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Article History

Received: 19 May 2026

Accepted: 23 August 2026

First Online: 28 August 2026

Declarations

Ethics approval and consent to participate: The study protocol received ethical approval from three institutional review boards: the Institutional Review Board for Research Ethics at the University of Klagenfurt (approval number 2023-013), the Ethical Commission for Human Research of the Medical Faculty at Ss. Cyril and Methodius University in Skopje (approval number 03-2144/4), and the National Committee of Ethical Expertise for Clinical Trials of the Ministry of Health of the Republic of Moldova (approval number 1476). All procedures were conducted in accordance with the ethical standards outlined in the Declaration of Helsinki as well as applicable national regulations. The study involved adolescents between 10 and 14 years of age. Prior to participation, written informed consent was obtained from caregivers for all adolescents. Additional assent and consent procedures differed according to national requirements. In Moldova, all participating adolescents provided written assent. In North Macedonia, adolescents aged 10–13 years provided assent, whereas 14-year-old participants provided written informed consent themselves, in line with local ethical regulations.

Consent for publication: Not applicable.

Competing interests: The authors declare no competing interests.