{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T22:39:58Z","timestamp":1761172798239,"version":"build-2065373602"},"reference-count":72,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People who inject drugs (PWID) in Bangladesh are part of a long-standing needle syringe program, which faced challenges in containing the spread of HIV, thus warranting exploration of the drivers of needle and syringe sharing. This article aimed to explore the underlying reasons for needle and syringe sharing among PWID through ethnographic lenses in Dhaka.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We adopted peer-driven Participatory Ethnographic and Evaluation Research, entailing 6,000 h of observations at service delivery points and drug-injecting spots, 66 in-depth interviews and seven focus groups with PWID and 29 key-informant interviews with service providers, program experts and policy stakeholders. Data were thematically analyzed as per the socioecological model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The findings presented multilayered contexts driving needle and syringe sharing. At the intrapersonal level, PWID possessed myths and misconceptions regarding needle and syringe sharing, which hindered their risk perception of needle and syringe sharing. As many PWID, especially street-based PWID, felt despondence and distress toward their life, they perceived safe injecting as futile as they were already in fatal conditions. Some PWID partook in concurrent substance use, clouding their judgment, increasing their aggression, and perpetuating risky injection. Moreover, findings showed that withdrawal took precedence in needle and syringe sharing behaviors. At the interpersonal level, PWID communities protected fraternal relationships through sharing, inherited community-bred misinformation about safe injecting practices, and were influenced by gendered and community hierarchies and power dynamics within the PWID sub-culture, which all fueled needle and syringe sharing. Shadowing sessions, observations and interviews revealed challenges at the organizational level (i.e., the PWID intervention) such as inconvenient outreach schedules in relation to PWID's drug-injecting time windows; challenges in the needle and syringe distribution approach; and a predominantly peer-focused outreach approach where peers exhibited work performance and compliance issues, and challenges in capacity building and upholding motivation among OWs. At the structural level, changes in infrastructure and associated inconveniences, criminalization of drug use and harassment of PWID, increased drug prices and financial constraints, and changes in fund allocation policy of the donor engendered risky injection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings presented multifaceted reasons for needle and syringe sharing, thus warranting multilayered interventions. It is not possible to contain needle and syringe sharing and alleviate HIV epidemics through addressing proximate causes or structural interventions alone, thus efforts need to be invested in broadening the horizons for harm reduction interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2025.1527307","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:31:27Z","timestamp":1761111087000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cSharing is my only option\u201d: an ethnographic analysis of the underlying contexts of needle and syringe sharing among people who inject drugs using the socio-ecological framework"],"prefix":"10.3389","volume":"13","author":[{"given":"Mohammad Niaz Morshed","family":"Khan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samira Dishti","family":"Irfan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md. Alamgir","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michiko","family":"Moriyama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharful Islam","family":"Khan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,22]]},"reference":[{"key":"B1","volume-title":"World Drug Report 2023","year":"2023"},{"key":"B2","volume-title":"World Drug Report 2025: Key Findings","year":"2025"},{"key":"B3","volume-title":"The Global State of Harm Reduction 2022","year":"2022"},{"key":"B4","unstructured":"Geneva\n          Joint United Nations Programme for HIV and AIDS\n          HIV and AIDS - Basic Facts\n          \n          2024"},{"key":"B5","unstructured":"Geneva\n          World Health Organization\n          Hepatitis C: Key Facts\n          \n          2025"},{"key":"B6","unstructured":"Atlanta, GA\n          Centre for Diseases Control\n          About HIV\n          \n          2025"},{"key":"B7","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s12954-016-0099-9","article-title":"Understanding differences in HIV\/HCV prevalence according to differentiated risk behaviors in a sample of PWID in rural Puerto Rico","volume":"13","author":"Abadie","year":"2016","journal-title":"Harm Reduction J."},{"key":"B8","doi-asserted-by":"publisher","first-page":"9","DOI":"10.14745\/ccdr.v39i01a02","article-title":"Brief\u2014synopsis of the current evidence on the risk of HIV transmission","volume":"39","author":"Paquette","year":"2013","journal-title":"Can Commun Dis Rep."},{"key":"B9","doi-asserted-by":"publisher","first-page":"186","DOI":"10.4254\/wjh.v10.i2.186","article-title":"Hepatitis C virus: morphogenesis, infection and therapy","volume":"10","author":"Morozov","year":"2018","journal-title":"World J Hepatol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1267","DOI":"10.3748\/wjg.v27.i13.1267","article-title":"Metabolic complications of hepatitis C virus infection","volume":"27","author":"Chaudhari","year":"2021","journal-title":"World J Gastroenterol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"533","DOI":"10.1016\/S2468-1253(23)00018-3","article-title":"Incidence of HIV and hepatitis C virus among people who inject drugs, and associations with age and sex or gender: a global systematic review and meta-analysis","volume":"8","author":"Artenie","year":"2023","journal-title":"Lancet Gastroenterol Hepatol."},{"key":"B12","volume-title":"Full Report \u2014 In Danger: UNAIDS Global AIDS Update 2022","year":"2022"},{"key":"B13","volume-title":"Global State of Harm Reduction Report","year":"2024"},{"key":"B14","doi-asserted-by":"publisher","first-page":"102866","DOI":"10.1016\/j.drugpo.2020.102866","article-title":"Injecting risk behaviours amongst people who inject drugs: a global multi-stage systematic review and meta-analysis","volume":"84","author":"Tran","year":"2020","journal-title":"Int J Drug Policy."},{"key":"B15","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1080\/20477724.2023.2191234","article-title":"Risk factors of HIV and variation in access to clean needles among people who inject drugs in Pakistan","volume":"117","author":"Capelastegui","year":"2023","journal-title":"Pathog Glob Health."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1529","DOI":"10.1186\/s12889-022-13922-2","article-title":"HIV among people who inject drugs in India: a systematic review","volume":"22","author":"Pachuau","year":"2022","journal-title":"BMC Public Health."},{"key":"B17","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1186\/1477-7517-3-33","article-title":"Vulnerability to HIV infection among sex worker and non-sex worker female injecting drug users in <city>Dhaka <\/city>, Bangladesh: evidence from the baseline survey of a cohort study","volume":"3","author":"Azim","year":"2006","journal-title":"Harm Reduct J."},{"key":"B18","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1080\/10550887.2020.1781346","article-title":"Factors associated with injecting-related risk behaviors among people who inject drugs: a systematic review and meta-analysis study","volume":"38","author":"Rezaei","year":"2020","journal-title":"J Addict Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1016\/j.drugalcdep.2014.01.021","article-title":"Cross-border activities and association with current methamphetamine use among Chinese injection drug users (IDUs) in a China\u2013Myanmar border region","volume":"138","author":"Li","year":"2014","journal-title":"Drug Alcohol Depend."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1718","DOI":"10.1186\/s12889-021-11783-9","article-title":"Use of methamphetamine and alcohol among people with opioid use disorder and HIV in Vietnam: a qualitative study","volume":"21","author":"Edsall","year":"2021","journal-title":"BMC Public Health."},{"key":"B21","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1007\/s11469-023-01134-7","article-title":"Characterizing methamphetamine use among people who use opioids: a systematic review","volume":"23","author":"Cui","year":"2023","journal-title":"Int J Mental Health Addict."},{"key":"B22","doi-asserted-by":"crossref","DOI":"10.1596\/27592","volume-title":"20 Years of HIV in Bangladesh","author":"Azim","year":"2009"},{"key":"B23","volume-title":"Integrated Biological and Behavioural Surveillance for Key Populations at Risk of HIV","year":"2020"},{"key":"B24","volume-title":"World AIDS Day 2022: HIV\/AIDS Situation in Bangladesh","year":"2022"},{"key":"B25","volume-title":"World AIDS Day 2023","year":"2023"},{"key":"B26","doi-asserted-by":"publisher","first-page":"2124","DOI":"10.1080\/10826080802344583","article-title":"Prevalence of infections, HIV risk behaviors and factors associated with HIV infection among male injecting drug users attending a needle\/syringe exchange program in <city>Dhaka <\/city>, Bangladesh","volume":"43","author":"Azim","year":"2008","journal-title":"Subst Use Misuse."},{"key":"B27","doi-asserted-by":"publisher","first-page":"e0148276","DOI":"10.1371\/journal.pone.0148276","article-title":"Sharing of needles and syringes among men who inject drugs: HIV risk in Northwest Bangladesh","volume":"11","author":"Pasa","year":"2016","journal-title":"PLoS ONE."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.3855\/jidc.13629","article-title":"Correlates of sharing of needles and syringes among people who inject drugs in Dhaka city, Bangladesh","volume":"15","author":"Hemel","year":"2021","journal-title":"J Infect Dev Ctries."},{"key":"B29","doi-asserted-by":"publisher","first-page":"2261","DOI":"10.1111\/add.14417","article-title":"Gendered violence and overdose prevention sites: a rapid ethnographic study during an overdose epidemic in Vancouver, Canada","volume":"113","author":"Boyd","year":"2018","journal-title":"Addiction."},{"key":"B30","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1177\/1466138107076109","article-title":"Intimate apartheid: ethnic dimensions of habitus among homeless heroin injectors","volume":"8","author":"Bourgois","year":"2007","journal-title":"Ethnography."},{"key":"B31","doi-asserted-by":"publisher","first-page":"18768","DOI":"10.7448\/IAS.16.4.18768","article-title":"A cross-sectional assessment of the burden of HIV and associated individual- and structural-level characteristics among men who have sex with men in Swaziland","volume":"16","author":"Baral","year":"2013","journal-title":"J Int AIDS Soc."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1325","DOI":"10.1016\/S0277-9536(01)00277-5","article-title":"Researching sexual and reproductive behaviour: a peer ethnographic approach","volume":"55","author":"Price","year":"2002","journal-title":"Soc Sci Med."},{"key":"B33","doi-asserted-by":"publisher","first-page":"2323","DOI":"10.3109\/10826089809056260","article-title":"The moral economies of homeless heroin addicts: confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments","volume":"33","author":"Bourgois","year":"1998","journal-title":"Subst Use Misuse."},{"key":"B34","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1080\/01459740.2000.9966161","article-title":"Needle exchange, HIV infection, and the politics of science: confronting Canada's cocaine injection epidemic with participant observation","volume":"18","author":"Bourgois","year":"2000","journal-title":"Med Anthropol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1080\/16066350600826180","article-title":"Visual data in addictions research: seeing comes before words?","volume":"14","author":"Rhodes","year":"2006","journal-title":"Addict Res Theory."},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1037\/e495722006-005","article-title":"Drug Use, AIDS, and Ethnography: Advanced Ethnographic Research Methods Exploring the HIV Epidemic","author":"Trotter","year":"1995"},{"key":"B37","volume-title":"Mapping Study and Size Estimation of Key Populations in Bangladesh for HIV Programs 2015\u20132016","year":"2017"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.1177\/1077800408318318","article-title":"Conspicuous invisibility: shadowing as a data collection strategy","volume":"14","author":"Quinlan","year":"2008","journal-title":"Qual Inq."},{"key":"B39","doi-asserted-by":"publisher","first-page":"9","DOI":"10.17169\/fqs-9.3.1166","article-title":"Mobilising visual ethnography: making routes, making place and making images","author":"Pink","year":"2008","journal-title":"FQS Forum Qual Soc Res"},{"key":"B40","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1016\/j.apgeog.2010.09.005","article-title":"The walking interview: methodology, mobility and place","volume":"31","author":"Evans","year":"2011","journal-title":"Appl Geogr."},{"key":"B41","volume-title":"Qualitative Research and Evaluation Methods","author":"Patton","year":"2015"},{"key":"B42","doi-asserted-by":"publisher","first-page":"1408","DOI":"10.46743\/2160-3715\/2015.2281","article-title":"Are we there yet? Data saturation in qualitative research","volume":"20","author":"Fusch","year":"2015","journal-title":"Qual Rep."},{"key":"B43","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1093\/heapol\/12.4.372","article-title":"Comparing manual with software analysis in qualitative research: undressing Nud","volume":"12","author":"Lewando-Hundt","year":"1997","journal-title":"Health Policy Plan"},{"key":"B44","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1111\/j.1547-5069.2000.00393.x","article-title":"The pros and cons of data analysis software for qualitative research","volume":"32","author":"John","year":"2000","journal-title":"J Nurs Scholarsh."},{"key":"B45","article-title":"Computer-assisted qualitative data analysis software: an illustration of limitations and advantages","volume-title":"Sustainable IT Collaboration Around the Globe. 16th Americas Conference on Information Systems, AMCIS 2010, Lima, Peru, August 12\u201315, 2010","author":"Ahmad","year":"2010"},{"key":"B46","first-page":"19","volume-title":"Doing Reflexive Thematic Analysis. Supporting Research in Counselling and Psychotherapy: Qualitative, Quantitative, and Mixed Methods Research","author":"Braun","year":"2023"},{"key":"B47","doi-asserted-by":"crossref","DOI":"10.18260\/1-2--28777","article-title":"Qualitative coding: an approach to assess inter-rater reliability","volume-title":"2017 ASEE Annual Conference & Exposition, Columbus, Ohio","author":"McAlister","year":"2017"},{"key":"B48","volume-title":"Qualitative Analysis","year":"2013"},{"key":"B49","first-page":"37","article-title":"Ecological models of human development","author":"Bronfenbrenner","year":"1994","journal-title":"International encyclopedia of Education"},{"key":"B50","doi-asserted-by":"publisher","first-page":"507214","DOI":"10.1155\/2015\/507214","article-title":"Risk factors associated with unsafe injection practices at the first injection episode among intravenous drug users in France: results from priminject, an internet survey","volume":"2015","author":"Guichard","year":"2015","journal-title":"J Addict."},{"key":"B51","doi-asserted-by":"publisher","first-page":"62","DOI":"10.4103\/0971-8990.153712","article-title":"Psychosocial factors associated with HIV-related high-risk injection behavior among people who inject drugs","volume":"19","author":"Gupta","year":"2014","journal-title":"J Mental Health Hum Behav"},{"key":"B52","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1080\/02791072.2014.914611","article-title":"A qualitative study of methamphetamine users' perspectives on barriers and facilitators of drug abstinence","volume":"46","author":"Herbeck","year":"2014","journal-title":"J Psychoact Drugs."},{"key":"B53","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.drugpo.2018.08.017","article-title":"A qualitative study of methamphetamine initiation among Chinese male users: patterns and policy implications","volume":"62","author":"Liu","year":"2018","journal-title":"Int J Drug Policy."},{"key":"B54","unstructured":"Injecting and sexual networks and sociodemographic factors and dual HIV risk among people who inject drugs: a cross-sectional study in Kermanshah Province, Iran\n          \n          186\n          94\n          \n            \n              Noroozi\n              M\n            \n            \n              Mirzazadeh\n              A\n            \n            \n              Noroozi\n              A\n            \n            \n              Sharifi\n              H\n            \n            \n              Higgs\n              P\n            \n            \n              Jorjoran-Shushtari\n              Z\n            \n          \n          28496957\n          Addict Health.\n          8\n          2016"},{"key":"B55","doi-asserted-by":"publisher","first-page":"102934","DOI":"10.1016\/j.drugpo.2020.102934","article-title":"et al. Patterns, contexts, and motivations for polysubstance use among people who inject drugs in non-urban settings in the US Northeast","volume":"85","author":"Valente","year":"2020","journal-title":"Int J Drug Policy"},{"key":"B56","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02791072.1991.10472569","article-title":"Drug sharing and HIV transmission risks: the practice of frontloading in the dutch injecting drug user population","volume":"23","author":"Grund","year":"1991","journal-title":"J Psychoact Drugs."},{"key":"B57","doi-asserted-by":"publisher","first-page":"107885","DOI":"10.1016\/j.drugalcdep.2020.107885","article-title":"Reasons for assisting with injection initiation: results from a large survey of people who inject drugs in Los Angeles and San Francisco, California","volume":"209","author":"Simpson","year":"2020","journal-title":"Drug Alcohol Depend."},{"key":"B58","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1186\/s12954-019-0281-y","article-title":"HIV risk behaviours among women who inject drugs in coastal Kenya: findings from secondary analysis of qualitative data","volume":"16","author":"Mburu","year":"2019","journal-title":"Harm Reduct J."},{"key":"B59","doi-asserted-by":"publisher","first-page":"98","DOI":"10.22122\/ahj.v12i2.255","article-title":"Understanding the reasons for sharing syringes or needles to inject drugs: conventional content analysis","volume":"12","author":"Faghir-Gangi","year":"2020","journal-title":"Addict Health."},{"key":"B60","volume-title":"An Assessment of Needle and Syringe Program (NSP) Delivery Models for People Who Inject Drugs in the Kyrgyz Republic","author":"Deryabina","year":"2016"},{"key":"B61","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1016\/j.drugpo.2015.10.011","article-title":"The effect of on-site and outreach-based needle and syringe programs in people who inject drugs in Kermanshah, Iran","volume":"27","author":"Nazari","year":"2016","journal-title":"Int J Drug Policy."},{"key":"B62","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12954-018-0214-1","article-title":"\u201cThey accept me, because I was one of them\u201d: formative qualitative research supporting the feasibility of peer-led outreach for people who use drugs in Dakar, Senegal","volume":"15","author":"Stengel","year":"2018","journal-title":"Harm Reduct J."},{"key":"B63","volume-title":"The Quality of Outreach Workers and the Services They Provide for the NSEP Program in Malaysia","author":"Baba","year":"2014"},{"key":"B64","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1080\/15332640.2018.1532854","article-title":"Challenges and value of peer outreach workers in needle and syringe exchange programs: evidence from an HIV prevention program in Yunnan province, China","volume":"19","author":"Haw","year":"2020","journal-title":"J Ethn Subst Abuse."},{"key":"B65","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1097\/00124784-200403000-00007","article-title":"Disseminating effective behavioral interventions for HIV prevention: a cost analysis of a risk-reduction intervention for drug users","volume":"10","author":"Trentacoste","year":"2004","journal-title":"J Public Health Manag Pract"},{"key":"B66","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12954-015-0069-7","article-title":"Factors that influence the characteristics of needles and syringes used by people who inject drugs in Tajikistan","volume":"12","author":"Zule","year":"2015","journal-title":"Harm Reduct J."},{"key":"B67","doi-asserted-by":"publisher","first-page":"102868","DOI":"10.1016\/j.drugpo.2020.102868","article-title":"HIV prevention cascades for injection and sexual risk behaviors among HIV-negative people who inject drug in Iran","volume":"84","author":"Gangi","year":"2020","journal-title":"Int J Drug Policy."},{"key":"B68","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1111\/dar.13828","article-title":"Needle and syringe sharing among people who have recently injected drugs in Australia: the ETHOS Engage Study","volume":"43","author":"Farooq","year":"2024","journal-title":"Drug Alcohol Rev."},{"key":"B69","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1186\/s12954-023-00802-0","article-title":"Social and environmental determinants influencing injection drug use and HIV risk among two sister cities on the US\u2013Mexico border: a comparative cross-sectional study, 2016\u20132018","volume":"20","author":"Lechuga","year":"2023","journal-title":"Harm Reduct J."},{"key":"B70","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/1477-7517-8-9","article-title":"Social-structural contexts of needle and syringe sharing behaviours of HIV-positive injecting drug users in Manipur, India: a mixed methods investigation","volume":"8","author":"Chakrapani","year":"2011","journal-title":"Harm Reduct J."},{"key":"B71","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1477-7517-6-21","article-title":"Needle and syringe sharing among Iranian drug injectors","volume":"6","author":"Rafiey","year":"2009","journal-title":"Harm Reduct J."},{"key":"B72","unstructured":"Lisbon\n          Transform Drug Policy\n          Transform\n          \n          2021"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1527307\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T05:31:32Z","timestamp":1761111092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1527307\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,22]]},"references-count":72,"alternative-id":["10.3389\/fpubh.2025.1527307"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1527307","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,22]]},"article-number":"1527307"}}