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Article History

Received: 19 September 2024

Accepted: 22 October 2025

First Online: 27 November 2025

Competing interests

: The authors declare no competing interests.

: The study was approved by the Institutional Review Board for the Social and Behavioral Sciences (IRB-SBS) at the University of Virginia (Approval No: Project#2015-0506-00/ Initial Approval Date: January 13, 2016, Revised Approval Date: April 1, 2016, for a protocol amendment). All procedures involving human participants were conducted 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 outlined in the Belmont Report.

: All participants were fully informed about the purpose of the study, the voluntary nature of their participation, their right to withdraw from the study at any time, as well as the procedures for doing so. Information regarding anonymity, confidentiality, data use, potential risks and benefits was clearly informed. Data collection took place between May 1, 2016 and May 29, 2016. Written consent and assent were obtained electronically from both parents and students during this period. To obtain consent, the first author sent emails to the parents of students. Parents who agreed to their child’s participation provided an electronic signature and were then instructed to allow their child to participate in the survey on their computers.