Abstract
Young adults engage in digital dating abuse (DDA), or threatening, monitoring, and controlling behavior towards a romantic partner through technology. Alcohol use and jealousy are well-established risk factors for in-person partner abuse but have not yet been investigated in couples in the context of DDA. Jealousy might be a relevant moderator in the digital context, potentially amplifying the negative associations between problematic alcohol use and DDA. Thus, we examine dyadic associations between young adults’ problematic alcohol use and DDA perpetration, with romantic jealousy as a moderator. Participants are young adult heterosexual couples (N = 91 couples, M age = 21.03 years, 54.4% White, 19.2% Latino, 26.3% other). Results from actor-partner interdependence models suggest that men’s jealousy significantly moderates both the actor effect for men and the partner effect for women. In contrast, women’s jealousy significantly moderates the partner effects for both men and women. Men’s problematic alcohol use is a risk factor for their own DDA perpetration at high levels of jealousy and is a risk factor for their partner’s DDA perpetration across their own or their partner’s jealousy. Women’s problematic alcohol use is a risk factor for their partner’s DDA perpetration across levels of their jealousy. These findings underscore the importance of considering individual and relational factors in understanding DDA. The study highlights the need for dyadic interventions targeting problematic alcohol use and jealousy to prevent DDA. Future research should utilize longitudinal designs and diary studies to investigate in-the-moment processes and within-person variability.
Introduction
Forming and maintaining healthy romantic relationships is a critical developmental task of young adulthood (Arnett, 2004). However, young adults experience negative relationship experiences, such as dating abuse, which peak during young adulthood (Johnson et al., 2015). Communication with romantic partners is increasingly digital, with 96% of young adults owning smartphones (Perrin, 2021). Although digital communication can promote relationship maintenance and intimacy (Kwok & Wescott, 2020), digital dating abuse (DDA) has also emerged (Zweig et al., 2013). DDA is the use of technology to engage in monitoring, controlling, intimidating, or coercive behaviors toward a romantic partner (Reed et al., 2017). DDA prevalence rates among young adults range from 40% to 80% (Li et al., 2023). Experiencing DDA may have harmful effects on mental health, including increased feelings of depression and anxiety (Cano-Gonzalez et al., 2022). Thus, understanding risk factors for DDA is pertinent.
Alcohol use is a well-established risk factor for young adult in-person partner abuse (Capaldi et al., 2012). Alcohol is the most common substance used by young adults; 83.5% of young adults in 2022 consumed alcohol (Patrick et al., 2023). Emerging research suggests that young adults’ problematic alcohol use is associated with increased DDA, but findings are mixed, with studies finding both significant and non-significant associations between problematic alcohol use and DDA (Brem et al., 2021; Watkins et al., 2018; Woerner et al., 2023). These mixed findings warrant further investigation of potential moderators. We propose that negative romantic jealousy may strengthen the association between problematic alcohol use and DDA, as it prompts controlling and possessive behaviors towards a romantic partner (Barelds & Barelds-Dijkstra, 2007). In addition, studies suggest that young adults report being both perpetrators and victims of DDA (Ellyson et al., 2021); dyadic studies are needed to better understand how DDA emerges within couples. Therefore, the current study investigated dyadic associations of problematic alcohol use and DDA perpetration and romantic jealousy as a moderator.
Digital dating abuse
DDA shares similarities to in-person psychological partner abuse, such as name-calling, yelling, manipulation, and partner control (Leadbeater et al., 2008). Further, DDA behaviors predict in-person partner abuse (Lu et al., 2021). However, DDA is a distinct form of partner abuse due to unique digital features, including constant access, asynchronicity, anonymity, and the absence of social and in-person cues (Stonard, 2020). These unique features facilitate DDA (Caridade et al., 2019). For example, whereas in-person partner abuse only occurs when the couple is physically together, DDA can happen at any time. Within the digital context, reduced inhibitions and increased confidence behind the screen make it easy to send abusive messages without face-to-face repercussions. Additionally, similar to in-person partner abuse, DDA is often bi-directional; multiple meta-analyses have found that both men and women are victims and perpetrators of DDA (Gilbar et al., 2023; Li et al., 2023). Thus, understanding dyadic risk factors of DDA is essential.
Problematic alcohol use as a dyadic risk factor for DDA
The dynamic developmental systems (DDS) approach theorizes that both partners’ behaviors are essential to consider in the emergence of in-person partner abuse (Capaldi et al., 2004, 2019). Dyadic research designs are critical because they allow researchers to account for interdependence between romantic partners and understand the nuanced, complex reality of romantic relationships and abuse (Bartholomew & Cobb, 2010). Problematic alcohol use behaviors (i.e., level of alcohol consumption and alcohol-related problems; Patrick et al., 2023) increase negative interactions, which can escalate into partner abuse. Indeed, a robust literature found that higher problematic alcohol use predicted more partner abuse (Capaldi et al., 2012; Shorey et al., 2015). In line with the DDS approach, dyadic associations between alcohol use and in-person partner abuse have been found, in which both men’s and women’s problematic alcohol use predicted their partner’s abuse perpetration (Dokkedahl & Elklit, 2019; Eckhardt et al., 2019; Leone et al., 2016). However, other studies have not found partner effects (O’Hair et al., 2023; Watkins et al., 2014). These studies suggest that alcohol’s effects are not isolated but interactive within couples and imply there may be other risk factors that moderate associations between problematic alcohol use and abusive behaviors.
A small amount of literature has investigated the associations between problematic alcohol use and DDA, with inconclusive results. While a recent meta-analysis concluded that DDA was strongly correlated with problematic alcohol use, results across studies are mixed (Crane et al., 2021). Cross-sectional research has found that young adults’ problematic alcohol use and frequent drinking are associated with higher DDA perpetration (Brem et al., 2021; Melander & Hughes, 2018; Watkins et al., 2018). Other studies have revealed nonsignificant effects of past-year problematic alcohol use on DDA perpetration one month later, as well as nonsignificant effects of daily alcohol use on same-day DDA perpetration (Brem et al., 2022; Woerner et al., 2023). However, none of these studies investigated the effects of problematic alcohol use on DDA dyadically. Additionally, more research is needed on moderators (Crane et al., 2021). For example, relationship quality has been found to be a moderator, such that when relationship quality is low, problematic alcohol use is strongly associated with higher DDA (Woerner et al., 2023). Thus, research is needed on dyadic patterns of problematic drinking and DDA perpetration, as well as potential moderators, to better understand when and how problematic alcohol use amplifies risk.
Jealousy as a moderator
Studies on in-person partner abuse have found that problematic alcohol use is positively related to partner abuse perpetration for individuals with high but not low romantic jealousy (Brem et al., 2018; Foran & O’Leary, 2008; Rodriguez et al., 2015). Moreover, there are essential differences in how romantic jealousy relates to partner abuse, depending on the dimension of jealousy. Positive jealousy, such as feelings of distress when imagining their partner in romantic relations with another, is protective against partner abuse perpetration; however, negative dimensions of jealousy, such as feelings of distrust and possessiveness, are associated with increased partner abuse perpetration (Rodriguez et al., 2015). Within a digital context, high romantic jealousy is a relevant context in which adolescents and young adults engage in DDA perpetration (Reed et al., 2021; Rodríguez-Domínguez et al., 2018). One study investigated romantic jealousy as a moderator, finding problematic alcohol use was positively associated with DDA for women and not for men with high romantic jealousy (Brem et al., 2021). Thus, we consider aspects of negative romantic relationship jealousy as a moderator in problematic alcohol use and DDA dyadically to better understand whether problematic alcohol use in one partner and negative romantic jealousy might escalate DDA perpetration in romantic relationships.
The current study
The current study examined dyadic associations between young adults’ problematic alcohol use and DDA perpetration, as well as romantic jealousy as a moderator, using an Actor-Partner Interdependence Model (APIM; Cook & Kenny, 2005). We predict actor effects, such that the actor’s problematic alcohol use will be associated with his or her own greater DDA perpetration. We also predict partner effects, such that one’s problematic alcohol use will be associated with their partners’ greater DDA perpetration. We predict that jealousy will moderate both actor effects. For example, for the women’s actor effect, we hypothesize that the association between women’s problematic alcohol use and their own DDA perpetration will be stronger when both partners have higher romantic jealousy. We also predict that jealousy will moderate both partner paths. For example, for the women’s partner effect, we hypothesize that the association between a woman’s problematic alcohol use and her partner’s DDA perpetration will be stronger when both partners have higher jealousy. We do not predict specific gender differences in these actor and partner effects. We will also control for whether the couple was living together.
Methods
Participants
The sample consisted of 96 young adult couples. Participants were required to be 18–30 years old and in a romantic relationship of at least three months. Our final sample included 91 heterosexual couples (N = 182 individuals); one couple was omitted due to ages outside the predefined range, two couples were omitted due to incomplete data, and two non-heterosexual couples were omitted due to planned analyses considering dyads distinguishable based on sex. Individuals were recruited from a southwestern public university through newsletters, presentations, and class credit. Participants could participate individually or with their partner. The current sample only includes those who participated with their partner. At least one partner had to be currently attending post-secondary school (e.g., university, community college). The mean age of participants was 21.03 years (SD = 2.12, range: 18–30 years), with most participants ages 19 – 23 (87.3%). For ethnic-racial composition, 99 (54.4%) identified as White, 35 (19.2%) as Hispanic/Latino, 30 (16.5%) as Asian, 8 (4.4%) as Black, 2 (1.1%) Native American, 1 (.5%) Pacific Islander, and 7 (3.8%) another race/ethnicity. The mean relationship length was 22.64 months (SD = 20.57; range = 3–108 months). The relationship statuses were as follows: 167 (91.8%) were dating the same person regularly, 8 (4.4%) were engaged, 4 (2.2%) were married, and 3 (1.6%) other. Additionally, 76.9% of the couples lived together.
Procedure
Approval was obtained from the Arizona State University Institutional Review Board (#00011349). Data collection took place in April and May 2020. Participants provided consent before completing an online survey with trained research assistants during a Zoom session. The survey included measures of romantic relationships, dating behaviors, and substance use. Couples could either join the same Zoom session as their partner or a separate session, depending on availability. If both members of a couple joined the same Zoom session, they were reminded to complete the survey separately. The average time to complete the online survey was 97 minutes (SD = 30.80). Research assistants were available to answer questions. Participants either received research credits or $30.
Measures
Problematic alcohol use
Problematic alcohol use was measured using the Alcohol Use Disorders Identification Test (AUDIT; Babor et al., 1992), which assesses three domains. The AUDIT utilizes different time frames to ask about the participants’ perception of their drinking globally. The AUDIT aims to understand risky, problematic alcohol use patterns. The first domain, alcohol consumption, is measured by two questions. Responses to the first question, “How often do you have a drink containing alcohol?” were scored from zero (Never) to 4 (4 or more times a week). The second question, “How many drinks containing alcohol do you have on a typical day when you are drinking?” was scored from zero (1 or 2 drinks) to 4 (10 or more drinks). Six questions measured the second domain, alcohol dependence. An example includes “How often during the last year have you found that you were not able to stop drinking once you had started?”. Responses were scored from zero (Never) to 4 (Daily). Lastly, two questions measured the third domain, the experience of alcohol-related harm. An example includes, “Has a relative, a friend, a doctor, or another health worker been concerned about your drinking or suggested you cut down?” scored as zero (No), 2 (Yes, but not in the last year), and 4 (Yes, during the last year). A sum score was created from all items, with higher values indicating higher problematic alcohol use (α = .83). The minimum score (for non-drinkers) is 0, and the maximum is 40. While the AUDIT can be used to make clinical diagnoses of alcohol use disorders, researchers also use the AUDIT as a continuous measure of problematic alcohol use (Watkins et al., 2014; Blow et al., 2013; Foran et al., 2012). The AUDIT has been widely used in young adult samples and has shown good psychometric properties in validation studies (García Carretero et al., 2016; Kokotailo et al., 2004).
Romantic jealousy
Jealousy within the relationship was measured using the 5-item possessive jealousy subscale from the Reactive, Anxious, and Possessive Jealousy Scale (Buunk, 1997). There is no timescale for this measure, and participants were prompted to consider the relationship with their current partner and mark the number that best reflects their opinion. An example item includes “It is difficult for me to give my partner enough space.” Responses ranged from 1 (does not apply to me) to 5 (applies to me very much). A mean score was calculated, with higher values indicating higher jealousy behaviors. The measure has been validated and used with older adults, but the scale showed adequate reliability within our young adult sample (α
Digital dating abuse
DDA was measured using the Cyber Aggression in Relationships Scale (CARS; Watkins et al., 2018). The CARS asks about behaviors in the past six months. The scale consists of 17 items asking how often individuals engage in (perpetration) and experience (victimization) DDA within their current romantic relationship. Subscales include psychological DDA (e.g., controlling and intimidating behaviors), sexual DDA (e.g., sexually coercive behaviors), and monitoring or tracking of their partner. Example items include “I/my partner sent threatening or harassing messages to me/my partner via text or social media,” and “I/my partner checked my/my partner’s phone to see whom I/he/she was talking to or texting without my/my partner’s permission.” Responses ranged from zero (this has never happened) to 6 (more than 20 times in the past six months). Mean scores were created for both perpetration and victimization, with higher scores reflecting a greater degree of DDA perpetration (α = .89) or victimization (α = .91). This scale was initially developed with a diverse age sample (18–81) and has been validated on a young adult sample (Nacar et al., 2021). DDA victimization was also evaluated as a sensitivity analysis (Appendix C).
Data analytic strategy
First, we conducted descriptive statistics and bivariate correlations to probe associations between DDA perpetration, problematic alcohol use, and romantic jealousy. Then, we conducted a distinguishability test constraining means, variances, and inter- and intra-individual correlations to be equal for men and women. The constrained model fit significantly differently from a model that allowed parameters to be freely estimated (χ2 (12) = 27.419, p = .007), suggesting the dyads are distinguishable based on sex. For distinguishable dyads, nonindependence is measured using Pearson’s product moment correlation for men and women’s DDA perpetration, both partialling out sex and not. The correlation between men’s DDA and women’s DDA was large (r = 0.602). The correlation partialling out sex was also large (rp = .589), indicating nonindependence.
Next, we fit two APIMs, estimated with distinguishable dyads, using a structural equation modeling (SEM) framework. The first APIM assessed actor and partner effects between problematic alcohol use and DDA perpetration; the second APIM included romantic jealousy as the moderator for all paths as well as directly predicting DDA perpetration. Both models included the couple’s cohabitation status as a dyad-level covariate (0 = couple not living together). Two moderated models were initially assessed: one with the moderators on all paths, and one with the moderators only for significant actor and partner paths from the first APIM. While model fit indices suggested that both models fit the data well, AIC and sample-size adjusted BIC values favored the “all paths moderated” model. Thus, the saturated moderation model was retained.
For significant interactions, we constructed Johnson-Neyman plots (Johnson & Fay, 1950; Preacher et al., 2006) to probe the interaction by evaluating for which values of romantic jealousy the relationship between problematic alcohol use and DDA perpetration were statistically significant. Both models were fit using Mplus version 8.8 (Muthén & Muthén, 1998–2018). Because both models were fully saturated, model fit statistics are not presented. In the first APIM, problematic alcohol use was grand mean centered, and the results were standardized by both predictor and outcome standard deviation in Mplus. For the second APIM, all variables were standardized to have a mean of zero and variance of 1 prior to being used in the model. As such, results were standardized by both outcome and predictor(s). A post-hoc power analysis via a Monte-Carlo simulation with 500 replications was conducted and suggested sufficient power to detect significant direct and actor effects with estimates ranging between 78% and 100%. The power to detect moderation ranged from 97.6% to 100%. A full breakdown of power analysis results can be found in Appendix A.
Results
Descriptives and Correlations.
APIM results without moderation
Results for the first APIM are visualized in Figure 1. See Appendix B for results in table format. Without considering romantic jealousy, a significant actor effect for women was found (b = 0.26, p = .012), as well as a significant partner effect (b = 0.29, p = .007). The actor and partner effects for men’s DDA perpetration were non-significant. For women, around 22% of the variance in their DDA perpetration is explained by their own and their partner’s problematic alcohol use. For men, only around 8% of the variance in their DDA perpetration is explained by their own and their partner’s problematic alcohol use. Path diagram for APIM results, without moderation. Note. Dashed line indicates non-significant path. *p < .05; **p < .01.
APIM results with moderation
Overview and main effects of romantic jealousy
Results for the second APIM with the jealousy moderator included are visualized in a path diagram in Figure 2. The explained variance in DDA perpetration increased to 55% for men and 63% for women. The effect of living together was statistically significant for men such that their DDA perpetration was lower on average compared to couples who did not live together (b = −0.36, p = .039). The results for the effects of romantic jealousy on DDA revealed men’s jealousy is related to both men’s DDA perpetration (see Path B; b = 0.50, p < .001) and women’s DDA perpetration (see Path D; b = 0.18, p = .010). Women’s romantic jealousy was not significantly related to either men’s or women’s DDA perpetration. Path diagram for moderated APIM results. Note. Dashed line indicates non-significant path. *p < .05; **p < .01.
Actor effects
The actor effect for women was statistically significant, indicating, on average, women’s problematic alcohol use is related to their greater DDA perpetration (b = 0.19, p = .025). This relationship was not significantly moderated by men’s or women’s romantic jealousy. The actor effect for men was non-significant, indicating that conditional on problematic alcohol use, whether they lived together, and romantic jealousy at their average, men’s problematic alcohol use is unrelated to men’s DDA perpetration. However, we found an actor-moderated actor effect for men (see Path A, b = 0.32, p = .001), indicating the relationship between men’s problematic alcohol use and their own DDA perpetration varied across levels of their jealousy such that men with higher jealousy had a more positive relationship between problematic alcohol use and DDA perpetration. Johnson-Neyman analyses (Appendix C) show that the relationship between men’s problematic alcohol use and their own DDA perpetration was negative and statistically significant when men’s jealousy values were −1.15 and lower and were positive and statistically significant when men’s jealousy values were 0.40 or higher.
Partner effects
Finally, both partner effects were nonsignificant, indicating conditional on problematic alcohol use and jealousy variables at their average, men’s and women’s problematic alcohol use is unrelated to their partner’s DDA perpetration. Both paths, however, were moderated by one or both partner’s romantic jealousy. First, the partner effect of women’s problematic alcohol use on men’s DDA perpetration was significantly moderated by women’s romantic jealousy (i.e., partner-moderated partner effect for men; Path E, b = 0.23, p = .008). Johnson-Neyman analyses show women’s problematic alcohol use had a positive relationship with their partner’s DDA perpetration for those whose jealousy levels are 1.10 and higher and a negative relationship for those whose jealousy levels are −1.10 and lower.
The partner effect of men’s problematic alcohol use on women’s DDA perpetration was significantly moderated by both women’s romantic jealousy (actor-moderated partner effect for women; see Path F, b = 0.21, p = .004) and men’s romantic jealousy (a partner-moderated partner effect for women; see Path C, b = 0.35, p < .001). Johnson-Neyman analyses show men’s problematic alcohol use had a positive relationship with their partner’s DDA perpetration for those whose jealousy levels are 0.95 and higher and a negative relationship for those whose jealousy levels are −1.45 and lower. Johnson-Neyman analyses for the men’s romantic jealousy moderation effect shows men’s problematic alcohol use had a positive relationship with their partner’s DDA perpetration for those whose jealousy levels are 0.50 and higher, and a negative relationship for those with jealousy levels of −0.70 and lower.
Discussion
The current study examined associations between young adult problematic alcohol use and DDA perpetration, with a focus on whether romantic jealousy moderated these associations within couples, controlling for cohabitation status. For women, problematic alcohol use was associated with their own increased DDA perpetration but not with men’s. Men’s problematic alcohol use was not associated with their own DDA perpetration, but it was significantly associated with women’s increased DDA perpetration. Thus, our hypotheses on main effects were partially supported. In investigating romantic jealousy as a moderator of the association between problematic alcohol use and DDA perpetration, our hypotheses were also partially supported. First, for actor effects, we found that for women, the relationship between their problematic alcohol use and increased DDA perpetration was not moderated by their own nor their partner’s romantic jealousy. However, men's higher romantic jealousy amplified the association between men's problematic alcohol use and their DDA perpetration, but lower jealousy mitigated this association. Next, for partner effects, women's high romantic jealousy amplified the association between their problematic alcohol use and men’s DDA perpetration, but lower romantic jealousy mitigated this association. Lastly, women’s and men’s high romantic jealousy amplified the risk of men’s problematic alcohol use and increased women’s DDA perpetration, but low levels of men’s and women’s jealousy mitigated this association.
Overall, our results emphasize the importance of a dyadic approach to fully capture the nuances and interdependence of risk within romantic relationships. Specifically, for men’s DDA perpetration risk, problematic alcohol use alone is not a robust risk factor, but this risk increases with high levels of their romantic jealousy. Women’s problematic alcohol use, combined with high romantic jealousy, also poses a risk for men’s DDA perpetration. For women’s DDA perpetration risk, their problematic alcohol use is strongly associated with their own DDA perpetration, as well as their partner’s problematic alcohol use, which is further amplified by both partners’ high romantic jealousy. Lower romantic jealousy mitigates these associations across all significant moderations, suggesting it could be a protective factor and a focus for future prevention and intervention strategies.
This study extends previous findings and aligns with previous research indicating that alcohol problems are linked to in-person and digital partner abuse in the context of romantic jealousy (Brem et al., 2018, 2021; Rodriguez et al., 2015). They also support previous research on the dyadic role of problematic alcohol use and in-person partner abuse perpetration while extending the research to DDA perpetration (Low et al., 2017; Watkins et al., 2018). While further research is needed to elucidate and replicate these effects, our study contributes to the literature by highlighting the complex interdependencies between problematic alcohol use, romantic jealousy, and DDA perpetration within young adult couples.
Strengths and limitations
The current study has several strengths, such as the inclusion of both romantic partners in the models, controlling for cohabitation status, diversity in terms of race/ethnicity, and the inclusion of romantic jealousy as a moderator to understand the nuances of DDA perpetration. However, several limitations should be noted. First, measurements of study variables were completed concurrently and on different timescales, prohibiting conclusions about temporal order. We also note the limitations of moderation analyses, as our data may not represent the range and averages of possible scores that might exist in the population. Next, research studying proximal effects and applying proximal theories, such as Finkel and Eckhardt’s (2013) I3 theory, is important, as there may be differences in how jealousy interacts with problematic alcohol use in different contexts. Additionally, the findings from this study should not be assumed to be generalizable to sexual and gender minority couples. Further, self-report surveys may have also introduced bias, as young adults may not accurately report their behaviors (Wincentak et al., 2017). Participants also completed the surveys on Zoom; thus, we could not confirm that couples were physically separate. This study was conducted during the COVID-19 pandemic, which may have impacted alcohol use (Horigian et al., 2021) and digital communication with romantic partners due to social distancing. Future research should also aim to include a larger sample size. Although we conducted a post-hoc power analysis and concluded we had sufficient power, future work could re-examine effects with a larger sample to assess if they replicate in terms of significance, direction, and strength.
Clinical and policy recommendations
The findings from this study highlight clinical and policy implications. Managing jealousy and improving digital communication skills to mitigate DDA, as well as assisting in understanding how alcohol use may impact digitally abusive behaviors, could be added to couples’ therapy (McCollum et al., 2011) and existing educational programs for college students (Crooks et al., 2019).
Conclusion
This study contributes to the growing literature on DDA among young adult couples by using a dyadic design and investigating the moderating role of romantic jealousy. Problematic alcohol use is a key risk factor for women’s DDA perpetration, both their own problematic alcohol use and when their partner has high problematic alcohol use and romantic jealousy. For men, problematic alcohol use alone is not a risk factor for DDA perpetration, but it becomes significant when combined with high levels of their own or their partner’s romantic jealousy. We highlight the importance of studying both the digital and physical contexts and recognizing the interdependence of online and in-person behaviors.
Supplemental Material
Supplemental Material - Problematic alcohol use, jealousy, and digital dating abuse: A dyadic analysis
Supplemental Material for Problematic alcohol use, jealousy, and digital dating abuse: A dyadic analysis by Olivia Maras, Andrea Savord, Thao Ha, and Selena I. Quiroz in Journal of Social and Personal Relationships
Footnotes
Acknowledgements
The authors thank the participating youth, staff and research assistants who assisted in this study.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Research reported in this publication was supported by the Arizona State University Department of Psychology, through the Developmental Psychology Small Catalyst Grant, awarded to S. Quiroz and funds of T. Ha.
Open research statement
As part of IARR’s encouragement of open research practices, the author(s) have provided the following information: This research was not pre-registered. The data used in the research cannot be publicly shared but are available upon request. The data can be obtained via email, by emailing
Ethical statement
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References
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