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Dogbe W, Akaichi F, Rungapamestry V, Revoredo-Giha C. Effectiveness of implemented global dietary interventions: a scoping review of fiscal policies. BMC Public Health 2024; 24:2552. [PMID: 39300446 DOI: 10.1186/s12889-024-19988-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 09/04/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Although the World Health Organisation (WHO) has proposed the use of fiscal policies to mitigate consumption externalities such as overweight and obesity-related diseases, very little is known about the impacts of the different types and framing of national and/or regional fiscal policies that have been implemented over the years. There is the need to provide up-to-date evidence on the impact of fiscal policies that have been enacted and implemented across the globe. METHODS We conducted a scoping review of all implemented government fiscal policies in the food and drinks sector to identify the different types of fiscal policies that exist and the scope of their impact on consumers as well as the food environment. Electronic databases such as the Web of Science and Google Scholar were used to search for appropriate literature on the topic. A total of 4,191 articles were retrieved and 127 were synthesized and charted for emerging themes. RESULTS The results from this review were synthesized in MS Excel following Arksey & O'Malley (2005). Emerging themes were identified across different countries/settings for synthesis. The results confirms that fiscal policies improve consumers' health; increase the prices of foods that are high in fats, sugar, and salt; increase government revenue; and shift consumption and purchases towards healthier and untaxed foods. CONCLUSION Governments already have the optimum tool required to effect changes in consumer behaviour and the food environment.
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Affiliation(s)
- Wisdom Dogbe
- The Rowett Institute, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Faical Akaichi
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
| | | | - Cesar Revoredo-Giha
- Scotland's Rural College (SRUC), Peter Wilson Building, King's Buildings, West Mains Road, Edinburgh, EH9 3JG, UK
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Rostami M, Babashahi M, Ramezani S, Dastgerdizad H. A scoping review of policies related to reducing energy drink consumption in children. BMC Public Health 2024; 24:2308. [PMID: 39187818 PMCID: PMC11346296 DOI: 10.1186/s12889-024-19724-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 08/08/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND Frequent consumption of Energy Drinks (EDs) is associated with numerous health problems, including overweight and obesity, particularly among children and adolescents. The extensive promotion, wide accessibility, and relatively low cost of EDs have significantly increased their popularity among this age group. This paper examines policies/programs that, directly and indirectly, contribute to reducing ED consumption in children and adolescents and shares global experiences to help policymakers adopt evidence-based policies. METHODS A systematic search was performed using PubMed, Scopus, and Web of Science databases from January 2000 to June 2024, along with reputable international organization websites, to find literature on policies aimed at reducing ED consumption among children and adolescents. All sources meeting the inclusion criteria were included without restrictions. Titles and abstracts were initially screened, followed by a full-text review. After evaluating the quality of the selected studies, data were extracted and, along with information from the selected documents, compiled into a table, detailing the country, policy type, and the effectiveness and weaknesses of each policy. RESULTS Out of 12166 reviewed studies and documents, 84 studies and 70 documents met the inclusion criteria. 73 countries and territories have implemented policies like taxation, sales bans, school bans, labeling, and marketing restrictions on EDs. Most employ fiscal measures, reducing consumption despite enforcement challenges. Labeling, access restrictions, and marketing bans are common but face issues like black markets. CONCLUSION This scoping review outlines diverse strategies adopted by countries to reduce ED consumption among children and teenagers, such as taxation, school bans, sales restrictions, and labeling requirements. While heightened awareness of ED harms has reinforced policy efforts, many Asian and African nations lack such measures, some policies remain outdated for over a decade, and existing policies face several challenges. These challenges encompass industry resistance, governmental disagreements, public opposition, economic considerations, and the intricacies of policy design. Considering this, countries should tailor policies to their cultural and social contexts, taking into account each policy's strengths and weaknesses to avoid loopholes. Inter-sectoral cooperation, ongoing policy monitoring, updates, and public education campaigns are essential to raise awareness and ensure effective implementation.
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Affiliation(s)
- Mohammadhassan Rostami
- Student Research Committee, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Babashahi
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shaghayegh Ramezani
- Department of Community Nutrition, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadis Dastgerdizad
- Department of Public Health, University of South Carolina, Bluffton, SC, 29909, USA
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Chatelan A, Rouche M, Kelly C, Fismen AS, Pedroni C, Desbouys L, Castetbon K. Tax on sugary drinks and trends in daily soda consumption by family affluence: an international repeated cross-sectional survey among European adolescents. Am J Clin Nutr 2023; 117:576-585. [PMID: 36775689 DOI: 10.1016/j.ajcnut.2023.01.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The WHO recommends soda taxes to reduce sugar consumption, but the effect across socioeconomic groups is unclear. OBJECTIVES We assessed 16-y trends in daily soda consumption among adolescents in 4 European countries with a soda tax and 5 comparison countries, by family affluence. METHODS Five rounds of the international "Health Behaviour in School-Aged Children" school-based survey were used (school years 2001/2002 to 2017/2018, repeated cross-sectional design). Finland, France, Belgium, and Portugal introduced or updated a soda tax during this period. For comparison, we selected 5 neighboring countries without such a tax. Nationally representative samples of adolescents aged 13 and 15 y (n = 165,521; 51.2% girls) completed a standardized questionnaire, including a question on soda consumption frequency. Using the family affluence scale (FAS), we categorized adolescents into lower-, middle- or higher-affluent groups. Changes in daily soda consumption were assessed in each country independently. RESULTS Before taxation, daily soda consumption was more likely among lower-affluent adolescents in France and Belgium (P < 0.001, socioeconomic inequalities) and was similar across FAS groups in Finland and Portugal (no inequalities). After the tax, daily soda consumption was reduced across all FAS groups in Finland, Belgium, and Portugal (Pinteractions ≥ 0.33). In France, a posttax decrease was observed only among lower-affluent adolescents (ORlower, 0.76; 95% CI: 0.60, 0.96; reduced inequalities). During the same periods, socioeconomic patterns remained stable in 3 comparison countries (Pinteractions ≥ 0.38), and larger reductions in daily soda consumption were observed among middle- or higher-affluent adolescents compared with lower-affluent adolescents in the remaining 2 comparison countries (Pinteractions ≤ 0.08, increased inequalities). CONCLUSIONS Socioeconomic patterns did not change after the tax implementation in 3 out of 4 countries, and socioeconomic inequalities were reduced in France. Taxing sodas might be an effective measure to attenuate, or at least not exacerbate, socioeconomic inequalities in adolescent daily soda consumption. Am J Clin Nutr 20XX;xx:xx-xx.
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Affiliation(s)
- Angeline Chatelan
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium; Department of Nutrition and Dietetics, Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Geneva, Switzerland.
| | - Manon Rouche
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - Anne-Siri Fismen
- Department of Health Promotion and Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Bergen, Norway
| | - Camille Pedroni
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Lucille Desbouys
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Katia Castetbon
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
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Hammaker J, Anda D, Kozakiewicz T, Bachina V, Berretta M, Shisler S, Lane C. Systematic review on fiscal policy interventions in nutrition. Front Nutr 2022; 9:967494. [PMID: 36532551 PMCID: PMC9756132 DOI: 10.3389/fnut.2022.967494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/31/2022] [Indexed: 05/04/2024] Open
Abstract
Introduction Both the World Health Organization and the Lancet Series on Adolescent nutrition recommend that governments adopt fiscal policies to combat diet-related non-communicable diseases (NCDs). However, rigorous, systematic evidence regarding the effects of these interventions is lacking. Methods We synthesize the available evidence regarding the impacts of taxes and subsidies that directly affect consumer prices on availability and accessibility of foods and beverages, purchasing behavior, diet quality, health and well-being outcomes as well as considerations for implementation, sustainability and equity. Results Our initial search returned 2,113 de-duplicated studies, and ultimately 24 impact evaluations and two systematic reviews met final eligibility criteria and represented unique evaluations. Our meta-analysis of these studies suggests that taxes may decrease purchases of taxed beverages (SMD = -0.14 [95% CI: -0.29 to -0.07], n = 15). Results should be interpreted cautiously due to considerable heterogeneity (Q(14) = 335.19, p = 0.01,τ ^ 2 = 0.03 , I 2 = 95.82%). Discussion The evidence base is too limited to draw conclusions about the effects of taxes on beverages and calorie-dense foods on purchases, or on the effects of subsidies on purchasing or diet quality. Overall, the evidence base is inconclusive on whether fiscal policies can meaningfully influence the availability and accessibility of foods and beverages, diet quality, and health outcomes. Policymakers implementing fiscal policies should consider information campaigns on health benefits and health risks associated with certain food and beverage consumption. For taxes, exposure to health information may amplify signaling effects of taxes and reduce avoidance behaviors, such as cross-border shopping. Future evaluations should diversify data sources to better understand impacts on diet and health outcomes.
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Affiliation(s)
| | | | | | | | | | | | - Charlotte Lane
- International Initiative for Impact Evaluation (3ie), Washington, DC, United States
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Stadelmaier J, Rehfuess EA, Forberger S, Eisele-Metzger A, Nagavci B, Schünemann HJ, Meerpohl JJ, Schwingshackl L. Using GRADE Evidence to Decision frameworks to support the process of health policy-making: an example application regarding taxation of sugar-sweetened beverages. Eur J Public Health 2022; 32:iv92-iv100. [PMID: 36444109 PMCID: PMC9706117 DOI: 10.1093/eurpub/ckac077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks are well-known tools that enable guideline panels to structure the process of developing recommendations and making decisions in healthcare and public health. To date, they have not regularly been used for health policy-making. This article aims to illustrate the application of the GRADE EtD frameworks in the process of nutrition-related policy-making for a European country. METHODS Based on methodological guidance by the GRADE Working Group and the findings of our recently published scoping review, we illustrate the process of moving from evidence to recommendations, by applying the EtD frameworks to a fictitious example. Sugar-sweetened beverage (SSB) taxation based on energy density was chosen as an example application. RESULTS A fictitious guideline panel was convened by a national nutrition association to develop a population-level recommendation on SSB taxation aiming to reduce the burden of overweight and obesity. Exemplary evidence was summarized for each EtD criterion and conclusions were drawn based on all judgements made in relation to each criterion. As a result of the high priority to reduce the burden of obesity and because of the moderate desirable effects on health outcomes, but considering scarce or varying research evidence for other EtD criteria, the panel made a conditional recommendation for SSB taxation. Decision-makers may opt for conducting a pilot study prior to implementing the policy on a national level. CONCLUSIONS GRADE EtD frameworks can be used by guideline panels to make the process of developing recommendations in the field of health policy more systematic, transparent and comprehensible.
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Affiliation(s)
- Julia Stadelmaier
- Correspondence: Julia Stadelmaier, Institute for Evidence in Medicine, Breisacher Strasse 86, 79110 Freiburg, Germany, Tel: +49 (0)761 203 679 57, e-mail:
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany,Pettenkofer School of Public Health, Munich, Germany
| | - Sarah Forberger
- Department of Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Angelika Eisele-Metzger
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Blin Nagavci
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada,Department of Medicine, McMaster University, Hamilton, Canada
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany,Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Chatelan A, Rouche M, Dzielska A, Fismen AS, Kelly C, Pedroni C, Desbouys L, Castetbon K. Sixteen-year trends in adolescent consumption of sugar-sweetened soda in six European countries with a soda tax and comparison countries: a repeated cross-sectional survey analysis. Public Health Nutr 2022; 26:1-12. [PMID: 36321519 PMCID: PMC9989715 DOI: 10.1017/s1368980022002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/27/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine changes in the proportions of daily, weekly and occasional consumers of sugar-sweetened soda in six European countries that introduced/updated a tax between 2001-2002 and 2017-2018 and in neighbouring comparison countries (without a tax). DESIGN Repeated cross-sectional surveys. SETTING Health Behaviour in School-aged Children study, spanning five survey years (school years 2001-2002 to 2017-2018). PARTICIPANTS Nationally representative samples of 13-year- and 15-year-old adolescents (n 236 623, 51·0 % girls). RESULTS Tax sizes (€0·02/l to €0·22/l) and pre-tax soda consumption were heterogeneous across countries. Prevalence of daily soda consumption reduced in the survey year following tax implementation in Latvia (from 17·9 to 11·9 %, P = 0·01), Finland (4·2 to 2·5 %, P = 0·001), Belgium (35·1 to 27·8 %, P < 0·001) and Portugal (17·4 to 14·9 %, P = 0·02), but not in Hungary (29·8 to 31·3 %, P = 0·47) or France (29·4 to 28·2 %, P = 0·27). However, reductions were similar (Finland) or smaller (Belgium, Portugal) than those in the comparison countries, except in Latvia where the reduction was larger (Pinteraction < 0·001). Prevalence of weekly soda consumption remained stable (Finland, Hungary and France) or increased (Latvia, Belgium); only Portugal experienced a decline (P < 0·001), which was larger than in the comparison country (Pinteraction < 0·001). Prevalence of occasional soda consumption (<1x/week) did not rise after implementation of the tax in Latvia, Finland, Hungary, France or Belgium, or the rise was similar to the comparison country in Portugal (Pinteraction = 0·15). CONCLUSIONS Countries with a soda tax did not experience larger beneficial changes in post-tax adolescent consumption frequency of soda than comparison countries. Further studies, with different taxation types, are needed in the adolescent population.
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Affiliation(s)
- Angeline Chatelan
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
- School of Public Health, Université libre de Bruxelles, Brussels, Belgium
| | - Manon Rouche
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
| | - Anna Dzielska
- Department of Child and Adolescent Health, Institute of Mother and Child, Warsaw, Poland
| | - Anne-Siri Fismen
- Department of Health Promotion, Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Bergen, Norway
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Galway, Ireland
| | - Camille Pedroni
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
| | - Lucille Desbouys
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
| | - Katia Castetbon
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Av. des Caroubiers 25, 1227 Carouge, Geneva, Switzerland
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Piekara A. Sugar Tax or What? The Perspective and Preferences of Consumers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12536. [PMID: 36231840 PMCID: PMC9566220 DOI: 10.3390/ijerph191912536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/18/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Reducing high-calorie food and beverages consumption is a multi-dimensional challenge spanning agriculture to food marketing. Adverse health effects resulting from sugar-sweetened beverages such as obesity, diabetes, cardiovascular disease or dental carries have been described on numerous occasions. Poland is one of the countries that have introduced the sugar tax. The study aims to understand the degree of consumers' awareness of the upcoming changes and their opinions and assessments of the efficiency of various activities. The study was based on Computer-Assisted Web Interview (CAWI). The sample comprised 500 adult consumers. Most of the respondents (69.6%) are aware that a new charge for sweetened beverages is going to be introduced, and for 78.9% of the respondents, it is important to take action aimed at reducing the consumption of sweetened beverages by consumers. Well-educated respondents as well as women perceive a greater degree of need to take specific action within the area of health policy (p-value 0.010 and 0.000 respectively). The sugar tax is considered an effective tool for limiting the purchase of sweetened products. Other types of activities within the framework of preventative healthcare that aim to reduce the consumption of sugar by society should also be developed.
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Affiliation(s)
- Agnieszka Piekara
- Department of Bioprocess Engineering, Wroclaw University of Economics and Business, Komandorska 118-120, 53-345 Wrocław, Poland
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Sugar-sweetened beverages, effects on appetite and public health strategies to reduce the consumption among children: a review. Porto Biomed J 2022; 7:e172. [PMID: 35146179 PMCID: PMC8824388 DOI: 10.1097/j.pbj.0000000000000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022] Open
Abstract
Sugar-sweetened beverages (SSBs) consumption have been of public health concern and a target of interventions due to their high consumption and burden in health-related consequences, particularly in children and adolescents. SSBs provide high energy intake with low nutritional value and are a major contributor for added and free sugars intake of Portuguese in all age-groups, especially adolescents. Despite its recognized effect on weight gain, it might also disrupt appetite regulation. Research on the effect of SSBs on appetitive traits is still scarce and unclear, and the current knowledge of these potential effects will be discussed in this review. This review also aims to describe public health strategies implemented to decrease SSBs consumption among children, particularly in Portugal, such as: (i) implemented taxation measures and its impact in sales and in preventable cases of disease and death, (ii) marketing regulations applied to children and adolescents, and ultimately (iii) the intention of application of a single Front-of-Package labeling system in all countries, aiming to increase consumers’ food literacy.
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Barker AR, Mazzucca S, An R. The Impact of Sugar-Sweetened Beverage Taxes by Household Income: A Multi-City Comparison of Nielsen Purchasing Data. Nutrients 2022; 14:922. [PMID: 35267897 PMCID: PMC8912695 DOI: 10.3390/nu14050922] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 12/04/2022] Open
Abstract
Due to the role that sugar-sweetened beverages (SSBs) play in the obesity epidemic, SSB taxes have been enacted in the United States in the California cities of Albany, Berkeley, Oakland, and San Francisco, as well as in Boulder, Philadelphia, and Seattle. We pooled five years of Nielsen Consumer Panel and Retail Scanner Data (2014-18) to examine purchasing behaviors in and around these cities that have instituted SSB taxes. We included households that were either subject to the tax during the study period or were in surrounding areas within the same state. The goal was to test for the differential impact of SSB taxes by income level and type of tax. Multivariate analyses of beverage purchases found that (1) there is a dose-response relationship with the size of the SSB tax; (2) the Philadelphia tax, which is the only one that includes low-calorie beverages, is associated with greater reductions in SSB purchases and an increase in bottled water purchase; and (3) approximately 72% of the tax is passed through to consumers, but this does not vary by income level of the household. Few income-related effects were detected. Overall, our findings suggest that the Philadelphia model may be the most effective at encouraging healthy habits in beverage choice.
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Affiliation(s)
| | | | - Ruopeng An
- Brown School, Washington University, St. Louis, MO 63130, USA; (A.R.B.); (S.M.)
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Nayak U, Nayak P, Akondi B. Sugar tax and its implications on health. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2022. [DOI: 10.4103/ajprhc.ajprhc_106_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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