Abstract
Background:
In 2023, the state of Texas, USA passed House Bill 114, which mandatorily placed students found using e-cigarettes on public school premises in an off-campus Disciplinary Alternative Education Program (DAEP). We examined adolescents’ awareness and support of the DAEP policy and factors associated with policy support.
Methods:
We surveyed adolescents attending Texas public schools (N = 500). A generalized linear model examined factors associated with policy support.
Results:
Less than half of the students (41%) were aware of the policy, 38% deemed the policy as effective, and 28% perceived no change in e-cigarette use. Students were generally supportive of the policy (M = 3.51, range: 1–5). Lower support was associated with current nicotine e-cigarette use, low harm perception of tetrahydrocannabinol (THC) e-cigarettes, perceptions of peer approval, perceptions of e-cigarette use not being a problem in school, being unsure if e-cigarette use was a problem in school, and perceptions that the policy was not effective or uncertainty about its effectiveness. Adolescents who were older and identified as non-heterosexual also expressed lower policy support. Students reported the need for more e-cigarette education resources.
Conclusion:
Future efforts should assess policy effectiveness and continue providing e-cigarette prevention and cessation education focusing on e-cigarette health harm and dependency risks.
Introduction
Electronic cigarettes (e-cigarettes) are electronic nicotine delivery systems that produce an inhalable aerosol by heating a glycol–glycerin solution, potentially infused with flavours and an active substance such as nicotine or tetrahydrocannabinol (THC). Nationally, 5.9% of middle and high school students in the USA report currently using e-cigarettes (Jamal et al., 2024). Although e-cigarettes may be used to help smokers quit smoking cigarettes (Kasza et al., 2021), their use among adolescents is harmful, especially among those who have never used any tobacco or are not using e-cigarettes to quit. E-cigarette use puts adolescents at significant risk of nicotine dependency, cardiovascular diseases, exposure to toxic chemicals, and interferes with brain development (National Academies of Sciences, Engineering, and Medicine, 2018; U.S. Department of Health and Human Services, 2022). Moreover, there are concerns that people who use e-cigarettes may start smoking conventional cigarettes (Berry et al., 2019). Therefore, it is important to discourage adolescent e-cigarette use. Reducing e-cigarette uptake among adolescents is also reflected in the latest tobacco guidelines from the World Health Organization.
Effective legislation (e.g. flavour bans, Tobacco 21) (Pastrana et al., 2023; U.S. Food and Drug Administration, 2019) is important in regulating e-cigarette marketing and discouraging use. Research has shown that the adoption of these polices is associated with a decrease in e-cigarette use or susceptibility to use (Friedman et al., 2024; Hansen et al., 2023). In addition to e-cigarette marketing rules and age restrictions on purchasing, the school environment and policies play an important role in determining the extent of e-cigarette use (Thomas, 2021). US Adolescents have reported that e-cigarette use is common in schools (e.g. in toilets/bathrooms, locker rooms) (Dai, 2021). Schools across the USA are taking various measures to prohibit e-cigarette use in school, including detention, school suspension, or confiscating vapes (Cruz, 2023; Minnesota Department of Health, 2023).
In 2023, 7.4% of middle and high school students in the state of Texas reported using e-cigarettes in the past 30 days (Texas Department of State Health Services, 2024). To discourage vaping among youth, the state of Texas enacted the Texas House Bill 114 (HB 114) in public school districts on 1 September 2023 (Texas Legislature Online, 2023). Under this Bill, students found possessing or using an e-cigarette device (including both nicotine and THC devices), within a 300-feet radius of school properties, are to be immediately removed from school and placed in a Disciplinary Alternative Education Program (DAEP) off the school premises for a period between 5 and 30 or more days depending on the use of nicotine or THC e-cigarettes and the number of offences (Cypress Fairbanks ISD, 2025; Dworaczyk, 2023).
During the mandatory DAEP placement, students are placed in a setting that is outside the regular classroom and kept separate from peers who remain in regular classes. They are not allowed to attend school or any school-related activities until they have completed their term at DAEP, and they may face removal from specific student clubs. DAEPs provide for students’ educational and behavioural needs alongside the provision of supervision and counselling; students are also offered education on drug use and cessation counselling, in addition to academic instruction in subject areas such as mathematics, self-discipline, and English language arts (Dallas ISD News Hub, 2023; Grapevine-Colleyville Independent School District, 2024; Texas Constitution and Statutes, 2025).
Different from the regular classroom setting, DAEP settings are more structured, with specific dress codes, behaviour expectations, and daily routines intentionally designed to encourage focus and reduce disruptions. Some DAEPs use a structured level system whereby students need to meet certain behavioural and academic criteria to demonstrate progress (Linda Tutt High School, n.d.). In some instances, students may be released from DAEP before 5 days if they attend an educational curriculum with their parents. Although other US states also take disciplinary action to discourage e-cigarette use in schools (e.g. a small fine, court costs, and school-specific measures in Pennsylvania; Gilsbach, 2019), the DAEP policy in Texas appears to be the strictest one to discourage e-cigarette use in US K-12 schools.
The impact of HB 114 remains unknown. Its efficacy may be contingent, at least in part, on how it is received by students – the target population. Existing research on tobacco use policies suggests that when students are unaware of or have opposing attitudes towards a policy, they are at substantial risk for occasional smoking (Paek et al., 2013) and the policy may not achieve its goals (Do et al., 2020). In contrast, student support for tobacco-free policies has been shown to be associated with policy compliance (Braverman et al., 2018). One study has examined perceptions of school personnel towards the DAEP policy in Texas and barriers and facilitators to its implementation in schools (Ma and Perez, 2025). However, it remains unexamined how the policy has been received by students and what factors are associated with their support for it. Understanding students’ perceptions of the policy can be useful to inform policymakers and schools about likely effectiveness and potential for improved policy implementation.
The current study enquired about perceptions of HB 114 among Texas public school students. Specifically, the study explored students’ support for the policy, factors associated with policy support, awareness of school e-cigarette use prevention and cessation resources, and other steps suggested to be taken to reduce e-cigarette use in school.
Methods
Participants and procedures
After receiving the Institutional Review Board approval from the University of Houston-Victoria (Reference: 24004), we conducted an anonymous, cross-sectional online survey among students in Texas between January and February 2025. Qualtrics Research Service was used to recruit participants and administer the survey through online panels. Eligible participants were 13–17 years old, in 6th to 12th grade, and attending Texas public schools. Participants were recruited from various channels, including website recruitment, member referrals, and social media. After parents had provided consent, they were asked to hand the survey to their adolescents to sign an assent form if their child agreed to participate; otherwise, they were automatically directed to the end of the survey.
Adolescent participants were first shown a description of e-cigarettes with sample visuals. Next, they were asked a series of questions to measure e-cigarette use and perceptions. Then they were informed of the Texas HB 114 relating to e-cigarette use in school and asked policy-related questions. Participants also reported demographics (e.g. age, gender, and race/ethnicity). Each adolescent was compensated for their participation in accordance with the panel provider’s standard compensation.
A total of 1,102 people clicked the survey link and started it, among whom 748 completed the entire survey, which equalled a 67.9% completion rate. Among the 748 people, 248 were excluded for failing to meet attention checks and Qualtrics quality checks. Qualtrics used a multi-layered approach to ensure data quality and fraud prevention (e.g. perform security checks for bots and speeders). In the final sample of 500 participants, students took an average of 11.85 minutes (SD = 9.97) to complete the study.
Instrumentation
E-cigarette use status
Participants were asked, “Have you ever used any of the following products? (nicotine vape, THC vape)” with the response options “Yes”/“No” to measure each type of e-cigarette use (Centers for Disease Control and Prevention, 2023). Participants who reported “Yes” were coded as those who had ever used that type of product. Participants who had ever used either nicotine or THC e-cigarettes were then asked one question about past 30-day use of that product. Participants who reported having ever used both nicotine and THC vapes were asked two separate questions to measure past 30-day use of each product (i.e. “On how many days out of the past 30 did you use nicotine vapes?” and “On how many days out of the past 30 did you use THC vapes?” (from 0 to 30)). If participants reported having vaped nicotine or THC more than one day in the past 30 days, they were current users. Based on answers to the questions above, e-cigarette use status (nicotine and/or THC) was categorised as (1) never used, (2) ever used but not currently using, and (3) currently using.
Policy awareness
One item measured awareness of the policy (i.e. “Before taking this survey, were you aware of this policy?” “Yes,” “No,” “Not sure”). 1 Participants were asked three separate questions about whether they had any previous communication about the policy from school, and with friends and parents, respectively (e.g. “Has your school communicated with you about this policy?”).
Support for the policy
Two items adapted from previous research (Haroun and O’Hanlon, 1997; Stoutenborough et al., 2014) measured policy support. They were: “Do you oppose or support this policy?” and “Do you agree that students who vape in school should be removed from class and placed at DAEP?” Response options ranged from 1 = “strongly oppose/disagree” to 5 = “strongly support/agree”. Scores on the two items were averaged to form the policy support measure (M = 3.51, SD = 1.19). Two-item correlations r = .75.
Perceived policy effectiveness
One question measured the perceived effects of the policy in discouraging e-cigarette use in school (i.e. “Has the policy reduced vaping among students in your school?”). Response options included, “for both nicotine and THC vaping,” “only for nicotine vaping,” “only for THC vaping,” “no change in students vaping in school,” and “do not know if the policy has any effect.”
E-cigarette harm perception
Two items measured perceived harms of vaping nicotine and THC (i.e. “How much do you think people harm themselves when they use nicotine vape/THC vape on some days but not every day?”) (Centers for Disease Control and Prevention, 2023). Response options ranged from 1 = “no harm” to 5 = “a lot of harm.” Harm perceptions for vaping nicotine and THC were M = 2.99, SD = 0.88, and M = 2.64, SD = 1.10, respectively.
Peer approval of using e-cigarettes
One item measured peer approval of using e-cigarettes (i.e. “How much do your three closest friends approve of you vaping?”; East et al., 2019). Response options ranged from 1 = “strongly disapprove” to 5 = “strongly approve” (M = 2.69, SD = 1.32).
School-based e-cigarette use being a problem
Participants were asked one question to measure the perception of e-cigarettes being a problem in school (i.e. “Do you think vaping among students is a problem in your school?” “Yes,” “No,” and “Don’t know.”)
Consequences of being caught using e-cigarettes in school
Participants were asked two separate questions to identify possible consequences of someone being caught using nicotine or THC e-cigarettes in school (i.e. “Generally, what are the consequences for someone caught vaping nicotine in your school? (Check all that apply)”). In each question, they were provided a list of 13 possible consequences (e.g. detention, suspension, confiscation of vapes) of being caught using nicotine or THC e-cigarettes, and were asked to select all that apply.
E-cigarette use prevention and cessation education
Participants were asked about awareness of classes/education to discourage students from using e-cigarettes in their school (e.g. “Are there classes/education intended to prevent students from vaping in your school?” “Yes,” “No,” “Don’t know”). They were also asked a question to collect endorsed strategies that might help discourage e-cigarette use with nine response categories (i.e. “In your opinion, are there other steps that could help discourage students in your school from vaping? (Select all that apply)”; e.g. “reducing stress,” “reducing the number of vape shops near school,” and “more punishment for students selling vapes in school.”)
Demographics
Adolescents’ demographics (e.g. age, gender, race/ethnicity) were also collected.
Data analysis
Descriptive analyses examined participants’ demographic information, their use of e-cigarettes, HB 114-related experiences, and support for the policy. A generalised linear model was used to examine factors associated with support for the policy. In the model, policy support was the outcome variable, demographics (e.g. age, gender, race/ethnicity), e-cigarette use status, perception of e-cigarette use being a problem in school, perception of policy effect, peer approval of using e-cigarettes, and e-cigarette use harm perception were included as independent variables. Maximum likelihood was used for parameter estimation. Wald’s Chi-square statistics, Wald confidence interval, and model goodness of fit were reported.
Results
The final sample consisted of 500 participants, among whom 52.6% identified as male, 43% as Non-Hispanic White, 22.8% as Non-Hispanic Black, 29.6% as Hispanic, and 89.4% as heterosexual, with the mean age of 15.00 (SD = 1.62, range: 10–17 years). There were 57.2% of participants who reported having ever used nicotine or THC e-cigarettes. Less than half of the participants were aware of e-cigarette use prevention education (47.8%) and cessation resources (47.4%) in school. See Table 1 for details.
Participant characteristics.
Note. N = 500.
Perceived use and consequences of use in schools, including DAEP placement
Across the sample, 67.4% of participants reported e-cigarette use as a problem in their school. Participants reported various consequences of using nicotine and THC e-cigarettes in school, including the school informing parents (nicotine: 58.4%; THC: 56.4%); confiscating vapes (nicotine: 55.6%; THC: 45%); in-school suspension (nicotine: 46.8%; THC: 29.6%); detention (nicotine: 42.6%; THC: 27%); out-of-school suspension (nicotine: 42.2%; THC: 50%); warning students (nicotine: 34.2%; THC: 20.6%); going on the school record (nicotine: 25.2%; THC: 31.4%); being sent to DAEP (nicotine: 24.6%; THC: 34.4%); taking counselling sessions (nicotine: 19.8%; THC: 19.4%); citation 2 (nicotine: 18.4%; THC: 26.4%); being sent to health classes (nicotine: 13.8%; THC: 15%); expulsion (nicotine: 11.2%; THC: 32%); and no consequences (0.8% for both). Chi-square analysis revealed that the reported differences in the consequences for using nicotine and THC e-cigarettes were significant, ps < .001.
Experiences with DAEP
Among the participants who had ever used e-cigarettes (including those who were currently using), 5.6% reported having been sent to DAEP due to using nicotine or THC e-cigarettes. The time they stayed in the DAEP ranged from “less than 5 days” to “more than 30 days.” Among them, 3.6% reported receiving a follow-up from the DAEP, and 3% had been sent to DAEP again for using e-cigarettes.
Policy awareness and perceived effectiveness
While 41% of participants were aware of the policy before taking the survey, over half (53.4%) reported not being aware of the policy. Among participants, 41% reported their school communicated this policy to them, while the other 40.2% and 18.8% reported either no communication or were not sure if their school communicated about the policy, respectively.
Less than half of the participants perceived the policy to be effective at reducing the number of students using e-cigarettes in school, whether for using both nicotine and THC e-cigarettes (21%), nicotine e-cigarettes only (7.2%), or THC e-cigarettes only (9.8%).
Factors associated with support for DAEP policy
Participants were generally supportive of the DAEP policy of short-term, off-campus education if caught possessing or using nicotine or THC e-cigarettes on the school grounds (M = 3.51). The generalised linear model that examined factors associated with policy support provided a good model fit, as evidenced by a Pearson Chi-square/df ratio of 0.95. The omnibus test was significant, χ2 (19) = 212.59, p < .001, suggesting the model fitted better than the intercept-only null model. Most of the entered predictors were associated with policy support except for gender and race/ethnicity (p > .05), detailed below.
Participants’ age and sexual orientation were associated with policy support. Each year’s increase in age was negatively associated with policy support (B = −.06, p = .021). Participants who identified as non-heterosexual reported lower policy support than those who were heterosexual (B = −.32, p = .034).
E-cigarette use status was associated with policy support. Adolescents who were currently using (vs had never used) nicotine e-cigarettes were less likely to support the policy (B = −.40, p = .001). THC e-cigarette use was not associated with policy support.
E-cigarette harm perceptions were associated with policy support. Participants were more likely to express support for the policy as perceived harm from THC e-cigarette use increased (B = .16, p = .001). Harm perceptions of nicotine e-cigarette use were not associated with policy support. Adolescents who perceived that their peers were more (vs less) approving of using e-cigarettes reported lower support for DAEP policy (B = −.13, p = .003). Participants who reported e-cigarette use was not a problem (B = −.40, p < .001) and who reported not knowing if e-cigarette use was a problem (B = −.31, p = .042) in their school had lower policy support than those who reported use was a problem.
Participants expressed greater support for the policy if they also perceived the policy as being effective for reducing both nicotine and THC e-cigarette use (B = .67, p < .001) and expressed lower support among those who reported no change in students’ e-cigarette use in school (B = −.24, p = .042). See Table 2 for details.
Factors associated with support for DAEP policy.
Note. N = 496. The participant group with the largest cell size was used as the reference group. Multicollinearity was assessed among the independent variables, and statistics indicate that multicollinearity was not a concern.
Factors were measured at a continuous level.
Participants (N = 4) who identified as non-binary or preferred not to report their gender were dropped from the generalised linear model due to a concern of biased results because of a very small sample size, leaving the total N for the analysis being 496.
Participants who identified as “Other” race and who preferred not to report their race were combined due to small cell sizes in each group.
Participants who identified as gay, lesbian, bisexual, not sure, or prefer not to report their sexual orientation were combined due to small cell sizes in each group.
Adolescents’ recommended strategies to discourage e-cigarette use
Less than half of the participants were aware of e-cigarette use prevention education (47.8%) and cessation resources (47.4%) in their school. Participants endorsed various strategies to discourage students from using e-cigarettes, including increasing punishment for students selling e-cigarettes in school, increasing educational content on e-cigarettes, and increasing posters in school about the health effects of e-cigarette use. See Table 3 for details.
Students’ endorsed strategies to discourage e-cigarette use.
Currently using either nicotine or THC e-cigarettes or both products.
Having never used either nicotine or THC e-cigarettes or having ever used either or both products.
Discussion
This study is among the first to examine adolescents’ perceptions, actual placement, and support for HB 114 policy mandating a disciplinary placement of Texas public school students using e-cigarettes in school in a short-term, off-campus educational setting. Over two-thirds of the participants reported e-cigarette use being a problem in their school. They reported various consequences of using e-cigarettes in school, such as the school informing parents, suspension, and DAEP placement. Less than half of the participants were aware of the DAEP policy, among whom, slightly more than half perceived the policy as effective in reducing e-cigarette use. In general, participants were supportive of the DAEP policy. Progressively older age, identifying as non-heterosexual, peer approval for using e-cigarettes, current use of nicotine e-cigarettes, perception of e-cigarette use not being a problem in school, being unsure if e-cigarette use is a problem in school, and perceptions of the policy not being effective were negatively associated with support for the policy. In contrast, harm perceptions of THC e-cigarettes and perception of the policy as effective in reducing e-cigarette use were positively associated with policy support. These findings are consistent with research on student attitudes towards tobacco-free school policies (Glasgow et al., 2021).
Where implemented, school-based e-cigarette policies are associated with a lower likelihood of using e-cigarettes among students (Phetphum et al., 2024). A lack of policy awareness has been associated with intent to use tobacco, as seen in the example of the Tobacco 21 policy (Dai et al., 2021). Considering that less than half of our sample were unaware of the DAEP policy, it is likely that the perceived effectiveness of the policy would differ if policy awareness improved. In our sample, 5% of students reported being sent to DAEP for using e-cigarettes in school, and 3% were sent back a second time after DAEP. Given our limited sample including a few students with experience of being assigned to DAEP, we suggest a deeper study of the use trajectories and relapse of students assigned to DAEP to understand the policy’s effects on improving cessation outcomes both during DAEP and after.
We found that non-heterosexual adolescents and older adolescents were less supportive of the DAEP policy. The finding suggests that non-heterosexual adolescents were at a greater risk for e-cigarette use and that policies may not be reaching such high-risk groups, suggesting more targeted interventions or education. Older adolescents may find these policies too punitive and restrictive of their freedoms. It is possible that the consequence of DAEP placement for older students who are caught using e-cigarettes at school is greater than that for younger students, as older students might be close to graduation, and being removed from school for a significant period may risk their likelihood of graduating. Therefore, older adolescents tended to be less supportive of the policy. It is also possible adolescents who currently use e-cigarettes are either doing so to quit other tobacco products or because they are addicted to nicotine as they grow. Overall, campaigns (e.g. The Real Cost campaign), school-based prevention education (e.g. Stanford Tobacco Prevention Toolkit), and tailored cessation programmes (e.g. This is Quitting text messaging intervention) can effectively discourage e-cigarette use among adolescents (Gaiha et al., 2024; Graham et al., 2024).
To increase effectiveness, school-based prevention and cessation approaches can be embedded within curricula and form part of a comprehensive drug prevention programme tailored to multiple age groups (Gardner et al., 2024). Indeed, participants in this study suggested the importance of schools providing ongoing support and resources to discourage e-cigarette use in school, including having more classes on e-cigarettes, increasing posters in school about the health effects of e-cigarette use, and offering counselling sessions. In addition, students in our study suggested that addressing accessibility of e-cigarettes on school campuses through stronger punishments for those selling e-cigarettes in school would deter use.
Current use of nicotine e-cigarettes was associated with lower support for DAEP policy, but perceived harm from nicotine e-cigarettes was not. In contrast, THC e-cigarette use was not associated with policy support, but perceived harm from THC e-cigarettes was positively associated with policy support. Existing evidence shows adolescents may use nicotine e-cigarettes for harm reduction from using other tobacco products or because they are nicotine dependent and use THC e-cigarettes for recreational purposes (Harrell et al., 2022; Warner, 2019). However, we lack information on the mechanism/mediating role of perceptions of harm between the use of nicotine or THC e-cigarettes and support for the policy.
Compared to other school-level policies on adolescent vaping, such as detention, school suspension, or confiscating vapes (Cruz, 2023; Minnesota Department of Health, 2023), current policy in Texas is harsher. Moving adolescents from their campus and placing them at DAEP may have its own educational and social harms, such as the disruption of learning time and the development of depressive symptoms (Angton et al., 2024; Black, 2016). Research has shown that punitive punishment is related to a higher rate of delinquency and increases the likelihood of students engaging in activities that lead to a juvenile criminal record (Geronimo, 2010; Justice Center, 2011). However, no conclusive conclusions can be made without further research regarding the long-term impact of the DAEP policy. The impact of the current policy per se (e.g. on academic performance, achievements, and social behaviours) and its relative effects compared to other policies should be explored in future research.
Study findings call for community-driven, blended disciplinary and educational interventions to improve policy awareness, enforcement, and public communication. Interventions to address nicotine and THC e-cigarette use should equitably engage multiple stakeholders (Collins et al., 2018), including the target student populations, parents, school teachers and staff, and DAEP staff, and incorporate inputs from them, to engage with diverse perspectives on risk and protective factors. Collaborative efforts between families, schools, and communities can provide support for adolescents (e.g. by offering stress management and refusal skills, by providing vaping education in both prevention and cessation, and by increasing the availability of school counsellors) and may help address the root causes of youth vaping (Cartujano-Barrera et al., 2021; Gaiha et al., 2021; McMahon et al., 2020).
Limitations
The study has several limitations. First, the sample is not representative of school-aged youth in Texas due to a non-probability sampling approach, limiting the generalisability of study findings. Second, the study was conducted 1.5 years after policy implementation, indicating that policy implementation may have had only a limited time in effect. We also did not inquire about the schools where participants were enrolled, which may have impacted implementation of the policy.
Future research should examine adolescents’ perception of the policy with a larger sample in a longer time frame. Future research might also consider examining parents’ support of the policy and parents’ use of nicotine and tobacco products, to provide a more comprehensive understanding of factors associated with students’ support of the policy. Furthermore, only limited information was gathered from students who were sent to DAEP because of e-cigarette use and a small number of participants reported being in and out of DAEP. Future research may consider focusing on students in DAEP and examining any unintended consequences of DAEP placement due to the use of e-cigarettes.
In addition, we remain unsure about the reason for the nonsignificant associations between nicotine e-cigarette harm perception and policy support. It could be that young people now agree that e-cigarettes containing nicotine are harmful and that other factors, such as social norms and enjoyment, are driving e-cigarette use. However, this study did not measure the reasons for using nicotine or THC e-cigarettes and this should be explored in future research. Finally, it should be noted that the prevalence of vaping reported in the current sample was higher than and not comparable to prevalence estimates in nationally representative survey data, likely due to differences in survey design and administration. Future research should replicate the current study and validate the findings with a different sample of Texas adolescents attending public schools.
Conclusion
E-cigarette use is common among adolescents in schools, which warrants a school-based intervention or policy to discourage use. This study examined Texas adolescent students’ perceptions and support for HB 114 – a disciplinary policy for short-term, off-campus education for those found using THC and nicotine e-cigarettes in school. Findings from the study revealed that only half of the students were aware of the policy and were generally supportive of the policy. Perceived harmfulness, e-cigarette use as a problem in school, perceived effect of the policy, peer approval, current use, age, and sexual orientation were associated with support for the policy. The study findings call for research on the efficacy of the DAEP policy among those who enter the programme, and stronger links to e-cigarette prevention and cessation resources to discourage use.
Footnotes
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This project received internal funding from the University of Houston-Victoria.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
AI use
AI was not used at all in the development of this manuscript.
