{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T21:05:21Z","timestamp":1791925521287,"version":"4.3.4"},"reference-count":49,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T00:00:00Z","timestamp":1634688000000},"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>Despite growing knowledge of the adverse effects of cigarette smoking on general health, smoking is one of the most widely prevalent addictions around the world. Globally, about 1.1 billion smokers and over 8 million people die each year because of cigarette smoking. Smoking acts as a source for a variety of oral and systemic diseases. Various periodontal issues such as increased pocket depth, loss of alveolar bone, tooth mobility, oral lesions, ulcerations, halitosis, and stained teeth are more common among smokers. This systematic review was conducted according to the guidelines from PRISMA, and research articles were retrieved from the Web database sources on 31 May 2021. The quality of research articles was ensured by the type of evidence from combined schema incorporating as schema-13 evidence type description, Cochrane health promotion and public health field (CHPPHF), and the health gains notation framework-14 screening question for quality assessment of qualitative and quantitative studies. Smokers have been found to have bleeding on probing, periodontal pockets, and clinical attachment loss compared to nonsmokers. Oral and respiratory cancers are among the most lethal known diseases caused by cigarette smoking and other commonly occurring sequelae such as stained teeth, periodontal diseases, etc.<\/jats:p>","DOI":"10.3390\/ijerph182111003","type":"journal-article","created":{"date-parts":[[2021,10,20]],"date-time":"2021-10-20T07:05:57Z","timestamp":1634713557000},"page":"11003","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Smoking a Dangerous Addiction: A Systematic Review on an Underrated Risk Factor for Oral Diseases"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1504-1705","authenticated-orcid":false,"given":"Naveed","family":"Ahmed","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sohaib","family":"Arshad","sequence":"additional","affiliation":[{"name":"Periodontics Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syed Nahid","family":"Basheer","sequence":"additional","affiliation":[{"name":"Department of Restorative Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0313-9695","authenticated-orcid":false,"given":"Mohmed Isaqali","family":"Karobari","sequence":"additional","affiliation":[{"name":"Conservative Dentistry Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia"},{"name":"Department of Conservative Dentistry & Endodontics, Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai 600077, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2009-4393","authenticated-orcid":false,"given":"Anand","family":"Marya","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University of Puthisastra, Phnom Penh 12211, Cambodia"},{"name":"Department of Orthodontics, Saveetha Dental College & Hospitals, Saveetha Institute of Medical and Technical Sciences University, Chennai 600077, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charu Mohan","family":"Marya","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad 121002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9805-2436","authenticated-orcid":false,"given":"Pratibha","family":"Taneja","sequence":"additional","affiliation":[{"name":"Department of Public Health Dentistry, Sudha Rustagi College of Dental Sciences and Research, Faridabad 121002, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietro","family":"Messina","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0034-7624","authenticated-orcid":false,"given":"Chan Yean","family":"Yean","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu 16150, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7305-530X","authenticated-orcid":false,"given":"Giuseppe Alessandro","family":"Scardina","sequence":"additional","affiliation":[{"name":"Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Swe, K.K., Soe, A.K., Aung, S.H., and Soe, H.Z. (2021). Effectiveness of oral health education on 8- to 10-year-old school children in rural areas of the Magway Region, Myanmar. BMC Oral Health, 21.","DOI":"10.1186\/s12903-020-01368-0"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zhu, S., H\u00e4ussling, V., Aspera-Werz, R.H., Chen, T., Braun, B., Weng, W., Histing, T., and Nussler, A.K. (2021). Bisphosphonates Reduce Smoking-Induced Osteoporotic-Like Alterations by Regulating RANKL\/OPG in an Osteoblast and Osteoclast Co-Culture Model. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22010053"},{"key":"ref_3","first-page":"207","article-title":"Behavioral Factors and Periodontal Disease","volume":"3","author":"Sharma","year":"2016","journal-title":"Eur. J. Pharm. Med. Res."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Peres, M.A., Antunes, J.L.F., and Watt, R.G. (2021). The Contribution of Epidemiology to Oral Health Research. Oral Epidemiology, Springer.","DOI":"10.1007\/978-3-030-50123-5"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.3390\/ijerph110201647","article-title":"Associations of Serum Retinol, \u03b1-Tocopherol, and \u03b3-Tocopherol with Biomarkers among Healthy Japanese Men","volume":"11","author":"Zou","year":"2014","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zheng, S., Zhao, L., Ju, N., Hua, T., Zhang, S., and Liao, S. (2021). Relationship between oral health-related knowledge, attitudes, practice, self-rated oral health and oral health-related quality of life among Chinese college students: A structural equation modeling approach. BMC Oral Health, 21.","DOI":"10.1186\/s12903-021-01419-0"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"NP2296","DOI":"10.1177\/1010539511428352","article-title":"Factors influencing perceived oral health of Japanese middle-aged adults","volume":"27","author":"Ueno","year":"2015","journal-title":"Asia Pac. J. Public Health"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"742","DOI":"10.22271\/oral.2020.v6.i3k.1030","article-title":"Smoking and its ramifications relating to oral mucosa","volume":"6","author":"Shah","year":"2020","journal-title":"Int. J. Appl. Dent. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/joor.13066","article-title":"Four-dimensional oral health-related quality of life impact in children: A systematic review","volume":"48","author":"Omara","year":"2021","journal-title":"J. Oral Rehabil."},{"key":"ref_10","unstructured":"World Health Organization (2015). WHO Global Report on Trends in Prevalence of Tobacco Smoking 2015, World Health Organization."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1902\/jop.2007.060296","article-title":"Nicotine and lipopolysaccharide affect cytokine expression from gingival fibroblasts","volume":"78","author":"Almasri","year":"2007","journal-title":"J. Periodontol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1016\/S0140-6736(18)32225-6","article-title":"Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017","volume":"392","author":"Collaborators","year":"2018","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Zhang, X., Oluyomi, A., Woodard, L., Raza, S.A., Adel Fahmideh, M., El-Mubasher, O., Byun, J., Han, Y., Amos, C.I., and Badr, H. (2021). Individual-Level Determinants of Lifestyle Behavioral Changes during COVID-19 Lockdown in the United States: Results of an Online Survey. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18084364"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Yun, C., Katchko, K.M., Schallmo, M.S., Jeong, S., Yun, J., Chen, C.H., Weiner, J.A., Park, C., George, A., and Stupp, S.I. (2018). Aryl Hydrocarbon Receptor Antagonists Mitigate the Effects of Dioxin on Critical Cellular Functions in Differentiating Human Osteoblast-Like Cells. Int. J. Mol. Sci., 19.","DOI":"10.3390\/ijms19010225"},{"key":"ref_15","unstructured":"Health Canada (2017). Canadian Tobacco, Alcohol and Drugs Survey (CTADS): Summary of Results for 2017."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zgliczynska, M., Szymusik, I., Sierocinska, A., Bajaka, A., Rowniak, M., Sochacki-Wojcicka, N., Wielgos, M., and Kosinska-Kaczynska, K. (2019). Contraceptive Behaviors in Polish Women Aged 18\u201335\u2014A Cross-Sectional Study. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16152723"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1111\/j.1600-051X.2008.01223.x","article-title":"Smoking-attributable periodontal disease in the Australian adult population","volume":"35","author":"Do","year":"2008","journal-title":"J. Clin. Periodontol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1111\/jcpe.12293","article-title":"Smoking rate and periodontal disease prevalence: 40-year trends in Sweden 1970\u20132010","volume":"41","author":"Bergstrom","year":"2014","journal-title":"J. Clin. Periodontol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1902\/jop.2016.160013","article-title":"Risk indicators for periodontitis in US adults: NHANES 2009 to 2012","volume":"87","author":"Eke","year":"2016","journal-title":"J. Periodontol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zhu, J., Shi, F., Xu, G., Li, N., Li, J., He, Y., and Yu, J. (2019). Conventional Cigarette and E-Cigarette Smoking among School Personnel in Shanghai, China: Prevalence and Determinants. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16173197"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e11389","DOI":"10.1097\/MD.0000000000011389","article-title":"A meta-analysis of the relationship between environmental tobacco smoke and lung cancer risk of nonsmoker in China","volume":"97","author":"Sheng","year":"2018","journal-title":"Medicine"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"460194","DOI":"10.1155\/2014\/460194","article-title":"Site specific effect of tobacco addiction in upper aerodigestive tract tumors: A retrospective clinicopathological study","volume":"2014","author":"Kumar","year":"2014","journal-title":"Sci. World J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.yrtph.2013.08.002","article-title":"Good relationship between saliva cotinine kinetics and plasma cotinine kinetics after smoking one cigarette","volume":"67","author":"Yuki","year":"2013","journal-title":"Regul. Toxicol. Pharmacol."},{"key":"ref_24","first-page":"684154","article-title":"The influence of cigarette smoking on gingival bleeding and serum concentrations of haptoglobin and alpha 1-antitrypsin","volume":"2013","author":"Baharuddin","year":"2013","journal-title":"BioMed Res. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"3169","DOI":"10.3390\/ijerph110303169","article-title":"National Survey of Oral\/Dental Conditions Related to Tobacco and Alcohol Use in Mexican Adults","volume":"11","author":"Cruz","year":"2014","journal-title":"Int. J. Environ. Res. Public Heal."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"356","DOI":"10.3109\/1354750X.2014.912354","article-title":"A cross-sectional analysis of candidate biomarkers of biological effect in smokers, never-smokers and ex-smokers","volume":"19","author":"Haswell","year":"2014","journal-title":"Biomarkers"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4383","DOI":"10.1007\/s00213-014-3586-2","article-title":"Comparison of nicotine oral soluble film and nicotine lozenge on efficacy in relief of smoking cue-provoked acute craving after a single dose of treatment in low dependence smokers","volume":"231","author":"Du","year":"2014","journal-title":"Psychopharmacology"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1007\/s00784-015-1432-5","article-title":"AURKA Phe31Ile polymorphism interacted with use of alcohol, betel quid, and cigarettes at multiplicative risk of oral cancer occurrence","volume":"19","author":"Lee","year":"2015","journal-title":"Clin. Oral Investig."},{"key":"ref_29","first-page":"405","article-title":"One-year clinical evaluation of resin composite restorations of noncarious cervical lesions in smokers","volume":"17","author":"Gondo","year":"2015","journal-title":"J. Adhes. Dent."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.pdpdt.2017.01.182","article-title":"Efficacy of photodynamic therapy in the inactivation of oral fungal colonization among cigarette smokers and non-smokers with denture stomatitis","volume":"18","author":"Abduljabbar","year":"2017","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.pdpdt.2017.04.015","article-title":"Role of mechanical curettage with and without adjunct antimicrobial photodynamic therapy in the treatment of peri-implant mucositis in cigarette smokers: A randomized controlled clinical trial","volume":"18","author":"Javed","year":"2017","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Rodr\u00edguez-Rabassa, M., L\u00f3pez, P., Rodr\u00edguez-Santiago, R.E., Cases, A., Felici, M., S\u00e1nchez, R., Yamamura, Y., and Rivera-Amill, V. (2018). Cigarette Smoking Modulation of Saliva Microbial Composition and Cytokine Levels. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15112479"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Blasi, P.R., Krakauer, C., Anderson, M.L., Nelson, J., Bush, T., Catz, S.L., and McClure, J.B. (2018). Factors associated with future dental care utilization among low-income smokers overdue for dental visits. BMC Oral Health, 18.","DOI":"10.1186\/s12903-018-0646-8"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.pdpdt.2019.01.006","article-title":"Effectiveness of scaling and root planning with and without adjunct antimicrobial photodynamic therapy in the treatment of chronic periodontitis among cigarette-smokers and never-smokers: A randomized controlled clinical trial","volume":"25","author":"AlAhmari","year":"2019","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1111\/jcpe.13178","article-title":"Supportive periodontal therapy in moderate-to-severe periodontitis patients: A two-year randomized clinical trial","volume":"46","author":"Angst","year":"2019","journal-title":"J. Clin. Periodontol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"101800","DOI":"10.1016\/j.pdpdt.2020.101800","article-title":"Clinical and immunological peri-implant parameters among cigarette and electronic smoking patients treated with photochemotherapy: A randomized controlled clinical trial","volume":"31","author":"Alresayes","year":"2020","journal-title":"Photodiagn. Photodyn. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Julkunen-Iivari, A., Heikkinen, A.M., R\u00e4is\u00e4nen, I.T., Ruokonen, H., Meurman, J.H., Toppila-Salmi, S., S\u00f6der, P., and S\u00f6der, B. (2020). Tobacco Products, Periodontal Health and Education Level: Cohort Study from Sweden. Dent. J., 8.","DOI":"10.3390\/dj8030090"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Javed, F., Al-Zawawi, A.S., Allemailem, K.S., Almatroudi, A., Mehmood, A., Divakar, D.D., and Al-Kheraif, A.A. (2020). Periodontal Conditions and Whole Salivary IL-17A and-23 Levels among Young Adult Cannabis sativa (Marijuana)-Smokers, Heavy Cigarette-Smokers and Non-Smokers. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17207435"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Nettore, I.C., Maione, L., Desiderio, S., De Nisco, E., Franchini, F., Palatucci, G., Ungaro, P., Cantone, E., Macchia, P.E., and Colao, A. (2020). Influences of Age, Sex and Smoking Habit on Flavor Recognition in Healthy Population. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17030959"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s10266-020-00496-x","article-title":"Salivary 8-hydroxyguanosine levels in smokers and non-smokers with chronic periodontitis","volume":"108","author":"Varghese","year":"2020","journal-title":"Odontology"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Wychowa\u0144ski, P., Starzy\u0144ska, A., Jereczek-Fossa, B.A., Iwanicka-Grzegorek, E., Kosewski, P., Adamska, P., and Woli\u0144ski, J. (2021). The Effects of Smoking Cigarettes on Immediate Dental Implant. Stability\u2014A Prospective Case Series Study. Appl. Sci., 11.","DOI":"10.3390\/app11010027"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.7314\/APJCP.2013.14.3.1919","article-title":"Smoking and associated factors among the population aged 40-64 in Shahroud, Iran","volume":"14","author":"Hamrah","year":"2013","journal-title":"Asian Pac. J. Cancer Prev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.drugalcdep.2011.03.026","article-title":"Oral tobacco products: Preference and effects among smokers","volume":"118","author":"Hatsukami","year":"2011","journal-title":"Drug Alcohol Depend."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Ramalingam, A., Santhanathas, T., Shaukat Ali, S., and Zainalabidin, S. (2019). Resveratrol Supplementation Protects against Nicotine-Induced Kidney Injury. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16224445"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Redondo-Fl\u00f3rez, L., Fern\u00e1ndez-Lucas, J., and Clemente-Su\u00e1rez, V.J. (2020). Cultural Differences in Stress-Related Psychological, Nutrition, Physical Activity and Oral Health Factors of Professors. Nutrients, 12.","DOI":"10.3390\/nu12123644"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1080\/10410236.2017.1407226","article-title":"The impact of smokeless tobacco risk information on smokers\u2019 risk perceptions and use intentions: A news media experiment","volume":"34","author":"Wackowski","year":"2019","journal-title":"Health Commun."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Radaeli, A., Nardin, M., Azzolina, D., and Malerba, M. (2019). Determinants of Smoking Status in a Sample of Outpatients Afferent to a Tertiary Referral Hospital. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16214136"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Protano, C., Manigrasso, M., Cammalleri, V., Biondi Zoccai, G., Frati, G., Avino, P., and Vitali, M. (2020). Impact of Electronic Alternatives to Tobacco Cigarettes on Indoor Air Particular Matter Levels. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17082947"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Jeon, H.G., Kim, G., Jeong, H.S., and So, W.-Y. (2021). Association between Cigarette Smoking and Physical Fitness Level of Korean Adults and the Elderly. Healthcare, 9.","DOI":"10.3390\/healthcare9020185"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/21\/11003\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:18:33Z","timestamp":1760167113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/21\/11003"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,20]]},"references-count":49,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["ijerph182111003"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182111003","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,20]]}}}