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Our Country’s Veteran Suicide Crisis

Our nation’s suicide epidemic takes a devastating toll on veterans.

Since 2006, veterans have died by suicide nearly 20 times more often than soldiers have been killed in war operations.((Calculated by Giffords Law Center comparing the number of Overseas Contingency Operations (OCO) deaths and veteran suicide deaths. From 2006 to 2021, 4,620 service-members were killed in OCO operations. From 2006 to 2020, 127,560 veterans died by suicide. Giffords Law Center included an estimate of 6,000 veteran suicides for 2021, to create comparable years of data. Hannah Fischer and Hibbah Kaileh, “Trends in Active-Duty Military Deaths From 2006 Through 2021,” Congressional Research Service, September 9, 2022, https://sgp.fas.org/crs/natsec/IF10899.pdf; “National Suicide Data Report Appendix, 2022” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, https://www.mentalhealth.va.gov/suicide_prevention/data.asp.)) These suicides overwhelmingly involve firearms. 

The people who so bravely sacrificed to serve and protect our nation deserve better. Fortunately, these tragedies are preventable. By encouraging responsible firearm ownership practices and enacting strong gun safety laws, we can help our veterans—and all Americans—overcome this preventable public health crisis.

You are not alone. If you or a loved one are contemplating suicide, please call the free and confidential national Suicide & Crisis Lifeline by dialing 988 or access help through their website at 988lifeline.org.

Veteran Suicide

Suicide is an urgent public health problem across the country. Each year, nearly 47,000 people die from suicide—more than half of which involve firearms.((Based on an average of the five most recent years of available data: 2016-2020. Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (WONDER), “Fatal Injury Data,” last accessed Oct. 24, 2022, https://wonder.cdc.gov/Deaths-by-Underlying-Cause.html.)) American veterans disproportionately shoulder the burden of our nation’s gun suicide epidemic. More than 6,500 veterans die by suicide each year, and veterans account for roughly one in five firearm suicides in the US.((Based on an average of the five most recent years of available data: 2016-2020. “National Suicide Data Report Appendix, 2022” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, https://www.mentalhealth.va.gov/suicide_prevention/data.asp.))  

For veterans and non-veterans alike, our country’s suicide problem is a gun problem. Nearly 70% of veteran suicides involve firearms, compared with roughly 51% of all suicides nationwide.((“National Suicide Data Report Appendix, 2022” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, https://www.mentalhealth.va.gov/suicide_prevention/data.asp; Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (WONDER), “Fatal Injury Data,” last accessed Oct. 15, 2018, https://wonder.cdc.gov/Deaths-by-Underlying-Cause.html.)) The proportion of veteran suicides that are carried out with firearms has increased in recent years. In fact, in 2020, 71% of veteran suicides involved firearms, the highest percentage on record.((“National Suicide Data Report Appendix, 2022” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, https://www.mentalhealth.va.gov/suicide_prevention/data.asp.)) 

Background on Guns and Suicide

1 in 5 gun suicide victims are veterans

Suicide disproportionately affects American veterans, who account for one in five adult firearm suicides.

Source

“2019 National Veteran Suicide Prevention Annual Report,” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, September 2019, https://www.mentalhealth. va.gov/docs/data-sheets/2019/2019_National_Veteran_Suicide_Prevention_Annual_ Report_508.pdf. See also, “National Suicide Data Report Appendix,” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, https://www.mentalhealth.va.gov/ suicide_prevention/data.asp.

Firearms are the most lethal of the commonly available means of suicide in the US. The vast majority of people who attempt suicide survive—unless they use a gun. This lethality explains why less than five percent of non-firearm suicide attempts result in death, while approximately 85% of gun suicide attempts are fatal.((Matthew Miller, Deborah Azrael, and Catherine Barber, “Suicide Mortality in the United States: the Importance of Attending to Method in Understanding Population-Level Disparities in the Burden of Suicide,” Annual Review of Public Health 33 (2012): 393–408.))  

Because of this unique lethality, easy access to firearms is one of the most salient risk factors for suicide. Research suggests that having a gun in the home triples a person’s overall risk of suicide.((Andrew Anglemyer, Tara Horvath, and George Rutherford, “The Accessibility of Firearms and Risk for Suicide and Homicide Victimization Among Household Members: a Systematic Review and Meta-analysis,” Annals of Internal Medicine 160, no. 2 (2014): 101–110.)) Nearly half of all veterans own firearms,((Emily C. Cleveland et al., “Firearm Ownership among American Veterans: Findings from the 2015 National Firearm Survey,” Injury Epidemiology 4, no. 1 (2017).)) compared to 30% of the general population.((Katherine Schaeffer, “Key Facts About Americans and Guns,” Pew Research Center, September 13, 2021, https://www.pewresearch.org/fact-tank/2021/09/13/key-facts-about-americans-and-guns/.))  

Importantly, however, gun suicide is preventable. Many suicide attempts are impulsive acts utilizing whatever methods are immediately available—48% of people harm themselves within 10 minutes of deciding to attempt suicide.((Eberhard A. Deisenhammer et al., “The Duration of the Suicidal Process: How Much Time Is Left for Intervention Between Consideration and Accomplishment of a Suicide Attempt?,” The Journal of Clinical Psychiatry 70, no. 1 (2008): 19–24.)) Of those who survive a suicide attempt, the vast majority never attempt again, and 90% do not go on to die by suicide.((David Owens, Judith Horrocks, and Allan House, “Fatal and Non-fatal Repetition of Self-Harm: Systematic Review,” The British Journal of Psychiatry 181, no. 3 (2002): 193–199.)) By delaying and limiting access to guns among those at a proven risk of suicide, we can save thousands of American lives every year.

Over the last decade, the suicide rate for veterans has been much higher than the suicide rate of the general population. The veteran suicide rate is 1.6 times higher than the non-veteran adult suicide rate.((Based on 2020 data. “2022 National Veteran Suicide Prevention Annual Report,” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, September 2022, https://www.mentalhealth.va.gov/docs/data-sheets/2022/2022-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf.)) 

Additionally, the veteran suicide rate has historically risen faster than the suicide rate for non-veterans. From 2006 to 2020, the veteran suicide rate increased by 48%, compared to a 16% increase for non-veterans.((“National Suicide Data Report Appendix, 2022” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, https://www.mentalhealth.va.gov/suicide_prevention/data.asp.)) However, suicide rates for both veterans and non-veterans dropped slightly in both 2019 and 2020. The decrease in veteran suicides (10%) was larger than the decrease in non-veteran suicides (6%) from 2018 to 2020.((Id.))  

These declines in veteran suicides are promising, and mirror other data which suggests that suicidal ideation among veterans may have decreased during the COVID-19 pandemic.((Brandon Nichter et al., “Prevalence and Trends in Suicidal Behavior Among US Military Veterans During the COVID-19 Pandemic,” JAMA Psychiatry (2021); “2022 National Veteran Suicide Prevention Annual Report,” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, September 2022, https://www.mentalhealth.va.gov/docs/data-sheets/2022/2022-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf.)) In fact, these declines led to 2020 seeing the lowest number of veteran suicides since 2006.((“2022 National Veteran Suicide Prevention Annual Report,” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, September 2022, https://www.mentalhealth.va.gov/docs/data-sheets/2022/2022-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf.))  

However, there are some indications that veteran suicides could rise in the coming years. For example, studies have found that veterans who contracted COVID-19 were twice as likely to report suicidal ideation.((Brandon Nichter et al., “Prevalence and Trends in Suicidal Behavior Among US Military Veterans During the COVID-19 Pandemic,” JAMA Psychiatry (2021).)) As of mid-July 2022, it is estimated that 82% of Americans have contracted COVID-19,((“COVID-19 Results Briefing,” Institute for Health Metrics and Evaluation, July 18, 2022, https://www.healthdata.org/sites/default/files/files/Projects/COVID/2022/102_briefing_United_States_of_America_8.pdf.)) suggesting that a high number of veterans may have this risk factor. Additionally, preliminary 2021 data suggests that national suicides rose five percent from 2020 to 2021.((Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (WONDER), “Provisional Multiple Cause of Death Data,” last accessed Oct. 24, 2022, https://wonder.cdc.gov/mcd.html.)) Should veteran suicide trends mirror trends in overall suicides, it is possible that they may also have risen slightly since 2020.

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Veteran Suicide by Characteristics

Geography

Veteran suicide rates are highest in the Western states, followed by the Midwestern and Southern states.((“2022 State-Level Veteran Suicide Data: State Data Appendix,” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, https://www.mentalhealth.va.gov/suicide_prevention/data.asp.)) Veteran suicide rates are lowest in the in Northeastern states.((Id.)) However, firearms are used in the highest proportion of suicides in Southern states (74%), followed by Midwestern (68%), Western (68%), and Northeastern states (59%).((Id.))  

In general, states which had the highest rates of veteran suicide saw a higher proportion of veteran suicides by firearm compared to states with lower rates of veteran suicide. For example, in 2020, Montana had the second highest veteran suicide rate.((Id.)) Seventy-six percent of veteran suicides in the state that year involved firearms.((Id.)) New Jersey had the lowest rate of veteran suicides that year, with less than 47% of these deaths involving firearms.((Id.))

Age

Veteran suicide rates are highest for those ages 18–34, who in 2020 died by suicide at nearly 1.5 times the rate as veterans overall.((“National Suicide Data Report Appendix, 2022” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, https://www.mentalhealth.va.gov/suicide_prevention/data.asp.)) Among veterans, 2020 suicide rates were lowest for those ages 55–74.((Id.)) Importantly, while veteran suicides for most other groups fell between 2019 and 2020, suicide rates among veterans ages 18–34 increased four percent.((Id.)) 

Although veterans of all ages die by suicide at higher rates than non-veterans of the same age, this disparity is most pronounced for 18–34 year old veterans, who died by suicide at nearly three times the rate of non-veterans the same age in 2020.((Id.))

Race and Ethnicity

Rates of suicide in 2020 were highest for white veterans, followed by American Indian/Alaska Native, Asian American, and Black veterans.((Id.)) Veterans of every racial group have higher suicide rates than the overall suicide rate by race: Asian American and Pacific Islander veterans die by suicide at nearly four times the overall Asian American and Pacific Islander suicide rate.((Id.)) Black, white, and American Indian/Alaska Native veterans die by suicide at twice the overall rate of their respective racial groups.((Based on 2020 data. Id.))   

Guns are the most common method of suicide

Firearms are used in more than 50% of suicide deaths in the United States, making guns the most common method used in suicide deaths.

Source

Centers for Disease Control and Prevention, Wide-ranging Online Data for Epidemiologic Research (WONDER), “Underlying Cause of Death, 2018-2022, Single Race,” last accessed May 1, 2024, https://wonder.cdc.gov/.

From 2001 to 2020, veteran suicide rates increased for every racial group, with the largest increase in Asian American and Pacific Islander veterans (168%), followed by white (48%), Black (18%), and American Indian/Alaska Native (11%) veterans.((Id.)) From 2018 to 2020, suicide rates fell slightly among white and American Indian/Alaska Native veterans. During the same time period, Black veteran suicide rates remained stable, and Asian Amercan and Pacific Islander veteran suicide rates rose sharply.((Id.)) In fact, Asian Amercan and Pacific Islander veteran suicide rates rose 30% from 2018 to 2020—a time when veteran suicide rates overall fell 10%. 

Veteran suicides also show substantial disparities for Hispanic and non-Hispanic veterans. Non-Hispanic veterans are 1.7 times as likely to die by suicide as Hispanic veterans.((Based on 2020 data. Id.)) However, recent data suggests a troubling trend: from 2019 to 2020, suicide rates among Hispanic veterans increased, while decreasing for non-Hispanic veterans.((Id.))  

Sex

Both male and female veterans have higher suicide rates—and are more likely to use firearms in suicide attempts—than non-veterans of the same sex. In 2020, female veterans died by suicide at twice the rate of non-veteran females; male veterans died by suicide at a rate 1.2 times higher than non-veteran males.((“2022 National Suicide Data Report Appendix,” US Department of Veterans Affairs, Office of Mental Health and Suicide Prevention, https://www.mentalhealth.va.gov/suicide_prevention/data.asp.))  

One study found that male veterans were 41% more likely to use a firearm in suicide attempts relative to non-veteran males; female veterans were 39% more likely to use a firearm in suicide attempts relative to non-veteran females.((Adam G. Horwitz et al., “Characteristics of Veteran and Civilian Suicide Decedents: A Sex–Stratified Analysis,” American Journal of Preventive Medicine 56, no. 5 (2019): e163–e168.))

LGBTQ Veterans

An estimated one million veterans in the United States are gay.((“Veterans with Lesbian, Gay, Bisexual and Queer Identities,” Community Provide Toolkit, US Department of Veterans Affairs, last accessed October 31, 2022, https://www.mentalhealth.va.gov/communityproviders/veterans-lgb.asp.)) Research suggests that these veterans face elevated risk of suicide compared to both their heterosexual veteran peers and the general population. In fact, in 2017, suicide was the fifth leading cause of death among gay, lesbian, and bisexual veterans, but the tenth leading cause of death in the general US population.((Kristine E. Lynch, “Evaluation of Suicide Mortality Among Sexual Minority US Veterans from 2000 to 2017,” JAMA Network Open 3, no. 12 (2020): e2031357–e2031357.)) Gay, lesbian, and bisexual veterans had a suicide rate more than twice as high as the general veteran population.((Id.))  

Suicide also takes a disproportionate toll on transgender veterans. Transgender adults serve in the US military at two to three times the rate of the general adult population.((Jack Harrison-Quintana and Jody L. Herman, “Still Serving in Silence: Transgender Service Members and Veterans in the National Transgender Discrimination Survey,” LGBTQ Policy Journal 3, no. 1 (2013): 1–13.)) However, transgender veterans die by suicide at twice the rate of their cisgender veteran peers((Taylor L. Boyer et al., “Suicide, Homicide, and All–cause Mortality Among Transgender and Cisgender Patients in the Veterans Health Administration,” LGBT Health 8, no. 3 (2021): 173–180.)) and nearly six times the rate of the general population.((Raymond P. Tucker, “Suicide in Transgender Veterans: Prevalence, Prevention, and Implications of Current Policy,” Perspectives on Psychological Science 14, no. 3 (2019): 452–468.))

Recommendations

To prevent veteran suicides, it is critical that we take steps to address the role that firearms play in this crisis. Veterans with firearms in their homes can work with friends, family members, clinicians, and others to develop a plan to reduce access to lethal means during times of crisis. There are a range of steps and related policies that can help address the risks associated with firearm access and prevent firearm suicide.

Physician Firearm Safety Counseling

Half of individuals, including veterans, who die by suicide are seen in primary care settings in the month prior to death.((Lauren M. Denneson et al., “Suicide Risk Documented During Veterans’ Last Veterans Affairs Health Care Contacts Prior to Suicide,” Suicide and Life-Threatening Behavior 46, no. 3 (2016): 363–374; Jason B. Luoma, Catherine E. Martin, and Jane L. Pearson, “Contact with Mental Health and Primary Care Providers Before Suicide: a Review of the Evidence,” American Journal of Psychiatry 159, no. 6 (2002): 909–916.)) In fact, one survey of veterans already receiving mental health care found that nearly 56% of patients with a suicide plan had guns in the household.((Marcia Valenstein et al., “Possession of Household firearms and Firearm–related Discussions with Clinicians Among Veterans Receiving VA Mental Health Care,” Archives of Suicide Research (2019).)) Clearly, medical professionals can play an important role in discussing suicide risk and firearms safety with patients. 

A majority of Americans, including veterans, believe it is appropriate for physicians to have conversations about firearms in the clinical setting.((Marian E. Betz, Deborah Azrael, Catherine Barber, and Matthew Miller, “Public Opinion Regarding Whether Speaking with Patients About Firearms is Appropriate: Results of a National Survey,” Annals of Internal Medicine 165, no. 8 (2016): 543–550; Summer Newell et al., “Veterans are Agreeable to Discussions About Firearms Safety in Primary Care,” The Journal of the American Board of Family Medicine 34, no. 2 (2021): 338–345.)) However, despite this comfort and the disproportionate risk of suicide veterans face, a recent study found that fewer than one in 10 veteran firearm owners report ever having spoken with a clinician about firearm safety.((Joseph A. Simonetti et al., “Receipt of Clinician-delivered Firearm Safety Counseling Among US Veterans: Results from a 2019 National Survey,” Suicide and Life-Threatening Behavior (2022).)) These results suggest that additional efforts to facilitate such discussions are warranted. 

Both veterans and clinicians emphasize that these conversations work best when they are personalized to the patient, emphasize the rationale for the conversation, and respect veterans’ unique relationship with firearms.((Summer Newell et al., “Veterans are Agreeable to Discussions About Firearms Safety in Primary Care,” The Journal of the American Board of Family Medicine 34, no. 2 (2021): 338–345; Steven K. Dobscha et al., “Strategies for Discussing Firearms Storage Safety in Primary Care: Veteran Perspectives,” Journal of General Internal Medicine 36, no. 6 (2021): 1492–1502.)) Many resources have been developed to help clinicians feel more comfortable and capable of engaging in firearm safety conversations with veteran patients.((See, e.g., Jennifer L. Bryan et al., “A High–need, High-impact Educational Session on Firearms and Death by Suicide,” Suicide and Life-Threatening Behavior (2021).))  

Safe Firearm Storage

More than one-third of veterans who own guns store at least one of their firearms loaded and unlocked,((Joseph A. Simonetti, Deborah Azrael, Ali Rowhani-Rahbar, and Matthew Miller, “Firearm Storage Practices Among American Veterans,” American Journal of Preventive Medicine 55, no. 4 (2018): 445–454.)) lower than the 54% of all gun owners who store at least one gun unsafely.((Cassandra K. Crifasi et al., “Storage Practices of US Gun Owners in 2016,” American Journal of Public Health 108, no. 4 (2018): 532–537.)) However, close to two-thirds of veteran gun owners store at least one gun unlocked, and 47% store at least one firearm loaded.((Joseph A. Simonetti, Deborah Azrael, Ali Rowhani-Rahbar, and Matthew Miller, “Firearm Storage Practices Among American Veterans,” American Journal of Preventive Medicine 55, no. 4 (2018): 445–454.))  

Safe firearm storage—where guns are stored unloaded, locked up, and ammunition locked and stored separately—is an important way to disrupt access to lethal means in times of crisis. In fact, recent studies suggest that veterans in suicidal crisis are more likely than other veterans to store firearms unsafely. For example, one study found that veterans who used a firearm for suicide were more likely to have a documented unsecured firearm in their home at the time of their death.((Brooke A. Ammerman and Mark A. Reger, “Evaluation of Prevention Efforts and Risk Factors Among Veteran Suicide Decedents who Died by Firearm,” Suicide and Life-Threatening Behavior 50, no. 3 (2020): 679–687.)) Another study of female veterans who served after 9/11 found that such veterans with lifetime or past month suicide ideation were more likely to store guns loaded.((Lindsey L. Monteith et al., “Prevalence and Correlates of Firearm Access Among Post-9/11 US Women Veterans Using Reproductive Healthcare: a Cross-sectional Survey,” Journal of General Internal Medicine 37, no. 3 (2022): 714–723.))  

Promoting safety around lethal means and firearms is an important part of the Department of Veterans Affairs suicide prevention campaign. In the fall of 2021, the VA released a series of ads targeted at veterans that indicate that “a simple lock puts space between a thought and a trigger.”((Leo Shane III, “VA Zeroes in on Gun Safety as a Way to Reduce Veteran Suicides,” Military Times, September 22, 2021, ​​https://www.militarytimes.com/veterans/2021/09/22/va-zeroes-in-on-gun-safety-as-a-way-to-reduce-veteran-suicides/.))

Temporary Out-of-Home Gun Storage

People at risk of suicide can often be active partners in promoting their own health and safety by taking voluntary steps to limit their own access to the most lethal means of suicide. In some cases, family, friends, therapists, or physicians can successfully convince a struggling person to temporarily and voluntarily store guns outside the home to make them less accessible in a moment of crisis. 

Previous studies have found that many firearm retailers and law enforcement agencies are willing to offer or have offered temporary, voluntary firearm storage of firearms to prevent suicide and other firearm-related harms.((Carol W. Runyan et al., “Law Enforcement and Gun Retailers as Partners for Safely Storing Guns to Prevent Suicide: A Study in 8 Mountain West States,” American Journal of Public Health 107, no. 11 (2017): 1789–1794.)) Community activists and researchers in several states, including Colorado,((Colorado Firearm Safety Coalition, “Gun Storage Map,” https://coloradofirearmsafetycoalition.org/gun-storage-map/.)) Maryland,((Marylanders to Prevent Gun Violence, “Maryland Safe Storage Map,” https://mdpgv.org/safestoragemap/.)) Mississippi,((University of Southern Mississippi, “Mississippi Gun Storage Map,” http://mikeanestis.weebly.com/ms-gun-storage-map.html.)) and Washington,((Harborview Injury Prevention and Research Center, “Washington Firearm Safe Storage Map,” https://hiprc.org/firearm/firearm-storage-wa/.)) have created firearm storage maps to help community members find options for voluntary out-of-home storage. Veterans and their families can use these resources to develop safety plans to help prevent firearm suicide.

Extreme Risk Laws

Extreme risk laws allow families, household members, or law enforcement officers to petition a court for an extreme risk protection order (ERPO) which temporarily restricts a person’s access to guns if they are deemed a danger to themselves or others. Nearly 80% of those contemplating suicide show concrete signs before a suicide attempt.((Robert N. Golden and Fred Peterson, The Truth about Illness and Disease (Infobase Publishing, 2009), 53.)) Extreme risk laws empower those most likely to notice warning signs to help remove firearms from people at a high risk of suicide. 

These laws have enormous lifesaving potential. Researchers estimate that for every 10 to 20 gun removals carried out under Connecticut and Indiana’s extreme risk law, one life was saved through an averted suicide.((Jeffrey W. Swanson et al., “Implementation and Effectiveness of Connecticut’s Risk–based Gun Removal Law: Does it Prevent Suicides,” Law & Contemporary Problems 80, (2017): 179–208; Jeffrey W. Swanson et al., “Criminal Justice and Suicide Outcomes with Indiana’s Risk-Based Gun Seizure Law,” The Journal of the American Academy of Psychiatry and the Law, (2019).)) Additionally, in 44% of Connecticut’s firearm removal cases, the request for an order to remove a gun resulted in the subject receiving mental health treatment they might not otherwise have received.((Jeffrey W. Swanson et al., “Implementation and Effectiveness of Connecticut’s Risk–based Gun Removal Law: Does it Prevent Suicides,” Law & Contemporary Problems 80, (2017): 179–208.))  

So far, 19 states—California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Indiana, Maryland, Massachusetts, Nevada, New Jersey, New Mexico, New York, Oregon, Rhode Island, Vermont, Virginia, and Washington—and Washington DC have passed extreme risk laws.

Conclusion

Far too many of our nation’s veterans have died at their own hands, and firearms have overwhelmingly been the means by which they have done so. Our nation’s veterans have bravely volunteered to risk their lives to fight for our country, and we owe them and their families meaningful action to address this crisis. 

Now is the time for our leaders to show courage and pass the gun safety reforms that address the role that firearms play in fueling our nation’s suicide crisis.

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