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Article History

Received: 21 May 2026

Accepted: 25 September 2026

First Online: 30 September 2026

Declarations

Ethics approval and consent to participate: Not applicable. This study used only publicly available, de-identified secondary data (2023 BRFSS) and did not involve direct contact with human participants. Per Saint Louis University IRB policy, analysis of publicly available, de-identified data does not constitute human subjects research and does not require IRB review. Not applicable. This study used only publicly available, de-identified secondary data (2023 BRFSS) and did not involve direct contact with human participants.

Consent for publication: Not applicable. This study used only publicly available, de-identified secondary data (2023 BRFSS) and did not include details, images, or videos relating to an individual person.

Competing interests: The authors declare no competing interests.