,
/"+'*#"+'3,><,Z<,P@MMNS<,&,5"9+"a,-.,a"+E7#,(-**,K5-E5$C*,2"(+9"5"2,9+$,#7",8'#"5'"#<,
>+),'&0%+4%@&,7#+8&$2)0&,%O),$#'/:%BDPJS3,@RI%@RQ<,,
/+((+$C*%>+"7-#$3,><3,AB7'"+2"53,4<,`<3,>+;$55-3,W<3,!-a$23,:<3,F,A$(-9")3,><,P@MMLS<,!$#B7+'E,
7"$(#7,C"**$E"*,#-,+'.-5C$#+-'%K5-B"**+'E,*#)("*O,V""2,.-5,B-E'+#+-',$'2,
C$CC-E5$K7),=#+(+;$#+-'<,?5&0*"%@+99)'#2&*#+':%DaPJS3,LTR%LX@<,2-+O,
IM<I@MTbAIRL@TM@T6DIRMJvMI,
/+((+$C*-'3,?<,&<3,/$(2"'3,6<,!<3,/7+#"3,!<,&<3,_-5\%D5-a"3,j<3,V"a#-'3,`<,:<3,&(.-'*-3,&<3,<,<,<,
`)$'3,?<,P@MMNS<,4a-%)"$5,8'#"5'"#%0$*"2,5$'2-C+;"2,B-'#5-(("2,#5+$(,.-5,a"+E7#,
(-**,+',&.5+B$'%&C"5+B$',E+5(*<,.=5$#*G:%D^PTS3,I@LI%I@JL<,2-+O,
IM<IMLQb-0)<@MMN<IJM,
/+'"##3,`<,&<3,&'2"5*-'3,j<3,/-YB+\3,W<3,/+'"##3,A<3,F,1-a2"'3,4<,P@MMTS<,]=+2",#-,7"$(#7O,
V=#5+#+-',$'2,K7)*+B$(,$B#+9+#),-=#B-C"*,-.,$,E5-=K%5$'2-C+;"2,#5+$(,-.,$',+'#"5'"#%
0$*"2,+'#"59"'#+-',+',B7=5B7"*<,(''&0$%+4%`5"&8#+,&0%157#2#'5:%EEPLS3,@RI%@NI<,2-+O,
IM<IMMTb1GM@QTXXMT,
/+'"##3,`<,&<3,`--2C$'3,&<,&<3,/+'"##3,A<,]<3,1$Y;"\3,/<3,`-9'+$\3,:<,A<3,F,/7+#"(")3,W<,&<,PIXXXS<,
47",".."B#*,-.,j$#J:+.",8'#"5'"#%0$*"2,7"$(#7,0"7$9+-5,K5-E5$C,-',#7",'=#5+#+-',$'2,
$B#+9+#),-.,7+E7,*B7--(,E+5(*<,>+),'&0%+4%c5'75,:%@)0*),5%&'7%?5&0*":%^PLS3,@LX%@RJ<,2-+O,
IM<IM@Lb$OIM@L@LLJINQRX,
/-C0("3,:<,]<3,/$22"'3,4<,&<3,!B]=B\+'3,1<,]<3,A$5E"'#3,A<,:<3,`-#7C$'3,`<,&<3,F,Z5$=#7$C"5%
ja+'E3,j<,A<,P@MMJS<,&,5$'2-C+;"2,B-'#5-(("2,#5+$(,-.,$,B-CC"5B+$(,8'#"5'"#,a"+E7#,
(-**,K5-E5$C<,.=5$#*G%<5$5&,2":%DBPNS3,IMII%IMIQ<,2-+O,IM<IMLQb-0)<@MMJ<I@J,
/--(.3,A<,6<3,Z5+*#3,&<,6<3,W-7'*-'3,`<,j<3,/+(*-'3,?<,1<3,`-#7"C+B73,A<,G<3,V-5C$'3,]<,W<3,F,
?"9"5*3,Z<,W<,P@MMNS<,&,K5$B#+B"%*K-'*-5"2,/"0,*+#",#-,7"(K,K$#+"'#*,K=5*=",7"$(#7),
0"7$9+-5*O,&',&Dh`V,*#=2)<,(''&0$%+4%I&9#0G%157#2#'5:%^P@S3,IJQ%IR@<,2-+O,
IM<ILTMb$.C<R@@,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
32
Appendix!A:!Tables!
4$0(",I,
]#$*%+4%V*)7#5$%R'20)757%#'%15*&S('&0G$#$%
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
33
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
34
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
35
%
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
36
4$0(",:,
Summary'of'Web-Based'Tailored'Health'Behavior'Change'Interventions'
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;&',"#,$(<3,:==>?,
@A-B+'C,
DEF,G-(("C",*#H2"'#,
*A-B"5*I,A"$',$C"J:=I,
FKL,."A$("I,M@,*"##+'C,
K=%N""B,#$+(-5"2,*A-B+'C,G"**$#+-',+'#"59"'#+-',
5"OH+5+'C,:=,9+*+#*,#-,$,N"0*+#"I,$(*-,+'G(H2"2,
"A$+(,5"A+'2"5*3,N""B(),*"(.%A-'+#-5+'C3,
+'#"5$G#+9",#$+(-5"2,OH+PP"*,$'2,"A$+(,*HQQ-5#,
.5-A,Q""5,G-$G7"*I,#$5C"#"2,0"7$9+-5R,F%,$'2,K=%
2$),*A-B+'C,Q5"9$("'G"I,E==L,5"#"'#+-',5$#",
#$+(-5"2,-'(+'",A$C$P+'",
;'J:DF?,9*<,C"'"5$(,-'(+'",
5"*-H5G"*,;'J:S=?,
;1H(("5,"#,$(<3,:==>?,
@A-B+'C,
E:KT,$2-("*G"'#*I,A"$',
$C"JE:I,D:L,."A$("I,M@,
*"##+'C,
N"0%0$*"2,#$+(-5"2,*A-B+'C,G"**$#+-',
+'#"59"'#+-',2"(+9"5"2,2H5+'C,S,G($**,A""#+'C*I,
"$G7,TD%S=,A+'H#",*"**+-',.-GH*"2,-',2+.."5"'#,
G-'#"'#,$'2,+'G(H2"2,*"(.%A-'+#-5+'C3,AH(#+%
A"2+$,G-'#"'#I,#$5C"#"2,0"7$9+-5R,K=%2$),
*A-B+'C,Q5"9$("'G"I,>EL,5"#"'#+-',
#$+(-5"2,N"0*+#",;'JST=?,9*<,
*#$'2$52,7"$(#7,"2HG$#+-',
;'JKST?,
;1H(("53,"#,$(<3,
:==>?,
@A-B+'C,
:=FF,$2-("*G"'#*I,A"$',
$C"JE:I,TUL,."A$("I,'-'%
M@,*"##+'C,;&H*#5$(+$?,
N"0%0$*"2,#$+(-5"2,*A-B+'C,G"**$#+-',
+'#"59"'#+-',2"(+9"5"2,2H5+'C,S,G($**,A""#+'C*I,
"$G7,TD%S=,A+'H#",*"**+-',.-GH*"2,-',2+.."5"'#,
G-'#"'#,$'2,+'G(H2"2,*"(.%A-'+#-5+'C3,AH(#+%
A"2+$,G-'#"'#I,#$5C"#"2,0"7$9+-5R,K=%2$),
*A-B+'C,Q5"9$("'G"I,FKL,5"#"'#+-',
#$+(-5"2,N"0*+#",;'JFDT?,9*<,
*#$'2$52,7"$(#7,"2HG$#+-',
;'JFDS?,
;V7+$HPP+3,W5""'3,
X-523,47HA3,Y,
W-(2*#"+'3,:==D?,
&(G-7-(+*A,
:SD,G-(("C",*#H2"'#*,N7-,
N"5",7"$9),25+'B"5*I,
A"$',$C"J:=I,TSL,
."A$("I,M@,*"##+'C,
T%N""B,N"0%0$*"2,#$+(-5"2,+'#"59"'#+-',
2"*+C'"2,#-,5"2HG",7"$9),25+'B+'CI,"$G7,:=%
A+'H#",*"**+-',+'G(H2"2,#$+(-5"2,G-'#"'#3,
+'#"5$G#+9",$G#+9+#+"*3,Q""5,*#-5+"*3,$*B,$',"ZQ"5#3,
$'2,$,*-G+$(,'-5A,[G$(GH($#-5[I,#$5C"#"2,
0"7$9+-5*R,$(G-7-(,H*"I,0+'C",25+'B+'C3,$'2,
5"$2+'"**,#-,G7$'C"I,>=L,5"#"'#+-',5$#",
#$+(-5"2,N"0*+#",;'JEKE,9*<,
C"'"5+G,N"0*+#",;'JEKT?,
;\H'#-',Y,
]-0"5#*-'3,:==>?,
^7)*+G$(,
&G#+9+#),
EDS,$2H(#,N-A"'I,A"$',
$C"JTKI,E==L,."A$("I,M@,
*"##+'C,
E:%N""B,N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,$(*-,+'G(H2"2,$G#+9+#),A-'+#-5,$'2,
N""B(),'"N*("##"5*,*"'#,9+$,"A$+(I,#$5C"#"2,
0"7$9+-5*R,("9"(,-.,Q7)*+G$(,$G#+9+#),$'2,
5"$2+'"**,#-,G7$'C"I,FTL,5"#"'#+-',
#$+(-5"2,N"0*+#",;'J>D?,9*<,
N$+#(+*#,G-'#5-(,;'JFE?,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
37
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;_5"'',"#,$(<3,:==D?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#),
EK:,A+22(",*G7--(,B+2*I,
A"$',$C"JEKI,D:L,
."A$("I,M@,*"##+'C,
N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),+'#"59"'#+-',
2"(+9"5"2,+',>3,T=%A+'H#",+'%G($**,*"**+-'*I,
+'G(H2"2,#$+(-5"2,G-'#"'#3,9+2"-*3,2+*GH**+-',
.-5HA*,$'2,#$+(-5"2,"A$+(,.""20$GBI,#$5C"#"2,
0"7$9+-5*R,("9"(,-.,Q7)*+G$(,$G#+9+#),Y,2+"#$5),.$#,
+'#$B"I,FFL,5"#"'#+-',
#$+(-5"2,"2HG$#+-'$(,*+#",9*<,
G-'#5-(,;*#$'2$52,G($**"*I,',
.-5,"$G7,G-'2+#+-','-#,G("$5(),
5"Q-5#"2?,
;6$C"A$'3,/$(B"53,
Y,^H(("'3,:==D?,
^7)*+G$(,
&G#+9+#),
KE,-(2"5,N-A"'I,A"$',
$C"JDSI,E==L,."A$("I,M@,
*"##+'C,
>%N""B,N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-',2"(+9"5"2,9+$,K,#$+(-5"2,-'(+'",
'"N*("##"5*I,#$5C"#"2,0"7$9+-5*R,("9"(,-.,Q7)*+G$(,
$G#+9+#),$'2,*"(.%"..+G$G)I,UFL,5"#"'#+-',5$#",
#$+(-5"2,;'JED?,9*<,C"'"5+G,
;'JES?,-'(+'",'"N*("##"5*,
;6H$'C,"#,$(<3,
:==S?,
`H#5+#+-'a\+"#,
TUF,-'(+'",G-'*HA"5*I,
A"$',$C"JT=I,>F<DL,
."A$("I,'-'%M@,*"##+'C,
;@)2'")3,&H*#5$(+$?,
05+".,N"0%0$*"2,#$+(-5"2,+'#"59"'#+-',#-,5"2HG",
7+C7%.$#,QH5G7$*"*,-',$',-'(+'",*7-QQ+'C,
N"0*+#"I,0$*"2,-',G-'#"'#*,-.,*7-QQ+'C,G$5#3,
#$+(-5"2,$29+G",N$*,C+9"',#-,"'G-H5$C",*7-QQ"5*,
#-,0H),*+A+($5,Q5-2HG#*,(-N"5,+',*$#H5$#"2,.$#I,
#$5C"#"2,0"7$9+-5R,QH5G7$*",-.,Q5-2HG#*,7+C7,+',
*$#H5$#"2,.$#I,E==L,5"#"'#+-',5$#",,
#$+(-5"2,;'J:DE?,9*<,C"'"5$(,
;'J:TS?3,'-'%*Q"G+.+G,
*7-QQ+'C,$29+G",
;6H5(+'C,"#,$(<3,
:==F?,
^7)*+G$(,
&G#+9+#),
FF,-9"5N"+C7#a-0"*",
$2H(#*I,A"$',$C"JT=I,
STL,."A$("I,'-'%M@,
*"##+'C,;1"2.-52*7+5"3,
M'+#"2,b+'C2-A?,
U%N""B,N"0%0$*"2,Q7)*+G$(,$G#+9+#),+'#"59"'#+-'I,
+'9-(9"2,#$+(-5"2,*-(H#+-'*I,N""B(),"Z"5G+*",Q($'3,
*"(.%A-'+#-5+'C,-.,^&3,2+*GH**+-',.-5HA3,
5"A+'2"5*,*"'#,9+$,"A$+(,$'2,#"Z#,;@!@?I,
#$5C"#"2,0"7$9+-5R,("9"(,-.,Q7)*+G$(,$G#+9+#)I,
E==L,5"#"'#+-',5$#",
#$+(-5"2,;'JTF?,9*<,C"'"5+G,
N"0*+#",;'JK=?,
;c-*"Q7,"#,$(<3,
:==F?,
&*#7A$,
KET,&&,7+C7,*G7--("5*I,
A"$',$C"JEFI,SKL,
."A$("I,M@,*"##+'C,
E:%A-'#7,N"0%0$*"2,$*#7A$,A$'$C"A"'#,
Q5-C5$AI,+'G(H2"2,#$+(-5"2,.""20$GB,$'2,
$'+A$#+-'I,#$5C"#"2,0"7$9+-5*R,G-'#5-(("5,
A"2+G$#+-',$27"5"'G"3,5"*GH",+'7$("5,
$9$+($0+(+#)3,$'2,*A-B+'C,G"**$#+-'a5"2HG#+-'I,
>SL,5"#"'#+-',
#$+(-5"2,;'JES:?,9*<,C"'"5+G,
;'JED:?,N"0*+#",
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
38
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;b)Q5+,Y,!G&'$(()3,
:==D?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#)I,
@A-B+'CI,
&(G-7-(+*A,
:E>,G-(("C",*#H2"'#*I,
A"$',$C"J:=I,TUL,
."A$("I,'-'%M@,*"##+'C,
;`"N,d"$($'2?,
05+".3,N"0%0$*"2,#$+(-5"2,+'#"59"'#+-',G-'2HG#"2,
$#,*#H2"'#,7"$(#7,*"59+G"*,#$5C"#+'C,AH(#+Q(",
7"$(#7,0"7$9+-5*I,+'9-(9"2,N"0%0$*"2,
$**"**A"'#,N+#7,+AA"2+$#",#$+(-5"2,.""20$GB,
$'2,,Q7-'",$'2,"A$+(,5"A+'2"5,#-,G-AQ("#",$,
.-((-N%HQ,*H59"),$#,S%N""B*I,#$5C"#"2,0"7$9+-5*R,
.5H+#,Y,9"C"#$0(",+'#$B"3,("9"(*,-.,Q7)*+G$(,
$G#+9+#)3,$(G-7-(,G-'*HAQ#+-'I,>DL,5"#"'#+-',,
E?,N"0%0$*"2,$**"**A"'#,$'2,
Q"5*-'$(+P"2,.""20$GB,
;'JF:?I,9*<,;:?,$**"**A"'#,
-'(),;'JFT?I,9*<,;K?,A+'+A$(,
G-'#$G#,;'JF:?,
;b)Q5+,"#,$(<3,:==T?,
&(G-7-(+*A,
E=T,G-(("C",*#H2"'#*,N7-,
N"5",7"$9),25+'B"5*I,
A"$',$C"J:=I,D=L,
."A$("I,'-'%M@,*"##+'C,
;`"N,d"$($'2?,
05+".3,N"0%0$*"2,#$+(-5"2,+'#"59"'#+-',#-,5"2HG",
7$P$52-H*,25+'B+'CI,+'9-(9"2,E=%ED,A+'H#",N"0%
0$*"2,$**"**A"'#,N+#7,+AA"2+$#",#$+(-5"2,
.""20$GB,$'2,Q7-'",$'2,"A$+(,5"A+'2"5,#-,
G-AQ("#",$,.-((-N%HQ,*H59"),$#,S%N""B*I,
#$5C"#"2,0"7$9+-5*R,$(G-7-(,G-'*HAQ#+-',$'2,
0+'C",25+'B+'CI,S:L,5"#"'#+-',,
N"0%0$*"2,$**"**A"'#,$'2,
#$+(-5"2,.""20$GB,;'JDE?,9*<,
C"'"5+G,Q5+'#,;'JDK?,
;b)Q5+3,X$'C(")3,
@$H'2"5*3,V$*7"((%
@A+#73,Y,6"50+*-'3,
:==>?,
&(G-7-(+*A,
DFS,G-(("C",*#H2"'#*,N7-,
N"5",7"$9),25+'B"5*I,
A"$',$C"J:=I,D:L,
."A$("I,'-'%M@,*"##+'C,
;`"N,d"$($'2?,
05+".,$'2,AH(#+Q("%2-*",N"0%0$*"2,#$+(-5"2,
A-#+9$#+-'$(,+'#"59"'#+-',#-,5"2HG",7$P$52-H*,
25+'B+'CI,+'9-(9"2,N"0%0$*"2,$**"**A"'#,N+#7,
#$+(-5"2,.""20$GB3,N+#7,-'",$5A,5"G"+9+'C,
AH(#+Q(",$**"**A"'#*,$'2,#$+(-5"2,.""20$GB,$#,E,
$'2,S,A-'#7*I,#$5C"#"2,0"7$9+-5*R,,$(G-7-(,
G-'*HAQ#+-',$'2,0+'C",25+'B+'CI,SKL,5"#"'#+-',,
;E?,*+'C(",2-*","9+2"'G"%
*HQQ-5#"2,*G5""'+'C,$'2,05+".,
+'#"59"'#+-',;"%@183,'JEK>?I,
;:?,AH(#+Q(",2-*","9+2"'G"%
*HQQ-5#"2,*G5""'+'CI,$'2,
05+".,+'#"59"'#+-'G-'#5-(,
;'JETD?I,;K?,C"'"5$(,
Q$AQ7("#,;'JETS?I,;T?,
$(#"5'$#",G-'#5-(,;'JETF?,
;X-5+C3,]+##"53,
X$H5"'#3,Y,^($'#3,
:==>?,
&5#75+#+*,
>DD,Q$#+"'#*,N+#7,
57"HA$#-+2,$5#75+#+*3,
-*#"-$5#75+#+*3,-5,
.+05-A)$(C+$I,A"$',
$C"JD:I,U=L,."A$("I,M@,
*"##+'C,
S%N""B,N"0%0$*"2,$5#75+#+*,*"(.%A$'$C"A"'#,
Q5-C5$AI,+'9-(9"2,+'#"5$G#+9"3,N"0%0$*"2,
+'*#5HG#+-'3,0H(("#+',0-$52,2+*GH**+-'3,"Z"5G+*",
(-C*3,A"2+G$#+-',2+$5+"*3,$'2,#$+(-5"2,"Z"5G+*",
Q5-C5$A*3,$'2,$',&5#75+#+*,6"(Q0--B,G-'#$+'+'C,
$((,-.,#7",Q5-C5$A,G-'#"'#I,#$5C"#"2,AH(#+Q(",
0"7$9+-5*R,+<"<3,$"5-0+G,"Z"5G+*"3,*#5"#G7+'C,$'2,
*#5"'C#7"'+'C,"Z"5G+*"3,Q5$G#+G",-.,*#5"**,
A$'$C"A"'#3,$'2,G-AAH'+G$#+-',N+#7,
Q7)*+G+$'*3,$'2,*"(.%"..+G$G)I,FDL,5"#"'#+-',
#$+(-5"2,N"0*+#",;'JTKK?,9*<,
H*H$(,G$5",;'JT::?,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
39
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;!$'CH'BH*HA-3,
15HC3,2",b-'+'C3,
9$',2"5,X"+3,Y,]$$#3,
:==F?,
`H#5+#+-'a\+"#,
TUD,$2-("*G"'#*I,A"$',
$C"JE=I,DKL,."A$("I,'-'%
M@,*"##+'C,;47",
`"#7"5($'2*?,
05+".,N"0%0$*"2,#$+(-5"2,'H#5+#+-',+'#"59"'#+-'I,
+'9-(9"2,N"0%0$*"2,$**"**A"'#,$'2,#$+(-5"2,
'H#5+#+-',$29+G"3,$#,$,($#"5,2$#",.-((-N"2,HQ,0),D%
A+'H#",2+"#$5),G-H'*"(+'C,+'9-(9+'C,Q$5"'#*I,
#$5C"#"2,0"7$9+-5R,.5H+#,Y,9"C"#$0(",+'#$B"I,U>L,
5"#"'#+-',
8'#"5'"#%#$+(-5"2,'H#5+#+-',
$29+G",.-5,*G7--(G7+(25"',$'2,
05+".,2+"#$5),G-H'*"(+'C,;N+#7,
G7+(2,$'2,Q$5"'#I,'J:SK?,9*<,
05+".,N"0%0$*"2,'H#5+#+-',
$29+G",;'J::K?,
;&<,V<,!$5GH*3,"#,$(<3,
:==D?,
^7)*+G$(,
&G#+9+#),
:TU,7"$(#7),0H#,*"2"'#$5),
$2H(#*I,A"$',$C"JTDI,
>KL,."A$("I,M@,*"##+'C,
N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,+'G(H2"2,#$+(-5"2,"9+2"'G"%0$*"2,
Q7)*+G$(,$G#+9+#),"2HG$#+-'$(,$'2,A-#+9$#+-'$(,
A$#"5+$(*3,A-'#7(),OH"*#+-''$+5"*,N+#7,#$+(-5"2,
+AA"2+$#",.""20$GB3,$,C-$(%*"##+'C3,$'2,(+'B*,#-,
-#7"5,*+#"*,$'2,"A$+(,5"A+'2"5*I,#$5C"#"2,
0"7$9+-5R,("9"(,-.,Q7)*+G$(,$G#+9+#)I,>UL,
5"#"'#+-',
;E?,A-#+9$#+-'$((),#$+(-5"2,
8'#"5'"#,;'J>E?I,9*<,;:?,
A-#+9$#+-'$((),#$+(-5"2,Q5+'#,
;'J>S?I,9*<,;K?,S,*#$'2$52,
N"0*+#",;'J>:?,
;!Gb$)3,b+'C3,
e$B+'3,@""(")3,Y,
W($*C-N3,:==E?,
^7)*+G$(,
&G#+9+#),
F>,4)Q",:,2+$0"#+G*I,A"$',
$C"JD:I,DKL,."A$("I,M@,
*"##+'C,
>%N""B,N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,#$+(-5"2,N"0*+#",+'G(H2"2,C-$(,
*"##+'C,$'2,Q"5*-'$(+P"2,.""20$GB3,-'(+'",$GG"**,
#-,Q"5*-'$(,G-$G7,$'2,Q""5,*HQQ-5#,C5-HQ*I,
#$5C"#"2,0"7$9+-5R,("9"(,-.,Q7)*+G$(,$G#+9+#)I,>FL,
5"#"'#+-',
.H((),#$+(-5"2,N"0*+#",;'JK>?,
9*<,+'.-5A$#+-'%-'(),N"0*+#",
;'JT=?,
;`$Q-(+#$'-,"#,$(<3,
:==K?,
^7)*+G$(,
&G#+9+#),
SD,*"2"'#$5),$2H(#*I,
A"$',$C"JTKI,>SL,
."A$("I,M@,*"##+'C,
E:%N""B,N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,#$+(-5"2,N"0*+#",N+#7,N""B(),"A$+(,
#+Q,*7""#*,$'2,$G#+9+#),OH+PP"*I,#$5C"#"2,
0"7$9+-5R,("9"(,-.,Q7)*+G$(,$G#+9+#)I,>>L,
5"#"'#+-',
#$+(-5"2,N"0*+#",;'JK=?,9*<,
N$+#(+*#,G-'#5-(,;'JKD?,
;`-5A$'3,!$(")3,X+3,
Y,@B+''"53,:==>?,
@A-B+'C,
ET=:,$2-("*G"'#*I,A"$',
$C"JEKI,TSL,."A$("I,'-'%
M@,*"##+'C,;4-5-'#-3,
V$'$2$?,
S%A-'#7,N"0%0$*"2,#$+(-5"2,*A-B+'C,G"**$#+-',
+'#"59"'#+-'I,+'9-(9"2,$,*+'C(",S=%A+'H#",
"ZQ(-5$#+-',-.,$',+'#"5$G#+9",#$+(-5"2,N"0*+#"3,
$'2,G-AQ("#+-',-.,Q$Q"5,f-H5'$(,$'2,*A$((%C5-HQ,
A-#+9$#+-'$(,+'#"59+"N3,$'2,*HQQ-5#"2,N+#7,
#$+(-5"2,.-((-N%HQ,"A$+(*,2"(+9"5"2,A-'#7(),-9"5,
#7",S%A-'#7,Q"5+-2I,#$5C"#"2,0"7$9+-5R,G+C$5"##",
H*"3,0"7$9+-5$(,+'#"'#+-'*,$'2,*"(.%"..+G$G),#-,
5"*+*#,*A-B+'CI,>KL,5"#"'#+-',
#$+(-5"2,N"0%0$*"2,
+'*#5HG#+-',;'J'-#,5"Q-5#"2?,
9*<,*#$'2$52,G($**,"Z"5G+*",
;'J'-#,5"Q-5#"2?,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
40
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;g"'"A$3,15HC3,
\+fB*#5$3,/""52#3,Y,
h5+"*3,:==>?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#)I,
@A-B+'C,
:EDU,$2H(#*I,A"$',
$C"JTTI,DTL,."A$("I,'-'%
M@,*"##+'C,;47",
`"#7"5($'2*?,
T%N""B,N"0%0$*"2,#$+(-5"2,(+."*#)(",+'#"59"'#+-'I,
+'9-(9"2,#$+(-5"2,+'.-5A$#+-',A-2H("*,N+#7,
-'(+'",OH+PP"*3,C5$Q7+G*,$'2,C-$(,*"##+'C,
$G#+9+#+"*I,#$5C"#"2,0"7$9+-5*R,*$#H5$#"2,.$#,
+'#$B"3,("9"(,-.,Q7)*+G$(,$G#+9+#),$'2,*A-B+'C,
G"**$#+-'I,SKL,5"#"'#+-',
#$+(-5"2,N"0,+'#"59"'#+-',
;'JE=>=?,9*<,N$+#(+*#,G-'#5-(,
;'JE=FU?,
;g"'"A$3,4$'3,Y,
15HC3,:==D?,
`H#5+#+-'a\+"#,
F>:,$2H(#*I,A"$',$C"JT:I,
TKL,."A$("I,'-'%M@,
*"##+'C,;47",`"#7"5($'2*?,
K%N""B,N"0%0$*"2,#$+(-5"2,'H#5+#+-',
+'#"59"'#+-'I,+'9-(9"2,$,#$+(-5"2,N"0*+#",
+'G(H2+'C,+'.-5A$#+-',-',7-N,#-,A$B",
+AQ("A"'#$#+-',+'#"'#+-'*3,*"Z,$'2,$C"%#$+(-5"2,
5-(",A-2"(,*#-5+"*,$'2,(+*#,-.,7"$(#7),5"G+Q"*I,
#$5C"#"2,0"7$9+-5*R,*$#H5$#"2,.$#,+'#$B",$'2,.5H+#,
$'2,9"C"#$0(",+'#$B"I,FUL,5"#"'#+-',
#$+(-5"2,+'#"59"'#+-',;'J:SE?,
9*<,C"'"5+G,+'.-5A$#+-',
G-'#5-(,;'J:S=?,9*<,'-%
+'.-5A$#+-',G-'#5-(,;'J:SE?,
;^$(A"53,W5$7$A3,
Y,e((+-##3,:==D?,
^7)*+G$(,
&G#+9+#),
:KK,.+.#7,C5$2"5*I,A"$',
$C",J,'5I,SSL,."A$("I,M@,
*"##+'C,
T%N""B,N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,+'9-(9"2,0+%N""B(),D=%A+'H#",
"ZQ(-5$#+-',-.,$,#$+(-5"2,N"0*+#",+'G(H2+'C,-'(+'",
OH+PP"*3,N5+#+'C,$G#+9+#+"*3,N""B(),$G#+9+#),
G7"GB(+*#3,C5$Q7+G*,$'2,$'+A$#+-'I,#$5C"#"2,
0"7$9+-5R,("9"(,-.,Q7)*+G$(,$G#+9+#)I,E==L,
5"#"'#+-',
+'9-(9"2,Q5"%Q-*#,G5-**%-9"5,
2"*+C',
;]+##"50$'2,"#,$(<3,
:==K?,
e'G-Q5"*+*,
:T,G7+(25"',N+#7,
"'G-Q5"*+*I,:EL,."A$("I,
M@,*"##+'C,
K%N""B,N"0%0$*"2,#$+(-5"2,+'#"59"'#+-',2"$(+'C,
N+#7,"'G-Q5"*+*I,+'9-(9"2,#75"",N"0%0$*"2,G-5",
A-2H("*,#7$#,G-H(2,0",G-AQ("#"2,+',$,#-#$(,-.,S=%
U=,A+'H#"*,+',*+'C(",-5,AH(#+Q(",*"**+-'*3,#7+*,
N$*,.-((-N"2,HQ,N+#7,$**"**A"'#*,$'2,#$+(-5"2,
A-2H("*,$'2,Q"5*-'$(+P"2,+'*#5HG#+-',*7""#*,E,
$'2,:,N""B*,$.#"5,G-AQ("#+-',-.,#7",G-5",
A-2H("*3,Q5"*"'#$#+-',.-5A$#*,+'G(H2"2,
$'+A$#+-'3,-'(+'",OH+PP"*3,$H2+-,'$55$#+-'3,
-'(+'",C$A"*3,9+2"-3,#"("Q7-'",$'2,Q5+'#,
*HQQ-5#I,#$5C"#"2,0"7$9+-5R,#-+("#+'C,0"7$9+-5*I,
E==L,5"#"'#+-',
N"0%0$*"2,"'7$'G"2,#-+("#,
#5$+'+'C,+'#"59"'#+-',;'JE:?,
9*<,'-%N"0,+'#"59"'#+-',
+'9-(9+'C,H'*Q"G+.+"2,5-H#+'",
A"2+G$(,G$5",;'JE:?,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
41
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;]-#7"5#,"#,$(<3,
:==S?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#),
:>S:,-9"5N"+C7#a-0"*",
$2H(#*I,A"$',$C"JTDI,
>KL,."A$("I,M@,*"##+'C,
S%N""B,N"0%0$*"2,#$+(-5"2,*"(.%7"(Q,N"+C7#,
A$'$C"A"'#,Q5-C5$AI,+'9-(9"2,2"9"(-QA"'#,-.,
+'2+9+2H$((),#$+(-5"2,N"+C7#,A$'$C"A"'#,Q($'*3,
"Z"5G+*",Q($'*3,[0H22)[,*HQQ-5#,9+$,"A$+(3,$'2,
.-((-N%HQ,#$+(-5"2,$G#+-',Q($'*I,#$5C"#"2,
0"7$9+-5R,N"+C7#,A$'$C"A"'#,0"7$9+-5*,
+'G(H2+'C,2+"#$5),$'2,Q7)*+G$(,$G#+9+#)I,E==L,
5"#"'#+-',
#$+(-5"2,N"0*+#",;'JETFD?,9*<,
+'.-5A$#+-',-'(),G-'#5-(,
;'JEK>F?,
;@"9"5*-'3,W-52-'3,
\$'$7"53,Y,&B"5*3,
:==>?,
@A-B+'C,
:D:K,$2H(#,*A-B"("**,
#-0$GG-,H*"5*I,A"$',
$C"JKFI,:<DL,."A$("I,M@,
*"##+'C,
S%A-'#7,N"0%0$*"2,#$+(-5"2,*A-B+'C,G"**$#+-',
+'#"59"'#+-'I,#$+(-5"2,N"0*+#",+'G(H2",$',
[Q"5*-'$(,OH+##+'C,$**+*#$'#[,#-,G5"$#",
+'2+9+2H$(+P"2,OH+#,Q($'*3,*#5"$A+'C,9+2"-*,;N+#7,
OH+##+'C,+'.-5A$#+-',$'2,#"*#+A-'+$(*?3,Q5+'#$0(",
5"*-H5G"*3,$''-#$#"2,(+'B*,#-,-#7"5,N"0*+#"*3,
Q""5,$'2,"ZQ"5#,*HQQ-5#,9+$,2+*GH**+-',.-5HA*,
$'2,"A$+(,5"A+'2"5*I,#$5C"#"2,0"7$9+-5R,
*A-B"("**,#-0$GG-,H*"I,KTL,5"#"'#+-',,
+'#"5$G#+9"3,#$+(-5"2,N"0%
0$*"2,+'#"59"'#+-',;'JE:S=?,
9*<,(+'"$5,#"Z#%0$*"2,N"0*+#",
;'JE:SK?,
;@(--#A$B"53,
V7+'$Q$N3,@G7H+#3,
@"+2"((3,Y,h$',
!"G7"("'3,:==U?,
^7)*+G$(,
&G#+9+#),
E=:,$2H(#*I,A"$',$C"JK:I,
S=L,."A$("I,'-'%M@,
*"##+'C,;47",`"#7"5($'2*?,
K%A-'#7,N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,+'9-(9"2,H*",-.,Q7)*+G$(,$G#+9+#),
A-'+#-5,N+#7,$,^&!,V-$G7,N7+G7,2"9"(-Q"2,
+'2+9+2H$(+P"2,^&,$29+G",0$*"2,-',G-AQ("#+-',-.,
-'(+'",OH"*#+-''$+5"*3,$G#+9+#),(-C*3,C-$(,*"##+'C,
$G#+9+#+"*I,#$5C"#"2,0"7$9+-5R,("9"(*,-.,Q7)*+G$(,
$G#+9+#)I,US<KL,5"#"'#+-',
#$+(-5"2,N"0*+#",;'JDE?,9*<,
C"'"5+G,Q5+'#,05-G7H5",
;'JDE?,
;@Q+##$"(*3,\",
1-H52"$H27H+f3,Y,
h$'2"($'-##"3,
:==F?,
^7)*+G$(,
&G#+9+#),
TKT,$2H(#*I,A"$',$C"JTEI,
SSL,."A$("I,'-'%M@,
*"##+'C,;1"(C+HA?,
S%A-'#7,N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,+'9-(9"2,#$+(-5"2,^&,$29+G",
C"'"5$#"2,9+$,H*"5,$**"**A"'#,$'2,+'G(H2"2,
(+'B*,#-,C-$(,*"##+'C,#--(*3,N""B(),Q($'*3,
.("Z+0+(+#),$'2,*#5"'C#7,"Z"5G+*"*3,2+*GH**+-',
.-5HA*,$'2,#$+(-5"2,"A$+(,.""20$GBI,#$5C"#"2,
0"7$9+-5R,("9"(*,-.,Q7)*+G$(,$G#+9+#)I,SSL,
5"#"'#+-',
#$+(-5"2,+'#"59"'#+-',N+#7,
5"Q"$#"2,#$+(-5"2,.""20$GB,
;'JEFK?,9*<,#$+(-5"2,
+'#"59"'#+-',N+#7,*+'C(",
#$+(-5"2,.""20$GB,;'JE:U?,9*<,
N$+#(+*#,G-'#5-(,;'JEK:?,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
42
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;@Q+##$"(*3,\",
1-H52"$H27H+f3,
15HC3,Y,
h$'2"($'-##"3,
:==F?,
^7)*+G$(,
&G#+9+#),
D:S,$2H(#*I,A"$',$C"JT=I,
KEL,."A$("I,'-'%M@,
*"##+'C,;1"(C+HA?,
>%N""B,N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,+'9-(9"2,#$+(-5"2,^&,$29+G",$'2,
+'2+9+2H$(+P"2,$G#+-',Q($'*,N+#7,D,*#$C"%0$*"2,
5"+'.-5G"A"'#,"A$+(*I,#$5C"#"2,0"7$9+-5*R,("9"(*,
-.,Q7)*+G$(,$G#+9+#),$'2,*"2"'#$5),0"7$9+-5*I,
F:L,5"#"'#+-',
;E?,-'(+'"%#$+(-5"2,Q7)*+G$(,
$G#+9+#),$29+G",i,*#$C"%0$*"2,
5"+'.-5G"A"'#,"A$+(*,
;'JEFT?,9*<,;:?,-'(+'"%
#$+(-5"2,Q7)*+G$(,$G#+9+#),
$29+G",-'(),;'JEFD?,9*<,;K?,
-'(+'",'-'%#$+(-5"2,*#$'2$52,
Q7)*+G$(,$G#+9+#),$29+G",
;'JEFF?,
;@#5"G7"53,
@7+..A$'3,Y,/"*#3,
:==D?,
@A-B+'C,
KUFE,-'(+'",G-'*HA"5*,-.,
'+G-#+'",Q$#G7I,A"$',
$C"JKFI,DFL,."A$("I,'-'%
M@,*"##+'C,;e'C($'2,Y,
85"($'2?,
E=%N""B,N"0%0$*"2,#$+(-5"2,*A-B+'C,G"**$#+-',
+'#"59"'#+-'I,+'9-(9"2,$,#$+(-5"2,N"0%0$*"2,
G"**$#+-',CH+2"3,#75"",*"OH"'#+$(,#$+(-5"2,N"0%
0$*"2,'"N*("##"5*,$'2,0"7$9+-5$(,*HQQ-5#,
A"**$C"*,2"(+9"5"2,9+$,"%,A$+(,-9"5,$,E=%N""B,
Q"5+-2I,#$5C"#"2,0"7$9+-5R,$0*#+'"'G",.5-A,
*A-B+'CI,DKL,5"#"'#+-',
#$+(-5"2,+'#"59"'#+-',
;'JEFDU?,9*<,C"'"5+G,
+'#"59"'#+-',;'JEFT:?,
;@N$5#P3,`-"((3,
@G75-"2"53,Y,&5)3,
:==S?,
@A-B+'C,
KDE,$2H(#*,N+((+'C,#-,
A$B",OH+#,$##"AQ#,+',K=,
2$)*I,A"$',$C"JT=I,T>L,
."A$("I,M@,*"##+'C,
N"0%0$*"2,#$+(-5"2,*A-B+'C,G"**$#+-',
+'#"59"'#+-'I,#7",#$+(-5"2,N"0*+#",G-H(2,0",
$GG"**"2,+',-'","Z#"'2"2,*"**+-',-5,AH(#+Q(",
#+A"*,-9"5,#7",U=%2$),+'#"59"'#+-',Q"5+-23,#7+*,
+'G(H2"2,#$+(-5"2,G-'#"'#3,+'2+9+2H$(+P"2,#+Q*,$'2,
OH+#,Q($',G$("'2$53,9+2"-,*"CA"'#*,$'2,"A$+(,
5"A+'2"5*I,#$5C"#"2,0"7$9+-5R,$0*#+'"'G",.5-A,
*A-B+'CI,DEL,5"#"'#+-',
#$+(-5"2,+'#"59"'#+-',;'JEF=?,
9*<,N$+#(+*#,G-'#5-(,;'JE>=?,
;4$#"3,c$GB9-')3,Y,
/+'C3,:==S?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#),
EU:,-9"5N"+C7#a-0"*",
$2H(#*I,A"$',$C"JTUI,
>TL,."A$("I,M@,*"##+'C,
S%A-'#7,N"0%0$*"2,#$+(-5"2,N"+C7#,(-**,
Q5-C5$AI,#7",+'#"5$G#+9",N"0*+#",+'G(H2"2,
N""B(),5"Q-5#*,$'2,C5$Q7*,*7-N+'C,N"+C7#,
G7$'C"*3,"A$+(,Q5-AQ#*3,"A$+("2,N"+C7#,(-**,#+Q*3,
5"G+Q"*,$'2,$GG"**,#-,$,N"+C7#%(-**,"%0H22),
'"#N-5B,*)*#"A,Q(H*,G-AQH#"5%$H#-A$#"2,
#$+(-5"2,.""20$GBI,#$5C"#"2,0"7$9+-5R,("9"(*,-.,
Q7)*+G$(,$G#+9+#),$'2,2+"#$5),0"7$9+-5*I,>EL,
5"#"'#+-',
;E?,#$+(-5"2,N"0*+#",-'(),
;'JSF?,9*<,,;:?,#$+(-5"2,
N"0*+#",N+#7,G-AQH#"5%
$H#-A$#"2,.""20$GB,;'JSE?,
9*<,;K?,#$+(-5"2,N"0*+#",N+#7,
7HA$',"A$+(,G-H'*"(+'C,
;'JST?,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
43
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;4",^-"(3,"#,$(<3,
:==U?,
@A-B+'C,
SED,$2H(#*,*A-B"5*I,A"$',
$C"JTSI,DSL,."A$("I,'-'%
M@,*"##+'C,;47",
`"#7"5($'2*?,
05+".,N"0%0$*"2,*A-B+'C,G"**$#+-',+'#"59"'#+-'I,
+AA"2+$#"(),$.#"5,G-AQ("#+'C,$,05+".%N"0%0$*"2,
$**"**A"'#3,Q$5#+G+Q$'#*,N"5",*"'#,"A$+(*,N+#7,
#$+(-5"2,.""20$GBI,#$5C"#"2,0"7$9+-5R,$0*#+'"'G",
.5-A,*A-B+'CI,TKL,5"#"'#+-',5$#",
#$+(-5"2,+'#"59"'#+-',;'J::T?,
9*<,'-'%#$+(-5"2,+'#"59"'#+-',
;'J:KT?,
;!<,6<,h$',\"',
1"5C,"#,$(<3,:==S?,
^7)*+G$(,
&G#+9+#),
ES=,Q7)*+G$((),+'$G#+9",]&,
Q$#+"'#*I,A"$',$C"JD=I,
SEL,."A$("I,'-'%M@,
*"##+'C,;47",`"#7"5($'2*?,
E:%A-'#7,N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,+'9-(9"2,$',+'2+9+2H$(+P"2,#5$+'+'C,
+'#"59"'#+-',5"OH+5+'C,N""B(),$G#+9+#),(-C*3,
Q"5*-'$(+P"2,Q5-C5$A,*G7"2H(",+'9-(9+'C,
2+.."5"'#,"Z"5G+*",$'2,Q7)*+G$(,$G#+9+#),
5"G-AA"'2$#+-',*HQQ-5#"2,0),N""B(),#$+(-5"2,
"A$+(*,.5-A,Q7)*+G$(,#7"5$Q+*#*3,$GG"**,#-,$,
2+*GH**+-',.-5HA,$'2,+'9+#$#+-'*,#-,$##"'2,.$G"%
#-%.$G",C5-HQ,A""#+'C*,"9"5),K,A-'#7*I,#$5C"#"2,
0"7$9+-5R,("9"(,-.,Q7)*+G$(,$G#+9+#)I,E==L,
5"#"'#+-',
N"0%0$*"2,+'2+9+2H$(+P"2,
#5$+'+'C,;'J>:?,9*<,;N"0%
0$*"2,C"'"5$(,#5$+'+'C,;'JF>?,
;h"57"+f2"',"#,$(<3,
:==T?,
`H#5+#+-'a\+"#,
ETS,Q$#+"'#*,N+#7,7+C7%
5+*B,.-5,Vh\I,A"$',
$C"JSKI,TDL,."A$("I,'-'%
M@,*"##+'C,;V$'$2$?,
>%A-'#7,N"0%0$*"2,#$+(-5"2,'H#5+#+-',
+'#"59"'#+-'I,#$+(-5"2,N"0*+#",+'G(H2"2,N""B(),
$**"**A"'#*,$'2,Q"5*-'$(+P"2,'H#5+#+-',
G-H'*"(+'C3,$GG"**,#-,Q""5,*HQQ-5#,9+$,$,
2+*GH**+-',.-5HA3,2+"#$5),.$#,+'#$B",(-C*3,$'2,
(+'B*,#-,-#7"5,5"*-H5G"*I,#$5C"#"2,0"7$9+-5R,
2+"#$5),.$#,5"2HG#+-'I,>SL,5"#"'#+-',
#$+(-5"2,+'#"59"'#+-',;'JFK?,
9*<,H*H$(,G$5",;'JFK?,
;/$''"53,!$5#+'%
\+"'"53,15$H'%
_$75($'2"53,1$H"53,
Y,!$5#+'3,:==U?,
^7)*+G$(,
&G#+9+#),
EKSU,$2H(#*I,A"$',
$C"JTTI,FDL,."A$("I,'-'%
M@,*"##+'C,;W"'"9$3,
@N+#P"5($'2?,
N"0%0$*"2,#$+(-5"2,Q7)*+G$(,$G#+9+#),
+'#"59"'#+-'I,+'9-(9"2,#$+(-5"2,N"0*+#",N+#7,
+'2+9+2H$(,$**"**A"'#*,("$2+'C,#-,*#$C"%A$#G7"2,
G-'#"'#3,#$+(-5"2,.""20$GB,$'2,+'2+9+2H$(+P"2,
"A$+(*,%,$22+#+-'$(,*HQQ-5#,#--(*3,*HG7,$*,
*#5"'C#7,$'2,*#5"#G7+'C,"Z"5G+*",*7""#*3,$'2,
-5C$'+P$#+-'$(,$'2,A-#+9$#+-'$(,.-5A*,N"5",
$9$+($0(",.-5,2-N'(-$2I,#$5C"#"2,0"7$9+-5R,("9"(*,
-.,Q7)*+G$(,$G#+9+#)I,FU<:L,5"#"'#+-',5$#",
#$+(-5"2,N"0*+#",;'JS>E?,9*<,
'-'%#$+(-5"2,N"0*+#",;'JS>>?,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
44
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;/+((+$A*-',"#,$(<3,
:==S?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#),
KF,-9"5N"+C7#,&&,."A$(",
$2-("*G"'#*I,N+#7,$#,("$*#,
E,-0"*",Q$5"'#,A"$',
$C"JEKI,E==L,."A$("I,M@,
*"##+'C,
:T%A-'#7,N"0%0$*"2,#$+(-5"2,N"+C7#,(-**,
Q5-C5$A,.-5,-9"5N"+C7#,&.5+G$'%&A"5+G$',
."A$(",$2-("*G"'#*I,+'9-(9"2,$,#$+(-5"2,0"7$9+-5,
#7"5$Q),N"0*+#",N+#7,*"(.%A-'+#-5+'C,#--(*3,C-$(%
*"##+'C,#--(*3,+'#"5$G#+9",$G#+9+#+"*,$'2,"A$+(,
*HQQ-5#I,#$5C"#"2,0"7$9+-5R,Q7)*+G$(,$G#+9+#),$'2,
2+"#$5),0"7$9+-5*I,F=L,5"#"'#+-',
#$+(-5"2,*+#",;'J'-#,5"Q-5#"2?,
9*<,C"'"5+G,*+#",;'J'-#,
5"Q-5#"2?,
;/+'"##,"#,$(<3,
EUUU?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#),
E>=,."A$(",7+C7,
*G7--("5*I,A"$',$C"JEDI,
E==L,."A$("I,M@,*"##+'C,
N"0%0$*"2,#$+(-5"2,'H#5+#+-',+'#"59"'#+-'I,
+'9-(9"2,D3,ED%:=,A+'H#",+'#"5$G#+9",#$+(-5"2,
A-2H("*,N+#7,-'(+'",$**"**A"'#*,$'2,
Q"5*-'$(+P"2,.""20$GB,Q5-9+2"2,+',#"Z#,$'2,
C5$Q7+G*,.-5A*I,#$5C"#"2,0"7$9+-5*R,2+"#$5),
0"7$9+-5*,$'2,("9"(,-.,Q7)*+G$(,$G#+9+#)I,E==L,
5"#"'#+-',
#$+(-5"2,+'#"59"'#+-',;'JE=K?,
9*<,'-%#5"$#A"'#,G-'#5-(,
;H*H$(,G($**"*?,;'JFF?,
;/+'"##3,&'2"5*-'3,
/-fG+B3,/+'"##3,Y,
1-N2"'3,:==F?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#),
E=FE,-9"5N"+C7#a-0"*",
$2H(#*I,A"$',$C"JDEI,
FFL,."A$("I,M@,*"##+'C,
E:%N""B,N"0%0$*"2,#$+(-5"2,'H#5+#+-',$'2,
Q7)*+G$(,$G#+9+#),+'#"59"'#+-'I,+'9-(9"2,$,E:%
A-2H(",#$+(-5"2,N"0*+#",%,"$G7,A-2H(",H*"2,ED,
#-,:=,*G5""'*,N+#7,*#5"$A+'C,$H2+-3,#--B,D,#-,
E=A+',#-,G-AQ("#"3,$'2,+'G(H2"2,Q5-C5$A,
+'#"5$G#+-'*,$'2,$,'$55$#-5,jjCH+2"kk3,$(*-,
+'G(H2"2,-'(+'",$**"**A"'#*3,9+2"-3,C-$(,$'2,*"(.%
A-'+#-5+'C,#--(*I,#$5C"#"2,0"7$9+-5R,2+"#$5),
0"7$9+-5*,$'2,Q7)*+G$(,$G#+9+#)I,>UL,5"#"'#+-',
#$+(-5"2,N"0*+#",;'JKST?,9*<,
#$+(-5"2,N"0*+#",Q(H*,Q""5,
*HQQ-5#,;'JKST?,9*<,N$+#(+*#,
G-'#5-(,;'JKTK?,
;/-A0(","#,$(<3,
:==T?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#),
TF,-9"5N"+C7#a-0"*",
N-A"'I,A"$',$C"JTTI,
E==L,."A$("I,M@,*"##+'C,
D:%N""B,G-AA"5G+$(3,N"0%0$*"2,#$+(-5"2,N"+C7#,
(-**,+'#"59"'#+-'I,+'9-(9"2,$GG"**,#-,$',-'(+'",
G-AA"5G+$(,N"+C7#,(-**,Q5-C5$A,#7$#,+'G(H2"2,
#$+(-5"2,2+"#,Q($'*3,GH*#-A+P"2,C5-G"5),(+*#*3,
$'+A$#"2,.+#'"**,+'*#5HG#-53,-'(+'",*-G+$(,
*HQQ-5#3,0+%N""B(),"A$+(,'"N*("##"5*,$'2,"A$+(,
5"A+'2"5*I,#$5C"#"2,0"7$9+-5*R,2+"#$5),0"7$9+-5*,
$'2,("9"(,-.,Q7)*+G$(,$G#+9+#)I,SSL,5"#"'#+-',
"\+"#*<G-A,;'J:K?,-5,
G-AA"5G+$(,#$+(-5"2,N"0*+#",
9*<,N"+C7#,(-**,A$'H$(,;'J:T?,
!"#$%&'$()*+*,-.,/"0%1$*"23,4$+(-5"2,6"$(#7,8'#"59"'#+-'*,
45
Study&
Focus&
Sample&Characteristics&
Intervention&Characteristics&
Conditions&
;/--(.,"#,$(<3,:==S?,
`H#5+#+-'a\+"#I,
^7)*+G$(,
&G#+9+#)I,
@A-B+'CI,
&(G-7-(+*A,
:FK,$2H(#*I,A"$',$C"J,
'-#,5"Q-5#"2I,L,."A$(",
'-#,5"Q-5#"2I,M@,*"##+'C,
U%A-'#7,N"0%0$*"2,#$+(-5"2,7"$(#7,0"7$9+-5,
+'#"59"'#+-'I,#7",N"0*+#",N$*,#$+(-5"2,0$*"2,-',
H*"5*l,7"$(#7,0"7$9+-5*,$'2,5"$2+'"**,#-,G7$'C",
$'2,+'G(H2"2,#$+(-5"2,7"$(#7,$29+G",$'2,
GH*#-A+P"2,(+'B*,#-,5"*-H5G"*I,#$5C"#"2,
0"7$9+-5*R,("9"(*,-.,,Q7)*+G$(,$G#+9+#)3,2+"#$5),
0"7$9+-5*3,#-0$GG-,H*"3,$(G-7-(,G-'*HAQ#+-'I,
:UL,5"#"'#+-',5$#",
Q5"%Q-*#,2"*+C',
,
Meta-Analysis
46
Table 3
Summary of Characteristics of the 40 Studies
Study Characteristic
k
%
Target Population
General population
26
65
Children
7
18
Patients (diagnosed with condition)
6
15
Students
1
2
Total
40
100
Gender
Female
5
12
Male
0
0
Both (mean proportion = 63% female)
35
88
Total
40
100
Behaviors
Single Behavior
29
73
Multiple Behaviors
11
27
Total
40
100
Behaviors
Physical Activity
23
42
Nutrition/Diet
14
25
Smoking/Tobacco
10
18
Drinking
5
9
Medication Adherence (Asthma management)
1
2
Stress Management
1
2
Fecal Soiling (Encopresis)
1
2
Total
55
100
Behavioral Theories
Stages of Change/Transtheoretical Model
11
50
Social Cognitive Theory
8
36
Health Belief Model
6
27
Theory of Reasoned Action/Planned Behavior
3
14
Precaution Adoption Process Model
2
9
Social Comparison Theory
2
9
Decisional Balance
2
9
I-Change Model
1
5
Problem Behavior Model
1
5
Elaboration Likelihood Model
1
5
Goal Theory
1
5
Meta-Analysis
47
Self-Determination Theory
1
5
Total
39
---
Note: k = number of studies. The behavioral theories sum to more than 100 because some
studies used more than 1 theory.
Meta-Analysis
48
Table 4
Sample Size-Weighted Effect Sizes by Participant/Descriptive Moderating Variables
Variable
k
d
95% CI
p
QB
Population Type
General population
26
.181
[.148, .214]
***
Children
7
-.007
[-.068, .054]
NS
Patients
6
.140
[.037, .244]
*
***
Country of Sample
United States
22
.182
[.141, .223]
***
Non-US
18
.101
[.063, .139]
***
**
Gender
Mixed samples
35
.140
[.111, .168]
***
Female Samples
5
.102
[-.088, .292]
NS
NS
Single Vs. Multiple Behavior
Single
30
.146
[.113, .180]
***
Multiple
10
.121
[.070, .172]
***
NS
Single Behavior Studies
Smoking/Tobacco
8
.152
[.110, .193]
***
Nutrition/Diet
4
.223
[.118, .328]
***
Physical Activity
12
.059
[-.020, .138]
NS
Drinking
3
.081
[-.088, .251]
NS
NS
Note: k = number of studies, d = sample size-weighted mean effect size,
CI = Confidence Interval, NS = non-significant.
*p<.05; **p<.01; ***p<.001
Meta-Analysis
49
Table 5
Sample Size-Weighted Effect Sizes by Tailoring Strategies
Variable
k
d
95% CI
p
QB
No. of Tailoring
Assessments1
Baseline
11
.194
[.136, .252]
***
Iterative
10
.140
[.098, .182]
***
NS
User Control
Expert led
8
.159
[.070, .247]
***
Self guided
32
.137
[.107, .166]
***
NS
Note: k = number of studies, d = sample size-weighted mean effect size,
CI = Confidence Interval, NS = non-significant. 1This variable was tested using the
follow-up data (N=21) to allow enough time for baseline vs. iterative assessment to have
an impact.
*p<.05; **p<.01; ***p<.001
Meta-Analysis
50
Table 6
Sample Size-Weighted Effect Sizes by Methodological Moderating Variables
Variable
k
d
95% CI
p
QB
Study Design
Randomized controlled trial
31
.159
[.127, .190]
***
Quasi-experimental
9
.066
[.006, .126]
*
**
Comparison Condition
No treatment control
18
.071
[.027, .115]
**
Non-tailored website
18
.188
[.152, .225]
***
Non-tailored print materials
4
.078
[-.107, .264]
NS
***
Note: k = number of studies, d = sample size-weighted mean effect size,
CI = Confidence Interval, NS = non-significant.
*p<.05; **p<.01; ***p<.001
Meta-Analysis
51
Appendix(B:(Figures(
Figure 1. Summary of the selection process used in the meta-analysis.
Meta-Analysis
52
Figure 2. Forest plot displaying effect sizes and 95% confidence intervals for all 40
studies (short term effects).
!
Meta-Analysis
53
Figure 3. Forest plot displaying effect sizes and 95% confidence intervals for the 21
studies reporting long term effects.
!
!
... Decision aids promote positive health behavior change, improve health outcomes and mitigate health literacy barriers. Relatively little work has been conducted to understand the decision-making process among racial/ ethnic minority women recommended for genetic counseling for breast cancer risk, or to develop culturally-tailored decision aids to promote uptake of genetic services [27,[29][30][31][32][33]. The tools developed to date are primarily to supplement information provided in genetic counseling sessions, are largely print or telephone-based, are often not developed with input from end-users, do not support familial communication, and for the most part are not targeted to specific cultural groups [27,30,34,35]. ...
Article
Full-text available
Background Despite the benefits of genetic counseling and testing, uptake of cancer genetic services is generally low and Black/African American (Black) women are substantially less likely to receive genetic services than non-Hispanic White women. Our team developed a culturally sensitive, narrative decision aid video to promote uptake of genetic counseling among Black women at risk for a hereditary breast cancer syndrome that can be incorporated in conjunction with population-based cancer risk assessment in a clinical setting. We report here a pilot study to demonstrate changes in intention to access genetic counseling and intervention satisfaction. Methods Black women who were personally unaffected by breast cancer and were recommended for genetic counseling based on family history screening in a mammography center were recruited at the time of the mammogram. A prospective, pre-post survey study design, guided by theoretical constructs, was used to evaluate baseline and immediate post-intervention psychosocial factors, including intention to participate in genetic counseling and intervention satisfaction. Results Pilot recruitment goals were met (n = 30). Pre-intervention, 50% of participants indicated that they were extremely likely to make a genetic counseling appointment, compared with 70% post-intervention (p = 0.05). After watching the intervention, 50% of participants indicated that the video changed their mind regarding genetic counseling. Conclusions This study demonstrated cultural satisfaction with a decision aid intervention designed to motivate Black women with hereditary breast cancer risk to attend a genetic counseling appointment. Our study showed that intention may be a specific and key construct to target in interventions designed to support decision-making about genetic services. Study results informed the design of a subsequent large scale, randomized implementation study. Trial registration Trial registration: Clinicaltrials.govNCT04082117. Registered September 9, 2019. Retrospectively registered.
... To join the fight against the global prevalence of physical inactivity, technological innovations need to motivate individuals who are not sufficiently active to incorporate regular exercise into their daily routine. Research has shown that interactive technology can incite desirable health behavior change (HBC) in terms of healthy nutrition, regular physical activity, and disease management, among others [33,47]. Ultimately though, physical activity interventions are the most prevalent among all HBC technological interventions, accounting for more than 1 out of 3 publications in the related literature [17]. ...
Preprint
Full-text available
Despite the indisputable personal and societal benefits of regular physical activity, a large portion of the population does not follow the recommended guidelines, harming their health and wellness. The World Health Organization has called upon governments, practitioners, and researchers to accelerate action to address the global prevalence of physical inactivity. To this end, an emerging wave of research in ubiquitous computing has been exploring the potential of interactive self-tracking technology in encouraging positive health behavior change. Numerous findings indicate the benefits of personalization and inclusive design regarding increasing the motivational appeal and overall effectiveness of behavior change systems, with the ultimate goal of empowering and facilitating people to achieve their goals. However, most interventions still adopt a "one-size-fits-all" approach to their design, assuming equal effectiveness for all system features in spite of individual and collective user differences. To this end, we analyze a corpus of 12 years of research in self-tracking technology for health behavior change, focusing on physical activity, to identify those design elements that have proven most effective in inciting desirable behavior across diverse population segments. We then provide actionable recommendations for designing and evaluating behavior change self-tracking technology based on age, gender, occupation, fitness, and health condition. Finally, we engage in a critical commentary on the diversity of the domain and discuss ethical concerns surrounding tailored interventions and directions for moving forward.
... 31 Results from another study in the US mid-west found that AI/ANs commonly use computers to seek health information. 37,38 Future research might focus on disseminating AD brochures or websites that contain information explicitly drawn from and featuring AI/AN doctors and health professionals working in the field of AD research. ...
Article
Full-text available
Introduction American Indian and Alaska Native (AI/AN) people infrequently participate in Alzheimer's disease (AD) research, despite the rapidly increasing population of AI/AN people aged 65 and older. Methods We surveyed 320 adults who identified as AI/AN at two Native-focused events and used ordinary least squares regression and logistic regression models to test associations between demographic factors and perceived risk of AD, knowledge about AD, and willingness to participate in research, along with preferred source of AD information. Results Willingness to participate in research was highest among those living in a city versus reservation and associated with perceived personal risk for AD. Health professionals and the internet were preferred sources of information about AD. Discussion These hypothesis-generating results provide insight into perceptions of AD and willingness to participate in research. Conclusions could inform development of AD recruitment strategies for AI/ANs and influence participation in AD research.
... Previous research suggests that SMIs may be effective and lead to better patient outcomes and less health care use (9)(10)(11). Literature also shows self-management supporting interventions are more effective when they are tailored to a patient's individual needs and preferences as there is a vast variation in the extent to which patients are able and motivated to self-manage (12)(13)(14). ...
Article
Full-text available
Background:For many chronically ill patients self-management of their disease is difficult. This may be especially true for people with limited health literacy as they are faced with additional challenges in the day-to-day management of their disease. Research has shown that self-management support is most effective when tailored to the needs and preferences of patients. Therefore, this study explores the preferences regarding self-management outcomes of chronically ill patients with limited health literacy.MethodsA total of 35 patients with limited health literacy were invited to a concept-mapping procedure consisting of two card sorting tasks. Patients ranked 60 outcomes, which are often found in literature in relation to self-management, to the level that was important for themselves. Means were calculated for each outcome and domain, and differences within the group were analyzed.ResultsFor patients with limited health literacy, satisfaction with care is the most important outcome domain. This domain includes overall satisfaction, the communication with health care providers, the provision of information and trust. At an outcome level, outcomes related to symptom management and improving competences to self-management scored very high. No differences between patient groups for age and sex were found.Conclusion Chronically ill patients with limited health literacy prefer a wide variety of outcomes for their self-management. Next to health related outcomes, patients mostly prefer to work on their competences for self-management. For health care professionals, acting on these patient preferences and building a solid relationship will enhance successful self-management.
... Since the GA + intervention was not tailored to prior knowledge and physical abilities, participants often mentioned that they were already aware of the provided information and that the intervention insufficiently considered physical impairments. Previous research suggests that health-promoting messages and interventions are more effective if tailored to individual needs or targeted to specific subgroups because such messages command greater attention, contain less redundant information, and enhance the personal relevance of information [57][58][59]. Regarding differences between subgroups, we found that the intervention differently impacted men versus women. Web-based interventions may especially interest women, as women are more likely than men to participate in web-based physical activity interventions [55]. ...
Article
Full-text available
Background Promoting active (i.e., conscious, autonomous, informed, and value-congruent) choices may improve the effectiveness of physical activity interventions. This web-based four-arm experimental study investigated the effect of promoting an active versus passive choice regarding physical activity on behavioural and psychological outcomes (e.g., physical activity intentions and behaviours, autonomy, commitment) among physically inactive adults. Methods Dutch inactive adults were randomized into four groups: physical activity guideline only (control group G), guideline & information (GI), guideline & active choice (GA), or guideline & active choice & action planning (GA +). GA and GA + participants were stimulated to make an active choice by weighing advantages and disadvantages of physical activity, considering personal values, and identifying barriers. GA + participants additionally completed action/coping planning exercises. Passive choice groups G and GI did not receive exercises. Self-reported behavioural outcomes were assessed by a questionnaire pre-intervention (T0, n = 564) and at 2–4 weeks follow-up (T2, n = 493). Psychological outcomes were assessed post-intervention (T1, n = 564) and at follow-up. Regression analyses compared the outcomes of groups GI, GA and GA + with group G. We also conducted sensitivity analyses and a process evaluation. Results Although promoting an active choice process (i.e., interventions GA and GA +) did not improve intention (T1) or physical activity (T2 versus T0), GA + participants reported higher commitment at T1 (β = 0.44;95%CI:0.04;0.84) and more frequently perceived an increase in physical activity between T0 and T2 (β = 2.61;95%CI:1.44;7.72). GA participants also made a more active choice at T1 (β = 0.16;95%CI:0.04;0.27). The GA and GA + intervention did not significantly increase the remaining outcomes. GI participants reported higher intention strength (β = 0.64;95%CI:0.15;1.12), autonomy (β = 0.50;95%CI:0.05;0.95), and commitment (β = 0.39;95%CI:0.04;0.74), and made a more active choice at T1 (β = 0.13;95%CI:0.02;0.24). Interestingly, gender and health condition modified the effect on several outcomes. The GA + intervention was somewhat more effective in women. The process evaluation showed that participants varied in how they perceived the intervention. Conclusions There is no convincing evidence of a beneficial effect of an active versus passive choice intervention on physical activity intentions and behaviours among inactive adults. Further research should determine whether and how active choice interventions that are gender-sensitized and consider health conditions can effectively increase physical activity. Trial registration ClinicalTrials.gov: NCT04973813. Retrospectively registered.
Article
Background According to the Elaboration Likelihood Model, persuasion can occur via two different routes (the central route and peripheral route), with the route utilized dependent on factors associated with motivation and ability. This study aimed to explore the moderating role of need for cognition (NFC) and perceived relevance on the processing of physical activity messages designed to persuade via either the central route or the peripheral route. Method Participants ( N = 50) were randomized to receive messages optimized for central route processing or messages optimized for peripheral route processing. Eye-tracking devices were used to assess attention, which was the primary outcome. Message perceptions and the extent of persuasion (changes in physical activity determinants) were also assessed via self-report as secondary outcomes. Moderator effects were examined using interaction terms within mixed effects models and linear regression models. Results There were no detected interactions between condition and NFC for any of the study outcomes (all p s > .05). Main effects of personal relevance were observed for some self-report outcomes, with increased relevance associated with better processing outcomes. An interaction between need for cognition and personal relevance was observed for perceived behavioral control ( p = 0.002); greater relevance was associated with greater perceived behavioral control for those with a higher need for cognition. Conclusion Matching physical activity messages based on NFC may not increase intervention efficacy. Relevance of materials is associated with greater change in physical activity determinants and may be more so among those with a higher NFC.
Article
Objective: Informal male caregivers of women with breast cancer have significant psychological, emotional, and social burdens that are inadequately addressed by current face-to-face interventions. Online interventions overcome barriers that limit engagement with face-to-face interventions. This study aimed to develop the contents of Care Assist, an online supportive care resource for male caregivers of breast cancer patients, through expert consensus. Methods: A Delphi study comprising two survey rounds and an expert consultation was conducted. In Round 1, experts in breast cancer care rated the importance of 25 content items. In Round 2, they re-rated content items that failed to reach consensus (i.e. 80% agreement) in Round 1 or were newly developed. Free-text responses were also collected. During expert consultation, the resource was reviewed and revised for clarity. Iterative refinement followed all rounds. Quantitative data was analysed descriptively, and qualitative data was analysed using content analysis. Results: Twenty-two experts participated and reached consensus on 96% of items, with 217 comments provided on: (a) the perceived benefits of Care Assist to caregivers and care recipients, (b) recommendations of newly suggested content items, wording, and use of external links, and (c) concerns regarding information overload and need for tailoring. The expert consultation comments focused on clarifying scope, wording, and information tailoring. Conclusion: The rigorous Delphi process resulted in the content for a comprehensive online supportive care intervention for male caregivers. Information overload can be minimised through self-identification of needs and utilisation of eHealth to personalise the resource for the heterogeneous male caregiver population. This article is protected by copyright. All rights reserved.
Article
Background: Internet-based interventions (IBIs) are as efficient as face-to-face psychotherapy for a variety of mental health disorders, including complicated grief. Most evidence stems from guided IBIs. However, recent research indicates that the benefit of guidance is lower in more interactive IBIs. As such, providing guidance only to people requiring it (guidance on demand) appears a cost-effective solution. This is particularly important to develop given the recent rise in grief symptoms in the context of the COVID-19 pandemic. This paper presents the protocol of a randomized controlled trial comparing the efficacy and adherence rate of 2 IBIs for grief-related symptoms after the loss a close one following death or romantic separation, using a guidance on demand framework. LIVIA 2.0 was developed based on theoretical and empirical findings on grief processes and IBIs, and it will be compared to LIVIA 1 that has already demonstrated its efficacy. Objective: Our main hypotheses are that LIVIA 1 (control condition) and LIVIA 2.0 (experimental condition) increase participants' well-being and decrease their distress at posttest and at follow-up, that LIVIA 2.0 is more efficient than LIVIA 1 for all outcomes, and that LIVIA 2.0 has less dropouts than LIVIA 1. Methods: Outcomes will be assessed at pretest, posttest (12 weeks later), and follow-up (24 weeks later). We will recruit 234 participants through a variety of means, including social media and contacts with the press. Primary outcomes are grief symptoms, depressive symptoms, and eudemonic well-being. Secondary outcomes are anxiety symptoms, grief coping strategies, aspects related to self-identity reorganization, and program satisfaction. LIVIA 2.0 participants will additionally undergo a weekly mood and grief symptom monitoring, allowing us to explore the short-term efficacy of the sessions. Results: The creation and development of the content of LIVIA 2.0 was completed during the first phase of the project. Participant recruitment will begin in May 2022 and will last until January 2023. Conclusions: This study will emphasize the relevance of the innovations included in LIVIA 2.0 regarding the efficacy and dropout rate of IBIs for grief symptoms and will allow investigations on how these changes impact the demand for guidance. In the current postpandemic times, developing and assessing IBIs targeting grief symptoms are particularly critical given the rise in grief-related symptoms. Trial registration: clinicaltrials.gov NCT05219760; https://tinyurl.com/3dzztjts. International registered report identifier (irrid): PRR1-10.2196/39026.
Chapter
This chapter describes the development of a theory-driven and evidence-based digital intervention to facilitate self-care in older adults with Type 2 Diabetes (T2D) and, additionally, its contribution to healthy aging and the individual care plan. T2D is highly prevalent in older adults. Difficulties in adopting and maintaining desirable self-care behaviors is associated with lack of glycemic control and subsequent complications, which significantly burden patients, their families, and the health system. The VASelfCare (Virtual Assistant Self-Care) intervention is a software application that provides an interface with a 3D anthropomorphic virtual assistant targeting three key self-care behaviors: medication-taking, physical activity, and a healthy diet. Other VASelfCare elements are intended for nurses providing diabetes consultations, including a web-based back-office with a patient data dashboard, which streamlines integration of care. The application prototype has been co-produced with older adults with T2D, primary care health professionals, and other stakeholders.
Article
Full-text available
This chapter provides an overview of the literature on tailored health communication messages, an innovative area of health communication research that has broad applicability to other areas of communication. Unlike traditional message targeting practices, which operate at the group level, tailored interventions involve the development of persuasive health communications designed for (and based upon an assessment of) the individual. We introduce tailoring and discuss the historical context of message tailoring research. We then provide a broad review of seminal and more recent message tailoring studies. Next, we discuss the mechanisms through which tailored messages may exert their effects, reviewing theoretical perspectives as well as empirical data. Finally, we consider future directions for research on tailored health communication.
Article
Issue addressed: Potentially modifiable risk factors such as high body mass, physical inactivity and poor nutrition are, when combined, the largest contributors to the preventable burden of disease in Australia. Computer-tailoring has shown promise in modifying lifestyle risk factors. This paper describes a narrative systematic review examining the evidence for 'second' generation computer-tailored primary prevention weight reduction interventions. Method: Studies published from January 1996-2008 were identified through electronic databases and searches of reference lists of relevant articles. Only randomised controlled trials or quasi-experimental designs with pretest and post-test weight reduction outcome data were included. Results: Six articles were identified, three of which reported significant positive effects. The intervention intensity and duration, method of tailoring and theory used differed. The internal validity was good but external validity poor for the majority of studies. Conclusions: The evidence of effectiveness for computer-tailored primary prevention interventions for weight reduction is limited to a small number of heterogeneous studies. There is uncertainty whether reported effects are generalisable and sustained. The relative success of different components of efficacious interventions and the optimal intervention intensity and tailoring methods are unclear.
Article
In more and more medical settings, physicians have less and less ti me to be effective communicators. To be effective, they need accurate, current information about their patients. Tailored health communications can facilitate positive patient-provider communications and foster behavioral changes conducive to health. Tailored communications (TCs) are produced for an individual based on information about that person. The focus of this report is on tailored print communications (TPCs). TPCs also enhance the process of evaluation, because they require a database and the collection of patient-specific information. We present a Tailoring Model for Primary Care that describes the steps involved in creating TPCs. We also provide examples from three ongoing studies in which TPCs are being used in order to illustrate the kinds of variables used for tailoring the products that are developed and how evaluation is conducted. TPCs offer opportunities to expand the reach of health professionals and to give personalized, individualized massages in an era of shrinking professional contact time.
Article
American children continue to be less physically active than they were a decade ago. Web-based programs (e-Learning), requiring minimal teacher training and expertise, could contribute to improvements in children's health-related knowledge, attitudes and behaviors. The purpose of this study was to evaluate the impact of the e-Learning module Healthy Hearts 4 Kids (HH) on the physical activity knowledge, attitudes and behaviors of 233 fifth grade children. A 2×3 repeated measures design was employed and significant changes in knowledge and attitude were found upon completion of the module and also six weeks after the post-test was completed. Results of this study suggest HH could be an effective component of a coordinated school health program (CSHP).