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293
BoneJK, etal. J Epidemiol Community Health 2023;77:293–297. doi:10.1136/jech-2022-219653
Short report
Creative leisure activities, mental health and well-
being during 5 months of the COVID- 19 pandemic: a
fixed effects analysis of data from 3725 USadults
Jessica K Bone ,1 Daisy Fancourt ,1 Jill K Sonke,2 Meg E Fluharty ,1
Randy Cohen,3 Jenny B Lee ,2 Anthony J Kolenic,2 Heidi Radunovich ,4
Feifei Bu 1
To cite: BoneJK, FancourtD,
SonkeJK, etal. J Epidemiol
Community Health
2023;77:293–297.
►Additional supplemental
material is published online
only. To view, please visit
the journal online (http:// dx.
doi. org/ 10. 1136/ jech- 2022-
219653).
1Research Department of
Behavioural Science and Health,
Institute of Epidemiology &
Health Care, University College
London, London, UK
2Center for Arts in Medicine,
University of Florida, Gainesville,
Florida, USA
3Americans for the Arts,
Washington DC, Washington,
USA
4Family, Youth and Community
Sciences, University of Florida,
Gainesville, Florida, USA
Correspondence to
Dr Jessica K Bone, Research
Department of Behavioural
Science and Health, University
College London, London, WC1E
6BT, UK; jessica. bone@ ucl. ac. uk
Received 5 August 2022
Accepted 3 January 2023
Published Online First
27February2023
© Author(s) (or their
employer(s)) 2023. Re- use
permitted under CC BY.
Published by BMJ.
ABSTRACT
Introduction We investigated whether changes in
engagement in home- based creative activities were
associated with changes in depressive symptoms, anxiety
symptoms and life satisfaction during the COVID- 19
pandemic, aiming to replicate findings from the UK in a
USA sample.
Methods 3725 adults were included from the
COVID- 19 Social Study in the USA, a panel study
collecting data weekly during the COVID- 19 pandemic.
We measured engagement in eight types of creative
leisure activities on the previous weekday between April
and September 2020. Data were analysed using fixed
effects regression models.
Results Increased time spent gardening was associated
with reductions in depressive and anxiety symptoms and
enhanced life satisfaction. Spending more time doing
woodwork/DIY and arts/crafts were also associated
with enhanced life satisfaction. However, more time
watching television, films or other similar media (not for
information on COVID- 19) was associated with increased
depressive symptoms. Other creative activities were not
associated with mental health or well- being.
Conclusion Some findings differ from evidence
obtained in the UK, demonstrating the importance of
replicating research across countries. Our findings should
also be considered when formulating guidelines for
future stay- at- home directives, enabling individuals to
stay well despite the closure of public resources.
INTRODUCTION
Given the widespread stay- at- home orders during
the COVID- 19 pandemic, identifying activities
that people engaged in at home and that helped
to support their mental health and well- being is a
key priority.1 In the UK, spending more time doing
outdoor activities (eg, gardening, exercising), as
well as creative hobbies (eg, painting, digital arts),
was associated with improvements in depression,
anxiety and life satisfaction.2 However, it is unclear
whether these findings from the UK will generalise
to the USA. The USA differs from the UK in terms
of social, cultural and demographic context, the
inconsistent COVID- 19 restrictions across states
in the country, and varying job subsidy schemes for
cultural workers during the pandemic.
In the USA, cross- sectional studies have found
that self- reported decreases in leisure activities,
compared with before the pandemic, were associ-
ated with higher depressive symptoms and lower
well- being.3 Some older adults also reported doing
hobbies and other creative activities, such as cooking
and baking, listening to music and reading to help
them cope during the pandemic.4 Elsewhere, also
in cross- sectional surveys, people have reported
increases in creativity during the pandemic,5–8 with
increased time spent on creative activities such as
crafts, fine arts, music and performing arts all associ-
ated with enhanced well- being.6 In correlation anal-
yses of another cross- sectional survey of Australian
adults, more time spent on artistic creative activities
was correlated with lower anxiety and depressive
symptoms and less loneliness.9 However, the longi-
tudinal associations between creative leisure activ-
ities and mental health and well- being during the
pandemic outside of the UK remain unclear.
Therefore, in this study, we aimed to replicate find-
ings from the UK in a USA sample, with a focus on
creative activities. There is extensive prepandemic
longitudinal evidence that creative activities are benefi-
cial for mental and physical health.10 As opportunities
for engaging in creative activities changed dramatically
WHAT IS ALREADY KNOWN ON THIS TOPIC
⇒During the COVID- 19 pandemic in the UK,
spending more time doing outdoor activities
and creative hobbies was associated with
improvements in depression, anxiety and life
satisfaction.
WHAT THIS STUDY ADDS
⇒In the US, increases in time spent doing
gardening, woodwork and DIY, and arts and
crafts were longitudinally associated with
improvements in mental health and wellbeing
during the COVID- 19 pandemic.
HOW THIS STUDY MIGHT AFFECT RESEARCH,
PRACTICE AND/OR POLICY
⇒Our findings demonstrate the importance of
replicating research across countries, exploring
how cultural or contextual nuances affect the
associations between creative engagement and
health outcomes. Future guidelines for stay-
at- home directives should consider the role of
creative leisure activities.
on July 4, 2023 by guest. Protected by copyright.http://jech.bmj.com/J Epidemiol Community Health: first published as 10.1136/jech-2022-219653 on 27 February 2023. Downloaded from
294 BoneJK, etal. J Epidemiol Community Health 2023;77:293–297. doi:10.1136/jech-2022-219653
Short report
with the onset of the pandemic,11 12 this may have limited their
benefits. We, therefore, examined whether changes in engagement
in home- based creative leisure activities were longitudinally asso-
ciated with mental health and well- being during the COVID- 19
pandemic in the USA.
METHODS
Sample
This panel study was a USA extension of the UK COVID- 19
Social Study run by UCL (https://github.com/UCL-BSH/CSSUser-
Guide; online supplemental file 1). Adults in the USA completed
an online survey weekly between April and September 2020 for a
maximum of 12 waves. A heterogeneous sample was recruited using
a snowballing approach with a focus on reaching diverse popula-
tions. National social, health and arts organisations and networks
shared the study invitation through email lists and social media. We
included a total of 3725 participants (22 190 observations; observa-
tions per person: mean=6, median=5, ranging from 2 to 12). More
information on sample selection is available in online supplemental
file 1.
Measures
Leisure activities
Participants reported how long they had spent on the last
weekday engaging in (1) reading for pleasure, (2) arts/crafts
activities (eg, painting, creative writing, sewing, playing music),
(3) digital arts activities (eg, streaming a concert, virtual tour
of a museum), (4) gardening, (5) watching television, films,
Netflix or similar, (6) listening to the radio or music, (7) doing
DIY (do- it- yourself), woodwork, metal work, model making
or similar and (8) another hobby not already mentioned. Time
spent on each activity was categorised as none, low (<30 min) or
high (≥30 min).
Mental health and well-being
Depressive symptoms were measured using the Patient Health
Questionnaire (PHQ- 9).13 Across waves, Cronbach’s α for the
PHQ- 9 ranged from 0.87 to 0.89. Anxiety symptoms were
measured using the Generalised Anxiety Disorder Assessment
(Cronbach’s α ranged from 0.91 to 0.92).14 Life satisfaction
(evaluative well- being) was measured with one question ‘Overall,
in the past week, how satisfied have you been with your life?’.
Covariates
Most demographic, socioeconomic and health- related covari-
ates were measured at baseline in this study (age, gender,
race/ethnicity, education, marital status, employment status,
household income, urbanicity of home area, keyworker status
(whether participants were a critical employee who provided an
essential service throughout the pandemic), diagnosed mental
health problem, diagnosed physical health problem or disability).
However, several COVID- 19- related factors were reported in
each wave. We measured (yes, no) whether participants: had
ever been diagnosed with or suspected having COVID- 19; had
been in contact with someone with COVID- 19 in the last week;
had lost their job, partner lost their job or had a major cut to
household income due to changes in employment; were unable
to pay bills, rent or mortgage, or were evicted or lost accommo-
dation; had face- to- face contact or a phone or video call with
another person for 15 min or more. We also measured whether
participants’ isolation status (living as normal or almost normal,
only going out for essentials or exercise, fully isolating).
Statistical analysis
Fixed effects models tested the longitudinal associations of
engagement in creative leisure activities with mental health and
well- being. This approach uses only within- individual varia-
tion to examine how change in activity engagement is related
to change in mental health within individuals over time. All
time- invariant factors are accounted for automatically, even
if unobserved. We standardised all outcomes and tested three
models, using depressive symptoms, anxiety symptoms and life
satisfaction as separate outcomes, including all leisure activities
simultaneously. We then adjusted these fixed effects models for
time- varying covariates.
In sensitivity analyses, we first tested whether the associations
between leisure activities, mental health and well- being differed
according to baseline employment status. We then included a
combined index of time spent on creative hobbies (arts/crafts,
digital arts, woodwork/DIY) to allow comparison to previous
research.2 For all analyses, we weighted data to match the char-
acteristics of the non- institutionalised USA population aged 18
and over. We weighted the final analytical sample according to
age, gender, race/ethnicity and education, obtained from the US
Census Bureau.15
RESULTS
After weighting, 49% of the sample were aged 30–59 years, 59%
were female and 81% were white (table 1). Participants who
were older, had fewer depressive and anxiety symptoms, and
had higher life satisfaction were more likely to complete more
survey waves, although frequency of leisure activity engagement
did not differ by participation rates (online supplemental table
S1). The most common activity was watching television and the
least common was woodwork/DIY (online supplemental table
S2). Across the study period, there were substantial changes in
activity engagement and mental health and well- being (online
supplemental tables S2 and S3).
Depressive symptoms
The largest reduction in depressive symptoms was for partici-
pants who increased their time spent gardening from none to
less than 30 min per day (table 2). More than 30 min per day
gardening was associated with a smaller reduction in depressive
symptoms. In contrast, increasing time spent watching television
from none to more than 30 min per day was associated with
increases in depressive symptoms. Adjusting for time- varying
covariates did not alter these associations (online supplemental
table S4).
Anxiety symptoms
Gardening was the only activity associated with changes in
anxiety symptoms. Only increasing time spent gardening to less
than 30 min per day was associated with lower anxiety symp-
toms, and this association was maintained after adjusting for
time- varying covariates.
Life satisfaction
Increases in time spent doing arts/crafts, gardening and doing
woodwork/DIY were associated with higher life satisfaction. The
largest improvement was for participants who increased their
time spent doing woodwork/DIY from none to more than 30
min per day. Increasing from no gardening and not doing arts/
crafts to more than 30 min per day was also associated with
improved life satisfaction. Adjusting for time- varying covariates
did not alter these associations.
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Sensitivity analysis
There was no evidence that any of the associations between
time on spent on creative leisure activities, depressive or anxiety
symptoms, or life satisfaction differed according to employment
status (online supplemental table S5). Additionally, total time
spent on creative hobbies was not associated with depressive or
anxiety symptoms or life satisfaction (online supplemental table
S6).
DISCUSSION
In the USA, during the COVID- 19 pandemic, increased time
spent on gardening was associated with reductions in depres-
sive and anxiety symptoms and enhanced life satisfaction.
Spending more time doing woodwork/DIY and arts/crafts were
also associated with improvements in life satisfaction. However,
spending more than half an hour per day watching television or
other similar media was associated with increases in depressive
symptoms.
During the UK COVID- 19 lockdown, increases in watching
television were also associated with higher depressive symptoms,
but not anxiety symptoms or life satisfaction.2 Alongside our find-
ings, this provides strong evidence for an association of watching
television specifically with depressive symptoms. It is possible
that having more depressive symptoms caused people to increase
television watching, and not vice versa. In lagged analyses that
attempted to remove reverse causality, watching television was
not associated with subsequent depressive symptoms during the
pandemic in the UK.2 However, prepandemic evidence indicates
that the association is bidirectional.16 17 Future studies should
explore the direction of this association and determine whether
other coping strategies may be more beneficial. For example, in
our study, digital arts were also screen- based sedentary activities,
but were not associated with depressive symptoms. These activi-
ties could include more health- promoting active ingredients that
counteract the negative effects of sedentary screen time.
Evidence that gardening was associated with mental health
and well- being is in line with findings from the UK lockdown2
and prepandemic research.18 During stay- at- home orders,
gardening may have provided distance from difficult situations
in the home, a change of scenery, access to nature and the feeling
of being connected to something bigger.19 Gardening includes
gentle physical activity, which has extensive benefits for mental
health and well- being,20 through numerous distinct psycholog-
ical, physiological and behavioural mechanisms,21 particularly
during the pandemic.22 It was surprising that spending less (vs
more) than 30 min gardening was more strongly associated with
depressive and anxiety symptoms. People who spent more time
gardening may have been doing different types of activities,
such as larger projects, which were more stressful. This warrants
further investigation.
The lack of evidence for associations between other creative
leisure activities and mental health and well- being was unex-
pected. During the UK lockdown, creative hobbies, reading for
pleasure and listening to music were associated with reduced
depressive and anxiety symptoms and enhanced life satisfaction.2
Creative hobbies included arts/crafts, digital arts and woodwork/
DIY. We assessed these activities separately in our main analyses
and combined them in a sensitivity analysis. It is unclear why we
did not replicate the associations found in the UK, particularly
as listening to music and other creative hobbies were effective
methods of emotion regulation, which is linked to mental health
and well- being, during the pandemic in Australia.9 It could be
a result of greater heterogeneity in experiences in the USA due
to variation in lockdown rules across states, compared with the
homogeneity of the UK’s approach early in the pandemic. Alter-
natively, it could be because of cultural differences in the profile
of people using these activities.23 24
This study has several strengths, including the large sample,
with follow- ups over 12 waves during the first 5 months of the
COVID- 19 pandemic. We measured longitudinal changes in
time spent on leisure activities instead of relying on self- reported
changes in engagement (compared with before the pandemic)
Table 1 Characteristics of the sample at baseline
Unweighted Weighted
Proportion of sample
Age (years)
18–29 14% 18%
30–59 53% 49%
60+ 33% 33%
Gender
Male 16% 41%
Female 84% 59%
Race/ethnicity
White 87% 81%
Black/African American 3% 8%
Asian/Asian American 2% 5%
Mixed Race 3% 3%
Other 5% 3%
Education
High school or less 3% 14%
Some college 17% 35%
Undergraduate 32% 31%
Postgraduate/professional 49% 20%
Marital status
Single, never married 20% 26%
Single, divorced or widowed 16% 16%
In a relationship/married, living apart 6% 6%
In a relationship/married, cohabiting 58% 52%
Employment status
Unemployed 34% 46%
Employed 66% 54%
Household income
<US$75 000 45% 54%
≥US$75 000 55% 46%
Urbanicity
City 52% 51%
Town 37% 35%
Rural 11% 14%
Keyworker 23% 22%
Mental health problem 37% 38%
Physical health problem or disability 37% 40%
Had COVID- 19 (diagnosed or suspected) 8% 8%
Mean (SD)
Depressive symptoms (PHQ- 9) 7.60 (5.79) 8.00 (6.27)
Anxiety symptoms (GAD- 7) 5.96 (5.22) 5.93 (5.42)
Life satisfaction 5.71 (2.30) 5.52 (2.49)
Note. Mental health problem includes clinically diagnosed anxiety, clinically diagnosed
depression, or other clinically diagnosed mental health problem. Physical health problem
or disability includes diabetes, heart disease, lung disease, cancer, another clinically
diagnosed chronic physical health condition, a disability that affects ability to leave the
house, or another disability.
GAD- 7, Generalised Anxiety Disorder- 7; PHQ- 9, Patient Health Questionnaire- 9.
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296 BoneJK, etal. J Epidemiol Community Health 2023;77:293–297. doi:10.1136/jech-2022-219653
Short report
as in previous cross- sectional studies.3–9 Fixed effects models
account for observed and unobserved individual heterogeneity.
However, they do not address the directionality of associations,
so our analyses do not demonstrate whether changes in leisure
activities cause changes in mental health and well- being or vice
versa. Although we adjusted for COVID- 19- related factors,
unmeasured time- varying confounders could have influenced
our findings. The study did not include a random sample and
is thus not representative of the USA population. Data collec-
tion began during the pandemic (April 2020) rather than before
the pandemic, which may have influenced sample selection. It
is unclear how this may have impacted our findings, so anal-
yses should be replicated in a larger more representative sample.
As the number of waves completed by participants differed
according to their age, mental health and well- being, this may
also have caused selection bias. Before weighting, females,
people of white race/ethnicity, those with higher education and
household income, and those who were employed were over-
represented in our sample. Although we weighted data to make
it representative of the USA population, we cannot rule out
potential biases due to omitting factors associated with survey
participation in the weighting process. To match our data to
available population statistics,15 we excluded participants who
did not identify as male or female, but we recognise that gender
is not a binary construct.
During the COVID- 19 pandemic in the USA, doing gardening,
woodwork/DIY and arts/crafts had the most potential to
improve mental health and well- being. Despite the similarity
of our approach to previous research, our findings differ from
evidence obtained in the UK.2 This demonstrates the importance
of replicating research across countries, as cultural or contextual
nuances may affect the associations between creative engage-
ment and health outcomes. Future research should explore the
factors underlying these cross- country differences. Our find-
ings should also be considered when formulating guidelines for
future stay- at- home directives, enabling individuals to prepare
for periods of isolation and stay well despite the closure of many
public resources.
Twitter Jessica K Bone @jessicakbone, Daisy Fancourt @Daisy_Fancourt, Randy
Cohen @ArtsInfoGuy and Feifei Bu @FeifeiBu
Acknowledgements The researchers are grateful for the support of Americans
for the Arts and members of the University of Florida Center for Arts in Medicine
Interdisciplinary Research Lab with their recruitment efforts. We also gratefully
acknowledge the contribution of the COVID- 19 Social Study participants.
Contributors JKS, JBL, AJK, HR, RC and DF were responsible for the study
protocol development and participant recruitment. JKB, DF, JKS and FB designed the
analyses in this manuscript. JKB and FB conducted the analysis and JKB drafted the
manuscript. JKB, FB, JKS, MEF, JBL, AJK, HR, RC and DF contributed to the writing,
made critical revisions and approved the final manuscript.
Funding This COVID- 19 Social Study was funded by the Nuffield Foundation
(WEL/FR- 000022583), but the views expressed are those of the authors and not
necessarily the Foundation. The study was also supported by the MARCH Mental
Health Network funded by the Cross- Disciplinary Mental Health Network Plus
initiative supported by UK Research and Innovation (ES/S002588/1), and by the
Wellcome Trust (221400/Z/20/Z). The EpiArts Lab, a National Endowment for the
Arts Research Lab at the University of Florida, is supported in part by an award from
the National Endowment for the Arts (1862896- 38- C- 20). The National Endowment
for the Arts does not guarantee the accuracy or completeness of the information
included in this material and is not responsible for any consequences of its use.
Table 2 Fixed effects models testing associations between changes in time spent on leisure activities and changes in mental health and well- being
across the follow- up period (6 April 2020–6 September 2020)
Depressive symptoms Anxiety symptoms Life satisfaction
Coef (95% CI) P value Coef (95% CI) P value Coef (95% CI) P value
Reading for pleasure
Low 0.01 (−0.03 to 0.05) 0.548 0.02 (−0.02 to 0.06) 0.283 0.01 (−0.03 to 0.06) 0.531
High 0.02 (−0.02 to 0.06) 0.311 0.01 (−0.03 to 0.05) 0.610 0.01 (−0.04 to 0.06) 0.648
Arts/crafts
Low 0.04 (0.00 to 0.08) 0.083 0.01 (−0.02 to 0.05) 0.416 −0.01 (−0.06 to 0.04) 0.730
High 0.01 (−0.03 to 0.06) 0.579 −0.01 (−0.06 to 0.03) 0.621 0.06 (0.00 to 0.11)0.034
Digital arts
Low 0.01 (−0.03 to 0.06) 0.582 −0.01 (−0.04 to 0.03) 0.753 −0.04 (−0.09 to 0.02) 0.180
High 0.04 (−0.03 to 0.10) 0.251 0.04 (−0.01 to 0.09) 0.161 −0.05 (−0.12 to 0.02) 0.166
Gardening
Low −0.07 (−0.11 to 0.02)0.003 −0.05 (−0.09 to 0.01)0.015 0.04 (−0.01 to 0.09) 0.107
High −0.05 (−0.09 to 0.00)0.046 0.00 (−0.06 to 0.05) 0.882 0.06 (0.00 to 0.12)0.043
Watching television
Low 0.04 (−0.01 to 0.09) 0.148 −0.02 (−0.07 to 0.03) 0.457 0.00 (−0.07 to 0.06) 0.948
High 0.06 (0.01 to 0.10)0.010 −0.02 (−0.06 to 0.03) 0.479 −0.01 (−0.06 to 0.04) 0.785
Listening to music
Low −0.01 (−0.04 to 0.03) 0.725 −0.01 (−0.04 to 0.02) 0.407 0.00 (−0.04 to 0.04) 0.927
High −0.02 (−0.06 to 0.02) 0.346 −0.01 (−0.05 to 0.02) 0.457 0.00 (−0.04 to 0.04) 0.870
Woodwork/DIY
Low 0.02 (−0.05 to 0.08) 0.604 0.02 (−0.05 to 0.08) 0.619 −0.04 (−0.10 to 0.03) 0.260
High 0.00 (−0.05 to 0.05) 0.984 −0.02 (−0.07 to 0.03) 0.428 0.11 (0.03 to 0.18)0.004
Other hobbies
Low 0.02 (−0.03 to 0.07) 0.376 0.03 (−0.02 to 0.07) 0.235 −0.04 (−0.09 to 0.02) 0.158
High 0.01 (−0.03 to 0.06) 0.577 0.00 (−0.04 to 0.05) 0.858 −0.02 (−0.09 to 0.04) 0.438
Note. Time spent doing activities measured on the last weekday. Low=less than 30 min doing activity during the day. High=30 min or more spent on activity during the day. Both low and
high were compared with doing none of this activity. Outcomes were standardised, so coefficients represent changes in SD units. Bold text indicates p<0.05. Fixed effects analysis does not
test the direction of associations, so we cannot conclude that changes in leisure activities lead to subsequent changes in mental health and well- being.
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BoneJK, etal. J Epidemiol Community Health 2023;77:293–297. doi:10.1136/jech-2022-219653
Short report
The EpiArts Lab is also supported by the University of Florida, the Pabst Steinmetz
Foundation, and Bloomberg Philanthropies. DF is supported by the Wellcome Trust
(205407/Z/16/Z).
Disclaimer The opinions expressed are those of the authors and do not represent
the views of the National Endowment for the Arts Office of Research & Analysis
or the National Endowment for the Arts. The funders had no final role in the study
design; in the collection, analysis, and interpretation of data; in the writing of the
report; or in the decision to submit the paper for publication. All researchers listed as
authors are independent from the funders and all final decisions about the research
were taken by the investigators and were unrestricted.
Competing interests None declared.
Patient consent for publication Not applicable.
Ethics approval This study involves human participants and was approved by
UCL Research Ethics Committee (12467/005) and University of Florida Institutional
Review Board (IRB202000785). Participants gave informed consent before taking
part.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It
has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have
been peer- reviewed. Any opinions or recommendations discussed are solely those
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and
responsibility arising from any reliance placed on the content. Where the content
includes any translated material, BMJ does not warrant the accuracy and reliability
of the translations (including but not limited to local regulations, clinical guidelines,
terminology, drug names and drug dosages), and is not responsible for any error
and/or omissions arising from translation and adaptation or otherwise.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits
others to copy, redistribute, remix, transform and build upon this work for any
purpose, provided the original work is properly cited, a link to the licence is given,
and indication of whether changes were made. See:https://creativecommons.org/
licenses/by/4.0/.
ORCID iDs
Jessica KBone http://orcid.org/0000-0002-6019-7066
DaisyFancourt http://orcid.org/0000-0002-6952-334X
Meg EFluharty http://orcid.org/0000-0001-9586-8600
Jenny BLee http://orcid.org/0000-0003-3403-5044
HeidiRadunovich http://orcid.org/0000-0003-4973-1480
FeifeiBu http://orcid.org/0000-0003-2060-3768
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