The Social Context of Sedentary Behaviors and Their Relationships With Health in Later Life

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David Russell
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Jo-Ana D. Chase
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This study examined sedentary behaviors among older adults and explored associations with social context and health measures using cross-sectional data from the National Health and Aging Trends Study (N = 1,687). Multivariate models were estimated to explore associations of time in six sedentary behaviors (i.e., television watching, sitting and talking, hobbies, computer use, driving, and resting) with sociodemographic characteristics and level of social engagement and with health status. Results indicated substantial variability in sedentary behaviors, with television watching being the most frequent and resting the least frequent activities. Sedentary behaviors varied by sociodemographic characteristics, including age, race/ethnicity, and education, as well as by level of social engagement. Television watching and resting, but not other behaviors, were associated with poorer health. These findings help to unpack the role of social context in sedentary behaviors and could inform public health interventions aimed at reducing time spent in behaviors that are adversely associated with health.

Russell is with the Department of Sociology, Appalachian State University, Boone, NC. Chase is with the Sinclair School of Nursing, University of Missouri, Columbia, MO.

Russell (russelldj@appstate.edu) is corresponding author.
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  • Abumaria, I.M., Hastings-Tolsma, M., & Sakraida, T.J. (2015). Levine’s conservation model: A framework for advanced gerontology nursing practice. Paper presented at the Nursing forum.

    • Search Google Scholar
    • Export Citation
  • Balboa-Castillo, T., León-Muñoz, L.M., Graciani, A., Rodríguez-Artalejo, F., & Guallar-Castillón, P. (2011). Longitudinal association of physical activity and sedentary behavior during leisure time with health-related quality of life in community-dwelling older adults. Health and Quality of Life Outcomes, 9(1), 47. doi:10.1186/1477-7525-9-47

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Bavishi, A., Slade, M.D., & Levy, B.R. (2016). A chapter a day: Association of book reading with longevity. Social Science & Medicine, 164 ,4448. PubMed ID: 27471129 doi:10.1016/j.socscimed.2016.07.014

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Boulos, R., Vikre, E.K., Oppenheimer, S., Chang, H., & Kanarek, R.B. (2012). ObesiTV: How television is influencing the obesity epidemic. Physiology & Behavior, 107(1), 146153. PubMed ID: 22677722 doi:10.1016/j.physbeh.2012.05.022

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Brim, O.G., Ryff, C.D., & Kessler, R.C. (2004). The MIDUS National Survey: An overview. In O.G Brim, C.D Ryff, & R.C Kessler (Eds.), The John D. and Catherine T. MacArthur foundation series on mental health and development. Studies on successful midlife development. How healthy are we?: A national study of well-being at midlife (pp. 134). Chicago, IL: University of Chicago Press.

    • Search Google Scholar
    • Export Citation
  • Busschaert, C., Scherrens, A.-L., De Bourdeaudhuij, I., Cardon, G., Van Cauwenberg, J., & De Cocker, K. (2016). Socio-ecological variables associated with context-specific sitting time in Belgian older adults: A one-year follow-up study. PLoS ONE, 11(12), e0167881. PubMed ID: 27997603 doi:10.1371/journal.pone.0167881

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Chastin, S.F., Fitzpatrick, N., Andrews, M., & DiCroce, N. (2014). Determinants of sedentary behavior, motivation, barriers and strategies to reduce sitting time in older women: A qualitative investigation. International Journal of Environmental Research and Public Health, 11(1), 773791. doi:10.3390/ijerph110100773

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Choi, N.G., & DiNitto, D.M. (2013). The digital divide among low-income homebound older adults: Internet use patterns, eHealth literacy, and attitudes toward computer/Internet use. Journal of Medical Internet Research, 15(5), e93. PubMed ID: 23639979 doi:10.2196/jmir.2645

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Clark, B.K., Sugiyama, T., Healy, G.N., Salmon, J., Dunstan, D.W., Shaw, J.E., … Owen, N. (2010). Socio-demographic correlates of prolonged television viewing time in Australian men and women: The AusDiab study. Journal of Physical Activity & Health, 7(5), 595601. PubMed ID: 20864754 doi:10.1123/jpah.7.5.595

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Copeland, J.L., Clarke, J., & Dogra, S. (2015). Objectively measured and self-reported sedentary time in older Canadians. Preventive Medicine Reports, 2 ,9095. PubMed ID: 26844055 doi:10.1016/j.pmedr.2015.01.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • DeMatteis, J., Freedman, V., & Kasper, J. (2016). National Health and Aging Trends Study round 5 sample design and selection. Baltimore, MD: Johns Hopkins University School of Public Health.

    • Search Google Scholar
    • Export Citation
  • de Rezende, L.F.M., Rey-López, J.P., Matsudo, V.K.R., & do Carmo Luiz, O. (2014). Sedentary behavior and health outcomes among older adults: A systematic review. BMC Public Health, 14(1), 333. doi:10.1186/1471-2458-14-333

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Diaz, K.M., Howard, V.J., Hutto, B., Colabianchi, N., Vena, J.E., Blair, S.N., & Hooker, S.P. (2016). Patterns of sedentary behavior in US middle-age and older adults: The REGARDS study. Medicine & Science in Sports & Exercise, 48(3), 430438. PubMed ID: 26460633 doi:10.1249/MSS.0000000000000792

    • Crossref
    • Search Google Scholar
    • Export Citation
  • DiPietro, L. (1996). The epidemiology of physical activity and physical function in older people. Medicine & Science in Sports & Exercise, 28(5), 596600. PubMed ID: 9148090

    • Search Google Scholar
    • Export Citation
  • DiPietro, L. (2001). Physical activity in aging: Changes in patterns and their relationship to health and function. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 56(Suppl. 2), 1322. doi:10.1093/gerona/56.suppl_2.13

    • Crossref
    • Search Google Scholar
    • Export Citation
  • DiPietro, L., Jin, Y., Talegawkar, S., & Matthews, C.E. (2017). The joint associations of sedentary time and physical activity with mobility disability in older people: The NIH-AARP Diet and Health Study. The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 73(4), 532538. doi:10.1093/gerona/glx122

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Dunlop, D.D., Song, J., Arntson, E.K., Semanik, P.A., Lee, J., Chang, R.W., & Hootman, J.M. (2015). Sedentary time in US older adults associated with disability in activities of daily living independent of physical activity. Journal of Physical Activity & Health, 12(1), 93101. PubMed ID: 24510000 doi:10.1123/jpah.2013-0311

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Evenson, K.R., Buchner, D.M., & Morland, K.B. (2012). Objective measurement of physical activity and sedentary behavior among US adults aged 60 years or older. Preventing Chronic Disease, 9 ,E26.

    • Search Google Scholar
    • Export Citation
  • Feldman, D.E., Barnett, T., Shrier, I., Rossignol, M., & Abenhaim, L. (2003). Is physical activity differentially associated with different types of sedentary pursuits? Archives of Pediatrics & Adolescent Medicine, 157(8), 797802. PubMed ID: 12912786 doi:10.1001/archpedi.157.8.797

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Freedman, V.A., Kasper, J.D., Cornman, J.C., Agree, E.M., Bandeen-Roche, K., Mor, V., … Wolf, D.A. (2011). Validation of new measures of disability and functioning in the National Health and Aging Trends Study. Journals of Gerontology, Series A: Biomedical Sciences and Medical Sciences, 66(9), 10131021. doi:10.1093/gerona/glr087

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gardiner, P.A., Clark, B.K., Healy, G.N., Eakin, E.G., Winkler, E.A., & Owen, N. (2011). Measuring older adults’ sedentary time: Reliability, validity, and responsiveness. Medicine & Science in Sports & Exercise, 43(11), 21272133. PubMed ID: 21448077 doi:10.1249/MSS.0b013e31821b94f7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gardiner, P.A., Healy, G.N., Eakin, E.G., Clark, B.K., Dunstan, D.W., Shaw, J.E., … Owen, N. (2011). Associations between television viewing time and overall sitting time with the metabolic syndrome in older men and women: The Australian diabetes obesity and lifestyle study. Journal of the American Geriatrics Society, 59(5), 788796. PubMed ID: 21568949 doi:10.1111/j.1532-5415.2011.03390.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gennuso, K.P., Gangnon, R.E., Matthews, C.E., Thraen-Borowski, K.M., & Colbert, L.H. (2013). Sedentary behavior, physical activity, and markers of health in older adults. Medicine & Science in Sports & Exercise, 45(8), 14931500. PubMed ID: 23475142 doi:10.1249/MSS.0b013e318288a1e5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Gorman, E., Hanson, H., Yang, P., Khan, K., Liu-Ambrose, T., & Ashe, M. (2014). Accelerometry analysis of physical activity and sedentary behavior in older adults: A systematic review and data analysis. European Review of Aging and Physical Activity, 11(1), 3549. doi:10.1007/s11556-013-0132-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Grøntved, A., & Hu, F.B. (2011). Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: A meta-analysis. JAMA, 305(23), 24482455. doi:10.1001/jama.2011.812

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hamer, M., & Stamatakis, E. (2013). Screen-based sedentary behavior, physical activity, and muscle strength in the English longitudinal study of ageing. PLoS ONE, 8(6), e66222. PubMed ID: 23755302 doi:10.1371/journal.pone.0066222

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Hamer, M., & Stamatakis, E. (2014). Prospective study of sedentary behavior, risk of depression, and cognitive impairment. Medicine & Science in Sports & Exercise, 46(4), 718723. PubMed ID: 24121248 doi:10.1249/MSS.0000000000000156

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Herbolsheimer, F., Mosler, S., Peter, R., & Group, A.U.S. (2017). Relationship between social isolation and indoor and outdoor physical activity in community-dwelling older adults in Germany: Findings from the ActiFE study. Journal of Aging & Physical Activity, 25(3), 387394. doi:10.1123/japa.2016-0060

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ip, W., Woo, J., Yue, S., Kwan, M., Sum, S.M., Kwok, T., & Hui, S.S. (2006). Evaluation of the effect of energy conservation techniques in the performance of activity of daily living tasks. Clinical Rehabilitation, 20(3), 254261. PubMed ID: 16634345 doi:10.1191/0269215506cr908oa

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Jones, S.A., Wen, F., Herring, A.H., & Evenson, K.R. (2016). Correlates of US adult physical activity and sedentary behavior patterns. Journal of Science and Medicine in Sport, 19(12), 10201027. PubMed ID: 27053434 doi:10.1016/j.jsams.2016.03.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Joseph, A., Zimring, C., Harris-Kojetin, L., & Kiefer, K. (2006). Presence and visibility of outdoor and indoor physical activity features and participation in physical activity among older adults in retirement communities. Journal of Housing for the Elderly, 19(3-4), 141165. doi:10.1300/J081v19n03_08

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kasper, J., & Freedman, V. (2014). National Health and Aging Trends Study (NHATS) User Guide Rounds 1 & 2. Baltimore: Johns Hopkins University School of Public Health. Retrieved from www.NHATS.org

    • Search Google Scholar
    • Export Citation
  • Keadle, S.K., Arem, H., Moore, S.C., Sampson, J.N., & Matthews, C.E. (2015). Impact of changes in television viewing time and physical activity on longevity: A prospective cohort study. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 156. doi:10.1186/s12966-015-0315-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kikuchi, H., Inoue, S., Sugiyama, T., Owen, N., Oka, K., Nakaya, T., & Shimomitsu, T. (2014). Distinct associations of different sedentary behaviors with health-related attributes among older adults. Preventive Medicine, 67 ,335339. PubMed ID: 25117527 doi:10.1016/j.ypmed.2014.08.011

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Kozo, J., Sallis, J.F., Conway, T.L., Kerr, J., Cain, K., Saelens, B.E., … Owen, N. (2012). Sedentary behaviors of adults in relation to neighborhood walkability and income. Health Psychology, 31(6), 704713. PubMed ID: 22545974 doi:10.1037/a0027874

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Larumbe, R. (1997). Detection of early cases of Alzheimer’s disease. Application of the CERAD neuropsychological test battery. Revista de Medicina de la Universidad de Navarra, 41(1), 611. PubMed ID: 9527716

    • Search Google Scholar
    • Export Citation
  • Leask, C.F., Harvey, J.A., Skelton, D.A., & Chastin, S.F. (2015). Exploring the context of sedentary behaviour in older adults (what, where, why, when and with whom). European Review of Aging and Physical Activity, 12(1), 4. doi:10.1186/s11556-015-0146-7

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Litwin, H. (2003). Social predictors of physical activity in later life: The contribution of social-network type. Journal of Aging and Physical Activity, 11(3), 389406. doi:10.1123/japa.11.3.389

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Lumley, T. (2004). Analysis of complex survey samples. Journal of Statistical Software, 9(1), 119.

  • Marques, E.A., Baptista, F., Santos, D.A., Silva, A.M., Mota, J., & Sardinha, L.B. (2014). Risk for losing physical independence in older adults: The role of sedentary time, light, and moderate to vigorous physical activity. Maturitas, 79(1), 9195. PubMed ID: 25022468 doi:10.1016/j.maturitas.2014.06.012

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Martin, L.M., Leff, M., Calonge, N., Garrett, C., & Nelson, D.E. (2000). Validation of self-reported chronic conditions and health services in a managed care population. American Journal of Preventive Medicine, 18(3), 215218. PubMed ID: 10722987 doi:10.1016/S0749-3797(99)00158-0

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Matthews, C.E., Chen, K.Y., Freedson, P.S., Buchowski, M.S., Beech, B.M., Pate, R.R., & Troiano, R.P. (2008). Amount of time spent in sedentary behaviors in the United States, 2003–2004. American Journal of Epidemiology, 167(7), 875881. doi:10.1093/aje/kwm390

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Meneguci, J., Sasaki, J.E., da Silva Santos, Á., Scatena, L.M., & Damião, R. (2015). Socio-demographic, clinical and health behavior correlates of sitting time in older adults. BMC Public Health, 15(1), 65. doi:10.1186/s12889-015-1426-x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Montaquila, J., Freedman, V.A., Edwards, B., & Kasper, J.D. (2012). National Health and Aging Trends Study round 1 sample design and selection. NHATS Technical Paper 1. Baltimore: Johns Hopkins University School of Public Health. Retrieved from www.NHATS.org

    • Search Google Scholar
    • Export Citation
  • Murphy, M., & O’leary, E. (2010). Depression, cognitive reserve and memory performance in older adults. International Journal of Geriatric Psychiatry, 25(7), 665671. PubMed ID: 19806601 doi:10.1002/gps.2404

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Owen, N., Healy, G.N., Matthews, C.E., & Dunstan, D.W. (2010). Too much sitting: The population-health science of sedentary behavior. Exercise and Sport Sciences Reviews, 38(3), 105113. PubMed ID: 20577058 doi:10.1097/JES.0b013e3181e373a2

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Owen, N., Salmon, J., Koohsari, M.J., Turrell, G., & Giles-Corti, B. (2014). Sedentary behaviour and health: Mapping environmental and social contexts to underpin chronic disease prevention. British Journal of Sports Medicine, 48(3), 174177. doi:10.1136/bjsports-2013-093107

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Owen, N., Sparling, P.B., Healy, G.N., Dunstan, D.W., & Matthews, C.E. (2010). Sedentary behavior: Emerging evidence for a new health risk. Paper presented at the Mayo Clinic Proceedings.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • Pate, R.R., O’neill, J.R., & Lobelo, F. (2008). The evolving definition of “sedentary”. Exercise and Sport Sciences Reviews, 36(4), 173178. PubMed ID: 18815485 doi:10.1097/JES.0b013e3181877d1a

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Paxton, R.J., Anderson, A., Sakar, S., & Taylor, W.C. (2016). Breaking up sedentary behavior: Perceptions from cancer survivors. Cancer Nursing, 39(4), 272278. PubMed ID: 26713501 doi:10.1097/NCC.0000000000000330

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Robins, L.M., Hill, K.D., Finch, C.F., Clemson, L., & Haines, T. (2018). The association between physical activity and social isolation in community-dwelling older adults. Aging & Mental Health, 22(2), 175182. PubMed ID: 27736192 doi:10.1080/13607863.2016.1242116

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Rosenberg, D.E., Norman, G.J., Wagner, N., Patrick, K., Calfas, K.J., & Sallis, J.F. (2010). Reliability and validity of the Sedentary Behavior Questionnaire (SBQ) for adults. Journal of Physical Activity & Health, 7(6), 697705. PubMed ID: 21088299 doi:10.1123/jpah.7.6.697

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Russell, D. (2009). Living arrangements, social integration, and loneliness in later life: The case of physical disability. Journal of Health and Social Behavior, 50(4), 460475. PubMed ID: 20099451 doi:10.1177/002214650905000406

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Sallis, J.F., Conway, T.L., Cain, K.L., Carlson, J.A., Frank, L.D., Kerr, J., … Saelens, B.E. (2018). Neighborhood built environment and socioeconomic status in relation to physical activity, sedentary behavior, and weight status of adolescents. Preventive Medicine, 110 ,4754. PubMed ID: 29432790 doi:10.1016/j.ypmed.2018.02.009

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Schlaff, R.A., Baruth, M., Boggs, A., & Hutto, B. (2017). Patterns of sedentary behavior in older adults. American Journal of Health Behavior, 41(4), 411418. doi:10.5993/AJHB.41.4.5

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shankle, W.R., Romney, A.K., Hara, J., Fortier, D., Dick, M.B., Chen, J.M., … Sun, X. (2005). Methods to improve the detection of mild cognitive impairment. Proceedings of the National Academy of Sciences, 102(13), 49194924. doi:10.1073/pnas.0501157102

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Shelton, R.C., McNeill, L.H., Puleo, E., Wolin, K.Y., Emmons, K.M., & Bennett, G.G. (2011). The association between social factors and physical activity among low-income adults living in public housing. American Journal of Public Health, 101(11), 21022110. PubMed ID: 21330588 doi:10.2105/AJPH.2010.196030

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Singh, H., Arya, S., Talapatra, P., Lather, K., Mathur, R., Singhania, A., & Chaudhary, V. (2014). Assessment of fatigue in rheumatoid arthritis (by functional assessment of chronic illness therapy–fatigue score) and its relation to disease activity and anemia. Journal of Clinical Rheumatology, 20(2), 8790. PubMed ID: 24561411

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Small, S., & Lamb, M. (1999). Fatigue in chronic illness: The experience of individuals with chronic obstructive pulmonary disease and with asthma. Journal of Advanced Nursing, 30(2), 469478. PubMed ID: 10457250 doi:10.1046/j.1365-2648.1999.01102.x

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Team, R.C. (2013). R: A language and environment for statistical computing.

  • Toepoel, V. (2013). Ageing, leisure, and social connectedness: How could leisure help reduce social isolation of older people? Social Indicators Research, 113(1), 355372. PubMed ID: 23874058 doi:10.1007/s11205-012-0097-6

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Tremblay, M.S., Aubert, S., Barnes, J.D., Saunders, T.J., Carson, V., Latimer-Cheung, A.E., … Chinapaw, M.J. (2017). Sedentary behavior research network (SBRN)—terminology consensus project process and outcome. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 75. PubMed ID: 28599680 doi:10.1186/s12966-017-0525-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Van Cauwenberg, J., Nathan, A., Barnett, A., Barnett, D.W., & Cerin, E. (2018). Relationships between neighbourhood physical environmental attributes and older adults’ leisure-time physical activity: A systematic review and meta-analysis. Sports Medicine, 48(7), 16351660. PubMed ID: 29721838 doi:10.1007/s40279-018-0917-1

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Vance, D.E., Wadley, V.G., Ball, K.K., Roenker, D.L., & Rizzo, M. (2005). The effects of physical activity and sedentary behavior on cognitive health in older adults. Journal of Aging and Physical Activity, 13(3), 294313. PubMed ID: 16192657 doi:10.1123/japa.13.3.294

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Ware, J.E., Jr., & Sherbourne, C.D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30 ,473483. PubMed ID: 1593914

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Werner, J.M., Carlson, M., Jordan-Marsh, M., & Clark, F. (2011). Predictors of computer use in community-dwelling, ethnically diverse older adults. Human Factors, 53(5), 431447. PubMed ID: 22046718 doi:10.1177/0018720811420840

    • Crossref
    • Search Google Scholar
    • Export Citation
  • Wilcox, S., Castro, C., King, A.C., Housemann, R., & Brownson, R.C. (2000). Determinants of leisure time physical activity in rural compared with urban older and ethnically diverse women in the United States. Journal of Epidemiology & Community Health, 54(9), 667672. PubMed ID: 10942445 doi:10.1136/jech.54.9.667

    • Crossref
    • Search Google Scholar
    • Export Citation
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