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US Surgeon General Declares E-cigarette Epidemic Among Youth [pdf] (surgeongeneral.gov)
111 points by Pulcinella 4 months ago | hide | past | web | favorite | 156 comments



We should be clear what the actual object of this "epidemic" is. It isn't really about vaping. It's about Nicotine. And this fight is just one battle in a larger war: the societal struggle to define the proper moral dimensions of chemical dependency.

Many people have a knee-jerk reaction to "chemical dependency"... they assume it must be a bad thing. That somehow sobriety is the "natural" state of human beings, and that any dependence on a mind-altering chemical is a weakness, a deviation.

You can see this in the way we mix up terms like "dependency" and "addiction". People treat the former as if it were equivalent to the latter, but it isn't: "addiction" is when the harms of a dependency outweigh the benefits, when it becomes "maladaptive" (a vague, value-laden term). But a dependency by itself isn't necessarily maladaptive. Sometimes it's a positive adaptation.

Consider this, one of my favorite essays, about a woman whose relationship with Nicotine appears to have enriched her life:

https://www.nytimes.com/2016/03/06/opinion/sunday/can-nicoti...

There are certainly chemicals that cause far more harm than good... there's no denying that. I'm not saying we should embrace Fentanyl. But it would be a mistake to treat every chemical dependency as an obvious evil. The moral valence of Nicotine dependency is far from black-and-white. Sometimes we depend on something because it's good for us. (Notice how nobody's complaining about a coffee epidemic.)


Yes to the moral dimension -- obscured by the health issue.

It's also about children. Most parents won't allow young kids to drink coffee, for instance. Childhood ought to be a preparation for freedom and addictions have the potential to limit that freedom before it even gets started.

Adults may weigh the benefits for themselves. Sometimes the result is indeed positive.


Agree about the age issue... it does change the equation, especially if these companies are targeting their advertising toward younger kids.

I also appreciate that you brought up the issue of freedom. Dependencies do require freedom to be sacrificed, and perhaps that partially explains the aversion to them. When we need something, we give it power over us.

Yet a life without dependencies would be a life without friends and family, a life without valued people, places, and things. We give up total freedom for the benefit of forging deep and meaningful connections. And these connections are, in important ways, like any other dependency: when you lose someone you love, you go through a powerful kind of psychological withdrawal. But a life without love would be an impoverished existence.

I think it would be useful if we, as a society, stepped back and considered the nature of dependency, how our dependencies can hurt us and help us, and why certain kinds are valued over others.


Strangely, coffee is taboo for children, yet Coke is fine.


What world are you living in? The soda tax has been a hot issue for the last 10 years. Schools went from having soda sponsorships in sports to, "the horror"


I'm pretty sure your parent was talking about the caffeine in Coca-Cola, not the sugar.

But it's not like panicking over the sugar is coherent either; you see the same people praising fruit juice.


I don't know a single kid at my current high school or my past high school that was not allowed to drink coffee. I mean, kids literally come into school with starbucks cups and thermoses. My old school actually sold coffee in the morning to students. Furthermore, Caffeine in my opinion is a lot worse than nicotine, because it disrupts sleep a lot, and will cover up the symptoms of short term sleep well enough that someone will think they are fine when in reality they are chronically sleep deprived.


What age roughly do kids start drinking coffee in the US?


Idk, I remember kids talking about drinking coffee as early their 6-7th grade year. I don't think I remember anybody bringing in coffee to middle school though. I think most kids really started drinking coffee regularly in high school.


Do any states prohibit selling caffeine to minors?


Googling this: "law minor energy drink" shows that many places are considering it, although I have not seen any that actually passed such a law.


In Russia, "energy drinks" are forbidden for minors (< 18 years), but coffee, tea and coca-cola-like drinks (which AFAIK can have caffeine too) don't have such restriction.


Dosage and sweetness is surly part of the rationale. Coffee is not a cool, sweet, refreshing drink. Soda is but has around 50 mg of caffeine, while energy drinks have between 80-160 mg. Probable harm from high levels of caffeine much easier to hit with energy drinks.


Im not against drugs by any stretch of the imagination, and not necessarily against addiction- despite the fact that dependency on anything must limit some aspects of your autonomy.

However! Nicotine itself is specifically not a good drug. In the vast majority of people, myself included, it induces cravings that quickly upgrade your brain's ACh receptors to the point where you no longer experience the enjoyable drug effects, and you're only left with a habit. Technology promises to limit the harm of that habit, which is terrific. But the habit doesn't provide any benefit to the vast majority of people, and technology hasn't made any progress on that front.


As someone else referenced: https://www.gwern.net/Nicotine - there _is_ research that indicates that nicotine is not as addictive on its own as it is in cigarettes. And that's it's not, on its own, harmful.

And could you not say similar things about caffeine and caffeine dependence?


"And that's it's not, on its own, harmful."

I'm sorry to say, but that statement is incorrect. Even the gwern.net link has a section titled "Health Issues". I'll add that it is an immunosuppressant, which Gwern does not appear to mention (or I missed it when skimming the link).


No. It's a public health issue. while I would not be surprised if some have moral opinions about it, that's not the point. nicotine is objectively a toxic substance; it is an immunosuppressant and there is evidence mounting linking it with cancer. there is science to back this up. if there are other studies that paint a different picture, or other data that is pertinent, then reviewing and comparing the evidence we have so far is what we should be doing, and then shaping public policy based on the best evidence we have.

But to paint this as a moral issue -- and do things like compare it to caffiene -- seems like rhetorical trickery and which results in diverting the discussion.

science and public health are topics that companies like jl, etc., would very much like us all to avoid engaging in, so i am not surprised (though i am saddened) to see the parent post so highly voted.


> You can see this in the way we mix up terms like "dependency" and "addiction".

I don't believe many people have an issue with dependency. Nor do they have any issue teasing apart the two concepts. We do not have qualms with someone who is dependent on an insulin pump, tetanus shots, or HIV medication.

These days most fair people also wouldn't have issues with someone being dependent on marijuana, for example.

So I think the concepts are quite clear in people's minds.

When talking about an epidemic of vaping, people aren't worried about dependency. We're worried about addiction.

Is it, strictly speaking, possible for someone to have a healthy, beneficial relationship with nicotine? Sure. But the trouble is that nicotine doesn't give anyone a choice. You're going to be addicted whether it's good for you or not. That's the issue.

The reality is that human history is filled with death and misery caused directly by substance abuse. And we can see that history reflected in our public consciousness and policies.

And I believe that is rightfully so. I'm happy to agree with you in theory, that we should take a measured approach to substances to view their objective benefits. But reality makes that metered approach difficult.

Because the reality is that we have no real treatments for addiction. Which means we live in a world where a large percentage of people are addicted to substances they probably wouldn't want to be on if given the choice. And of those people, most will have degraded quality of life, some will commit violence against others, and some will die.

So in this world we live in today, I can't fault people for having prejudice against addictive substances. And in many ways I view that prejudice as helpful.

I certainly don't agree with the way we've waged war on drugs (at least in America). But I don't disagree with the reasons, and I don't view a prejudice against addictive substances as "knee-jerk" but rather a well informed policy birthed from a long human history of pain and suffering at the hands of these chemicals.

(P.S. Re: the war on drugs; the crux of the issue is that we demonized not only the chemicals but also the victims of the chemicals. It is the former that I have no qualms with. It is the latter that has lead the war to perhaps cause more harm in itself than the chemicals ever did. But I'm really not trying to incite a discussion on those topics.)


> But the trouble is that nicotine doesn't give anyone a choice. You're going to be addicted whether it's good for you or not. That's the issue.

If something's good for you, you're per definition not addicted to it. That was the main point of the post you responded to.

I know people who can enjoy the occasional cigarette. Are they addicted in your opinion? Nicotine is also used extensively by people to self-medicate emotions. Are they all addicts? Would they all be better off if they didn't smoke? Some would, some wouldn't. Who are you to tell?


Great article, thanks for sharing. Having quit cigarettes many years ago now, I can absolutely relate. I spent the first couple of years fighting myself (mentally and emotionally) on a daily basis, stuck on the fact that I was deprived. Eventually the feelings and cravings subsided, but I still felt like I had lost something. The key and lock analogy were indeed perfect. I didn't feel like myself. I had trouble talking to others. I felt less intelligent. I developed some social anxiety. I often wondered if I was self-medicating through nicotine and if I'd never be the same.

My dependency on chemicals never really went away, but I found a better way to feed it: exercise. Working out gave me that little boost of whatever it is, je ne sais quois, that made me feel more confident, more comfortable in my own skin. It wasn't the same at first (and at this point, I'll never know if I'm back to "baseline"), but for me at this time in my life, it's enough.

It's funny because objectively, life is so much better post-smoking. You don't smell, you don't have mandatory breaks, airplane rides aren't hell, family and friends don't complain, etc etc etc. And yet, while I don't miss smoking, I can distinctly remember all that trouble being worth it at the time.


I agree. I am very dependent upon matcha green tea. If I don’t have at least two cups per day, I feel terrible. But when I do take it daily, it provides an incredible amount of clarity and energy. I’ve come to accept the downsides - and there are always downsides - because overall, it’s a net positive in my life. I don’t doubt there are people in similarly positive but dependent relationships with far harder substances.


what brand / dose do you drink? looking to switch off coffee to something more benign


I don’t remember what I drink right now, but it’s about $16 for a tiny tin at Sprouts, which is very expensive (Edit: it’s Aiya Ceremonial Grade). I’m planning on ordering some from a supplier who ships directly from Japan soon - likely O-Cha. I’ve had their sencha and it’s fantastic, looking forward to trying their matcha.

As for dose, I measure 1tsp (measuring, not table) per cup. I have one or two cups per day. But I drink it more western style than most would.

I’m trying to wean off my one and only cup of coffee first thing in the morning. Coffee makes me jittery and gives me reflux. Tea makes me alert but calm in the most pleasant and bizarre way, and doesn’t cause me reflux.


That’s a fascinating essay, thanks for sharing. I sometimes fret over my caffeine habit - in fact I’ve quit several times, enduring headaches and nausea, just to start again. But maybe caffeine is what would be prescribed to me anyway to optimize my productivity and happiness, and I should stop fighting it and feeling ashamed of “dependency.”


Just make sure your caffeine habit isn't masking unhealthy sleep habits.

Usually when I notice that my caffeine intake is going up, it's because I'm not sleeping enough for whatever reason, including staying up late to play video games.


The reason they go after nicotine is because kids use these vapes and become addicted to the nicotine in them, much of the time without wanting to do so. It is pernicious. It’s why cigarettes were demonized, but not banned. Cigarettes were doing everything that Juul and Co. are doing now, hooking kids, spreading because it’s cool and marketed to children. It’s kind of like rape. Hooking you without your consent, and taking advantage of the most vulnerable market, kids.


The fun part about the e-cigarette epidemic: states have a perverse incentive to keep cigarette smoking rates from dropping too quickly. The Tobacco Master Settlement Agreement gave states an annuity from tobacco profits, and many states took a lump-sum payment instead. That money has already been spent. If cigarette smoking rates (and thus, profits) drop too much, they have to pay back the money.

Everything with e-cigarettes was fairly hunky-dory and not an 'epidemic' until 2014, the year teen smoking rates plummeted and e-cigarettes took off. Most of those teen smokers who took up vaping instead of cigarettes will likely never become cigarette smokers. This alters the math on the annuity payments that were already cashed in for up-front money, and thus the states could end up in the red on their bond payments. Thus they have a financial incentive to keep e-cigarettes from fully replacing combustible cigarettes, even if they are a definite harm reduction tool.


> Everything with e-cigarettes was fairly hunky-dory and not an 'epidemic' until 2014, the year teen smoking rates plummeted and e-cigarettes took off.

Yes. E-cigarette usage wasn't an epidemic until usage “took off”.

That's just the definition of “epidemic”; everything else you try to associate is irrelevant.


Don't epidemics usually create sick people? I realize the counter-argument will of course be "we don't know the long-term effects," but people have been exposed to aerosolized glycerine/propylene glycol for decades in the form of fog machines at concerts and clubs. Surely if this was the next asbestos we'd be seeing something by now.


How many people spend a significant percentage of their time right next to a fog machine breathing in highly concentrated amounts?


That's not the definition of epidemic.

The dictionary definition is: a widespread occurrence of an infectious disease in a community at a particular time.

"Infectious disease" being the key. If we limit the definition to "took off" then any new and popular software becomes an epidemic.

It's naive to assume that something like this couldn't possibly be politicized simply because it relates to health. His points absolutely could be relevant to how the Surgeon General chooses to describe the uptick in vaping.

Overall tobacco usage is still going down: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/yout...


> That money has already been spent. If cigarette smoking rates (and thus, profits) drop too much, they have to pay back the money.

I don't believe there was a clawback provision when the states securitized their MSA claims into Tobacco Bonds. These bonds aren't general obligation bonds and therefore cannot tap into the states general fund. That being said, the states would like to avoid the bad publicity of a default, and thus some states have pledged additional tax revenue as a restructuring plan. In short, there is some incentive on the states end but its not as strong as you implied.


Do you have any citations for this? If it's true and the states are actually acting on that incentive, it's an epic conspiracy. I wonder if you could look at differences in anti-vape policy between states that took a lump sum payment and ones that didn't to validate it.


June 23, 2014: "E-cigarettes could stub out tobacco bonds sooner than thought"

"NEW YORK (Reuters) - The rapid growth of electronic cigarette sales poses a rising but under-appreciated risk to holders of as much as $96 billion of bonds tied to payments tobacco companies make to U.S. states from a sweeping legal settlement in 1998."

https://www.reuters.com/article/us-tobacco-bonds-ecigs-insig...


Starting to think that maybe, just maybe, finding ways to securitize everything under the sun is not such a good idea.


> Starting to think that maybe, just maybe, finding ways to securitize everything under the sun is not such a good idea.

It's weird to blame that on the security - ie, the vehicle that enabled the payment of this settlement in the first place - rather than the manipulation and outright fraud that the tobacco companies conducted for years (which is why the suit even existed).


Bonds didn't enable the payment of the settlement. The tobacco companies were going to hand over ~$8B cash every year. The securitization added a layer of complexity that capitalized on greed and, surprise surprise, looks guaranteed to blow up in these state's faces.

> Nine states — Alaska, California, Iowa, Michigan, New Jersey, New York, Ohio, Rhode Island and West Virginia — and Washington, D.C., Puerto Rico and Guam decided to get as much of those annual payments as fast as they could by mortgaging any future payments as collateral and issuing bonds. They traded their future lifetime income for cash today — at only pennies on the dollar.

> A typical bond is like an interest-only loan with a balloon payment in 30 years. But to avoid having to pay yearly interest payments, these 12 chose to issue capital appreciation bonds, deferring all interest payments and repayment for up to 50 years. Then the entire amount is due — with no plans made as to how it will be repaid. By the time these bonds come due, the legislators who approved them will be retired or dead.

> The 12 issued $22.6 billion in bonds, receiving only $573.2 million in cash. With compounded interest, they will have to repay $67.1 billion. Imagine borrowing $200,000 to buy a house today and your children having to pay back $234 million in 40 or 50 years.

https://www.nytimes.com/2014/10/07/opinion/how-the-big-tobac...


Interesting, I didn't know this!

But what different does it make? Whether you're getting the revenues from the indefinite future, or you need to keep the sum over several years at a certain level, you're incentivized to ensure sales don't fall.


Just my personal take but as an adult who just quite smoking a few weeks ago the availability of vaps has been tremendously helpful. I feel night and day better in terms of health despite consuming probably similar levels of nicotine.

And while I don't view nicotine (or vaporized VG, PG) as particularly harmful it probably should be reserved for those 18+. What doesn't seem to be helpful is that vaping comes in all sorts of flavors (beyond synthetic tobacco flavor)that would probably appeal to people minors (mango, cotton-candy, etc). In contrast any flavorings of those types in cigarettes was banned a decade ago (with the notable exception of menthol).

> Currently, no flavors are banned from other tobacco products, although research suggests flavors may also make these products more enticing to youth and young adults. Data from FDA’s Population Assessment of Tobacco and Health found that nearly 80 percent of youth ages 12-17 and nearly 75 percent of young adults ages 18-25 who were current tobacco users in 2014 reported that the first tobacco product they ever used was flavored.25 Alternatively, FDA is aware of self-reported information suggesting that the availability of flavors in some noncombusted tobacco products such as e-cigarettes and other ENDS may help some adult users reduce cigarette use or switch to potentially less harmful products.

https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredi...


This narrative that high schoolers are all about cotton candy and mangos, but when given menthol they find it disgusting, is absolutely hilarious and so clearly woven by old men in a government complex somewhere. Kids were smoking long before ecigs popped up, and they'll keep doing all sorts of drugs as long as they exist.

Taste means practically nothing. But it sure does sell better to worried mothers.


As an adult, I like flavors. Flavors aren't addictive, nicotine is.

As a teenager, I used to steal bottles from my parents' liquor cabinet and drink them neat. Needless to say they (with few exceptions) don't taste good this way.

Kids use drugs (partially) because they want to play at being adults. Requiring the e-cig to taste bad isn't going to inhibit that at all. It is going to inconvenience a lot of law-abiding adults who enjoy flavored e-liquid.

Stop trying to ruin my e-cig based on narratives and weak evidence.


Nicotine is little different from caffeine. Either you ban both, none, or you decide your policy is arbitrary moral posturing supported by no evidence.

Ultimately, there is little in the way of physical dependency; nicotine is as addicting as sugar and fat loaded burgers and fries, and the health risk to the population of those blow any risk from nicotine out of the water. In fact, the evidence probably shows we could promote the use of vaping instead of overeating on junk-food, and should ban minors from entering fast food places.


>Nicotine is little different from caffeine. Either you ban both, none, or you decide your policy is arbitrary moral posturing supported by no evidence.

They are quite different in their mechanism of action. Caffeine works via Adenosine, Nicotine works via Nicotinic Acetylcholine receptors.


Yes, they are both nerve agents, harmless to humans beyond some nootropic effect. No physical dependency.


> Nicotine on direct application in humans causes irritation and burning sensation in the mouth and throat, increased salivation, nausea, abdominal pain, vomiting and diarrhea.[17] Gastrointestinal effects are less severe but can occur even after cutaneous and respiratory exposure.[18] Predominant immediate effects as seen in animal studies and in humans consist of increase in pulse rate and blood pressure. Nicotine also causes an increase in plasma free fatty acids, hyperglycemia, and an increase in the level of catecholamines in the blood.[19,20] There is reduced coronary blood flow but an increased skeletal muscle blood flow.[20,22] The increased rate of respiration causes hypothermia, a hypercoagulable state, decreases skin temperature, and increases the blood viscosity.

Nicotine is one of the most toxic of all poisons and has a rapid onset of action. Apart from local actions, the target organs are the peripheral and central nervous systems. In severe poisoning, there are tremors, prostration, cyanosis, dypnoea, convulsion, progression to collapse and coma. Even death may occur from paralysis of respiratory muscles and/or central respiratory failure with a LD50 in adults of around 30-60 mg of nicotine. In children the LD50 is around 10 mg.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363846/


"...hypokalemia, hyponatremia, ventricular arrhythmias, hypertension followed by hypotension, respiratory failure, seizures, rhabdomyolysis, ventricular fibrillation and finally circulatory collapse."

https://www.ncbi.nlm.nih.gov/m/pubmed/20096021/


You can also die from caffeine. What is your point, beyond "the dose makes the poison"?


The fact that a risk exists is irrelevant, and it was never the point. If you want to understand the risks associated with nicotine and caffeine, you measure them. There are a number of metrics we can use as a proxy for risk, like margin of exposure or margin of safety, but these give us an incomplete understanding of the risks. The problem with electronic cigarettes is that children are particularly prone to the following things:

- Eating or drinking inappropriate things,

- Eating or drinking things which are colorful or have a pleasant aroma, and

- Being more sensitive to certain chemicals (e.g. nicotine) than adults.

So if you told me, "Let's put nicotine in a mango-scented liquid and put it in reach of children," I think we should be alarmed. Likewise, when we took iron supplements and put them in the shape of colorful pills or animals with a sweet taste like candy, and then children started eating them and getting iron poisoning, we got concerned.


I read an article the other day about how juul modifies the nicotine to make it less painful so they can put more in each pod. An interesting side effect of this is that people who don't smoke can start smoking easier because it's less painful. That information combined with this report just makes me so upset on so many levels...


That's not the whole story. Juuls are ultra high resistance devices due to their size. Generally that means they can't vaporize as much liquid into vapor, which means traditional eliquid (lets say 3-9mg/ml) isn't as effective anymore, especially for someone trying to quit smoking.

Going anywhere above 12mg/ml with traditional eliquid production techniques produces a liquid that is very harsh.

So, here are your business requirements: You've got a device that is high resistance. You want high nicotine content because your primary market is ex-cigarette smokers. You can't use traditional eliquid because it would result in a harsh experience, which reduces the probability of cigarette smokers quitting and using your product. So you invent something new.


Correct. They have proprietary technology around nicotine salts.


Can you cite the article? I cannot find any reference to Juul modifying nicotine to make it more palatable.


Juul uses nicotine salts, where as standard vape juice is just freebase nicotine. The salts are said to be 'milder' or easier to consume. In the US, vape juice comes in 0, 3 and 6mg/mL doses. Juul does not publish nic levels, but its probably closer to 48+mg/mL.


Most vape liquids I've seen come in 0-24 mg/ml (in 6mg increments, except for 3).


Apologies, i'm unable to find the article i read before, but googling "nicotine salts" should get you on the right path.


To start, this advisory mentions nicotine salts in JUUL pods toward the top of page two.


Is this more serious than the sugar epidemic?

Or exposure to traffic pollution?

Or reduced freedom to roam?

It would seem that there are many social threats to my children, and vaping is maybe in the top 10? Should it be higher?


Public health doesn't talk about your individual child. It talks about a population of 100,000 children.

If none of them smoke, and they all take up vaping, some of them will be harmed by vaping (because nothing is risk free). Do they get any benefit from vaping? Does that benefit outweigh the risk? How much regulation does a society impose?

There's been a bit too much talk of vaping as totally harm free. Partly that's because we were comparing it to smoking, which is very much worse than vaping. But if non-smokers are taking up vaping we need to have the different discussion about risks and benefits.


> Do they get any benefit from vaping?

Yes, almost certainly. Nicotine is effectively a nootropic, having "significant positive effects on aspects of fine motor abilities, alerting and orienting attention, and episodic and working memory". Nicotine has a (afaik) unique mix of stimulating and anxiolytic effects and there's reasonable evidence that it has antipsychotic effects helpful in reducing symptoms of schizophrenia. There's even evidence that nicotine has general neuroprotective properties helpful against brain trauma or neurodegenerative disease. There are many studies highlighting potentially beneficial effects of nicotine, you can find a handful linked here: https://www.ncbi.nlm.nih.gov/pubmed?linkname=pubmed_pubmed&f...

That isn't to say that vaping has no dangers or potential downsides, but I think, likely in large part due to how dangerous tobacco smoking is, there's been a dearth of communication to the public of the variety of potential positives of nicotine. For many non-smokers who use nicotine the significant benefits may well outweigh the downsides.


I've by and large been on nicotine since I was 13. I'm 50 now. I quit smoking when my children were born. I switched to dipping, which my wife finds disgusting as a medical professional. I then went to vaping, which she doesn't like any more, but tolerates.

It's a proven fact that nicotine re-wires the brain receptors over time. I smoked for over 25 years. I'm sure my brain receptors were re-wired in that time. When I quit, I went zero nicotine for two years. I was an *hole during that time. I always craved it. I would walk from my car into the supermarket and smelled smoke and wanted it. I would be out with my wife on a date, smell it and want it. I wanted it after a heavy meal and other times. When vaping went mainstream, I got onboard. I use a pen vape that's 1.9 ml of nicotine. I still dip Skoal if I'm doing yard work, more for the oral sensation than anything, but a dip is the rough equivalent of three cigarette's worth of nicotine. I'd like to get off of everything, but the nicotine does have benefits. It largely prevents jet lag, gets me going in the morning before I down my 16oz. French press high-caffeine concoction. It helps me think and get through tough technical problems. For those never addicted to nicotine, please be understanding of those in your life that are long-term users. Scientists now understand that the re-wiring of the brain is somewhat permanent. It's sad that kids are getting on this treadmill. If I'm honest, I wish I never did, but I also enjoy it tremendously after a meal and when coding.


This long-form article/confession from a self-professed (adult) vaping addict might give you some idea as to just how bad it can be:

https://medium.com/s/love-hate/confessions-of-a-juul-junkie-...


Wow. An important reminder that the space between “harmless” and “can kill you” has room for plenty of ills.


It is rising faster than any of those which is concerning. In terms of danger, it's hard to say since we don't know what the long term effects of vaping are going to be, and how many of these teens are going to consume other tobacco products in the future.


Airborne pollution and sugar are both orders of magnitude worse than vaping could ever be. The authorities certainly seem to pick and choose which battles they fight.


I disagree. In most of the US the air pollution is less likely to harm you than vaping would. Sugar is a different story but it's one where you can have a healthy relationship to it, whereas you can't with vaping.


> I disagree. In most of the US the air pollution is less likely to harm you than vaping would.

Area wise? Sure.

In regards to population centers?

Air pollution has a known, life long, negative impact. https://nypost.com/2015/05/26/new-yorks-pollution-and-povert...


>. In most of the US the air pollution is less likely to harm you than vaping would

We don't know what the affects of vaping are, so how can you say that?


We don't know the effects, but we can be pretty confident on the floor. Meaning we know the minimum amount of harm nicotine in vaping is definitely causing, but we aren't sure how much extra harm could be caused by the flavorings, the heating process, problems with safety and quality control with the vaping juice and other issues.


"you can have a healthy relationship to it, whereas you can't with vaping."

Could you elaborate? Why can't one have as healthy a relationship with vaping as with sugar? Are we talking about occasional moderate use, or is it something else?


Given that nicotine addiction is a thing, I don’t think “occasional moderate use” is possible.


Is sugar addiction not a thing? I consider myself addicted to sugar, and have cravings when I try to stop, but maybe I'm getting the terminology wrong? English is my second language.


'could ever be' on which measurement?

I don't think that we as a socieity don't have enough energy or mindpower to think about airborn pollution, sugar, smoking and vaping.

Independetly of the risk for the consumer, i'm quite happy that vaping is also banned indoors. Imagine strawberry everywhere brrr


One is easy to pin on a small private company, the other would involve targeting other politicians, larger deep pocketed companies, and raising taxes.


One is easy to pin on a particular category of non-essential products (The world won't stop if non-smokers don't pick up vaping), the other (air pollution) is a communal externality of nearly every single productive activity that our society engages in (Because those activities involve either electricity or transportation, or both.)


Are you saying sugary foods and drinks are essential products?


While the excessive amount of sugar in some food and drinks is bad, at least they don’t give you withdrawal when you stop taking them.


I think it's an issue of really [deliberately] inconsistent messaging. The general public thinks e-cigs are harmless compared to tobacco and what little common counter argument (maybe the coils are degrading and leeching into the vapor?) exists is not particularly compelling to the average person. Thus we have a perfect storm where manufacturers have a literal chemically induced captive audience and we're starting to see how they're making use of that feature to make money. Most of us don't see it but if you go to the right communities, everyone and their sister is vaping furiously. It has a rather distopian feel to it...


From what I've heard, vaping can be dangerous because if it condensates into the lungs all chemicals used to get the fragrance can't be expelled anymore, so it's not that different from traditional cigs.

Luckily I quit smoking over 20 years ago and never ever considered trying ecigs. But still like the smell of burning tobacco, which is why since the day I quit I didn't have a single puff, not even to light one for a friend; after all those years I still like it.


Do you think that there are so many similiar topics that you have to choose?

I would personally put vaping in the top 10.


The point is they like to make a big splash about problems that aren't really huge and are cheap to fix for the government with minimal pushback. The actual huge problems are ignored, mostly due to money.


I wonder if the big tobacco companies are behind this.

They have much to lose because e-cigs are not used for tobacco, in my experience.

So they (tobacco corps) will lose future tobacco addicts to e-cigs and vaping liquid producers.

peace.


The nicotine in e-cigs are produced using tobacco and I'm pretty sure big tobacco doesn't care if kids are smoking actual cigarettes or e-cigs, only that they are smoking.


> I'm pretty sure big tobacco doesn't care if kids are smoking actual cigarettes or e-cigs, only that they are smoking.

I disagree.

Tobacco is an industry with high regulatory barriers to entry and decades of very effective marketing behind it. "Big Tobacco" makes money at the wholesale and retail levels pretty much unopposed.

Vaping is effectively unregulated, and there really aren't any truly big players in e-liquid market. Everyone who vapes seems to have their favorites, but even a small vape shop will have a dozen or more brands on the shelves.

Vaping isn't going to kill tobacco use, because as you said, the nicotine ultimately comes from tobacco - but its rise is cutting significantly into the revenue of "Big Tobacco".


Marlboro's parent company Altria is in the process of buying a 35% stake in Juul.


Add to that:

-US schools not offering nutritional meals

-Waking up kids so early in the morning it hurts their sleep

-Not having soda and candy machines on school property

-Proper sex education

-Vaccinations and other healthcare for children


> approximately two-thirds of JUUL users aged 15-24 do not know that JUUL always contains nicotine.

I find this very, very difficult to believe.


I don't know if it's 2/3, but there's a decent amount that don't. I teach high school, and they talk all the damn time about their JUULing habits (they have literally no concept of privacy anymore), and several of them say they only do it since it's nicotine free. They're shocked when I tel them that most they're smoking probably do contain nicotine.


Third-party pods which do not contain nicotine do exist. I wonder if that confounded their survey.

I think there are even some companies making some with only THC and/or CBD.


How many people do you know aged 15-24? It would not surprise me one bit.


I'm a high school teacher (and kids have no concept of privacy and talk openly about everything), and I completely agree. Not sure if it's 2/3, but I'd say definitely over 50% don't realize that most probably contain nicotine.


This does not surprise me at all.


Juul is cited many times in that document. I am generally intrigued by Juul. Their intention to "end combustible smoking" and help "adult smokers" smoke with less pain/more easily seems good for the target user (create a system with fewer toxins-to-nicotine ratio). The side-effect of engineering a better system is that it's easier for all users to smoke, i.e. intended for adults, but tech-savy kids will devour this concept).


Juul is reported to have higher nicotine levels though.


Isn't higher concentration better? Users titrate the dose to their preferred subjective effects, so the only difference concentration makes is the exposure to the carrier liquid and the flavorings, which are less well understood than nicotine.

If all alcoholic drinks contained 1% mystery liquid, would you rather drink beer or spirits?


I see. I'm not very familiar with their product. I would think that their product is good for weening "adult smokers" off of nicotine through tapered usage (e.g. reducing nicotine intake over a timeline by using specific dosage cartridges). Which of course go against a sustainable business?


They actually did just introduce lower level nicotine packs of their pods. The device worked for me because if you look into the world of vaping, it is almost like another hobby. So many parts, batteries, coils, juices, etc... the juul was dead simple and really just replaced my 13 year pack-a-day habit. It is a little unfortunate how it took off in schools and I do truly believe that was never their intention. It really works as a "cigarette replacement" if you aren't ready to quit cold turkey.


Thanks for sharing! That's an interesting point regarding simplicity of design and how the complexity of vaping can actually create a hobbyism that keeps you in the realm.

If you don't mind me asking (and you sharing): How long did it take to stop smoking? Can you describe the weening process?


Sorry for late reply. It was literally overnight....I didn't wean myself off the real thing it just sort of changed. It felt good and certainly has social benefits, but the downside is I can smoke the juul basically anywhere, including indoors. I would still recommend it for some who "wants" to quit (but doesn't really want to). No more smells or coughing up gunk every morning.


It's pretty easy to control dosage with number of inhalations. A counterpoint could be that it may be better to give someone a tool to quickly satiate that will be used less frequently. A lower concentration would likely increase the number of 'hits' to satiation, so may increase frequency of use.

Would be interesting to see a model of nicotine satiation.


That is true, the concentration is higher. But you get a lot less vapor so it evens out. Think about the people who blow clouds the size of cars. Even with 3mg nic the volume of vapor makes the difference.


Yep. One of the reason school administrators are particularly concerned with Juuls is that they produce so little vapor that students can inhale and hold for a few seconds, and by the time they exhale no visible vapor emerges. Kids are even doing it during classes.

Speaks to the 'lack-of-unnecessary-chemicals' but unfortunate unintended consequence.


fwiw, vaping is treated the same as tobacco use by most insurance companies with regards to what is provided to employees.

I have been amazed at how some who vape think it is acceptable indoors in public places that other tobacco use is not. At work it had to be reminded more than once it was not acceptable outside of designated areas. It simply is an addiction that is easier to partake of and hide than most.


People who vape are under the impression that exhalation only releases water vapor into their immediate surroundings; I've heard this on multiple occasions from smokers. The question then of course becomes, how does it have a scent if it is just water vapor?


I've heard people say this but it's never even been water vapor. It's vegetable glycerin and/or propylene glycol even if there were no other flavorings or nicotine.


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Recent related discussion: https://news.ycombinator.com/item?id=18712622.


Ecigs are this generations 70's cigarette moment, thanks to social media. It has been glamorized and thus cool:

https://vsco.co/search/images/juul


E-cigs haven't shown to be harmful in the least bit, in fact, there's a lot of evidence that nicotine is a nootropic with neuro-protective properties. Increases cognitive performance and decreases the likelihood of developing Parkinson's or Alzheimer's.

Also while nicotine is addictive, there is some research showing that it is addictive only in the presence of MAOI's (present in normal cigarettes not but E-cigs).

EDIT: I'm getting downvoted, and maybe you guys are right, E-cigs haven't been shown to "not be harmful in the least bit." But their risk profile is more akin to eating junk food than tobacco, which is on a whole different level (disclosure: I don't smoke E-cigs, but I do smoke tobacco)


lol nicotine is addictive as shit. I got hooked via ecigs, not that I'm complaining. Anecdotally I agree with the so-called cognitive benefits. It's similar to caffeine in many respects. But let's not be coy and pretend it's not an addictive substance.


I didn't nicotine wasn't addictive, all I said it there is some evidence to suggest that MAOIs are responsible for a significant portion of nicotine's addictiveness.


Similar scenario here. Did not smoke/dip before I started vaping. I really only became addicted when I switched to salts. Quit cold turkey for about a month but came back because I enjoy the effects.



Thank you for the links. I did read them, but failed to reach the conclusion “pretty far from “harmless””.

It sounds like an understudied but potentially very safe mechanism for nicotine delivery. The big issue seams to be poor behaviour from companies like JUUL, and large quaestions around dosing for adolescents.

I honestly couldn’t tell you from those links if I should be more concerned about nicotine, sugar, caffeine, THC, or alcohol.

At this point I suspect that I should be more worried about soda than vaping.


> Even still, the mounting evidence shows that these devices are not harmless.

> Chronic nicotine exposure may lead to insulin resistance and type 2 diabetes, although this risk may be offset by the well-known appetite suppressant effects of nicotine. Inhaled nicotine increases heart rate and blood pressure. Nicotine is highly addictive in its own right, and it may lead to changes in the brain that increase the risk of addiction to other drugs, especially in young people. Nicotine may also impair prefrontal brain development in adolescents, leading to attention deficit disorder and poor impulse control. These potential harms of nicotine are particularly worrisome in view of soaring rates of e-cigarette use in U.S. teenagers.

> Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.

> Many people incorrectly believe that these devices produce a water vapor when in fact they create aerosols that contain harmful chemicals, and ultra-fine particles that are inhaled into the lungs and out into the environment, making them harmful to the user and others nearby.

I guess you're assuming people aren't going to read the actual links?

Further, this isn't a zero sum game; you can be worried about soda and e-cigs.

It bothers me more than it probably should, your attitude. You're letting this stuff ruin lives all because you want to get high.


> Using nicotine in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.

There is evidence that individuals with ADHD are more likely to become tobacco users. I would be careful about inferring causality on this point.


What about the positive effects of nicotine? Are you saying that the negative effects out weight the good? Or are you just opposed to anything that gets you "high."?


PCP also gives you immense strength. Let's give our kids PCP!

Short term advantages don't make up for long term consequences.

Edit: I'm sorry, that was overly snarky. I should be clear, I don't give a shit what adults do to themselves. My sole concern is this normalization of nicotine reaching kids. They're being marketed to very strongly with this "it's safe!" argument, which doesn't hold up to scrutiny.


I mean, maybe not. But it's a personal decision.


Hey, I think you jumped to another conclusion. I'm not a smoker, vaper or toker.

And I did read your links. I'm even reading your quotes, and I don't reach your conclusion. The language used here is defensive and deliberately vague: Using X in adolescence can harm the parts of the brain that control attention, learning, mood, and impulse control.

X could be almost any activity and be true. Without quantification it even applies to water and O2 consumption. Its the sort of languages our scientists at work use when they not ready to make assertions and would like more money to do research.

> These potential harms of nicotine are particularly worrisome in view of soaring rates of e-cigarette use in U.S. teenagers

This is an appeal to demonstrate that the research should happen soon, not a statement that harm is happening now. Its a sales trigger not a statement of fact. They would like money now, to do research on a topic that I agree, should get significant funding.

I am worried about soda and e-cigs. I'm not sure I'm not more worried about soda, than e-cigs and that seems contrary to social norms at the moment. e-cigs _might_ trigger addictive personalities, and the _might_ marginally increase blood pressure. Soda will rot your teeth, and it will put pressure on your insulin system and it does cause obesity - all in very short order, especially given my families genetics.

I'm not sure how you get to the statement "ruin lives" from our interaction at all. Quite the opposite.

New things are inherently risky. We drank milk for generations without research. It literally killed children who couldn't digest lactase, but also saw the average height and muscle mass of adults increase dramatically in adults that could. If we'd have had science, would we have banned milk? Would we have delayed people from enjoying milk until we reached scientific consensus? Should we ban milk now that we know that 85% of the global population is still lactose intolerant and that its strongly linked with heart disease?

If I'd been similarly on the fence about milk 10k years ago, would you have accused me of ruining lives then as well?

Getting dosing right has also been an issue. Even opiods have safe, non addictive dosing levels for the vast majority of humans. JUUL Pods sound like everclear being marketed as shandy. That needs to be addressed, not necessarily banned. There is a reason whisky is sold at 40% and its not because thats how it comes out of the barrel. We probably need legistlation that marks JUUL as different similar to how we split liquor from beer.

I'm also concerned that we're very good at figuring out how to make a product addictive. And whilst I'm happy to point fingers at big tobacco as they engineered tobacco plants that cigarettes more addictive, we should also look at nestle, kraft and coke cola. Ever wondered why, even though you probably don't like it, Kraft Macaroni Cheese is so compelling? Or why Skyrim and WoW feel so compelling even though the rewards are so sparse?


I'm sorry, and you may legitimately consider this an appeal to authority, but I don't care what you think about this topic, because you are a random stranger, and the people who wrote those links work for some of the best scientific institutions on the planet.

If they say e-cigs are unhealthy, I trust them implicitly, even if they sound vague and defensive (Which I'll admit, they do). When these organizations say something, collectively with one voice such as they have, I take their word, because historically, they've been in chorus exclusively in my interest. Over time, if they degrade that trust I will begin to question them, but they haven't yet, and more importantly, you haven't built anything even on the same plane as them, trust and respect wise.

The fact that you think you can contend with them, arguing about their conclusions is, to me, the absolute height of Internet Arrogance. Who are you? Why do you have the facts and the people involved with creating the above linked documents don't? Why do you think your understanding of the situation is superior to theirs? Don't you think they've considered, analyzed, synthesized, and thrown out everything you've just said?

Hell, where do you think you learned this information in the first place, if not from research done by these very people?

You're punching way too far up, and the fact that you don't realize that or don't care shows you're not worth listening to on this topic, or any topic you do the same thing about.

Someone once told me that if you don't have an advanced degree on a topic, to not try and contribute to that field without the backing of someone (hopefully multiple someones) who do have advanced degrees in that field. I suggest you listen to that person.


Also an excellent read on the subject: https://www.gwern.net/Nicotine


Maybe harmless is too strong a word. We don't have enough data to really know about E-cigs at the moment, but nicotine doesn't have any deleterious health effects, in fact, quite the opposite; nicotine is good for you.

When we are talking about E-cigs, it's good to keep in mind the alternative, smoking tobacco. Smoking cigarettes is absolutely terrible for your health, something like 2/3s of life-long smokers die of tobacco related issues. I highly doubt E-cigs are even 1/000th are harmful, in terms of long-term outcomes.


> it's good to keep in mind the alternative, smoking tobacco

OR not sell and advertise to children? It is proven that there is damage to young people so let's admit that the problem exists and find a way to protect the young but let the adults smoke or do whatever they want.


I mean do you think it really makes a difference? Kids have been doing drugs and drinking and having sex for as long as anybody remembers.

Teens are genetically programmed to engage in risky behavior, it's a very old evolutionary adaptation. I don't think you or anyone else is ever going to be able to change that.


All kinds of risky behavior dropped among teens: unprotected sex, alcohol consumption, heroin consumption, they even drive safer and commit less violent crime. So, it is very safe to assume that with changing society and circumstances, they will drop e-smoking too.

Also, teenagers are easy to influence through ads and eager to mimic cool characters in entertainment and what not. That makes them more likely to be influenced by both advertisement and lack of it.

Teenagers being somewhat more likely to take risk then equivalent single person of older age does not imply that the amount and kind of their risk taking is constant through human history and will not change as adults change their behavior.


The cigarettes usage dropped after we did something about it, so why are you against of informing parents and children about the reality, what I think we should investigate as a possible action:

1 write all the downsides on the packaging similar as for cigarettes

2 do not allow products that target children, I am referring to products with bright colors and candy aromas etc

I believe that the society can do a difference, it is true that some kids will use drugs, alcohol but those will usually have a problem at home, what we need to stop is having regular kids using e-cigarettes because they think are safe and cool.


> do not allow products that target children, I am referring to products with bright colors and candy aromas etc

the wide range of flavors is one of the main reasons that vaping is an effective smoking cessation tool for me and many other adults. please do not advocate banning flavors.


Your opinions must be considered too, so maybe we only force how packaging and ads look like.


yeah I'm fine with the whole packaging being gruesome images of lung cancer or whatever you need. all I ask is that you don't break the part that makes it actually work for me.


I wouldn't limit this to tobacco.

Advertising to children is real problem. Adults may be equipped to deal with the psychological games advertisers employ, children are most certainly not.

If children must be exposed to advertising, they shouldn't be the target.


certain widely eaten food plants contain small amounts of nicotine: tomatoes, potatoes, eggplants, chili peppers, even some kinds of tea

https://en.wikipedia.org/wiki/Nicotine#Occurrence_and_biosyn...

so billions of people are consuming a little bit of nicotine all the time. OTOH, wikipedia notes a few adverse effects, especially for children and during pregnancy

https://en.wikipedia.org/wiki/Nicotine#Adverse_effects


It's the volume of nicotine, not presence, that causes the problem.


Says who?

I occasionally smoke Nicotiana Rustica, or farmers tobacco; which is plenty stronger than regular tobacco. And it's less addictive, even helps some people to quit because their bodies finally get all the nicotine they've been craving. And not surprisingly it's forbidden to sell it in most countries.

Someone fucked around with regular tobacco, that seems pretty obvious from here. It's basically designed to hook you more effectively and make you sicker by raising the nicotine levels really quick and then dropping them like a stone.

Which I assume is exactly what they're doing with the vaping liquids/salts as well. Profits, returning customers; who gives a shit about the world?


Says the links above? I didn't make it up, if that's what you're asking...


These are wild claims and we are going to need to see some references.



Why are there conflicting reports on the stats from the CDC?

The CDC's website[1] says there's been a 0.6% increase in vaping in middle school and 1.5% increase in high school since 2011. This advisory however says "E-cigarette use among U.S. middle and high school students increased 900% during 2011-2015, before declining for the first time during 2015-2017." Was there a nearly 899% drop in 2015-2017?

https://www.cdc.gov/tobacco/data_statistics/fact_sheets/yout...


> Why are there conflicting reports on the stats from the CDC?

There aren't.

> The CDC's website[1] says there's been a 0.6% increase in vaping in middle school and 1.5% increase in high school

No, it doesn't. The 0.6% and 1.5% numbers appear, but as the base incidence in 2011 from which an increase occurred, not the percent increase. Quoting the relevant passage of your own source (emphasis added):

“Nearly 5 of every 100 middle school students (4.9%) reported in 2018 that they used electronic cigarettes in the past 30 days—an increase from 0.6% in 2011.”

“Nearly 21 of every 100 high school students (20.8%) reported in 2018 that they used electronic cigarettes in the past 30 days—an increase from 1.5% in 2011.”

There is a difference between an “an increase FROM x% IN 2011” and “an increase OF x SINCE 2011”; you seem to have confused the former for the latter.

The middle school increase reported is 717%; the high school increase reported is 1287%. There is nothing obviously inconsistent with aggregate 900% increase 2011-2015 with a slight aggregate decline thereafter.


Yes, yayana explained my error pretty succinctly before you did...


A rise from 0.6% to 4.9%.. 0.5->5 would be 1000%. I think you misread the CDC numbers.


Yup! You're right.


Epidemic seems a little strong...


Because you feel it's not widespread enough or not damaging enough (or both)?


I think it would be about rates of increase or decrease rather than overall numbers. If it were about overall numbers, well, its pretty clear we've ended a tobacco epidemic over the past 60 years.

Not sure if any one else here remembers cigarettes in restaurants, but imagine spelling camels while getting your salad bar refill at Sizzler.

We've come a long way.


That doesn't mean we're finished. Pretending this problem is solved will just result in it getting out of hand again.


What do you mean by 'finished' and 'solved'? You speak as if there is some sort of societal goal in mind here. You've clearly got an agenda here and I think you should make it clear that you've got a goal in mind here regarding whats 'right' and 'wrong' for other people to do with their time, lives, and money.

If people want to smoke, let them smoke. Is it bad for them? Yeah. Does it have a negative cost against society? Yeah. But its a slight cost that I'm willing to bear to uphold personal liberty and freedom of choice.

Overall, smoking rates are pretty low, and we're probably on the other side of the overall costs smoking writ-large will have on society. So its fine. If people still want to smoke, warn them of the negatives, then let them smoke.


I assume the societal goal is to help young people, whose brains aren't yet able to make sound decisions (https://www.aacap.org/aacap/families_and_youth/facts_for_fam...) and keep them from doing things which might really hurt them in life like developing nicotine or alcohol dependency. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519837/)


They already require people be over 18, maybe the punishment should be higher on those who are supplying children with them?

The reason I'm so against more regulation is that the current trend in the war against ecigs is to ban pretty much any good tasting flavors (all but menthol), and I don't like that what entails for our future. I don't even vape, but the idea that the majority will go around banning what they don't like "for the good of the children" is something I refuse to support.

It's not going to stop if it gets started.


How about we focus on the fact that today's kids have a shorter life expectancy than their parents due to shitty eating habits? I think that is an epidemic. Never heard anything about that from the Surgeon General though. Can't upset the Big Food apple cart too much.


Especially when you compare overall tobacco and tobacco derivative consumption across time. Simply put, the overall rate of tobacco and nicotine consumption now is significantly lower than 20 years ago, which was significantly lower than 20 years prior, which was significantly lower than 20 years prior, which was... well you get the idea.

https://www.cdc.gov/tobacco/data_statistics/tables/trends/ci...


Well, this was due to the fact that the dangers were recognized when adoption was already widespread and, as you mention, dozens and dozens of years of PSAs, bans and medical consulting were necessary to lower consumption rates.

Maybe this time it would make sense to start this process sooner?


I think we largely already have. If something is legal in society, there is always going to be some rate of individuals interested in participating. At some point, if you want the government to nanny over you and make your choices for your, just possessing the substance illegal. Otherwise, warn people of its ills, then let them choose.


The references go way back! (Also applies to your user name. Actually, if I press on that link, I get a blank page.)


ELI5: what makes vaping more dangerous or concerning than say coffee or energy drinks?


The withdrawal symptoms are far worse, for one.

If you go off caffeine, you're drowsy for a few days, no big deal.

If you go off nicotine, you're condemning yourself to months or years of craving that never fully goes away: the physiological components of nicotine addiction are more or less permanent.

That's just off the top of my head. I wouldn't be surprised if there are detrimental dosage effects of nicotine that caffeine doesn't have.


I quit smoking daily (at least half a pack per day) for 3 years straight,and it was "cold turkey" as they say.

Once I quit,I felt a bit uncomfortable like a very mild headache(almost background annoyance) for about two weeks and that was all there was to it. Now,I've never been addicted to caffeine even though I drink espresso shots daily for weeks and for a few more weeks might not drink any caffeine,so I have no frame of reference for comparison.

Stress does still cause me to be tempted but it's no worse than being tempted to eat fast food.




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