643595

research-article2016
HPQ0010.1177/1359105316643595Journal of Health PsychologyEmanuel et al.

Article

Journal of Health Psychology

Spontaneous self-affirmation is
1­–8
© The Author(s) 2016
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DOI: 10.1177/1359105316643595
well-being: Evidence from a US hpq.sagepub.com

national adult survey sample

Amber S Emanuel1, Jennifer L Howell2,

Jennifer M Taber3, Rebecca A Ferrer3,
William MP Klein3 and Peter R Harris4

Abstract
Emerging evidence suggests that individuals spontaneously self-affirm, by reflecting on values and strengths,
in response to daily threats. We examined the prevalence and demographic and well-being correlates of
spontaneous self-affirmation in the general population. Participants (n = 3185) completed the cross-sectional,
nationally representative 2013 Health Information National Trends Survey (HINTS 4, Cycle 3), and answered
questions about spontaneous self-affirmation, demographic factors, well-being, and affect. The majority of
the population reported spontaneously self-affirming. Black and Hispanic respondents reported engaging in
more spontaneous self-affirmation. Engaging in spontaneous self-affirmation was related to greater happiness,
hopefulness, optimism, subjective health, and personal health efficacy, and less anger and sadness.

Keywords
affect, physical health, self-affirmation, spontaneous self-affirmation, well-being

People are generally motivated to view them- on the “big picture,” and appreciate the context of
selves positively (e.g. as moral, high in self- the threat as well as approach it more effectively
integrity, and competent; Steele, 1988). Threats (Sherman, 2013). This process makes the threat
to these positive self-perceptions are common less psychologically impactful and decreases
and varied, including negative performance defensiveness (Cohen and Sherman, 2014). In
feedback, messages advocating personal behav- most prior work, researchers have experimentally
ior change, or feeling threatened because of
one’s gender or race (i.e. stereotype threat).
1University of Florida, USA
People differ in how they cope with self-threats,
2Ohio University, USA
and the effectiveness of these coping strategies 3National Cancer Institute, USA
has tangible consequences for physical and 4University of Sussex, UK

mental health (Taylor and Broffman, 2011).

Corresponding author:
One coping strategy is self-affirmation, or
Amber S Emanuel, Department of Health Education
focusing on one’s personal values and strengths and Behavior, University of Florida, P.O. Box 118210,
(Steele, 1988). When people self-affirm, they are Gainesville, FL 32611, USA.
reminded of their psychosocial resources, focus Email: [email protected]

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2 Journal of Health Psychology 

induced participants to self-affirm, and these of seeking information about cancer among
induced self-affirmations generally lead to posi- cancer survivors (Taber et al., 2016b). Together,
tive health outcomes (Epton et al., 2014), includ- these findings suggest that spontaneous self-
ing greater acceptance of health messages affirmations are linked to health benefits
(Sherman et al., 2000), increased performance of (although measurement of spontaneous self-
healthy behaviors (Harris et al., 2014), greater affirmation varies across these studies).
weight loss (Logel and Cohen, 2012), reduced To date, there are many unexamined ques-
health information avoidance (Howell and tions concerning spontaneous self-affirmation.
Shepperd, 2012), dampened stress reactivity In this study, we examined two primary ques-
(Creswell et al., 2005), and better psychological tions: (1) Given that spontaneous self-affirma-
well-being (Nelson et al., 2014). tions occur frequently in the general population
Self-affirmations can also occur spontane- (Taber et al., 2016a), are standard demographic
ously. That is, individuals may respond natu- factors (i.e. age, gender, race/ethnicity, and edu-
rally to threat by reflecting on their values or cation) associated with the extent to which peo-
strengths (as opposed to in response to labora- ple spontaneously self-affirm? and (2) Is the
tory or intervention instructions) either in a tendency to spontaneously self-affirm associ-
planned or a less deliberative manner. It is ated with more positive well-being (i.e. positive
largely unknown to what extent people self- affect, greater optimism, health efficacy, and
affirm spontaneously in response to daily subjective health) controlling for demograph-
threats and whether such affirmations lead to ics? We had no predictions about demographic
positive outcomes. Some studies have provided correlates. Most importantly, we expected that
initial evidence that spontaneous self-affirma- spontaneous self-affirmations would be associ-
tion might promote physical and mental health. ated with more positive well-being.
For instance, sports fans who spontaneously
self-affirmed after their favored team lost con-
sumed fewer calories than those who did not Methods
(Cornil and Chandon, 2013), spontaneous self-
affirmation buffered against anticipated nega-
Study design and participants
tive affect in the context of seeking threatening We analyzed data from HINTS 4, Cycle 3 (http://
genomic information (Ferrer et al., 2014), and hints.cancer.gov). Details of the sampling design,
cancer survivors who wrote essays with more methodology, and materials are available at http://
spontaneous self-affirmations reported fewer hints.cancer.gov/docs/HINTS_4_Cycle_3_
physical health symptoms 3 months later Methods_Report_FINAL_508c_03_21_2014.pdf
(Creswell et al., 2007). Two studies have linked and are discussed in prior research (Finney Rutten
spontaneous self-affirmation with increased et al., 2012; Nelson et al., 2004). We summarize
openness to a self-threatening message this information here. Initially, a stratified sample
(Pietersma and Dijkstra, 2012; Townsend and of addresses was selected from a database of a
Sood, 2012). Using a nationally representative random sample of addresses. Sampling frames
data set (the Health Information National included areas with high and low concentrations
Trends Survey (HINTS), the same one used for of minority populations and addresses located in
this study), spontaneous self-affirmation was Central Appalachia. The high-minority stratum
associated with better perceived communica- was over-sampled. The initial sampling included
tion with and quality of care from health care 12,010 possible respondents. Participants received
providers and greater health information seek- four mailings as needed: the initial mailing, a
ing (Taber et al., 2016a), and with lower likeli- reminder postcard, and two follow-up mailings.
hood of cognitive impairment, greater happiness Spanish mailings were sent to households in lin-
and hopefulness, greater self-efficacy for get- guistically isolated areas or with potentially
ting health information, and greater likelihood Hispanic surnames. Mailings included a US $2

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Emanuel et al. 3

incentive to encourage completion, and partici- the two items load highly on their respective
pants were given toll-free numbers to call with subscales and reliability decreases when these
questions. One adult from each sampled house- particular items are omitted (Harris et al., 2016).
hold (with the next birthday) completed the sur- Moreover, a version of this two-item index has
vey. Data collection occurred from September to been used successfully in earlier research exam-
December 2013. Completed surveys were ining spontaneous self-affirmation (Ferrer
returned by 3185 people. The response rate for et al., 2014; Taber et al., 2014). Participants
HINTS 4, Cycle 3 is similar to that of other mailed selected one of four response options: strongly
surveys (Dillman, 2000). We used jackknife repli- agree (1), somewhat agree (2), somewhat disa-
cate sample weights in all analyses to account for gree (3), or strongly disagree (4).
the complex sampling design and to generate sta-
tistical estimates that can be generalized to the Affective states. Using items adapted from
non-institutionalized US adult population (see another national survey (Ryff et al., 2012), par-
hints.cancer.gov for further details on recom- ticipants indicated “how often [they] felt” five
mended statistical approaches). specific emotions (happy, angry, anxious, hope-
The survey was deemed exempt from ful, sad) “in the past 30 days” using five response
Institutional Review Board’s (IRB) review by options: all of the time (1), most of the time (2),
the NIH Office of Human Subjects Research. some of the time (3), a little of the time (4), or
All research was conducted in accordance with none of the time (5).
the principles expressed in the Declaration of
Helsinki. Personal health efficacy. Participants rated their
As noted in the Introduction, the associa- perceived personal health efficacy with the
tions of spontaneous self-affirmation with affect question “Overall, how confident are you about
(i.e. happiness, anger, anxiety, hopefulness, and your ability to take good care of your health?”
sadness) and self-reported health, as well as selecting one of five response options: com-
several measures not examined in this study, pletely confident (1), very confident (2), some-
have been examined elsewhere using a subsam- what confident (3), a little confident (4), or not
ple of the 326 cancer survivors in HINTS 4, at all confident (5).
Cycle 3 (Taber et al., 2016b). The pattern of
results and magnitude of effects reported in this Subjective health. Participants indicated whether
study do not change when excluding the 326 “In general, [they] would say [their] health is
survivors from analyses. We retained survivors …” by selecting one of five options: excellent
in the analyses reported here so that prevalence (1), very good (2), good (3), fair (4), or poor (5).
estimates of spontaneous self-affirmation
would be nationally representative. Optimism. Using a single item from Scheier
et al. (1994), participants indicated their dispo-
sitional optimism on the item “I’m always opti-
Measures mistic about my future” selecting one of four
Spontaneous self-affirmation. Two items meas- response options: strongly agree (1) to strongly
ured the extent to which participants spontane- disagree (4) outlined earlier. Although opti-
ously self-affirmed (“When I feel threatened or mism is dispositional, it is also an indicator of
anxious I find myself thinking about my values psychological well-being.
[strengths]”; r = 0.69, p < 0.001). These items
were summed and averaged to form the two- Sociodemographic factors. Participants indicated
item index. These items were taken from a their age, gender, race/ethnicity, and education.
longer scale currently in development. The We collapsed race/ethnicity responses into four
longer scale includes two key subscales assess- categories (White/Black/Hispanic/Other). We
ing strengths and values with high reliability; used a three-level indicator (less than high

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4 Journal of Health Psychology 

school, high school or some college, college responses for affirmation of values was
graduate or post-baccalaureate) for education 17.9 percent strongly agree, 48.2 percent some-
(Almeida et al., 2005). what agree, 22.2 percent somewhat disagree,
and 11.8 percent strongly disagree. For affirma-
tion of strengths, the distribution was 20.5 per-
Analysis
cent strongly agree, 48.1 percent somewhat
First, to test the association between demo- agree, 19.2 percent somewhat disagree, and
graphic factors and spontaneous self-affirmation, 12.2 percent strongly disagree.
we conducted weighted linear regressions using Age, gender, race/ethnicity, and education
spontaneous self-affirmations as the outcome were simultaneously entered as predictors of
and demographic items (i.e. age, gender, race/ self-affirmation in a linear regression. Older
ethnicity, and education) simultaneously entered individuals were more likely than younger indi-
as predictors. To answer our second question, we viduals to spontaneously self-affirm, b = 0.003,
conducted separate weighted linear regressions standard error (SE) = 0.002, t = 2.06, p = 0.045,
using spontaneous self-affirmation as the predic- r = 0.28. Race was also significantly associated
tor and well-being variables as the outcome vari- with affirmation such that Black (M = 2.90,
ables, controlling for sociodemographic factors. SD = 0.42, b = 0.23, SE = 0.06, t = 3.43,
Finally, we computed the overall meta-analytic p = < 0.01, r = 0.44) and Hispanic (M = 2.93,
association between affirmation and well-being SD = 0.35, b = 0.26, SE = 0.06, t = 4.23,
outcomes. All analyses were completed using p = < 0.01, r = 0.52) respondents were more
Stata 13. All outcome variables were normally likely to spontaneously self-affirm than were
distributed. We reverse-coded items so that White respondents (M = 2.67, SD = 0.21).
higher values indicated higher levels of the con- Gender and education were not significantly
struct. We used p < 0.05 as a guideline for statis- associated with spontaneous self-affirmation.
tical significance. In sum, older individuals and ethnic minorities
were most likely to spontaneously self-affirm.
Results
The sample was primarily White (66.69%; Psychological well-being and
14.27% Black, 11.92% Hispanic, 7.12% other) affirmation
with a mean age of 47.12 years (standard devia- People who were more likely to spontaneously
tion (SD) = 1.13). Approximately half were men self-affirm reported more positive and less
(48.39%) and most had an educational level of negative affect including greater happiness,
high school or some college (57.12%) or college b = 0.14, 95% confidence interval (CI) = [0.08,
graduate or post-baccalaureate degree (33.21%; 0.22], SE = 0.03, t = 4.28, rpartial = 0.52,
9.67% had less than high school education). p < 0.01; greater hopefulness, b = 0.39, 95%
CI = [0.31, 0.48], SE = 0.04, t = 9.39,
Spontaneous self-affirmation: rpartial = 0.80, p < 0.01; less sadness, b = −0.09,
prevalence and demographic 95% CI = [−0.15, −0.03], SE = 0.03, t = −2.97,
rpartial = 0.39, p = 0.01; and less anger, b = −0.10,
correlates 95% CI = [−0.16, −0.05], SE = 0.03, t = −3.86,
Overall, people indicated a relatively high rpartial = 0.48, p < 0.01. Individuals high in
degree of spontaneous self-affirmation spontaneous self-affirmation also tended to be
(M = 2.74 out of 4, SD = 0.14), with 76 percent more dispositionally optimistic, b = 0.40, 95%
agreeing on at least one item, suggesting the CI = [0.07, 0.21], SE = 0.03, t = 12.11,
majority of the population spontaneously self- rpartial = 0.86, p < 0.01. Spontaneous self-
affirms (Taber et al., 2016a). The distribution of affirmation was unrelated to anxiety, b = −0.07,

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Emanuel et al. 5

Figure 1. Correlation of self-affirmation with facets of well-being.

*The overall effect was computed using the absolute value of negative associations.

95% CI = [−0.16, −0.02], SE = 0.04, t = −1.59, sample size weighted, correlation of absolute
rpartial = 0.22, p = 0.12. rpartial = 0.53, 95% CI = [0.46, 0.60]. Notably,
Participants reporting higher self-affirma- the relationship between affirmation and men-
tion tendencies also reported greater personal tal health was significantly larger among facets
health efficacy, b = 0.15, 95% CI = [0.08, 0.24], of positive well-being (e.g. optimism, happi-
SE = 0.04, t = 3.96, rpartial = 0.49, p < 0.01, and ness, and efficacy), rpartial = 0.62, 95%
better subjective health, b = 0.09, 95% CI = [0.54, 0.69], than among negative well-
CI = [0.02, 0.16], SE = 0.03, t = 2.68, being (e.g. sadness, anger), rpartial = −0.35, 95%
rpartial = 0.35, p = 0.01. In sum, across seven of CI = [−0.48, −0.20].
eight predictors spontaneous self-affirmation
was associated with more positive psychologi-
Discussion
cal well-being, controlling for demographics.
Figure 1 presents a forest plot of the partial Spontaneous self-affirmation was associated
correlations and 95% CI between affirmation with better mental and physical well-being
and each measure of well-being, and the over- including greater happiness, hopefulness, opti-
all meta-analytic association among affirma- mism, personal health efficacy, and subjective
tion and well-being outcomes. An examination health, and less sadness and anger.
of the weighted partial correlations between This is the first study to assess the frequency
affirmation and the constructs of psychological and mental health correlates of spontaneous self-
well-being presented in the forest plot sug- affirmation in a large, national sample. Older
gested that the size of the effects of affirmation adults were higher in spontaneous self-affirmation
ranged from rpartial = 0.86 (the correlation with tendencies, as were Blacks and Hispanics com-
optimism) to rpartial = −0.22 (the correlation pared to Whites. Education and gender were unre-
with anxiety) and culminated in an average, lated to spontaneous self-affirmation. Although

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6 Journal of Health Psychology 

we did not have firm a priori predictions about be interpreted with caution and be replicated
demographic correlates, the pattern of results is using multi-item, psychometrically validated,
consistent both with evidence suggesting that stig- measures of our constructs.
matized individuals (e.g. older people and racial One possible explanation for our results is
minorities) may be better at managing threats to that people who spontaneously self-affirm may
the self (Crocker and Major, 1989). also hold more positive self-concepts. However,
The present research links prior work sug- recent research has shown that people low in
gesting that self-affirmation is an effective psy- self-esteem benefit more from a self-affirmation
chological threat-management strategy (Sherman manipulation than do individuals high in self-
and Cohen, 2006) with work suggesting that bet- esteem (Düring and Jessop, 2014), suggesting
ter psychological-threat management improves that the relationship between self-affirmation
well-being (Taylor and Broffman, 2011) and and self-esteem may be complex. Also, in previ-
establishes a more direct association between ous research, correlations between the two spon-
spontaneous self-affirmation and well-being. taneous self-affirmation items and the Rosenberg
Moreover, the present work adds to a growing Self-Esteem Scale (Rosenberg, 1965) were sig-
body of literature examining the effects of spon- nificant but modest (r = 0.27) (Harris et al.,
taneous affirmations (e.g. Toma and Hancock, 2016). Thus, self-affirmation does not appear to
2013), suggesting that affirmations occur with- be simply a proxy for self-esteem.
out researcher prompting. Future research might examine differences
Although these results are promising, the and similarities between spontaneous and
cross-sectional design prevents us from con- manipulated self-affirmations. Because sponta-
cluding that there is a temporal, causal effect neous self-affirmations are employed at the
between spontaneous self-affirmation and well- exact moment of threat, they may be more pow-
being. Induced self-affirmations have been erful than manipulated self-affirmations when
linked to increased well-being for up to 4 weeks such inductions are unable to be ideally timed.
(Nelson et al., 2014) and to increased other- Whether spontaneous self-affirmation leads to
directed positive affect (Crocker et al., 2008), better physiological health outcomes is also
providing support for such a causal relation- unknown. Future research is also needed to test
ship. Nevertheless, it is also possible that whether spontaneous self-affirmation is unique
greater levels of well-being allow people to from other psychological resources such as
spontaneously self-affirm. This may be espe- resilience and trait self-esteem.
cially true for optimism, which is regarded as a
trait and therefore may increase the propensity Declaration of conflicting interests
to spontaneously self-affirm. Consistent with The author(s) declared no potential conflicts of inter-
this idea, research suggests that people in nega- est with respect to the research, authorship, and/or
tive moods benefit less from induced self-affir- publication of this article.
mation (Ferrer et al., 2012) and studies suggest
that induced self-affirmation does not influence Funding
general positive affect (Harris and Napper, The author(s) received no financial support for the
2005). As such, future research should more research, authorship, and/or publication of this
directly examine the direction of the association article.
between spontaneous self-affirmation and
well-being. References
Another limitation is the use of several one- Almeida DM, Neupert SD, Banks SR, et al. (2005)
or two-item measures, as is common in national Do daily stress processes account for socio-
surveys limited in space. Although we do not economic health disparities? Journals of
suspect that an investigation using more items Gerontology Series B: Psychological Sciences
would yield different results, the results should and Social Sciences 60: S34–S39.

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Emanuel et al. 7

Cohen GL and Sherman DK (2014) The psychol- information. Personality and Social Psychology
ogy of change: Self-affirmation and social Bulletin 31: 1250–1263.
psychological intervention. Annual Review of Harris PR, Brearley I, Sheeran P, et al. (2014)
Psychology 65: 333–371. Combining self-affirmation with implementa-
Cornil Y and Chandon P (2013) From fan to fat? tion intentions to promote fruit and vegetable
Vicarious losing increases unhealthy eating, consumption. Health Psychology 33: 729–736.
but self-affirmation is an effective remedy. Harris PR, Napper L, Griffin DW, et al. (2016)
Psychological Science 24: 1936–1946. Developing a measure of spontaneous self-
Creswell JD, Lam S, Stanton AL, et al. (2007) Does affirmation. Manuscript in Preparation.
self-affirmation, cognitive processing, or dis- Howell JL and Shepperd JA (2012) Reducing
covery of meaning explain cancer-related health information avoidance through affirmation.
benefits of expressive writing? Personality and Psychological Science 23: 141–145.
Social Psychology Bulletin 33: 238–250. Logel C and Cohen GL (2012) The role of the self
Creswell JD, Welch WT, Taylor SE, et al. (2005) in physical health testing the effect of a val-
Affirmation of personal values buffers neu- ues-affirmation intervention on weight loss.
roendocrine and psychological stress responses. Psychological Science 23: 53–55.
Psychological Science 16: 846–851. Nelson DE, Kreps GL, Hesse BW, et al. (2004)
Crocker J and Major B (1989) Social stigma and The health information national trends survey
self-esteem: The self-protective properties of (HINTS): Development; design, and dissemi-
stigma. Psychological Review 96: 608–630. nation. Journal of Health Communication 9:
Crocker J, Niiya Y and Mischkowski D (2008) Why 443–460.
does writing about important values reduce Nelson SK, Fuller JA, Choi I, et al. (2014) Beyond
defensiveness? Self-affirmation and the role of self-protection: Self-affirmation benefits
positive other-directed feelings. Psychological hedonic and eudaimonic well-being. Personality
Science 19: 740–747. and Social Psychology Bulletin 40: 998–1011.
Dillman DA (2000) Mail and Internet Surveys: The Pietersma S and Dijkstra A (2012) Cognitive self-
Tailored Design Method, vol. 2. New York: affirmation inclination: An individual differ-
Wiley. ence in dealing with self-threats. British Journal
Düring C and Jessop DC (2014) The moderat- of Social Psychology 51: 33–51.
ing impact of self-esteem on self-affirmation Rosenberg M (1965) Society and the adolescent self-
effects. British Journal of Health Psychology image. Princeton, NJ: Princeton Univeristy.
20: 274–289. Ryff C, David M, Almeida J, et al. (2012)
Epton T, Harris PR, Kane R, et al. (2014) The impact National Survey of Midlife Development in
of self-affirmation on health-behavior change: A the United States (MIDUS II), 2004–2006
meta-analysis. Health Psychology 34: 187–196. (CPSR04652-v6). Ann Arbor, MI: Inter-
Ferrer RA, Shmueli D, Bergman HE, et al. (2012) University Consortium for Political and Social
Effects of self-affirmation on implementation Research.
intentions and the moderating role of affect. Scheier MF, Carver CS and Bridges MW (1994)
Social Psychological and Personality Science Distinguishing optimism from neuroticism (and
3: 300–307. trait anxiety, self-mastery, and self-esteem): A
Ferrer RA, Taber JM, Klein WM, et al. (2014) The reevaluation of the life orientation test. Journal
role of current affect, anticipated affect and of Personality and Social Psychology 67: 1063–
spontaneous self-affirmation in decisions to 1078.
receive self-threatening genetic risk informa- Sherman DK (2013) Self-affirmation: Understanding
tion. Cognition & Emotion 29: 1456–1465. the effects. Social and Personality Psychology
Finney Rutten LJ, Davis T, Beckjord EB, et al. Compass 7: 834–845.
(2012) Picking up the pace: Changes in method Sherman DK and Cohen GL (2006) The psychol-
and frame for the health information national ogy of self-defense: Self-affirmation theory.
trends survey (2011–2014). Journal of Health Advances in Experimental Social Psychology
Communication 17: 979–989. 38: 183–242.
Harris PR and Napper L (2005) Self-affirmation and Sherman DK, Nelson LD and Steele CM (2000) Do
the biased processing of threatening health-risk messages about health risks threaten the self?

Downloaded from hpq.sagepub.com at TEXAS SOUTHERN UNIVERSITY on May 31, 2016

8 Journal of Health Psychology 

Increasing the acceptance of threatening health Taber JM, Klein WMP, Ferrer RA, et al. (2016b)
messages via self-affirmation. Personality and Optimism and spontaneous self-affirmation
Social Psychology Bulletin 26: 1046–1058. are associated with lower likelihood of cog-
Steele CM (1988) The psychology of self-affirmation: nitive impairment and greater positive affect
Sustaining the integrity of the self. Advances in among cancer survivors. Annals of Behavioral
Experimental Social Psychology 21: 261–302. Medicine 50: 198-209.
Taber JM, Howell J, Emanuel A, et al. (2016a) Taylor SE and Broffman JI (2011) Psychosocial
Associations of spontaneous self-affirmation resources: Functions, origins, and links to
with health care experiences and health infor- mental and physical health. Advances in
mation seeking in a national survey of US Experimental Social Psychology 44: 1–57.
adults. Psychology & Health 31: 292–309. Toma CL and Hancock JT (2013) Self-affirmation
Taber JM, Klein WM, Ferrer RA, et al. (2014) underlies Facebook use. Personality and Social
Information avoidance tendencies, spontane- Psychology Bulletin 39: 321–331.
ous self-affirmation, and interest in genetic Townsend C and Sood S (2012) Self-affirmation
sequencing feedback. Annals of Behavioral through the choice of highly aesthetic products.
Medicine 49: 616–621. Journal of Consumer Research 39: 415–428.

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