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Article History

Received: 30 December 2024

Accepted: 2 September 2025

First Online: 1 October 2025

Competing interests

: The authors declare no competing interests.

: This study was conducted in accordance with the ethical standards of the Texas A&M University–Corpus Christi Institutional Review Board (TAMU-CC IRB) and the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was reviewed and granted exemption from full ethics review by the TAMU-CC IRB on February 24, 2025 (IRB Protocol Number: TAMU-CC-IRB-2024-1119). The project qualified for exemption under Category 4 of 45 CFR §46.104(d)(4), as it involved secondary research using previously collected identifiable private information, which was subsequently de-identified prior to analysis. The original data were collected as part of an internal program evaluation initiative. The current research team accessed only de-identified datasets for the purposes of secondary analysis. No re-identification or participant contact occurred during the study. This research received no specific grant or funding from any funding agency in the public, commercial, or not-for-profit sectors. Documentation of the exemption is on file and available upon request.

: The requirement for informed consent was formally waived by the Texas A&M University–Corpus Christi Institutional Review Board (TAMU-CC IRB) under IRB Protocol Number TAMU-CC-IRB-2024-1119. The waiver was granted on the basis that the data were originally collected for internal program evaluation and quality improvement, not for research. For the purposes of this study, only de-identified data were analyzed. No identifiable private information was used, and participants were neither contacted nor re-identified at any stage. The IRB determined that the study met the criteria for exemption under federal regulations for exempt research (45 CFR §46.104(d)(4)). Written documentation of the waiver is on file and available upon request.