Abstract
Understanding the COVID-19 pandemic's effect on alcohol sales and consumption is critical in mitigating alcohol abuse and morbidity. We sought to determine how the onset of the COVID-19 pandemic and changes in viral incidence affected alcohol sales and consumption in the United States. We conducted a retrospective observational analysis regressing National Institute on Alcohol Abuse and Alcoholism (NIAAA) alcohol sales data and Behavioral Risk Factor Surveillance System (BRFSS) survey data for 14 states for 2017 to 2020 with COVID-19 incidence in 2020 in the United States. The onset of the pandemic was associated with higher monthly alcohol sales per capita of 1.99 standard drinks (95% Confidence Interval: 0.63 to 3.34, p = 0.007). Increases of one COVID-19 case per 100 were associated with lower monthly alcohol sales per capita of 2.98 standard drinks (95% CI: −4.47 to −1.48, p = 0.001) as well as broad decreases in alcohol consumption, notably 0.17 fewer days per month with alcohol use (95% CI: −0.31 to −0.23, p = 0.008) and 0.14 fewer days per month of binge drinking (95% CI: −0.23 to −0.052, p < 0.001). The COVID-19 pandemic is associated with increased monthly average alcohol purchases, but higher viral incidence is linked to lower alcohol purchases and consumption. Continued monitoring is needed to mitigate the effects of higher population alcohol use during the pandemic.
Keywords: alcohol consumption, alcohol sales, BRFSS, COVID-19, NIAAA, pandemic
Introduction
The onset of the Coronavirus-19 (COVID-19) pandemic rapidly changed how alcohol was consumed due to lockdowns, stay-at-home orders, and social distancing, precluding activities such as bar gatherings, dining in restaurants, and parties with friends. Early reports from the start of the pandemic suggested that overall population-level alcohol consumption in the United States increased, including more drinks per day and higher frequency of alcohol consumption at the individual level, extending also to more heavy drinking days (Barbosa, Cowell, & Dowd, 2021; Pollard, Tucker, & Green, 2020). Surveyed reasons for this increase included decreases in employment, more available time, boredom, and elevated stress (Grossman, Benjamin-Neelon, & Sonnenschein, 2020; Weerakoon, Jetelina, Knell, & Messiah, 2021). Additionally, working remotely was associated with higher alcohol consumption relative to those who continued to work in-person unchanged (Szajnoga, Klimek-Tulwin, & Piekut, 2020).
Consequently, alcohol sales too evolved, with retail alcohol sales increasing 34% early in the pandemic, including throughout all United States geographic and almost all demographic categories (Lee, Dodge, Leventhal, & Terrault, 2021). Lockdowns and social distancing led to bar closures, and March to September 2020 saw a 27% decrease in on-premises alcohol sales and a 20% increase in off-premises sales, suggesting a shift from bar consumption to home drinking (Castaldelli-Maia, Segura, & Martins, 2021).
While the previous literature has indicated that alcohol consumption likely increased at the onset of the pandemic at both the population and individual level, prior studies have not assessed how alcohol sales and consumption changed with variations in COVID-19 incidence and throughout 2020 in the United States. This is critical as the overall increase in alcohol consumption has resulted in profound adverse health outcomes. Alcohol-related deaths in the US increased by 25% from 2019 to 2020 and alcohol-associated liver disease deaths increased by 22.4% (White, Castle, Powell, Hingson, & Koob, 2022). The increase in liver disease also manifested as a statistically significant increase in liver transplant recipients and waiting list additions due to alcoholic liver disease (Cholankeril et al., 2021).
It is unclear, for example, whether higher COVID-19 rates led to changes in behavior leading to decreased purchasing and consumption of alcohol due to viral containment measures and avoidance of exposures or whether the increased time spent at home and in isolation drove higher alcohol consumption. As the pandemic continues in a baseline-surge dynamic, knowledge of how these elements change remains crucial in optimizing interventions for risky health behaviors. We sought to answer these questions by regressing National Institute for Alcohol Abuse and Alcoholism alcohol sales data and alcohol consumption data from the Behavioral Risk Factor Surveillance System (BRFSS) on community COVID-19 incidence. Neither the NIAAA nor BRFSS data sets have been previously applied to the question of how COVID-19 incidence affects alcohol purchasing and consumption.
Methods
Study design and data sources
This project was exempted from the Institutional Review Board Review as it did not meet the criteria for Stanford University's definition of Human Subject research requiring IRB approval per OHRP 45 CFR 46.102.
We elected to use both sales and behavior data to provide multiple complementary data components. While the NIAAA sales data benefit from being objective figures, it is limited by being available for only 14 states; conversely, the BRFSS consumption data are survey data and potentially less reliable but available for all 50 states (Subbaraman, Ye, Martinez, Mulia, & Kerr, 2020). In addition, large differences between purchasing and consumption may provide insight into consumer behaviors such as stockpiling.
Monthly sales data for spirits, wine, and beer were obtained from the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) “Surveillance Report COVID-19” for January 2017 to December 2020 for the 14 states where these data were fully available: Alaska, Colorado, Connecticut, Delaware, Florida, Illinois, Kentucky, Massachusetts, Minnesota, Missouri, North Dakota, Tennessee, Texas, and Virginia (National Institute on Alcohol Abuse and Alcoholism, 2022). We converted the monthly sales to composite gallons of ethanol sold, using the NIAAA standard of 41.1% alcohol by volume (ABV) for spirits, 12.9% ABV for wine, and 4.5% ABV for beer. These were then converted to per capita figures using the NIAAA population of people older than 14. The gallons of ethanol, wine, spirits, and beer sold were then converted to standard drinks using the NIAAA's conversion of 0.6 fluid ounces (fl. oz) of ethanol per drink: 0.6 fl. oz of ethanol per 1.5 fl. oz of spirits, 0.6 fl. oz of ethanol per 5 fl. oz of wine, and 0.6 fl. oz of ethanol per 12 fl. oz of beer.
Monthly alcohol consumption data for January 2017 to December 2020, the last currently available month, were procured for the same above 14 states from the Behavioral Risk Factor Surveillance System (BRFSS) at the state and month level results for “Days in the past 30 had alcoholic beverage”; “Avg alcoholic drinks per day in past 30”; “Binge Drinking [days in past 30]”; and “Most drinks on single occasion past 30 days” (Appendix Table 1 ) (Centers for Disease Control, 2021). Drinks were defined as standard 6-oz ethanol equivalents. Data were not included for March 2020 as the event. Mean response rates for the BRFSS were 44.9% for 2017, 49.8% for 2018, 50.0% for 2019, and 47.8% for 2020 (Centers for Disease Control, 2021). COVID-19 incidence was chosen over hospitalization or deaths as a marker of virus presence as it allowed the quantitative analysis of COVID-19 prevalence comparable across the most geographic regions. Cumulative COVID-19 case volumes for January 2020 to December 2020 by county were obtained via the New York Times online repository and aggregated to the state and month level for the 14 states (“NYTimes COVID-19-data: An ongoing repository of data on coronavirus cases and deaths in the U.S.“; New York Times, 2023). New COVID-19 cases were then computed by state and month and per capita rates were calculated using the 2020 United States Census population data (United States Census Bureau, 2022).
Table 1.
Changes in overall monthly alcohol consumption after the onset of the pandemic.
Alcohol Sales (14 states) | Coefficient | Std. error | 95% CI | Observations | p value |
---|---|---|---|---|---|
Ethanol Sales (Std. Drinks) | +1.99 | 0.63 | 0.63 to 3.34 | 658 | 0.007 |
Spirits Sales (Std. Drinks) | +2.26 | 0.49 | 1.19 to 3.32 | 658 | <0.001 |
Wine Sales (Std. Drinks) | +0.15 | 0.11 | −0.078 to 0.38 | 658 | 0.18 |
Beer Sales (Std. Drinks) |
−0.55 |
0.15 |
−0.88 to −0.22 |
658 |
0.004 |
Alcohol Consumption Patterns (14 states) |
Coefficient |
Std. error |
95% CI |
Observations |
p value |
Days per month with alcohol use | +0.36 | 0.17 | −0.0086 to 0.72 | 658 | 0.055 |
Average drinks per day | −0.080 | 0.028 | −0.14 to −0.019 | 658 | 0.014 |
Days per month of binge drinking | +0.0062 | 0.033 | −0.066 to 0.078 | 658 | 0.85 |
Maximum drinks per day | −0.065 | 0.055 | −0.18 to 0.054 | 658 | 0.26 |
Statistical analysis
Analyses were then run using STATA 17 for two scenarios. Alcohol sales and BRFSS data before the onset of the pandemic, January 2017 to February 2020, and after the onset of the pandemic, April 2020 to December 2020, were compared for statistically significant differences with the t statistic on the dependent variable for April 2020 to December 2020, within the following multivariate linear regression:
where Alcohol is a measure of alcohol sales or consumption for state s in month m and year y. Pandemic is a dummy variable that equals zero for January 2017 to February 2020 and one for April 2020 to December 2020. γ and δ are state and year fixed effects, respectively. Robust standard errors are clustered at the state level.
Multivariate linear regressions were then also run with changes in COVID-19 incidence as the independent variable and the dependent variables outlined above, utilizing the time frame of March 2020 to December 2020, using the following equation:
where again Alcohol is a measure of alcohol sales or consumption for state s in month m. δ and θ are state and month fixed effects. Location-invariant differences across months and time-invariant differences across states were controlled for with month and state fixed effects, respectively. Now, COVIDrate is the COVID-19 rate of new cases per 100 individuals. Robust standard errors are clustered at the state level. Statistical significance was placed at p < 0.05.
Results
Changes in alcohol sales and consumption with the onset of the COVID-19 pandemic
Onset of the pandemic was associated with higher monthly alcohol sales per capita of 1.99 standard drinks (95% CI: 0.63–3.34, p = 0.007) (Fig. 1 A, Table 1). This was driven by higher monthly per capita sales of 2.26 standard drinks of spirits (95% CI: 1.19 to 3.32, p < 0.001) (Fig. 1B). Wine sales were not statistically significantly different before and after the onset of the pandemic (0.15 more standard glasses of wine sold monthly per capita, 95% CI: −0.078 to 0.38, p = 0.18) (Fig. 1C). Monthly per capita beer sales decreased by 0.55 standard beers after the onset of the pandemic (95% CI: −0.88 to −0.22, p = 0.004) (Fig. 1D).
Fig. 1.
A) Change in monthly per capita standard drink sales with the onset of the pandemic. B) Change in monthly per capita standard spirits drink sales with the onset of the pandemic. C) Change in monthly per capita standard wine drink sales with the onset of the pandemic. D) Change in monthly per capita standard beer drink sales with the onset of the pandemic. Raw monthly per capita sales figures not adjusted for time-invariant, location-specific effects or location-invariant, time-specific effects.
The pandemic was linked to 0.080 fewer drinks consumed per day (95% CI: −0.14 to −0.019, p = 0.014) (Table 1). However, there was no statistically significant change in days per month of alcohol use, days per month of binge drinking, or maximum drinks per day after the pandemic started (0.36 more days per month with alcohol use, 95% CI −0.0086 to 0.72, p = 0.55; 0.062 days more per month of binge drinking, 95% CI: −0.066 to 0.078, p = 0.85; 0.065 fewer maximum drinks per day, 95% CI: −0.18 to 0.054, p = 0.26).
Changes in alcohol sales and consumption with increases in COVID-19 incidence
The effect of increases in COVID-19 incidence was then assessed on both alcohol sales and drinking behavior (Table 2 ). An increase in one case of COVID-19 per 100 was associated with 2.98 fewer standard drinks sold monthly per capita (95% CI: −4.47 to −1.48, p = 0.001) (Fig. 2 ). The decrease in alcohol sales was driven by lower spirit and beer sales (1.13 fewer standard drinks of spirits sold monthly per capita per additional COVID-19 case per 100, 95% CI: −1.93 to −0.33, p = 0.01; 1.84 fewer standard beers sold monthly per capita per additional case per 100 of COVID-19, 95% CI: −2.51 to −1.17, p < 0.001). Wine sales remained unaffected by changes in COVID−19 incidence (0.15 fewer glasses of wine sold monthly per capita per additional case per 100 of COVID-19, 95% CI: −0.50 to 0.19, p = 0.35).
Table 2.
Changes in alcohol consumption with each additional case of COVID-19 per 100.
Alcohol Sales (14 states) | Coefficient | Std. error | 95% CI | Observations | p value |
---|---|---|---|---|---|
Ethanol Sales (Std. Drinks) | −2.98 | 0.69 | −4.47 to −1.48 | 140 | 0.001 |
Spirits Sales (Std. Drinks) | −1.13 | 0.37 | −1.93 to −0.33 | 140 | 0.01 |
Wine Sales (Std. Drinks) | −0.15 | 0.16 | −0.50 to 0.19 | 140 | 0.35 |
Beer Sales (Std. Drinks) |
−1.84 |
0.31 |
−2.51 to −1.17 |
140 |
<0.001 |
Alcohol Consumption Patterns (14 states) |
Coefficient |
Std. error |
95% CI |
Observations |
p value |
Days per month with alcohol use | −0.17 | 0.067 | −0.31 to −0.23 | 140 | 0.026 |
Average drinks per day | −0.081 | 0.037 | −0.16 to −0.0005 | 140 | 0.049 |
Days per month of binge drinking | −0.14 | 0.041 | −0.23 to −0.052 | 140 | <0.001 |
Maximum drinks per day | −0.20 | 0.036 | −0.28 to −0.11 | 140 | <0.001 |
Fig. 2.
Change in monthly per capita standard drink sales with each additional COVID-19 case per 100.
Alcohol consumption showed statistically significant decreases for all metrics with increases in COVID-19 incidence. Each additional case of COVID-19 per 100 was linked to 0.17 fewer days per month of alcohol use (95% CI: −0.31 to −0.23, p = 0.026) and 0.081 fewer drinks consumed per day (95% CI: −0.16 to −0.0005, p = 0.049). Binge drinking decreased too, with each additional case of COVID-19 per 100 being associated with 0.14 fewer days per month of binge drinking (95% CI: −0.23 to −0.052, p < 0.001) (Fig. 3 ) and 0.20 fewer maximum drinks per day (95% CI: −0.28 to −0.11, p < 0.001). To further examine the relationship between monthly per capita drink sales and average drinks per day per person, as they should correlate strongly, these were plotted and yielded an increase of 0.005 average drinks per day per person for each additional monthly per capita standard drink sold (95% CI: 0.004 to 0.007, p < 0.001) (Fig. 4 ).
Fig. 3.
Days of binge drinking with each additional case of COVID-19 case per 100.
Fig. 4.
Average drinks per day per person with monthly per capita standard drink sales.
One outlier and one high leverage point were determined to be present in the regression of ethanol sales with COVID-19 increases. When removed, this gives nearly identical results of 3.02 fewer standard drinks sold monthly per capita with each additional case of COVID-19 per 100 (p < 0.01). Two outlier points and one high leverage point were observed in the regression of binge drinking with additional cases of COVID-19 per 100; removing them gives a similar result of 0.11 fewer days per month of binge drinking (p < 0.05).
Discussion
At the onset of the pandemic, lockdowns and social distancing necessitated changes to the way alcohol was previously consumed. Consistent with previous data, we found that overall alcohol sales increased after the onset of the pandemic (Castaldelli-Maia et al., 2021; Lee et al., 2021). We observed an increase in alcohol sales driven by elevated sales of spirits. Conversely, we noted a decrease in beer sales consistent with previous work in Australia that showed decreases in on-premises sale of beer with lockdown restrictions but no change in off-premises beer sales (Vandenberg, Livingston, & O'Brien, 2021). While the NIAAA sales data only report aggregated on-premises and off-premises sales, our work in conjunction with previous work showing a decrease in on-premises sales and increases in off-premises sales in the US after the onset of the pandemic in 2020 indicates this is likely the case (Castaldelli-Maia et al., 2021). Wine sales showed no statistically significant changes after the pandemic's start or with changes in COVID-19 incidence.
The absence of an appreciable change in wine sales was likely driven in part by the demographics of wine consumers. Wine consumers are more likely to be female, 55 and older, with a college degree, and with an income greater than $100,000 annually (Brenan, 2023). At the onset of the pandemic in March 2020, the highest job losses were associated with the lowest wage earners, a sub-set that consumes less wine than their higher wage cohort (Gould & Kandra, 2021). Conversely, beer drinking is most associated with men, 18–34, without college degrees, and with an income less than $40,000, groups that could be at higher risk of job losses with the pandemic itself as well as with changes in employment during the pandemic that could be linked to viral incidence changes (Gould & Kandra, 2021).
Changes in consumption patterns due to COVID-19 have varied based on country. A survey of alcohol users in France, Italy, Spain, and Portugal after the onset of the pandemic noted heterogeneous results by country but some trends toward net decreased spirit and beer consumption and net increased wine consumption (Dubois et al., 2021). A national survey in Poland noted the majority with unchanged alcohol consumption patterns, but net negative consumption for beer, wine, and spirits (Szajnoga et al., 2020). Conversely, a multinational cohort demonstrated similar preferences for unchanged consumption patterns with net increases in wine and spirit consumption, and net decrease in beer consumption. Of note, 71.3% of those surveyed did not change their beer consumption pattern (Agnoli & Charters, 2022).
One systematic review and meta-analysis of 128 studies from 58 countries has shown a nonsignificant change in alcohol consumption with equal numbers (23%) indicating increased and decreased consumption (Acuff, Strickland, Tucker, & Murphy, 2022). Multiple systematic reviews have identified specific risk factors for increased alcohol use, including caregiving responsibilities, stress, depression, and anxiety (Roberts et al., 2021; Schmidt et al., 2021). A different meta-analysis of alcohol use during the COVID-19 pandemic in Europe showed more individuals decreased alcohol use than increased it, and these decreases extended to drinking frequency, quantity consumed, and heavy episodic drinking. However, those with prior high use of alcohol had increased usage (Kilian et al., 2022).
While alcohol sales increased at the onset of the pandemic, this did not neatly translate into increased alcohol consumption, as there was not a statistically significant increase in the days per month where alcohol was consumed, and in fact there was a slight decrease in the average drinks per day consumed. This is different than previous literature that showed increases in alcohol consumption after the onset of the pandemic (Barbosa et al., 2021). However, the majority of the surveys on this topic were conducted in the early months of the pandemic. Our study utilizes alcohol sales and BRFSS data extending through December 2020, allowing analysis of the entirety of 2020 and not solely the start of the pandemic.
That said, this increase in alcohol sales also did not translate to an increase in binge drinking, with no statistically significant change in the days per month of binge drinking or the maximum drinks per day. Previous literature on changes in binge drinking with the pandemic yielded mixed results, with studies reporting lower frequencies of binge drinking in a first-year college student cohort, and two separate cohorts in Japan and the Netherlands after the start of the pandemic (Bonar et al., 2021, Merlo et al., 2022; Stickley, Shirama, Inagawa, & Sumiyoshi, 2022). Conversely, hazardous drinking was elevated in Hubei at the epicenter of the pandemic in March 2020 relative to less affected areas of China at that time (Ahmed et al., 2020). However, given the nature of our analysis, it is possible that a small cohort increased their binge drinking but that this was offset by larger groups decreasing their binge drinking, yielding a net negative decrease. In the Japanese cohort, of the 11.5% who decreased their binge drinking in the pandemic, 65.3% of these were occasional drinkers who stopped drinking altogether (Stickley et al., 2022).
Despite this overall increase in alcohol sales after the pandemic's start, we unexpectedly found lower alcohol sales when COVID-19 rates increased. This was driven by decreases in beer and spirits sales. Wine sales remained unchanged regardless of COVID-19 incidence. This decrease in beer and spirits sales was potentially driven by the decreases in binge drinking that were also associated with higher COVID-19 rates. Previous studies using the 2003 and 2004 BRFSS data indicated that beer is the mostly commonly consumed beverage for binge drinking (67.1%), followed by spirits (21.9%) and wine (10.9%) (Naimi, Brewer, Miller, Okoro, & Mehrotra, 2007). As a result, decreased binge drinking would indeed likely result in fewer purchases of beer and spirits. The small minority of wine binge drinkers was likely insufficient to alter the sales data with decreased binge drinking.
This drop in binge drinking likely stemmed from the fewer opportunities present to drink in bars or together in-person with friends as a result of virus-containment measures triggered by elevated COVID-19 rates. A 2011 study of parenthood and heavy drinking noted that a reduction in drinking occasions at bars resulted in decreased heavy drinking for women, and a reduction in opportunities for drinking with friends decreased heavy drinking for men (Paradis, 2011). Work in New Zealand showed that alcohol outlet density was associated with the quantity of alcohol consumed among teenaged drinkers (Huckle, Huakau, Sweetsur, Huisman, & Casswell, 2008); the closure of bars and in-person drinking opportunities represented an ersatz decrease in alcohol outlet density, also potentially contributing to less heavy drinking. Additional studies have shown that spending time with friends who drink and observing people intoxicated at an event also contribute to increased alcohol consumption (Clapp, Reed, Holmes, Lange, & Voas, 2006; Kuntsche, Kuntsche, Thrul, & Gmel, 2017). The absence of these risk factors with home consumption of alcohol may also have had a potential positive feedback effect, further decreasing binge drinking. This decrease in binge drinking remains critical as binge drinking has also been linked to worse adherence to COVID-19 preventive measures (Stickley et al., 2022).
In addition to alcohol sales and binge drinking decreasing with increased COVID-19 rates, overall drinking decreased too, including both days per month with alcohol use and average drinks per day. Previous research has not examined changes in drinking with variations in COVID-19 incidence, but prior studies have shown average alcohol consumption did not change with the onset of the pandemic, mostly consistent with our results (Callinan et al., 2021). Additionally, partial removal of restrictions on on-premises consumption of alcohol in Australia saw an increase in beer consumption per capita, demonstrating the inverse effect, consistent with our result (Vandenberg et al., 2021). Linking our results to the previously documented downstream effects of increased liver transplants and mortality from alcohol-related disease remains a moving target (Cholankeril et al., 2021; White et al., 2022). Overall increased alcohol sales are potentially the primary driving factor. However, our work has shown no change in days per month with alcohol use or binge drinking, complicating this causal picture.
Our study was limited by the nature of the available data. At the time of data collection, the NIAAA monthly alcohol sales data were only available for 14 states up until June 2021, which we limited up to December 2020 to be consistent with available BRFSS data. While the included states do represent diverse sociocultural American regions and account for 35% of the United States’ population, it is possible, if unlikely, that the excluded states have notably different alcohol sales. In addition, since the data were only granular at the month and state level, it is possible that more nuanced changes in case rates and alcohol sales were occurring on the county or week level. Additionally, the BRFSS data are known to underestimate binge drinking at both the national and state level. However, given that we looked at relative changes, this underestimation should be present in similar levels at all times in the data; given that relative changes were examined, this effect should not affect the outcomes (Boniface, Kneale, & Shelton, 2014; Boniface, Scholes, Shelton, & Connor, 2017). The BRFSS data were limited to 2020 only and as the pandemic matured and evolved into 2021 and 2022, it is possible too that the effect on alcohol consumption changed also. Moreover, vaccination campaigns and shifting comfort with COVID-19 may have altered alcohol consumption patterns over this time-extended time frame.
Strong concerns have been placed on increased alcohol consumption during the pandemic. However, our results indicate that as viral rates climb alcohol consumption decreases including lower alcohol purchases, fewer days per month with alcohol usage, fewer average drinks per day, fewer days per month with binge drinking, and fewer maximum drinks per day. The overall increase in alcohol sales that occurred during the pandemic remains a public health crisis that requires ongoing intervention campaigns to return the health burden to pre-pandemic levels.
Funding
No funding was received for this project.
Authorship statement
LSM and DS conceptualized and designed the study. DS conducted the data analysis. LSM drafted the original manuscript. LSM and DS interpreted the results of the study and approved the final manuscript as submitted.
Disclosures
LSM and DJGS report no conflicts of interest.
Appendix Table 1.
Behavioral risk factor surveillance system questions and variables
Label | Question |
---|---|
Days in past 30 had alcoholic beverage | During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage, or liquor? |
Avg alcoholic drinks per day in past 30 | One drink is equivalent to a 12-ounce beer, a 5-ounce glass of wine, or a drink with one shot of liquor. During the past 30 days, on the days when you drank, about how many drinks did you drink on the average? (A 40-ounce beer would count as 3 drinks, or a cocktail drink with 2 shots would count as 2 drinks.) |
Binge Drinking | Considering all types of alcoholic beverages, how many times during the past 30 days did you have 5 or more drinks for men or 4 or more drinks for women on an occasion? |
Most drinks on single occasion past 30 days | During the past 30 days, what is the largest number of drinks you had on any occasion? |
Acknowledgments
None.
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