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We obtained this data from TSI in return for a contract without needing an ethics committee document and used it in our study. TSI is an institution that compiles, evaluates, and presents statistical information to decision-makers to prepare development plans and programs, make economic decisions, and address all other issues needed. TSI carries out internationally comparable statistical production activities according to the standards of organizations such as the European Union Statistical Office, the United Nations, OECD, ILO, etc. TSI collects data within the scope of the Official Statistics Program. The Official Statistics Program is prepared for five-year periods based on the Turkish Statistics Law No. 5429 to determine the basic principles and standards regarding the production and publication of official statistics and to ensure the production of up-to-date, reliable, timely, transparent and impartial data in areas of need at national and international levels [\n                      \n                      ]. TSI also conducts the Income and Living Conditions Survey within the scope of the Official Statistics Program put into effect by law. Since the Income and Living Conditions Survey is conducted within the scope of legal responsibility by the state, ethical approval is not required [\n                      \n                      ]. For this study, secondary data were employed. Official approval was received from the Turkish Statistical Institute to use the microdata set from the Income and Living Conditions Survey. The Income and Living Conditions Survey provides many indicators in the field of health, including the utilization of health services by individuals aged 15 and over, the degree of difficulty they experience in performing their daily activities, and their smoking and alcohol use habits. The Turkish Statistical Institute also received a \u201cLetter of Undertaking\u201d authorizing it to use the study\u2019s data. The letter of undertaking for the use of micro data without restrictions in dissemination: Article 1- This letter of undertaking determines the rules, principles and obligations of the use of micro data, which are safe to disclose apart from the Presidency. Article 2-This letter of undertaking regulates the use of micro data sets of T\u00fcrkiye Health Survey in 2019, 2022, within the framework of the Directive on Access and Use of Micro Data in line with the purpose specified in Article 1. Article 3- The following provisions apply for the use of micro data: a) Findings obtained by the researcher as a result of incorrect calculation only bind the researcher. b) The researcher refers to the micro data of the Institution that he uses while disclosing the results obtained from the study. c) The researcher is obliged to send a copy of the published report, article, publication etc. to the Institution Library within three months at the latest. Subsequent micro data usage requests of the researcher who is found not to fulfill this obligation are not covered. d) The researcher cannot reproduce, give to third parties, sell or transfer the micro data set he obtained. Article 4-The researcher, by taking into account the principles of confidentiality defined in 13. and 14. articles of Turkish Statistical Institution numbered 5429 and Regulation on Procedures and Principles Regarding Data Confidentiality and Confidential Data Security in Official Statistics, is deemed to guarantee hereby that he shall not disclose the information, table, etc. violating this principle and shall only use micro data for statistical purposes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"37"}}