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We further identified C-shaped associations between health-promoting domains of the HLI and substance problems , meaning decreasing access to features of built and natural environments is associated with higher odds of substance problems, except in the most remote places that seem to be protective

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Conclusion This study demonstrates that the hematologic effects of smoking are dose-dependent, with heavier exposure producing more pronounced elevations in red cell mass surrogates and inflammatory leukocytosis, reinforcing the link between smoking intensity and cardiovascular risk

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