International Journal of

Environmental Research
and Public Health

Article
The Effects of School Climate, Parent–Child Closeness,
and Peer Relations on the Problematic Internet Use of Chinese
Adolescents: Testing the Mediating Role of Self-Esteem
and Depression
Hua Wang

School of Sociology and Population Studies, Nanjing University of Posts and Telecommunications,
Nanjing 210023, China; [email protected]; Tel.: +86-13913037273

Abstract: Although previous research has investigated the associations among family factors, school
factors, peer factors, and problematic Internet use, its causal direction has not been verified, par-
ticularly in the Chinese context. Using school-based data, this study aims to explore the possible
causal direction among school climate, parent–child closeness, peer relations, and the problematic
Internet use of Chinese adolescents. Nine hundred and sixty students in junior and senior high
schools participated in a questionnaire survey. The results showed that parent–child closeness, school
climate, and peer relations had a significantly direct effect on the problematic Internet use of Chinese
adolescents. Meanwhile, the effects of parent–child closeness, school climate, and peer relations
on problematic Internet use were mediated by self-esteem and depression. Implications are also
discussed to prevent the problematic Internet use of adolescents.

Citation: Wang, H. The Effects of

Keywords: school climate; parent–child closeness; peer relations; problematic internet use; adoles-
School Climate, Parent–Child
cents
Closeness, and Peer Relations on the
Problematic Internet Use of Chinese
Adolescents: Testing the Mediating
Role of Self-Esteem and Depression.
1. Introduction
Int. J. Environ. Res. Public Health 2022,
19, 7583. https://doi.org/10.3390/ An increasing number of people use the Internet for daily work, socialization, and
ijerph19137583 entertainment in the digital era. At the end of 2021, the worldwide Internet penetration
rate is 59.5%, and Internet users have reached approximately 4.66 billion worldwide, up by
Academic Editors: Shan Jiang and
7.3% from the previous year [1]. In China, according to the China Internet Development
Chunkai Li
Report (2021), the Internet penetration rate has reached 70.4%, and the number of Internet
Received: 12 May 2022 users reached 989 million by the end of 2020. Among them are approximately 180 million
Accepted: 18 June 2022 youngsters under 18 years old, accounting for 18.3% of total Internet users [2]. These data
Published: 21 June 2022 show that the Internet has become an indispensable tool for Chinese adolescents. However,
compared with the overall global rate of 6%, the prevalence of Internet addiction among
Publisher’s Note: MDPI stays neutral
with regard to jurisdictional claims in
Chinese adolescents is approximately 10.4%, which is much higher than that of adolescents
published maps and institutional affil-
in other countries [3]. Problematic Internet use has been labeled as computer addiction,
iations.
Internet addiction, pathological Internet use, and Internet dependence in previous research.
Problematic Internet use was defined as “use of the Internet that creates psychological,
social, school and/or work difficulties in an individual’s life” [4]. Previous studies have
suggested that generalized and compulsive Internet use leads to loss of control and other
Copyright: © 2022 by the author. negative consequences, such as dissatisfactory school performance or physical and psycho-
Licensee MDPI, Basel, Switzerland. logical problems for adolescents [5]. With this background, this study aims to investigate
This article is an open access article the influencing factors and mechanisms of problematic Internet use among adolescents in
distributed under the terms and Mainland China. Empirical evidence is provided for social policy, psychological counseling,
conditions of the Creative Commons and social work interventions to promote the physical and the psychological development
Attribution (CC BY) license (https:// of Chinese adolescents.
creativecommons.org/licenses/by/
4.0/).

Int. J. Environ. Res. Public Health 2022, 19, 7583. https://doi.org/10.3390/ijerph19137583 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022, 19, 7583 2 of 11

2. Literature Review
2.1. School Climate, Parent–Child Closeness, and Peer Relations on Problematic Internet Use
2.1.1. School Climate and Problematic Internet Use
The school climate covers multidimensional factors, such as school values, school
culture, teaching quality, interpersonal relationships, and school safety [6,7]. A positive
school climate can provide adolescents with a safe, cohesive, and harmonious environment,
which has a positive effect on adolescents’ academic outcomes [8], sense of school belong-
ing [9], pro-social behaviors [10], and moral identity [11]. Conversely, a poor school climate
may exert negative influences on adolescents’ behavioral and mental development, such
as school bullying, problematic Internet use, and depression [12]. Authoritative school
climate theory suggests that strict school rules and an emphasis on academics can foster
discipline and learning habits, which can prevent students from engaging in unhealthy
behaviors [13]. From the development perspective, the positive youth development model
suggests that school climate has a positive impact on adolescents’ personality, potential,
and self-awareness [14], as well as reducing the probability of adolescents’ problematic
Internet use [15,16]. Several empirical studies show that a positive school climate can
promote corrective Internet use among adolescents [17]. Conversely, a negative school
climate may lead to problematic Internet use [18], including cyberbullying [19] and gaming
addiction [20]. Moreover, school types [21] and stress from the school environment [22] are
also significantly and positively related to adolescents’ problematic Internet use.

2.1.2. Parent–Child Closeness and Problematic Internet Use

For adolescents, a high-quality family environment contributes to their healthy de-
velopment. Parent–child closeness is particularly important for adolescents’ development
because in the family context, parents take care of their children for a long time [23]. Parent–
child closeness refers to the long-term interaction and connection between parents and their
children, covering aspects such as parenting styles, family member relationships, family
values, and quality of communication [24,25]. According to attachment theory, high-quality
parent–child interactions can positively influence children’s physical, emotional, and social
development in [26,27]. Proper ways of communication from parents, including patiently
listening to children’s ideas, encouraging children to participate in family discussions, and
creating a warm family atmosphere, can reduce their children’s fear of missing out and
problematic Internet use [28]. Conversely, parents’ punishment and monitoring inevitably
lead to children’s insecurity, social fear, and antisocial behaviors [29,30]. Empirical studies
have shown that adolescents’ problematic Internet use is caused by limited communication
with parents, limited emotional attachment to parents, and poor parenting quality [31,32].
Low quality parent–child relationships is verified to be a main cause of adolescents’ prob-
lematic Internet use. In addition, these negative effects are more pronounced for adolescents
with low self-control [33].

2.1.3. Peer Relations and Problematic Internet Use

Adolescence is an important transitional period between childhood and adulthood.
Social learning theory is often used to explain the correlations between adolescents’ in-
teractions with peers and their behavioral outcomes [34]. The theory argues that peers
serve as one of the most important interaction groups for adolescents. In the Internet
era, adolescents also learn, imitate, and construct Internet use behaviors from interactions
with their peers. Several empirical studies show that peer relations have significant effects
on adolescents’ problematic Internet use [35,36]. In a study comparing high school stu-
dents, girls were found to have much lower problematic Internet use than boys, and peer
relationship is negatively correlated to problematic Internet use [37]. Similarly, insecure
peer attachment relationships tend to elicit a high risk of problematic Internet use among
adolescents [38].
Int. J. Environ. Res. Public Health 2022, 19, 7583 3 of 11

2.2. The Mediating Role of Self-Esteem and Depression

2.2.1. Self-Esteem as a Mediator
Self-esteem is a psychological condition shaped by social experiences, including
concepts of self-worth, acceptance, and identity [39]. Individuals with high self-esteem
may feel positive and confident about themselves. Conversely, individuals with low self-
esteem always feel worthless and insecure, and tend to adopt escapist behaviors, such as
indulging in Internet use to pursue psychological comfort and subjective well-being [40,41].
Based on a sample of American schools, findings suggest that a healthy school climate can
mitigate the effects of self-esteem on problematic Internet use [42]. Similarly, compared with
younger pupils, senior students with more awareness of school climate have more positive
and distinct trajectories of self-esteem development [43]. Thus, low self-esteem predicts
problematic Internet use [44,45]. In other words, adolescents’ problematic Internet use is
often closely related to their self-esteem [46], which can then act as a mediating factor in the
relationship between school disconnectedness and Internet addiction. In a study examining
the effects of parental and peer relationships on adolescents’ self-esteem, the latter did not
mediate the effect of communication with mothers, but it significantly mediated the effect
of peer relations on problematic Internet use [47]. In addition, parental attachment, peer
attachment, and self-esteem are all significantly and positively correlated [48].

2.2.2. Depression as a Mediator

As a common mental disorder, depression is typically characterized by persistent
sadness or negative emotions [49,50], making the individuals lose interest in their daily
lives [51]. Moreover, depression can have long-lasting adverse effects on physical and
behavioral development, such as sleep disturbances, loss of appetite, and distraction [52,53].
The World Health Organization believes that adolescents need to prevent depression by de-
veloping self-capacity, self-confidence, and social relationships [49]. School climate, whether
positive or negative, may directly promote or hinder adolescents’ mental health [54]. For
specific adolescents, the psychological effect of the school climate may be even more sig-
nificant. For example, homeless youth in California are found to have a significantly high
risk of school victimization and a propensity for depression. By contrast, a positive school
climate, particularly teacher encouragement and perceived safety, can be effective in mitigat-
ing depression [55]. Moreover, parent–child closeness and peer relations can directly affect
adolescents’ psychological states. If adolescents have low quality parent–child relationships
and high levels of peer stress, their symptoms of depression increase [56]. Conversely,
adolescents with secure attachments to their parents and high levels of peer support show
fewer depressive symptoms [57]. Female students with depression also have a high risk of
problematic Internet use [58]. However, in Minnesota, the relationship between depression
and problematic Internet use for students shows no significant difference [59]. Therefore,
more empirical studies are needed to further validate this mechanism.

2.3. The Present Study

Based on the theories and the empirical evidence, this study aims to explore the
possible causal direction among school climate, parent–child closeness, peer relations, and
the problematic Internet use of Chinese adolescents. Meanwhile, it also investigates the
mediating role of self-esteem and depression on the above mentioned associations. The
proposed hypotheses are as follows:

Hypothesis 1 (H1). School climate, parent–child closeness, peer relations are more likely to affect
the problematic Internet use of Chinese adolescents.

Hypothesis 2 (H2). School climate, parent–child closeness, peer relations would have indirect
effects on the problematic Internet use of Chinese adolescents through the mediating role of self-esteem
and depression.
Int. J. Environ. Res. Public Health 2022, 19, 7583 4 of 11

3. Method
3.1. Participants and Procedures
The data used in this study was obtained by a youth development project in Huai’an
in Mainland China. The following are the steps of the multi-stage cluster random sampling
method. First, three junior high schools and three senior high schools were selected from a
list provided by the educational department using a simple random sample procedure. As
a result, six schools were established. Second, three classes were chosen at random from
each of the schools. As a consequence, 18 classes was obtained. Finally, 60 students who
would take part in the survey were selected using a simple random selection approach. A
total of 1080 people were included in the study.
The study adhered to all research ethics guidelines. We initially asked the selected
students if they would be willing to take part in our questionnaire survey, and then we
declared the confidentiality and authenticity agreement to them. We requested that they
and their guardians sign the consent form if they wished to participate in the study. In
the end, 1039 students and their guardians signed the consent form. We handed out 1039
questionnaires, and they returned 1006 with a response rate of 96.8%. After double-checking
each questionnaires, we were able to collect 960 questionnaires, with a 95.4 percent effective
response rate. Furthermore, the author’s university’s Survey and Behavioral Research
Ethics Committee examined and approved all research tools.

3.2. Measures
3.2.1. Dependent Variables
Problematic Internet use was measured by the problematic social media use (PSMU)
scale adapted from the Bergen Facebook Addiction Scale (BFAS) [60], and it consisted of
seven items on a five-point Likert scale, with “never, seldom, sometimes, often, always”
recorded as “1, 2, 3, 4, 5” points, respectively. “One example in this scale is “tried to
cut down on the use of SM without success”. A higher score indicated a higher level of
depression in the subjects. In our research, the Cronbach’s alpha for this scale was 0.818.

3.2.2. Independent Variables

The SCBC [61] was used to assess the school climate, which included readiness to seek
help, aggressive attitudes, and bullying and teasing predominance. The responses ranged
from “strongly disagree = 1” to “strongly agree = 5” for each of the 20 issues. One example
in this scale is “if another student was bullying me, I would tell one of the teachers or staff
at school”. In this investigation, the Cronbach’s alpha was 0.882.
The revised family communication pattern instrument [62] was used to assess parent–
child closeness. This scale was divided in social and concept orientation. This scale com-
prised 23 items, 5 points for the Likert scale, and ranged from “agree = 1” to “disagree = 5”.
One example in this scale is “my parents often asked my opinion when the family was talk-
ing about something”. A higher score indicated a greater degree of parent–child closeness.
In our investigation, the Cronbach’s alpha for this scale was 0.906.
The peer relationship scale [63] was used to assess peer relationships. It consisted
of 29 components that were divided into four dimensions (intimacy, popularity, trust,
insightfulness). A five-point Likert scale was used to respond, ranging from “strongly
disagree = 1” to “totally agree = 5”. “When I have an issue, I discuss it with my friends,”
for example, is an example item for this scale. A higher score indicated a greater degree of
peer relations. In our investigation, the Cronbach’s alpha for this scale was 0.947.

3.2.3. Mediating Variable

Rosenberg’s Children’s Self-Esteem Scale (CSES) [64] was used to assess self-esteem.
The CSES was a ten-item questionnaire. Each issue was assessed on a 5-point scale, with
1 being the most strongly disagreed with and 5 being the most strongly agreed with. “I
believe I possess a variety of positive attributes,” for example, is one of the scale’s examples.
The results are added together to get a total score ranging from 5 to 50, with higher values
Int. J. Environ. Res. Public Health 2022, 19, 7583 5 of 11

indicating stronger self-esteem. In our investigation, the Cronbach’s alpha for this scale
was 0.896.
Fendrich et al. [65] established the Center for Epidemiologic Studies Depression Scale
for Children (CES-D), which was used to assess depression. The CES-D consisted of a
20-item questionnaire. Each item was scored on a 5-point scale, with 1 being the worst
and 5 being the best. “I didn’t feel like eating, yet I wasn’t too hungry,” for example, is an
example of this scale. The results are added together to get a total score that ranges from 5
to 100, with higher scores indicating more depression. In our investigation, the Cronbach’s
alpha for this scale was 0.910.

3.3. Data Analysis

The data was analyzed using structural equation modeling with Amos 24.0. The
modeling fitness of the structural equation model was evaluated using the three criteria of
χ2 , CFI, and RMSEA in this study. (1) χ2 . The hypothetical model is well matched to the
sample data when the chi-square value is non-significant (p > 0.05) [66]. Due to sample size
sensitivity, it is fairly uncommon for a well-fit hypothesized model to produce a significant
χ2 if the sample size is too big [67]. (2) The Comparative Fit Index (CFI), which indicates a
strong model fit when the value is more than 0.90 [68]. (3) The Root Mean Square Error of
Approximation (RMSEA), with values less than 0.05 indicating a ‘tight match,’ and values
between 0.05 and 0.08 indicating a ‘good fit’ [69].

4. Results
4.1. Descriptive Results
The descriptive statistical results of social demographic variables are presented in
Table 1. The factors are mainly related to gender, grade, age, and household registration.

Table 1. Sociodemographic characteristics (N = 960).

Frequency (N) Percentage (%)

Gender
Male 474 49.4
Female 486 50.6
Grade
Junior high school in grade 1 163 17.0
Junior high school in grade 2 171 17.8
Junior high school in grade 3 148 15.4
Senior high school in grade 1 166 17.3
Senior high school in grade 2 157 16.4
Senior high school in grade 3 155 16.1
Household registration
Rural 84 8.8
Urban 876 91.2
Age Mean = 14.86 S.D. = 1.639

4.2. Correlations
Pearson correlations (Table 2) were conducted in SPSS 24.0. In this study, all the
variables (school climate, parent–child closeness, peer relations, self-esteem, depression,
and problematic Internet use) are correlated with each other at a 0.01 significance level.
Int. J. Environ. Res. Public Health 2022, 19, 7583 6 of 11

Table 2. Pearson correlations among the key variables.

1 2 3 4 5 6
1. Parent–child closeness -
2. School climate 0.348 ** -
3. Peer relations 0.256 ** 0.331 ** -
4. Self-esteem 0.339 ** 0.323 ** 0.443 ** -
5. Depression −0.448 ** −0.339 ** −0.440 ** −0.651 ** -
6. Problematic Internet use −0.313 ** −0.308 ** −0.187 ** −0.402 ** 0.500 ** -
** p < 0.01.

4.3. Measurement Model

The results show that the measurement model provided good fit indices [χ2 (42,
N = 960) = 259.791, p = 0.000, and with CFI = 0.902 > 0.9, RMSEA = 0.055 < 0.08]. The
three latent variables of parent–child closeness, school climate, and peer relations in the
measurement model are well represented by the observed variables (shown in Table 3).

Table 3. Results of measurement model.

Latent Variables Observed Variables β

Social orientation 0.474 ***
Parent–child closeness
Concept orientation 0.563 ***
Willingness to seek help 0.612 ***
School climate Aggressive attitudes 0.567 ***
Prevalence of bullying 0.688 ***
Intimacy 0.765 ***
Popularity 0.820 ***
Peer relation
Trust 0.924 ***
Insightfulness 0.672 ***
*** p < 0.001.

4.4. Structural Model

Based on the total sample, the results showed a good fit to the data [χ2 (66, N = 960) =
307.298, p= 0.000, and with CFI = 0.917 > 0.9, RMSEA = 0.067 < 0.08]. This suggested that
the model was good. Figure 1 demonstrates the paths of this model.

Figure 1. Overall structure equation model (*** p < 0.001; ** p < 0.01).

Figure 1 shows that parent–child closeness (β = −0.348, p < 0.001), school climate
(β = −0.267, p < 0.001), and peer relations (β = −0.204, p < 0.01) have a significantly direct
effect on the problematic Internet use of Chinese adolescents, suggesting that adolescents
Int. J. Environ. Res. Public Health 2022, 19, 7583 7 of 11

with higher levels of parent–child closeness, school climate, and peer relations would have
lower levels of problematic Internet use behaviors.
Figure 1 also shows that the effects of parent–child closeness, school climate, and
peer relations on problematic Internet use are mediated by self-esteem and depression. In
terms of the mediator of self-esteem, higher levels of parent–child closeness (β = 0.574,
p < 0.001), school climate (β = 0.461, p < 0.001), and peer relations (β = 0.215, p < 0.001)
are significantly associated with higher levels of self-esteem, which, in turn, predicts
lower levels of problematic Internet use outcomes (β = −0.109, p < 0.01). In terms of
the mediating effect of depression, higher levels of parent–child closeness (β = −0.462,
p < 0.001), school climate (β = −0.329, p < 0.001), and peer relations (β = −0.178, p < 0.01)
are significantly associated with lower levels of depression, which, in turn, predicts lower
levels of problematic Internet use outcomes (β = 0.371, p < 0.01). Together, the overall
model accounted for 51.8 percent of the explained variance for adolescents’ problematic
Internet use (R2 = 0.518).

5. Discussion
This study aims to investigate the effects of school climate, parent–child closeness, and
peer relations on adolescents’ problematic Internet use. The results show that school climate,
parent–child closeness, and peer relations have significant direct effects on adolescents’
problematic Internet use, and this influencing path is mediated through self-esteem and
depression. All hypotheses are verified in this study.

5.1. The Main Effect Model

This study finds that school climate, parent–child closeness, and peer relations have
significant effects on the problematic Internet use of adolescents, which is consistent
with previous studies indicating such negative effects on adolescents in the Chinese con-
text [15,16,32,35]. The findings also verify the first hypothesis in our study, which suggests
that school climate, parent–child closeness, and peer relations affect the problematic Internet
use of Chinese adolescents. In a negative school climate, adolescents without supervision
usually neglect discipline, which leads to boredom and self-indulgence. These adolescents
often fail to control their behaviors when using the Internet, which in turn creates prob-
lematic habits [16,18]. This result is also consistent with the authoritative school climate
theory [13]. Given the fierce educational competition among Chinese adolescents, middle
schools commonly implement strict discipline to minimize distraction and to keep students
focused on their studies. In addition to the effect of school climate, harmonious parent–
child relationships can also prevent adolescents’ problematic Internet use. A satisfactory
relationship with parents can make adolescents feel safe and give them a sense of belonging,
thus reducing the incidence of delinquent behaviors [28]. The finding also illustrates the
applicability of attachment theory on the explanation of adolescents’ Internet use in the
Chinese context. Adolescents can imitate and influence each other’s behaviors during
their interaction with peers, from where—according to social learning theory—adolescents’
problematic Internet use can also emerge [70]. This study supports the view that high
quality peer relations can reduce the odds of problematic Internet use, negating the finding
that negative peer normative use has no such effect [71]. Therefore, to reduce problematic
Internet use among adolescents, policy makers must pay more attention to school climate,
parent–child closeness, and peer relations. Conducive measures must be developed and
implemented to improve the school climate and to enhance the quality of parent–child
relationships. In addition, social workers must make efforts to help adolescents deal with
peer relations and attempt to help them to improve their positive attitudes to reduce the
risk of problematic Internet use.

5.2. The Mediating Model

The results reveal that self-esteem and depression could mediate the effects of school
climate, parent–child closeness, and peer relations on adolescents’ problematic Internet
Int. J. Environ. Res. Public Health 2022, 19, 7583 8 of 11

use. The findings also verify the second hypothesis in our study, which demonstrates that
school climate, parent–child closeness, and peer relations have indirect effects on the prob-
lematic Internet use of Chinese adolescents through the mediating role of self-esteem and
depression. School climate not only influences adolescents’ learning interest and academic
achievement but also their self-esteem [42]. Adolescents with low self-esteem usually lack
self-confidence, and they tend to indulge in Internet use [44,72]. Moreover, parent–child
closeness can indirectly affect adolescents’ problematic Internet use through the mediating
role of self-esteem [73]. Adolescents spend most of their time in the school context and
thus peer relations naturally become their most important interpersonal relationship. This
study suggests that self-esteem can mediate the association between peer relations and
adolescents’ problematic Internet use. Thus, social workers and counselors can help to
cultivate adolescents’ self-esteem by improving their self-worth and identity to effectively
prevent and to eliminate their problematic Internet use.
The findings suggest that depression can mediate the relationships of school cli-
mate, parent–child closeness, and peer relations on problematic Internet use. This finding
supports most previous empirical studies [55,56], which indicate the mediating effect of
depression. Such negative effects have varying levels of impact on adolescents’ academic
achievement and social behaviors [74]. Especially in terms of problematic Internet use,
depression shows a significant positive correlation [75], which means that adolescents with
depression have a very high risk of problematic Internet use [58]. The results are consistent
with a meta-analysis, which confirms the correlation between problematic Internet use and
depression in adolescents [76]. Adolescents with depression gradually develop negative
attitudes and emotions, and become isolated and disconnected from real life, eventually
becoming addicted to the Internet. Thus, from the perspective of social work interventions,
the present findings can shed new light on prevention and intervention strategies for ado-
lescents’ problematic Internet use [77], advocating for greater focus on programs targeting
depression.

6. Limitations
This study also presents certain limitations. First, we investigated the effects of
school climate, parent–child closeness, and peer relations on adolescents’ problematic
Internet use. The mediating effect of self-esteem and depression was also tested. However,
other potential factors (e.g., self-control, personality traits) may affect these mechanisms.
Therefore, more comprehensive research is necessary to fill the gaps. Second, this study
was carried out with cross-sectional data, which cannot reveal the causal relationship.
Thus, longitudinal studies are needed to analyze the direct and the indirect effects among
variables in this study. Third, the restrictions of the COVID-2019 caused difficulties in
obtaining a nationally representative sample. Thus, data was collected only in Jiangsu
province, which limits the generalization of results to a certain extent.

7. Conclusions
The prevalence of problematic Internet addiction among adolescents is high all over
the world. Based on the authoritative school climate theory, attachment theory, and social
learning theory, this study investigated the associations among school climate, parent–child
closeness, peer relations, and problematic Internet use as well as the mediating role of
self-esteem and depression. Our results showed that parent–child closeness, school climate,
and peer relations had a significantly direct effect on the problematic Internet use of Chinese
adolescents. Meanwhile, the effects of parent–child closeness, school climate, and peer
relations on problematic Internet use were mediated by self-esteem and depression. Based
on the findings, we developed an integrated theoretical framework to explain the causal
relationship among environmental factors, mental health, and problematic Internet use
behaviors. This model can be utilized to explain the influencing mechanism of problematic
Internet use behaviors for youth and adolescent groups. What’s more, this study also shed
Int. J. Environ. Res. Public Health 2022, 19, 7583 9 of 11

light on the prevention and the intervention programs of adolescents’ problematic Internet
use behaviors.

Funding: This research was funded by the key project of philosophy and social science research in
colleges and universities in Jiangsu province (Grant No.: 2021SJZDA038) and the introduced talents
scientific research start-up fund project of Nanjing University of Posts and Telecommunications
(Grant No.: NYY220021).
Institutional Review Board Statement: The study was conducted in accordance with the Declaration
of Helsinki, and it was approved by the Institutional Review Board of Nanjing University of Posts
and Telecommunications.
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement: The data presented in this study are available on request from the
corresponding author.
Conflicts of Interest: The authors declare no conflict of interest.

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