{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T16:00:30Z","timestamp":1790092830849,"version":"4.0.1"},"reference-count":66,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2017,3,20]],"date-time":"2017-03-20T00:00:00Z","timestamp":1489968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Substance use disorders (SUD) and mental health disorders are significant public health issues that co-occur and are associated with high risk for suicide attempts. SUD and mental health disorders are more prevalent among offenders (i.e., prisoners or inmates) than the non-imprisoned population, raising concerns about the risk of self-harm. This cross-sectional study examined the population of a state prison system (10,988 out of 13,079) to identify associations among SUD (alcohol, cannabis, intravenous drugs, narcotics, and tobacco smoking), mental health disorders (anxiety, bipolar, depression, and psychotic disorders), and suicide attempts. The primary aim was to determine which groups (SUD, mental health disorders, and co-occurrences) were strongly association with suicide attempts. Groups with a documented SUD or mental health disorders compared to peers without these issues had 2.0 and 9.2 greater odds, respectively, for attempting suicide, which was significant at p &lt; 0.0001 for both conditions. There were also significant differences within SUD and mental health disorders groups in regard to suicide attempts. Groups with the greatest odds for suicide attempts were offenders with comorbid bipolar comorbid and anxiety, alcohol combined with depression, and cannabis co-occurring with depression. Documentation of suicide attempts during imprisonment indicates awareness, but also suggest a need to continue enhancing screening and evaluating environmental settings.<\/jats:p>","DOI":"10.3390\/ijerph14030317","type":"journal-article","created":{"date-parts":[[2017,3,20]],"date-time":"2017-03-20T11:39:09Z","timestamp":1490009949000},"page":"317","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Associations among Substance Use, Mental Health Disorders, and Self-Harm in a Prison Population: Examining Group Risk for Suicide Attempt"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5677-6017","authenticated-orcid":false,"given":"Madison","family":"Gates","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Medical College of Georgia, Institute of Public and Preventive Health, Augusta University, 1120 15th Street, CJ 2300, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9175-6425","authenticated-orcid":false,"given":"Asher","family":"Turney","sequence":"additional","affiliation":[{"name":"Centurion, LLC, 53 Century Blvd, Suite 150, Nashville, TN 37214, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Ferguson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, 997 St. Sebastian Way, Augusta, GA 30912, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Walker","sequence":"additional","affiliation":[{"name":"Lexington Public Library, 3628 Walden Drive, Lexington, KY 40517, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Staples-Horne","sequence":"additional","affiliation":[{"name":"Georgia Department of Juvenile Justice, Central Office, 3408 Covington Highway, Decatur, GA 30032, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jad.2016.03.072","article-title":"Screening for bipolar disorders: A public health issue","volume":"205","author":"Carta","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_2","unstructured":"Arias, F., Szerman, N., Vega, P., Mes\u00edas, B., Basurte, I., and Rentero, D. (2016). Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders\/pathology. Adicciones."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jpsychires.2016.10.003","article-title":"Epidemiology of DSM-5 bipolar I disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions\u2014III","volume":"84","author":"Blanco","year":"2017","journal-title":"J. Psychiatr. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.alcohol.2008.05.003","article-title":"The impact of co-morbid alcohol use disorder in bipolar patients","volume":"42","author":"Cardoso","year":"2008","journal-title":"Alcohol"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jad.2014.05.066","article-title":"Attempted suicide in people with co-occurring bipolar and substance use disorders: Systematic review and meta-analysis","volume":"167","author":"Bartoli","year":"2014","journal-title":"J. Affect. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.psychres.2008.01.008","article-title":"Alcohol use disorders increase the risk of completed suicide\u2014Irrespective of other psychiatric disorders. A longitudinal cohort study","volume":"167","author":"Knop","year":"2009","journal-title":"Psychiatry Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"434127","DOI":"10.1155\/2015\/434127","article-title":"The Use of Cannabis as a Predictor of Early Onset of Bipolar Disorder and Suicide Attempts","volume":"2015","author":"Leite","year":"2015","journal-title":"Neural Plast."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1177\/0141076814522033","article-title":"Risk of self-harm and suicide in people with specific psychiatric and physical disorders: Comparisons between disorders using English national record linkage","volume":"107","author":"Singhal","year":"2014","journal-title":"J. R. Soc. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.addbeh.2015.10.001","article-title":"Substance use in incarcerated male offenders: Predictive validity of a personality typology of substance misusers","volume":"53","author":"Anthony","year":"2016","journal-title":"Addict. Behav."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1111\/j.1360-0443.2006.01316.x","article-title":"Substance abuse and dependence in prisoners: A systematic review","volume":"101","author":"Fazel","year":"2006","journal-title":"Addiction"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/bsl.831","article-title":"Gender Differences in Comorbid Disorders among Offenders in Prison Substance Abuse Treatment Programs","volume":"26","author":"Zlotnick","year":"2008","journal-title":"Behav. Sci. Law"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jad.2015.12.059","article-title":"Substance use is a risk factor for violent behavior in male patients with bipolar disorder","volume":"193","author":"Mutlu","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jsat.2014.05.002","article-title":"Co-Occurring Risk Factors for Arrest among Persons with Opioid Abuse and Dependence: Implications for Developing Interventions to Limit Criminal Justice Involvement","volume":"47","author":"Fisher","year":"2014","journal-title":"J. Subst. Abus Treat."},{"key":"ref_14","unstructured":"Mumola, C., and Karberg, J. (2004). Drug Use and Dependence, State and Federal Prisoners, Available online: http:\/\/www.bjs.gov\/index.cfm?ty=pbdetail&iid=778."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1176\/appi.ps.201300044","article-title":"Patterns of Justice Involvement among Adults with Schizophrenia and Bipolar Disorder: Key Risk Factors","volume":"65","author":"Robertson","year":"2014","journal-title":"Psychiatr. Serv."},{"key":"ref_16","unstructured":"Glaze, L., and James, D. Mental Health Problems of Prison and Jail Inmates, Available online: http:\/\/www.bjs.gov\/index.cfm?ty=pbdetail&iid=789."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S0165-0327(03)00194-0","article-title":"A different depression: Clinical distinctions between bipolar and unipolar depression","volume":"84","author":"Bowden","year":"2005","journal-title":"J. Affect. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1016\/S0140-6736(15)00241-X","article-title":"Bipolar disorder","volume":"387","author":"Grande","year":"2016","journal-title":"Lancet"},{"key":"ref_19","unstructured":"Karg, R.S., Bose, J., Batts, K.R., Forman-Hoffman, V.L., Liao, D., Hirsch, E., Pemberton, M.R., Colpe, L.J., and Hedden, S.L. (2012). Past Year Mental Disorders among Adults in the United States: Results from the 2008\u20132012 Mental Health Surveillance Study, CBHSQ Data Review."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1016\/j.jpsychires.2013.08.005","article-title":"Clinical, psychological and environmental predictors of prospective suicide events in patients with Bipolar Disorder","volume":"47","author":"Antypa","year":"2013","journal-title":"J. Psychiatr. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.jad.2014.09.003","article-title":"Risk factors for suicide in bipolar disorder: A systematic review","volume":"170","author":"Alencar","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jad.2012.04.041","article-title":"Suicidal behavior in bipolar disorder: Epidemiology, characteristics and major risk factors","volume":"143","author":"Gonda","year":"2012","journal-title":"J. Affect. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jad.2008.09.014","article-title":"A review of panic and suicide in bipolar disorder: Does comorbidity increase risk?","volume":"115","author":"Kilbane","year":"2009","journal-title":"J. Affect. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1002\/da.20674","article-title":"The relationship between anxiety disorders and suicide attempts: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions","volume":"27","author":"Nepon","year":"2010","journal-title":"Depression Anxiety"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/S0165-0327(99)00129-9","article-title":"Suicidal behavior in bipolar mood disorder: Clinical characteristics of attempters and nonattempters","volume":"59","author":"Oquendo","year":"2000","journal-title":"J. Affect. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jpsychires.2015.10.004","article-title":"A clinical measure of suicidal ideation, suicidal behavior, and associated symptoms in bipolar disorder: Psychometric properties of the Concise Health Risk Tracking Self-Report (CHRT-SR)","volume":"71","author":"Ostacher","year":"2015","journal-title":"J. Psychiatr. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/bdi.12271","article-title":"International Society for Bipolar Disorders Task Force on Suicide: Meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder","volume":"17","author":"Schaffer","year":"2015","journal-title":"Bipolar Disord."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1111\/bdi.12219","article-title":"Suicide in bipolar disorder: Characteristics and subgroups","volume":"16","author":"Schaffer","year":"2014","journal-title":"Bipolar Disord."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.jad.2015.12.033","article-title":"Differences and similarities of risk factors for suicidal ideation and attempts among patients with depressive or bipolar disorders","volume":"193","author":"Aaltonen","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jad.2015.02.002","article-title":"A qualitative investigation into the relationships between social factors and suicidal thoughts and acts experienced by people with a bipolar disorder diagnosis","volume":"176","author":"Owen","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1002\/da.22203","article-title":"Anxiety Disorders Are Independently Associated with Suicide Ideation and Attempts: Propensity Score Matching in Two Epidemiological Samples","volume":"30","author":"Thibodeau","year":"2013","journal-title":"Depression Anxiety"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1016\/j.jad.2016.07.010","article-title":"The association between cannabis use and suicidality among men and women: A population-based longitudinal study","volume":"205","author":"Shalit","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/ajad.12185","article-title":"Addiction and suicide: A review","volume":"24","author":"Ries","year":"2015","journal-title":"Am. J. Addict."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.psychres.2010.07.007","article-title":"Cannabis involvement in individuals with bipolar disorder","volume":"185","author":"Agrawal","year":"2011","journal-title":"Psychiatry Res."},{"key":"ref_35","first-page":"982","article-title":"Smoking and Suicidality in Subjects with Bipolar Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)","volume":"30","author":"Baek","year":"2013","journal-title":"Depression Anxiety"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jad.2015.04.038","article-title":"Increased risk of suicide attempt in bipolar patients with severe tobacco dependence","volume":"183","author":"Ducasse","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s00127-012-0567-9","article-title":"Recent criminal offending and suicide attempts: A national sample","volume":"48","author":"Cook","year":"2013","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1016\/j.disamonth.2014.04.004","article-title":"Suicide in corrections: An overview","volume":"60","author":"Kellogg","year":"2014","journal-title":"Dis. a-Month"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1002\/da.22248","article-title":"Co-Occurrence of Anxiety and Bipolar Disorders: Clinical and Therapeutic Overview","volume":"31","author":"Baldessarini","year":"2014","journal-title":"Depression Anxiety"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.mpmed.2016.08.007","article-title":"Bipolar disorder","volume":"44","author":"Goodwin","year":"2016","journal-title":"Medicine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.genhosppsych.2013.03.014","article-title":"Suicide attempts and clinical risk factors in patients with bipolar and unipolar affective disorders","volume":"35","author":"Pawlak","year":"2013","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_42","unstructured":"Substance Abuse and Mental Health Services Administration (2016). 2015 National Survey on Drug Use and Health: Detailed Tables."},{"key":"ref_43","unstructured":"Adult Smoking in the US, Available online: https:\/\/www.cdc.gov\/vitalsigns\/AdultSmoking\/index.html."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1001\/archpsyc.62.6.617","article-title":"Prevalence, Severity, and Comorbidity of Twelve-month DSM-IV Disorders in the National Comorbidity Survey Replication (NCS-R)","volume":"62","author":"Kessler","year":"2005","journal-title":"Arch. Gen. Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1038\/mp.2008.98","article-title":"Suicidal ideation and suicide attempts in the United States: 1991\u20131992 and 2001\u20132002","volume":"15","author":"Keyes","year":"2010","journal-title":"Mol. Psychiatry"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1017\/S0033291711002340","article-title":"Suicidality, ethnicity and immigration in the USA","volume":"42","author":"Borges","year":"2012","journal-title":"Psychol. Med."},{"key":"ref_47","first-page":"44","article-title":"Ethnic Differences in Suicidal Ideation and Attempts","volume":"15","author":"Oquendo","year":"2008","journal-title":"Prim. Psychiatry"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1617","DOI":"10.4088\/JCP.08m04967blu","article-title":"Twelve Month Prevalence of and Risk Factors for Suicide Attempts in the WHO World Mental Health Surveys","volume":"71","author":"Borges","year":"2010","journal-title":"J. Clin. Psychiatry"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Player, M.J., Proudfoot, J., Fogarty, A., Whittle, E., Spurrier, M., Shand, F., Christensen, H., Hadzi-Pavlovic, D., and Wilhelm, K. (2015). What Interrupts Suicide Attempts in Men: A Qualitative Study. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0128180"},{"key":"ref_50","unstructured":"Men and Mental Health, Available online: https:\/\/www.nimh.nih.gov\/health\/topics\/men-and-mental-health\/index.shtml."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.psychres.2013.09.026","article-title":"Risk and protective factors predicting multiple suicide attempts","volume":"210","author":"Wang","year":"2013","journal-title":"Psychiatry Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/1745-0179-3-20","article-title":"Predictors of suicide attempters in substance-dependent patients: A six-year prospective follow-up","volume":"3","author":"Bakken","year":"2007","journal-title":"Clin. Pract. Epidemiol. Ment. Health"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Berlin, I., Hakes, J.K., Hu, M.-C., and Covey, L.S. (2015). Tobacco Use and Suicide Attempt: Longitudinal Analysis with Retrospective Reports. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0122607"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1177\/070674371105600306","article-title":"The relation between nicotine dependence and suicide attempts in the general population","volume":"56","author":"Yaworski","year":"2011","journal-title":"Can. J. Psychiatry Rev. Can. Psychiatr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.cpr.2015.11.008","article-title":"Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: A meta-analytic review","volume":"43","author":"Bentley","year":"2016","journal-title":"Clin. Psychol. Rev."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/ADM.0000000000000019","article-title":"Does Dual Diagnosis Affect Violence and Moderate\/Superficial Self-harm in Heroin Addiction at Treatment Entry?","volume":"8","author":"Maremmani","year":"2014","journal-title":"J. Addict. Med."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/add.12381","article-title":"Tobacco use disorder and the risk of suicide mortality","volume":"109","author":"Bohnert","year":"2014","journal-title":"Addiction"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1111\/j.1399-5618.2009.00744.x","article-title":"Cigarette smoking is associated with suicidality in bipolar disorder","volume":"11","author":"Ostacher","year":"2009","journal-title":"Bipolar Disord."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.4088\/JCP.v67n1210","article-title":"The relationship between smoking and suicidal behavior, comorbidity, and course of illness in bipolar disorder","volume":"67","author":"Ostacher","year":"2006","journal-title":"J. Clin. Psychiatry"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1016\/j.addbeh.2011.11.039","article-title":"Reasons for substance use among people with mental disorders","volume":"37","author":"Thornton","year":"2012","journal-title":"Addict. Behav."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jpsychores.2016.06.011","article-title":"Non-psychiatric inpatient care preceding admission for self-harm in young people","volume":"88","author":"Idenfors","year":"2016","journal-title":"J. Psychosom. Res."},{"key":"ref_62","unstructured":"U.S. Supreme Court (1976). Estelle v. Gamble, 429 U.S. 97 (1976)."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1016\/j.pbb.2006.11.009","article-title":"Association between illicit drug and alcohol use and first manic episode","volume":"86","author":"Frank","year":"2007","journal-title":"Pharmacol. Biochem. Behav."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.biopsych.2004.05.008","article-title":"Bipolar disorder and substance abuse","volume":"56","author":"Levin","year":"2004","journal-title":"Biol. Psychiatry"},{"key":"ref_65","first-page":"9","article-title":"A Study of Effects of MultiCollinearity in the Multivariable Analysis","volume":"4","author":"Yoo","year":"2014","journal-title":"Int. J. Appl. Sci. Technol."},{"key":"ref_66","first-page":"268","article-title":"A Comparison of Logistic Regression, Logic Regression, Classification Tree, and Random Forests to Identify Effective Gene-Gene and Gene-Environmental Interactions","volume":"2","author":"Yoo","year":"2012","journal-title":"Int. J. Appl. Sci. Technol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/3\/317\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:30:51Z","timestamp":1760207451000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/14\/3\/317"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,20]]},"references-count":66,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2017,3]]}},"alternative-id":["ijerph14030317"],"URL":"https:\/\/doi.org\/10.3390\/ijerph14030317","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,3,20]]}}}