{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:59:53Z","timestamp":1780552793952,"version":"3.54.1"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007602","name":"Programme Grants for Applied Research","doi-asserted-by":"publisher","award":["RP-PG-1212-20006"],"award-info":[{"award-number":["RP-PG-1212-20006"]}],"id":[{"id":"10.13039\/501100007602","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The effectiveness of population-level intervention for HIV elimination is influenced by individual-level variation in sexual behaviour. We assess within-person changes in the frequency of condomless anal sex with two or more partners (CLS2+), estimate the transition probabilities and examine the predictors of transitions among a prospective cohort of HIV-negative gay, bisexual, and other men who have sex with men (GBMSM). Participants were recruited through one of three sexual health clinics in London and Brighton (July 2013 to April 2016) and self-completed a baseline paper questionnaire in the clinic. During follow-up, they were invited to complete four-monthly questionnaires twice a year and subsequent annual online questionnaires once a year (March 2015 to March 2018). We used Markov chain models to estimate transition probabilities from \u2018higher-risk\u2019 (CLS2+) to \u2018lower-risk\u2019 (no CLS2+) and vice versa, and to assess factors associated with transitions between different sexual risk levels. Among 1,162 men enrolled in the study, 622 (53.5%) completed at least one online questionnaire. Higher-risk behaviour was reported in 376\/622 (60.4%) men during online follow-up. Overall, 1,665\/3,277 (37.5%) baseline and follow-up questionnaires reported higher-risk behaviour. More than 60% of men (376\/622) reported higher-risk behaviour at least one period during the follow-up, while 39.5% of men (246\/622) never reported CLS2+ during the follow-up. In the next four months, the estimated probability of continuing higher-risk behaviour among men who reported higher-risk behaviour was 78%. Calendar time, recent HIV tests, PrEP and PEP use were the predictors of staying in higher-risk behaviour, while less stable housing status was associated with switching to lower-risk behaviour. Among men who reported lower-risk behaviour, the probability of engaging in the same behaviour was 88%. Recent HIV tests, PrEP and PEP use, recreational drugs, chemsex-associated drug and injection drugs, and bacterial STIs diagnosis were the predictors of switching to higher-risk behaviour. Our results indicate that at any one point in time, the majority of GBMSM are at low risk for HIV acquisition, although many experience short periods in which they are at higher risk. Markers of transitions can be utilized to identify which GBMSM are likely to increase or decrease their risk, thus helping the timing of HIV prevention interventions.<\/jats:p>","DOI":"10.1371\/journal.pone.0308238","type":"journal-article","created":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T18:22:45Z","timestamp":1741112565000},"page":"e0308238","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Transitions in sexual behaviour among gay, bisexual, and other men who have sex with men in England: Data from a prospective study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9648-5115","authenticated-orcid":true,"given":"Nadia","family":"Hanum","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Cambiano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7148-2391","authenticated-orcid":true,"given":"Janey","family":"Sewell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alison J.","family":"Rodger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Asboe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Whitlock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Gilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Clarke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ada R.","family":"Miltz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3537-2432","authenticated-orcid":true,"given":"Simon","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew N.","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6851-5471","authenticated-orcid":true,"given":"Fiona C.","family":"Lampe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the AURAH2 Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,4]]},"reference":[{"key":"pone.0308238.ref001","unstructured":"UNAIDS. Unaids Global AIDS Update 2016. 2016."},{"issue":"9839","key":"pone.0308238.ref002","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S0140-6736(12)60821-6","article-title":"Global epidemiology of HIV infection in men who have sex with men","volume":"380","author":"C Beyrer","year":"2012","journal-title":"Lancet"},{"issue":"1","key":"pone.0308238.ref003","article-title":"Heterogeneity in number and type of sexual contacts in a Gay Urban Cohort","volume":"4","author":"EO Romero-Severson","year":"2012","journal-title":"Stat Commun Infect Dis"},{"issue":"3","key":"pone.0308238.ref004","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1093\/aje\/kwv044","article-title":"Dynamic variation in sexual contact rates in a Cohort of HIV-negative Gay Men","volume":"182","author":"EO Romero-Severson","year":"2015","journal-title":"Am J Epidemiol"},{"issue":"8","key":"pone.0308238.ref005","doi-asserted-by":"crossref","first-page":"e1005012","DOI":"10.1371\/journal.pcbi.1005012","article-title":"Impact of heterogeneity in sexual behavior on effectiveness in reducing HIV transmission with test-and-treat strategy","volume":"12","author":"G Rozhnova","year":"2016","journal-title":"PLoS Comput Biol"},{"key":"pone.0308238.ref006","doi-asserted-by":"crossref","first-page":"9467","DOI":"10.1038\/srep09467","article-title":"Strong influence of behavioral dynamics on the ability of testing and treating HIV to stop transmission","volume":"5","author":"CJ Henry","year":"2015","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0308238.ref007","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s10654-020-00615-6","article-title":"Identifying typical trajectories in longitudinal data: modelling strategies and interpretations","volume":"35","author":"M Herle","year":"2020","journal-title":"Eur J Epidemiol"},{"issue":"2","key":"pone.0308238.ref008","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1093\/jpepsy\/jst085","article-title":"An introduction to latent variable mixture modeling (part 2): longitudinal latent class growth analysis and growth mixture models","volume":"39","author":"KS Berlin","year":"2014","journal-title":"J Pediatr Psychol"},{"issue":"8","key":"pone.0308238.ref009","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1093\/aje\/kww239","article-title":"Measuring transitions in sexual risk among men who have sex with men: the novel use of latent class and latent transition analysis in HIV sentinel surveillance","volume":"185","author":"AL Wilkinson","year":"2017","journal-title":"Am J Epidemiol"},{"issue":"1","key":"pone.0308238.ref010","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1177\/002204261004000106","article-title":"Latent transition analysis: benefits of a latent variable approach to modeling transitions in substance use","volume":"40","author":"ST Lanza","year":"2010","journal-title":"J Drug Issues"},{"issue":"5","key":"pone.0308238.ref011","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1097\/QAI.0000000000000101","article-title":"Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery","volume":"65","author":"HA Pines","year":"2014","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"1","key":"pone.0308238.ref012","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s10461-010-9866-x","article-title":"Changes in stimulant drug use over time in the MACS: evidence for resilience against stimulant drug use among men who have sex with men","volume":"16","author":"SH Lim","year":"2012","journal-title":"AIDS Behav"},{"issue":"3-4","key":"pone.0308238.ref013","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s10464-012-9562-2","article-title":"Changes in developmental contexts as predictors of transitions in HIV-risk behaviors among young men who have sex with men (YMSM)","volume":"51","author":"CF Wong","year":"2013","journal-title":"Am J Commun Psychol"},{"issue":"6","key":"pone.0308238.ref014","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1007\/s10461-014-0892-y","article-title":"A longitudinal investigation of syndemic conditions among young gay, bisexual, and other MSM: the P18 Cohort Study","volume":"19","author":"PN Halkitis","year":"2015","journal-title":"AIDS Behav"},{"issue":"1 Suppl 1","key":"pone.0308238.ref015","doi-asserted-by":"crossref","first-page":"i62","DOI":"10.1093\/jurban\/jti025","article-title":"Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of san francisco men who have sex with men","volume":"82","author":"G Colfax","year":"2005","journal-title":"J Urban Health"},{"issue":"14","key":"pone.0308238.ref016","doi-asserted-by":"crossref","first-page":"1884","DOI":"10.1177\/1359105316671187","article-title":"Relationship cognitions and longitudinal trajectories of sexual risk behavior among young gay and bisexual men: The P18 cohort study","volume":"23","author":"SH Cook","year":"2018","journal-title":"J Health Psychol"},{"issue":"9","key":"pone.0308238.ref017","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1097\/QAD.0000000000001803","article-title":"Sexual risk behaviour trajectories among MSM at risk for HIV in Amsterdam, the Netherlands","volume":"32","author":"M Basten","year":"2018","journal-title":"AIDS"},{"issue":"sup1","key":"pone.0308238.ref018","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1080\/09540121.2016.1146653","article-title":"Uptake of PrEP and condom and sexual risk behavior among MSM during the ANRS IPERGAY trial","volume":"28","author":"L Sagaon-Teyssier","year":"2016","journal-title":"AIDS Care"},{"issue":"10","key":"pone.0308238.ref019","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1097\/01.aids.0000131331.36386.de","article-title":"Increasing prevalence of male homosexual partnerships and practices in Britain 1990-2000: evidence from national probability surveys","volume":"18","author":"CH Mercer","year":"2004","journal-title":"AIDS"},{"issue":"3","key":"pone.0308238.ref020","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1097\/OLQ.0b013e3181f2ebe1","article-title":"Changing patterns of sexual risk behavior among London gay men: 1998-2008","volume":"38","author":"S Lattimore","year":"2011","journal-title":"Sex Transm Dis"},{"issue":"9","key":"pone.0308238.ref021","doi-asserted-by":"crossref","first-page":"e431","DOI":"10.1016\/S2352-3018(16)30037-6","article-title":"Sexual behaviours, HIV testing, and the proportion of men at risk of transmitting and acquiring HIV in London, UK, 2000-13: a serial cross-sectional study","volume":"3","author":"A Aghaizu","year":"2016","journal-title":"Lancet HIV"},{"issue":"3","key":"pone.0308238.ref022","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1136\/sti.2010.045047","article-title":"HIV-related sexual risk behaviour between 1996 and 2008, according to age, among men who have sex with men (Scotland)","volume":"87","author":"C Knussen","year":"2011","journal-title":"Sex Transm Infect"},{"issue":"2","key":"pone.0308238.ref023","doi-asserted-by":"crossref","first-page":"e128","DOI":"10.2196\/resprot.5582","article-title":"Attitudes to and understanding of risk of acquisition of HIV over time: design and methods for an internet-based prospective Cohort Study among UK men who have sex with men (the AURAH2 Study)","volume":"5","author":"J Sewell","year":"2016","journal-title":"JMIR Res Protoc"},{"issue":"2","key":"pone.0308238.ref024","doi-asserted-by":"crossref","first-page":"e58","DOI":"10.2196\/resprot.4873","article-title":"A cross-sectional study on attitudes to and understanding of risk of acquisition of HIV: design, methods and participant characteristics","volume":"5","author":"J Sewell","year":"2016","journal-title":"JMIR Res Protoc"},{"issue":"9","key":"pone.0308238.ref025","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"K Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"issue":"10","key":"pone.0308238.ref026","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"RL Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"pone.0308238.ref027","unstructured":"WHO. AUDIT: the Alcohol Use Disorders Identification Test: guidelines for use in primary health care. 2001."},{"issue":"2","key":"pone.0308238.ref028","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1177\/1536867X19854015","article-title":"mixmcm: A community-contributed command for fitting mixtures of Markov chain models using maximum likelihood and the EM algorithm","volume":"19","author":"LDF Saint-Cyr","year":"2019","journal-title":"Stata J"},{"issue":"6","key":"pone.0308238.ref029","doi-asserted-by":"crossref","first-page":"e1003677","DOI":"10.1371\/journal.pmed.1003677","article-title":"Trends in HIV incidence between 2013-2019 and association of baseline factors with subsequent incident HIV among gay, bisexual, and other men who have sex with men attending sexual health clinics in England: A prospective cohort study","volume":"18","author":"N Hanum","year":"2021","journal-title":"PLoS Med"},{"issue":"3","key":"pone.0308238.ref030","doi-asserted-by":"crossref","first-page":"e0248582","DOI":"10.1371\/journal.pone.0248582","article-title":"Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men-is it time to re-evaluate STI-screening as a control strategy?","volume":"16","author":"U Marcus","year":"2021","journal-title":"PLoS One"},{"issue":"12","key":"pone.0308238.ref031","doi-asserted-by":"crossref","first-page":"e0259913","DOI":"10.1371\/journal.pone.0259913","article-title":"Time for change: transitions between HIV risk levels and determinants of behavior change in men who have sex with men","volume":"16","author":"MGJ Basten","year":"2021","journal-title":"PLoS One"},{"issue":"2","key":"pone.0308238.ref032","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1136\/sextrans-2013-051195","article-title":"Alcohol and drug use during unprotected anal intercourse among gay and bisexual men in Scotland: what are the implications for HIV prevention?","volume":"90","author":"J Li","year":"2014","journal-title":"Sex Transm Infect"},{"issue":"8","key":"pone.0308238.ref033","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1111\/j.1743-6109.2009.01323.x","article-title":"Use of illicit drugs and erectile dysfunction medications and subsequent HIV infection among gay men in Sydney, Australia","volume":"6","author":"G Prestage","year":"2009","journal-title":"J Sex Med"},{"issue":"7","key":"pone.0308238.ref034","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1097\/OLQ.0b013e3182515601","article-title":"Recreational drug use during sex and sexually transmitted infections among clients of a city sexually transmitted infections clinic in Amsterdam, the Netherlands","volume":"39","author":"M Heiligenberg","year":"2012","journal-title":"Sex Transm Dis"},{"issue":"7","key":"pone.0308238.ref035","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1007\/s10461-013-0622-x","article-title":"MSM and drug use: a latent class analysis of drug use and related sexual risk behaviors","volume":"18","author":"D McCarty-Caplan","year":"2014","journal-title":"AIDS Behav"},{"issue":"2","key":"pone.0308238.ref036","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1136\/sti.2005.017129","article-title":"Methamphetamine and sildenafil (Viagra) use are linked to unprotected receptive and insertive anal sex, respectively, in a sample of men who have sex with men","volume":"82","author":"G Mansergh","year":"2006","journal-title":"Sex Transm Infect"},{"issue":"1","key":"pone.0308238.ref037","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1177\/1757913918778872","article-title":"Sexualised drug taking among men who have sex with men: a systematic review","volume":"139","author":"A Tomkins","year":"2019","journal-title":"Perspect Public Health"},{"issue":"7","key":"pone.0308238.ref038","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/sextrans-2017-053439","article-title":"Changes in recreational drug use, drug use associated with chemsex, and HIV-related behaviours, among HIV-negative men who have sex with men in London and Brighton, 2013-2016","volume":"94","author":"J Sewell","year":"2018","journal-title":"Sex Transm Infect"},{"issue":"1","key":"pone.0308238.ref039","doi-asserted-by":"crossref","first-page":"e22-31","DOI":"10.1016\/S2352-3018(14)70001-3","article-title":"Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study","volume":"1","author":"M Daskalopoulou","year":"2014","journal-title":"Lancet HIV"},{"issue":"5","key":"pone.0308238.ref040","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1136\/sti.2004.013995","article-title":"Increase in HIV sexual risk behaviour in homosexual men in Scotland, 1996\u20132002: prevention failure?","volume":"81","author":"GJ Hart","year":"2005","journal-title":"Sex Transm Infect"},{"issue":"11","key":"pone.0308238.ref041","doi-asserted-by":"crossref","first-page":"1407","DOI":"10.1097\/00002030-199907300-00019","article-title":"Sexual risk behaviour among gay men in a relationship","volume":"13","author":"J Elford","year":"1999","journal-title":"AIDS"},{"issue":"9","key":"pone.0308238.ref042","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1097\/QAD.0b013e3282f8af9b","article-title":"Sexual risk behaviour and knowledge of HIV status among community samples of gay men in the UK","volume":"22","author":"LM Williamson","year":"2008","journal-title":"AIDS"},{"issue":"9","key":"pone.0308238.ref043","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1097\/OLQ.0b013e31825c8018","article-title":"HIV infection among ethnic minority and migrant men who have sex with men in Britain","volume":"39","author":"J Elford","year":"2012","journal-title":"Sex Transm Dis"},{"key":"pone.0308238.ref044","article-title":"Tactical dangers. Findings from the United Kingdom Gay Men\u2019s Sex Survey 2008","author":"FBA Hickson","year":"2010","journal-title":"SIGMA Res"},{"issue":"1","key":"pone.0308238.ref045","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/S1473-3099(17)30540-6","article-title":"Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation","volume":"18","author":"V Cambiano","year":"2018","journal-title":"Lancet Infect Dis"},{"issue":"7","key":"pone.0308238.ref046","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.2105\/AJPH.84.7.1116","article-title":"Substance use and HIV-related sexual behaviors among US high school students: are they related?","volume":"84","author":"R Lowry","year":"1994","journal-title":"Am J Public Health"},{"issue":"2","key":"pone.0308238.ref047","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3109\/10826089209068734","article-title":"Alcohol, drugs, and adolescent sexual behavior","volume":"27","author":"L Strunin","year":"1992","journal-title":"Int J Addict"},{"issue":"1","key":"pone.0308238.ref048","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1177\/2631831818822015","article-title":"Defining \u201cHigh-risk Sexual Behavior\u201d in the context of substance use","volume":"1","author":"N Chawla","year":"2019","journal-title":"J Psychosex Health"},{"issue":"2","key":"pone.0308238.ref049","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1001\/jama.2016.5148","article-title":"Sexual activity without condoms and risk of HIV transmission in Serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy","volume":"316","author":"AJ Rodger","year":"2016","journal-title":"JAMA"},{"issue":"10189","key":"pone.0308238.ref050","doi-asserted-by":"crossref","first-page":"2428","DOI":"10.1016\/S0140-6736(19)30418-0","article-title":"Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): final results of a multicentre, prospective, observational study","volume":"393","author":"AJ Rodger","year":"2019","journal-title":"Lancet"},{"issue":"6","key":"pone.0308238.ref051","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1080\/13548506.2023.2230884","article-title":"Behaviour changes following HIV diagnosis among men who have sex with men in the era of treatment as prevention: data from a prospective study","volume":"36","author":"N Hanum","year":"2024","journal-title":"AIDS Care"},{"key":"pone.0308238.ref052","volume-title":"WHO implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection: module 11: PrEP users","author":"World Health O","year":"2017"},{"issue":"2","key":"pone.0308238.ref053","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/OLQ.0b013e3182838474","article-title":"Improving the validity of self-reported sexual behavior: no easy answers","volume":"40","author":"RJ DiClemente","year":"2013","journal-title":"Sex Transm Dis"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308238","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T18:23:03Z","timestamp":1741112583000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308238"}},"subtitle":[],"editor":[{"given":"Daniel","family":"Demant","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,4]]},"references-count":53,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0308238","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,4]]}}}