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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Psychol.</journal-id>
<journal-title>Frontiers in Psychology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Psychol.</abbrev-journal-title>
<issn pub-type="epub">1664-1078</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fpsyg.2023.1067165</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Psychology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Cybervictimization and cyberbullying among college students: The chain mediating effects of stress and rumination</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes"><name><surname>Luo</surname><given-names>Qing</given-names></name><xref rid="aff1" ref-type="aff"><sup>1</sup></xref><xref rid="c001" ref-type="corresp"><sup>&#x002A;</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/2023146/overview"/>
</contrib>
<contrib contrib-type="author"><name><surname>Wu</surname><given-names>Na</given-names></name><xref rid="aff2" ref-type="aff"><sup>2</sup></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Huang</surname><given-names>Lu</given-names></name><xref rid="aff3" ref-type="aff"><sup>3</sup></xref>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Department of Psychology, School of Public Policy and Administration, Nanchang University</institution>, <addr-line>Nanchang</addr-line>, <country>China</country></aff>
<aff id="aff2"><sup>2</sup><institution>Department of Psychology, College of Education and Science, Hubei Normal University</institution>, <addr-line>Huangshi</addr-line>, <country>China</country></aff>
<aff id="aff3"><sup>3</sup><institution>School of Marxism, Wuhan Business University</institution>, <addr-line>Wuhan</addr-line>, <country>China</country></aff>
<author-notes>
<fn id="fn0001" fn-type="edited-by">
<p>Edited by: Beatriz Delgado, University of Alicante, Spain</p>
</fn>
<fn id="fn0002" fn-type="edited-by">
<p>Reviewed by: Arta Dodaj, University of Zadar, Croatia; Aiman El Asam, Kingston University, United Kingdom</p>
</fn>
<corresp id="c001">&#x002A;Correspondence: Qing Luo, &#x02709; <email>luoqingncu@ncu.edu.cn</email></corresp>
<fn id="fn0003" fn-type="other">
<p>This article was submitted to Educational Psychology, a section of the journal Frontiers in Psychology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>10</day>
<month>02</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="collection">
<year>2023</year>
</pub-date>
<volume>14</volume>
<elocation-id>1067165</elocation-id>
<history>
<date date-type="received">
<day>13</day>
<month>10</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>27</day>
<month>01</month>
<year>2023</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2023 Luo, Wu and Huang.</copyright-statement>
<copyright-year>2023</copyright-year>
<copyright-holder>Luo, Wu and Huang</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>The popularity of the Internet has led to an increase in cybervictimization and cyberbullying. Many studies have focused on the factors influencing cybervictimization or cyberbullying, but few have researched the mechanism that mediates these phenomena. Therefore, in this study, we use a chain mediation model to explore the mechanisms of cybervictimization and cyberbullying. This research is based on the general aggression model and examines whether stress and rumination play a mediating role in the relationship between cybervictimization and cyberbullying among Chinese college students. This study included 1,299 Chinese college students (597 men and 702 women, <italic>M</italic> =&#x2009;21.24 years, <italic>SD</italic> =&#x2009;3.16) who completed questionnaires on cybervictimization, stress, rumination, and cyberbullying. Harman&#x2019;s one-factor test was used to analyze common method bias; mean and standard deviations were used to analyze the descriptive statistics, Pearson&#x2019;s moment correlation was used to determine the relationship between variables, and Model 6 of the SPSS macro examined the mediating effect of stress and rumination. The results indicate that rumination mediated the relationship between cybervictimization and cyberbullying. In addition, stress and rumination acted as a chain mediator in this association. These results have the potential to reduce the likelihood of college students engaging in cyberbullying as a result of cybervictimization, minimize the rate of cyberbullying among youths, and lead to the development of interventions for cybervictimization and cyberbullying.</p>
</abstract>
<kwd-group>
<kwd>cybervictimization</kwd>
<kwd>cyberbullying</kwd>
<kwd>stress</kwd>
<kwd>rumination</kwd>
<kwd>college students</kwd>
</kwd-group>
<counts>
<fig-count count="2"/>
<table-count count="3"/>
<equation-count count="0"/>
<ref-count count="105"/>
<page-count count="9"/>
<word-count count="7786"/>
</counts>
</article-meta>
</front>
<body>
<sec id="sec1" sec-type="intro">
<label>1.</label>
<title>Introduction</title>
<p>The Internet plays an important role in people&#x2019;s lives; however, there are risks associated with using the Internet, such as cybervictimization and cyberbullying (<xref ref-type="bibr" rid="ref22">Ferrara et al., 2018</xref>). It is obvious that the proliferation of the internet has resulted to an increased cases of cybervictimization and cyberbullying, which have become prevalent in society (<xref ref-type="bibr" rid="ref15">Ding et al., 2020</xref>). Studies from the United States, the United Kingdom, Switzerland, and Turkey have demonstrated a strong correlation between increased Internet use and increased cybervictimization and cyberbullying (<xref ref-type="bibr" rid="ref37">Hinduja and Patchin, 2008</xref>; <xref ref-type="bibr" rid="ref80">Smith et al., 2008</xref>; <xref ref-type="bibr" rid="ref82">Sticca et al., 2013</xref>). Cybervictimization and cyberbullying have become a major concern for college students (<xref ref-type="bibr" rid="ref41">Khine et al., 2020</xref>; <xref ref-type="bibr" rid="ref56">Mart&#x00ED;nez-Monteagudo et al., 2020</xref>; <xref ref-type="bibr" rid="ref76">Qudah et al., 2020</xref>), and several recent studies have investigated cyberbullying behavior among college students (<xref ref-type="bibr" rid="ref4">Alrajeh et al., 2021</xref>; <xref ref-type="bibr" rid="ref46">Lam et al., 2022</xref>).</p>
<p>Cyber-victims are those affected by cyberbullying (<xref ref-type="bibr" rid="ref01">Betts, 2015</xref>), and cybervictimization usually occurs through electronic media (<xref ref-type="bibr" rid="ref85">Tokunaga, 2010</xref>). Cybervictimization is widespread, with a large and serious scope of abuse (<xref ref-type="bibr" rid="ref13">Dempsey et al., 2009</xref>). <xref ref-type="bibr" rid="ref5">Ansary (2020)</xref> analyzed numerous studies and found that the average annual cybervictimization rate was 14&#x2013;21%. Globally, 10 to 72% of youths have reported being victims of cyberbullying (<xref ref-type="bibr" rid="ref85">Tokunaga, 2010</xref>; <xref ref-type="bibr" rid="ref61">Mishna et al., 2011</xref>). Most adolescents who are bullied online experience mental health problems, including stress and maladaptive regulation strategies (<xref ref-type="bibr" rid="ref85">Tokunaga, 2010</xref>; <xref ref-type="bibr" rid="ref3">Albdour et al., 2017</xref>; <xref ref-type="bibr" rid="ref72">Palermiti et al., 2017</xref>; <xref ref-type="bibr" rid="ref65">Musharraf et al., 2019</xref>), some have even committed suicide (<xref ref-type="bibr" rid="ref04">Quintana-Orts et al., 2022</xref>). Cyber-victims experience bullying multiple times and are more likely to be involved in cyberbullying (<xref ref-type="bibr" rid="ref103">Zhu et al., 2019</xref>; <xref ref-type="bibr" rid="ref18">Dong, 2020</xref>; <xref ref-type="bibr" rid="ref92">Wang et al., 2020</xref>). <xref ref-type="bibr" rid="ref20">Faucher et al. (2014)</xref> found that of the 24.1% of Canadian university students who experienced cyberbullying, 5.1% engaged in cyberbullying.</p>
<p>Cybervictimization is more likely to lead to cyberbullying, thus creating a vicious cycle (<xref ref-type="bibr" rid="ref83">Sun et al., 2020</xref>). Many studies have found a strong correlation between cybervictimization and cyberbullying (<xref ref-type="bibr" rid="ref50">Leung et al., 2018</xref>; <xref ref-type="bibr" rid="ref54">Lozano-Blasco et al., 2020</xref>). A meta-analysis based on cyberbullying found a significantly positive correlation between cybervictimization and cyberbullying (<xref ref-type="bibr" rid="ref43">Kowalski et al., 2014</xref>). Moreover, cybervictimization has been identified as a strong predictor of cyberbullying (<xref ref-type="bibr" rid="ref45">Kwan and Skoric, 2013</xref>; <xref ref-type="bibr" rid="ref43">Kowalski et al., 2014</xref>). Cyber-victims are at high risk of becoming cyberbullies (<xref ref-type="bibr" rid="ref91">Walrave and Heirman, 2011</xref>; <xref ref-type="bibr" rid="ref36">Hemphill et al., 2012</xref>). Some cyber-victims might respond to cyberbullying with cyberbullying behavior (<xref ref-type="bibr" rid="ref99">Yilmaz,&#x202F;2011</xref>). Cybervictimization is the strongest predictor of cyberbullying (<xref ref-type="bibr" rid="ref2">Akbulut and Eristi, 2011</xref>). <xref ref-type="bibr" rid="ref12">Dehue et al. (2008)</xref> found that 5.7% of cyberbullied adolescents chose a retaliatory coping strategy, such as cyberbullying. Cyber-victims often commit cyberbullying in the same online environment where they experience bullying (<xref ref-type="bibr" rid="ref30">Gradinger et al., 2010</xref>). A longitudinal study of teenagers from four Midwestern U.S. middle schools found that teens who had been bullied online demonstrated aggressive behavior (e.g., cyber relational or verbal aggression) 6&#x2009;months later (<xref ref-type="bibr" rid="ref96">Wright and Yan, 2013</xref>). <xref ref-type="bibr" rid="ref11">Chu et al. (2018)</xref> found that previous cybervictimization experiences positively predicted subsequent cyberbullying behavior, and <xref ref-type="bibr" rid="ref19">Espelage et al. (2012)</xref> argued that cyber-victims would perpetrate cyberbullying.</p>
<p>Cyberbullying is an intentional act repeatedly committed against an individual or a group by an individual or group using electronic information communication tools (<xref ref-type="bibr" rid="ref80">Smith et al., 2008</xref>; <xref ref-type="bibr" rid="ref59">Menesini et al., 2012</xref>; <xref ref-type="bibr" rid="ref39">Jadambaa et al., 2019</xref>). The incidence of cyberbullying is increasing with the continuous development of Internet technology (<xref ref-type="bibr" rid="ref98">Y&#x0131;ld&#x0131;z Durak, 2019</xref>). Cyberbullying is a serious global social problem that affects individuals who access the Internet or mobile networks regardless of age, education, and socioeconomic problems (<xref ref-type="bibr" rid="ref2">Akbulut and Eristi, 2011</xref>; <xref ref-type="bibr" rid="ref27">Garaigordobil and Mart&#x00ED;nez-Valderrey, 2015</xref>; <xref ref-type="bibr" rid="ref23">Festl, 2016</xref>). Cyberbullying is common among college students with an incidence rate of 10&#x2013;50% (<xref ref-type="bibr" rid="ref44">Kowalski et al., 2012</xref>; <xref ref-type="bibr" rid="ref42">Kokkinos et al., 2014</xref>). Compared to individuals at other ages, college students are more likely to engage in cyberbullying because they can use the Internet for long periods of time and unsupervised, as well as frequently showcase their lives on social media, seek experiences, and form social cliques (<xref ref-type="bibr" rid="ref40">Jones and Scott, 2012</xref>). A study of Turkish university students demonstrated that 59.8% of undergraduates engaged in cyberbullying (<xref ref-type="bibr" rid="ref88">Turan et al., 2011</xref>). A meta-analysis study on bullying prevalence across contexts revealed that the average incidence of cyberbullying was about 15%; however, the study included traditional bullying, and the study only focused on peer cyberbullying (<xref ref-type="bibr" rid="ref62">Modecki et al., 2014</xref>). According to UNICEF study, 19.7% college students reported participating in cyberbullying at least once in their lifetime, and 54.4% reported experiencing cyberbullying at least once in their lifetime (<xref ref-type="bibr" rid="ref71">Ozden and Icellioglu, 2014</xref>).</p>
<p>The general aggression model is considered a valuable theoretical framework for explaining cyberbullying among college students (<xref ref-type="bibr" rid="ref95">Wong et al., 2018</xref>). The model (<xref ref-type="bibr" rid="ref9">Bushman and Anderson, 2002</xref>) provides a comprehensive theoretical framework that includes both individual-specific and situation-specific factors that can be effectively used to explain cybervictimization and cyberbullying. The general aggression model suggests that the occurrence of aggression includes three processes: an individual and situational input variable process, a path process, and an output variable process. According to the generalized aggression model, the cyberbullying experience is an individual and situational input variable process that changes the individual&#x2019;s state and drives aggressive behavior. Cybervictimization acts as a trigger for individuals to instigate cyberbullying behaviors (<xref ref-type="bibr" rid="ref95">Wong et al., 2018</xref>). <xref ref-type="bibr" rid="ref47">Lang (1968)</xref> proposed that aversive events awaken an individual&#x2019;s hostile attitude and eventually provoke the impulse to engage in aggressive behavior. The impulses triggered by aversive events are also the strongest situational triggers (<xref ref-type="bibr" rid="ref24">Finkel and Eckhardt, 2013</xref>).</p>
<p>Most extant studies have focused on the relationship between traditional bullying and cyberbullying (<xref ref-type="bibr" rid="ref86">Tomazin and Smith, 2007</xref>; <xref ref-type="bibr" rid="ref6">Bhat, 2008</xref>; <xref ref-type="bibr" rid="ref17">Doneman, 2008</xref>) and the influencing factors of cybervictimization and cyberbullying such as gender, emotional problems, depression, anxiety, and other physical and psychosomatic problems (<xref ref-type="bibr" rid="ref14">Desmet et al., 2014</xref>; <xref ref-type="bibr" rid="ref28">Gimenez Gualdo et al., 2015</xref>; <xref ref-type="bibr" rid="ref97">Yildirim et al., 2019</xref>). However, the mechanisms underlying the mediating or moderating factors between cybervictimization and cyberbullying remain unclear. The general aggression model explains the occurrence of cyberbullying from both person-specific and situation-specific factors. Therefore, this study applies this theory to analyze the mechanism of the association between cybervictimization and cyberbullying.</p>
<sec id="sec2">
<label>1.1.</label>
<title>The role of stress as a mediator between cybervictimization and cyberbullying</title>
<p>According to the general aggression model, stress is a pathway process that affects an individual&#x2019;s current cognitive and affective states, which in turn stimulate the individual&#x2019;s physiological state. Stress is a cacoethic state that has harmful effects on the mind and body (<xref ref-type="bibr" rid="ref93">Weiten et al., 2014</xref>). Stress is also an important correlate of aggressive tendencies in college students (<xref ref-type="bibr" rid="ref90">Velezmoro et al., 2010</xref>). Within the social information processing framework, research has primarily investigated the mechanisms that link this stressor to simultaneous and future aggressive behaviors (<xref ref-type="bibr" rid="ref16">Dodge, 1993</xref>). The experience of being cyberbullied can lead to stress (<xref ref-type="bibr" rid="ref63">Monks et al., 2012</xref>). Cyber-victims have reported symptoms of stress (<xref ref-type="bibr" rid="ref94">Williams et al., 2017</xref>). <xref ref-type="bibr" rid="ref81">Snyman and Loh (2015)</xref> demonstrated that cyber-victims might experience stress, while <xref ref-type="bibr" rid="ref56">Mart&#x00ED;nez-Monteagudo et al. (2020)</xref> showed that cyber-victims could exhibit high levels of stress. <xref ref-type="bibr" rid="ref29">Gonz&#x00E1;lez-Cabrera et al. (2017)</xref> measured stress perceptions based on cortisol and found that cybervictimization events induce stress. Many studies have found a positive correlation between cybervictimization and stress (<xref ref-type="bibr" rid="ref02">Martins et al., 2016</xref>), including an association with high levels of social stress (<xref ref-type="bibr" rid="ref25">Fredstrom et al., 2011</xref>), and a meta-analysis study indicated that stress is very highly correlated with cybervictimization (<xref ref-type="bibr" rid="ref43">Kowalski et al., 2014</xref>). Peer victimization is a significant stressor for adolescents, and victimized adolescents are more likely to develop aggressive behaviors than adolescents who are not victimized (<xref ref-type="bibr" rid="ref75">Prinstein et al., 2005</xref>). <xref ref-type="bibr" rid="ref73">Patchin and Hinduja (2011)</xref> argued that as a response to stressful life events, some young people may engage in bullying behaviors (both traditional and online). In addition, <xref ref-type="bibr" rid="ref52">Lianos and Mcgrath (2018)</xref> revealed that cybervictimization, as a negative stimulus, was an important stressor that led to cyberbullying and that adolescents were more likely to exhibit cyberbullying behaviors after experiencing stressful events. <xref ref-type="bibr" rid="ref26">Garaigordobil and Machimbarrena (2019)</xref> confirmed positive correlations among cybervictimization, cyberbullying, and stress. The experience of cybervictimization will affect cyber victims&#x2019; responses to stress, and they might become involved in cyberbullying (<xref ref-type="bibr" rid="ref43">Kowalski et al., 2014</xref>).</p>
</sec>
<sec id="sec3">
<label>1.2.</label>
<title>The mediating role of rumination between cybervictimization and cyberbullying</title>
<p>According to the general aggression model, rumination is another pathway process, and rumination affects an individual&#x2019;s current cognitive and affective states, which in turn stimulate the individual&#x2019;s physiological state. Rumination is considered an emotion regulation strategy in which individuals repetitively focus on the reasons, consequences, and meanings of negative emotions (<xref ref-type="bibr" rid="ref67">Nolen-Hoeksema, 1991</xref>). A victimization environment may influence an individual&#x2019;s sense of self so that they attribute the bullying to their own personality or behavior, thus engaging in self-blame, a form of rumination (<xref ref-type="bibr" rid="ref31">Graham and Juvonen, 2001</xref>). Victimization is related to self-blaming attributions (<xref ref-type="bibr" rid="ref84">Taylor et al., 2013</xref>); after being bullied, individuals will attribute the cause to themselves, which leads to rumination. Cybervictimization has been found to be positively correlated with rumination (<xref ref-type="bibr" rid="ref21">Feinstein et al., 2014</xref>; <xref ref-type="bibr" rid="ref03">Rey et al., 2020</xref>). <xref ref-type="bibr" rid="ref100">Zhong et al. (2015)</xref> demonstrated that cybervictimization was perceived as a negative life event, leading many junior high school students to wonder why they were always bullied; moreover, they showed that it positively predicted rumination.</p>
<p>Negative thinking can cause negative behaviors, and high levels of rumination can induce aggressive behavior (<xref ref-type="bibr" rid="ref102">Zhu, 2014</xref>; <xref ref-type="bibr" rid="ref100">Zhong et al., 2015</xref>). According to <xref ref-type="bibr" rid="ref21">Feinstein et al. (2014)</xref>, the tendency to ruminate was elevated after exposure to online violence. Rumination can significantly and accurately predict a variety of aggressive behaviors (<xref ref-type="bibr" rid="ref74">Peters et al., 2015</xref>), and cyberbullying is a sub-category of aggressive behavior (<xref ref-type="bibr" rid="ref80">Smith et al., 2008</xref>).</p>
</sec>
<sec id="sec4">
<label>1.3.</label>
<title>The chain mediating role of stress and rumination between cybervictimization and cyberbullying</title>
<p>Victimization experiences may promote ruminative responses to social stress (<xref ref-type="bibr" rid="ref60">Miernicki, 2015</xref>). People facing chronic highly intense sources of stress and factors beyond their control may adopt ruminative behaviors (<xref ref-type="bibr" rid="ref68">Nolen-Hoeksema and Girgus, 1994</xref>), which can be amplified in the presence of stress (<xref ref-type="bibr" rid="ref64">Morrison and O&#x2019;Connor, 2005</xref>). Numerous studies have demonstrated that rumination is influenced by stress (<xref ref-type="bibr" rid="ref69">Nolen-Hoeksema et al., 2008</xref>). More stressful events cause higher levels of negative emotions; therefore, individuals repeatedly think about ways to reduce stress to reduce the level of negative emotions, leading to ruminant thinking (<xref ref-type="bibr" rid="ref33">Guo et al., 2011</xref>).</p>
</sec>
<sec id="sec5">
<label>1.4.</label>
<title>The present study</title>
<p>To effectively reduce cyberbullying, it is crucial to explain the factors influencing various aspects of cyberbullying (<xref ref-type="bibr" rid="ref65">Musharraf et al., 2019</xref>; <xref ref-type="bibr" rid="ref76">Qudah et al., 2020</xref>; <xref ref-type="bibr" rid="ref89">T&#x00FC;rk et al., 2021</xref>). Therefore, this study constructs a sequential mediation model that is based on the general aggression model. In the study model, cybervictimization is an individual and situational input variable process, stress and rumination are path processes, and cyberbullying is an output variable process. As mentioned above, cybervictimization is one of the stressors (<xref ref-type="bibr" rid="ref52">Lianos and Mcgrath, 2018</xref>), and stress and rumination lead to risk factors for cyberbullying (<xref ref-type="bibr" rid="ref43">Kowalski et al., 2014</xref>; <xref ref-type="bibr" rid="ref74">Peters et al., 2015</xref>). In addition, cyber-victims report perceived stress; as there is a positive correlation between perceived stress and cybervictimization, stress-motivated individuals are more likely to engage in cyberbullying behaviors. Therefore, based on the general aggression model, a chain mediation model is used, and the following three hypotheses are proposed (<xref rid="fig1" ref-type="fig">Figure 1</xref>):</p>
<fig position="float" id="fig1">
<label>Figure 1</label>
<caption>
<p>Theoretical model.</p>
</caption>
<graphic xlink:href="fpsyg-14-1067165-g001.tif"/>
</fig>
<disp-quote>
<p><italic>Hypothesis&#x202F;1</italic>: Stress mediates the relationship between cybervictimization and cyberbullying.</p>
</disp-quote>
<disp-quote>
<p><italic>Hypothesis&#x202F;2</italic>: Rumination mediates the relationship between cybervictimization and cyberbullying.</p>
</disp-quote>
<disp-quote>
<p><italic>Hypothesis 3</italic>: Stress and rumination play a sequential mediating role in the relationship between cybervictimization and cyberbullying.</p>
</disp-quote>
</sec>
</sec>
<sec id="sec6" sec-type="materials|methods">
<label>2.</label>
<title>Materials and methods</title>
<sec id="sec7">
<label>2.1.</label>
<title>Participants</title>
<p>A convenience sampling technique was used to select 1,335 undergraduates from two universities in East China through. Of the total sample, 597 were males and 702 were females. Freshmen, sophomores, juniors, and seniors were 297, 315, 246 and 441, respectively. The participants&#x2019; ages ranged from 18 to 24&#x2009;years (<italic>M</italic> =&#x2009;21.24, <italic>SD</italic> =&#x2009;3.16). A total of 36 participants were excluded from the questionnaire because they could not respond within the short response time. Finally, 1,299 valid questionnaires were obtained (return rate of 97.3%).</p>
</sec>
<sec id="sec8">
<label>2.2.</label>
<title>Measures</title>
<sec id="sec9">
<label>2.2.1.</label>
<title>Cybervictimization</title>
<p>The Chinese version of the cybervictimization scale was used to measure cybervictimization (<xref ref-type="bibr" rid="ref10">Chu and Fan, 2017</xref>). The scale comprises 14 items measuring how often the participants experienced cyberbullying through various channels, such as QQ, Weibo, and WeChat, over 6&#x2009;months. An example of the questionnaire items is, &#x201C;Someone abused me online (e.g., QQ, WeChat, Weibo, chat rooms, RenRen, etc.).&#x201D; The items were rated using a four-point Likert-type scale (1&#x2009;=&#x2009;&#x201C;never experienced&#x201D; to 4&#x2009;=&#x2009;&#x201C;experienced more than 3 times&#x201D;), where a higher score indicated more frequent cybervictimization experiences. The Cronbach&#x2019;s alpha coefficient in the present study was 0.94.</p>
</sec>
<sec id="sec10">
<label>2.2.2.</label>
<title>Stress</title>
<p>The stress sensitivity scale was used to assess the level of stress (<xref ref-type="bibr" rid="ref51">Li and Mei, 2002</xref>). The scale comprises 15 items regarding stress experienced after cyberbullying events. An example of the questionnaire items is &#x201C;Someone sent me a threatening or hurtful text message.&#x201D; The items were rated on a four-point Likert-type scale (1&#x2009;=&#x2009;&#x201C;no stress&#x201D; to 4&#x2009;=&#x2009;&#x201C;severe stress&#x201D;), where a higher score indicated a higher level of stress. The Cronbach&#x2019;s alpha in the present study was 0.96.</p>
</sec>
<sec id="sec11">
<label>2.2.3.</label>
<title>Rumination</title>
<p>The ruminant thinking scale was used to measure the degree of ruminative thinking induced by negative life events in general (<xref ref-type="bibr" rid="ref34">Han and Yang, 2009</xref>). An example of the questionnaire items is &#x201C;I often wonder what I have done to cause this.&#x201D; The scale comprises 22 items rated on a four-point Likert-type scale (1&#x2009;=&#x2009;&#x201C;never&#x201D; to 4&#x2009;=&#x2009;&#x201C;always&#x201D;), where higher scores indicate more severe ruminative thinking. The Cronbach&#x2019;s alpha coefficient in the present study was 0.97.</p>
</sec>
<sec id="sec12">
<label>2.2.4.</label>
<title>Cyberbullying</title>
<p>The Chinese version of the cyberbullying questionnaire (<xref ref-type="bibr" rid="ref10">Chu and Fan, 2017</xref>) was used to measure how often the participants engaged in cyberbullying behavior, such as ostracizing someone online by limiting and deleting comments, over 6&#x2009;months. An example of the questionnaire items is &#x201C;Abuse someone online (e.g., QQ, WeChat, Weibo, chat rooms, RenRen, etc.).&#x201D; The scale comprises 14 items rated on a four-point Likert-type scale (1&#x2009;=&#x2009;&#x201C;never implemented&#x201D; to 4&#x2009;=&#x2009;&#x201C;implemented more than 3 times&#x201D;), where a higher score indicated more frequent cyberbullying experiences. The Cronbach&#x2019;s alpha coefficient in the present study was 0.97.</p>
</sec>
</sec>
<sec id="sec13">
<label>2.3.</label>
<title>Procedure and data analysis</title>
<p>Before the questionnaires were distributed, three psychology and cyberpsychology experts were invited to evaluate the questionnaire to ensure that the content would not affect the participants. Participants were recruited <italic>via</italic> QQ, WeChat, and school forums, and completed the questionnaire <italic>via</italic> Wenjuanxing&#x2019; platform. The participants completed the questionnaire online, and prior to participation, privacy and confidentiality were assured, informed consent was obtained, and the instructions were clearly articulated. Before completing the questionnaire, the participants were told that there were no right or wrong answers.</p>
<p>The data were collected between May and June 2021. Class instructors were contacted in advance to determine a time to complete the questionnaire online. The average time to complete the questionnaire was approximately 15&#x2009;min.</p>
<p>The collected data were subjected to a stepwise analysis with the aid of statistical software, including IBM SPSS 25.0 and PROCESS. First, we used Harman&#x2019;s one-factor test for common method bias for the original data; second, the mean and standard deviations of all variables were analyzed; third, the Pearson&#x2019;s correlation coefficients between all variables were determined; then, we examined the mediating effect of stress and rumination using Model 6 of the SPSS macro developed by <xref ref-type="bibr" rid="ref35">Hayes (2017)</xref>. We estimated the 95% confidence intervals of the mediating effect with 5,000 resamples.</p>
</sec>
</sec>
<sec id="sec14" sec-type="results">
<label>3.</label>
<title>Results</title>
<sec id="sec15">
<label>3.1.</label>
<title>Common method bias</title>
<p>To effectively control for common method bias, the participants were informed of the anonymity and rigor of the questionnaires; to promote truthful responses, they were also assured that information would not be disclosed. An exploratory factor analysis was conducted using Harman&#x2019;s one-way method to examine the items for common method bias. The results indicated that there was no common method bias in this study. There were 17 factors with eigenvalues greater than 1, with 28.52% of the variance explained by the first factor, which was less than the critical criterion of 40% (<xref ref-type="bibr" rid="ref101">Zhou and Long, 2004</xref>).</p>
</sec>
<sec id="sec16">
<label>3.2.</label>
<title>Mean, standard deviation, and correlation analysis of each variable</title>
<p>The results revealed significant positive correlations among cybervictimization, stress, rumination, and cyberbullying (<xref rid="tab1" ref-type="table">Table 1</xref>).</p>
<table-wrap position="float" id="tab1">
<label>Table 1</label>
<caption>
<p>Means, standard deviations, and correlations between cybervictimization, stress, rumination, and cyberbullying.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top">Variable</th>
<th align="center" valign="top"><italic>M</italic></th>
<th align="center" valign="top"><italic>SD</italic></th>
<th align="center" valign="top">1</th>
<th align="center" valign="top">2</th>
<th align="center" valign="top">3</th>
<th align="center" valign="top">4</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">Cybervictimization</td>
<td align="char" valign="top" char=".">1.71</td>
<td align="char" valign="top" char=".">0.71</td>
<td align="char" valign="top" char=".">1</td>
<td/>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="top">Stress</td>
<td align="char" valign="top" char=".">1.86</td>
<td align="char" valign="top" char=".">0.81</td>
<td align="char" valign="top" char=".">0.70<sup>&#x002A;&#x002A;</sup></td>
<td align="char" valign="top" char=".">1</td>
<td/>
<td/>
</tr>
<tr>
<td align="left" valign="top">Rumination</td>
<td align="char" valign="top" char=".">1.80</td>
<td align="char" valign="top" char=".">0.76</td>
<td align="char" valign="top" char=".">0.76<sup>&#x002A;&#x002A;</sup></td>
<td align="char" valign="top" char=".">0.84<sup>&#x002A;&#x002A;</sup></td>
<td align="char" valign="top" char=".">1</td>
<td/>
</tr>
<tr>
<td align="left" valign="top">Cyberbullying</td>
<td align="char" valign="top" char=".">1.53</td>
<td align="char" valign="top" char=".">0.77</td>
<td align="char" valign="top" char=".">0.92<sup>&#x002A;&#x002A;</sup></td>
<td align="char" valign="top" char=".">0.71<sup>&#x002A;&#x002A;</sup></td>
<td align="char" valign="top" char=".">0.79<sup>&#x002A;&#x002A;</sup></td>
<td align="char" valign="top" char=".">1</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p><italic>N</italic>&#x2009;=&#x2009;1,299. <sup>&#x002A;&#x002A;</sup><italic>p</italic>&#x2009;&#x003C;&#x2009;0.01.</p>
</table-wrap-foot>
</table-wrap>
</sec>
<sec id="sec17">
<label>3.3.</label>
<title>Chain mediation analysis</title>
<p>Controlling for gender variables, the chain mediation model in the PROCESS plugin was used to examine the chain mediation between stress and rumination (<xref rid="tab2" ref-type="table">Table 2</xref>).</p>
<table-wrap position="float" id="tab2">
<label>Table 2</label>
<caption>
<p>Regression analysis of the relationship between the variables in the chain mediation model.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top" colspan="2">Regression equation (<italic>N</italic>&#x2009;=&#x2009;1,299)</th>
<th align="center" valign="top" colspan="3">Overall fit index</th>
<th align="center" valign="top" colspan="2">Significance of regression coefficients</th>
</tr>
<tr>
<th align="left" valign="top">Result variables</th>
<th align="left" valign="top">Predictive variables</th>
<th align="center" valign="top"><italic>R</italic></th>
<th align="center" valign="top"><italic>R<sup>2</sup></italic></th>
<th align="center" valign="top"><italic>F</italic></th>
<th align="center" valign="top"><italic>&#x03B2;</italic></th>
<th align="center" valign="top"><italic>T</italic></th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">Stress</td>
<td align="left" valign="top">Cybervictimization</td>
<td align="char" valign="top" char=".">0.73</td>
<td align="char" valign="top" char=".">0.53</td>
<td align="char" valign="top" char=".">97.41<sup>&#x002A;&#x002A;</sup></td>
<td align="char" valign="top" char=".">0.82</td>
<td align="char" valign="top" char=".">21.27<sup>&#x002A;&#x002A;&#x002A;</sup></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="2">Rumination</td>
<td align="left" valign="top">Stress</td>
<td align="char" valign="top" char="." rowspan="2">0.88</td>
<td align="char" valign="top" char="." rowspan="2">0.78</td>
<td align="char" valign="top" char="." rowspan="2">256.38<sup>&#x002A;&#x002A;&#x002A;</sup></td>
<td align="char" valign="top" char=".">0.52</td>
<td align="char" valign="top" char=".">16.76<sup>&#x002A;&#x002A;&#x002A;</sup></td>
</tr>
<tr>
<td align="left" valign="top">Cybervictimization</td>
<td align="char" valign="top" char=".">0.42</td>
<td align="char" valign="top" char=".">11.79<sup>&#x002A;&#x002A;&#x002A;</sup></td>
</tr>
<tr>
<td align="left" valign="top" rowspan="3">Cyberbullying</td>
<td align="left" valign="top">Stress</td>
<td align="char" valign="top" char="." rowspan="3">0.93</td>
<td align="char" valign="top" char="." rowspan="3">0.86</td>
<td align="char" valign="top" char="." rowspan="3">377.03<sup>&#x002A;&#x002A;&#x002A;</sup></td>
<td align="char" valign="top" char=".">0.01</td>
<td align="char" valign="top" char=".">0.18</td>
</tr>
<tr>
<td align="left" valign="top">Rumination</td>
<td align="char" valign="top" char=".">0.23</td>
<td align="char" valign="top" char=".">5.80<sup>&#x002A;&#x002A;&#x002A;</sup></td>
</tr>
<tr>
<td align="left" valign="top">Cybervictimization</td>
<td align="char" valign="top" char=".">0.79</td>
<td align="char" valign="top" char=".">24.02<sup>&#x002A;&#x002A;&#x002A;</sup></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<p><sup>&#x002A;&#x002A;</sup><italic>p</italic>&#x2009;&#x003C;&#x2009;0.01; <sup>&#x002A;&#x002A;&#x002A;</sup><italic>p</italic>&#x2009;&#x003C;&#x2009;0.001.</p>
</table-wrap-foot>
</table-wrap>
<p><xref rid="tab2" ref-type="table">Table 2</xref> presents the overall path coefficients of the mediation analysis. The results indicated that cybervictimization positively predicted stress (<italic>&#x03B2;</italic>&#x2009;=&#x2009;0.82, <italic>p</italic>&#x2009;&#x003C;&#x2009;0.001), and there was a significant predictive effect of stress for rumination (<italic>&#x03B2;</italic>&#x2009;=&#x2009;0.52, <italic>p</italic>&#x2009;&#x003C;&#x2009;0.001). Cybervictimization significantly predicted rumination (<italic>&#x03B2;</italic>&#x2009;=&#x2009;0.42, <italic>p</italic>&#x2009;&#x003C;&#x2009;0.001), and cybervictimization positively predicted cyberbullying (<italic>&#x03B2;</italic>&#x2009;=&#x2009;0.79, <italic>p</italic>&#x2009;&#x003C;&#x2009;0.001). Rumination significantly predicted cyberbullying (<italic>&#x03B2;</italic>&#x2009;=&#x2009;0.23, <italic>p</italic>&#x2009;&#x003C;&#x2009;0.001); however, stress was not a significant predictor of cyberbullying (<italic>&#x03B2;</italic>&#x2009;=&#x2009;0.01, <italic>p</italic>&#x2009;&#x003E;&#x2009;0.05).</p>
<p>The bias-corrected nonparametric bootstrap method was used to test for the mediation effect in this study. The test for mediation effects was performed with 5,000 replicate samples, and 95% confidence intervals were calculated (<xref rid="tab3" ref-type="table">Table 3</xref>). The results revealed two pathways with significant indirect effects: (1) cybervictimization &#x2192; stress &#x2192; rumination &#x2192; cyberbullying, with an indirect effect value of 0.09, indicating that stress and rumination were significant in cybervictimization and cyberbullying, and (2) cybervictimization &#x2192; rumination &#x2192; cyberbullying, with an indirect effect value of 0.09, indicating that rumination partially mediated the relationship between cybervictimization and cyberbullying (<xref rid="fig2" ref-type="fig">Figure 2</xref>).</p>
<table-wrap position="float" id="tab3">
<label>Table 3</label>
<caption>
<p>Standardized indirect effects from stress and rumination.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th/>
<th align="center" valign="top"><italic>&#x03B2;</italic></th>
<th align="center" valign="top">Boot SE</th>
<th align="center" valign="top">Boot confidence interval lower limit</th>
<th align="center" valign="top">Boot confidence interval upper limit</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">Total indirect effect</td>
<td align="char" valign="top" char=".">0.19</td>
<td align="char" valign="top" char=".">0.03</td>
<td align="char" valign="top" char=".">0.14</td>
<td align="char" valign="top" char=".">0.27</td>
</tr>
<tr>
<td align="left" valign="top"><italic>Via</italic> stress</td>
<td align="char" valign="top" char=".">0.005</td>
<td align="char" valign="top" char=".">0.03</td>
<td align="char" valign="top" char=".">&#x2212;0.06</td>
<td align="char" valign="top" char=".">0.07</td>
</tr>
<tr>
<td align="left" valign="top"><italic>Via</italic> stress and rumination</td>
<td align="char" valign="top" char=".">0.09</td>
<td align="char" valign="top" char=".">0.02</td>
<td align="char" valign="top" char=".">0.06</td>
<td align="char" valign="top" char=".">0.15</td>
</tr>
<tr>
<td align="left" valign="top"><italic>Via</italic> rumination</td>
<td align="char" valign="top" char=".">0.09</td>
<td align="char" valign="top" char=".">0.03</td>
<td align="char" valign="top" char=".">0.05</td>
<td align="char" valign="top" char=".">0.15</td>
</tr>
</tbody>
</table>
</table-wrap>
<fig position="float" id="fig2">
<label>Figure 2</label>
<caption>
<p>Model of the chain-mediating effects of stress and rumination on the relationship between cybervictimization and cyberbullying.</p>
</caption>
<graphic xlink:href="fpsyg-14-1067165-g002.tif"/>
</fig>
</sec>
</sec>
<sec id="sec18" sec-type="discussions">
<label>4.</label>
<title>Discussion</title>
<p>This study built on the existing literature to clarify the roles of stress and rumination in cybervictimization and cyberbullying. The results of this study support the hypotheses that rumination plays a mediating role in the relationship between cybervictimization and cyberbullying and that stress and rumination act as chain mediators.</p>
<p>The first hypothesis proposed that stress plays a mediating role in the relationship between cybervictimization and cyberbullying. However, this hypothesis was not supported by this study&#x2019;s results, nor were the results consistent with <xref ref-type="bibr" rid="ref52">Lianos and Mcgrath (2018)</xref>. There could be multiple reasons for this result. According to <xref ref-type="bibr" rid="ref1">Agnew&#x2019;s (1992)</xref> general stress theory, stress from cyberbullying causes negative emotions and can lead to bullying others or increase the level of delinquent adaptations (<xref ref-type="bibr" rid="ref57">Mazerolle et al., 2000</xref>). Based on general stress theory, stress may be caused by negative emotions resulting from cybervictimization experiences; however, negative emotions were not considered in this study. According to the stress-and-coping model (<xref ref-type="bibr" rid="ref48">Lazarus and Folkman, 1984</xref>), an individual determines whether cybervictimization is a stressful event by going through two processes; first, evaluating whether the stressor (cybervictimization) is a threat; second, if it is a threat, evaluating whether there are sufficient skills or resources to deal with the stressor (cybervictimization). For some individuals, cybervictimization may be a threat, but they have sufficient skills or resources to deal with it; for others, cybervictimization may not be a threat. Hence, the mediating effect of stress would not be observed. Additionally, other studies have concluded that cyberbullying is a series of stressful events (<xref ref-type="bibr" rid="ref52">Lianos and Mcgrath, 2018</xref>) and have emphasized the continuity of stressful experiences. However, this study only investigated cybervictimization without considering the severity or duration of the stressful event. Consequently, the mediating role of stress in the relationship between cybervictimization and cyberbullying would not be identified.</p>
<p>The second hypothesis, which proposed that rumination plays a mediating role in the relationship between cybervictimization and cyberbullying, was supported. This result was consistent with <xref ref-type="bibr" rid="ref55">Malamut and Salmivalli (2021)</xref> findings on traditional bullying. Numerous studies have confirmed that cybervictimization positively predicts adolescents&#x2019; rumination (<xref ref-type="bibr" rid="ref21">Feinstein et al., 2014</xref>; <xref ref-type="bibr" rid="ref100">Zhong et al., 2015</xref>); this study further confirms that cybervictimization significantly predicts rumination among adolescents in China. Several studies have shown that rumination significantly predicts aggressive behavior in individuals (<xref ref-type="bibr" rid="ref102">Zhu, 2014</xref>; <xref ref-type="bibr" rid="ref32">Guerra and White, 2017</xref>). This study confirmed that cyberbullying, as a specific type of aggression, was positively predicted by rumination. There was an association among cyber-victimization, rumination, and cyberbullying, and experiences of cyber-victimization induced rumination, leading to retaliation in the form of cyberbullying. The model of victim schema (<xref ref-type="bibr" rid="ref78">Rosen et al., 2009</xref>) explains that victims have difficulty regulating emotions, leading them to react aggressively to perceived threats. Rumination is maladaptive and can play an important role in the process of cybervictimization, which predicts externalizing problems such as cyberbullying.</p>
<p>The third hypothesis proposes the influence of stress and rumination in the relationship between cybervictimization and cyberbullying. The results demonstrated that stress and rumination played a chain-mediating role in the theoretical model. The results further validate the general aggression model. According to the stress response model, negative, stressful events encountered by individuals are the most direct cause of ruminative thinking (<xref ref-type="bibr" rid="ref77">Robinson and Alloy, 2003</xref>). Life stressors can elevate adolescents&#x2019; rumination levels (<xref ref-type="bibr" rid="ref58">McLaughlin et al., 2009</xref>), and rumination mediates the association between life stress and externalizing problems, such as aggressive behavior (<xref ref-type="bibr" rid="ref49">LeMoult et al., 2019</xref>). The results of the current study can be better understood with response style theory (<xref ref-type="bibr" rid="ref66">Nolen-Hoeksema, 1987</xref>), which states that individuals who adopt rumination repeatedly think about stressful events and pay constant attention to them, causing them to experience more intense stress, leading to aggressive behavior. Therefore, participants who were cyberbullied and repeatedly thought about the reasons for this bullying were more likely to treat others in the same way, that is, by committing cyberbullying.</p>
</sec>
<sec id="sec19" sec-type="conclusions">
<label>5.</label>
<title>Conclusion</title>
<p>This study investigated the relationship between cybervictimization and cyberbullying among college students, including the mediating roles of stress and rumination. The results show that cybervictimization not only directly affects cyberbullying but also has indirect effects through rumination and the chain mediating effect of stress and rumination. The Internet&#x2019;s proliferation has led to the attack on Internet users and has made it inevitable for users to be cyberbullied or engage in cyberbullying.</p>
<p>The findings indicate that college students, first, experience cybervictimization before engaging in cyberbullying. The stress associated with their cyberbullying experience affects their way of thinking and makes them retaliate violently by engaging in cyberbullying to relieve themselves from the stress resulting from their bullying experiences. This behavior may be due to the fact that parents pay much attention to grades obtained by their adult children but disregard their psychological well-being, which makes the college students to bear the pain of cyberbullying alone without disclosing it to their parents or to their teachers or friends for a solution. This phenomenon is applicable to all cultures; therefore, it is necessary that teachers, parents, or friends, should provide proper guidance to college students who experience cyberbullying to relieve them from stress and change their negative attitude towards cyberbullying, as well as prevent them from self-blame and from becoming cyberbullies in retaliation to their bully experiences. Similarly, Internet platforms should be designed in such a way that they can actively block the occurrence of cyberbullying and make the Internet better for all. We suggest that future research should investigate the influencing factors and macro systems between cybervictimization and cyberbullying, and investigate factors that inhibit cyberbullying from cultural norms, social help, and family protection, while establishing a tripartite cyberbullying intervention system and measures for schools, society, and families.</p>
<sec id="sec20">
<label>5.1.</label>
<title>Limitations</title>
<p>As with all research, this study has some limitations. First, all data in this study were reported by participants, and thus its validity may be influenced by social desirability. Future research should attempt to use a variety of perspectives and collect data from peers, online social platforms, and strictly controlled experiments to improve data validity. Second, this study investigated only a certain time period; therefore, the temporal effect on the variables cannot be determined. Future studies should include a longitudinal design to examine the relationship between cybervictimization, stress, rumination, and cyberbullying over longer periods. Finally, this study only examined individual-level variables. The interaction of multi-layer environmental systems shapes individuals&#x2019; online experiences (<xref ref-type="bibr" rid="ref7">Bronfenbrenner, 1979</xref>; <xref ref-type="bibr" rid="ref8">Bronfenbrenner and Morris, 2007</xref>; <xref ref-type="bibr" rid="ref70">O&#x2019;Neill and Dinh, 2015</xref>), which may influence the hazard and protective factors associated with cybervictimization (<xref ref-type="bibr" rid="ref53">Livingstone and Helsper, 2013</xref>; <xref ref-type="bibr" rid="ref87">Tsitsika et al., 2014</xref>; <xref ref-type="bibr" rid="ref70">O&#x2019;Neill and Dinh, 2015</xref>). Future research should consider multiple levels of influencing factors.</p>
</sec>
</sec>
<sec id="sec21" sec-type="data-availability">
<title>Data availability statement</title>
<p>The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.</p>
</sec>
<sec id="sec22">
<title>Ethics statement</title>
<p>The studies involving human participants were reviewed and approved by Scientific Review Committee of the School of Public Policy and Administration, Nanchang University. The patients/participants provided their written informed consent to participate in this study.</p>
</sec>
<sec id="sec23">
<title>Author contributions</title>
<p>QL contributed to the experimental design, analyzed the data, and drafted the manuscript. NW helped revise the manuscript. LH provided final approval of the manuscript. All authors contributed to the article and approved the submitted version.</p>
</sec>
<sec id="sec24" sec-type="funding-information">
<title>Funding</title>
<p>This study was supported by The National Social Science Foundation of China(Grant no. 21CKS037), The Jiangxi Provincial Social Science Thirteenth Five-Year Plan Planning Youth Project (Grant no. 17JY32) and The Humanities and Social Sciences Research Planning Youth Project for Universities and Colleges in Jiangxi Province (Grant no. XL18106).</p>
</sec>
<sec id="conf1" sec-type="COI-statement">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="sec100" sec-type="disclaimer">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
<ref-list>
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