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Under pressure program: using live theatre to investigate adolescents' attitudes and behavior related to drug and alcohol abuse education and prevention.

INTRODUCTION

Alcohol and other drugs have drastically permeated our society. Throughout adolescents' school careers, and indeed their lives, most will be faced with many drug-related decisions, that is, whether to abstain or to use alcohol and other drugs, and if they choose to use them, determine the liabilities and consequences; how to behave in potentially drug-related situations such as attending or hosting a party, riding with someone who has been drinking, or dealing with a friend or relative who is chemically dependent; and eventually voting on laws related to alcohol and other drugs. The goals of an effective alcohol and drug education program are clear: to help adolescents develop the confidence needed to foster refusal skills, and to provide assistance in developing communication skills. Given that the school is one of the single most important facets of adolescents' social system, it should be utilized to impart critical information. The Under Pressure Program incorporates this philosophy through the dynamic combination of a high-quality artistic presentation and applied learning techniques. This unique blend enables adolescents to understand the pressures they face and teaches them to make responsible choices.

The program is targeted at predominantly minority, low-income, Chicago elementary, junior, and senior high school students who have been identified as "high risk." The design of the Under Pressure Program was made possible through a collaborative agreement between Loyola University of Chicago, Loyola University Center for Children and Families, and the Chicago-based not-for-profit Music Theatre Workshop. Funding was made possible through a 1990-93 grant awarded to the Center for Children and Families from the United States Department of Education Drug-Free Schools and Communities Program/Demonstration Grants to Institutions of Higher Education.

The centerpiece of the Under Pressure Program is an original, professionally scripted 30-minute live musical play, Captain Clean, which features singing, dancing, and contemporary music specifically designed to enhance the action of the play. The play concentrates on the difficult choices made by the young characters, who are challenged by school stresses, peer pressure, and failed family relationships. Their situations are familiar to adolescents of all socioeconomic, racial, and ethnic backgrounds. Secondary issues often coinciding with adolescent substance abuse are also addressed, including teenage pregnancy, gang involvement, male-female relationships, and dysfunctional family structures.

The nonthreatening format of the professional theatrical performance is followed immediately by 90 minutes of discussion and role playing--the crucial segment in addressing alcohol and drug abuse. Students are engaged in active participation rather than the traditional "teach and preach" format of television and radio. The result is an increase in adolescent knowledge, an understanding of the choices they face, and an increased repertoire of problem solving and social skills needed for making appropriate decisions regarding drug and alcohol abuse. Using the play as a springboard for dialogue, the teenage audience and the Loyola University Center for Children and Families professional staff explore the pressures of drug and alcohol abuse. Pre- and postperformance support is provided for the adolescents, teachers, counselors, and community representatives by a psychologist from the Center. One feature that sets the program apart from traditional media techniques is that it is interactive; it takes place in the intimacy of a classroom where the social learning model is implemented, confronting problems that the adolescents must discuss and solve together.

UNDER PRESSURE PROGRAM

Faculty. Staff, and Community In-Service

Prior to the play and postperformance discussion, an in-service is conducted by a Center specialist. This is to acquaint faculty, counselors, administrators, and community representatives with the program format and prepare them for a wide range of student reactions. If these participants indicate a specific need, postperformance discussion and role playing are directed toward that issue (i.e., gang pressures or family drug/alcohol abuse).

Theatrical Performance (Captain Clean)

The centerpiece of each program is a 30-minute live contemporary musical play covering drug and alcohol abuse. It is usually presented in a week-long residency at the host Chicago school and consists of eight performances with 35-50 adolescents in attendance per performance.

Postperformance Discussion and Role Play

The postperformance role playing and discussion pick up where the play leaves off by initiating a discussion of drug use as it relates to family, school, and self-esteem. A counseling psychologist from the Center, who is trained in child development, crisis counseling, and adolescent behavior disorders, leads the actors and adolescents in the discussion and role-playing exercises. The students' acceptance of the actors as contemporaries enables them to delve into their attitudes and feelings about drug and alcohol abuse.

The program is based on the students' participation, both physically and intellectually. The postperformance discussion takes place in a circle, with student volunteers engaging in role play. Unlike creative drama improvisations, the action of the role play does not stem entirely from the students; they do not make up the plot or invent the characters. Instead, they are guided through a series of events in which they have a specific role and can influence what happens next. The role play is carefully geared to the students' intellectual level and experience. The theatrical elements are a means, not an end in themselves--providing a plot, suspense, dramatic climax, and characterization. The actor-teachers usually stay in character throughout, helping the students solve the various problems they encounter in the course of the "plot." The role-playing activities enable the adolescents to learn and practice social and decision-making skills. Since the actors stay in character during the discussion period, the students are given the opportunity to question the actual character about his/her ideas and actions.

Student, Faculty, Counselor, and Community Follow-up

All participants receive information regarding school-approved local counseling and social service agencies in addition to approved hot-line numbers. At the conclusion of the program, adolescents are encouraged to continue ongoing discussion in their classrooms or with their school counselor. If adolescents choose to use a hot line or agency resource, they are advised to investigate a number of agencies until they find one that provides appropriate help.

REVIEW OF THE RESEARCH

The use of mass media is often viewed as critical for providing information, changing attitudes, and modifying behavior in large numbers of people. In the past several years, there has been an increasing interest among educators in the role of the media in deglamorizing drug abuse, reinforcing non-drug-taking behavior, and promoting appropriate use of licit drugs. According to Flay (1986), a historical cycle is evident in the beliefs about the power of mass media to induce behavioral change. Yet, many scholars reject the view that the media succeed in changing knowledge, beliefs, attitudes, and behavior.

Hanneman and McEwen (1973) studied the effectiveness of prevention communication. Their main thesis was that public service announcements (PSAs) have tended to be directed toward a heterogeneous audience with nonspecific informational needs. Flay (1986)also asserted that PSAs did not reach those for whom they were intended, and thus could not be expected to be effective. Sobel and Flay (1983) cited research on the conditions under which the media might best be able not only to "hit" the target audience, but also to be most influential. They suggested that the most appropriate role for mass media in preventing substance abuse is to increase the dissemination of approaches found to be effective in such settings as classrooms.

Johnson and Ettema (1982) demonstrated that children who discussed a television show viewed in the classroom evidenced more changes than children who did not discuss it. Flay (1986) emphatically argued that mass media would never be truly effective unless supplemented with complementary school-based programs which afford children the opportunity to thoughtfully discuss a prevention message. Mass media can be used as a major source of intervention; however, by themselves, "mass media programs are usually not as effective" (Flay, 1986).

Bandy and President(1983) provided an overview of the factors that may explain why some prevention advertising campaigns are unsuccessful. They argued for a firm understanding of the media's functions and limitations in communicating prevention messages. Their research emphasized that human communication is complicated, affected by wide-ranging variables, any of which can reduce effectiveness. They concluded that the media are most effective in reinforcing certain behaviors and attitudes. Thus, the most successful health behavior change campaign aimed at a school population should incorporate mass media within a school curriculum that promotes interpersonal communication.

Mass media programming, according to Flay(1986), when used as a supplement to a school-based intervention approach, should reinforce the information and skills being provided. In doing so, dissemination, message effectiveness, and the probability that students and their parents will discuss the content will be increased.

An example of one such school-based program is the use of theatre in education. Redington (1983) acknowledged that playwrights from Sophocles to Brecht have used their plays to convey facts, political attitudes, or moral instruction to their audiences. She cited a recent development in London in which schools utilized the theatre as a teaching medium: "The aim of theatre in education is that presentations in schools should educate, widen pupils' horizons, and lead them to ask questions about the world around them, as well as entertain." One reason for the potency of the theatre in conveying a message on the evils of drug abuse is that students are not just passive recipients of information. Their active participation can vary from becoming involved in a drama session to taking part in a discussion.

Louis Glickman of the Addiction Research Foundation stated that the search for effective alcohol education programming has resulted in an approach that can be labeled unique in the drug education literature. The content does not appear to be different from the "personal choice" message, but what has changed is the medium of the message: the programs are presented via live theatrical performance (Glickman et al., 1983).

Glickman et al. conducted a study with approximately 1,000 students on the impact of a high school alcohol education program utilizing a live theatrical performance. It was hypothesized that the theatrical program would have a positive impact (when compared to a control group) on the students' knowledge, attitudes, motivation, and behaviors with respect to alcohol. The results of the study were extremely encouraging, and perhaps the most exciting finding was that significant effects on behavior seemed to have occurred for those with the greatest need for change.

Several organizations have used theatre as a vehicle for drug and alcohol prevention. Plays for Living, a division of the Family Service Association of America, has developed and sponsored tours of professional productions addressing a variety of social and health issues, including alcohol problems in the workplace. Small Change Theatre offered a production for the Minnesota Lung Association aimed at deterring smoking in grade schools. Since 1978, the Catalyst Theatre Society in Edmonton has developed several socially oriented productions to acquaint students with lifestyle issues. Theatrical performances have been used to mobilize rural communities in Botswana to resolve social problems, and to help New York teenagers understand complex social and health problems (Davidson, 1977; Kidd & Byram, 1977; Boria et al., 1981; Bossio et al., 1978-79).

GENERAL DEMOGRAPHICS

Based upon the estimated 1986 U.S. Census, as measured by the consolidated metropolitan statistical area, Chicago ranks third in population in the United States with just over eight million people. In Chicago, minority populations have the highest levels of poverty; only 26.4% of the poor are white, while 62.3% are African-American and 11.3% are Hispanic, Asian, or Native American (U.S. Bureau of the Census, 1983).

The school system in Chicago is particularly besieged by educational problems, crime, and health issues. Among the African-American and Hispanic students enrolled in the city's nonselective high schools, approximately 63% of those who enter the ninth grade drop out, and only 21% of those who complete their senior year are reading at or above the national norm (Designs for Change, 1985). Drop-out rates for the class of 1984 as reported by the Illinois State Board of Education, the Chicago Panel on Public School Finance, and Designs for Change were 47.9%, 39.5%, and 53%, respectively. The typical Illinois student in 1984 had an ACT composite score of 18.7 (on a scale of 1-35), while the average Chicago high school student had a composite score of 13.6 (Illinois State Board of Education, 1985; Orfield et al., 1984).

With regard to the overall health of Chicago's poor, a low-income child has half the chance of attaining his/her first birthday when compared to a more affluent child (Lawlor, 1988). Even more alarming is that the greatest health risks for those between the ages of 15 and 24 are homicide, accidents, and suicide. In 1982, homicides represented 64% of the deaths in this age category--the majority attributed to gang activity (Metropolitan Planning Council, 1986).

According to the Chicago Tribune (1986):

... lack of contact with middle-class whites and with middle-class blacks who have escaped the inner city has left underclass youths with few role models except drug pushers, gang members, pimps, small-time criminals and unwed mothers.

"The frustration and grimness of life in the ghetto forces young blacks to aspire to these roles," says Pierre de Vise, a Roosevelt University urbanologist. "Young people would prefer to be middle-class people, but that seems so far from reality."

To get away from the depressing reality around them, many in the underclass flee to alcohol and drugs, in particular heroin.

Drug use "is one of the leading causes of all our criminal offenses," says Sanford Neal, commander of the nearly all-black district on the Far West Side.

Examination of the nature and scope of drug and alcohol abuse among Chicago youths reveals some significant findings. The Alcoholism Center of the Comprehensive Council of Metropolitan Chicago reported that 12% of youths (61,269) use drugs excessively; over 20,000 are alcoholics and 67% (41,417) of those who abuse drugs also abuse alcohol as well. The Youth Service Project, Inc., a Northwest Youth Coalition member, reported that its survey of adolescents revealed that 68% considered drug dealing and use a serious problem in their neighborhood, 59% found violent crime a serious problem, and 33% said they personally experienced pressure to join a gang. They also reported that the youths in its substance abuse programs often use marijuana and alcohol, and to a lesser extent cocaine, crack, PCP, and acid.

The Chicago public school system includes 58 junior and senior high schools. The total elementary and secondary school enrollment is 410,230, with 84.7% representing minorities. During the 1989-90 pilot year, the Captain Clean performance was viewed by a total audience of 8,643 (7,952 youths and 691 adults). Forty-seven percent were low income and included 4,174 African-Americans, 2,573 Hispanics, 1,794 white non-Hispanics, and 8 American Indians. The majority of the participants were in Grades 9-12, and over 500 were categorized as physically or emotionally handicapped, trainable mentally handicapped, behavior disordered, or learning disabled.

To date, the Captain Clean performance has been presented in six K-8 and seven Grade 9-12 schools including two special schools: Cook County Detention School (correctional) and Bartolome de Las Casas Occupational High School (special education). At each elementary, junior, and senior high school, teachers, counselors, administrators, parents, and community representatives have participated as observers, facilitators of postperformance discussions and role play, and as points of contact for student counseling.

METHOD

Subjects

The target population for the funded research is city of Chicago School District No, 299 K-8 and 9-12 students, who are predominantly minority, low income, and considered "at risk." As of March 11, 1991, pretest data have been collected on 553 students (both experimental and control) and posttest data on 278 students (both experimental and control). Anecdotal and observational data from the postperformance discussion have been collected on 939 students. The ages of the subjects have ranged from 10 to 21, in Grades 4 through 12. The racial/ethnic distribution of the students to date has been 84% African-American, 9% Hispanic, 3% white, and 4% other.

Procedure

Evaluation design. In order to evaluate the effectiveness of the live theatre (Captain Clean) relative to adolescent substance abuse, both qualitative and quantitative research methods are employed. The two goals of the evaluation deal with the objectives--attitudinal and behavioral change.

Instrumentation. Evaluation of attitudinal change requires measures that are sensitive to the nature of the topics covered in Captain Clean. Review of the alcohol/drug abuse literature yielded no instruments appropriate for evaluating program objectives. Consequently, it was necessary to develop an instrument that was directly related to the substance abuse issues addressed. Content of the play was carefully outlined to specify the major alcohol and drug abuse issues being treated: (1) general health concerns, (2) boyfriend/girlfriend relationships, (3) peer/friend relationships, (4) parent/family relationships, (5) counseling actions.

Twenty items were designed to measure students' attitudes toward alcohol and drug abuse relative to each area of concern. The response format for each item was agree, disagree, and do not know. Ten of the twenty items were positive attitudinal statements and ten were negative. A Likert-type scale was used, with +1 assigned to a positive attitudinal response, 0 to an uncertain response, and -1 to a negative response. This resulted in an instrument which yielded a total scale score that could vary from +20 (very positive)to -20 (very negative). All survey instruments collected were reviewed to determine if subjects had difficulty with the format, wording, and clarity. The staff administering the instruments was also instructed to note any perceived difficulties with the instrument. Item analyses were performed and estimates of reliability were calculated using Cronbach's coefficient alpha. Initial estimates from the pilot test were moderate. Based upon the information derived, format and wording revisions were initiated. At present, pretest data have been analyzed from 375 students. An estimate of total score reliability using Cronbach's coefficient alpha (.78) is viewed as adequate. The instrument also contains questions concerning students' birth date, sex, ethnic background, and grade in school. The birth date and other demographic information are used for matching a subject's pretest and posttest.

Behavioral information is gathered from school counselors and the group facilitator/counselor. Counselors from each of the schools are requested to keep a log documenting referrals and requests. for assistance. To make sure the counselors are maintaining the log and documenting appropriate information, they are contacted by evaluation staff at regular intervals.

During the pilot testing sessions, the group facilitator and a trained professional counselor, along with evaluation staff, developed an observational protocol based on the structured group session that follows each play. The topics and number of participants in each discussion are systematically recorded. Other topics of interest are documented following ethnographic procedures employing field notes, which are summarized to yield both quantitative and qualitative information.

Research design. To determine the effects of the program on students' attitudes concerning the previously identified aspects of drug and alcohol abuse, a pre-posttest/experimental-control group design is employed. At each school, the experimental group and a comparable group of students who will not see the play (control group) are identified. Both groups are pretested two weeks prior to viewing the play, and posttested two to three weeks following the play. If a control group cannot be identified within a school, students from other schools with similar demographic characteristics who have not viewed Captain Clean are selected. Data are gathered on a similar time frame for these schools.

The behavioral effects are evaluated using qualitative, descriptive techniques. High school counselors record relevant information on project activities. In addition, behavioral interactions are documented during the group session following the play.

Data analysis. Standard ANOVA/ANCOVA procedures are employed to determine statistically significant differences. Appropriate post hoc procedures follow statistically significant results. SPSS-X 4.0 and SAS are utilized for the analyses.

RESULTS

Results are discussed according to the stated goals and objectives of the research design.

One goal of the program is to evaluate the effectiveness of live theatre in preventing and intervening in adolescent substance abuse. A program objective is to measure the difference in immediate attitude change on a standardized questionnaire, following the live theatre performances, through the use of a pretest/posttest design with 10% (1,000 students) of the classrooms participating in the program matched with classrooms of nonparticipants.

Tables 1 and 2 display the results of the analysis of variance for the pretest scores and analysis of covariance for the posttest scores. The control group's mean score (14.7) at pretesting was significantly higher than that of the experimental group (11.3). Consequently, analysis of covariance with the pretest as the covariate was run on the posttest scores. Table 2 indicates that the covariate was statistically significant, and that there were no significant differences between experimental and control groups at posttesting. The control group, although displaying a significantly more positive attitude than the experimental group at pretesting, demonstrated no attitudinal change at the posttest. The experimental group, after viewing the play and participating in the discussion session, demonstrated a significantly more positive attitude at the posttest than at the pretest. Further statistical analysis showed that the experimental group displayed positive attitudinal growth, while the control group demonstrated no change. Although preliminary, these results indicate that the Under Pressure Program is effective in producing immediate attitude change as measured on a standardized questionnaire.
Table 1
Tests of Significance for Total Pretest Attitudinal Scores
Source of Variation SS DF MS F p
Within Cells 12957.88 38 34.10 22.11 .000
Group (Exp, Control) 753.92 1 753.9
Table 2
Tests of Significance for Total Posttest Attitudinal Scores
Source of Variation SS DF MS F p
Within Cells 163.96 33 4.97
Regression 120.82 1 120.82 24.32 .000
Group (Exp, Control) 3.46 1 3.46 .70 .410


A second goal is to examine the effectiveness of live theatre, via postperformance dialogue and role playing, in soliciting feedback from adolescents as to their own feelings about substance abuse and using school counselors and other available resources. One program objective is to increase the rate of self-reporting of adolescents' feelings and attitudes about substance abuse, as measured by responses on a standardized questionnaire, immediately after observing Captain Clean.

A brief questionnaire was completed by each student immediately following the Captain Clean performance. The primary source of information obtained from this instrument was the number of students indicating a positive reaction to the performance by requesting counseling immediately afterwards. To date, out of 939 questionnaires, 178 requests for counseling have been recorded. Thus, approximately 19% of the students participating in the theatrical presentation were not only willing to express their feelings through the discussion and questionnaire, but also were motivated to request further counseling.

Other program objectives are: to identify adolescents' self-reported attitudes about peer influence on substance abuse, as indicated on a standardized questionnaire, immediately following Captain Clean; to identify adolescents' self-reported use of school counselors in regard to substance abuse, as indicated on a standardized questionnaire, immediately following Captain Clean; and to identify adolescents' self-reported use of parents and community agents in regard to substance abuse, as indicated on a standardized questionnaire, immediately following Captain Clean.

Results were obtained through field notes recorded by the counselor, who acted as a participant-observer in the theatre performance and discussion. The counselor recorded information derived from students' behaviors displayed during the performance and group discussion.

Over 1,000 students from nine high schools have been observed by the counselor. Information derived from the counselor's field notes is summarized below.

Peer influences. Both males and females consistently indicated that it is difficult to withstand peer pressure to engage in substance abuse. Females specifically expressed difficulty in withstanding the pressure exerted by their boyfriends. Most adolescents indicated that friends should not manipulate each other to use drugs or alcohol, although many had experienced such behavior. Most adolescents were unable to explain how they could help friends who were abusing alcohol or drugs other than by talking to them or getting other friends to talk to them.

Family influences. Family issues involving substance abuse appeared to generate much discussion, although adolescents said that these were difficult to discuss. In all discussion groups, the point was made that when a family member is having a substance abuse problem, it is very difficult to seek help outside the family. Although adolescents consistently expressed the desire to help a drug-abusing family member, several expressed helplessness when confronted with family-related drug problems. Seldom did an adolescent indicate that he or she would discuss a family member's drug problem with anyone outside the family.

Seeking help. Although family members, teachers, and counselors were discussed as sources of help, adolescents expressed reluctance to seek help when confronted with a drug problem. On occasion, members of their extended families were mentioned, as were teachers and counselors (although issues of trust were cited) and abstract sources of information such as "the Lord" or "some 800 number or hot line." Although few specifically mentioned school counselors as sources of help, approximately 19% of the adolescents requested counseling in writing through the questionnaire distributed after the theatrical performance.

Overall, most adolescents expressed some feelings or described experiences during the discussions. The most active discussions were generated around issues involving family members, with 50% to 90% of the adolescents participating. Thus, summaries of the field notes indicate that the live theatre presentation, with subsequent discussion and role play, does solicit feedback in regard to the adolescents' feelings about substance abuse and using school counselors and other resources available to them.

CONCLUSION

There is no doubt that theatre provides an exciting form of teaching. The Under Pressure Program seems capable of doing what the school curriculum and many teachers cannot, that is, involve the students, interest them in the topic of substance abuse, lead them to see its relevance to the world around them, and motivate them to learn more. Captain Clean invariably serves as a springboard for meaningful dialogue in postperformance group discussion. Students identify with particular characters, accept the characters' point of view, feel they can discuss things with them, and care what happens to them. This empathy is often used to make the students aware of the moral problems associated with alcohol and drug abuse. Thus, the program appears to be having success in motivating students to understand an important message at a time when the educational system is being criticized for failing to do exactly that.

REFERENCES

Bandy, P., & President, P. A. (1983). Recent literature on drug abuse prevention and mass media: Focusing on youth, parents, women and the elderly. Journal of Drug Education, 13(3), 255-269.

Boria, M. C., Welch, E. J., & Vargas, A. M. (1981). Family life theatre and youth health services. American Journal of Public Health, 2 (February).

Bossio, E., Barnet, O., & Osler, S. (1978-79). The Black Creek Project. Mimeograph.

Chicago Tribune. (1986). The American millstone. Chicago: Contemporary Books.

Davidson, B. K. (1977) Message in a Bottle: A play on alcoholism in industry. Plays for Living, a division of Family Service Association of America.

Designs for Change. (1985). The bottom line: Chicago's failing schools and how to save them. Chicago: Designs for Change.

Flay, B. R. (1986). Mass media linkages with school-based programs for drug abuse prevention. Journal of School Health, 56(9) 402-406.

Glickman, L., et al. (1983). The impact of a high school alcohol education program utilizing a live theatrical performance: A comparative study. Journal of Drug Education, 13(3), 229-248.

Hanneman, C. J., & McEwen, W. J. (1973). Televised drug abuse appeals: A content analysis. Journalism Quarterly, 59(2), 329-333.

Illinois State Board of Education. (1985). Student achievement in Illinois: An analysis of student progress. Springfield: ISBE.

Johnson, J., & Ettema, J. S. (1982). Positive images: Breaking stereotypes with children's television. Beverly Hills, CA: Sage.

Kidd, R., & Byram, M. (1977). Popular theatre and development. Convergence, 10(2), 20-31.

Lawlor, E. F. (1988). The regional health agenda. The state of the region: Background papers. Chicago: Metropolitan Planning Council.

Metropolitan Planning Council and the University of Chicago. (1986). Report of the Task Force on Health Care for the Poor in Cook County. Chicago: Authors.

Orfield, C., et al. (1984). The Chicago study of access and choice in higher education (Committee on Public Policy Studies Research Project). Chicago: University of Chicago.

Redington, C. (1983). Can theatre teach? Great Britain: Pergamon.

Sobel, J. L., & Flay, B. R. (1983). The role of mass media in preventing adolescent substance abuse. In T. J. Glynn et al. (Eds. L Preventing adolescent drug abuse: Intervention strategies. Washington, DC: NIDA Research Monograph No. 47.

U.S. Bureau of the Census. (1983). 1980 census of population: Vol. 1. Characteristics of the population. Part 15--Illinois. Washington, DC: U.S. Government Printing Office.

Cheryl Ann Black, doctoral candidate, New Mexico State University.

Reprint requests to L. Arthur Safer, Ph.D., Associate Professor of Educational Leadership and Policy Studies, Loyola University of Chicago, 820 North Michigan Avenue, Chicago, Illinois 60611.
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Author:Safer, L. Arthur; Harding, Carol Gibb
Publication:Adolescence
Date:Mar 22, 1993
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