Parental Perceptions of Antibiotics and Their Association with Vaccine Attitudes and Rational Drug Use: A Cross-Sectional Study in Central Anatolia, Türkiye

Parental Perceptions of Antibiotics and Their Association with Vaccine Attitudes and Rational Drug Use: A Cross-Sectional Study in Central Anatolia, Türkiye | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Parental Perceptions of Antibiotics and Their Association with Vaccine Attitudes and Rational Drug Use: A Cross-Sectional Study in Central Anatolia, Türkiye Seval Çalışkan Pala, Ece Elif Öcal Yanık This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9060861/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Backgrounds: This study aims to evaluate parents' perceptions of antibiotics, their attitudes towards childhood vaccinations, their attitudes towards rational drug use, and potentially related factors. Methods: This study is a cross-sectional research conducted in 2024 on mothers and fathers living in a province in the Central Anatolia region of Türkiye. The data collection form consists: sociodemographic characteristics, Parental Perception of Antibiotics Scale (PAPAS), Parents' Attitudes about Childhood Vaccines Scale (PACVS), and Parental Attitude Scale Towards Rational Drug Use (PASTRDU). Since the data showed a normal distribution, t-test, ANOVA, Pearson correlation analysis, and Multiple Linear Regression Analysis were applied for comparison. Results: The median age of the 519 parents in the study group was 34.0 (standard deviation) (10.0), 363 (69.9%) were female and 156 (20.1%) were male. The average score of the parents on the PAPAS was 104.8 (14.5). 47% of the parents scored above average on the PAPAS. According to the results of the linear regression analysis, which was created after controlling for variables that were found to be significant with single analyses (age, gender, education level, marital status, family type, number of children, knowledge about vaccination, primary source of information about vaccination, PASTRDU, PACVS score), it was determined that mothers and fathers in the 25–34 age group had better antibiotic perceptions than other age groups, those who were knowledgeable about vaccination had better perceptions than those who were not, those whose source of information about vaccination was physicians and health personnel had better perceptions than those whose source was television/radio and social media, and those who scored high on PASTRDU had better perceptions than others. Conclusion: Nearly half of the parents have a negative perception of antibiotics, and four out of five parents have vaccine hesitancy. Parents' age, knowledge about vaccination, primary sources of information about vaccination, and attitudes towards rational drug use are important factors in determining antibiotic perceptions. Parental perceptions of antibiotics should be addressed at both individual and societal levels, along with attitudes towards vaccination and rational drug use, and strategies should be developed and detailed studies conducted accordingly. Parental perception antibiotic use vaccine attitude rational drug use Figures Figure 1 Background Antimicrobial resistance (AMR) represents one of the most significant global public health threats, largely stemming from inappropriate and excessive antibiotic use in community settings ( 1 ). Childhood is one of the periods with the highest antibiotic exposure, particularly due to respiratory tract infections characterized by symptoms such as cough, runny nose, sore throat, and earache ( 2 ). Children experience an average of 6–10 respiratory tract infections per year, increasing the likelihood of unnecessary antibiotic use. However, most of these infections are viral in origin, and prescribing antibiotics in such cases contradicts the principles of rational drug use (RDU) ( 3 ). Inappropriate antibiotic use has particularly contributed to the development of AMR in pediatric populations over the last decade ( 4 ). The limited development of new antibiotics and insufficient pediatric pharmacokinetic and safety data further increase children's vulnerability to resistant infections ( 5 ). The determinants of inappropriate antibiotic use in children are multifactorial. Geographic, health system-related, physician-related, and parental sociodemographic factors all contribute to inappropriate practices. Among these, parental knowledge, attitudes, and perceptions are key determinants of antibiotic demand, compliance, and treatment decisions. Studies consistently show widespread misconceptions among parents regarding antibiotic indications, resistance mechanisms, and side effects. For example, many caregivers believe that symptoms such as green runny nose or a cold require antibiotic treatment ( 4 , 6 , 7 ). These misconceptions can lead to problems such as self-medication, miscalculation of dosage, improper storage, and premature discontinuation of medication ( 8 ). Parallel to antibiotic misuse, vaccine hesitancy has also emerged as a growing public health problem. Despite the success of immunization programs, vaccine refusal and hesitancy have increased globally and in Türkiye since 2010 ( 9 ). Rising vaccine refusal threatens herd immunity and increases the risk of outbreaks of vaccine-preventable diseases, which continue to cause approximately 1.5 million deaths worldwide annually ( 7 ). Although national policies in Türkiye, including RDU campaigns and restrictions on the over-the-counter sale of antibiotics, have reduced antibiotic consumption rates, attitudinal and informational determinants of misuse persist. Children require special attention in RDU initiatives. Caregiver-related medication errors, including incorrect dosing, premature termination, and improper storage, are frequently reported. Therefore, identifying parental hesitations, raising their awareness, and providing them with accurate information are critical components of antimicrobial management efforts ( 10 ). Antibiotic misuse and vaccine hesitancy may reflect interconnected components of a broader health belief system rather than isolated behaviors ( 11 ). The Health Belief Model (HBM) proposes that individuals' health behaviors are shaped by perceived sensitivity, perceived seriousness, perceived benefits, perceived barriers, and action cues ( 12 ). Parents who underestimate the seriousness of AMR or overestimate the benefits of antibiotics for viral infections may be more prone to demanding antibiotics ( 13 ). Similarly, perceived vaccine risks may reduce vaccination acceptance. The Theory of Planned Behavior (TPB) further emphasizes the role of attitudes, subjective norms, and perceived behavioral control in shaping health behaviors ( 14 ). Parents' decisions regarding antibiotic use and vaccine choices are influenced by social norms, trust in healthcare providers, and perceived control over child health outcomes. Therefore, vaccine hesitancy and irrational antibiotic use may share common cognitive and social determinants, including health literacy, risk perception, and trust in health systems. Vaccine refusal, antibiotic misuse, and irrational drug use among parents have increasingly emerged as important public health concerns, including in Eskişehir province, located in the Central Anatolia region of Türkiye. Identifying these parental attitudes is therefore of great importance. This study aims to evaluate the perceptions of parents living in Eskişehir regarding antibiotics, their attitudes towards childhood vaccinations, their attitudes towards RDU, and potentially related factors. Methods This study is a cross-sectional study conducted on parents with children living in Eskişehir between January 2024 and April 2024. The study was conducted in Eskişehir, a province located in the Central Anatolia Region of Turkey, with a population of 927,956 ( 15 ). The province has a mixed urban structure and accessible primary healthcare services, making it a suitable setting for assessing parental perceptions related to antibiotic use and child health practices. The study was conducted online among parents living in Eskişehir after obtaining the necessary administrative and ethical permissions. After being informed about the purpose and methodology of the study, the parents who voluntarily participated were asked to read and sign the informed consent form. All study procedures were conducted in accordance with the ethical standards of the national research committee and the Declaration of Helsinki. The study was designed and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. As data were collected through an online survey, the study also adhered to the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines. The completed STROBE and CHERRIES checklists are provided as supplementary materials ( 16 , 17 ). The questionnaire consists of four separate sections: sociodemographic characteristics, Parental Perception on Antibiotics Scale (PAPAS), Parental Attitudes toward Childhood Vaccinations Scale (PACVS), and Parental Attitudes toward Rational Drug Use Scale (PASTRDU). Parental Perception on Antibiotics Scale (PAPAS) The PAPAS was developed by Alumran et al. in 2014 ( 18 ) and adapted into Turkish by Özdemir ( 19 ). The scale consists of 5 sub-areas and is a 5-point Likert type with 31 items (1: Strongly disagree − 5: Strongly agree / 1: Never − 5: Always). The number of items in the subscales is: Knowledge and Beliefs: 10, Behaviors: 5, Information Seeking: 7, Compliance: 5, and Awareness of Antibiotic Resistance : 4. The PAPAS allows for a minimum score of 31 and a maximum score of 155. A higher score indicates a better perception of antibiotics. The Cronbach's alpha value of the scale is reported as 0.78, while in our study group, the Cronbach's alpha coefficient was calculated as 0.86. Parent Attitudes About Childhood Vaccines Scale(PACVS) The PACVS, developed by Opel in 2011, is a 15-item scale consisting of three sub-dimensions (behavior, general attitudes, and safety-effectiveness) ( 20 ). Its Turkish validity and reliability study was conducted by Mutlu (2021), and the Cronbach alpha value was determined as 0.845 ( 21 ). In our study, the Cronbach alpha value of the PACVS was found to be 0.842. The scale's score calculation varies. The raw score obtainable from the scale is a value between 0 and 30. If the total converted score of the participating parent is less than 50, they are defined as a parent without vaccine hesitancy; if it is 50 or greater, they are defined as a parent hesitant about vaccines. In our study, the Cronbach alpha coefficient was 0.86. Parental Attitude Scale Towards Rational Drug Use (PASTRDU) Developed by Çelebi (2018), the scale consists of 40 items and determines the attitude levels of parents towards RDU. The scale is a 5-point Likert type (1: strongly disagree – 5: strongly agree). 12 items in the scale are reverse scored. Scores obtained from the scale range from 40 to 200. As the score obtained from the scale increases, the positive attitudes of parents towards RDU increase. It includes the sub-dimensions of "correct and conscious" and "effective and safe" use. The Cronbach Alpha coefficient of the scale is 0.88 ( 22 ), while in our study group, the Cronbach Alpha coefficient of the scale was found to be 0.96. Evaluation of Data The obtained data were evaluated in the R Studio statistical package program. Descriptive statistics were calculated as mean, standard deviation, median for numerical variables, and categorical variables. The results were presented as numbers and percentages. Kolmogorov-Smirnov and Sharipo-Wilk tests were applied to test the normality of the data distribution. Pearson correlation analysis was used for correlation analysis. Since the data showed a normal distribution, t-test, ANOVA, and Multiple Linear Regression Analysis were applied for comparison. Before proceeding with regression analysis, the assumption of multicollinearity was evaluated. Collinearity diagnostics results showed that some dimensions had Condition Index scores above 30, and multiple variables had high variance shares in the same dimensions. Therefore, the sub-field scores of the scales were not included in the model. Homogeneity of variance was evaluated with the Levene test. Tukey test was used when the variances were homogeneous, and Games–Howell post-hoc test was used when homogeneity was not achieved. Statistical significance was considered to be < 0.05 (p). Results The median age (min-max) of the 519 parents comprising the study group was 34.0 (18–58), with an average (SD) of 34.0 (10.0). 363 (69.9%) of the parents were female and 156 (20.1%) were male. Parents scored on the PAPAS between 69.0 and 146.0, with an average of 104.8 (14.5) and a median of 104. 47% of the parents scored above average on the PAPAS. A comparison of PAPAS and sub-domain scores based on sociodemographic characteristics of individuals in the study group is given in Table 1 . Table 1 Comparison of PAPA Scale and sub-domain scores of individuals in the study group according to their sociodemographic characteristics. Sociodemographic characteristics PAPAS Mean (SD) 1.Subdomain Knowledge and beliefs 2.Subdomain Behaviors 3.SubdomainSeeking information 4.Subdomain Adherence 5.Subdomain: Awareness about antibiotics resistance PAPA Total score Age group 18–24 31.6 (6.3) 18.6 (3.8) b2 21.3 (5.0) 14.5 (3.8) b2 14.5 (2.5) 103.5 (15.2) b1 25–34 32.4 (7.4) 20.1 (4.1) a 22.0 (4.6) 19.2 (3.9) a 14.7 (2.4) a1 108.4 (15.2) a 35–44 31.3 (6.3) 18.8 (3.6) b1 21.5 (4.8) 18.0 (3.4) b1*** 14.6 (2.2) a2 104.2 (12.9) b2 45 and over 30.5 (6.1) 18.2 (3.5) b3 21.4 (4.5) 16.7 (3.6) c 13.6 (2.4) b 100.4 (13.4) b3 p* 0.156 < 0.001 0.546 < 0.001 0.007 0.001* Gender Male 31.0 (6.2) 18.4 (3.6) 21.5 (4.5) 17.6 (3.6) 14.2 (2.4) 102.8 (13.8) Female 31.8 (6.9) 19.4 (3.9) 21.7 (4.8) 18.3 (3.8) 14.5 (2.4) 105.7 (14.7) p** 0.177 0.006 0.701 0.083 0.245 0.036** Marital status Single/Separated 31.2 (6.3) 18.2 (3.8) 21.6 (4.8) 17.3 (3.5) 14.3 (2.4) 102.1 (14.6) Married 31.8 (6.8) 19.4 (3.8) 21.6 (4.7) 18.3 (3.8) 14.5 (2.4) 105.7 (14.4) p* 0.108 < 0.001 0.926 0.004 0.616 0.038 Family type Nuclear 31.8 (6.5) a1 19.0 (3.7) b 21.6 (4.9) 17.9 (3.6) b 14.5 (2.3) 104.8 (14.3) a2 Large 31.2 (7.3) a2 20.3 (4.1) a 21.9 (3.6) 19.3 (4.4) a 14.0 (2.4) 106.7 (14.7) a1 Fragmented 26.2 (5.2) b 15.6 (4.0) c 20.2 (3.5) 16.7 (4.0) 12.9 (3.8) 91.6 (14.2) b p* 0.019 < 0.001 0.503 0.004 0.700 0.005 Occupation Civil servant 32.6 (7.0) 19.4 (3.8) 20.3 (4.0) b 18.7 (3.4) a1 15.1 (2.4) a 106.0 (14.7) Worker 30.7 (5.1) 19.1 (3.3) 22.3 (4.2) 18.0 (3.6) 14.3 (2.0) 104.4 (11.5) Self-employed 30.9 (6.9) 19.2 (3.8) 21.8 (4.4) 18.1 (3.7) 14.4 (2.4) 104.4 (14.3) Tradesman 38.3 (5.7) 22.3 (1.5) 23.3 (4.2) 19.3 (4.9) 12.7 (1.2) 116.0 (11.8) Other 31.5 (6.3) 17.9 (3.9) b 21.2 (4.7) 16.9 (3.8) b 14.6 (2.3) 101.9 (14.8) Unemployed / Housewife 31.5 (6.8) 19.5 (4.0) a 22.2 (5.3) a 18.3 (4.0) a2 14.1 (2.4) b 105.6 (15.1) p* 0.173 0.026 0.026 0.033 0.036 0.268 Educational status Literate 27.0 (3.6) 16.8 (3.3) 20.0 (3.8) 15.9 (3.2) 12.0 (3.1) 91.8 (11.6) b Primary school 32.2 (5.8) 18.4 (3.5) 22.1 (5.9) 16.9 (3.6) b 14.1 (2.6) 103.7 (13.9) Middle school 31.7 (7.3) 18.5 (3.7) 21.9 (5.6) 17.1 (3.6) 13.6 (2.6) b 102.8 (15.5) High school 30.9 (6.6) 19.5 (3.9) 22.3 (4.1) 18.5 (4.0) a 14.3 (2.2) 105.5 (13.9) a2 University and above 32.1 (6.8) 19.2 (3.9) 21.2 (4.6) 18.3 (3.6) 14.9 (2.3) a 105.6 (14.6) a1 p* 0.047 0.052 0.065 0.003 < 0.001 0.015* Number of children One 31.9 (7.0) 19.6 (4.1) a1 22.1 (4.7) 18.5 (3.7) a1 14.8 (2.2) a1 106.7 (15.1) a1 Two 31.1 (6.6) 19.0 (3.7) a2 21.2 (4.9) 18.2 (3.8) a2 14.5 (2.3) a2 104.1 (14.7) Three 32.4 (7.0) 19.3 (3.5) a3 21.4 (4.5) 18.3 (3.4) a3 14.3 (2.5) a3 105.7 (13.0) a2 Four and above 31.0 (5.1) 17.5 (3.6) b 22.0 (4.2) 15.5 (3.8) b 13.0 (2.7) b 98.9 (12.4) b p* 0.383 0.008 0.344 < 0.001 < 0.001 0.009* Family income status Poor 30.0(6.2) 17.3(4.6) b 21.4(4.9) 17.0(3.6) 14.5(3.0) 100.2(13.0) Medium 31.6(6.7) 19.4(3.7) a 21.9(4.7) 18.2(3.7) 14.4(2.4) 105.4(14.3) Good 31.7(6.7) 18.8(3.7) 20.8(4.6) 18.0(3.9) 14.7(2.1) 103.8(15.3) p* 0.521 0.014 0.103 0.326 0.372 0.171* Smoking status No 31.8(6.7) 18.8(3.7) 21.7(4.9) 17.6(3.6) 14.3(2.5) 104.1(14.2) Yes 31.2(6.7) 19.6(4.0) 21.6(4.5) 18.9(3.9) 14.7(2.1) 105.8(15.0) p** 0.305 0.030 0.777 c a >b>c Abbreviations: PAPA, Parental Awareness of Antibiotic Use Scale; SD, standard deviation. Parents in the study group who were knowledgeable about vaccines had a higher perception of antibiotics. Those whose primary source of information about vaccination was a physician/healthcare professional scored higher than those whose sources were social media and radio/TV. Table 2 compares the scores obtained from the PAPAS by individuals in the study group according to potentially related factors. It was found that those with vaccine hesitancy scored higher on the PAPAS (p<0.001). Table 3 presents the correlation analyses of the PAPAS, PACVS, and PASTRDU scores for individuals in the study group. Figure 1 shows the distribution of PAPAS scores for those with vaccine hesitancy. Table 2. Comparison of PAPA Scale scores of individuals in the study group according to potentially related factors. Potentially related factors PAPAS Mean (SD) 1.Subdomain Knowledge and beliefs 2.Subdomain Behaviors 3.SubdomainSeeking information 4.Subdomain Adherence 5.Subdomain: Awareness about antibiotics resistance PAPA Total score Knowledge of vaccination No 30.1 (6.1) 17.9 (3.6) 20.4 (5.2) 17.0 (3.4) 13.9 (2.4) 99.3 (14.1) Yes 32.2 (6.8) 19.6 (3.8) 22.2 (4.4) 18.6 (3.8) 14.7 (2.4) 107.2 (14.0) p* 0.001 <0.001 <0.001 <0.001 0.001 0.001 Primary source of information about vaccination Relative 29.1 (7.4) 18.4 (4.0) 23.7 (6.2) 18.3 (3.9) 13.2 (2.7) 102.6 (17.0) Newspaper/Magazine 31.9 (7.3) 18.1 (3.2) 19.7 (5.2) 16.3 (3.8) b1 13.4 (2.9) 99.3 (15.9) Neighbor 31.3 (8.6) 18.6 (2.7) 22.5 (2.7) 18.3 (4.9) 13.5 (3.2) 104.1 (16.7) Doctor/Healthcare personnel 32.3 (6.6) 20.1 (3.7) a 21.9 (4.4) 19.0 (3.6) a 14.7 (2.3) 108.0 (13.9) a Social media 30.9 (6.5) 18.5 (3.7) b1 21.0 (4.8) 17.4 (3.6) b2 14.6 (2.1) 102.5 (13.4) b1 Television/Radio 30.6 (6.5) 17.5 (4.0) b2 21.5 (4.9) 16.5 (3.6) b3 14.0 (2.5) 100.1 (13.4) b2 p** 0.112 <0.001 0.060 b>c Abbreviations: PAPA, Parental Awareness of Antibiotic Use Scale; SD, standard deviation. Table 3. Correlation analyses of individuals in the study group according to PAPAS, PACVS and PASTRDU. PAPAS PACVS PASTRDU 1. subdomain 2. subdomain 3. subdomain Total Score 1. subdomain 2. subdomain Total score 1.subdomain: Knowledge and beliefs r:-0.037 p:0.403 r:0.028 p:0.520 r:0.001 p:0.992 r:0.017 p:0.697 r:0.190* p<0.001 r:0.300* p<0.001 p:0.255* p<0.001 2.subdomain: Behaviors r:-0.213* p<0.001 r:0.292* p<0.001 r:0.169* p<0.001 r:0.265* p<0.001 r:0.553** p<0.001 r:0.520** p<0.001 r:0.618** p<0.001 3.subdomain: Seeking information r:-0.022 p:0.622 r:0.116* p:0.008 r:0.070 p:0.114 r:0.114* p:0.010 r:0.174* p<0.001 r:0.257 p:0.519 r:0.227* p<0.001 4.subdomain: Adherence r:-0.196* p<0.001 r:0.287* p<0.001 r:0.195* p<0.001 r:0.273* p<0.001 r:0.449** p<0.001 r:0.470** p<0.001 r:0.519** p<0.001 5.Subdomain: Awareness about antibiotics resistance r:-0.067 p:0.127 r:0.313** p<0.001 r:0.126* p:0.004 r:0.280* p<0.001 r:0.287* p<0.001 r:0.233* p<0.001 r:0.308** p<0.001 PAPAS Total Score r:-0.142* p:0.001 r:0.254* p<0.001 r:0.139* p:0.001 r:0.232* p<0.001 r:0.455** p<0.001 r:0.520** p<0.001 r:0.541** p<0.001 *:weak correlation, **:medium correlation Abbreviations: PAPA, Parental Awareness of Antibiotic Use Scale; PACVS,Parent Attitudes About Cildhhood Vaccines Scale; PASTRDU, Parental Attitude Scale Towards Rational Drug Use Uniform analyses revealed that the variables “age, gender, education level, marital status, family type, number of children, knowledge about vaccination, primary source of information about vaccination, PASTRDU and PACVS scores” were related to the PAPAS score. According to the results of the linear regression analysis, which was created after controlling for factors associated with the variables found to be significant, it was determined that parents' perceptions of antibiotics were better among those in the 25-34 age group compared to other age groups (β:2.014 (95% CI:0.688 to 3.341)), those who were knowledgeable about vaccination compared to those who were not (β:2.895 (95% CI:0.410 to 5.380)), those whose source of information about vaccination was physicians and healthcare personnel compared to those whose source was television/radio and social media (β:0.843 (95% CI:0.224 to 1.462)), and those who scored high on the PAPAS (β:0.306 (95% CI:0.258 to 0.353)) (R²:0.337; F:25.791; p<0.01). The results of the multiple linear regression analysis are presented in Table 4. Table 4. Results of Multiple Linear Regression Analysis Model Unstandardized Coefficients Standardized Coefficients t Sig. 95,0% Confidence Interval for B B Std. Error Beta Lower Bound Upper Bound Age -1.980 0.676 -0.136 -2.929 0.004 -3.308 -0.652 Gender 0.460 1.174 0.015 0.392 0.695 -1.846 2.767 Marital status -1.483 1.343 -0.044 -1.104 0.270 -4.121 1.155 Family type -1.533 1.220 -0.047 -1.256 0.210 -3.930 0.864 Educational status -0.283 0.576 -0.021 -.491 0.624 -1.414 0.849 Number of children -.016 0.689 -0.001 -0.023 0.981 -1.370 1.338 Knowledge about vaccination 3.592 1.226 0.114 2.929 0.004 1.183 6.000 Basic source of information about vaccines -1.262 0.529 -0.087 -2.386 0.017 -2.301 -0.223 PASTRDU total score 0.305 0.024 0.535 12.631 <0.001 0.257 0.352 PACVS total score -0.095 0.070 -0.058 -1.357 0.175 -0.233 0.043 (Constant) 67.650 6.155 - 10.990 <0.001 55.557 79.743 R 2 =0.335 F=25.573 p<0.01 Abbreviations:PACVS,Parent Attitudes About Cildhhood Vaccines Scale; PASTRDU, Parental Attitude Scale Towards Rational Drug Use Discussion Parents play a central role in shaping children's health decisions, including antibiotic demand, treatment adherence, and vaccination acceptance. Therefore, parental perceptions constitute a strategic intervention point for both antibiotic use and vaccination programs in children (23). To our knowledge, this study is the first to simultaneously examine parental perceptions of antibiotics, vaccine attitudes, and awareness of RDU in Türkiye within a unified analytical framework. By integrating these interrelated areas, the current research offers a multidimensional perspective on parents' health beliefs rather than evaluating antibiotic use in isolation. This comprehensive approach is particularly important in the Turkish context, where fluctuations in vaccine trust and ongoing challenges in antibiotic use continue to raise significant public health concerns. Parental attitudes toward antibiotics are critical in terms of both unnecessary use and avoidance (8). The study found that almost half of the parents had negative perceptions of antibiotics. In many countries, a large proportion of parents view antibiotics as medicines that are good for colds and viral infections (8, 24, 25). Many studies have reported that parents hold at least one misconception about antibiotic use and have never heard of antibiotic resistance (8, 26). Parents may perceive antibiotics as a "quick fix" or "cure for all illnesses" (26, 27), or they may experience significant anxiety and reluctance when antibiotics are prescribed for their children (28). Parents' attitudes towards antibiotics are similar to the literature, but may show some differences from society to society depending on educational level, socioeconomic status, previous experiences, social environment, and risk perception. It is important for family physicians and pediatricians to provide accurate guidance to parents by considering both societal characteristics and individual differences when offering counseling services. In our study, four out of five parents had vaccine hesitancy. The frequency of hesitancy regarding routine childhood vaccinations varies by country and vaccine type, and is roughly 21.1% among parents worldwide, or 1 in 5 (29). This may reflect the impact of regional and sociocultural dynamics, health literacy levels, or changing risk perceptions in the post-pandemic era on vaccination attitudes. In particular, this high level of hesitation regarding routine childhood vaccinations indicates a critical area for intervention to ensure the sustainability of immunization programs in the region. In the study group, individuals aged 25-34 had higher scores on the PAPAS than other age groups. In Jordan, parents aged 30–49 were reported to have significantly better antibiotic knowledge than those aged 20–29 (30). In Peru, parents aged 20 and under were reported to have approximately 2.4 times better knowledge than those aged 40 and over (26). In Tanzania, the 36–45 age group was reported to be more likely to have good knowledge than those aged 25 and under (25). In India, parents aged 40 and over were reported to be more inclined to discontinue antibiotics when the child felt better, while parents under 30 tended to stockpile antibiotics at home (31). While current studies in different countries report that older parental age is often associated with better antibiotic knowledge and more appropriate attitudes, it appears that findings may vary depending on the context. In this study, the higher scores on the PAPAS for parents aged 25–34 compared to other age groups may be related to young adult parents' greater exposure to current health information, more effective use of digital information resources, and more intensive interaction with primary healthcare services. This suggests that antibiotic perception is shaped not only by chronological age but also by the way information is accessed, health literacy, and social environment dynamics. In the study, those who were knowledgeable about vaccination had a higher perception of antibiotics than those who were not. In a study conducted in the United Kingdom, those who perceived the side effects of vaccines as very high were more likely to give incorrect answers about which infections antibiotics are effective against. Those who said that the risk of vaccine side effects was "non-existent" had more accurate information about antibiotics. Misconceptions about the use of antibiotics were more frequent in those who said that vaccines were "sometimes effective" or "almost never effective" (32). In Austria, those who correctly knew that "antibiotics are ineffective against viruses, colds, and the flu" were more likely to get the flu vaccine (33). In Sweden and Norway, a high level of knowledge about antibiotics and resistance is associated with more restrictive/rational antibiotic attitudes and adherence to health recommendations (34, 35). Studies indicate that individuals with accurate and positive information about vaccines tend to have a more accurate understanding of when and how to use antibiotics; conversely, vaccine distrust can be seen in conjunction with antibiotic misconceptions. Accordingly, it is suggested that vaccine and antibiotic awareness should be planned within integrated public health programs targeting common cognitive determinants, rather than separately. Those who received information about vaccination from physicians and other health personnel scored higher on the PAPAS (in terms of behavior, adherence, and total score) compared to sources such as social media and TV/radio. This shows that health professionals stand out as a reliable source of information, similar to the literature (36, 37). Social media, on the other hand, is preferred more, especially among anti-vaccination or hesitant individuals (36, 38). In addition, conversations with family and friends and traditional media (TV, radio) are seen as important persuasive sources in vaccine decisions (38). Parents with high vaccine hesitancy tend to turn to alternative sources of information, and those with low health literacy also tend to prefer such sources (37). Consequently, the role of healthcare personnel in vaccine education is critical, and the dissemination of accurate and reliable information on digital platforms such as social media is necessary (38, 39). This indicates that the quality of the information source is decisive in shaping perceptions of vaccines and antibiotics, and that trust-based communication strategies relying on healthcare professionals constitute a critical public health intervention area in terms of counteracting the impact of digital misinformation. The study found that those with high RDU had a better perception of antibiotics compared to others. In many societies, antibiotics are still perceived as the “powerful and fast” remedy for viral diseases such as fever, flu, and the common cold (40, 13). While increased knowledge in some studies has led to a better understanding of the harms and resistance of antibiotics, it can also lead to more self-treatment and irrational use with the confidence of “I can use them correctly myself.” Nevertheless, generally, better knowledge and more appropriate attitudes increase the likelihood of RDU; factors such as age, education level, and easy access to pharmacies shape perception (41). RDU, by targeting knowledge, attitude, and behavior together, can weaken the perception of antibiotics as “good for every disease, the more the better,” and strengthen the understanding of using them when necessary, in the correct dose and for the correct duration. A moderately positive correlation was found between the PAPAS behaviors and adherence sub-domain and the PASTRDU. Parental attitudes are influenced by past experiences, the quality of communication with healthcare providers, and socioeconomic factors; this underscores the need for targeted educational interventions to increase knowledge and promote RDU (22). Overall, there is a moderately positive correlation between parents' PASTRDU, suggesting that improving one can positively influence the other (42). The moderately positive correlation indicates that cognitive attitudes toward antibiotic use and behavioral tendencies are interrelated. The moderate correlation may point to a gap between attitude and behavior, suggesting that cognitive awareness-enhancing interventions alone may not be sufficient. This highlights that the role of healthcare professionals is not limited to the prescribing process; it also emphasizes their responsibility to increase risk communication and health literacy. A moderately positive correlation was found between the PAPAS sub-domain, the PACVS general attitudes sub-domain, and the PASTRDU total score. Studies show a moderate positive correlation between PACVS, awareness of antibiotic resistance, and scores for RDU Vaccination in children significantly reduces antibiotic consumption by preventing infections requiring antibiotic treatment, particularly in low- and middle-income countries (43). This reduction in antibiotic use helps combat AMR, a growing global health threat stemming from the overuse and misuse of antibiotics (44). Vaccine hesitancy and antibiotic overuse coexist in child populations, influenced by individual incentives, risk perceptions, and social norms, making efforts to promote both vaccination and RDU challenging (45). Overall, vaccines play a crucial role in reducing AMR by lowering infection rates and thus antibiotic demand, highlighting the importance of parental awareness and positive attitudes toward vaccination for RDU (44, 46). Overall, our findings demonstrate that parental perceptions of antibiotics cannot be addressed independently of broader health belief systems, including vaccination attitudes and awareness of RDU. This interrelationship highlights the importance of integrated behavioral and communication-based strategies at the primary care level for antimicrobial management policies. Developing evidence-based, culturally sensitive educational strategies is vital to reducing inappropriate antibiotic use and combating AMR. Conclusions Nearly half of parents hold negative perceptions of antibiotics, while four out of five parents are vaccine hesitants. Parental age, knowledge of vaccination, primary sources of information about vaccination, and attitudes toward RDU are important factors in determining antibiotic perceptions. The moderate correlations observed between antibiotic perception, awareness of AMR, attitudes toward vaccination, and RDU behaviors indicate that these areas do not operate independently. Therefore, addressing antibiotic misuse in isolation may be insufficient to combat AMR at the community level. The relationship between vaccine awareness and more positive antibiotic perceptions, and RDU, further supports the need for integrated education strategies. Interventions that address vaccine awareness, awareness of AMR, and RDU simultaneously can create synergistic effects by targeting common cognitive determinants. From a public health perspective, parents' perceptions of antibiotic use management programs should be integrated into primary care communication strategies that emphasize clear risk communication, culturally sensitive messaging, and building trust between healthcare professionals and families. Physicians and primary care professionals play a crucial role not only in prescribing medication but also in correcting misconceptions about viral infections, antibiotic resistance, and vaccine safety. Strengthening healthcare professional-parent communication can help reduce both unnecessary antibiotic demand and vaccine hesitancy. Consequently, promoting RDU and combating AMR requires detailed studies that necessitate multifaceted, coordinated strategies that simultaneously strengthen vaccine trust, health literacy, and evidence-based medication use behaviors among parents. Limitations The cross-sectional design of the study limits the establishment of a definitive cause-and-effect relationship between variables, presenting only a projection of the current situation. Collecting data through social media and using a non-probability sampling method resulted in reaching only parents with access to digital platforms; this created a risk of selection bias by excluding those who do not use the internet or certain socioeconomic groups from the sample. In the context of CHERRIES criteria, technical limitations include the inability to calculate precise response rates due to the technical inability to track the total reach of social media announcements, and the fact that repeated entries could only be checked via IP address due to institutional infrastructure limitations. Furthermore, the self-reported nature of the data raises the possibility that participants may have responded with social bias, while the study's limitation to Eskişehir province restricts the generalizability of the results to the entire parent population in Turkey. Strengths The planning and reporting of the research in accordance with the STROBE guidelines, an international reporting standard, constitutes a fundamental strength in terms of methodological transparency and scientific quality. The fact that the validity and reliability of the PAPAS, PACVS, and PASTRDU scales used in the data collection process have been proven beforehand, and the Cronbach's alpha coefficients calculated in the current study group (0.84-0.96) indicate high internal consistency, reinforces the reliability of the findings. Consideration of the CHERRIES criteria, which determine the reporting quality in online survey applications, has increased the compliance and traceability of the digital data collection process with standards. In the statistical analysis phase, not only descriptive data but also the establishment of a multiple linear regression model allowed for an in-depth examination of the relationships between variables. In particular, the rigorous verification of the multicollinearity assumption through Condition Index values before the regression analysis and the revision of the model in line with these technical findings is a critical approach that maintains the statistical validity of the analysis. Furthermore, the dynamic selection between Tukey or Games-Howell tests based on homogeneity of variance in intergroup comparisons indicates that the most appropriate analytical method has been applied to the data. Abbreviations PAPAS Parental Perception on Antibiotics Scale PACVS Parent Attitudes About Cildhhood Vaccines Scale PASTRDU Parental Attitude Scale Towards Rational Drug Use RDU Rational Drug Use AMR Antimicrobial resistance STROBE Strengthening the Reporting of Observational Studies in Epidemiology CHERRIES Strengthening the Reporting of Observational Studies in Epidemiology Declarations Corresponding author: Seval Çalışkan Pala, [email protected] , Eskişehir Provincial Health Directorate, Eskişehir, Türkiye Author's contribution: All authors actively contributed to every stage of the writing process of the article. SÇP wrote manuscript, collected information, performed statistical analysis, co-wrote the paper. EEÖY participated in the questionnaire survey and sample collection and gave academic support. All authors read and approved the final manuscript. Ethics approval and consent to participate: Permission was obtained from Eskişehir City Hospital Ethics Committee. (Number: ESH/GOEK 2023/67SK, Date:22.11.2023). After being informed about the purpose and methodology of the study, the parents who voluntarily participated were asked to read and approved the informed consent form. All study procedures were conducted in accordance with the ethical standards of the national research committee and the Declaration of Helsinki. Consent for publication: Not applicable. Data availability: Data supporting the conclusions of this article will be made available upon reasonable request. Seval Çalışkan Pala, the corresponding author, can be contacted. Conflict of interest: There is no conflict of interest among the authors. Funding: The study was not funded by any source. References World Health Organization. Antimicrobial resistance [Internet]. Geneva: WHO; [cited 2024 Nov 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance Vaz LE, Kleinman KP, Lakoma MD, et al. Prevalence of parental misconceptions about antibiotic use. Pediatrics. 2015;136(2):221–231. doi: 10.1542/peds.2015-0883 Kurt NC, Çankaya İİ. Phytotherapeutic approaches in pediatric respiratory tract diseases: a review on efficacy and safety. Mersin Univ Tip Fak Lokman Hekim Tip Tarihi Folklorik Tip Derg. 2026;16(1):63–78. doi: 10.31020/mutftd.1667344 World Health Organization. World health statistics 2018: monitoring health for the SDGs. Geneva: WHO; 2018. Available from: https://iris.who.int/server/api/core/bitstreams/8aea53eb-41d5-4a64-9a64-b8ff18cefd47/content Parimi N, Pinto Pereira LM, Prabhakar P. Caregivers' practices, knowledge and beliefs of antibiotics in paediatric upper respiratory tract infections in Trinidad and Tobago: a cross-sectional study. BMC Fam Pract. 2004;5:28. doi:10.1186/1471-2296-5-28 Jensen JN, Bjerrum L, Boel J, Jarløv JO, Arpi M. Parents' socioeconomic factors related to high antibiotic prescribing in primary health care among children aged 0–6 years in the Capital Region of Denmark. Scand J Prim Health Care. 2016;34(3):274–281. doi: 10.1080/02813432.2016.1207145 World Health Organization. Together we can close the immunization gap [Internet]. Geneva: WHO; [cited 2020 Jan 24]. Available from: https://www.who.int Luhas A, Galiș R, Rus M, Balmoș A, Marinău C, Niulaș L, et al. Misconceptions and behavioral risks in parental antibiotic use on Romanian children: a cross-sectional study on knowledge, attitudes, and practices. Antibiotics (Basel). 2025;14. doi:10.3390/antibiotics14050479 Tan, A. K., & Yalçın, S. S. (2024). Childhood vaccination and vaccine hesitancy: a comparison between Türkiye and the world. Türkiye Çocuk Hastalıkları Dergisi , 18 (6), 387-395. doi: 10.12956/tchd.1547693 Gülbetekіn E, Gül Can F. The mediating role of e-health literacy in the effect of digital parenting on rational drug use in parents with school-age children: a structural equation model. Psychol Health Med. 2026;1–15. doi: 0.1080/13548506.2026.2632397 Anderson A. Attitudes towards vaccination and knowledge about antibiotics: analysis of Wellcome Monitor survey data. Vaccine. 2022. doi:10.1016/j.vaccine.2022.04.024 Champion VL, Skinner CS. The health belief model. In: Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: Jossey-Bass; 2008. p. 45–65. Wang X, Liu C, Zheng S, Zhang X, Lin R, Duan L, et al. The public’s irrational use of antibiotics for upper respiratory tract infections: a cross-sectional study based on the health belief model. Sci Rep. 2025;15(1):17220. doi: 10.1038/s41598-025-01767-9 Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179–211. doi:10.1016/0749-5978(91)90020-T Turkish Statistical Institute. Address-based population registration system database [Internet]. Ankara: TURKSTAT; [cited 2024 Nov 20]. Available from: https://www.tuik.gov.tr EQUATOR Network. The STROBE reporting guideline for observational studies [Internet]. [cited 2024 Nov 20]. Available from: https://www.equator-network.org Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004 Sep 29;6(3):e34. doi: 10.2196/jmir.6.3.e34. Erratum in: doi:10.2196/jmir.2042. PMID: 15471760; PMCID: PMC1550605. Alumran A, Hou XY, Hurst C. Assessing the overuse of antibiotics in children in Saudi Arabia: validation of the parental perception on antibiotics scale (PAPAS). Health Qual Life Outcomes. 2013;11:39. doi: 10.1186/1477-7525-11-39 Özdemir C. Anne ve Babaların Antibiyotik Algıları Ölçeği’nin Türkçeye Uyarlanması [thesis]. 2018. Opel DJ, Taylor JA, Mangione-Smith R, Solomon C, Zhao C, Catz S, et al. Validity and reliability of a survey to identify vaccine-hesitant parents. Vaccine. 2011;29(38):6598–6605. doi:10.1016/j.vaccine.2011.06.115 Mutlu M. Turkish validity and reliability study of the scale of parents' attitudes towards childhood vaccinations. [thesis]. 2021. Çelebi A, Çelebioğlu A. Development of Parental Attitude Scale Towards Rational Drug Use [Internet]. [cited 2023 Nov 10]. Available from: https://tr-scales.arabpsychology.com/wp-content/uploads/pdf/akilci-ilac-kullanimina-yonelik-ebeveyn-tutum-olcegi-toad.pdf Bosley H, Henshall C, Appleton J, Jackson D. A systematic review to explore influences on parental attitudes towards antibiotic prescribing in children. J Clin Nurs. 2018;27:892–905. doi:10.1111/jocn.14073 Darweesh O, Kurdi A, Merkhan M, Ahmed H, Ibrahem S, Al-Zidan R, et al. Knowledge, attitudes, and practices of Iraqi parents regarding antibiotic use in children. Antibiotics (Basel). 2025;14. doi:10.3390/antibiotics14040376 Mutagonda R, Marealle A, Nkinda L, Kibwana U, Maganda B, Njiro B, et al. Determinants of misuse of antibiotics among parents of children attending clinics in Tanzania. Sci Rep. 2022;12. doi:10.1038/s41598-022-08895-6 Paredes J, Navarro R, Watanabe T, Morán F, Balmaceda M, Reateguí A, et al. Knowledge, attitudes and practices of parents towards antibiotic use in rural Peru. BMC Public Health. 2022;22. doi:10.1186/s12889-022-12855-0 Asghar S, Atif M, Arshad S, Masood I, Hashmi A. Probing parental cognizance of antibiotic resistance using health belief model. Res Social Adm Pharm. 2023. doi:10.1016/j.sapharm.2023.09.005 Szymczak J, Klieger S, Miller M, Fiks A, Gerber J. What parents think about the risks and benefits of antibiotics. J Pediatric Infect Dis Soc. 2018;7:303–309. doi:10.1093/jpids/pix073 Abenova M, Shaltynov A, Jamedinova U, Semenova Y. Worldwide child routine vaccination hesitancy rate among parents: a systematic review. Vaccines (Basel). 2023;12. doi:10.3390/vaccines12010031 Naser A, Al-Shehri H. Parental knowledge, attitudes and practices on antibiotic use in Jordan. BMJ Paediatr Open. 2025;9. doi:10.1136/bmjpo-2025-003698 Kumar S, Agrawal S, Yasmin T, Sinha SKumar S, Agrawal S, Yasmin T, Sinha S. Exploring knowledge and consequences of parental misuse of antibiotics for children. Porto Biomed J. 2025 Mar 18;10(2):e286. doi: 10.1097/j.pbj.0000000000000286. PMID: 40104446; PMCID: PMC11913405. Anderson A. ttitudes towards vaccination and knowledge about antibiotics: Analysis of Wellcome Monitor survey data. Vaccine. . 2022;40(22), 3038-3045 doi:10.31235/osf.io/bnadr Hoffmann K, Van Bijnen E, George A, Kutalek R, Jirovsky E, Wojczewski S, et al. Associations between influenza vaccination and antibiotic knowledge. BMC Public Health. 2015;15. doi:10.1186/s12889-015-2297-x Waaseth M, Adan A, Røen I, Eriksen K, Stanojević T, Halvorsen K, et al. Knowledge of antibiotics among Norwegian pharmacy customers. BMC Public Health. 2019;19. doi:10.1186/s12889-019-6409-x Vallin M, Polyzoi M, Marrone G, Rosales-Klintz S, Wisell T, Lundborg S. Knowledge and attitudes towards antibiotic use and resistance. PLoS One. 2016;11. doi:10.1371/journal.pone.0152160 Ebi S, Deml M, Jafflin K, Buhl A, Engel R, Picker J, et al. Parents’ vaccination information seeking and trust in providers. BMJ Open. 2022;12. doi:10.1136/bmjopen-2021-053267 Bellomo R, Cerabona V, Massimi A, Migliara G, Sparano M, Novello F, et al. Alternative sources of information about childhood vaccinations. Front Public Health. 2023;11. doi:10.3389/fpubh.2023.1225761 Jordan S, Böttger S, Zinn S. Persuasiveness of information sources on vaccination decisions. PLoS One. 2025;20. doi:10.1371/journal.pone.0333268 Ashfield S, Donelle L. Parental online information access and vaccination decisions. J Med Internet Res. 2020;22. doi:10.2196/20002 Santra A, Bandyopadhyay S, Roy S, Sarkar P. Perceptions regarding rational antibiotic use. J Family Med Prim Care. 2025;14:1307–1312. doi:10.4103/jfmpc.jfmpc_1563_24 Lin R, Duan L, Liu C, Wang D, Zhang X, Wang X, et al. Antibiotic use behavioural patterns in China. Front Public Health. 2023;11. doi:10.3389/fpubh.2023.1231370 Lima G, Lima F, Medina L, Sombra S, Magalhães F, Florencio SGS, et al. Parental perception of antibiotic use in children. Rev Bras Enferm. 2025;78. doi:10.1590/0034-7167-2025-0030 Lewnard JA, Lo NC, Arinaminpathy N, Frost I, Laxminarayan R. Childhood vaccines and antibiotic use in LMICs. Nature. 2020;581:94–99. doi:10.1038/s41586-020-2238-4 Zhang J, Nizet V. The central importance of vaccines in mitigating antibiotic resistance. Vaccines (Basel). 2025;13. doi:10.3390/vaccines13090893 Wagner C, Prentice J, Saad-Roy C, Yang L, Grenfell B, Levin S, et al. Economic and behavioral influencers of vaccination and antimicrobial use. Front Public Health. 2020;8. doi:10.3389/fpubh.2020.614113 Micoli F, Bagnoli F, Rappuoli R, Serruto D. The role of vaccines in combatting antimicrobial resistance. Nat Rev Microbiol. 2021;19:287–302. doi:10.1038/s41579-020-00506-3 Additional Declarations No competing interests reported. Supplementary Files STROBECHERRIEScriters.docx CHERRIES criters report Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9060861","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":626249306,"identity":"53c49beb-fb5c-42f8-aa91-2b5e5b067bd2","order_by":0,"name":"Seval Çalışkan Pala","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYLCCBwwWDBIMzAeATAkZ4rQkADVIMLAlgLTwkKKFxwDEJqxFvr3H8ENCjYS95Oyez69u1FjwMLAfProBnxaDM2eMJRKOSSTOljm7zTrnGNBhPGlpN/BqkUhLkEhskEiQk8jdZpzDBtQiwWOGV4v8/GfJP4Ba7OUkcp4Z5/wjQgvDDeZjIFsYZ0vkMD/ObSNCi8GZ5GMWIL/MnJFmxpzbJ8HDRsgv8u0Hm298qLGxl7iR/Phzzrc6OX72w8fwOwwJsEmASWKVgwDzB1JUj4JRMApGwcgBAHfiQ0atz9KwAAAAAElFTkSuQmCC","orcid":"","institution":"Eskişehir Provincial Health Directorate","correspondingAuthor":true,"prefix":"","firstName":"Seval","middleName":"Çalışkan","lastName":"Pala","suffix":""},{"id":626249307,"identity":"c74fc6a2-459b-48e1-b0f7-bfa9b9fe477f","order_by":1,"name":"Ece Elif Öcal Yanık","email":"","orcid":"","institution":"Usak University","correspondingAuthor":false,"prefix":"","firstName":"Ece","middleName":"Elif Öcal","lastName":"Yanık","suffix":""}],"badges":[],"createdAt":"2026-03-07 21:23:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9060861/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9060861/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107839392,"identity":"0c3f841a-4db8-47e0-b911-8e090c12fd73","added_by":"auto","created_at":"2026-04-26 17:19:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":362000,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of PAPAS scores received by those who are hesitant about vaccination.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9060861/v1/1b062691a4773f056bf28370.png"},{"id":108218469,"identity":"25d9c4cf-4a19-4708-8d07-cf80e268443e","added_by":"auto","created_at":"2026-04-30 14:55:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1033471,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9060861/v1/54387949-3e6b-4a79-a9cb-173aa826186c.pdf"},{"id":107870562,"identity":"7e0f4543-fbd2-4e62-a040-1a896628cc42","added_by":"auto","created_at":"2026-04-27 07:39:56","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18200,"visible":true,"origin":"","legend":"\u003cp\u003eCHERRIES criters report\u003c/p\u003e","description":"","filename":"STROBECHERRIEScriters.docx","url":"https://assets-eu.researchsquare.com/files/rs-9060861/v1/bd7e17f662a5018837cf548c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Parental Perceptions of Antibiotics and Their Association with Vaccine Attitudes and Rational Drug Use: A Cross-Sectional Study in Central Anatolia, Türkiye","fulltext":[{"header":"Background","content":"\u003cp\u003eAntimicrobial resistance (AMR) represents one of the most significant global public health threats, largely stemming from inappropriate and excessive antibiotic use in community settings (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Childhood is one of the periods with the highest antibiotic exposure, particularly due to respiratory tract infections characterized by symptoms such as cough, runny nose, sore throat, and earache (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Children experience an average of 6\u0026ndash;10 respiratory tract infections per year, increasing the likelihood of unnecessary antibiotic use. However, most of these infections are viral in origin, and prescribing antibiotics in such cases contradicts the principles of rational drug use (RDU) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Inappropriate antibiotic use has particularly contributed to the development of AMR in pediatric populations over the last decade (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The limited development of new antibiotics and insufficient pediatric pharmacokinetic and safety data further increase children's vulnerability to resistant infections (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The determinants of inappropriate antibiotic use in children are multifactorial. Geographic, health system-related, physician-related, and parental sociodemographic factors all contribute to inappropriate practices. Among these, parental knowledge, attitudes, and perceptions are key determinants of antibiotic demand, compliance, and treatment decisions. Studies consistently show widespread misconceptions among parents regarding antibiotic indications, resistance mechanisms, and side effects. For example, many caregivers believe that symptoms such as green runny nose or a cold require antibiotic treatment (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These misconceptions can lead to problems such as self-medication, miscalculation of dosage, improper storage, and premature discontinuation of medication (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParallel to antibiotic misuse, vaccine hesitancy has also emerged as a growing public health problem. Despite the success of immunization programs, vaccine refusal and hesitancy have increased globally and in T\u0026uuml;rkiye since 2010 (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Rising vaccine refusal threatens herd immunity and increases the risk of outbreaks of vaccine-preventable diseases, which continue to cause approximately 1.5\u0026nbsp;million deaths worldwide annually (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Although national policies in T\u0026uuml;rkiye, including RDU campaigns and restrictions on the over-the-counter sale of antibiotics, have reduced antibiotic consumption rates, attitudinal and informational determinants of misuse persist. Children require special attention in RDU initiatives. Caregiver-related medication errors, including incorrect dosing, premature termination, and improper storage, are frequently reported. Therefore, identifying parental hesitations, raising their awareness, and providing them with accurate information are critical components of antimicrobial management efforts (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAntibiotic misuse and vaccine hesitancy may reflect interconnected components of a broader health belief system rather than isolated behaviors (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The Health Belief Model (HBM) proposes that individuals' health behaviors are shaped by perceived sensitivity, perceived seriousness, perceived benefits, perceived barriers, and action cues (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Parents who underestimate the seriousness of AMR or overestimate the benefits of antibiotics for viral infections may be more prone to demanding antibiotics (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Similarly, perceived vaccine risks may reduce vaccination acceptance. The Theory of Planned Behavior (TPB) further emphasizes the role of attitudes, subjective norms, and perceived behavioral control in shaping health behaviors (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Parents' decisions regarding antibiotic use and vaccine choices are influenced by social norms, trust in healthcare providers, and perceived control over child health outcomes. Therefore, vaccine hesitancy and irrational antibiotic use may share common cognitive and social determinants, including health literacy, risk perception, and trust in health systems.\u003c/p\u003e \u003cp\u003eVaccine refusal, antibiotic misuse, and irrational drug use among parents have increasingly emerged as important public health concerns, including in Eskişehir province, located in the Central Anatolia region of T\u0026uuml;rkiye. Identifying these parental attitudes is therefore of great importance. This study aims to evaluate the perceptions of parents living in Eskişehir regarding antibiotics, their attitudes towards childhood vaccinations, their attitudes towards RDU, and potentially related factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study is a cross-sectional study conducted on parents with children living in Eskişehir between January 2024 and April 2024. The study was conducted in Eskişehir, a province located in the Central Anatolia Region of Turkey, with a population of 927,956 (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The province has a mixed urban structure and accessible primary healthcare services, making it a suitable setting for assessing parental perceptions related to antibiotic use and child health practices. The study was conducted online among parents living in Eskişehir after obtaining the necessary administrative and ethical permissions. After being informed about the purpose and methodology of the study, the parents who voluntarily participated were asked to read and sign the informed consent form. All study procedures were conducted in accordance with the ethical standards of the national research committee and the Declaration of Helsinki.\u003c/p\u003e \u003cp\u003eThe study was designed and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. As data were collected through an online survey, the study also adhered to the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines. The completed STROBE and CHERRIES checklists are provided as supplementary materials (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The questionnaire consists of four separate sections: sociodemographic characteristics, Parental Perception on Antibiotics Scale (PAPAS), Parental Attitudes toward Childhood Vaccinations Scale (PACVS), and Parental Attitudes toward Rational Drug Use Scale (PASTRDU).\u003c/p\u003e \u003cp\u003eParental Perception on Antibiotics Scale (PAPAS)\u003c/p\u003e \u003cp\u003eThe PAPAS was developed by Alumran et al. in 2014 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and adapted into Turkish by \u0026Ouml;zdemir (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The scale consists of 5 sub-areas and is a 5-point Likert type with 31 items (1: Strongly disagree\u0026thinsp;\u0026minus;\u0026thinsp;5: Strongly agree / 1: Never\u0026thinsp;\u0026minus;\u0026thinsp;5: Always). The number of items in the subscales is: Knowledge and Beliefs: 10, Behaviors: 5, Information Seeking: 7, Compliance: 5, and Awareness of Antibiotic Resistance : 4. The PAPAS allows for a minimum score of 31 and a maximum score of 155. A higher score indicates a better perception of antibiotics. The Cronbach's alpha value of the scale is reported as 0.78, while in our study group, the Cronbach's alpha coefficient was calculated as 0.86.\u003c/p\u003e \u003cp\u003eParent Attitudes About Childhood Vaccines Scale(PACVS)\u003c/p\u003e \u003cp\u003eThe PACVS, developed by Opel in 2011, is a 15-item scale consisting of three sub-dimensions (behavior, general attitudes, and safety-effectiveness) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Its Turkish validity and reliability study was conducted by Mutlu (2021), and the Cronbach alpha value was determined as 0.845 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). In our study, the Cronbach alpha value of the PACVS was found to be 0.842. The scale's score calculation varies. The raw score obtainable from the scale is a value between 0 and 30. If the total converted score of the participating parent is less than 50, they are defined as a parent without vaccine hesitancy; if it is 50 or greater, they are defined as a parent hesitant about vaccines. In our study, the Cronbach alpha coefficient was 0.86.\u003c/p\u003e \u003cp\u003eParental Attitude Scale Towards Rational Drug Use (PASTRDU)\u003c/p\u003e \u003cp\u003eDeveloped by \u0026Ccedil;elebi (2018), the scale consists of 40 items and determines the attitude levels of parents towards RDU. The scale is a 5-point Likert type (1: strongly disagree \u0026ndash; 5: strongly agree). 12 items in the scale are reverse scored. Scores obtained from the scale range from 40 to 200. As the score obtained from the scale increases, the positive attitudes of parents towards RDU increase. It includes the sub-dimensions of \"correct and conscious\" and \"effective and safe\" use. The Cronbach Alpha coefficient of the scale is 0.88 (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), while in our study group, the Cronbach Alpha coefficient of the scale was found to be 0.96.\u003c/p\u003e \u003cp\u003eEvaluation of Data\u003c/p\u003e \u003cp\u003eThe obtained data were evaluated in the R Studio statistical package program. Descriptive statistics were calculated as mean, standard deviation, median for numerical variables, and categorical variables. The results were presented as numbers and percentages. Kolmogorov-Smirnov and Sharipo-Wilk tests were applied to test the normality of the data distribution. Pearson correlation analysis was used for correlation analysis. Since the data showed a normal distribution, t-test, ANOVA, and Multiple Linear Regression Analysis were applied for comparison. Before proceeding with regression analysis, the assumption of multicollinearity was evaluated. Collinearity diagnostics results showed that some dimensions had Condition Index scores above 30, and multiple variables had high variance shares in the same dimensions. Therefore, the sub-field scores of the scales were not included in the model. Homogeneity of variance was evaluated with the Levene test. Tukey test was used when the variances were homogeneous, and Games\u0026ndash;Howell post-hoc test was used when homogeneity was not achieved. Statistical significance was considered to be \u0026lt;\u0026thinsp;0.05 (p).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe median age (min-max) of the 519 parents comprising the study group was 34.0 (18\u0026ndash;58), with an average (SD) of 34.0 (10.0). 363 (69.9%) of the parents were female and 156 (20.1%) were male. Parents scored on the PAPAS between 69.0 and 146.0, with an average of 104.8 (14.5) and a median of 104. 47% of the parents scored above average on the PAPAS. A comparison of PAPAS and sub-domain scores based on sociodemographic characteristics of individuals in the study group is given in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of PAPA Scale and sub-domain scores of individuals in the study group according to their sociodemographic characteristics.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSociodemographic characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"6\" nameend=\"c7\" namest=\"c2\"\u003e \u003cp\u003ePAPAS\u003c/p\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.Subdomain\u003c/p\u003e \u003cp\u003eKnowledge and beliefs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.Subdomain\u003c/p\u003e \u003cp\u003eBehaviors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.SubdomainSeeking information\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.Subdomain\u003c/p\u003e \u003cp\u003eAdherence\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.Subdomain:\u003c/p\u003e \u003cp\u003eAwareness about antibiotics resistance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePAPA\u003c/p\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003eAge group\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003cp\u003e(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003cp\u003e(3.8)\u003csup\u003eb2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.3\u003c/p\u003e \u003cp\u003e(5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003cp\u003e(3.8)\u003csup\u003eb2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003cp\u003e(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e103.5\u003c/p\u003e \u003cp\u003e(15.2)\u003csup\u003eb1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003cp\u003e(7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003cp\u003e(4.1)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003cp\u003e(4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003cp\u003e(3.9)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.7\u003c/p\u003e \u003cp\u003e(2.4)\u003csup\u003ea1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e108.4\u003c/p\u003e \u003cp\u003e(15.2)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.3\u003c/p\u003e \u003cp\u003e(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.8\u003c/p\u003e \u003cp\u003e(3.6)\u003csup\u003eb1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.5\u003c/p\u003e \u003cp\u003e(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003cp\u003e(3.4)\u003csup\u003eb1***\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003cp\u003e(2.2)\u003csup\u003ea2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104.2\u003c/p\u003e \u003cp\u003e(12.9)\u003csup\u003eb2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e45 and over\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.5\u003c/p\u003e \u003cp\u003e(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003cp\u003e(3.5)\u003csup\u003eb3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003cp\u003e(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003cp\u003e(3.6)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003cp\u003e(2.4)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100.4\u003c/p\u003e \u003cp\u003e(13.4)\u003csup\u003eb3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.007\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003cp\u003e(6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003cp\u003e(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.5\u003c/p\u003e \u003cp\u003e(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.6\u003c/p\u003e \u003cp\u003e(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.2\u003c/p\u003e \u003cp\u003e(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e102.8\u003c/p\u003e \u003cp\u003e(13.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003cp\u003e(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003cp\u003e(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.7\u003c/p\u003e \u003cp\u003e(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003cp\u003e(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105.7\u003c/p\u003e \u003cp\u003e(14.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.701\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.036**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle/Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003cp\u003e(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003cp\u003e(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.3\u003c/p\u003e \u003cp\u003e(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003cp\u003e(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e102.1\u003c/p\u003e \u003cp\u003e(14.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003cp\u003e(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003cp\u003e(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003cp\u003e(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105.7\u003c/p\u003e \u003cp\u003e(14.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.926\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.038\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNuclear\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003cp\u003e(6.5)\u003csup\u003ea1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003cp\u003e(3.7)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003cp\u003e(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003cp\u003e(3.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003cp\u003e(2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104.8\u003c/p\u003e \u003cp\u003e(14.3)\u003csup\u003ea2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLarge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.2\u003c/p\u003e \u003cp\u003e(7.3)\u003csup\u003ea2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003cp\u003e(4.1)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003cp\u003e(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.3\u003c/p\u003e \u003cp\u003e(4.4)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003cp\u003e(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e106.7\u003c/p\u003e \u003cp\u003e(14.7)\u003csup\u003ea1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFragmented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.2\u003c/p\u003e \u003cp\u003e(5.2)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003cp\u003e(4.0)\u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.2\u003c/p\u003e \u003cp\u003e(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003cp\u003e(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91.6\u003c/p\u003e \u003cp\u003e(14.2)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003cp\u003e(7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.4\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.3\u003c/p\u003e \u003cp\u003e(4.0)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.7\u003c/p\u003e \u003cp\u003e(3.4)\u003csup\u003ea1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003cp\u003e(2.4)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e106.0\u003c/p\u003e \u003cp\u003e(14.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.7\u003c/p\u003e \u003cp\u003e(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.1\u003c/p\u003e \u003cp\u003e(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.3\u003c/p\u003e \u003cp\u003e(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.0\u003c/p\u003e \u003cp\u003e(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003cp\u003e(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104.4\u003c/p\u003e \u003cp\u003e(11.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.9\u003c/p\u003e \u003cp\u003e(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.8\u003c/p\u003e \u003cp\u003e(4.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.1\u003c/p\u003e \u003cp\u003e(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003cp\u003e(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104.4\u003c/p\u003e \u003cp\u003e(14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTradesman\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.3\u003c/p\u003e \u003cp\u003e(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.3\u003c/p\u003e \u003cp\u003e(1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003cp\u003e(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.3\u003c/p\u003e \u003cp\u003e(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003cp\u003e(1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e116.0\u003c/p\u003e \u003cp\u003e(11.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003cp\u003e(6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.9\u003c/p\u003e \u003cp\u003e(3.9)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003cp\u003e(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003cp\u003e(3.8)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003cp\u003e(2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e101.9\u003c/p\u003e \u003cp\u003e(14.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed / Housewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003cp\u003e(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.5\u003c/p\u003e \u003cp\u003e(4.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.2\u003c/p\u003e \u003cp\u003e(5.3)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003cp\u003e(4.0)\u003csup\u003ea2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003cp\u003e(2.4)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105.6\u003c/p\u003e \u003cp\u003e(15.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.026\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.036\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.268\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiterate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.0\u003c/p\u003e \u003cp\u003e(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.8\u003c/p\u003e \u003cp\u003e(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.9\u003c/p\u003e \u003cp\u003e(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003cp\u003e(3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e91.8\u003c/p\u003e \u003cp\u003e(11.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.2\u003c/p\u003e \u003cp\u003e(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.4\u003c/p\u003e \u003cp\u003e(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.1\u003c/p\u003e \u003cp\u003e(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003cp\u003e(3.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003cp\u003e(2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e103.7\u003c/p\u003e \u003cp\u003e(13.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.7\u003c/p\u003e \u003cp\u003e(7.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003cp\u003e(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.9\u003c/p\u003e \u003cp\u003e(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003cp\u003e(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.6\u003c/p\u003e \u003cp\u003e(2.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e102.8\u003c/p\u003e \u003cp\u003e(15.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.9\u003c/p\u003e \u003cp\u003e(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.5\u003c/p\u003e \u003cp\u003e(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.3\u003c/p\u003e \u003cp\u003e(4.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003cp\u003e(4.0)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003cp\u003e(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105.5\u003c/p\u003e \u003cp\u003e(13.9)\u003csup\u003ea2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.1\u003c/p\u003e \u003cp\u003e(6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003cp\u003e(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003cp\u003e(4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003cp\u003e(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.9\u003c/p\u003e \u003cp\u003e(2.3)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105.6\u003c/p\u003e \u003cp\u003e(14.6)\u003csup\u003ea1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.052\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.015*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of children\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003cp\u003e(7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003cp\u003e(4.1)\u003csup\u003ea1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.1\u003c/p\u003e \u003cp\u003e(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003cp\u003e(3.7)\u003csup\u003ea1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003cp\u003e(2.2)\u003csup\u003ea1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e106.7\u003c/p\u003e \u003cp\u003e(15.1)\u003csup\u003ea1\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.1\u003c/p\u003e \u003cp\u003e(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.0\u003c/p\u003e \u003cp\u003e(3.7)\u003csup\u003ea2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003cp\u003e(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003cp\u003e(3.8)\u003csup\u003ea2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.5\u003c/p\u003e \u003cp\u003e(2.3)\u003csup\u003ea2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104.1\u003c/p\u003e \u003cp\u003e(14.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.4\u003c/p\u003e \u003cp\u003e(7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.3\u003c/p\u003e \u003cp\u003e(3.5)\u003csup\u003ea3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003cp\u003e(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.3\u003c/p\u003e \u003cp\u003e(3.4)\u003csup\u003ea3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3\u003c/p\u003e \u003cp\u003e(2.5)\u003csup\u003ea3\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105.7\u003c/p\u003e \u003cp\u003e(13.0)\u003csup\u003ea2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFour and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003cp\u003e(5.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003cp\u003e(3.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.0\u003c/p\u003e \u003cp\u003e(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15.5\u003c/p\u003e \u003cp\u003e(3.8)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e13.0\u003c/p\u003e \u003cp\u003e(2.7)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e98.9\u003c/p\u003e \u003cp\u003e(12.4)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.344\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.009*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily income status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.0(6.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.3(4.6)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.4(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.0(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.5(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100.2(13.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.6(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.4(3.7)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.9(4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.2(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.4(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105.4(14.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.7(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.8(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.8(4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.0(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.7(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e103.8(15.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.171*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSmoking status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.8(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.8(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.7(4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.6(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.3(2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e104.1(14.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.2(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.6(4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.6(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18.9(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14.7(2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e105.8(15.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003ep**\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.030\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.193**\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e*One-Way ANOVA **T-test ***b1\u0026gt;c\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003ea \u0026gt;b\u0026gt;c\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003eAbbreviations: PAPA, Parental Awareness of Antibiotic Use Scale; SD, standard deviation.\u003c/p\u003e\n\u003cp\u003eParents in the study group who were knowledgeable about vaccines had a higher perception of antibiotics. Those whose primary source of information about vaccination was a physician/healthcare professional scored higher than those whose sources were social media and radio/TV. Table 2 compares the scores obtained from the PAPAS by individuals in the study group according to potentially related factors. It was found that those with vaccine hesitancy scored higher on the PAPAS (p\u0026lt;0.001). Table 3 presents the correlation analyses of the PAPAS, PACVS, and PASTRDU scores for individuals in the study group. Figure 1 shows the distribution of PAPAS scores for those with vaccine hesitancy.\u003c/p\u003e\n\u003cp\u003eTable 2. Comparison of PAPA Scale scores of individuals in the study group according to potentially related factors.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePotentially related\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003efactors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 566px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAPAS\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMean (SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.Subdomain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge and beliefs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.Subdomain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBehaviors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.SubdomainSeeking information\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.Subdomain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAdherence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.Subdomain:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAwareness about antibiotics resistance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAPA\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal score\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of vaccination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e30.1\u003c/p\u003e\n \u003cp\u003e(6.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e17.9\u003c/p\u003e\n \u003cp\u003e(3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 103px;\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003cp\u003e(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003cp\u003e(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e13.9\u003c/p\u003e\n \u003cp\u003e(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e99.3\u003c/p\u003e\n \u003cp\u003e(14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e32.2\u003c/p\u003e\n \u003cp\u003e(6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003cp\u003e(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003cp\u003e(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003cp\u003e(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003cp\u003e(2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e107.2\u003c/p\u003e\n \u003cp\u003e(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003ep*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 604px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary source of information about vaccination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eRelative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e29.1\u003c/p\u003e\n \u003cp\u003e(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e18.4\u003c/p\u003e\n \u003cp\u003e(4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003cp\u003e(6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003cp\u003e(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003cp\u003e(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e102.6\u003c/p\u003e\n \u003cp\u003e(17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eNewspaper/Magazine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003cp\u003e(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e18.1\u003c/p\u003e\n \u003cp\u003e(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e19.7\u003c/p\u003e\n \u003cp\u003e(5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e16.3\u003c/p\u003e\n \u003cp\u003e(3.8)\u003csup\u003eb1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e13.4\u003c/p\u003e\n \u003cp\u003e(2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e99.3\u003c/p\u003e\n \u003cp\u003e(15.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eNeighbor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003cp\u003e(8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e18.6\u003c/p\u003e\n \u003cp\u003e(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e22.5\u003c/p\u003e\n \u003cp\u003e(2.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003cp\u003e(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003cp\u003e(3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e104.1\u003c/p\u003e\n \u003cp\u003e(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eDoctor/Healthcare personnel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003cp\u003e(6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e20.1\u003c/p\u003e\n \u003cp\u003e(3.7)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003cp\u003e(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003cp\u003e(3.6)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e14.7\u003c/p\u003e\n \u003cp\u003e(2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e108.0\u003c/p\u003e\n \u003cp\u003e(13.9)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eSocial media\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e30.9\u003c/p\u003e\n \u003cp\u003e(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e18.5\u003c/p\u003e\n \u003cp\u003e(3.7)\u003csup\u003eb1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003cp\u003e(4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003cp\u003e(3.6)\u003csup\u003eb2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003cp\u003e(2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e102.5\u003c/p\u003e\n \u003cp\u003e(13.4)\u003csup\u003eb1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eTelevision/Radio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003cp\u003e(6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003cp\u003e(4.0)\u003csup\u003eb2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e21.5\u003c/p\u003e\n \u003cp\u003e(4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e16.5\u003c/p\u003e\n \u003cp\u003e(3.6)\u003csup\u003eb3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e14.0\u003c/p\u003e\n \u003cp\u003e(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e100.1\u003c/p\u003e\n \u003cp\u003e(13.4)\u003csup\u003eb2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cem\u003ep**\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 162px;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*T-test **One-Way ANOVA\u003c/p\u003e\n\u003cp\u003ea\u0026nbsp;\u0026gt;b\u0026gt;c\u003c/p\u003e\n\u003cp\u003eAbbreviations: PAPA, Parental Awareness of Antibiotic Use Scale; SD, standard deviation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Correlation analyses of individuals in the study group according to PAPAS, PACVS and PASTRDU.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"639\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAPAS\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 295px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePACVS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 204px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePASTRDU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 98px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003cp\u003esubdomain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003cp\u003esubdomain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e3.\u003c/p\u003e\n \u003cp\u003esubdomain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003eTotal Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e1.\u003c/p\u003e\n \u003cp\u003esubdomain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 69px;\"\u003e\n \u003cp\u003e2.\u003c/p\u003e\n \u003cp\u003esubdomain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 65px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003escore\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.subdomain:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge and beliefs\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003er:-0.037\u003c/p\u003e\n \u003cp\u003ep:0.403\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003er:0.028\u003c/p\u003e\n \u003cp\u003ep:0.520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003er:0.001\u003c/p\u003e\n \u003cp\u003ep:0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003er:0.017\u003c/p\u003e\n \u003cp\u003ep:0.697\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.190*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.300*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep:0.255*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.subdomain:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBehaviors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:-0.213*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.292*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.169*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.265*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.553**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.520**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.618**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.subdomain:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSeeking information\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003er:-0.022\u003c/p\u003e\n \u003cp\u003ep:0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.116*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep:0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003er:0.070\u003c/p\u003e\n \u003cp\u003ep:0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.114*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep:0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.174*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003er:0.257\u003c/p\u003e\n \u003cp\u003ep:0.519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.227*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.subdomain:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAdherence\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:-0.196*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.287*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.195*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.273*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.449**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.470**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.519**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.Subdomain:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAwareness about antibiotics resistance\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003er:-0.067\u003c/p\u003e\n \u003cp\u003ep:0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.313**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.126*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep:0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.280*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.287*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.233*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.308**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAPAS Total Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:-0.142*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep:0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.254*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.139*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep:0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.232*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.455**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 69px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.520**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er:0.541**\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*:weak correlation, **:medium correlation\u003c/p\u003e\n\u003cp\u003eAbbreviations: PAPA, Parental Awareness of Antibiotic Use Scale; PACVS,Parent Attitudes About Cildhhood Vaccines Scale; PASTRDU, Parental Attitude Scale Towards Rational Drug Use\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Uniform analyses revealed that the variables \u0026ldquo;age, gender, education level, marital status, family type, number of children, knowledge about vaccination, primary source of information about vaccination, PASTRDU and PACVS scores\u0026rdquo; were related to the PAPAS score. According to the results of the linear regression analysis, which was created after controlling for factors associated with the variables found to be significant, it was determined that parents\u0026apos; perceptions of antibiotics were better among those in the 25-34 age group compared to other age groups (\u0026beta;:2.014 (95% CI:0.688 to 3.341)), those who were knowledgeable about vaccination compared to those who were not (\u0026beta;:2.895 (95% CI:0.410 to 5.380)), those whose source of information about vaccination was physicians and healthcare personnel compared to those whose source was television/radio and social media (\u0026beta;:0.843 (95% CI:0.224 to 1.462)), and those who scored high on the PAPAS (\u0026beta;:0.306 (95% CI:0.258 to 0.353)) (R\u0026sup2;:0.337; F:25.791; p\u0026lt;0.01). The results of the multiple linear regression analysis are presented in Table 4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. Results of Multiple Linear Regression Analysis\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"620\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnstandardized Coefficients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStandardized Coefficients\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95,0% Confidence Interval for B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStd. Error\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeta\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower Bound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper Bound\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-1.980\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-2.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-3.308\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.652\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.695\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-1.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.767\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-1.483\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1.343\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-1.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-4.121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-1.533\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-1.256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-3.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.864\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-.491\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-1.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.849\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of children\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.981\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-1.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.338\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge about vaccination\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e3.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e1.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e2.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1.183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e6.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBasic source of information about vaccines\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-1.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-2.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.017\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-2.301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e-0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePASTRDU total score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.535\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e12.631\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePACVS total score\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e-0.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e-1.357\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.175\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-0.233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(Constant)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e67.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 74px;\"\u003e\n \u003cp\u003e6.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e10.990\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e55.557\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e79.743\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 620px;\"\u003e\n \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e=0.335\u003c/p\u003e\n \u003cp\u003eF=25.573\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ep\u0026lt;0.01\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\n\u003cp\u003eAbbreviations:PACVS,Parent Attitudes About Cildhhood Vaccines Scale; PASTRDU, Parental Attitude Scale Towards Rational Drug Use\u003c/p\u003e\n"},{"header":"Discussion","content":"\u003cp\u003eParents play a central role in shaping children\u0026apos;s health decisions, including antibiotic demand, treatment adherence, and vaccination acceptance. Therefore, parental perceptions constitute a strategic intervention point for both antibiotic use and vaccination programs in children (23). To our knowledge, this study is the first to simultaneously examine parental perceptions of antibiotics, vaccine attitudes, and awareness of RDU in T\u0026uuml;rkiye within a unified analytical framework. By integrating these interrelated areas, the current research offers a multidimensional perspective on parents\u0026apos; health beliefs rather than evaluating antibiotic use in isolation. This comprehensive approach is particularly important in the Turkish context, where fluctuations in vaccine trust and ongoing challenges in antibiotic use continue to raise significant public health concerns.\u003c/p\u003e\n\u003cp\u003eParental attitudes toward antibiotics are critical in terms of both unnecessary use and avoidance (8). The study found that almost half of the parents had negative perceptions of antibiotics. In many countries, a large proportion of parents view antibiotics as medicines that are good for colds and viral infections (8, 24, 25). Many studies have reported that parents hold at least one misconception about antibiotic use and have never heard of antibiotic resistance (8, 26). Parents may perceive antibiotics as a \u0026quot;quick fix\u0026quot; or \u0026quot;cure for all illnesses\u0026quot; (26, 27), or they may experience significant anxiety and reluctance when antibiotics are prescribed for their children (28). Parents\u0026apos; attitudes towards antibiotics are similar to the literature, but may show some differences from society to society depending on educational level, socioeconomic status, previous experiences, social environment, and risk perception. It is important for family physicians and pediatricians to provide accurate guidance to parents by considering both societal characteristics and individual differences when offering counseling services.\u003c/p\u003e\n\u003cp\u003eIn our study, four out of five parents had vaccine hesitancy. The frequency of hesitancy regarding routine childhood vaccinations varies by country and vaccine type, and is roughly 21.1% among parents worldwide, or 1 in 5 (29). This may reflect the impact of regional and sociocultural dynamics, health literacy levels, or changing risk perceptions in the post-pandemic era on vaccination attitudes. In particular, this high level of hesitation regarding routine childhood vaccinations indicates a critical area for intervention to ensure the sustainability of immunization programs in the region.\u003c/p\u003e\n\u003cp\u003eIn the study group, individuals aged 25-34 had higher scores on the PAPAS than other age groups. In Jordan, parents aged 30\u0026ndash;49 were reported to have significantly better antibiotic knowledge than those aged 20\u0026ndash;29 (30). In Peru, parents aged 20 and under were reported to have approximately 2.4 times better knowledge than those aged 40 and over (26). In Tanzania, the 36\u0026ndash;45 age group was reported to be more likely to have good knowledge than those aged 25 and under (25). In India, parents aged 40 and over were reported to be more inclined to discontinue antibiotics when the child felt better, while parents under 30 tended to stockpile antibiotics at home (31). While current studies in different countries report that older parental age is often associated with better antibiotic knowledge and more appropriate attitudes, it appears that findings may vary depending on the context. In this study, the higher scores on the PAPAS for parents aged 25\u0026ndash;34 compared to other age groups may be related to young adult parents\u0026apos; greater exposure to current health information, more effective use of digital information resources, and more intensive interaction with primary healthcare services. This suggests that antibiotic perception is shaped not only by chronological age but also by the way information is accessed, health literacy, and social environment dynamics. In the study, those who were knowledgeable about vaccination had a higher perception of antibiotics than those who were not. In a study conducted in the United Kingdom, those who perceived the side effects of vaccines as very high were more likely to give incorrect answers about which infections antibiotics are effective against. Those who said that the risk of vaccine side effects was \u0026quot;non-existent\u0026quot; had more accurate information about antibiotics. Misconceptions about the use of antibiotics were more frequent in those who said that vaccines were \u0026quot;sometimes effective\u0026quot; or \u0026quot;almost never effective\u0026quot; (32). In Austria, those who correctly knew that \u0026quot;antibiotics are ineffective against viruses, colds, and the flu\u0026quot; were more likely to get the flu vaccine (33). In Sweden and Norway, a high level of knowledge about antibiotics and resistance is associated with more restrictive/rational antibiotic attitudes and adherence to health recommendations (34, 35). Studies indicate that individuals with accurate and positive information about vaccines tend to have a more accurate understanding of when and how to use antibiotics; conversely, vaccine distrust can be seen in conjunction with antibiotic misconceptions. Accordingly, it is suggested that vaccine and antibiotic awareness should be planned within integrated public health programs targeting common cognitive determinants, rather than separately.\u003c/p\u003e\n\u003cp\u003eThose who received information about vaccination from physicians and other health personnel scored higher on the PAPAS (in terms of behavior, adherence, and total score) compared to sources such as social media and TV/radio. This shows that health professionals stand out as a reliable source of information, similar to the literature (36, 37). Social media, on the other hand, is preferred more, especially among anti-vaccination or hesitant individuals (36, 38). In addition, conversations with family and friends and traditional media (TV, radio) are seen as important persuasive sources in vaccine decisions (38). Parents with high vaccine hesitancy tend to turn to alternative sources of information, and those with low health literacy also tend to prefer such sources (37). Consequently, the role of healthcare personnel in vaccine education is critical, and the dissemination of accurate and reliable information on digital platforms such as social media is necessary (38, 39). This indicates that the quality of the information source is decisive in shaping perceptions of vaccines and antibiotics, and that trust-based communication strategies relying on healthcare professionals constitute a critical public health intervention area in terms of counteracting the impact of digital misinformation.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The study found that those with high RDU had a better perception of antibiotics compared to others. In many societies, antibiotics are still perceived as the \u0026ldquo;powerful and fast\u0026rdquo; remedy for viral diseases such as fever, flu, and the common cold (40, 13). While increased knowledge in some studies has led to a better understanding of the harms and resistance of antibiotics, it can also lead to more self-treatment and irrational use with the confidence of \u0026ldquo;I can use them correctly myself.\u0026rdquo; Nevertheless, generally, better knowledge and more appropriate attitudes increase the likelihood of RDU; factors such as age, education level, and easy access to pharmacies shape perception (41). RDU, by targeting knowledge, attitude, and behavior together, can weaken the perception of antibiotics as \u0026ldquo;good for every disease, the more the better,\u0026rdquo; and strengthen the understanding of using them when necessary, in the correct dose and for the correct duration.\u003c/p\u003e\n\u003cp\u003eA moderately positive correlation was found between the PAPAS behaviors and adherence sub-domain and the PASTRDU. Parental attitudes are influenced by past experiences, the quality of communication with healthcare providers, and socioeconomic factors; this underscores the need for targeted educational interventions to increase knowledge and promote RDU (22). Overall, there is a moderately positive correlation between parents\u0026apos; PASTRDU, suggesting that improving one can positively influence the other (42). The moderately positive correlation indicates that cognitive attitudes toward antibiotic use and behavioral tendencies are interrelated. The moderate correlation may point to a gap between attitude and behavior, suggesting that cognitive awareness-enhancing interventions alone may not be sufficient. This highlights that the role of healthcare professionals is not limited to the prescribing process; it also emphasizes their responsibility to increase risk communication and health literacy.\u003c/p\u003e\n\u003cp\u003eA moderately positive correlation was found between the PAPAS sub-domain, the PACVS general attitudes sub-domain, and the PASTRDU total score. Studies show a moderate positive correlation between PACVS, awareness of antibiotic resistance, and scores for RDU Vaccination in children significantly reduces antibiotic consumption by preventing infections requiring antibiotic treatment, particularly in low- and middle-income countries (43). This reduction in antibiotic use helps combat AMR, a growing global health threat stemming from the overuse and misuse of antibiotics (44). Vaccine hesitancy and antibiotic overuse coexist in child populations, influenced by individual incentives, risk perceptions, and social norms, making efforts to promote both vaccination and RDU challenging (45). Overall, vaccines play a crucial role in reducing AMR by lowering infection rates and thus antibiotic demand, highlighting the importance of parental awareness and positive attitudes toward vaccination for RDU (44, 46). Overall, our findings demonstrate that parental perceptions of antibiotics cannot be addressed independently of broader health belief systems, including vaccination attitudes and awareness of RDU. This interrelationship highlights the importance of integrated behavioral and communication-based strategies at the primary care level for antimicrobial management policies. Developing evidence-based, culturally sensitive educational strategies is vital to reducing inappropriate antibiotic use and combating AMR.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eNearly half of parents hold negative perceptions of antibiotics, while four out of five parents are vaccine hesitants. Parental age, knowledge of vaccination, primary sources of information about vaccination, and attitudes toward RDU are important factors in determining antibiotic perceptions. The moderate correlations observed between antibiotic perception, awareness of AMR, attitudes toward vaccination, and RDU behaviors indicate that these areas do not operate independently. Therefore, addressing antibiotic misuse in isolation may be insufficient to combat AMR at the community level.\u003c/p\u003e\n\n\u003cp\u003eThe relationship between vaccine awareness and more positive antibiotic perceptions, and RDU, further supports the need for integrated education strategies. Interventions that address vaccine awareness, awareness of AMR, and RDU simultaneously can create synergistic effects by targeting common cognitive determinants.\u003c/p\u003e\n\n\u003cp\u003eFrom a public health perspective, parents\u0026apos; perceptions of antibiotic use management programs should be integrated into primary care communication strategies that emphasize clear risk communication, culturally sensitive messaging, and building trust between healthcare professionals and families. Physicians and primary care professionals play a crucial role not only in prescribing medication but also in correcting misconceptions about viral infections, antibiotic resistance, and vaccine safety. Strengthening healthcare professional-parent communication can help reduce both unnecessary antibiotic demand and vaccine hesitancy. Consequently, promoting RDU and combating AMR requires detailed studies that necessitate multifaceted, coordinated strategies that simultaneously strengthen vaccine trust, health literacy, and evidence-based medication use behaviors among parents.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe cross-sectional design of the study limits the establishment of a definitive cause-and-effect relationship between variables, presenting only a projection of the current situation. Collecting data through social media and using a non-probability sampling method resulted in reaching only parents with access to digital platforms; this created a risk of selection bias by excluding those who do not use the internet or certain socioeconomic groups from the sample. In the context of CHERRIES criteria, technical limitations include the inability to calculate precise response rates due to the technical inability to track the total reach of social media announcements, and the fact that repeated entries could only be checked via IP address due to institutional infrastructure limitations. Furthermore, the self-reported nature of the data raises the possibility that participants may have responded with social bias, while the study\u0026apos;s limitation to Eskişehir province restricts the generalizability of the results to the entire parent population in Turkey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe planning and reporting of the research in accordance with the STROBE guidelines, an international reporting standard, constitutes a fundamental strength in terms of methodological transparency and scientific quality. The fact that the validity and reliability of the PAPAS, PACVS, and PASTRDU scales used in the data collection process have been proven beforehand, and the Cronbach\u0026apos;s alpha coefficients calculated in the current study group (0.84-0.96) indicate high internal consistency, reinforces the reliability of the findings. Consideration of the CHERRIES criteria, which determine the reporting quality in online survey applications, has increased the compliance and traceability of the digital data collection process with standards. In the statistical analysis phase, not only descriptive data but also the establishment of a multiple linear regression model allowed for an in-depth examination of the relationships between variables. In particular, the rigorous verification of the multicollinearity assumption through Condition Index values before the regression analysis and the revision of the model in line with these technical findings is a critical approach that maintains the statistical validity of the analysis. Furthermore, the dynamic selection between Tukey or Games-Howell tests based on homogeneity of variance in intergroup comparisons indicates that the most appropriate analytical method has been applied to the data.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePAPAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eParental Perception on Antibiotics Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePACVS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eParent Attitudes About Cildhhood Vaccines Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePASTRDU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eParental Attitude Scale Towards Rational Drug Use\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRDU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRational Drug Use\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAMR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAntimicrobial resistance\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTROBE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStrengthening the Reporting of Observational Studies in Epidemiology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHERRIES\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStrengthening the Reporting of Observational Studies in Epidemiology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eCorresponding author: Seval \u0026Ccedil;alışkan Pala, [email protected], Eskişehir Provincial Health Directorate, Eskişehir, T\u0026uuml;rkiye\u003c/p\u003e\n\u003cp\u003eAuthor\u0026apos;s contribution: All authors actively contributed to every stage of the writing process of the article. S\u0026Ccedil;P wrote manuscript, collected information, performed statistical analysis, co-wrote the paper. EE\u0026Ouml;Y participated in the questionnaire survey and sample collection and gave academic support. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: Permission was obtained from Eskişehir City Hospital Ethics Committee. (Number: ESH/GOEK 2023/67SK, Date:22.11.2023). After being informed about the purpose and methodology of the study, the parents who voluntarily participated were asked to read and approved the informed consent form. All study procedures were conducted in accordance with the ethical standards of the national research committee and the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable.\u003c/p\u003e\n\u003cp\u003eData availability: Data supporting the conclusions of this article will be made available upon reasonable request. Seval \u0026Ccedil;alışkan Pala, the corresponding author, can be contacted.\u003c/p\u003e\n\u003cp\u003eConflict of interest: There is no conflict of interest among the authors.\u003c/p\u003e\n\u003cp\u003eFunding: The study was not funded by any source.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Antimicrobial resistance [Internet]. Geneva: WHO; [cited 2024 Nov 20]. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance\u003c/li\u003e\n\u003cli\u003eVaz LE, Kleinman KP, Lakoma MD, et al. Prevalence of parental misconceptions about antibiotic use. Pediatrics. 2015;136(2):221\u0026ndash;231. doi: 10.1542/peds.2015-0883\u003c/li\u003e\n\u003cli\u003eKurt NC, \u0026Ccedil;ankaya İİ. Phytotherapeutic approaches in pediatric respiratory tract diseases: a review on efficacy and safety. Mersin Univ Tip Fak Lokman Hekim Tip Tarihi Folklorik Tip Derg. 2026;16(1):63\u0026ndash;78. doi: 10.31020/mutftd.1667344\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. World health statistics 2018: monitoring health for the SDGs. Geneva: WHO; 2018. Available from: https://iris.who.int/server/api/core/bitstreams/8aea53eb-41d5-4a64-9a64-b8ff18cefd47/content \u003c/li\u003e\n\u003cli\u003eParimi N, Pinto Pereira LM, Prabhakar P. Caregivers\u0026apos; practices, knowledge and beliefs of antibiotics in paediatric upper respiratory tract infections in Trinidad and Tobago: a cross-sectional study. BMC Fam Pract. 2004;5:28. doi:10.1186/1471-2296-5-28\u003c/li\u003e\n\u003cli\u003eJensen JN, Bjerrum L, Boel J, Jarl\u0026oslash;v JO, Arpi M. Parents\u0026apos; socioeconomic factors related to high antibiotic prescribing in primary health care among children aged 0\u0026ndash;6 years in the Capital Region of Denmark. Scand J Prim Health Care. 2016;34(3):274\u0026ndash;281. doi: 10.1080/02813432.2016.1207145\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Together we can close the immunization gap [Internet]. Geneva: WHO; [cited 2020 Jan 24]. Available from: https://www.who.int\u003c/li\u003e\n\u003cli\u003eLuhas A, Galiș R, Rus M, Balmoș A, Marinău C, Niulaș L, et al. Misconceptions and behavioral risks in parental antibiotic use on Romanian children: a cross-sectional study on knowledge, attitudes, and practices. Antibiotics (Basel). 2025;14. doi:10.3390/antibiotics14050479\u003c/li\u003e\n\u003cli\u003eTan, A. K., \u0026amp; Yal\u0026ccedil;ın, S. S. (2024). Childhood vaccination and vaccine hesitancy: a comparison between T\u0026uuml;rkiye and the world. \u003cem\u003eT\u0026uuml;rkiye \u0026Ccedil;ocuk Hastalıkları Dergisi\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(6), 387-395. doi: 10.12956/tchd.1547693\u003c/li\u003e\n\u003cli\u003eG\u0026uuml;lbetekіn E, G\u0026uuml;l Can F. The mediating role of e-health literacy in the effect of digital parenting on rational drug use in parents with school-age children: a structural equation model. Psychol Health Med. 2026;1\u0026ndash;15. doi: 0.1080/13548506.2026.2632397\u003c/li\u003e\n\u003cli\u003eAnderson A. Attitudes towards vaccination and knowledge about antibiotics: analysis of Wellcome Monitor survey data. Vaccine. 2022. doi:10.1016/j.vaccine.2022.04.024\u003c/li\u003e\n\u003cli\u003eChampion VL, Skinner CS. The health belief model. In: Health behavior and health education: theory, research, and practice. 4th ed. San Francisco: Jossey-Bass; 2008. p. 45\u0026ndash;65.\u003c/li\u003e\n\u003cli\u003eWang X, Liu C, Zheng S, Zhang X, Lin R, Duan L, et al. The public\u0026rsquo;s irrational use of antibiotics for upper respiratory tract infections: a cross-sectional study based on the health belief model. Sci Rep. 2025;15(1):17220. doi: 10.1038/s41598-025-01767-9\u003c/li\u003e\n\u003cli\u003eAjzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50(2):179\u0026ndash;211. doi:10.1016/0749-5978(91)90020-T\u003c/li\u003e\n\u003cli\u003eTurkish Statistical Institute. Address-based population registration system database [Internet]. Ankara: TURKSTAT; [cited 2024 Nov 20]. Available from: https://www.tuik.gov.tr\u003c/li\u003e\n\u003cli\u003eEQUATOR Network. The STROBE reporting guideline for observational studies [Internet]. [cited 2024 Nov 20]. Available from: https://www.equator-network.org\u003c/li\u003e\n\u003cli\u003eEysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004 Sep 29;6(3):e34. doi: 10.2196/jmir.6.3.e34. Erratum in: doi:10.2196/jmir.2042. PMID: 15471760; PMCID: PMC1550605. \u003c/li\u003e\n\u003cli\u003eAlumran A, Hou XY, Hurst C. Assessing the overuse of antibiotics in children in Saudi Arabia: validation of the parental perception on antibiotics scale (PAPAS). Health Qual Life Outcomes. 2013;11:39. doi: 10.1186/1477-7525-11-39\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zdemir C. Anne ve Babaların Antibiyotik Algıları \u0026Ouml;l\u0026ccedil;eği\u0026rsquo;nin T\u0026uuml;rk\u0026ccedil;eye Uyarlanması [thesis]. 2018.\u003c/li\u003e\n\u003cli\u003eOpel DJ, Taylor JA, Mangione-Smith R, Solomon C, Zhao C, Catz S, et al. Validity and reliability of a survey to identify vaccine-hesitant parents. Vaccine. 2011;29(38):6598\u0026ndash;6605. doi:10.1016/j.vaccine.2011.06.115\u003c/li\u003e\n\u003cli\u003eMutlu M. Turkish validity and reliability study of the scale of parents\u0026apos; attitudes towards childhood vaccinations. [thesis]. 2021.\u003c/li\u003e\n\u003cli\u003e\u0026Ccedil;elebi A, \u0026Ccedil;elebioğlu A. Development of Parental Attitude Scale Towards Rational Drug Use [Internet]. [cited 2023 Nov 10]. Available from: https://tr-scales.arabpsychology.com/wp-content/uploads/pdf/akilci-ilac-kullanimina-yonelik-ebeveyn-tutum-olcegi-toad.pdf \u003c/li\u003e\n\u003cli\u003eBosley H, Henshall C, Appleton J, Jackson D. A systematic review to explore influences on parental attitudes towards antibiotic prescribing in children. J Clin Nurs. 2018;27:892\u0026ndash;905. doi:10.1111/jocn.14073\u003c/li\u003e\n\u003cli\u003eDarweesh O, Kurdi A, Merkhan M, Ahmed H, Ibrahem S, Al-Zidan R, et al. Knowledge, attitudes, and practices of Iraqi parents regarding antibiotic use in children. Antibiotics (Basel). 2025;14. doi:10.3390/antibiotics14040376\u003c/li\u003e\n\u003cli\u003eMutagonda R, Marealle A, Nkinda L, Kibwana U, Maganda B, Njiro B, et al. Determinants of misuse of antibiotics among parents of children attending clinics in Tanzania. Sci Rep. 2022;12. doi:10.1038/s41598-022-08895-6\u003c/li\u003e\n\u003cli\u003eParedes J, Navarro R, Watanabe T, Mor\u0026aacute;n F, Balmaceda M, Reategu\u0026iacute; A, et al. Knowledge, attitudes and practices of parents towards antibiotic use in rural Peru. BMC Public Health. 2022;22. doi:10.1186/s12889-022-12855-0\u003c/li\u003e\n\u003cli\u003eAsghar S, Atif M, Arshad S, Masood I, Hashmi A. Probing parental cognizance of antibiotic resistance using health belief model. Res Social Adm Pharm. 2023. doi:10.1016/j.sapharm.2023.09.005\u003c/li\u003e\n\u003cli\u003eSzymczak J, Klieger S, Miller M, Fiks A, Gerber J. What parents think about the risks and benefits of antibiotics. J Pediatric Infect Dis Soc. 2018;7:303\u0026ndash;309. doi:10.1093/jpids/pix073\u003c/li\u003e\n\u003cli\u003eAbenova M, Shaltynov A, Jamedinova U, Semenova Y. Worldwide child routine vaccination hesitancy rate among parents: a systematic review. Vaccines (Basel). 2023;12. doi:10.3390/vaccines12010031\u003c/li\u003e\n\u003cli\u003eNaser A, Al-Shehri H. Parental knowledge, attitudes and practices on antibiotic use in Jordan. BMJ Paediatr Open. 2025;9. doi:10.1136/bmjpo-2025-003698\u003c/li\u003e\n\u003cli\u003eKumar S, Agrawal S, Yasmin T, Sinha SKumar S, Agrawal S, Yasmin T, Sinha S. Exploring knowledge and consequences of parental misuse of antibiotics for children. Porto Biomed J. 2025 Mar 18;10(2):e286. doi: 10.1097/j.pbj.0000000000000286. PMID: 40104446; PMCID: PMC11913405.\u003c/li\u003e\n\u003cli\u003eAnderson A. ttitudes towards vaccination and knowledge about antibiotics: Analysis of Wellcome Monitor survey data. Vaccine. . 2022;40(22), 3038-3045 doi:10.31235/osf.io/bnadr\u003c/li\u003e\n\u003cli\u003eHoffmann K, Van Bijnen E, George A, Kutalek R, Jirovsky E, Wojczewski S, et al. Associations between influenza vaccination and antibiotic knowledge. BMC Public Health. 2015;15. doi:10.1186/s12889-015-2297-x\u003c/li\u003e\n\u003cli\u003eWaaseth M, Adan A, R\u0026oslash;en I, Eriksen K, Stanojević T, Halvorsen K, et al. Knowledge of antibiotics among Norwegian pharmacy customers. BMC Public Health. 2019;19. doi:10.1186/s12889-019-6409-x\u003c/li\u003e\n\u003cli\u003eVallin M, Polyzoi M, Marrone G, Rosales-Klintz S, Wisell T, Lundborg S. Knowledge and attitudes towards antibiotic use and resistance. PLoS One. 2016;11. doi:10.1371/journal.pone.0152160\u003c/li\u003e\n\u003cli\u003eEbi S, Deml M, Jafflin K, Buhl A, Engel R, Picker J, et al. Parents\u0026rsquo; vaccination information seeking and trust in providers. BMJ Open. 2022;12. doi:10.1136/bmjopen-2021-053267\u003c/li\u003e\n\u003cli\u003eBellomo R, Cerabona V, Massimi A, Migliara G, Sparano M, Novello F, et al. Alternative sources of information about childhood vaccinations. Front Public Health. 2023;11. doi:10.3389/fpubh.2023.1225761\u003c/li\u003e\n\u003cli\u003eJordan S, B\u0026ouml;ttger S, Zinn S. Persuasiveness of information sources on vaccination decisions. PLoS One. 2025;20. doi:10.1371/journal.pone.0333268\u003c/li\u003e\n\u003cli\u003eAshfield S, Donelle L. Parental online information access and vaccination decisions. J Med Internet Res. 2020;22. doi:10.2196/20002\u003c/li\u003e\n\u003cli\u003eSantra A, Bandyopadhyay S, Roy S, Sarkar P. Perceptions regarding rational antibiotic use. J Family Med Prim Care. 2025;14:1307\u0026ndash;1312. doi:10.4103/jfmpc.jfmpc_1563_24\u003c/li\u003e\n\u003cli\u003eLin R, Duan L, Liu C, Wang D, Zhang X, Wang X, et al. Antibiotic use behavioural patterns in China. Front Public Health. 2023;11. doi:10.3389/fpubh.2023.1231370\u003c/li\u003e\n\u003cli\u003eLima G, Lima F, Medina L, Sombra S, Magalh\u0026atilde;es F, Florencio SGS, et al. Parental perception of antibiotic use in children. Rev Bras Enferm. 2025;78. doi:10.1590/0034-7167-2025-0030\u003c/li\u003e\n\u003cli\u003eLewnard JA, Lo NC, Arinaminpathy N, Frost I, Laxminarayan R. Childhood vaccines and antibiotic use in LMICs. Nature. 2020;581:94\u0026ndash;99. doi:10.1038/s41586-020-2238-4\u003c/li\u003e\n\u003cli\u003eZhang J, Nizet V. The central importance of vaccines in mitigating antibiotic resistance. Vaccines (Basel). 2025;13. doi:10.3390/vaccines13090893\u003c/li\u003e\n\u003cli\u003eWagner C, Prentice J, Saad-Roy C, Yang L, Grenfell B, Levin S, et al. Economic and behavioral influencers of vaccination and antimicrobial use. Front Public Health. 2020;8. doi:10.3389/fpubh.2020.614113\u003c/li\u003e\n\u003cli\u003eMicoli F, Bagnoli F, Rappuoli R, Serruto D. The role of vaccines in combatting antimicrobial resistance. Nat Rev Microbiol. 2021;19:287\u0026ndash;302. doi:10.1038/s41579-020-00506-3\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Parental perception, antibiotic use, vaccine attitude, rational drug use","lastPublishedDoi":"10.21203/rs.3.rs-9060861/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9060861/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackgrounds: This study aims to evaluate parents' perceptions of antibiotics, their attitudes towards childhood vaccinations, their attitudes towards rational drug use, and potentially related factors.\u003c/p\u003e \u003cp\u003eMethods: This study is a cross-sectional research conducted in 2024 on mothers and fathers living in a province in the Central Anatolia region of T\u0026uuml;rkiye. The data collection form consists: sociodemographic characteristics, Parental Perception of Antibiotics Scale (PAPAS), Parents' Attitudes about Childhood Vaccines Scale (PACVS), and Parental Attitude Scale Towards Rational Drug Use (PASTRDU). Since the data showed a normal distribution, t-test, ANOVA, Pearson correlation analysis, and Multiple Linear Regression Analysis were applied for comparison.\u003c/p\u003e \u003cp\u003eResults: The median age of the 519 parents in the study group was 34.0 (standard deviation) (10.0), 363 (69.9%) were female and 156 (20.1%) were male. The average score of the parents on the PAPAS was 104.8 (14.5). 47% of the parents scored above average on the PAPAS. According to the results of the linear regression analysis, which was created after controlling for variables that were found to be significant with single analyses (age, gender, education level, marital status, family type, number of children, knowledge about vaccination, primary source of information about vaccination, PASTRDU, PACVS score), it was determined that mothers and fathers in the 25\u0026ndash;34 age group had better antibiotic perceptions than other age groups, those who were knowledgeable about vaccination had better perceptions than those who were not, those whose source of information about vaccination was physicians and health personnel had better perceptions than those whose source was television/radio and social media, and those who scored high on PASTRDU had better perceptions than others.\u003c/p\u003e \u003cp\u003eConclusion: Nearly half of the parents have a negative perception of antibiotics, and four out of five parents have vaccine hesitancy. Parents' age, knowledge about vaccination, primary sources of information about vaccination, and attitudes towards rational drug use are important factors in determining antibiotic perceptions. Parental perceptions of antibiotics should be addressed at both individual and societal levels, along with attitudes towards vaccination and rational drug use, and strategies should be developed and detailed studies conducted accordingly.\u003c/p\u003e","manuscriptTitle":"Parental Perceptions of Antibiotics and Their Association with Vaccine Attitudes and Rational Drug Use: A Cross-Sectional Study in Central Anatolia, Türkiye","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-26 17:19:42","doi":"10.21203/rs.3.rs-9060861/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8bca5807-fd2b-4865-98d2-bc7aa21a531a","owner":[],"postedDate":"April 26th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Rejected","date":"2026-04-30T14:41:20+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T14:55:39+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-26 17:19:42","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9060861","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9060861","identity":"rs-9060861","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}