TIME tobacco

E-Cig Benefits Outweigh Their Harms, New Research Says

A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014.
A patron demonstrates an e-cigarette at Vape store in Chicago, April 23, 2014. Nam Y. Huh—AP

That doesn't mean you should hop on the bandwagon

The debate over e-cigarettes—now a$2 billion industry in the U.S. and growing—is constantly up in smoke.

The primary problem is that we simply do not know what e-cigarettes’ long-term health impacts are, with some people heralding it an effective smoking cessation while others say it’s just more nicotine products on the market—and not smoking, no matter what you inhale, is your best bet. Some early research found that adolescents smoking e-cigarettes will also smoke regular tobacco products, and that there’s an increase in e-cigarette related calls to poison centers around the nation.

But this week, a new paper looking at over 80 studies on e-cigarettes’ safety and their effects on users plays devil’s advocate.

The researchers found that based on the evidence, e-cigs are much less harmful to smokers and bystanders compared to conventional cigarettes. They are becoming more popular, but the numbers—so far—don’t suggest that they are being regularly used by non-smokers or kids. Finally, the researchers found that e-cigs can help some users cut down on their use of regular cigarettes and even quit. As regulating bodies around the world make decisions about how to deal with e-cigs, the researchers conclude that letting e-cigarettes compete with traditional tobacco on the market might actually decrease smoking morbidity and mortality.

“Health professionals may consider advising smokers unable or unwilling to quit through other routes to switch to [e-cigarettes] as a safer alternative to smoking and a possible pathway to complete cessation of nicotine use,” the Queen Mary University of London researchers write in their study, published in the journal Addiction.

When it comes to the question of what’s safer, e-cigs or cigarettes, no one is in disagreement. E-cigarettes win. While they still provide smokers with nicotine, which is highly addictive, users do not inhale the toxic smoke and chemicals from regular cigarettes.

Public health experts are split on what role e-cigarettes will play in the nation’s health, but more evidence and further research from both sides of the debate will hopefully keep policy members informed about where the current science stands.

TIME tobacco

$23.6 Billion Lawsuit Winner to Big Tobacco: “Are You Awake Now?”

Cynthia Robinson with her attorneys Willie Gary (left) and Christopher Chestnut (right) as she speaks during an interview on July 21, 2014 in New York City.
Cynthia Robinson with her attorneys Willie Gary (left) and Christopher Chestnut (right) as she speaks during an interview on July 21, 2014 in New York City. Bebeto Matthews—AP

The widow who won a $23.6 billion lawsuit against R.J. Reynolds talks to TIME about the suit and what she hopes the victory will accomplish

“Are you awake now? Do you hear what the jury is saying? You have to stop,” Cynthia Robinson wants to tell the tobacco industry. The Florida widow recently won a $23.6 billion lawsuit against tobacco company R.J. Reynolds, one of the largest recent judgments on the industry, and in an interview with TIME, she says she hopes they listen to the jury’s message.

Robinson’s husband Michael Johnson died in 1996 at age of 36 from lung cancer, and in her lawsuit against R.J. Reynolds, she and her attorneys argued that the company was aware that cigarettes were addictive and caused lung cancer, but was negligent in telling smokers like Johnson about those risks.

Johnson got hooked on cigarettes when he was just 13-years-old, and eventually smoked up to three packs a day, often lighting his next cigarette with the burning end of the one he just finished. “He was a quiet person. He read the Bible every day, he took the kids swimming, he mowed the yards of all the elderly neighbors,” Robinson says. He was diagnosed with lung cancer in 1995 and lived for almost a year in constant pain. “The pain [from the cancer] was always there. When you’re on oxygen and you have to step outside for a cigarette, you can’t stop. You’re addicted.”

Johnson tried multiple times to stop smoking with no success. During one of her husband’s hospital visits, Robinson knew something was wrong when he began sweating and one of his eyes started to droop. The doctor said he would live for only a couple of months, but he survived for 10 more months. “He suffocated and died for so long, it was awful,” says Robinson, recalling how hard it was for her husband to breathe in the months before his death.

The day Johnson died, he could not stop coughing up blood. His brother tried to hold him up, and Robinson wanted to get him into an ambulance, but his mother told her that he was already gone. “The blood was everywhere, it was awful. Only 36 years old and he was already gone,” says Robinson.

Ten years later Robinson filled her lawsuit. It’s one of many Florida lawsuits referred to as an “Engle progeny,” stemming from a 2000 $145 billion verdict in a class action suit led Dr. Howard A. Engle, a Miami Beach pediatrician who smoked, and eventually died of chronic obstructive pulmonary disease. The case was overturned in appeals court, and it was ruled that smokers could not make up a class. But the Engle case established that the tobacco industry had deceived Americans, by knowingly putting addictive and cancerous products on the market, and paved the way for thousands of individual Florida cases to take on Big Tobacco. On Friday July 18, Robinson did, and won her bittersweet victory.

“It was justice. It was time, and it had been a long time,” Robinson says. “I thought, oh my God, we did it. We may have to keep fighting, and will. It’s for Michael, and anyone who lost their lives to lung cancer. There are thousands right now dying of lung cancer. Michael died so young, he missed graduations and weddings.”

“We expected every dime and more,” says Robinson’s attorney Willie E Gary. “Johnson started smoking when he was a teen. How aware of the risks can you be at that age? But [the tobacco industry] would market and target kids. To this day they are going after our youth, stuffing their pockets. It’s all about the profits and it’s nothing about the health and safety of the people.”

As TIME reported earlier this week, R.J. Reynolds plans to appeal, and based on the industry’s track record with lawsuits, the damages will likely be lowered. Gary isn’t deterred: ” We expect to win. Winning is not about getting everything that you want. We know that we made a difference.”

It’s small consolation for losing her husband, but Robinson is satisfied that her time, effort, and daily prayers were enough to topple Goliath, at least in court last Friday. “We had to go all the way no matter how many years it took. Life has been lost,” she says. For the thousands of other pending lawsuits, she urges plaintiffs to persevere. “Don’t give up no matter how much they try to discourage and belittle you, you fight them to the very end, and you’ll succeed,” she says.

 

TIME Cancer

It’s Unlikely Tobacco Company Will Pay $23.6 Billion

Based on the industry's track record, the second-largest tobacco company probably won't pay the billions in damages it owes to a Florida widow

Big Tobacco took a hit on Friday when a court ordered the second-largest tobacco company in the U.S. to pay damages to a Florida widow who had sued them for her husband’s smoking-related death. However, it’s unlikely that the company will pay full price for its negligence.

Although the verdict will likely stand, tobacco company R.J. Reynolds says it plans to appeal the $23.6 billion that the jury determined it owed widow Cynthia Robinson. Based on the industry’s track record, that will likely result in them paying far less.

Robinson’s husband, Michael Johnson, began chain-smoking when he was 13-years-old and died at the young age of 36 in 1996. A decade after her husband’s untimely death, Robinson took the cigarette-makers to court, saying they were not forthcoming about the extremely harmful effects of their product, suing them for not informing the public that smoking was addictive. And almost another decade later, she proved her case.

Unsurprisingly, R.J. Reynolds, whose holding company Reynolds American Inc. recently announced a $27 billion deal to buy out rival Lorillard, contested the verdict. “Regardless of the rhetoric surrounding this case, the damages awarded are grossly excessive and impermissible under state and constitutional law,” said Jeff Raborn, vice president and assistant general counsel for R.J. Reynolds Tobacco Company in a statement sent to TIME. “We will file post-trial motions with the trial court promptly, requesting that the verdict in the case be set aside. We are confident that the law will be followed and the punitive damages verdict will not be allowed to stand.”

Raborn is probably right.

“It is quite likely, bordering on certainty, that the amount of punitive damages will be reduced, though it is unclear how much,” says John Banzhaf, a law professor at George Washington University known for his successful litigations against the tobacco industry. There’s not a lot of dispute among the legal community that the verdict will be reduced–probably substantially. Prior verdicts against Big Tobacco demanding billions in court have been reduced to millions–something the industry, which spends about $23 million on cigarette marketing each day, can pay off rather comfortably. In 2009, Phillip Morris failed to overturn a $79.5 million punitive-damages ruling in the U.S. Supreme Court, and business continued as usual.

“This doesn’t set a legal precedent, but the result of this verdict has people asking how much money will it take to deter tobacco companies? Previous verdicts against tobacco companies have been treated as just the cost of doing business,” says Richard Daynard, a law professor at Northeastern University who specializes in tobacco control. So far, no verdict has changed the economic fundamentals of the industry. But this time, the industry might being feeling less confident.

“I think this is the first time in many years that tobacco companies are going to have to start thinking about really doing something different,” says Daynard. After all, it’s likely we will see many more cases like Robinson’s land similar verdicts in Florida, and it’s possible that similar lawsuits will start to pop up nationwide.

Robinson’s case is one of thousands of lawsuits referred to as an “Engle progeny,” which was developed after a $145 billion verdict in favor of a class action lawsuit led by Dr. Howard A. Engle, a Miami Beach pediatrician. The award was voided in appeals court, under the finding that individual smokers could not make up a class. Though the tobacco industry did not have to pay the award, which was the largest punitive damages payment decided by a jury, the decision opened the floodgates for individual cases to head to Florida court with the support of the Engle case, which proved that the tobacco industry knew cigarettes were addictive, and failed to warn the public.

“The [Robinson] case indicates that juries, when a case is properly presented, are willing to sock it to tobacco companies,” says Banzhaf. “They are angry as hell at these tobacco companies, and when an attorney presents a strong case, they are willing to hit them, and hit them hard.”

Banzhaf says the case will likely motivate attorneys in other states that are less gung-ho to take on Big Tobacco. Lawyers in states like New York, California, and Washington with good tobacco control track records, he said, are likely “salivating” at the future possibilities.

Banzhaf believes that the public is finally grasping the health implications of smoking and is now willing to punish those that profit from it. The numbers seem to support this claim: smoking rates are down 2.8% since 2005 according to CDC data, and smokers can be charged up to 50% more under Obamacare. “Clearly the public is angry. But the courts have to allow damages that are substantially higher than ordinary damages,” says Banzhaf.”Hitting them with $16 million is pocket change.”

It will be no surprise if the final bill for R.J. Reynolds is significantly lower than what the Florida jury determined to be sufficient, but it’s encouraging for the pending cases. “About 70% of Engle cases that have gone to verdict have gone in favor of the plaintiff,” says Daynard. “There are thousands more of these cases pending. Any of them could produce a jury verdict like this because it’s the same misbehavior.”

Unfortunately, the tobacco industry can also produce the same appeals solution they’ve achieved successfully in the past.

TIME Culture

Up in Smoke: The Rise and Fall of Big Tobacco

"According to this survey, more doctors smoke Camels than any other cigarette," is just one of the phrases we no longer hear in commercials

+ READ ARTICLE

Earlier this week, a $27.4 billion deal was announced that will merge two of the largest American tobacco companies, Reynolds American and Lorillard.

The deal comes at a time when cigarette smokers are at a steady decline. Even so, Marlboro still makes some lists of most valuable brands in the world.

And while it’s hard to remember the days when Camels were advertised as the most preferred cigarettes by doctors, a small segment of the industry is quickly growing: e-cigarettes.

Above, take a quick look at the history of America’s complicated relationship with the addictive habit.

TIME mergers

Tobacco Mergers Are Creating a More Efficient Killing Machine

Several brands of cigarettes are arranged for a photograph in Tiskilwa, Illinois, U.S., on April 17, 2012.
Several brands of cigarettes are arranged for a photograph in Tiskilwa, Illinois, U.S., on April 17, 2012. Bloomberg/Getty Images

It’s been a year of colossal mergers or proposed mergers among some consumer goods and services companies. Comcast wants to take over Time Warner Cable (not affiliated with TIME) to form the nation’s largest cable company. AT&T and DirectTV want to combine to compete against them. The market also expects T-Mobile and Sprint to hook up, further reducing competition in mobile phone service.

Now add to that the tobacco industry. Reynolds American announced a deal to acquire Lorillard Inc. which it values at $27.4 billion. It’s a combination of the second and third largest cigarette makers after Altria Group, which owns Philip Morris USA. As part of the deal, British American Tobacco Plc retains its 42% stake in Reynolds by providing $4.7 billion in funding.

That’s a lot of dealmaking for the Federal Trade Commission and the antitrust division of the Justice Department to bless or deny. The goal of antitrust statutes is to preserve competition in any industry segment. Trustbusters don’t care who provides that competition, just as long as enough of it exists. That’s the ongoing debate in the proposed cable combination. It’s axiomatic that when two dominant players mergers prices rise and consumers suffer.

The proposed tobacco merger has a similar competitive profile. Combining the second and third largest companies will certainly reduce competition, giving Reynolds a 34.1% market share after divestitures. Unlike the media mergers, though, this one takes place in a shrinking market, as smoking continues to decline. Consolidation in a declining market certainly makes sense from an economic point of view. And there’s a clever wrinkle in this deal, in that Reynolds will sell off the KOOL, Salem, Winston, Maverick and blu brands to Imperial Tobacco for $7.1 billion—the idea is to create a stronger No. 3 competitor to keep the antitrust forces at bay.

There’s one other big difference, though: the merger will allow these two companies to be more efficient in killing people with their products. In its merger document, Reynolds says the deal would produce $800 million in cost savings and produce double digit profit gains by the second year. Not that Reynolds is a laggard. The company had already doubled its operating profit margin to 36.7% since 2004. And its 10–year return to shareholders of 542.2% has dwarfed the S&P’s return. This is a profit machine, even if a lethal one. According to the American Cancer Society, about 224,210 new cases of lung cancer will be diagnosed this year and 159,260 people will die from lung cancer—that’s more than colon, breast, and prostate cancers combined, says the ACS.

The new company will feature brands including Camel, one of the top premium smokes, and Vuse, a fast growing e-cigarette, but the prize in deal for Reynolds is Lorillard’s Newport, now the No. 1 menthol brand. Newport now owns a 12.6% share of the entire cigarette market in the U.S. and it’s growing —33.7 billion menthol “sticks” were sold last year. According to the Reynolds’ presentation, Newport has an “attractive demographic profile.” That profile, says smokefree.gov, includes blacks, women, Hispanics and younger people, all of whom are higher-than-average consumers of menthol cigarettes. These very characteristics have put menthol under the regulatory spotlight, leading to speculation that the Food and Drug Administration might ban menthol. But Reynolds clearly doesn’t believe that the feds will make any such move. “While cigarettes are dangerous there is not a significant difference between a menthol cigarette and a non menthol cigarette,” noted Murray Kessler, Lorillard’s CEO. “And ultimately the science will prevail.”

The same science holds the view, which none of these companies disputes, that tobacco use is deadly. And smoking costs our health care system billions of dollars annually to treat smokers. Should the FTC or Justice factor public health considerations into the deal? For instance, if the FTC believes that cigarette prices will increase, would it still bless the deal because rising prices might help ration demand—force more smokers to quit. Conversely, would blocking the deal, and keeping the competitors in place, have the opposite effect and lower prices, thus attracting more smokers?

That’s not necessarily an analysis that antitrust regulators are willing to make. Typically the antitrust agencies look only at the competition effects. As a former FTC official told me: “The traditional view has been that if the health and safety regulators wish to impose conditions, that’s their call entirely.” Expect the FTC to stick to the economics, which will be great for the tobacco companies, and their investors. The customers are on their own.

TIME Companies

Big Tobacco Firms Merge as Cigarette Sales Decline

Packs of Camel cigarettes, manufactured by Reynolds American Inc., in a display rack in London on July 11, 2014.
Packs of Camel cigarettes, manufactured by Reynolds American Inc., in a display rack in London on July 11, 2014. Bloomberg/Getty Images

Reynolds American announced Tuesday that it would buy the third largest tobacco company in the U.S., Lorillard for $27.4 billion

Faced with a steady decline in cigarette sales, Reynolds American Inc. announced Tuesday that it would buy the third largest tobacco company in the U.S., Lorillard, Inc. for $27.4 billion.

The deal will make Reynolds American the second largest tobacco company in the U.S. after Altria Inc., maker of Marlboro cigarettes.

The companies will merge Reynold’s flagship brands, Camel, Pall Mall and American Spirit cigarettes, with Lorillard’s portfolio of Newport menthol-flavored cigarettes and e-cigarettes. Those two sectors are isolated areas of growth in an industry that has seen U.S. cigarette consumption decline by 4% last year, the Wall Street Journal reports.

TIME Smoking

This Is The New Best Way to Quit Smoking, Study Finds

Combining varenicline and the nicotine patch was more effective in helping smokers quit after six months than the drug alone

Quitting smoking can be a frustrating challenge, and no single therapy works dramatically well. Nicotine replacement strategies – the patch, gum or lozenges—can help wean smokers off nicotine gradually, but don’t often work in keeping smokers abstinent over the long term. The prescription drug varenicline, or Chantix, which curbs smoking by occupying and blocking the same nicotine receptors in the brain used by the nicotine in cigarettes, makes nicotine less pleasurable. But studies show that it’s only about 33% effective in keeping smokers off cigarettes after 12 weeks.

Researchers in South Africa, however, report in JAMA that combining varenicline with the nicotine patch boosted that quit rate to 49% among a group of 435 smokers who were randomly assigned to take either the pills and the patch or the pills and a placebo patch. Smokers on the pills and patch were nearly twice as likely to be abstinent after six months than those who took the pills alone with a dummy patch.

MORE: Nicotine Gum and Patch Don’t Help Smokers Quit Long Term

“The efficacy of combining the two drugs cannot be readily explained,” Dr. Coenraad Koegelenberg, lead author of the study from Stellenbosch University in Cape Town, wrote in an email response to questions about the findings.

It’s possible that the timing of the pills and the patch worked in the smokers’ favor. While both varenicline and the nicotine patch target the same nicotine receptors in the brain, they have different effects; the nicotine from the patch activates the nicotine receptors and provides the same pleasurable sensations that cigarettes would, while varenincline is designed to bind and block the effects of nicotine on the brain. Varenincline is more effective at binding to these receptors, while nicotine from the patch is slower to activate, so starting on the patch may wean smokers from nicotine, and the varenicline may have helped them to drop cigarettes completely.

MORE: Hope for Quitters? Scientists Devise a New Nicotine Vaccine

Interestingly, the one-two punch didn’t work by lowering craving for nicotine. They also did not find a significantly increased risk of side effects, including depression or nausea, in the varenicline group. The U.S. Food and Drug Administration in 2009 added a black box warning alerting users to the potential for suicidal thoughts, although a 2013 study found no greater risk of depression among smokers with depression or who had had depression in the past.

The results raise important questions about how current smoking cessation treatments might be more effective if used in combination. Currently, varenicline is not recommended with other nicotine-replacement strategies; for that to change, other studies showing similar results to this one would be needed.

TIME tobacco

Nearly 1 in 5 High School Seniors Smoke Hookah, Study Finds

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Emy Kat—Getty Images/GraphEast RF

The variety of flavors of tobacco makes hookah attractive and easier to conceal from parents, study found

Almost 1 in 5 (18%) of high school seniors smoke waterpipes, or “hookahs”, according to a new study from New York University (NYU) researchers.

The new report, which is published in the journal Pediatrics, looked at a survey of 15,000 high school seniors from 130 public and private high schools nationwide and focused on a population of 5,540 students who were asked about their hookah use between 2010 and 2012.

The researchers found that about one in five seniors reported smoking hookah–waterpipes used to smoke specially-made tobacco–in the last year. And smoking hookah was more common among teens in big cities.

“What we find most interesting is that students of higher socioeconomic status appear to be more likely to use hookah,” said study author Joseph J. Palamar, an assistant professor of Population Health at NYU Langone Medical Center (NYULMC). “Surprisingly, students with more educated parents or higher personal income are at high risk for use.”

Cigarette smoking rates among young people are down, with a recent CDC report showing rates of cigarette smoking among high school students has dropped to its lowest level in 22 years. But public health workers are also worried about other tobacco and nicotine products like cigars, hookah, and e-cigarettes. A 2012 report showed a 123% increase in the use of other smokable tobacco products like cigars and pipes.

The researchers note, however, that smoking hookah doesn’t usually happen as often as cigarettes, and tends to happen more occasionally. Still, the researchers are worried about “hookah pens,” smoking devices similar to e-cigs which makes smoking hookah simpler. “These nifty little devices are likely to attract curious consumers, possibly even non-cigarette smokers,” said Palamar. Hookah tobacco tends to come in different flavors, and may be easier to conceal.

TIME E-Cigarettes

Teen Smoking Is Way Down. But What About E-cigs?

Cigarette smoking among high school students has dropped to lowest level in two decades

Rates of cigarette smoking among high school students has dropped to lowest level in 22 years, the CDC reports.

In 2013, the smoking rate among high school students hit 15.7%, which means the U.S. government has already reached its goal of lowing the teen smoking rate to 16% of less by 2020. That’s according to the National Youth Risk Behavior Survey (YRBS), which began in 1991. Another important data set on teen smoking and drug use—Monitoring the Future (MTF)—reports the rate is at 16.3%. Regardless, both surveys show fewer kids are smoking.

That’s good news, and it’s likely thanks to a combination of several factors, the most important being the rising costs of cigarettes. Others include the growing stigmatization of smoking, with half of states prohibiting smoking in places like bars and restaurants. The adult smoking rate is dropping too, which means teens have fewer smoking role models.

If teens are passing around fewer packs of cigarettes, does that mean they’re not smoking other things? Past data has shown a 123% increase in the consumption of other smokable tobacco products like cigars and pipes, though the recent numbers from the larger data sets show no change in smokeless tobacco use since 1999, and a drop in cigar use.

CDC

One question you’re likely going to see is whether teens are switching to e-cigarettes. E-cigarettes is a subject the public health community is uncharacteristically split on. On one side of the spectrum, you have critics arguing that it’s possible e-cigarettes serve as a gateway to regular cigarettes. One vocal critic being the head of the CDC himself. “The increased use of e-cigarettes by teens is deeply troubling,” said CDC Director Dr. Tom Frieden in a statement about teen tobacco use going down. “Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes.”

Emerging data points to certain trends, but e-cigs are still so new. Earlier this fall, a CDC report showed that e-cig use among teens, while still low, had doubled in a year, from 3.3% in 2011 to 6.8% in 2012.

Dr. Kenneth Warner, a professor of health management and policy at the University of Michigan School of Public Health, looked back through the data and found that among kids who have never smoked a conventional cigarette, only 0.7% have ever tried an e-cigarette within the last 30 days. What this shows is that the same kids who are smoking regular cigarettes are smoking e-cigs.

“Everyone thinks they are right and the logical thing is that nobody knows,” says Warner. “This is a huge-stakes issue, because the proliferation of e-cigs has the potential to either reduce the cigarette problem or increase it over time among kids.”

The reality is we have a long way to go. It took 40 years to get the adult smoking rate down to around 20%, and it won’t be easy to cut it in half again. Warner and his colleague David Mendez have created a smoking-prevalence model that’s been used since the 1990s. Their predictions show that at the rate we are going, we might not be able to hit a 10% adult smoking rate until the middle of the century. But that’s if we don’t try anything radically different.

“I believe we will do better because I don’t think we’ll stick with just status quo tobacco control,” says Warner. “In my judgment, the future lies in how effectively FDA can regulate cigarettes and other [nicotine] products.”

The FDA announced it is expanding its regulatory powers to cover more tobacco products including e-cigs, but anti-smoking advocates are arguing it’s still not enough.

“The data on kids is great, but we have a long way to go before we can pack up and go home and say we solved the problem,” says Warner.

You can read more on the latest CDC numbers here.

 

 

 

TIME Family

If You’re a Strict Parent, Your Kid Is More Likely to Smoke Pot

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Getty Images

Overbearing parents may be putting their children at a greater risk of using drugs

A study conducted in six European countries reveals that children who have strict parents are more likely to smoke cannabis, as well as use tobacco and alcohol. The team, led by the European Institute of Studies on Prevention, observed the relationships between parents and their children in Spain, Sweden, the Czech Republic, the U.K., Slovenia and Portugal to determine what parenting style best prevents drug usage.

Over 7,000 adolescents between 11 and 19 years old were asked if their parents had a more controlling or lenient parental style. The study found that parents who reasoned with their children were most effective in persuading their kids to abstain from drugs.

“Our results support the idea that extremes are not effective: neither authoritarianism nor absence of control and affection,” Amador Calafat, the main author of the study, told the journal Drug and Alcohol Dependence.

Calafat noted that different styles of parenting are helpful in varying situations: when dealing with a child’s school performance, parents who assert low levels of control are the most effective. But, when protecting students from drugs, Calafat asserts that “a good relationship with children” is essential.

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