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In a large American cohort study, Hays et al

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For example, the 20 counties with the highest rates of smoking-related cancers in 2016 had an average smoking prevalence nearly twice the overall average (32% versus 18%) and all 20 counties were in Kentucky

Step 3: Tobacco Cutting Conditioned tobacco leaf is fed into a cutting machine that cuts the leaf into the fine, consistent cut width required for cigarette production

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Limitations Due to the cross-sectional study design and non-random sampling methods, no causal inferences can be made about the broader young adult population