An electronic cigarette (e-cigarette) is a device that heats liquid nicotine and flavorings so they can be inhaled. The use of e-cigarettes is often called “vaping,” because many people believe it produces a vapor. E-cigarettes create an aerosol composed of tiny particles, which is different from a true vapor.

E-cigarettes are known by many different names. This includes e-cigs, vapes, vape pens, electronic nicotine delivery systems (ENDS), alternative nicotine delivery systems (ANDS), e-hookahs, mods, vaporizers, and tank systems. E-cigarettes are also sometimes known by their brand names.

Vaping works by heating liquid inside a small device, which turns it into an aerosol that is then inhaled into the lungs. Unlike smoking, which burns tobacco, vaping heats liquid to release particles suspended in air. The aerosol contains nicotine, flavorings, and other chemicals. When inhaled from the mouthpiece, these particles travel down the throat and into the lungs.

E-cigarettes are available in many shapes and sizes. They can look like cigarettes, cigars, pipes, pens, and USB flash drives. Most types of e-cigarettes have:

• A cartridge, tank or pod that holds liquid (can be refillable).
• A heating element for turning the liquid into breathable particles (aerosol, commonly called “vapor”).
• A battery to power the heating element.
• A power or control button (some are activated by sensors when you inhale).
• A mouthpiece to breathe in the aerosol.

E-cigarettes don’t have tobacco, but many of them have nicotine, which comes from tobacco. E-cigarettes heat liquid to make an aerosol; cigarettes burn tobacco, which creates smoke. Because of this, the U.S. Food and Drug Administration (FDA) classifies them as “tobacco products.”

Electronic cigarettes (e-cigarettes) were developed as a smoking cessation tool and a safer alternative to traditional cigarettes for people unable or unwilling to quit nicotine. The intention was to help people who smoke to reduce nicotine intake without exposure to the harmful tar and toxins in tobacco smoke, thus, reducing smoking-related diseases and deaths. However, 21 years since Chinese pharmacist Hon Lik, first introduced the modern e-cigarettes in 2003, to help himself quit smoking cigarettes, this did not work. He is now a dual user, both smoking and vaping. We must question whether they have achieved their intended objectives or if they have inadvertently become a Trojan horse in public health, presenting unforeseen risks and challenges.

Patterns of use

Some groups of adults use e-cigarettes at a higher percentage than others. For example:

• More men than women report current e-cigarette use.
• A higher percentage of young adults (18–24 years old) use e-cigarettes compared to older adults, usage declines with age.
• Use is higher among adults with less education, lower incomes, or without health insurance.
• Adults who identify as lesbian, gay, or bisexual report higher rates of use compared to heterosexual adults.
• Adults experiencing serious psychological distress are more likely to use e-cigarettes.

In 2024, e-cigarettes were the most used tobacco product among middle and high school students in the United States:

1. 63 million (5.9%) students currently used e-cigarettes. This includes:
   3. 410,000 (3.5%) middle school students.
   4. 21 million (7.8%) high school students.
2. Among students who had ever used e-cigarettes, 43.6% reported current use.
3. Among students who currently used e-cigarettes:
   38. 4% used an e-cigarette on at least 20 of the last 30 days.
   39. 3% used an e-cigarette every day.
4. 6% used flavored e-cigarettes. Vapes come in a variety of youth-friendly flavors, including fruit, candy, mint, and menthol.
5. Among students who currently used e-cigarettes; 55.6% used disposable e-cigarettes, 15.6% used prefilled or refillable pods or cartridges, and 7.0% used tanks or mod systems.

Most middle and high school students who vape both want to quit and have attempted to do so. In 2020, 63.9% of students who were current e-cigarette users reported wanting to quit, and 67.4% reported that they had tried to quit within the past year.

Why youth vape

Most tobacco use, including vaping, starts and is established during adolescence. There are many factors associated with youth tobacco product use. These include:

1. Tobacco advertising that targets youth: In 2021, 7 out of 10 U.S. middle and high school students reported exposure to e-cigarette marketing. Most students reported seeing e-cigarette advertisements or promotions in retail settings. Students also reported seeing advertisements on the internet, television, streaming services, movies, or in print media. In addition, about three out of four students (74%) who used social media reported seeing e-cigarette–related posts or content.
2. Product accessibility: Some e-cigarettes cost less than regular cigarettes, which may also contribute to youth vaping.
3. Availability of flavored products: A study from 2013–2015 showed that most youth who use e-cigarettes first start with a flavored variety. Availability of flavored vapes is among the top 10 reasons youth report ever trying an e-cigarette. In 2024, nearly 9 out of 10 middle and high school students who currently used e-cigarettes reported using a flavored product, with the most commonly used flavors being fruit, candy, and mint.
4. d) Social influences: The most common reason U.S. middle and high school students give for trying an e-cigarette is that a friend used them. Youth also report vaping because they are curious about e-cigarettes or because a family member used them.

Youth often obtain the e-cigarettes from others. Among U.S. middle and high school students who used e-cigarettes in 2021:

• 3% got them from a friend.
• 1% bought the products themselves.
• 7% had someone else buy the products for them.
• 7% had someone offer the products to them.

Dual use of e-cigarettes: Many young people who vape also use other tobacco products, including cigarettes and cigars. This is called dual use. In 2024:

• Among U.S. students who currently use a tobacco product, more than one-third report using more than one type of product, including 6%of high school students and 38.9% of middle school students.

Cannabis content of e-cigarettes: E-cigarettes can also be used to deliver other substances, including cannabis. In 2016, nearly one out of three (30.6%) of U.S. middle and high school students who had ever used an e-cigarette reported using marijuana in the device.

Health risks of E-cigarettes

The term “vapor” might sound harmless. But the aerosol that comes out of an e-cigarette is not water vapor, and it can be harmful. The aerosol from an e-cigarette can contain nicotine and other substances that are addictive.

1. Nicotine content: The e-liquid in most e-cigarettes has nicotine, the same addictive chemical in regular cigarettes, cigars, hookah, and other tobacco products. But nicotine levels are not the same in all types of e-cigarettes. Sometimes, product labels do not list the true nicotine content. There are some e-cigarette brands that have been found to contain nicotine even though they claim to be nicotine-free.

Young people can start showing signs of nicotine addiction quickly, sometimes before the start of regular or daily use. Because the adolescent brain is still developing, it is uniquely susceptible to nicotine.

The nicotine content of e-cigarettes has increased over time. Many e-cigarettes contain nicotine salts. These allow people to consume high levels of nicotine without experiencing the harshness of freebase nicotine.

High-nicotine products dominate US e-cigarette unit sales. In March 2022, products with a nicotine strength of 5% or more made up 81% of total e-cigarette unit sales. In recent years, the price of high-nicotine products decreased or stayed the same while the price of low-nicotine products increased.

2. Cancer risk: E-cigarettes contain chemicals that can cause cancer (carcinogens), like acetaldehyde and formaldehyde but their long term effect on cancer development is not yet clear.
3. Heart and lung disease: E-cigarettes contain chemicals known to cause lung disease, such as acrolein, diacetyl and diethylene glycol. A Johns Hopkins Medicine-led analysis of medical information gathered on a diverse group of almost 250,000 people over four years has significantly clarified the link between the “exclusive” use of e-cigarettes and chronic obstructive pulmonary disease, as well as high blood pressure in a sub-group of adults 30 to 70 years of age.

E-cigarettes and other similar products have been linked to lung problems. Using them can increase your risk of breathing problems. This includes worsening asthma symptoms, more frequent bronchitis, and lung infections.

The nicotine in e-cigarettes also increases heart rate, raises blood pressure, and might irritate blood vessels.

4. Vitamin E acetate, linked to lung injury caused by vaping (EVALI): An outbreak of EVALI in late 2019 and early 2020 put thousands of people in the hospital. At least 68 people died. Since then, EVALI cases have been declining, but people who vape can still get EVALI. Among people hospitalized with severe EVALI, most were younger than 35 and used THC-containing vapes from informal sources, such as online sellers or family and friends. However, EVALI can occur in anyone who uses either nicotine or THC-containing vapes.

Symptoms of EVALI included:

• Cough, trouble breathing, or chest pain
• Nausea, vomiting, or diarrhea
• Fatigue, fever, or weight loss

Some people had to be hospitalized, and some died from their illness. Some of these lung injuries were linked to products that were changed, including products that had vitamin E acetate. But there were also many EVALI cases that did not involve added vitamin E.

The number of EVALI cases has since dropped, but there are still people being diagnosed with EVALI. More studies are being done to look for other possible causes.

5. Heavy metals: E-cigarettes may contain heavy metals like nickel, tin, lead and cadmium which have been shown to have adverse health effects.
6. Tiny particles: E-cigarettes may contain tiny (ultrafine) particles that can get deep into your lungs passing the filtration system of the lungs.
7. Seizures: There have been reports of people having seizures after vaping. This has been reported most often in young people. These seizures are thought to be caused by nicotine, but more studies are being done.
8. Dental problems: Studies are also starting to show a link between e-cigarette use and damage to teeth and other oral tissues. This includes cavities in the teeth and irritation of gums and other membranes in the mouth.
9. Secondhand aerosol: E-cigarettes expose people to secondhand aerosol or vapor that can contain harmful chemicals. Scientists are still learning about the health effects of being exposed to secondhand e-cigarette aerosol. Secondhand aerosol can expose others to nicotine and possibly to other harmful chemicals.
10. Explosions: There have been reports of e-cigarettes exploding and causing serious injuries. The explosions are thought to be caused by faulty batteries or because the batteries were not handled as they should be.

Can e-cigarettes help people quit?

E-cigarettes are not approved by the FDA and European Medicines Agency as smoking cessation devices due to limited data on safety and effectiveness. This is because there is not enough research to show that they help people to stop using tobacco.

Recent research indicates that people who use both cigarettes and e-cigarettes have a higher risk of getting lung cancer than people who only use cigarettes. People should not use both products at the same time and are strongly encouraged to completely stop using all tobacco products.

Globally, regulation varies:

• 88 countries have no minimum purchase age.
• 74 countries lack regulations entirely.
• E-cigarettes are banned in about 35 countries.
• Others regulate them as consumer, pharmaceutical, or tobacco products.

Marketing frequently targets youth, with over 16,000 flavors, cartoon packaging, and sleek designs resembling toys or tech gadgets. Alarmingly, in many countries, e-cigarette use among adolescents exceeds adult use. Even brief exposure to vaping content on social media increases the likelihood of trying these products.

One of the greatest public health risks is that vaping could “re-normalize” smoking after decades of successful tobacco control. Smoking remains the leading preventable cause of death, killing more than 480,000 people annually in the United States alone.

Conclusion

Taken together, these findings show that no tobacco products, including e-cigarettes, are safe. Most e-cigarettes contain nicotine, a highly addictive substance that poses serious health risks, particularly for youth, pregnant women, and developing fetuses. In addition to nicotine, e-cigarette aerosol can contain harmful and potentially harmful substances, including cancer-causing chemicals and ultrafine particles that can be inhaled deep into the lungs. For these reasons, e-cigarettes should not be used by youth, young adults, or individuals who are pregnant. Moreover, e-cigarettes pose potential health risks not only to those who vape but also to others exposed to secondhand emissions, while placing an added burden on public health systems and government healthcare budgets. Compounding these concerns, the short- and long-term health effects of e-cigarette use remain unclear, and much is still unknown about their full impact on human health. Until more is understood, this evidence underscores the importance of prevention, education, and informed decision-making.

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2. Centers for Disease Control and Prevention. (n.d.). E-cigarettes. Retrieved October 9, 2025, from https://www.cdc.gov/tobacco/e-cigarettes/
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In recent years, people have been divided by conflicting studies about the risk of cancer posed by cell phone radiation. Does the current conflicting research eradicate or support the cell phone-cancer controversy?

Cell phone use has shown a dramatic increase in the world during the 1990s. The heated controversy today is about whether there is a relationship between cell phone use and the risk of developing malignant and benign brain tumors. This controversy did not exist—at least in the eyes of the public—until accumulating anecdotal evidence began suggesting a link between cell phone use and cancer. Since the first pieces of anecdotal evidence, numerous studies have investigated the cell phone-brain cancer link and a general summary of the findings is, at best, confusing. The substantial room for improvement in the experimental designs of these studies, the appearance of brain cancer after a long period of exposure, and some conflicts of interest among researchers prevented the results from being conclusive. More recent studies provide growing evidence for the link, suggesting there is reason to be suspicious about the studies that refute the relationship between cell phone use and brain cancer.

Possible health issues regarding exposure to radio frequency (RF) energy were described in a previous Fountain article (Tombak, 2002). This article also stated that proving or disproving the existence of RF exposure’s biological hazards remains an issue for epidemiology due to relatively low exposure levels, relatively small populations, and a lack of reliable dose estimates. The National Cancer Institute (NCI) is now maintaining an up-to-date web page to inform the public on key points that can be drawn from epidemiological studies investigating the cell phone-brain cancer link. It would be advisable that individuals concerned about this potential link become familiar with this web page and visit frequently to check the updates. A regular visitor will notice that the language on this page is evolving in every update in a way that the most recent version is less likely than the previous one to discredit the link as “out of the question”. This is because we are starting to see—albeit still opposed as weak—stronger signs of the alleged link as there is an increase in both the sheer number and the experimental design quality of relevant studies.

The first two key points that NCI draws on concern the type of electromagnetic energy emitted by cell phones, and the factors that determine a users energy exposure level. It would not be surprising if this train of thought followed with a third key point that stated that the cancer risk depended on the amount of energy that each individual was exposed to. However, the third key point quickly draws the conclusion that “studies thus far have not shown a consistent link between cell phone use and cancers of the brain, nerves, or other tissues of the head and the neck.” It further states “more research is needed because cell phone technology and how people use cell phones have been changing rapidly”.

Regardless of what type of general message one gets from these three key points, I want to emphasize that there is benefit in avoiding a lump-sum conclusion, and in making oneself aware of the results of individual studies. Before I move on to individual studies, however, I will point out how scientifically sound interpretations of statistical power and significance may lead to categorizations as ‘non-existent’ or ‘weak’, but how this scientific reasoning can potentially be misleading for the population at large. In this manner, one would better be able to make sense of why cell phone companies are, on one hand, highlighting the studies that have failed to find a causal link between cell phone use and brain cancer, but on the other hand, are taking all legal precautions necessary to prevent a future litigation by inserting a warning slip in fine print that cautions users not to hold the phone closer than a certain distance against one’s head or body.

The null vs. the alternative

A statistical hypothesis test involves two hypotheses: the null and the alternative hypothesis. The null hypothesis represents the status quo; it assumes that there is no real difference between the two groups under study and the observed difference can be attributed to random chance. Drawing a parallel with legal systems, the presumption that a defendant is innocent until proven guilty can be interpreted as saying that his or her innocence is the null hypothesis. There has to be sufficient evidence on the contrary, i.e showing the guilt, in order to be able to convict the defendant. In a similar fashion, an epidemiological study investigating the presence of a link between cell phone use and brain cancer would have a null hypothesis that states the absence of such a link. The cell phone technology is assumed to be innocent unless the data prove otherwise.

The alternative hypothesis, the latter of the two, represents the claim that there actually is a statistically significant link between cell phone use and brain cancer, and the observed link cannot be attributed to random chance. In our legal analogy, the alternative hypothesis is laying the charges against cell phone technology, thus as the Latin maxim “semper necessitas probandi incumbit ei qui agit” states, the burden of proof lies with the alternative hypothesis.

As a consequence of this construction, a hypothesis test can have only one of two conclusions. If the data shows results that are beyond some predetermined significance level, the null hypothesis is rejected and the researchers believe that there is sufficient evidence to say that the alternative is true. Such a conclusion would establish a link between cell phone use and brain tumors. On the other hand, if the results do not reach the desired significance level, the conclusion is not the confirmation of the null hypothesis, but a failure to conclude that the alternative is true. In other words, when the desired significance level is not reached, the only outcome is a lack of conclusion; the test would not falsify the null hypothesis but would not declare it to be true either. The accused would be vindicated on the basis of insufficient evidence.

News on the innocence of cell phone technology, or any technology for that matter, should be read primarily with this perspective in mind. The conclusions of research studies are reported on the basis of whether the results “reach or fail to reach significance”. However, a more meaningful statistic to report from the study would be the deviation of the results from significance, if they were not significant. Results that are close to statistical significance can still be “meaningful”. After all, the significance level chosen for most studies relies more on traditional scientific habits than anything else. In this perspective, it can even be called arbitrary. In reality, we may not have expertise in today’s world to determine whether a 5% significance level is more meaningful than a 10% when it comes to studying the link between cell phone use and brain cancer. So when the NCI officials mention “lack of a consistent link,” all of what they mean is that the desired significance level has not been reached in most credible and up-to-date studies. Yet, the public is not informed about how significant the results were. Furthermore, as we see in the much-acclaimed Interphone study, failure to reach significance in the entire study may be overshadowing the fact that significance was attained for a subgroup of people, for instance, the top 10% of the population with highest cell phone use (The Interphone study group, 2010).

Perspectives on brain cancer risk

News regarding cell phone tumor risks is plainly confusing because a battle continues among different international panels and interest groups over how to analyze and interpret cell phone tumor data. An article (July 6, 2011) on Microwave News explains why there is no overlap in the conclusions made by the International Commission for Non-Ionizing Radiation Protection (ICNIRP) and the International Agency for Research on Cancer (IARC), the two panels that are supposed to work together, but fell into deep disagreement as the data started showing some link between cell phone use and brain cancer. This piece is a highly suggested read for anyone who would like to be able to make more sense of the past and potentially future news on cell phone tumor risks.

The Interphone study

Much of the current debate on cell phone tumor risks actually revolve around the Interphone study, which was conducted by a consortium of researchers from 13 countries, and is the largest health related case control study of the use of cell phones and head and neck tumors. According to NCI’s summary, “most published analyses from this study have shown no statistically significant increases in brain or central nervous system cancers related to higher amounts of cell phone use. One recent analysis showed a statistically significant, albeit modest, increase in the risk of glioma among the small proportion of study participants who spent the most total time on cell phone calls. However, the researchers considered this finding inconclusive because they felt that the amount of use reported by some respondents was unlikely and because the participants who reported lower levels of use appeared to have a reduced risk of brain cancer.”¹

The general message that comes across in NCI’s summary of Interphone results is that we do not have enough reason to believe that cell phones are dangerous. However, it is very important to remember that one can never accept the null hypothesis that “cell phones are safe.” The only conclusion that can be drawn is on the basis of insufficient evidence, which is to say that cell phones are dangerous since the desired significance level has not been reached.

As the Interphone study is the largest of its kind, it has drawn substantial attention from concerned parties, and a significant part of this attention has been in the form of harsh criticisms for the experimental design, data analysis, and stated conclusions. For instance, one of Interphone’s biggest critics, the International Electromagnetic Field (EMF) Collaborative, published a paper in May 2010 detailing the flaws of the study. Among other things, these flaws included using data from 2004 and before when cell phone use was much less common, categorizing subjects who used cordless phones (which emit the same microwave radiation as cell phones,) as ‘unexposed’; exclusion of many types of brain tumors; exclusion of people who had died, or were too ill to be interviewed, as a consequence of their brain tumor; and exclusion of children and young adults who are more vulnerable.

In August 2009, more than forty leading independent scientists, physicians and other experts from fourteen countries endorsed the white paper “Cell-phones and Brain Tumors: 15 Reasons for Concern, Science, Spin and the Truth Behind Interphone” by US researcher Lloyd Morgan. Investigating the research on cell phone tumor risks including the Interphone study, this paper concluded that “there is a risk of brain tumors from cell phone use; telecom funded studies underestimate the risk of brain tumors; and children have larger risks than adults for brain tumors”. Unlike the Interphone study, some industry funded research also accepts the risks associated with cell phone use. In 1999, Dr. George Carlo, head of a $25m research body funded by the mobile phone industry in the US, said his study showed an increased risk of getting a type of rare brain tumor from using mobile phones. This early in the debate, he was probably one of the first researchers with links to industry who stopped ruling out the tumor risks of cell phones.

A review of other main studies

Hardell et al.

Dr. Lennart Hardell, from Örebro University in Sweden, is one of the most adamant leaders in cautioning the world about cell phone tumor risks. In 2007, he and his team reported that cell phone users were at an increased risk of malignant glioma, and that a daily one-hour exposure significantly increased the risk for developing a brain tumor after 10 years (Hardell et al., 2007). In a more recent study also cited by NCI, they found statistically significant trends of increasing brain cancer risk for the total amount of cell phone use and the years of use among people who began using cell phones before the age of 20 (Hardell et al., 2011). They also published a number of other papers in epidemiological journals pointing to the risks associated with cell phone and cordless phone usage.

The Danish cohort study

A 2011 cohort study in Denmark linked billing information from more than 420,000 cell phone subscribers with brain tumor incidence data from the Danish Cancer Registry (Frei et al., 2011). This study was an update on the 2006-update of a 2001 cohort study (Schüz et al., 2006; Johansen et al., 2001) that has been dogged by controversy and political suspicions since the first results were published ten years ago. NCI cites the study and states that the analyses found no association between cell phone use and the incidence of glioma, meningioma, or acoustic neuroma, even among people who had been cell phone subscribers for 10 or more years. However, there is no mention of the published or vocal criticisms of the study.

The main criticism for the study is that more than 200,000 corporate mobile subscribers were excluded from the cohort as cell phone bills were not in users’ names. Microwave News states, “In the time period covered in the Danish project—from 1987 through 1995—cell phones were expensive and it’s no stretch to assume that those who did not have to pay their own bills racked up the most talk time.”² Thus, the study designers effectively removed one-third of the population with the heaviest cell phone use. Dr. Lennart Hardell had also criticized the original 2001 paper by publishing on the shortcomings that make the conclusions premature (Hardell and Mild, 2001). Concerning the 2011 update, the Microwave News bluntly suggests, “Don’t believe a word of it”.

It is also interesting to note that the results came just five months after a panel of experts from the World Health Organization’s International Agency for Research on Cancer (IARC) deemed cell phones a possible cause of cancer—a statement that sparked fear in many of the world’s 5 billion cell phone users.

Conclusion

While there is still no established causal link between cell phone use and cancer, we know as a fact that different research groups have found an increased risk of a rare type of brain cancer among heavy users. Even though children are known to be at a greater risk because of being in earlier stages of neural development, it is unfortunate that data from children were not included in studies until very recently. Concerned citizens of the world need to raise awareness about the behind-the-scenes battle taking place between different international panels and interest groups. This will make a reliable interpretation of conflicting news more possible. Further corroboration for both statistical and anecdotal evidence on the relationship between cell phone use and brain cancer may be necessary to “prove” a link, but this should, by no means, be interpreted as a vindication of cell phones. In the meantime, it is only safe to take precautions oneself, and encourage loved ones to reduce exposure to electromagnetic energy from cell phones by using a hands-free device and by reserving the use of cell phones for shorter conversations.

Notes

1 http://www.cancer.gov/cancertopics/factsheet/Risk/cellphones

2 http://www.microwavenews.com/DanishCohort.html#Continued

References

• Frei P, Poulsen AH, Johansen C, et al. 2011. “Use of mobile phones and risk of brain tumours: update of Danish cohort study.” British Medical Journal; DOI: 10.1136/bmj.d6387.
• Hardell, L., Walker, M. J., Walhjalt, B., Friedman, L. S. and Richter, E. D. 2007. “Secret ties to industry and conflicting interests in cancer research.” American Journal of Industrial Medicine,; 50: 227–233. doi: 10.1002/ajim.20357.
• Hardell L, Carlberg M, Soderqvist F, Hansson-Mild K, Morgan LL. 2007. “Long-term use of cellular phones and brain tumours: Increased risk associated with use for > or = 10 years.” Occup Environ Med. 64:626–632.
• Hardell L, Carlberg M, Hansson Mild K. 2011. “Pooled analysis of case-control studies on malignant brain tumours and the use of mobile and cordless phones including living and deceased subjects.” International Journal of Oncology; 38(5):1465–1474.
• Hardell L, Mild KH. 2001. “Re: Cellular Telephones and Cancer—a Nationwide Cohort Study in Denmark”; JNCI J Natl Cancer Inst. 93(12): 952.
• Johansen C, Boice Jr. JD, McLaughlin JK, Olsen JH. 2001. “Cellular telephones and cancer: a nationwide cohort study in Denmark.” Journal of the National Cancer Institute; 93(3):203–207.
• Schüz J, Jacobsen R, Olsen JH, et al. 2006. “Cellular telephone use and cancer risk: update of a nationwide Danish cohort.” Journal of the National Cancer Institute; 98(23):1707–1713.
• Tombak, Ali. 2002. “Biological Effects of Cellular Phones.” The Fountain, 37 (1).
• The Interphone Study Group. 2010. “Brain tumour risk in relation to mobile telephone use: results of the Interphone international case-control study.” International Journal of Epidemiology; 39(3):675–694.