HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hsu, J. L. Articles by Lee, H. J. Search for Related Content PubMed PubMed Citation Articles by Hsu, J. L. Articles by Lee, H. J.

Consumer Knowledge and Risk Perceptions of Avian Influenza¹

J. L. Hsu^*,2, K. E. Liu, M.-H. Huang and H. J. Lee^*

^* Department of Marketing, National Chung Hsing University, Taichung 40227, Taiwan; Department of Economics, National Chung Cheng University, Chia-Yi 62102, Taiwan; and Department of Asia-Pacific Industrial and Business Management, National University of Kaohsiung, Kaohsiung 81148, Taiwan

² Corresponding author: jlu{at}dragon.nchu.edu.tw

	ABSTRACT

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS AND DISCUSSION REFERENCES

 
This study examined consumer risk perceptions and knowledge of avian influenza and its linkage to behavioral changes in chicken consumption. A consumer survey was administered in 3 metropolitan areas in Taiwan in 2007. Multivariate analyses were utilized in this study to analyze data. Findings in this study indicated that respondents who were more knowledgeable of avian influenza with relatively high levels of risk perceptions would be likely to stay away from birds and the crowd. Respondents with relatively low levels of avian influenza knowledge were likely to prefer not eating chicken at all under a possible threat of avian influenza outbreaks. Respondents with low risk perception levels would be more likely to maintain usual chicken consumption than those with high risk perception levels if outbreaks of avian influenza occurred. Contributions of this study are to provide new insights into knowledge and risk perceptions of avian influenza and to reveal behavioral changes in chicken consumption in an area that a pandemic situation like avian influenza has not occurred but under a possible threat. Findings in this study would be beneficial to government administration and industry managers in designing effective information communication for educational purposes to ease possible effect on the industry as well as the consumer market if outbreaks had occurred in Taiwan.

Key Words: avian influenza • consumer knowledge • risk perception • chicken consumption

	INTRODUCTION

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS AND DISCUSSION REFERENCES

 
Outbreaks of highly pathogenic avian influenza (H5N1) in Asian countries and reported human cases have raised public concerns. Although neighboring countries (China, Japan, Korea, Malaysia, Indonesia, Vietnam, Thailand, Myanmar, and Cambodia) have confirmed avian influenza outbreaks, Taiwan has never had the disease and is in a situation of alert. Strict quarantine regulations and surveillance of migration birds as well as educating the general public about the importance of self-protection is essential. Policies in effect to reinforce consumer knowledge of avian influenza cannot be effective without knowing what information consumers need to be acquainted with. Due to the seriousness of H5N1 avian influenza outbreaks worldwide, epidemiologists are concerned about the development of a new kind of deadly influenza for which humans would have no resistance (Overby et al., 2005).

Studies conducted in the European countries revealed the importance of preparedness for avian influenza. Mounier-Jack and Coker (2006) assessed the development of national preparedness plans to evaluate European pre-paredness for pandemic influenza. Gaps in preparedness remained for surveillance, planning and coordination, and communication. Abbate et al. (2006) examined knowledge of avian influenza among Italian poultry workers and concluded that wearing protective equipment and hand-washing were not routine practices. Knowledge of avian influenza could be improved among poultry workers exposed to infectious particles from poultry droppings.

To investigate consumer knowledge of avian influenza in the European countries, a large-scale consumer survey was administered by the Directorate General Communication in Europe (Eurobarometer, 2006). Evaluating the knowledge of the risks linked to avian influenza was the main purpose of the survey. With 24,693 respondents from 25 European countries answering the 7 knowledge questions, the study concluded that European citizens in general understood the health risks linked to avian influenza with an average of 66% of the questions answered correctly. Specifically, the question regarding the extermination of contaminated poultry on farms had the greatest proportion of correct answers (84%). However, less than half of the respondents (47%) had correctly answered the question that it was not dangerous to eat the meat of chicken vaccinated against avian influenza. Due to various levels of effects of avian influenza outbreaks on European countries, knowledge levels varied considerably among countries. Consumers in France, Germany, Denmark, and Poland were more knowledgeable in avian influenza, but in Romania, Spain, Ireland, and Portugal, consumers were less informed. The list of 7 questions in Eurobarometer (2006) was adopted in this study to evaluate consumer knowledge of avian influenza in Taiwan.

The primary concern of avian influenza in Asian countries was to lessen the effect of outbreaks. Thailand, China, and Vietnam focused on a strategic vision to strengthen future capacity. Hong Kong, Australia, and New Zealand aimed at harnessing available resources or preparing for the deployment of resources such as stockpiled antiviral agents and vaccines (Coker and Mounier-Jack, 2006). Fielding et al. (2005) concluded that high population exposures to live chicken and low risk perceptions were potentially important health threats of avian influenza in Hong Kong.

In Taiwan, traditional markets with live chicken for sale provide a possible viral reservoir if outbreaks of avian influenza would have occurred. A survey conducted by Hsu and Chang (2002) found that 73.4% of surveyed urban household food shoppers purchased fresh meat products at traditional markets in Taiwan. It was a common belief that live chicken slaughtered at traditional markets preserved the freshness of chicken, which was an attribute food shoppers valued and could not be compared with it of chilled or frozen chicken sold at supermarkets. Shopping at traditional markets is an essential part of daily lives for most urban household food shoppers. Traditional markets are convenient, close to residential areas, and the retailers are friendly and willing to provide extra services for customers. Traditional markets outnumber hypermarts and grocery stores in metropolitan areas in Taiwan.

As Hsu and Chang (2002) described, most of the chicken sold at traditional markets in Taiwan was delivered from slaughterhouses outside or on the edge of urban areas early in the morning to retailers. Live chicken kept behind counters in traditional markets in Taiwan were mainly for customers with special requests. For hypermarts and grocery stores, contracted processors or integrated central processing units deliver slaughtered chicken (whole birds and parts) once or twice a day. Some processors are located near metropolitan areas, but most of them are in remote areas for cost efficiency. The agricultural administration has proposed to ban live chicken slaughtering in the traditional markets in Taiwan to prevent possible spread of infectious diseases.

In the relevant literature, Maciorowski et al. (1999) mentioned the importance of educating consumers on the safety issues of poultry meat handling. Beyhan and Aygoren (2006) explained that the construction and communication of knowledge was essential to the public risk perceptions of avian influenza outbreaks. Findings in the study of Beyhan and Aygoren (2006) indicated that respondents did not have a thorough knowledge of avian influenza, and the prominent response toward risk of avian influenza was to terminate poultry consumption. Leggat et al. (2007) concluded that the vast majority of travelers were concerned about the possibilities to be infected by avian influenza viruses in areas outbreaks had happened. Major sources of infection considered by respondents were from handling sick birds and consuming poultry products.

Olsen et al. (2005) mentioned the most significant change of respondents upon acknowledging avian influenza was the behavioral modifications of the way they touched sick or dead birds. Chamblee (2007) emphasized the importance of public education of poultry products to avoid misinformation in the media leading to reductions in poultry consumption. Consumers may have behavioral changes under a possible threat of avian influenza. Verbeke and Viaene (2000) evaluated safety perceptions and stated that meeting consumer concerns about food product safety was imperative. McCarthy et al. (2007) found respondents in the cluster at risk had relatively low knowledge of food safety and would require targeted education from food safety communicators.

The objectives of this study are to examine consumer risk perceptions and knowledge of avian influenza and its linkage to behavioral changes of chicken consumption under a possible threat of avian influenza outbreak in Taiwan. Taiwan has not experienced outbreaks of avian influenza. With live chicken slaughtered at traditional markets, the consumer risk perceptions and knowledge of avian influenza are of particular importance for agricultural administration in designing effective strategic marketing communication in the education programs. The contributions of this study are as follows: (1) to provide knowledge levels of primary household food shoppers in an area where a pandemic situation like avian influenza has not occurred but is a possible threat, (2) to reveal interactions of risk perceptions and knowledge levels of avian influenza on behavioral changes of primary household food shoppers, and (3) to present quantitative reduction of chicken consumption under the threat of avian influenza outbreaks.

	MATERIALS AND METHODS

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS AND DISCUSSION REFERENCES

 
Knowledge Measure

A study coordinated by Directorate General Communication in Europe examined consumer knowledge of avian influenza in 25 European countries using 7 knowledge statements of avian influenza (Eurobarometer, 2006). These 7 questions were utilized in this study to examine the knowledge of primary household food shoppers of avian influenza:

1. The avian influenza virus cannot be easily transmitted between humans.
   
2. Even when it is contaminated, poultry is not a health risk if it is thoroughly cooked.
   
3. Humans can catch avian influenza by touching contaminated birds.
   
4. The vaccination against seasonal influenza is not effective against avian influenza.
   
5. The avian influenza virus contained in an egg or present on its shell can be eliminated by prolonged cooking.
   
6. If a chicken is contaminated by avian influenza on a farm, all the poultry on that farm must be destroyed immediately.
   
7. It is not dangerous to eat the meat of a chicken vaccinated against avian influenza.
   

Two out of 7 questions were incorrectly stated in the questionnaire to test if respondents could correctly identify the right answers. Another set of scales was added to these 7 knowledge statements to measure how certain respondents were in answering the yes-no knowledge questions. Four-point Likert scales were used for certainty measures, from completely uncertain to completely certain. Certainty measures used in this study were like decision weights under uncertainty as mentioned in Abdellaoui et al. (2005). If a respondent had a correct answer of a knowledge statement but was completely uncertain about the answer, zero points were granted. Partial points (0, one-third, two-thirds, and 1) were given to respondents with correct answers of knowledge statements and various levels of certainty. For example, if a respondent had a correct answer of a knowledge statement but marked "uncertain" of the certainty scales (completely uncertain, uncertain, certain, and completely certain), one-third of the point was given to that knowledge statement. For respondents with correct knowledge statements but marked "certain" on the certainty scales, two-thirds of the points were given. One point was granted for respondents who had a correct answer of knowledge statements and was completely certain about the answer. For each respondent, weighted points (using certainty measures as weights) were summed up as a measure of knowledge. The range of knowledge measure is from 0 to 7.

Risk Measure

Risk can be a major factor influencing behavioral changes of chicken consumption if outbreaks of avian influenza were encountered. For perceived risk, the possibility of occurrence and severity were measured separately using 2 sets of 4-point Likert scales, from very much impossible to very much possible for the possibility of occurrence, and from the least severe to the most severe for severity. Six risk-related statements of avian influenza were included in the questionnaire. For each statement, the possibility of occurrence and severity were multiplied and then summed to form the risk variable. The range of risk measure is from 6 to 96. These 6 statements measuring risk perceptions of avian influenza are:

1. Risk of getting avian influenza infection from visiting slaughterhouses and live bird markets.
   
2. Risk of getting avian influenza infection from touching live birds and their droppings with bare hands.
   
3. Risk of getting avian influenza infection from traveling to areas with avian influenza outbreaks.
   
4. Risk of getting avian influenza infection from purchasing wild or smuggled live birds.
   
5. Risk of getting avian influenza infection from eating not thoroughly cooked poultry.
   
6. Risk of getting avian influenza infection from eating not thoroughly cooked eggs.
   

Survey

A consumer survey of primary household food shoppers was administered in metropolitan areas of Taipei, Taichung, and Kaohsiung in September 2007 in Taiwan. Stratified sampling was applied following the sex distribution of the population between the ages of 20 to 59 in the statistical data of June 2007 (Ministry of the Interior). Survey results in the literature revealed that primary household food shoppers in Taiwan were mainly females (80% females in Hsu and Liu, 2000; 79% in Hsu and Lin, 2006). Hence, the sampling followed age distribution but modified sex ratios to 80% females and 20% males (Table 1). Questionnaires were designed based on findings in the literature and discussions with professionals and practitioners. A pilot survey of 200 valid samples was administered in Taipei before the formal survey. Modifications of the questionnaires were made following suggestions from professionals, practitioners, and respondents who participated in the pilot survey.

Demographic characteristics of respondents are listed in Table 2. Approximately 80% of the respondents were females, and about 75% of the respondents were married. The average age of respondents was 39.4 years old, living in households of 3.8 persons on average. More than half of respondents had educational levels of college, reflecting relatively high educational levels of people living in metropolitan areas in general (residents in Taipei with educational levels above college were 50.54%, in Taichung were 43.51%, and in Kaohsiung were 38.80% as provided by the Department of Household Registration Affairs of residents above 15 yr old). Slightly more than a quarter of respondents worked in the business sector, and additional 32.9% were housewives. Average monthly household income was 1,970 US dollars, approximately.

	RESULTS AND DISCUSSION

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS AND DISCUSSION REFERENCES

Seven yes-no questions used to reveal consumer knowledge of avian influenza in 25 European countries (Eurobarometer, 2006) were utilized in this study to examine knowledge of primary household food shoppers of avian influenza in Taiwan. As mentioned in the materials and methods section, an additional set of scales measuring certainty in answering the knowledge statements was included in the questionnaire. Table 3 presents the percentages of correct answers and respective probabilities of certainty for primary household food shoppers in Taiwan. For comparison purposes, percentages of correct answers from the Eurobarometer (2006) are listed in the footnote of Table 3.

Moreover, nearly half of the surveyed primary household food shoppers in Taiwan had not correctly answered 2 statements related to elimination of avian influenza viruses in poultry and in eggs through prolonged cooking. Information disseminated in the media might not have reached primary household food shoppers effectively in emphasizing the critical know-how in safety issues of poultry consumption. Empirical findings in this study suggested a need of emphasizing general knowledge of avian influenza in public health education programs in Taiwan.

The probabilities of certainty ranged from 51.5 to 65.9%, indicating respondents were not completely sure about their answers of avian influenza knowledge statements. The statement of which respondents were least certain was whether chicken vaccinated against avian influenza was safe for consumption. Using certainty measures as weights (0, one-third, two-thirds, and 1), the points calculated for avian influenza knowledge averaged 2.6 (summed total points for each respondents then divided by the number of respondents). This result indicated that for primary household food shoppers, knowledge of avian influenza was not comprehensive, and for those who had correct answers of knowledge statements, respondents would not be totally sure if the answers were correct in general.

Preparedness for Avian Influenza

Exploratory factor analysis with the Varimax rotation method was applied to examine underlying dimensions of preparedness for avian influenza in case outbreaks in Taiwan. Three factors were extracted from 10 statements with 81% of total variance explained. The first factor was called "self-protection," indicating behavior adapted personally to protect oneself. The second factor was called "away from birds," describing behavioral modifications of respondents to stay away from slaughterhouses, live bird markets, and making direct contact with live birds or droppings with bare hands. The third factor was called "away from crowd," explaining avoidance of being in crowded areas (Table 4). Cronbach’s coefficients of 2 out of 3 factors were above the cut-off value of 0.7, with one between 0.6 and 0.7, reaching the lower limit of acceptability for reliability measures (Hair et al., 2006). Results of the factor analysis revealed that consumers would have various safety concerns in a situation of avian influenza occurrence.

Six risk-related statements were included in the questionnaire measuring risk perceptions of avian influenza. Possibility of happening and severity were measured separately using 4-point Likert scales and were then multiplied and summed up to form the risk variable. Average scores of each risk-related statement, including the possibility of occurrence and severity, in addition to risk measure, are listed in Table 5. Among risk-related statements, "risk of avian influenza infection from touching live birds and their droppings with bare hands," "risk of avian influenza infection from traveling to areas with avian influenza outbreaks," and "risk of avian influenza infection from purchasing wild or smuggled live birds" were what respondents would consider riskier than other activities.

Cluster analysis was utilized in this study to segment respondents into 4 clusters of various knowledge and risk combinations. Standardized knowledge and risk variables were used in the clustering procedure. Nonhierar-chical clustering procedure with the K-means method was applied. More respondents were in the low-knowledge, high-risk cluster (n = 172, 34.3% of respondents), whereas fewer were in the high-knowledge, high-risk cluster (n = 67, 13.4% of respondents; Table 6). Testing results of multivariate ANOVA (Wilks’ lambda = 0.1; F = 349.32) indicated that respondents in these 4 clusters had different knowledge and risk measures at 1% significance level. Analysis of variance F-testing results further confirmed that knowledge and risk were each statistically different among respondents in 4 clusters. Respondents in different clusters considered various factors of pre-paredness for avian influenza outbreaks differently as test results of multivariate ANOVA and ANOVA F indicated.

View larger version (22K): [in this window] [in a new window]   Figure 1. Factor scores of respondents in different knowledge-risk clusters.

This study was undertaken to examine consumer knowledge and risk perceptions of avian influenza in Taiwan with no occurrence of H5N1 outbreaks. Results indicated that respondents were not well-informed about the safety in chicken and egg consumption through prolonged cooking to eliminate avian influenza viruses. Respondents had a tendency to reduce chicken consumption in a situation of avian influenza outbreaks. Explanations of the results are that information disseminated by the agricultural administration about avian influenza might not have reached household food shoppers in a way to generate accurate knowledge. Attitudes toward live chicken in the traditional markets are strongly related to the freshness for household food shoppers. Hence, if in a situation outbreaks had occurred, reactions of household food shoppers would be likely to avoid chicken consumption. Conceptually, for household food shoppers, chicken contaminated with avian influenza viruses could not be as fresh as healthy chicken. Reductions in chicken consumption could be inevitable if outbreaks of avian influ-enza had occurred in Taiwan.

The implications of this study are that because behavioral changes in chicken consumption could not be avoided if avian influenza outbreaks had occurred, one important issue in information dissemination is to let consumers understand that as long as preparedness for avian influenza was well taken, the spread of avian influ-enza could be prevented and protection of oneself would be possible. Suggestions for policy-makers are as follows:

1. It is urgent to improve knowledge levels of avian influenza for the general public. The policy-makers need to have a well-designed plan to disseminate relevant information of avian influenza, emphasizing specific facts like handling procedures of chicken vaccinated or contaminated with avian influenza. Pre-paredness for the outbreaks and meat safety issues are priorities in education programs.
   
2. With all the confirmed outbreaks of avian influenza in neighboring countries, the government administration in Taiwan needs to constantly alert the general public of the threat of outbreaks. The preparedness for avian influenza needs to include the risk concerns of consumers in a way not to be frightened if the outbreaks had occurred.
   

For industry managers, the possible effect of outbreaks on the industry would be a huge reduction on chicken consumption. The suggestions for industry managers are as follows:

1. The sustainability of the industry depends upon the understanding of avian influenza of the general public if outbreaks had occurred in Taiwan. Only in a situation in which consumers realize that there is no safety concern to consume chicken as long as the meat is thoroughly cooked, the overall consumption could be maintained and the industry could be sustained in case the outbreaks had occurred.
   
2. The industry managers could assure consumers of the safety standards and handling procedures they have imposed. Because chilled and frozen chicken products sold in hypermarts and grocery stores could attract customers with safety assurance if outbreaks of avian influenza had occurred in Taiwan, industry managers could be advantageous in informing consumers the safety of chicken products and the proper cooking practice.
   

The contributions of this study are to provide new insights into knowledge and risk perceptions of avian influenza and to reveal behavioral changes in chicken consumption under a possible threat of avian influenza outbreaks. Findings in this study indicated urban food shoppers in general did not have a thorough knowledge of avian influenza. Hence, not only the education programs need to be designed for household food shoppers in urban areas but also for rural consumers to develop an understanding of a possible threat of the outbreaks and proper practice in the families for chicken consumption.

The limitations of this study are that data were generated from 3 metropolitan areas in Taiwan. In future studies, cross-national surveys should be considered to reveal differences of knowledge and risk perceptions of avian influenza in different countries. Other areas in Asian countries could be facing similar situations that consumer knowledge of avian influenza would not be comprehensive. Consumer surveys of general knowledge levels of avian influenza need to be considered for researchers as well as government administrations in improving effectiveness of information regarding avian influenza.

	FOOTNOTES

 
¹ This research was supported by Grant 96AS-14.6.2-BQ-B2 of the Council of Agriculture, Executive Yuan in Taiwan. Assistance from Kelsey Jing-Ru Hung (National Chung Hsing University) in this project was acknowledged.

Received for publication March 7, 2008. Accepted for publication April 29, 2008.

	REFERENCES

TOP ABSTRACT INTRODUCTION MATERIALS AND METHODS RESULTS AND DISCUSSION REFERENCES

 
Abbate, R., G. D. Giuseppe, P. Marinelli, and I. F. Angelillo. 2006. Knowledge, attitudes, and practices of avian influenza, poultry workers, Italy. Emerg. Infect. Dis. 12:1762–1765.[Web of Science][Medline]

Abdellaoui, M., F. Vossmann, and M. Weber. 2005. Choice-based elicitation and decomposition of decision weights for gains and losses under uncertainty. Manage. Sci. 51:1384–1399.[CrossRef]

Beyhan, B., and H. Aygoren. 2006. Knowledge and society facing the risk of bird flu in Turkey. Conference of the ESA Social Theory Research Network, Madrid, Spain. European Sociological Association, Paris, France.

Chamblee, T. N. 2007. Poultry education team: A novel approach to public education and student recruitment. Poult. Sci. 86:2692–2694.[Abstract/Free Full Text]

Coker, R. J., and S. Mounier-Jack. 2006. Pandemic influenza preparedness in the Asia-Pacific region. Lancet 368:886–889.[CrossRef][Medline]

Eurobarometer. 2006. Avian Influenza, Special Eurobarometer 257-Wave 65.2-TNS Opinion and Social. http://ec.europa.eu/public_opinion/archives/ebs/ebs_257_en.pdf Assessed March 2007.

Fielding, R., W. W. T. Lam, E. Y. Y. Ho, T. H. Lam, A. J. Hedley, and G. M. Leung. 2005. Avian influenza risk perception, Hong Kong. Emerg. Infect. Dis. 11:677–682.[Web of Science][Medline]

Hair, J. F., Jr., W. C. Black, B. J. Babin, R. E. Anderson, and R. L. Tatham. 2006. Multivariate Data Analysis. 6th ed. Pearson Education, Upper Saddle River, NJ.

Hsu, J. L., and W.-H. Chang. 2002. Market segmentation of fresh meat shoppers in Taiwan. Int. Rev. Retail Distrib. Consum. Res. 12:423–436.[CrossRef]

Hsu, J. L., and Y.-T. Lin. 2006. Consumption and attribute perception of fluid milk in Taiwan. Nutr. Food Sci. 36:177–182.[CrossRef]

Hsu, J. L., and G. S.-M. Liu. 2000. Consumer perceptions of fluid milk advertising in Taiwan. Int. J. Advert. 19:471–486.

Leggat, P. A., D. Mills, and R. Speare. 2007. Hostellers’ knowledge of transmission and prevention of avian influenza when travelling abroad. Travel Med. Infect. Dis. 5:53–56.[CrossRef][Medline]

Maciorowski, K. G., S. C. Ricke, and S. G. Birkhold. 1999. Consumer poultry meat handling and safety education in three Texas cities. Poult. Sci. 78:833–840.[Abstract/Free Full Text]

McCarthy, M., M. Brennan, A. L. Kelly, C. Ritson, M. de Boer, and N. Thompson. 2007. Who is at risk and what do they know? Segmenting a population on their food safety knowledge. Food Qual. Prefer. 18:205–217.[CrossRef]

Mounier-Jack, S., and R. J. Coker. 2006. How prepared is Europe for pandemic influenza? Analysis of national plans. Lancet 367:1405–1411.[CrossRef][Web of Science][Medline]

Olsen, S. J., Y. Laosiritaworn, S. Pattanasin, P. Prapasiri, and S. F. Dowell. 2005. Poultry-handling practices during avian influenza outbreak, Thailand. Emerg. Infect. Dis. 11:1601–1603.[Web of Science][Medline]

Overby, J., M. Rayburn, D. C. Wyld, and K. Hammond. 2005. Looming cognition for global competition: The approaching avian influenza pandemic. Asia Pac. J. Mark. Logistics 17:17–30.[CrossRef]

Verbeke, W. A. J., and J. Viaene. 2000. Ethical challenges for livestock production: Meeting consumer concerns about meat safety and animal welfare. J. Agric. Environ. Ethics 12:141–151.[CrossRef][Web of Science]

This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hsu, J. L. Articles by Lee, H. J. Search for Related Content PubMed PubMed Citation Articles by Hsu, J. L. Articles by Lee, H. J.