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They argued that there is no perfect way to model peer influence, and that approaches like SIENA are still subject to limitations (e.g., omitted variable bias) (Ragan et al., 2019)

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However, irrespective of pre or post PSM, when smoking pack-years are 2, the corresponding OR values remain close to 1, consistent with our post-PSM findings regarding the risk of MSAP or SAP (smoking pack-years 10, OR 1.72, 95% CI 0.525.69, P = 0.374)

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Therefore, the difference in calculated CEI in the studied cities was due to the difference in the density of litter and the difference in the composition of litter in the studied locations 11