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A random intercept was assumed by county and a random slope by year (different effects of calendar year by county)

While smoking side effects on the skin dont directly darken the skin, it can lead to a dull, greyish complexion and uneven skin tone, often referred to as smokers face. This effect is primarily due to the numerous harmful chemicals in cigarette smoke that damage collagen and elastin, crucial proteins for maintaining skin elasticity and brightness

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