Yunkyoung Lee; Hyun-Hee Kim; Yang-Sook Ko

doi:10.4163/jnh.2015.48.6.530

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Lee, Kim, and Ko: Perception on food allergy labelling and management of nutritional education among higher grade elementary school students in Jeju area∗

Research Article

J Nutr Health 2015;48(6):530-541.

Published online: 19 January 2015

DOI: https://doi.org/10.4163/jnh.2015.48.6.530

Perception on food allergy labelling and management of nutritional education among higher grade elementary school students in Jeju area^∗

Yunkyoung Lee, Hyun-Hee Kim, Yang-Sook Ko^†

Department of Food Science and Nutrition, Jeju National University, Jeju 63243, Korea

^†To whom correspondence should be addressed. tel: +82-64-754-3553, e-mail: yangsook@jejunu.ac.kr

^∗ This work was supported by the 2015 scientific promotion program funded by Jeju National University.

Received 8 October 2015 Revised 28 October 2015 Accepted 17 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study was conducted to examine the prevalence of food allergy, food allergy knowledge, and perception on food allergen labelling along with management of substitute meals in school foodservice in elementary school students in Jeju, South Korea.

Methods:

Six elementary schools in Jeju-si were randomly selected, and the higher grade elementary school students (n=1,500), from fourth graders to sixth graders, were surveyed using a questionnaire in July 2014. A total of 1,000 responses were used for data analysis.

Results:

The percentage of students who had experienced food allergy was 16.7%; 26.4% had been diagnosed as having a food allergy by doctors. Milk, crabs, and shrimps were the most frequent allergenic foods with common symptoms including urticaria followed by itching, and vomiting. As the student's grade went up, the knowledge scores on food allergy showed a significant increase. Although students with and without food allergy experience had a similar level of knowledge on food allergy and perception on food allergen labelling, students with food allergy experience had a significantly lower level of healthy dietary practices. Last, only 20.4% of students with food allergies were offered substitute meals by school foodservices, and 30.8% of students received food allergy education.

Conclusion:

For prevention and management of food allergies in school foodservice, schools should provide an individualized substitute meal plan and food allergy education to students, parents, and teachers.

Keywords: elementary school students, food allergies, food allergen labelling, school meal, nutritional education

REFERENCES

1.Sicherer SH., Sampson HA. Food allergy. J Allergy Clin Immunol. 2010. 125(2 Suppl 2):S116–S125.

2.Moneret-Vautrin DA., Kanny G., Morisset M., Flabbee J., Guénard L., Beaudouin E., Parisot L. Food anaphylaxis in schools: evaluation of the management plan and the efficiency of the emergency kit. Allergy. 2001. 56(11):1071–1076.

3.Branum AM., Lukacs SL. Food allergy among children in the United States. Pediatrics. 2009. 124(6):1549–1555.

4.Hong SJ., Ahn KM., Lee SY., Kim KE. The prevalences of asthma and allergic diseases in Korean children. Korean J Pediatr. 2008. 51(4):343–350.

5.Gupta RS., Springston EE., Warrier MR., Smith B., Kumar R., Pon-gracic J., Holl JL. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011. 128(1):e9–e17.

6.Sicherer SH., Sampson HA. Food allergy: epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol. 2014. 133(2):291–307.

7.Kim WK. Diagnosis and treatment of food allergy in children. Pediatr Allergy Respir Dis. 2006. 16(4):274–283.

8.Lim DH. Epidemiology of anaphylaxis in Korean children. Korean J Pediatr. 2008. 51(4):351–354.

9.Lim DH. Food anaphylaxis. Korean J Asthma Allergy Clin Immunol. 2010. 30(2):91–92.

10.Sampson HA. Food allergy. Part 1: immunopathogenesis and clinical disorders. J Allergy Clin Immunol. 1999. 103(5 Pt 1):717–728.

11.Lee AH., Kim KE., Lee KE., Kim SH., Wang TW., Kim KW., Kwak TK. Prevalence of food allergy and perceptions on food allergen labeling in school foodservice among Korean students. Allergy Asthma Respir Dis. 2013. 1(3):227–234.

12.Sampson MA., Muñoz-Furlong A., Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol. 2006. 117(6):1440–1445.

13.Gendel SM. Comparison of international food allergen labeling regulations. Regul Toxicol Pharmacol. 2012. 63(2):279–285.

14.Ministry of Education (KR). Statistics on school foodservice. Seoul: Ministry of Education;2011.

15.Ahn K. Food allergy: diagnosis and management. Korean J Asthma Allergy Clin Immunol. 2011. 31(3):163–169.

16.Seo WH., Jang EY., Han YS., Ahn KM., Jung JT. Management of food allergies in young children at a child care center and hospital in Korean. Pediatr Allergy Respir Dis. 2011. 21(1):32–38.

17.Kim S., Yoon J., Kwon S., Kim J., Han Y. Current status of managing food allergies in schools in Seoul, Korea. J Child Health Care. 2012. 16(4):406–416.

18.Ministry of Education, Science and Technology (KR). Perception of allergenic school food manual. Seoul: Ministry of Education, Science and Technology;2012.

19.Ministry of Food and Drug Safety (KR). Allergenic food labeling act 2013-132. Cheongju: Ministry of Food and Drug Safety;2013.

20.Lee SY., Kim KW., Ahn K., Kim HH., Pyun BY., Park YM., Kim KE. Consumer's use and satisfaction of allergic food labels. Pediatr Allergy Respir Dis. 2011. 21(4):294–301.

21.Kim YG., Yu KH., Ly SY. Perception of elementary school parents in Gyeongbuk area on allergenic food labeling system and children's food allergy status. Korean J Hum Ecol. 2013. 22(5):491–506.

22.Choi Y., Ju S., Chang H. Food allergy knowledge, perception of food allergy labeling, and level of dietary practice: a comparison between children with and without food allergy experience. Nutr Res Pract. 2015. 9(1):92–98.

23.Jeong KJ., Ly SY. Current status and food allergy related-dietary behaviors of atopy and asthma-friendly elementary school students in the Chungnam area. Korean J Hum Ecol. 2015. 24(1):123–135.

24.Chung SJ., Han YS., Chung SW., Ahn KM., Park HY., Lee SI., Cho YY., Choi HM. Marasmus and kwashiorkor by nutritional ignorance related to vegetarian diet and infants with atopic dermatitis in South Korea. Korean J Nutr. 2004. 37(7):540–549.

25.Park JY., Park GY., Han YS., Shin MY. Survey of food allergy in elementary school children in Bucheon-city and relationship between food allergy and other allergic diseases. Allergy Asthma Respir Dis. 2013. 1(3):266–273.

26.Oh JW., Pyun BY., Choung JT., Ahn KM., Kim CH., Song SW., Son JA., Lee SY., Lee SI. Epidemiological change of atopic dermatitis and food allergy in school-aged children in Korea between 1995 and 2000. J Korean Med Sci. 2004. 19(5):716–723.

27.Hong S. Korean ISAAC Study Group of Korean Association of Allergy and Respiratory Diseases. Report of Korean ISAAC epidemiologic study for asthma and allergic diseases in children. Pediatr Allergy Respir Dis. 2007. 17(Suppl 1):55–66.

28.Chen W., Mempel M., Schober W., Behrendt H., Ring J. Gender difference, sex hormones, and immediate type hypersensitivity reactions. Allergy. 2008. 63(11):1418–1427.

29.Schäfer T., Böhler E., Ruhdorfer S., Weigl L., Wessner D., Heinrich J., Filipiak B., Wichmann HE., Ring J. Epidemiology of food allergy/food intolerance in adults: associations with other manifestations of atopy. Allergy. 2001. 56(12):1172–1179.

30.Rancé F., Kanny G., Dutau G., Moneret-Vautrin DA. Food hypersensitivity in children: clinical aspects and distribution of allergens. Pediatr Allergy Immunol. 1999. 10(1):33–38.

31.Lee AJ., Thalayasingam M., Lee BW. Food allergy in Asia: how does it compare? Asia Pac Allergy. 2013. 3(1):3–14.

32.Yang SH., Kim EJ., Kim YN., Seong KS., Kim SS., Han CK., Lee BH. Comparison of eating habits and dietary intake patterns between people with and without allergy. Korean J Nutr. 2009. 42(6):523–535.

33.Barth GA., Weigl L., Boeing H., Disch R., Borelli S. Food intake of patients with atopic dermatitis. Eur J Dermatol. 2001. 11(3):199–202.

34.Flammarion S., Santos C., Guimber D., Jouannic L., Thumerelle C., Gottrand F., Deschildre A. Diet and nutritional status of children with food allergies. Pediatr Allergy Immunol. 2011. 22(2):161–165.

35.Min S., Cho M., Park K. Risk factors for allergic diseases in school-aged children. J Korean Soc Food Sci Nutr. 2013. 42(9):1387–1394.

36.Lee K., Myung C., Nam H., Hong CS., Lee YC. A study on nutritional status of allergic patients and food allergens in Korea. Korean J Diet Cult. 1996. 11(1):123–130.

37.Yu JW., Kagan R., Verreault N., Nicolas N., Joseph L., St Pierre Y., Clarke A. Accidental ingestions in children with peanut allergy. J Allergy Clin Immunol. 2006. 118(2):466–472.

38.Park SJ., Lee JS., Ahn K., Chung SJ. The comparison of growth and nutrient intakes in children with and without atopic dermatitis. Korean J Community Nutr. 2012. 17(3):271–279.

39.Cheong HS., Lee JS. Study on nutrition education and perception of nutrition teachers and dietitians in Gyeongnam area. Korean J Food Cookery Sci. 2012. 28(3):229–240.

40.Rona RJ., Keil T., Summers C., Gislason D., Zuidmeer L., Sodergren E., Sigurdardottir ST., Lindner T., Goldhahn K., Dahlstrom J., McBride D., Madsen C. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol. 2007. 120(3):638–646.

41.Burks AW., Tang M., Sicherer S., Muraro A., Eigenmann PA., Ebi-sawa M., Fiocchi A., Chiang W., Beyer K., Wood R., Hourihane J., Jones SM., Lack G., Sampson HA. ICON: food allergy. J Allergy Clin Immunol. 2012. 129(4):906–920.

Table 1.

Prevalence of food allergy and its diagnosis

Variables		Total (n = 1,000)	Food allergy experience		P value	Total (n = 167)	Diagnose		P value
Variables		Total (n = 1,000)	Yes	No	P value	Total (n = 167)	Yes	No	P value
Gender	Boy	496 (49.6)¹⁾	70 (14.1)	426 (85.9)		70 (41.9)	21 (30.0)	49 (70.0)	NS
Gender	Girl	504 (50.4)	97 (19.2)	407 (80.8)	∗	97 (58.1)	23 (23.7)	74 (76.3)	NS
Grade	4^th grade	284 (28.4)	53 (18.7)	231 (81.3)		53 (31.7)	13 (24.5)	40 (75.5)	NS
	5^th grade	275 (27.5)	44 (16.0)	231 (84.0)	NS²⁾	44 (26.4)	12 (27.2)	32 (72.8)
	6^th grade	441 (44.1)	70 (15.9)	371 (84.1)		70 (41.9)	19 (27.1)	51 (72.9)
Total		1,000 (100)	167 (16.7)	833 (83.3)		167 (100.0)	44 (26.4)	123 (73.6)

1) Values are n (%). 2) NS: not significant ∗p < 0.05

Table 2.

Primary food allergy symptoms that students experienced¹⁾

	Symptom	Urticaria/Rash	Itching	Vomiting	Diarrhea	Dyspnea	Others	P value
	Total	81 (33.2)²⁾	78 (32.0)	33 (13.5)	31 (12.7)	12 (4.9)	9 (3.7)	-
Gender	r Boys (n = 104)	38 (36.5)	33 (31.7)	13 (12.5)	8 (7.7)	8 (7.7)	4 (3.8)	NS³⁾
Gender	r Girls (n = 140)	43 (30.7)	45 (32.1)	20 (14.3)	23 (16.4)	4 (2.9)	5 (3.6)	NS³⁾
Grade	4^th grade (n = 74)	29 (39.2)	23 (31.1)	10 (13.5)	7 (9.5)	2 (2.7)	3 (4.1)	NS
	5^th grade (n = 68)	20 (29.4)	26 (38.2)	7 (10.3)	11 (16.2)	2 (2.9)	2 (2.9)
	6^th grade (n = 102)	32 (31.4)	29 (28.4)	16 (15.7)	13 (12.7)	8 (7.8)	4 (3.9)

1) Data are multiple responses. 2) Values are n (%). 3) NS: Not significant

Table 3.

Sources of food allergies¹⁾

Source	Total (N = 206)
Milk	29 (14.1)²⁾
Crab	25 (12.1)
Mackerel	17 (8.3)
Shrimp	14 (6.8)
Peanuts	11 (5.3)
Eggs	9 (4.4)
Wheat	9 (4.4)
Soy	8 (3.9)
Buckwheat	7 (3.4)
Pork	7 (3.4)
Peach	6 (2.9)
Tomato	5 (2.4)
Sulfite	4 (1.9)
Others (Kiwi, clam, sea urchin, abalone, sea mustard, cheese, watermelon, cucumber, Korean, melon, beef, melon, cuttlefish)	55 (26.7)

1) Data are multiple responses. 2) Values are n (%).

Table 4.

Rate of correct answers on food allergy knowledge and knowledge score

Questions	Total	Gender		P value	Grade			P value	Food allergy experience		P value
Questions	Total	Boys	Girls	P value	4^th grade	5^th grade	6^th grade	P value	Yes	No	P value
Definition of food allergies	33.9 ¹⁾	32.1	35.7	NS⁴⁾	29.2	34.2	36.7	NS	29.3	34.8	NS
Nutrients associated with food allergies	43.3	43.3	43.3	NS	35.9	44.4	47.4	∗∗	50.9	41.8	∗
Foods to induce wheat allergies	77.9	77.2	78.6	NS	73.6	77.1	81.2	NS	80.2	77.4	NS
Restricted foods for individuals with tomato allergy	82.5	80.8	84.1	NS	80.6	82.5	83.7	NS	86.2	81.8	NS
Substitute foods for milk allergy	82.2	79.4	84.9	∗	77.1	85.1	83.7	∗	83.2	82.0	NS
Treatment/prevention of food allergies	58.8	55.4	62.1	∗	52.1	67.6	57.6	∗∗∗	56.9	59.2	NS
Disease(s) that have similar symptoms to food allergies	89.8	88.3	91.3	NS	86.3	90.5	91.6	NS	92.2	89.3	NS
What to do when one experiences food allergies after eating a school meal	90.5	90.1	90.9	NS	90.5	89.5	91.2	NS	88.6	90.9	NS
Knowledge score²⁾ 5	5.59 ± 1.45	5.47 ± 1.49	5.71 ± 1.39	NS	5.25 ± 1.62^a,3)	5.71 ± 1.28^b	5.73 ± 1.40^b	∗∗∗	5.68 ± 1.44	5.57 ± 1.45	NS

1) Values are %. 2) Values are mean ± SD, summed correct answer scores of total 8 questions (incorrect answer = 0 score, correct answer = 1 score) 3) a, b: Duncan's multiple rang test, p < 0.05 4) NS: Not significant ∗p < 0.05, ∗∗p < 0.01, ∗∗∗p < 0.001

Table 5.

Perception of food allergy labelling on school menus¹⁾

Questions	Total (n = 1,000)	Gender		P value	Grade			P value	Food allergy experience		P value
Questions	Total (n = 1,000)	Boys (N = 496)	Girls (N = 504)	P value	4^th grade (N = 284)	5^th grade (N = 275)	6^th grade (N = 441)	P value	Yes	No	P value
Food allergy information posted on school menu is easy to be recognized	2.40 ± 1.03²⁾	2.36 ± 1.01	2.44 ± 1.04	NS⁴⁾	2.27 ± 1.04^a,3)	2.43 ± 1.04^b	2.47 ± 1.00^b	∗	2.40 ± 1.06	2.40 ± 1.02	NS
Food allergy information posted on school menu is easy to understand for students	2.48 ± 1.02	2.44 ± 1.05	2.52 ± 0.99	NS	2.46 ± 1.06	2.52 ± 1.04	2.47 ± 0.97	NS	2.52 ± 1.06	2.47 ± 1.01	NS
I am satisfied with food allergy labelling posted on menu	2.27 ± 0.93	2.26 ± 0.95	2.28 ± 0.92	NS	2.22 ± 0.95	2.23 ± 0.92	2.32 ± 0.93	NS	2.31 ± 0.94	2.26 ± 0.93	NS
Food allergy labelling is necessary	1.86 ± 0.88	1.83 ± 0.88	1.89 ± 0.88	NS	1.98 ± 0.96^b	1.69 ± 0.80^a	1.89 ± 0.85^b	∗∗∗	1.87 ± 0.91	1.86 ± 0.87	NS
Total	2.25 ± 0.79	2.22 ± 0.79	2.28 ± 0.78	NS	2.23 ± 0.84	2.21 ± 0.75	2.28 ± 0.77	NS	2.27 ± 0.80	2.24 ± 0.78	NS

1) 5 point scale (5: strongly agree, 4: agree, 3: neutral, 2: disagree, 1: strongly disagree) 2) Values are mean ± SD. 3) a, b: Duncan's multiple range test 4) NS: Not significant ∗p < 0.05, ∗∗p < 0.01, ∗∗∗p < 0.001

Table 6.

Levels of healthy dietary practices by gender, grade and food allergy experience¹⁾

Questions	Total (N = 1,000)	Gender		P value	Grade			P value	Food allergy experience		P value
Questions	Total (N = 1,000)	Boys (N = 496)	Girls (N = 504)	P value	4^th grade (N = 284)	5^th grade (N = 275)	6^th grade (N = 441)	P value	Yes (N = 167)	No (N = 833)	P value
Eat well-balanced diet 3	3.76 ± .0.98²⁾	⁾ 3.80 ± 1.00	3.72 ± 0.97	NS⁴⁾	3.60 ± 0.98^a,3)	3.86 ± 0.99^b	3.80 ± 0.97^b	∗	3.63 ± 1.07	3,79 ± 0.96	NS
Eat a variety of vegetables at each meal	3.64 ± 1.04	3.63 ± 1.05	3.65 ± 1.03	NS	3.60 ± 0.98	3.68 ± 1.09	3.64 ± 1.04	NS	3.55 ± 1.09	3.66 ± 1.03	NS
Eat protein foods such as fish, lean meat, soy products, eggs one or more times a day	4.05 ± 0.94	4.09 ± 0.94	4.00 ± 0.94	NS	3.84 ± 1.05^a	4.09 ± 0.92^b	4.15 ± 0.86^b	∗∗∗	3.99 ± 1.04	4.06 ± 0.92	NS
Drink two cups of milk every day	3.53 ± 1.26	3.74 ± 1.22	3.33 ± 1.27	∗∗∗	3.43 ± 1.33	3.52 ± 1.28	3.61 ± 1.21	NS	3.23 ± 1.42	3.59 ± 1.22	∗∗
Eat breakfast every day	4.07 ± 1.23	4.05 ± 1.21	4.09 ± 1.26	NS	4.14 ± 1.16	4.03 ± 1.25	4.05 ± 1.27	NS	3.94 ± 1.27	4.09 ± 1.23	NS
Eat slowly and chow it well	3.68 ± 1.03	3.55 ± 1.04	3.81 ± 1.00	∗∗∗	3.78 ± 1.05	3.68 ± 1.05	3.62 ± 1.00	NS	3.62 ± 1.02	3.69 ± 1.03	NS
Eat less salty food	3.57 ± 0.97	3.53 ± 1.00	3.61 ± 0.94	NS	3.62 ± 0.96	3.60 ± 1.00	3.52 ± 0.95	NS	3.56 ± 0.99	3.57 ± 0.97	NS
Eat less sweet food	3.32 ± 1.03	3.34 ± 1.04	3.31 ± 1.02	NS	3.33 ± 1.06	3.37 ± 1.04	3.29 ± 1.01	NS	3.25 ± 1.12	3.34 ± 1.011	NS
Eat less greasy food	3.41 ± 0.92	3.36 ± 0.92	3.44 ± 0.91	NS	3.44 ± 0.96	3.45 ± 0.94	3.36 ± 0.88	NS	3.31 ± 0.94	3.42 ± 0.91	NS
Do not frequently eat or drink cookies and soft drinks	3.43 ± 1.07	3.43 ± 1.06	3.44 ± 1.08	NS	3.47 ± 1.12	3.44 ± 1.05	3.40 ± 1.04	NS	3.26 ± 1.19	3.46 ± 1.04	∗
Total	3.64 ± 0.63	3.65 ± 0.64	3.64 ± 0.63	NS	3.62 ± 0.62	3.67 ± 0.64	3.64 ± 0.63	NS	3.53 ± .64	3.66 ± 0.63	∗

1) 5 point scale (5: strongly agree, 4: agree, 3: neutral, 2: disagree, 1: strongly disagree) 2) Values are mean ± SD. 3) a, b, c: Duncan's multiple range test 4) NS: Not significant ∗p < 0.05, ∗∗p < 0.01, ∗∗∗p < 0.001

Table 7.

Status of managing substitute meals to students with foo allergies in schools lunches ¹⁾

Whether or not substitute meals were offered in school lunches	Total (N = 167)
Yes	34 (20.4)
No	133 (79.6)
Types of foods/side dishes offered for a substitute meal	Foods/side dishes	Total (N = 34)
	Seasoned laver	14 (31.1)
	Fried eggs	7 (15.6)
	Stir-fried anchovies	5 (11.1)
	Stir-fried tofu	2 (4.4)
	Others	17 (37.8)

1) Values are n (%).

Table 8.

Comparison of methods and contents of nutritional education by gender, grade and food allergy experience¹⁾

Whether students have had nutritional education about food allergies or not		Gender		Grade			Food allergy experience
		Boys	Girls	4^th grade	5^th grade	6^th grade	Yes	No
Yes		139 (28.0)²⁾	169 (33.5)	96 (33.8)	77 (28.0)	135 (30.6)	67 (40.1)	241 (28.9)
No		357 (72.0)	335 (66.5)	188 (66.2)	198 (72.0)	306 (69.4)	100 (59.9)	592 (71.1)
Total		496 (49.6)	504 (50.4)	284 (28.4)	275 (27.5)	441 (44.1)	167 (16.7)	833 (83.3)
P value		NS³⁾		NS			∗∗
Methods of nutritional education		Gender		Grade			Food allergy experience
Methods of nutritional education		Boys	Girls	4^th grade	5^th grade	6^th grade	Yes	No
All	331	152 (45.9)	179 (54.1)	105 (31.7)	82 (24.8)	144 (43.5)	69 (20.8)	262 (79.1)
School newsletter/school website	159 (48.0)	63 (41.4)	96 (53.6)	39 (37.1)	36 (43.9)	84 (58.3)	32 (46.4)	127 (48.5)
Teacher or nutrition teacher	111 (33.5)	54 (35.5)	57 (31.8)	49 (46.7)	24 (29.3)	38 (26.4)	23 (33.3)	88 (33.6)
Hospital visit	16 (4.8)	10 (6.6)	6 (3.4)	6 (5.7)	3 (3.7)	7 (4.9)	6 (8.7)	10 (3.8)
TV, radio, books	45 (13.6)	25 (16.4)	20 (11.2)	11 (10.5)	19 (23.2)	15 (10.4)	8 (11.6)	37 (14.1)
P value		NS³⁾		∗∗			NS
contents on nutritional education		Gender		Grade			Food allergy experience
contents on nutritional education		Boys	Girls	4^th grade	5^th grade	6^th grade	Yes	No
All	330	152 (46.1)	178 (53.9)	103 (31.2)	78 (23.6)	149 (45.2)	71 (21.5)	259 (78.5)
Food labelling	88 (26.7)	39 (25.7)	49 (27.5)	16 (15.5)	25 (32.1)	47 (31.5)	23 (32.4)	65 (25.1)
Food allergens	129 (39.1)	60 (39.5)	69 (38.8)	41 (39.8)	31 (39.7)	57 (38.3)	23 (32.4)	106 (40.9)
Substitute food	37 (11.2)	20 (13.2)	17 (9.6)	16 (15.5)	8 (10.3)	13 (8.7)	5 (7.0)	32 (12.4)
Emergency management	66 (20.0)	29 (19.1)	37 (20.8)	24 (23.3)	12 (15.4)	30 (20.1)	16 (22.5)	50 (19.3)
Others	10 (3.0)	4 (2.6)	6 (3.4)	6 (5.8)	2 (2.6)	2 (1.3)	4 (5.6)	6 (2.3)
P value		NS³⁾		∗∗			NS

1) Data are multiple responses. 2) Values are n (%). 3) NS: Not significant ∗p < 0.05, ∗∗p < 0.01, ∗∗∗p < 0.001

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