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Just eyeballing CDC data (compare the map below with the map above), you can see theres a lot of overlap between regions that in 2020 had the highest rates of congenital syphilis and those with the least access to prenatal care

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In multivariable analysis, SLT use was associated with a 0.40 g/dL change in hemoglobin (95% CI: 0.97 to 0.17) ( p = 0.28)

They attempted to reduce their risk by going back to smoking