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A major limitation across the literature is residual confounding from tobacco, given the high prevalence of dual use and the collinearity of exposure metrics (pack-years, depth of inhalation, and mixing practices such as blunts and tobacco-mixed joints)

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A large majority of cases (80%) reported using THC in vapes, which is consistent with other series of VALI patients 12

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critical care, pulmonology, medical toxicology, or infectious disease) could help guide further evaluation