Health Promotion International Advance Access originally published online on November 8, 2004
Health Promotion International 2004 19(4):482-488; doi:10.1093/heapro/dah410
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HEALTH PROMOTION INTERNATIONAL Vol. 19. No. 4 © Oxford University Press 2004; All rights reserved.
PERSPECTIVES |
National legislation on school smoking restrictions in eight European countries
1Research Centre for Health Promotion, University of Bergen, Norway, 2Child and Adolescent Health Research Unit, University of Edinburgh, Scotland, UK and 3Health Promotion Division, Welsh Assembly Government, Wales
Address for correspondence: Bente Wold, University of Bergeb, Research Centre for Health Promotion, Christiesgate 13, N-5015 Bergen, Norway E-mail: Bente.wold{at}psych.uib.no
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SUMMARY |
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Objective: To review and compare national legislation addressing smoking at school in eight European countries during the late 1990s.
Design: The data are from the EC-funded Control of Adolescent Smoking (CAS) study in eight European countries. The information on national legislation was gathered during the period 1998–1999, through a review of scientific and official documents and interviews with key informants in each country.
Results: Four of the participating countries (Austria, French-speaking Belgium, Finland and Norway) had legislation specifically restricting smoking at school, while the remaining countries (Denmark, North Rhein Westphalia region of Germany, Scotland and Wales in the UK) did not have such legislation in place. In those countries with legislation in place, smoking among students aged 15 years and younger was not permitted. The position with regard to teacher smoking varied considerably among countries, but with the exception of Finland, there was no legislation regulating outdoor smoking by teachers during school hours.
Conclusions: The findings suggest that there were inconsistencies within countries in terms of legislation that had been developed and the enforcement, compliance and monitoring practices that were in place. Further work is required to develop and resource such mechanisms, although it may be possible to build on existing practice, such as increasing the involvement of school health services, school inspectorate services or working through health promoting school networks already established in many countries.
Key words: tobacco control legislation; adolescents; teachers; school smoking restrictions
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INTRODUCTION |
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Among the main developments in the prevention of tobacco use during the 1990s, has been the increase in legislation restricting smoking at national, regional and local levels (Harkin et al., 1997
; Lantz et al., 2000; Wakefield and Chaloupka, 2000). Given that school is one of the most important settings influencing adolescent development of health behaviours such as smoking and that school is considered a target arena for health education and health promotion (Millstein et al., 1993), legislation restricting smoking in schools has the potential to play an important preventive role in tackling adolescent smoking.
Harkin et al. (Harkin et al., 1997) concluded in their study of smoking policies in the WHO European Region that most countries did have some form of legislation restricting smoking in public places. The vast majority of countries were found to have some form of tobacco control policy in place but there was considerable variation in the extent and comprehensiveness of these policies. While this research showed that Finland, Iceland, Norway and Sweden had developed the most comprehensive legislative frameworks, the specific issue of restricting student and teacher smoking in schools was not examined. The study reported in this paper was designed to address the lack of information on school smoking policies and to make a contribution to the literature in the area of smoking control in Europe with reference to schools as public places.
According to Bodansky (Bodansky, 1999), legislation regulating human behaviour is more likely to be effective when accompanied by the following: (i) cognitive and normative consensus; (ii) adequate enforcement; (iii) compliance; (iv) monitoring or reporting to promote transparency; (v) participation by a wide variety of stakeholders; and (vi) threats of sanctions. Certain aspects of legislation and the programmes that follow are also thought to be critically important, such as the need for clarity, consistency, comprehensiveness and clearly defined strategies (Hill, 1997; Bodansky, 1999).
While legislation restricting smoking in schools may have a clearly defined strategy, this could be directed in many ways, such as the protection of adult non-smokers and minors from passive smoking, the reduction of smoking prevalences in the school setting or the protection of minors from smoker role models. It follows that legislation focusing on a single aim (restricting smoking in schools) could be expected to yield different results, depending on the specific goals that are being sought.
It should also be recognized that if restrictions on smoking at school are introduced in the absence of an enforcement mechanism at national and/or local levels, they are unlikely to be implemented effectively. Furthermore, if systems are not in place to monitor and report how schools implement restrictions, it will be difficult to establish how they are being enforced, if at all. For example, recent studies in the United States and the United Kingdom have found an association between school restrictions and smoking prevalence but that restrictions need to be strictly enforced (Wakefield et al., 2000; Moore et al., 2001).
Against this background, data on national legislation with regard to school smoking in eight European countries during the late 1990s are presented here, the aim being to assess country differences and to examine where legislation exist, whether it meets the effectiveness criteria outlined above by Bodansky (Bodansky, 1999). The specific research questions addressed are as follows.
- What legislation on school tobacco control was in place and how did they differ between countries?
- What were the goals of the legislation policies?
- To what extent was the legislation:
- clear, consistent and comprehensive;
- accompanied by a system to ensure adequate enforcement, compliance and monitoring;
- accompanied by threats of sanctions?
- clear, consistent and comprehensive;
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METHODS |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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The data presented in this paper were collected as part of the EC-funded Control of Adolescent Smoking (CAS) study in eight European countries: Austria, French-speaking Belgium, Denmark, Finland, North Rhine Westphalia region of Germany, Norway, Scotland and Wales (Wold and Currie, 2001
). The study is linked to an existing transnational study on health behaviours among children and adolescents, the Health Behaviour in School-aged Children (HBSC), a World Health Organization collaborative cross-national survey (Currie et al., 2000). Eight of the 29 countries participating in the 1997/98 HBSC study joined as partners in the research reported here, undertaking a series of interlinked surveys on tobacco control at national, school and student levels. This paper is based on the national level data.
Information on school smoking policies was collected as part of a broader exercise examining national policies relevant to adolescent smoking control. Data collection took place between September 1998 and February 1999, through a review of scientific and official documents and interviews with key informants in each country. Key informants included government officials at national and local level with responsibility for tobacco control policy. These activities yielded information on the status of relevant policies, their implementation, and cultural factors operating at national and regional levels. Of special note were those policies, which dealt specifically with school smoking restrictions. To assist with the collection of data, a standard international "interview guide"/schedule was developed, based on Crosswaite and McQueen's model of good practice in implementation (Crosswaite and McQueen's 1993). It is presented in full in Wold et al. (Wold et al., 2000). Important questions in the schedule specifically relating to school smoking restrictions included:
- Are there national targets for smoking reduction among adults and adolescents?
- Does the government have a clearly defined strategy for reducing smoking among the whole population? If so, describe it.
- Are there restrictions on smoking in public places?
- What are the policies/laws/codes of practice relevant to restriction of smoking in schools with 15-year-old students? (Quote them in their entirety.)
- How clearly and concisely are the aims of the policy/law/code of practice formulated? (Comment upon text of policy.)
- Were arrangements made to monitor and evaluate the implementation of the policy?
- What processes/structures have been set up to enforce the policy? Is it enforced? How?
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RESULTS |
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Given fieldwork dates, the results describe the legislative environment in the eight countries as they were during the 1997/1998 school year. All countries had national laws restricting smoking in public buildings, with the exception of the UK (Scotland and Wales). That said, only Finland and Norway had explicit published and government-funded strategies for reducing smoking among young people. The results presented below relate to national legislation restricting smoking in schools.
National legislation restricting smoking in schools
Data collected through the documentary analysis and interviews with key informants show that the main differences between the eight countries can be characterized by whether or not national laws were in place restricting smoking at school and how the laws were developed. The countries in the study can be classified into one of the following two groups:
- those countries with national laws that explicitly restricted smoking in schools—Austria, Belgium (French-speaking), Finland and Norway;
- those countries where there was no national laws specifically restricting smoking in schools—Denmark, Germany (North Rhine Westphalia) and the UK (Scotland and Wales).
Within the latter group, it should be noted that actual practice in schools varied considerably within countries and even within regions (in the case of North Rhine Westphalia). These two groups are now examined in turn.
Countries with national laws that prohibit smoking in schools
In Austria, Finland and Norway, smoking was restricted on the basis of national legislation prohibiting smoking in public buildings, and schools were specifically identified in this legislation. The main aim of the legislation was to provide a clean indoor environment, prevent harm from passive smoking and thus protect non-smokers. These restrictions were strengthened through legislative changes in 1987 in Austria and in 1995 in both Norway and Finland.
In all four countries, smoking in schools was not permitted among students aged 15 years and under but was permitted for teachers in restricted areas, typically staff rooms. This has been the case in Austria since 1987, when smoking was banned in schools with the exception of teachers smoking in the staff room. In Austria the law restricts smoking only within the school building, and does not stipulate any restriction outside the building on the school grounds. In Belgium, one law prohibited all smoking in school buildings, but another law on smoking in the workplace allowed teachers, in principle, to establish separate rooms for smokers. In Norway, the 1995 legislation does not allow smoking within the school building. However, teachers are permitted to smoke outdoors on the school premises. In both Norway and Austria, earlier proposals to implement a total ban on smoking in schools met with strong opposition from teachers' unions and resulted in compromises to allow teachers to smoke.
The only country to ban teachers from smoking outdoors on the school premises was Finland, following the Finnish Parliament's 1994 renewal of the Tobacco Control Act of 1977. The main aim of the new provisions (765/94) was to protect people from involuntary exposure to tobacco smoke at work and in public places, alongside the prevention of smoking by young people in their daily working environment. The new provisions came into force on 1 March 1995 [see (www.tupakka.org)] and prohibit smoking on educational premises, both indoors and outdoors, and in those premises used primarily by young people aged 18 years and below. Smoking rooms are permitted elsewhere but not in conjunction with indoor premises primarily used by persons under the age of 18.
The means by which information about national legislation was communicated to schools when it came into force varied from country to country. However, in all cases, the responsibility for implementing and enforcing the law in the school lay with the school head and teaching staff. There were no other formal structures to oversee the implementation and enforcement of policy in schools, nor were there systems in place for monitoring, reporting and evaluating the restrictions.
Countries with no national laws restricting smoking in schools
Legislation restricting smoking in public buildings was also in place in Denmark, although this legislation did not apply to schools under the jurisdiction of individual school boards. For this reason, if schools in Denmark had smoking restrictions at all, they varied considerably from school to school.
In Germany, smoking policies varied from region to region, but in the schools of North Rhine Westphalia, teachers were allowed to smoke, as were older pupils (16 years and above) with parental consent, in restricted areas of the school grounds. National legislation restricting smoking in public buildings did exist but schools were not specifically mentioned.
Turning to the UK, smoking restrictions were in place in the vast majority of schools in both Scotland and Wales (Moore et al., 2001; Wold and Currie, 2001; Griesbach et al, 2002), although these restrictions had generally been developed by local education authorities or by schools themselves rather than being a result of national legislation. It was common for such restrictions to have been developed using guidance for establishing general policies on staff smoking in the workplace, although the heads of individual schools had the autonomy to be able to modify such policies to suit the particular circumstances of the school.
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DISCUSSION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
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The findings from this study indicate that four of the participating countries (Austria, French-speaking part of Belgium, Finland and Norway) had national laws specifically targeting smoking at school, while the remaining countries (Denmark, North Rhine Westphalia region of Germany and Scotland and Wales in the UK) did not have such laws at the national level. In countries with national legislation, there were laws banning smoking in school among students who were 15 years and younger. The picture concerning teacher smoking varied considerably among the countries, but with the exception of Finland, there was no legislation restricting smoking outdoors on the school premises by teachers during school hours.
Policy development is a dynamic process and while a formal follow-up data-collection exercise has not been undertaken, the picture is now somewhat different to that of 1997/1998. For example, in Denmark, legislation introduced in 2001 has prohibited students from smoking at school and restrictions have been placed on teachers smoking [see (www.tobaksskaderaadet.dk)]. Two key developments have taken in place in the UK. First, in 1998, ‘Smoking Kills’, a White Paper on tobacco control was published, setting out a programme of action including initiatives targeted at young people (Secretary of State for Health, 1998; Action on Smoking and Health, 2002). This was followed in 1999 by devolution, which resulted in the establishment of the Welsh Assembly and Scottish Parliament and the subsequent development of comprehensive tobacco programmes in each country. In the past three years, Norway has also undertaken a number of new tobacco control initiatives, among them a substantial increase in public funding for tobacco control (Braverman et al., 2001). In addition, attention is being focused on greater enforcement of existing legislation. With the exception of Denmark, there would not appear to have been significant change relating specifically to national initiatives focusing on school smoking restrictions, although activity may well be taking place at school level.
A particular problem that this study has had to address is the difficulty of collecting truly comparable cross-national data on tobacco legislation, the reasons being that data were not available on the same issues in every country, and the form that the data took varied from country to country. However, the development of a common protocol facilitated a consistent approach to information collection. Overall, the research findings presented here are similar to those from earlier studies, primarily by Harkin et al. (Harkin et al., 1997) and Brownson et al. (Brownson et al., 1997).
The goals of restricting smoking by teachers
The findings of this study suggest that the direct goals of the laws restricting smoking by teachers focus largely on protecting students and staff from the harmful effects of exposure to smoking within the school building. As suggested in Brownson et al.'s (Brownson et al., 1997) review, efforts to restrict smoking in public have proliferated over the past decade, and bans have been found to be effective in reducing non-smokers' exposure to environmental tobacco smoke. Thus, legislative measures restricting indoor smoking at school may be effective in terms of solving the problem of harmful health effects of passive smoking (Bodansky, 1999).
However, when developing legislation, potential conflicts with other prevention aims need to be considered, for example, preventing young people from taking up smoking. Based on analyses of national, school and student level CAS data, Wold et al. (Wold et al., 2004) found that both national and school level laws and regulations restricting smoking by teachers were associated with a reduced probability of students reporting that they are exposed to teachers who smoke indoors, but conversely a greater probability of being exposed to teachers smoking outdoors. Analyses of Scottish CAS student data also indicate that in schools where a complete ban on teacher smoking existed, smoking among teachers was perceived less often in the staff rooms but more often outside on the school premises (Griesbach et al., 2002). Thus, the restrictions seem to enhance the risk of students' exposure to a certain type of smoker role model, which according to the principles of observational learning (Bandura, 1986) is expected to influence their adoption of the smoking habit. Indeed, analysis of Danish CAS data has shown that students exposed to teacher smoking are more likely to report being daily smokers and heavy smokers (Poulsen et al., 2002).
Clear, consistent and comprehensive policies?
The present findings on national legislation on school smoking restrictions indicate that those countries with more restrictive national tobacco policies in 1997/1998 (notably Finland and Norway) also had clearly formulated and published targets and strategies at this time. It could be suggested that in these countries, more so than others, problem definition and the development of policy options has been considered at the highest political level. However, this interpretation is somewhat simplistic. For example, while there was no national policy restricting smoking in schools in the UK, smoking was prohibited among students in almost all schools in Scotland and Wales and for teachers in the vast majority of cases. Since devolution in the UK, school smoking policy is still the responsibility of schools but both Scotland and Wales have developed comprehensive tobacco control programmes.
Another issue to emerge from the study is that even if legislation is in place, it may not be effective if it is perceived to be inconsistent and/or confusing. For example, there is evidence to suggest that in Finland, the legislation prohibiting smoking has been interpreted to mean that smoking is permitted if certain conditions are fulfilled, even though the intention was quite clearly the creation of smoke free schools.
As noted by Harkin et al. (Harkin et al., 1997) in their earlier work on Europe and confirmed by the present study, the comprehensiveness of tobacco control policies differed substantially between countries at the time of fieldwork. In both Finland and Norway, for example, strict policies had been in place for some time. However, it is possible that the overall policy package was not comprehensive enough to have had a substantial effect on smoking prevalence. For example, Braverman et al. (Braverman et al., 2001) conclude that the most likely explanation for the increase in smoking among young people in Norway during the 1990s is the lack of attention given to educational interventions and public information campaigns. Clearly legislation governing smoking restrictions in schools still needs to be supported by a range of complementary initiatives.
Systems ensuring adequate enforcement, compliance and monitoring
Several studies have shown that as a group, staff smokers may look unfavourably on a no-smoking policy at school and that there may be some resistance to implementing such a policy (de Moor et al., 1992; Galaif et al., 1996; Hartland et al., 1998), while other studies suggest that compliance with bans on smoking in school is low (Stephens and English, 2002; Wakefield and Chaloupka, 2000). Clearly legislative measures need to be accompanied by satisfactory systems for ensuring enforcement and compliance. However, the findings suggest that those countries with national laws restricting smoking at school did not have formal structures outside of the educational system to ensure the implementation and enforcement of these restrictions. Systems for monitoring, reporting and evaluating legislation did not appear to be in place and the study also provides evidence that legislation concerning school smoking restrictions was not accompanied by threats of sanctions.
Conclusion
The findings suggest that overall, national legislation with regard to school smoking in these eight European countries were not well developed in 1997/1998, although there is evidence of activity at school level and research published elsewhere suggests that such activity can contribute to tackling smoking among young people. Reflecting on the quality criteria for effective policy development proposed by Bodansky (Bodansky, 1999) and Hill (Hill, 1997), across the countries in the study there was more scope for developing consistent national legislation and mechanisms to encourage enforcement, compliance and monitoring. Further work is required to develop and resource such mechanisms, although it may be possible to build on existing practice, such as increasing the involvement of school health services, school inspectorate services or working through health promoting school networks already established in many countries.
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ACKNOWLEDGEMENTS |
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The project, Control of Adolescent Smoking (CAS), was funded by EC BIOMED II grant BMH4-CT98-3721 and a grant from the Norwegian Research Council. Thanks are due to the partners of the Control of Adolescent (CAS) study for their collaboration and use of their data: Wolfgang Dür, Austria; Danielle Piette, French-speaking Belgium; Lasse Kannas and Jorma Tynjälä, Finland; Bjorn Holstein and Lis Hentze Poulson, Denmark; Klaus Hurrelmann and Bettina Schmidt, Germany. Also thanks to Dawn Griesbach for her assistance in analysing the data, and Elisabeth Fosse for her comments on earlier drafts of the paper. The views expressed in this paper are those of the author and not necessarily those of the Welsh Assembly Government.
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REFERENCES |
|---|
|
TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONREFERENCES |
|---|
Action on Smoking and Health website (2004) www.ash.org.uk (last accessed 1 September 2004).
Bandura, A. (1986) Social Foundations of Thought and Action. Prentice-Hall, Englewood Cliffs, NJ.
Bodansky, D. (1999) What makes international agreements effective? Framework Convention of Tobacco Control. Technical Briefing Series, Paper 4. WHO, Geneva.
Braverman, M. T., Svendsen, T., Lund, K. E. and Aaroe, L.E. (2001) Tobacco use by early adolescents in Norway. European Journal of Public Health, 11, 218–224.
Brownson, R. C., Eriksen, M. P., Davies, R. M. and Warner, K. E. (1997) Environmental tobacco smoke: health effects and policies to reduce exposure. Annual Review of Public Health, 18, 163–185.[CrossRef][Web of Science][Medline]
Crosswaite, C. and McQueen, D. V. (1993) The implementation of smoking and nutrition policies in Scotland and Finland: a review. Report from Research Unit in Health and Behavioural Change, University of Edinburgh, Edinburgh.
Currie, C., Hurrelmann, K., Settertobulte, W., Smith, R. and Todd, J. (eds) (2000) Health and health behaviour among young people: Health Behaviour in School-aged Children: a WHO Cross-National Study (HBSC) International Report. WHO Policy Series Health policy for children and adolescents, 1, WHO-Euro, Copenhagen.
de Moor, C., Cookson, K., Elder, J. P., Young, R., Molgaard, C. A. and Wildey, M. (1992) The association between teacher attitudes, behavioral intentions, and smoking and the prevalence of smoking among seventh-grade students. Adolescence, 27, 565–578.[Web of Science][Medline]
Galaif, E. R., Sussman, S. and Bundek, N. (1996) The relations of school staff smokers' attitudes about modeling smoking behavior in students and their receptivity to no-smoking policy. Journal of Drug Education, 26, 313–322.[Web of Science][Medline]
Griesbach, D., Inchley, J. and Currie, C. (2002) More than words? The status and impact of smoking policies in Scottish schools. Health Promotion International, 17, 31–41.
Harkin, A. M., Anderson, P. and Goos, C. (1997) Smoking, drinking and drug taking in the European Region. WHO-Euro, Copenhagen.
Hartland, J., Tudor-Smith, C. and Bowker, S. (1998) Smoke-free policies in schools: a qualitative investigation of the benefits and barriers. Health Education Journal, 57, 51–59.
Hill, M. (1997) The Policy Process in the Modern State, 3rd edition. Prentice Hall/Harvester Wheatsheaf, Harlow.
Lantz, P. M., Jacobsen, P. D., Warner, K. E., Wasserman, J., Pollack, H. A., Berson, J., et al. (2000) Investing in youth tobacco control: a review of smoking prevention and control strategies. Tobacco Control, 9, 47–63.
Millstein, S. C., Petersen, A. C. and Nightingale, E. O. (1993) Promoting the Health of Adolescents. Oxford University Press, New York.
Moore, L., Roberts, C. and Tudor-Smith, C. (2001) School smoking policies and smoking prevalence among adolescents: multilevel analysis of cross-sectional data from Wales. Tobacco Control, 10, 117–123.
Poulsen, L. H., Osler, M., Roberts, C., Due, P., Damsgaard, M. T. and Holstein, B. (2002) Exposure to teachers smoking and adolescent smoking behaviour: analysis of cross sectional data from Denmark. Tobacco Control, 11, 246–251.
Secretary of State for Health, and the Secretaries of State for Scotland, Wales and Northern Ireland (1998) Smoking Kills. A White Paper on Tobacco. Cm 4177. HMSO, London.
Stephens, Y. D. and English, G. (2002) A statewide school tobacco policy review: process, results and implications. Journal of School Health, 72, 334–338.
Wakefield, M. A., Chaloupka, F. J., Kaufman, N. J., Orleans, C. T. and Barker, D.C. (2000) Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study. British Medical Journal, 321, 333–337.
Wakefield, M. and Chaloupka, F. (2000) Effectiveness of comprehensive tobacco control porgrammes in reducing teenage smoking in the USA. Tobacco Control, 9, 177–186.
Wold, B., Holstein, B., Griesbach, D. and Currie, C. (2000) Control of Adolescent Smoking. National policies on restriction of smoking at school in eight European countries. Report to EC BIOMED II. Child & Adolescent Health Research Unit, University of Edinburgh.
Wold, B. and Currie, C. (2001) Control of Adolescent Smoking: Transnational variation in prevalence of adolescent smoking: the role of national tobacco control policies and the school and family environment. Report to EC BIOMED II. Research Centre for Health Promotion, University of Bergen, Norway.
Wold, B., Torsheim, T., Currie, C. and Roberts, C. (2004) National and school policies on restrictions of teacher smoking: a multilevel analysis of student exposure to teacher smoking in seven European countries. Health Education Research, 19, 217–226.
www.tobaksskaderaadet.dk. (last accessed 1 September 2004).
www.tupakka.org. Finnish act for measures to reduce tobacco smoking (last accessed 1 September 2004).
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