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Inclusion criteria included enrollment in the center during academic years 20232025, aged 13 years, the ability to communicate effectively in Thai, no prior use of e-cigarettes, conventional cigarettes, or electronic hookah, and no existing respiratory conditions such as asthma or chronic cough
Future studies would benefit from longitudinal designs, along with objective measures such as wrist actigraphy for sleep assessment and air monitors for quantifying SHS exposure, to strengthen causal inference and measurement accuracy
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