{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:42:36Z","timestamp":1791373356154,"version":"4.3.1"},"reference-count":62,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,10]],"date-time":"2023-01-10T00:00:00Z","timestamp":1673308800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Spanish Ministerio de Ciencia e Innovaci\u00f3n","award":["PSI2015-66755-R"],"award-info":[{"award-number":["PSI2015-66755-R"]}]},{"name":"FEDER (European Regional Development Found)","award":["PSI2015-66755-R"],"award-info":[{"award-number":["PSI2015-66755-R"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Despite the fact that perceived stress is related to abstinence smoking outcomes, no studies have investigated the mediational effect of specific tobacco-related variables on this relationship. This study aimed to explore the indirect effect of perceived stress on abstinence at the end of treatment through smoking urges. The sample comprised 260 treatment-seeking smokers (58.5% female; Mage = 46.00; SD = 11.1) who underwent psychological smoking cessation treatment. The brief version of the Questionnaire of Smoking Urges (QSU) and the Perceived Stress Scale (PSS14) were used. Mediation analyses were conducted in which smoking urges and their dimensions were potential mediators in the relationship between perceived stress and abstinence at the end of treatment. The results showed a non-significant direct effect of perceived stress on abstinence. However, a significant indirect effect was found through smoking urges (QSU-total) and, specifically, through smoking urges associated with the expectation of negative affect relief (QSU-Factor 2). A non-significant indirect effect through smoking urges related to the expectation of tobacco use as a pleasurable experience (QSU-Factor 1) was also found. Analyzing possible mediator variables could contribute to understanding previous conflicting data. These findings point to potential interest in including treatment components targeting perceived stress and smoking urges to improve the effectiveness of smoking cessation treatments.<\/jats:p>","DOI":"10.3390\/ijerph20021257","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T01:33:12Z","timestamp":1673400792000},"page":"1257","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Perceived Stress and Smoking Cessation: The Role of Smoking Urges"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1897-639X","authenticated-orcid":false,"given":"Mar\u00eda","family":"Barroso-Hurtado","sequence":"first","affiliation":[{"name":"Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8400-230X","authenticated-orcid":false,"given":"Daniel","family":"Su\u00e1rez-Castro","sequence":"additional","affiliation":[{"name":"Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8503-1791","authenticated-orcid":false,"given":"Carmela","family":"Mart\u00ednez-Vispo","sequence":"additional","affiliation":[{"name":"Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6639-3834","authenticated-orcid":false,"given":"Elisardo","family":"Beco\u00f1a","sequence":"additional","affiliation":[{"name":"Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7661-8972","authenticated-orcid":false,"given":"Ana","family":"L\u00f3pez-Dur\u00e1n","sequence":"additional","affiliation":[{"name":"Smoking and Addictive Disorders Unit, Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,10]]},"reference":[{"key":"ref_1","unstructured":"Centers for Disease Control and Prevention (2022, December 02). Current Cigarette Smoking Among Adults in the United States, Available online: https:\/\/www.cdc.gov\/tobacco\/data_statistics\/fact_sheets\/adult_data\/cig_smoking\/index.htm."},{"key":"ref_2","unstructured":"World Health Organization (2022, December 02). Tobacco. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/tobacco."},{"key":"ref_3","unstructured":"U.S. Department of Health and Human Services (2014). The Health Consequences of Smoking\u201450 Years of Progress: A Report of the Surgeon General."},{"key":"ref_4","unstructured":"Royal College of Physicians (2013). Smoking and Mental Health: A Joint Report, Royal College of Physicians."},{"key":"ref_5","first-page":"CD013229","article-title":"Behavioural Interventions for Smoking Cessation: An Overview and Network Meta-Analysis","volume":"1","author":"Fanshawe","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1056\/NEJMsa1211128","article-title":"21st-Century Hazards of Smoking and Benefits of Cessation in the United States","volume":"368","author":"Jha","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_7","unstructured":"U.S. Department of Health and Human Services (2020). Smoking Cessation: A Report of the Surgeon General."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"g1151","DOI":"10.1136\/bmj.g1151","article-title":"Change in Mental Health after Smoking Cessation: Systematic Review and Meta-Analysis","volume":"348","author":"Taylor","year":"2014","journal-title":"BMJ"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1111\/j.1360-0443.2010.02979.x","article-title":"The Effect of Stopping Smoking on Perceived Stress Levels","volume":"105","author":"Hajek","year":"2010","journal-title":"Addiction"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101402","DOI":"10.1016\/j.pmedr.2021.101402","article-title":"Examining the Effects of Stress and Psychological Distress on Smoking Abstinence in Cancer Patients","volume":"23","author":"Streck","year":"2021","journal-title":"Prev. Med. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Kim, S.-J., Chae, W., Park, W.-H., Park, M.-H., Park, E.-C., and Jang, S.-I. (2019). The Impact of Smoking Cessation Attempts on Stress Levels. BMC Public Health, 19.","DOI":"10.1186\/s12889-019-6592-9"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Mart\u00ednez-Vispo, C., Rodr\u00edguez-Cano, R., L\u00f3pez-Dur\u00e1n, A., Senra, C., Fern\u00e1ndez del R\u00edo, E., and Beco\u00f1a, E. (2019). Cognitive-Behavioral Treatment with Behavioral Activation for Smoking Cessation: Randomized Controlled Trial. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0214252"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.jad.2015.11.042","article-title":"Smoking Cessation and Depressive Symptoms at 1-, 3-, 6-, and 12-Months Follow-Up","volume":"191","year":"2016","journal-title":"J. Affect. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Echeverria, I., Cotaina, M., Jovani, A., Mora, R., Haro, G., and Benito, A. (2021). Proposal for the Inclusion of Tobacco Use in Suicide Risk Scales: Results of a Meta-Analysis. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18116103"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Patnode, C.D., Henderson, J.T., Melnikow, J., Coppola, E.L., Durbin, S., and Thomas, R. (2021). Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality.","DOI":"10.1001\/jama.2020.23541"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"416","DOI":"10.3109\/00952990.2016.1171327","article-title":"Depression and Cigarette Smoking Behavior: A Critical Review of Population-Based Studies","volume":"43","author":"Weinberger","year":"2017","journal-title":"Am. J. Drug Alcohol. Abus."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1037\/a0018065","article-title":"Psychiatric Disorders in Smokers Seeking Treatment for Tobacco Dependence: Relations with Tobacco Dependence and Cessation","volume":"78","author":"Piper","year":"2010","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1034","DOI":"10.1111\/adb.12647","article-title":"A Bidirectional Path Analysis Model of Smoking Cessation Self-Efficacy and Concurrent Smoking Status: Impact on Abstinence Outcomes","volume":"24","author":"Clyde","year":"2018","journal-title":"Addict. Biol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Gellman, M.D., and Turner, J.R. (2013). Perceived Stress. Encyclopedia of Behavioral Medicine, Springer.","DOI":"10.1007\/978-1-4419-1005-9"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1097\/FBP.0b013e328330dcff","article-title":"Delay Discounting as a Mediator of the Relationship between Perceived Stress and Cigarette Smoking Status in Adolescents","volume":"20","author":"Fields","year":"2009","journal-title":"Behav. Pharmacol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12971-016-0084-9","article-title":"Gender Differences in the Association between Self-Reported Stress and Cigarette Smoking in Korean Adolescents","volume":"14","author":"Kim","year":"2016","journal-title":"Tob. Induc. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.addbeh.2015.07.011","article-title":"Perceived Stress and Smoking-Related Behaviors and Symptomatology in Male and Female Smokers","volume":"51","author":"Lawless","year":"2015","journal-title":"Addict. Behav."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"7597","DOI":"10.1038\/s41598-017-07579-w","article-title":"Perceived Stress and Smoking across 41 Countries: A Global Perspective across Europe, Africa, Asia and the Americas","volume":"7","author":"Stubbs","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.addbeh.2016.02.022","article-title":"Examining an Underlying Mechanism between Perceived Stress and Smoking Cessation-Related Outcomes","volume":"58","author":"Robles","year":"2016","journal-title":"Addict. Behav."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1007\/BF03404531","article-title":"Gender Differences in Predictors for Long-Term Smoking Cessation Following Physician Advice and Nicotine Replacement Therapy","volume":"92","author":"Reid","year":"2001","journal-title":"Can. J. Public Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s00213-005-2225-3","article-title":"Attenuated Adrenocorticotropic Responses to Psychological Stress Are Associated with Early Smoking Relapse","volume":"181","author":"Hatsukami","year":"2005","journal-title":"Psychopharmacology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1111\/add.12990","article-title":"Distress, Race\/Ethnicity and Smoking Cessation in Treatment-Seekers: Implications for Disparity Elimination","volume":"110","author":"Kolar","year":"2015","journal-title":"Addiction"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/s10865-005-9004-9","article-title":"Stress and Quitting Among African American Smokers","volume":"28","author":"Manning","year":"2005","journal-title":"J. Behav. Med."},{"key":"ref_29","first-page":"1467","article-title":"The Development and Initial Validation of a Questionnaire on Smoking Urges","volume":"86","author":"Tiffany","year":"1991","journal-title":"Addiction"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1749-6632.2011.06298.x","article-title":"The Clinical Significance of Drug Craving","volume":"1248","author":"Tiffany","year":"2012","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1037\/a0028339","article-title":"Smoker Reactivity to Cues: Effects on Craving and on Smoking Behavior","volume":"122","author":"Shiffman","year":"2013","journal-title":"J. Abnorm. Psychol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1093\/ntr\/ntr137","article-title":"Determinants of Tobacco Use and Renaming the FTND to the Fagerstrom Test for Cigarette Dependence","volume":"14","year":"2012","journal-title":"Nicotine Tob. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1080\/10826084.2017.1400569","article-title":"Effects of Negative Affect, Urge to Smoke, and Working Memory Performance (n-Back) on Nicotine Dependence","volume":"53","author":"Lechner","year":"2018","journal-title":"Subst. Use Misuse"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.drugalcdep.2010.10.009","article-title":"Enjoyment of Smoking and Urges to Smoke as Predictors of Attempts and Success of Attempts to Stop Smoking: A Longitudinal Study","volume":"115","author":"Fidler","year":"2011","journal-title":"Drug Alcohol Depend."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"395","DOI":"10.18865\/ed.27.4.395","article-title":"Smoking Urges during Treatment and Long-Term Cessation among Low-Income African Americans","volume":"27","author":"Hooper","year":"2017","journal-title":"Ethn. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/BF02246158","article-title":"Urges to Smoke during the First Month of Abstinence: Relationship to Relapse and Predictors","volume":"119","author":"Doherty","year":"1995","journal-title":"Psychopharmacology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s41533-021-00259-3","article-title":"Validity of Urges to Smoke Measures in Predicting Smoking Relapse during Treatment in Primary Care","volume":"31","author":"Kotz","year":"2021","journal-title":"Npj Prim. Care Respir. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"230","DOI":"10.20882\/adicciones.4","article-title":"Craving y Abstinencia de La Nicotina En Fumadores Espa\u00f1oles En Un Tratamiento Para Dejar de Fumar","volume":"26","author":"Brandon","year":"2014","journal-title":"Adicciones"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1080\/14622200701705076","article-title":"Craving, Withdrawal, and Smoking Urges on Days Immediately Prior to Smoking Relapse","volume":"10","author":"Allen","year":"2008","journal-title":"Nicotine Tob. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.drugalcdep.2007.01.011","article-title":"Subjective Reactivity to the First Cigarette of the Day as a Predictor of Smoking Relapse: A Preliminary Study","volume":"89","author":"Toll","year":"2007","journal-title":"Drug Alcohol Depend."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.addbeh.2010.10.008","article-title":"Smoking History, Nicotine Dependence, and Changes in Craving and Mood during Short-Term Smoking Abstinence in Alcohol Dependent vs. Control Smokers","volume":"36","author":"Heffner","year":"2011","journal-title":"Addict. Behav."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1037\/0893-164X.18.1.31","article-title":"Daily Processes in Stress and Smoking: Effects of Negative Events, Nicotine Dependence, and Gender","volume":"18","author":"Todd","year":"2004","journal-title":"Psychol. Addict. Behav."},{"key":"ref_43","unstructured":"Gra\u00f1a, J.L. (1994). Evaluaci\u00f3n de La Conducta de Fumar [Assessment of Smoking Behavior]. Conductas adictivas: Teor\u00eda, evaluaci\u00f3n y tratamiento, Debate."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1111\/j.1360-0443.1991.tb01879.x","article-title":"The Fagerstr\u00f6m Test for Nicotine Dependence: A Revision of the Fagerstrom Tolerance Questionnaire","volume":"86","author":"Heatherton","year":"1991","journal-title":"Br. J. Addict."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1136\/tc.5.1.52","article-title":"Nicotine Dependence versus Smoking Prevalence: Comparisons among Countries and Categories of Smokers","volume":"5","author":"Kunze","year":"1996","journal-title":"Tob. Control"},{"key":"ref_46","first-page":"1455","article-title":"The Fagerstr\u00f6m Test for Nicotine Dependence in a Spanish Sample","volume":"83","year":"1998","journal-title":"Psychol. Rep."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1080\/14622200020032051","article-title":"Evaluation of the Brief Questionnaire of Smoking Urges (QSU-Brief) in Laboratory and Clinical Settings","volume":"3","author":"Cox","year":"2001","journal-title":"Nicotine Tob. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1037\/1040-3590.16.4.402","article-title":"Development of a Brief Questionnaire of Smoking Urges--Spanish","volume":"16","year":"2004","journal-title":"Psychol. Assess."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A Global Measure of Perceived Stress","volume":"24","author":"Cohen","year":"1983","journal-title":"J. Health Soc. Behav."},{"key":"ref_50","first-page":"195","article-title":"Versi\u00f3n Espa\u00f1ola de La Escala de Estr\u00e9s Percibido (PSS-14): Estudio Psicom\u00e9trico En Una Muestra VIH+. [Spanish Version of the Perceived Stress Scale (PSS-14): Psychometric Study in a HIV+ Sample.]","volume":"7","author":"Remor","year":"2001","journal-title":"Ansiedad Y Estr\u00e9s"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1017\/S1138741600006004","article-title":"Psychometric Properties of a European Spanish Version of the Perceived Stress Scale (PSS)","volume":"9","author":"Remor","year":"2006","journal-title":"Span. J. Psychol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1093\/ntr\/ntz132","article-title":"Biochemical Verification of Tobacco Use and Abstinence: 2019 Update","volume":"22","author":"Benowitz","year":"2020","journal-title":"Nicotine Tob. Res."},{"key":"ref_53","unstructured":"Beco\u00f1a, E. (2007). Programa Para Dejar de Fumar [Smoking Cessation Program], Nova Galicia Edicions."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"717","DOI":"10.3758\/BF03206553","article-title":"SPSS and SAS Procedures for Estimating Indirect Effects in Simple Mediation Models","volume":"36","author":"Preacher","year":"2004","journal-title":"Behav. Res. Methods Instrum. Comput."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"879","DOI":"10.3758\/BRM.40.3.879","article-title":"Asymptotic and Resampling Strategies for Assessing and Comparing Indirect Effects in Multiple Mediator Models","volume":"40","author":"Preacher","year":"2008","journal-title":"Behav. Res. Methods"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.cpr.2005.11.007","article-title":"Relapse to Smoking","volume":"26","author":"Piasecki","year":"2006","journal-title":"Clin. Psychol. Rev."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1080\/14622200110050466","article-title":"Temporal Analysis of the Relationship of Smoking Behavior and Urges to Mood States in Men versus Women","volume":"3","author":"Delfino","year":"2001","journal-title":"Nicotine Tob. Res"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1111\/j.1360-0443.2004.00995.x","article-title":"Outcome Criteria in Smoking Cessation Trials: Proposal for a Common Standard","volume":"100","author":"West","year":"2005","journal-title":"Addiction"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Nohlert, E., \u00d6hrvik, J., and Helgason, \u00c1.R. (2018). Self-Perceived Ability to Cope with Stress and Depressive Mood without Smoking Predicts Successful Smoking Cessation 12 Months Later in a Quitline Setting: A Secondary Analysis of a Randomized Trial. BMC Public Health, 18.","DOI":"10.1186\/s12889-018-5973-9"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"230","DOI":"10.3109\/00952990.2014.891038","article-title":"Negative Affect and Smoking Motives Sequentially Mediate the Effect of Panic Attacks on Tobacco-Relevant Processes","volume":"40","author":"Farris","year":"2014","journal-title":"Am. J. Drug Alcohol Abus."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"565","DOI":"10.3389\/fpsyt.2018.00565","article-title":"A Systematic Review of Psychosocial Barriers and Facilitators to Smoking Cessation in People Living with Schizophrenia","volume":"9","author":"Lum","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.schres.2010.10.030","article-title":"Smoking History and Motivation to Quit in Smokers with Schizophrenia in a Smoking Cessation Program","volume":"126","author":"Bennett","year":"2011","journal-title":"Schizophr. Res."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1257\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:05:53Z","timestamp":1760119553000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/2\/1257"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,10]]},"references-count":62,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["ijerph20021257"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20021257","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,10]]}}}