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Article History

Received: 13 September 2023

Accepted: 18 June 2025

First Online: 30 July 2025

Competing interests

: The authors declare no competing interests.

: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study utilized secondary data from the Behavioral Risk Factor Surveillance System (BRFSS), which is publicly available and exempt from institutional review board approval as it contains de-identified data collected by the Centers for Disease Control and Prevention.

: This article utilized secondary analysis of publicly available, de-identified data from the Behavioral Risk Factor Surveillance System (BRFSS). The original data collection by the Centers for Disease Control and Prevention included appropriate informed consent procedures for all participants. No additional informed consent was required for this secondary analysis.