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Takeaways: "A four-year university-wide study of students' e-textbook practices found that e-textbook use has increased, particularly among younger students. The major barriers - including a student preference for print and unfamiliarity with e-textbooks - show signs of being alleviated. Other factors related to mobile device access and pedagogically effective e-textbooks show little change over the study period. Instructor practices have improved, but there is still room for growth, with implications for focused professional development."