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Moreover, the literature suggests that women living in counties with higher concentrations of black and Hispanic residents have a lower likelihood of smoking during pregnancy

Likewise, Zn may be replaced by lead, which may aggravate these disease processes

Age group stratification Three age groups were selected based on GBD conventions and WHO standards: 1549 years (to capture early morbidity and emerging chronic disease risk), 5069 years (to assess middle-aged populations where cumulative exposure typically manifests in elevated disease burden), and 70 years (to capture elderly populations with highest mortality risk from long-term smoking-related conditions such as COPD, lung cancer, and ischemic heart disease)