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1.  Perceived Weight, Not Obesity, Increases Risk for Major Depression Among Adolescents 
Journal of psychiatric research  2013;47(8):1110-1117.
This study examined the association between major depression, obesity and body image among adolescents. Methods: Participants were 4,175 youths 11–17 years of age sampled from the community who were interviewed using the Diagnostic Interview Schedule for Children and Adolescents, Version IV, completed a self-report questionnaire, and had their weight and height measured. There were 2 measures of body image: perceived weight and body satisfaction. Obesity was associated with increased risk of depression, with no controls for covariates. However, when the association was examined in models which included weight, major depression, and body image measures and covariates, there was no association between major depression and body weight, nor between body satisfaction and major depression. Perceived overweight was strongly and independently associated with body weight (O.R. = 2.62). We found no independent association between major depression and body weight. If there is an etiologic link between major depression and body weight among adolescents, it most likely operates through processes involving components of body image. Future research should focus on the role of depression and body image in the etiology of obesity.
PMCID: PMC3686272  PMID: 23643102
adolescents; major depression; obesity
2.  Perceived weight in youths and risk of overweight or obesity six years later 
To examine the association between perceived overweight in adolescents and the development of overweight or obesity later in life.
This paper uses data from a prospective, two-wave cohort study. Participants are 2445 adolescents 11-17 years of age who reported perceived weight at baseline and also had height and weight measured at baseline and at follow-up six years later sampled from managed care groups in a large metropolitan area.
Youths who perceived themselves as overweight at baseline were approximately 2.5 times as likely to be overweight or obese six years later compared to youths who perceived themselves as average weight (OR= 2.45, 95% CI=1.77-3.39), after adjusting for weight status at baseline, demographic characteristics, major depression, physical activity and dieting behaviors. Those who perceived themselves as skinny were less likely to be overweight or obese later (OR=0.36, 95% CI=0.27-0.49).
Perceived overweight was associated with overweight or obesity later in life. This relationship was not fully explained by extreme weight control behaviors or major depression. Further research is needed to explore the mechanism involved.
PMCID: PMC3927402  PMID: 24360137
Obesity; perceived weight; children; adolescence
3.  Depression and Insomnia Among Adolescents: A Prospective Perspective 
Journal of affective disorders  2012;148(1):66-71.
No studies of adolescents have examined the prospective, reciprocal association between insomnia and major depression.
A two-wave, community-based cohort of 3,134 youths aged 11–17 at baseline. Major depression was assessed using DSM-IV criteria. Three measures of insomnia were used also following DSM-IV: P1, any symptom of insomnia; P2, any symptom plus impairment; P3, P2 with no comorbid mood, anxiety or substance use disorders.
In general, the association between insomnia and depression was stronger and more consistent for major depression than for symptoms of depression. Baseline insomnia (P1 and P2) increased subsequent risk of major depression 2–3-fold and P1 2-fold in multivariate analyses. Major depression increased risk for subsequent insomnia 2–3-fold for P1 and P2 2-fold for P2 in multivariate analyses. Results varied by measure of insomnia used.
Only symptoms of insomnia were assessed, so we could not examine the effects of comorbid sleep disorders nor did we have objective or biological measures of disturbed sleep.
We also did not collect data on parental reports of youth depression nor insomnia or sleep problems.
Our results provide the first prospective data on insomnia and major depression among adolescents indicating the two are reciprocally related. More studies are needed examining trajectories of insomnia and major depression in childhood and adolescence.
PMCID: PMC3644326  PMID: 23261135
Major Depression; Insomnia; Adolescents; Epidemiology
4.  Obesity Has Few Effects on Future Psychosocial Functioning of Adolescents 
Eating behaviors  2013;14(2):128-136.
We reexamine the effects of obesity on a wide range (n=17) of indicators of functioning drawn from five broad domains: interpersonal problems, psychological problems, suicidal behaviors, academic performance, and psychiatric disorders. Evidence on this question is mixed. Data are analyzed from a large community sample of adolescents 11 – 17 at baseline (n=4175) who were followed up a year later (n=3,134). Using measured height and weight, overweight was defined as 95th > BMI ≤ 85th percentile and obese as BMI > 95th percentile. At baseline, obesity was associated with increased odds only for any mood disorder and poor perceived mental health. For boys, there were no significant associations, but girls had higher odds of problems at school, poor perceived mental health, and mood disorders. Results from the two-wave cohort reveal obesity increased future risk only for poor perceived mental health. For boys, the same pattern was observed, but for girls there were no significant associations. Overall, we found that weight status had few deleterious effects on adolescent social functioning, in multivariate, prospective analyses. If there is an effect of obesity on functioning, it may operate through mediators such as body image.
PMCID: PMC3618662  PMID: 23557808
Mental health; obesity; adolescents
5.  Heterogeneous trajectories of depressive symptoms: Adolescent predictors and adult outcomes 
Journal of affective disorders  2012;148(0):391-399.
Depressive symptoms display heterogeneous trajectories across adolescence and early adulthood. Identifying risk and protective factors for distinct trajectory groups, and their respective outcomes, may provide insight into the etiological underpinnings of different symptom courses and inform the targets and timing of intervention.
A school-based sample of 719 adolescents completed four diagnostic evaluations and up to 7 annually mailed questionnaires assessing psychiatric symptoms and psychosocial risk and protective factors. Parental history of psychiatric disorder was assessed. Growth mixture modeling (GMM) was used to identify latent depressive symptom trajectories from mid-adolescence through age 30, as well as their predictors in mid-adolescence and adult outcomes.
A three class model consisting of high stable (32%), moderate decreasing (44%), and low decreasing (24%) depressive symptom trajectories emerged as the preferred solution. Demographic, psychosocial, and psychiatric characteristics differentiated the low and high symptom classes, and provided support for interpersonal models of depression chronicity. Members of the moderate and high symptom classes evidenced the worst psychosocial and psychiatric outcomes by age 30, with members of the high symptom class showing the greatest levels of impairment.
Cross-sectional measurement and floor effects of several predictor variables may have obscured the relations between those predictors and trajectory class membership.
These findings suggest that prevention and intervention strategies may specifically target young women and those who experience poor interpersonal functioning in an effort to alter the course of depressive symptoms through early adulthood.
PMCID: PMC3654021  PMID: 22963892
Depression; Trajectories; Adolescence; Emerging adulthood; Growth mixture model
7.  Rates of DSM-IV Psychiatric Disorders Among Adolescents in a Large Metropolitan Area 
Journal of psychiatric research  2006;41(11):959-967.
We present prevalence data for adolescents in a large metropolitan area in the U.S. and the association of DSM-IV diagnoses to functional impairment and selected demographic correlates. We sampled 4,175 youths aged 11–17 years from households enrolled in large health maintenance organizations. Data were collected using questionnaires and the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Impairment was measured using the Child Global Assessment Scale and diagnostic specific impairment in the DISC-IV. 17.1% of the sample met DSM-IV criteria for one or more disorders in the past year; 11% when only DISC impairment was considered and 5.3% only using the CGAS. The most prevalent disorders were anxiety (6.9%), disruptive (6.5%), and substance use (5.3%) disorders. The most prevalent specific disorders were agoraphobia, conduct and marijuana abuse/dependence, then alcohol use and oppositional defiant disorder. Younger youths and females had lower odds for any disorder, as did youths from two parent homes. There was increased odds associated with lower family income. Females had greater odds of mood and anxiety disorders, males of disruptive and substance use disorders. There were greater odds of mood and disruptive disorders for older youths. Prevalences were highly comparable to recent studies using similar methods in diverse non-metropolitan populations. We found associations with age, gender, and to a lesser extent, socioeconomic status reported in previous studies. The inclusion of both diagnosis-specific impairment and global impairment reduced prevalence rates significantly. Our results suggest commonality of prevalences and associated factors in diverse study settings, including urban and rural areas.
PMCID: PMC2736593  PMID: 17107689
adolescents; DSM-IV disorders; prevalence; impairment; risk factors; metropolitan population
8.  Chronic Insomnia and Its Negative Consequences for Health and Functioning of Adolescents: A 12-Month Prospective Study 
To estimate prevalence and chronicity of insomnia and the impact of chronic insomnia on health and functioning of adolescents.
Data were collected from 4175 youths 11–17 at baseline and 3134 a year later sampled from managed care groups in a large metropolitan area. Insomnia was assessed by youth reported DSM-IV symptom criteria. Outcomes are three measures of somatic health, three measures of mental health, two measures of substance use, three measures of interpersonal problems, and three of daily activities.
Over one-fourth reported one or more symptoms of insomnia at baseline and about 5% met diagnostic criteria for insomnia. Almost 46% of those who reported 1 or more symptoms of insomnia in Wave 1 continued to be cases at Wave 2 and 24% met DSM-IV symptom criteria for chronic insomnia (cases in Wave 1 were also cases in Wave 2). Multivariate analyses found chronic insomnia increased subsequent risk for somatic health problems, interpersonal problems, psychological problems, and daily activities. Significant odds (p<.05) ranged from 1.6 to 5.6 for poor outcomes. These results are the first reported on chronic insomnia among youths and corroborate, using prospective data, previous findings on correlates of disturbed sleep based on cross-sectional studies.
Insomnia is both common and chronic among adolescents. The data indicate that the burden of insomnia is comparable to that of other psychiatric disorders such as mood, anxiety, disruptive and substance use disorders. Chronic insomnia severely impacts future health and functioning of youths. Those with chronic insomnia are more likely to seek medical care. These data suggest primary care settings might provide a venue for screening and early intervention for adolescent insomnia.
PMCID: PMC2488408  PMID: 18295138
insomnia; prevalence; persistence; outcomes; adolescents
9.  Comorbidity of Substance Use Disorders and Other Psychiatric Disorders Among Adolescents: Evidence from an Epidemiologic Survey 
Drug and alcohol dependence  2007;88(Suppl 1):S4-13.
This paper extends our knowledge of comorbidity of substance use disorders (SUDs) and other psychiatric disorders by examining comorbidity of specific types of SUDs and risk of comorbidity separately for abuse and dependence. The research question is whether there is specificity of risk for comorbidity for different SUDs and whether greater comorbidity is associated with dependence. Data are presented from a probability sample of 4,175 youths aged 11-17 assessed with the NIMH DISC-IV and self-administered questionnaires. SUDs outcomes are alcohol, marijuana and other substances in past year. Mean number of other comorbid disorders ranged from 1.9 for marijuana abuse to 2.2 for other substance abuse and 1.9 for marijuana dependence to 2.8 for other substance dependence. None of the abuse SUDs does not increase risk of anxiety disorders, but dependence does. Both abuse and dependence increased risk of comorbid mood disorders. Similar results were observed for disruptive disorders. Patterns of comorbidity varied by substance, by abuse versus dependence, and by category of other psychiatric disorders. In general, there was greater association of comorbidity with other disorders for dependence vs. abuse. Marijuana is somewhat less associated with other disorders than alcohol or other substances. The strongest association is for comorbid disruptive disorders, regardless of SUD category. Having SUDs and comorbid other psychiatric disorders was associated with substantial functional impairment. Females with SUDs tended to have higher rates of comorbid disorders, as did older youths. There were no differences observed among ethnic groups. When comorbidity of SUDs with other disorders was examined, controlling for other non-SUDs disorders for each specific disorder examined, the greater odds for dependence versus abuse essentially disappeared for all disorders except disruptive disorders, suggesting larger number of comorbid non-SUDs in part account for the observed effects for dependence.
PMCID: PMC1935413  PMID: 17275212
adolescents; comorbidity; disruptive disorders; etiology; gender difference
10.  Hostility, Physical Aggression and Trait Anger as Predictors for Suicidal Behavior in Chinese Adolescents: A School-Based Study 
PLoS ONE  2012;7(2):e31044.
This study explored the extent to which trait aggression is associated with suicidal behavior in a nationwide school-based sample of adolescents.
A nationwide sample of 14,537 high school students in urban areas of China was recruited. Information concerning suicide ideation, plans, attempts, trait aggression and other risk factors was collected by a self-reported questionnaire. Multivariate regression analyses were employed to predict suicidal behavior.
Approximately 18.5% of students reported suicide ideation, 8.7% reported suicide plans, and 4.1% reported attempts during the past one year. Hostility and trait anger had a significant positive association with suicidal ideation. Hostility and physical aggression were positively related to suicide plans. Hostility had a positive correlation with suicide attempts, while trait anger was inversely associated with suicide attempts.
This study suggests that hostility, physical aggression and trait anger may be able to be used to predict suicidal behavior among adolescents. Suicide prevention programs should target at attenuating the severity of hostility, anger and physical aggression. But teachers and parents should also give close attention to students with low trait anger.
PMCID: PMC3281042  PMID: 22359563
11.  Developmental Relations between Perceived Social Support and Depressive Symptoms through Emerging Adulthood: Blood is Thicker than Water 
Longitudinal trajectories of depressive symptoms, perceived support from family, and perceived support from friends were examined among 816 emerging adults (480 women; 59%). In the context of a larger longitudinal investigation on the predictors and course of depression, data were drawn from eight self-report questionnaire assessments that roughly spanned the third decade of life. An age-based scaling approach was used to model trajectories of depressive symptoms and perceived social support between the ages of 21 and 30. Associative models of the relations between depressive symptoms and perceived social support from family and friends were tested. Results indicated that depressive symptoms decreased and perceived social support increased during the study period. Associative models suggested that among women, higher initial levels of perceived support from family predicted slower decreases in depressive symptoms (b = .34, p < .01). Among men, higher initial levels of depressive symptoms predicted slower increases in perceived family support (b = −.23, p < .05). Cross-domain predictive effects were not observed for perceived support from friends and depressive symptoms. Implications of the findings are discussed.
PMCID: PMC3079557  PMID: 21355652
Depression; Social Support; Emerging Adulthood
12.  Developmental Relations between Depressive Symptoms, Minor Hassles, and Major Events from Adolescence Through Age 30 
Journal of abnormal psychology  2010;119(4):811-824.
Stress generation and stress exposure models of the relations between depressive symptoms, minor hassles, and major event stress were investigated among 815 community-dwelling participants. Autoregressive latent trajectory models were constructed to examine latent growth patterns from ages 15–30 and to test one-year lagged, reciprocal paths between depressive symptoms and stress constructs. Results indicated significant cross-sectional and longitudinal associations between depressive symptoms and both stress constructs at the latent level. At the manifest level, lagged paths from hassles at one year to depressive symptoms at the next year were significant between ages 17–24. Significant cross-sectional paths between major events and depressive symptoms were found between ages 24–28, and modest support was found for lagged paths from depressive symptoms to major events one year later. Findings generally suggest a high degree of covariation in depressive symptoms and stress concurrently and over time. One-year lagged predictive effects net of the associations between individuals’ latent trajectories appear to be weak, constrained to specific time periods, and most consistent with a stress exposure effect of hassles on depressive symptoms.
PMCID: PMC3058553  PMID: 21090879
Depression; Stress; Major Events; Hassles; Trajectories
13.  Disturbed Sleep Among Adolescents Living in 2 Communities on the Texas-Mexico Border, 2000-2003 
Preventing Chronic Disease  2010;7(2):A40.
Disturbed sleep is a public health problem, but few studies describe the prevalence of sleep problems among Hispanic adolescents. We estimated the prevalence of disturbed sleep and associated factors among ninth graders living on the Texas-Mexico border.
We used probabilistic sampling to conduct 2 cross-sectional, school-based surveys: 1 during the 2000-2001 school year in the Lower Rio Grande Valley, Texas (n = 4,901), and 1 during the 2002-2003 school year in Matamoros, Tamaulipas, Mexico (n = 669). We assessed disturbed sleep during the 4 weeks before the survey.
The prevalence of disturbed sleep in Matamoros was 36% and in the Lower Rio Grande Valley was 28%. Factors associated with disturbed sleep in both populations were smoking cigarettes, having ever used cocaine, having been forced to have sex, considering attempting suicide, feeling sad, and going without eating for 24 hours or more.
This study revealed a high prevalence of disturbed sleep in high school students living on the Texas-Mexico border. This public health issue should be further investigated in both communities.
PMCID: PMC2831794  PMID: 20158968
14.  Association between the Center for Epidemiologic Studies Depression Scale (CES-D) and mortality in a community sample: An artifact of the somatic complaints factor?1 
Most previous studies of the depression-mortality association have not examined distinct depressive symptom clusters. This ex post facto study examined which aspects of depression may account for its association with mortality. The Center for Epidemiologic Studies Depression Scale (CES-D) was administered to 3,867 community dwelling adults. Cox proportional hazards procedures estimated the risk of mortality as a function of depression status and each of 4 CES-D factor scores. Depressed participants (CES-D ≥ 16) had a 1.23-fold higher risk of mortality (95% CI 1.03-1.49), adjusting for sociodemographics. Somatic Complaints (SC) was the only factor to predict mortality (HR 1.19, 95% CI 1.03-1.38). After excluding SC, CES-D scores no longer predicted mortality (HR .98, 95% CI .79-1.21). The association between CES-D depressive symptoms and mortality appears to be a function of the SC factor. The association between non-somatic depressive symptoms and mortality may not be as robust as past findings suggest.
PMCID: PMC2779538  PMID: 19936326
CES-D; Depressive symptomatology; Mortality; Somatic complaints; Ex post facto study
15.  Intergenerational Transmission of Internalizing Problems: Effects of Parental and Grandparental Major Depressive Disorder on Child Behavior 
Effects of lifetime histories of grandparental (G1) and parental (G2) major depressive disorder (MDD) on children's (G3) internalizing problems were investigated among 267 G3 children (ages 2–18 years) who received Child Behavior Checklist (CBCL) ratings and had diagnostic data available on 267 biological G2 parents and 527 biological G1 grandparents. Results indicated that G1 MDD conferred risk for G2 MDD, but not for G3 CBCL scores. G2 MDD predicted higher G3 Internalizing and Anxious/Depressed scores. Also, there was an interaction between G1 MDD and G2 MDD in predicting higher G3 Anxious/Depressed scores such that scores were highest among children with both depressed parents and grandparents. These effects were robust to statistical adjustments for status variables and parental relationship measures but not to adjustment for concurrent parental depressive symptoms.
PMCID: PMC2527650  PMID: 18645754
16.  An Approach to Assessing Mental Health Service Needs 
Health Services Research  1971;6(3):224-234.
An evaluative survey of a sample of patients in Texas mental hospitals is reported and the implications of the findings for mental health programs at the community level discussed. On the basis of an extensive battery of examinations and interviews, supplemented by review of patient records, the majority of the patients were judged to be inappropriately placed in a mental hospital, and 25 percent were judged not to need any form of institutionalized care. The survey is evaluated in terms of unit costs and usefulness of the data generated, and suggestions are offered for increasing the efficiency of such surveys.
PMCID: PMC1067353  PMID: 5095659
17.  Short Sleep Duration across Income, Education and Race/Ethnic Groups: Population Prevalence and Growing Disparities over 34 Years of Follow-Up 
Annals of epidemiology  2007;17(12):948-955.
Little is known about population determinants of short sleep duration. The authors examined associations between short sleep duration and income, education and race/ethnicity, and assessed changes over time in relative disparities.
Questionnaire data from the Alameda County Health and Ways of Living Study (ACS) was obtained at five time-points (1965, 1974, 1983, 1994, and 1999) for short sleep duration (<7 hours sleep per night). Household income, education level and race/ethnicity were assessed at baseline (n=6928). Odds ratios were computed to examine short sleep duration across income, education and race/ethnicity, adjusting for age, sex and time-varying covariates, and to assess changes over time.
Prevalence of short sleep at baseline was 15.2%.The (age-adjusted) odds of short sleep was increased for the lowest household income quintile (OR = 1.62, 95% CI: 1.34, 1.94), those with less than high school education (OR = 1.51, 95% CI: 1.30, 1.75), and among African Americans (odds ratio (OR) = 1.97, 95% confidence interval (CI): 1.68, 2.30). Relative disparities increased over time for African Americans and Hispanics compared to whites.
Socioeconomic position is a robust determinant of short sleep duration, even after adjusting for health-related characteristics linked to short sleep duration.
PMCID: PMC2140008  PMID: 17855122
sleep; sleep deprivation; social class; socioeconomic factors; health behavior
18.  Physical activity and overweight among adolescents on the Texas-Mexico border 
To investigate differences in associations between physical activity and overweight for students in two adjacent areas on the border between Mexico and the United States of America: students in the city of Matamoros, Mexico, and Mexican-American students in the Lower Rio Grande Valley (LRGV) area of southern Texas. Since the extremely high prevalence of overweight among Mexican-American adolescents is well-recognized, we wanted to determine whether overweight has become a problem among Mexican adolescents.
Students from 6 schools (n = 669), representing 12% of the ninth-grade students in Matamoros during 2002-2003, and students from 13 high schools (n = 4 736), representing 22% of the ninth-grade students in the LRGV during 2000-2001, completed questionnaires. Polytomous logistic regression was performed to estimate the risk of being at risk of overweight (≥85th percentile to <95th percentile of body mass index (BMI) for age and sex) and the risk of being overweight (≥95th percentile of BMI-for-age and sex) versus normal weight associated with measures of physical activity. For simplicity normal weight includes underweight.
A higher percentage of adolescents in the LRGV were at risk of overweight (17.2%) in comparison with adolescents from Matamoros (14.8%). The percentages of LRGV and Matamoros adolescents who were overweight were identical (16.9%). LRGV adolescent boys (OR = 0.87, 95% CI = 0.77-0.98) who participated in team sports were less likely to be at or above the 85th percentile of BMI-for-age and sex. Although of borderline significance, Matamoros and LRGV adolescent boys who participated in physical education classes were less likely to be at risk of overweight. Neither in Matamoros nor LRGV students were any of the various physical activity categories or levels associated with being at risk of overweight or being overweight.
Nearly one-third of the students in both Matamoros and the LRGV are at risk of overweight and are overweight. Implementation of interventions on healthful dietary choices and participation in physical education classes and sports teams are essential for reducing the extremely high prevalence of overweight among students on both sides of the Texas/Mexico border.
ABSTRACT. Spanish.
Objetivo: Investigar si hay diferencias en las asociaciones entre la actividad física y el sobrepeso observadas en estudiantes de dos zonas colindantes en la frontera mexicanoestadounidense: estudiantes de la ciudad de Matamoros, México, y estudiantes mexicanoestadounidenses del valle a lo largo de la desembocadura del Río Bravo (VRB) en la parte sur del estado de Texas. Dada la consabida prevalencia extremadamente alta de sobrepeso en adolescentes mexicanoestadounidenses, los autores queríamos determinar si el sobrepeso también se ha convertido en un problema entre adolescentes mexicanos.
Métodos: Estudiantes de 6 escuelas (n = 653), que comprenden 11% de los estudiantes de noveno grado en Matamoros durante 2002–2003, y estudiantes de 13 bachilleratos (n = 4 736), que comprenden 22% de los estudiantes de noveno grado del VRB durante 2000–2001, contestaron cuestionarios. Se llevó a cabo una regresión logística politómica a fin de calcular el riesgo de estar en riesgo de tener sobrepeso (≥85.° percentil a <95.° percentil de índice de masa corporal (IMC) para la edad y el sexo) y el riesgo de tener sobrepeso (≥95.° percentil de índice de masa corporal (IMC) para la edad y el sexo), frente a un peso normal, que se asociaban con distintos grados de actividad física. En aras de la sencillez, en la clasificación del peso normal también se abarcó la insuficiencia de peso.
Resultados: Un mayor porcentaje de adolescentes estaban en riesgo de sufrir sobrepeso en el VRB (17%) que en Matamoros (15%). Los porcentajes de adolescentes de VRB y de Matamoros que tenían sobrepeso fueron idénticos (17%). Los varones adolescentes en el VRB (razón de posibilidades [RP] = 0,87; IC95% = 0,77 a 0,98) que participaron en deportes en equipo tuvieron una menor probabilidad de estar en riesgo de tener sobrepeso. No se encontraron asociaciones entre ningunas de las demás categorías de actividad física por un lado, y estar en riesgo de sufrir sobrepeso o tener sobrepeso por el otro, ni en estudiantes de Matamoros ni en los del VRB.
Conclusiones: Casi una tercera parte de los estudiantes tanto en Matamoros como en el VRB está en riesgo de tener sobrepeso o tiene sobrepeso. La puesta en práctica de intervenciones para fomentar hábitos alimentarios sanos y la participación en clases de educación física y en deportes en equipo es una medida esencial para reducir la prevalencia extremadamente alta de sobrepeso observada en estudiantes a ambos lados de la frontera entre México y Estados Unidos.
PMCID: PMC1525222  PMID: 16723065
Overweight; physical fitness; adolescent; Mexican-Americans; Mexico; Texas

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