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In addition to these cellular and molecular mechanisms, smoking may worsen joint pathology through systemic effects such as vascular dysfunction 30

Social distancing, health concerns, and the sudden change of routine may lead to adverse psychosocial outcomes such as stress, anxiety, depression, and increased substance use 3,4

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adult smoking and its variations over time but, to the best of our knowledge, we are the first to investigate smoking trends among Americans aged 1874 years old using HAPC analysis 1,2,5