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Article History

Received: 26 August 2025

Accepted: 1 August 2026

First Online: 6 August 2026

Declarations

Ethics approval and consent to participate: Not applicable.

Consent for publication: Not applicable.

Competing inerest: The author works as an independent consultant on various research projects undertaken by multiple research institutions and NGOs. At the time this research was conducted, the author had a service agreement as a data scientist with Knowledge-Action-Change (KAC), a UK-based private organization that focuses on harm reduction as a key public health strategy. KAC has over forty years of experience working on drug use, HIV, smoking, sexual health, and prisons.In parallel, the author has a service agreement with the Ukraine-based NGO Healthy Initiatives as an economist. Healthy Initiatives is a non-profit organization aimed at promoting and strengthening public health and well-being, tackling the most urgent questions in need of an answer. The organization supports and implements projects in Eastern Europe and Central Asia to address the growing risks of non-communicable diseases.Both organizations receive grants from Global Action to End Smoking. Global Action to End Smoking, formerly known as Foundation for a Smoke-Free World, is an independent, U.S. nonprofit 501(c)(3) grantmaking organization accelerating science-based efforts worldwide to end the smoking epidemic. Its mission is to end combustible tobacco use, which remains the leading preventable cause of death globally. The organization collaborates with academic and research centers and others to accelerate life-saving research and educational projects. Global Action does not seek or accept funding from companies that produce tobacco or non-medicinal nicotine products.The charitable gift agreement (the “Pledge Agreement”) between the organization and its prior funder, PMI Global Services Inc., was terminated in September 2023. To complement the termination of the Pledge Agreement, the organization’s Board of Directors established a new policy to not accept or seek any tobacco or non-medicinal nicotine industry funding. Global Action to End Smoking’s Certificate of Incorporation states that Global Action was formed to, among other things, “support independent scientific research free from the influence of any commercial entity that may be affected by the research outcome.” Global Action’s organizational documents, including the Certificate of Incorporation and bylaws, are publicly available on its website (www.globalactiontoendsmoking.org) and fully disclosed in public materials.This study was conducted as part of the author’s collaboration with Knowledge-Action-Change. The author declares no financial or non-financial competing interests beyond the affiliations disclosed above.

Use of AI-assisted technologies: The author discloses that AI chatbot ChatGPT was used solely for language editing purposes in the preparation of this manuscript. The model was not used for data analysis, data interpretation, or content generation. All intellectual content, analysis, and conclusions are my own, and I take full responsibility for the integrity and accuracy of the work.