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Even the surgeon general’s landmark warning in the late 1960s that linked smoking to cancer couldn’t get Americans to quit. Instead, they gave it up at a glacial pace — by 2016 just 15.5 percent of adults smoked, according to the most recent CDC data, and it was largely thanks to a culture shift that cast the small circles of smokers who’d gather to puff outside of office buildings and bars as deeply uncool. They were addicts.

And Juul kept the nicotine and chucked out all the rest — the thin casing of paper that always seemed to fall apart in the bottom of our purses, the flakes of tobacco, the tar, the carbon dioxide, the smell, the very form of the cigarette.

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To Allan M. Brandt, a historian and author of "The Cigarette Century," Juul is anything but new and different. "It represents the cultural norms and notions of the cigarette, which was very much youth-oriented," he said. "It was kind of forbidden; it was extremely cool."

Could it be that with Juul, it’s just a different generation simply doing what young people have always done — testing boundaries, sneaking independence? Teen pregnancy is down, and marijuana is practically normalized. Perhaps Juul is just the new boogeyman to replace all the old ones.

“It spread like wildfire, for two reasons,” he said. “The first reason is the flashy flavors like creme brulee. The flavors are responsible for bringing the kids in, the nicotine keeps them.”

“I think the history of this tells me, don’t trust these industries,” said Brandt, the smoking historian. “Juul can say, ‘We’re not interested in kids; we’re going to fight the use of this in kids.’ But with flavors like mango, and cool cucumber. . . .” Cigarette makers have always said they didn’t want kids to smoke, he continued. But bad news about children lighting up on the schoolyard, he said, “was always great news for the tobacco companies.

Mr. Trump has also been under an intense lobbying campaign over the past seven weeks, waged by tobacco and vaping companies, along with conservative organizations, like Americans for Tax Reform, which are opposed to regulatory limits that would affect retailers, small businesses and adult consumers of e-cigarettes.

the flavor ban has also become a proxy issue for how his advisers see Mr. Trump’s path to re-election. In one camp are those who believe he should try to win back suburban women, including mothers of teenagers who would presumably worry about their children becoming addicted to nicotine. In the other are those who advise him to assume that voting bloc would not favor him anyway and to focus only on energizing his base.

E-cigarette users have held protests outside the White House and outside Trump rallies that they may have attended under other circumstances. Protesters have also raised concerns about the potential closing of thousands of vape shops, which they said would hurt the economy and cost jobs across the country.

While some advice to Mr. Trump was grounded in polling, some was based on a gut-level understanding of Trump voters: Taking away the right to smoke or vape would be something akin to taking away firearms.

Mr. Azar, have been pushing the administration to address the issue, as parents and schools as well as public health experts have grown increasingly concerned about the rise in teenage vaping. Mr. Azar had told the president that about more than one-fourth of high school students reported vaping e-cigarettes within the previous 30 days, according to this year’s survey of tobacco use among youths

"Women in West Virginia smoked during pregnancy more than five times as often as women in the states with the lowest prevalence,"

The researchers also found that prevalence of smoking during pregnancy varied by age and race. The prevalence was highest among women 20 to 24 at 10.7%, followed by women 15 to 19 at 8.5% and 25 to 29 at 8.2%.

The prevalence also was highest among non-Hispanic American Indian or Alaska Native women at 16.7%, followed by non-Hispanic white women at 10.5%, non-Hispanic black women at 6%, Hispanic women at 1.8% and non-Hispanic Asian women at 0.6%.

"We still have a serious issue with infant mortality -- prematurity and infant mortality are clearly linked to cigarette smoking, as is low birth weight -- and when you begin to explain these things to patients, it really does appear to make a difference to them," he said.Brown pointed out that some of the states in the new CDC report with the highest prevalence of smoking during pregnancy also tend to have high rates of infant mortality. A CDC data brief released in January showed that, between 2013 and 2015, West Virginia and Kentucky had infant mortality rates higher than the overall national rate.

preferences can change quickly. The New York Times reported in January anecdotal accounts of teenagers ditching Juul devices and moving en masse to disposable devices packed with e-liquids in flavors such as banana ice, sour gummy and cool mint. The question is whether federal regulators will keep up with changing preferences.

The FDA should not have allowed disposable, candy-flavored e-cigarettes to continue to be sold. Regulators should not wait until there is enough youth survey data telling them what should have been obvious in the first place: Easy-to-use, easy-to-conceal products such as disposable vapes in candy flavorings will attract children — and create new addicts.

Waiting for more evidence that these products are hooking children would imply that it is acceptable for public health officials to sit back and watch while new addictions multiply.

“As we continue to reset the vapor category, we are committed to advancing the long-term potential for harm reduction for adult smokers while combating underage use,” Mr. Crosthwaite said in a statement.

Vaping

The school district lawsuits are added to the catalogue of woes besetting the cynical opportunists who undid decades of good work to create a new generation of nicotine addicts

the company founded by Bowen and Monsees set about fine-tuning their idea. It developed a vaporizer that resembled a high-tech gadget rather than the cylindrical cigarette look-alikes and bong-like pipes already on the market. And in a major chemical breakthrough, it perfected a “vape juice” based on nicotine salts rather than free-base nicotine. This allowed the company to deliver more of the addictive drug without the harsh effect that makes new smokers gag and hack.

When Juul debuted in 2015, the clever little rectangle wasn’t aimed exclusively at existing smokers — people who might receive a net health benefit from switching their addiction to a smokeless device. Eye-catching ads, viral hashtags and social media celebrities pushed the product into America’s high schools and middle schools.

Use of tobacco-related products by teenagers was falling at the time of Juul’s launch, according to the National Youth Tobacco Survey, but that hopeful trend is ruined now. Overall use by high school students rose 38 percent from 2017 to 2018, driven by a 78 percent rise in the daily use of e-cigarettes.

“Juuling” is a verb known to tens of millions of American children today; more than 3 million of them Juul daily.

Sadly, the horse is out of the barn. Anyone who has experienced nicotine addiction can report that kicking the habit is easier to pledge than to accomplish

An untold number of those 3 million-plus high school Juulers will be battling to quit for years, perhaps decades, to come.

get this: We know nothing of the long-term health effects of vaping. Nicotine’s potential harm to the development of young brains is well-documented, but the downstream toll will accrue over time.

This vape craze should never have been allowed to happen. It is a double failure: a failure of governance on the part of federal regulators who should never have permitted a new nicotine delivery system to proliferate without oversight, and a moral failure by investors willing to peddle drugs to kids.

She said the concern was both with the broader logic endorsing these products and with Vuse, which in the government’s most recent survey on youth tobacco use was found to be one of the most popular vaping brands with young people.

Allowing some vaping devices to stay on the market as an alternative to smoking, some public health experts believe, might make it easier for the government to impose more stringent regulation on traditional cigarettes,

appeared to leave plenty of room for other marketing that could affect youth.

The COVID vaccines are, without exaggeration, among the safest and most effective therapies in all of modern medicine. An unvaccinated adult is an astonishing 68 times more likely to die from COVID than a boosted one

Yet widespread vaccine hesitancy in the United States has caused more than 163,000 preventable deaths and counting

Even in absolute numbers, America’s unvaccinated and current-smoker populations seem to match up rather well: Right now, the CDC pegs them at 13 percent and 14 percent of all U.S. adults, respectively, and both groups are likely to be poorer and less educated.

Countries such as Denmark and Sweden have already declared themselves broken up with COVID. They are confidently doing so not because the virus is no longer circulating or because they’ve achieved mythical herd immunity from natural infection; they’ve simply inoculated enough people.

data suggest that most of the unvaccinated hold that status voluntarily at this point

The same arguments apply to tobacco: Smokers are 15 to 30 times more likely to develop lung cancer. Quitting the habit is akin to receiving a staggeringly powerful medicine, one that wipes out most of this excess risk.

If everyone who is eligible were triply vaccinated, our health-care system would be functioning normally again.

With a vaccination timeline that stretches over years, our patience for restrictions, especially on the already vaccinated, will be very limited. But there is middle ground. We haven’t banned tobacco outright—in fact, most states protect smokers from job discrimination—but we have embarked on a permanent, society-wide campaign of disincentivizing its use.

We should neither expect that every stubbornly unvaccinated person will get jabbed before next winter nor despair that none of them will ever change their mind. Let’s accept instead that we may make headway slowly, and with considerable effort

Long-term actions for COVID might include charging the unvaccinated a premium on their health insurance, just as we do for smokers, or distributing frightening health warnings about the perils of remaining uninoculated

And once the political furor dies down, COVID shots will probably be added to the lists of required vaccinations for many more schools and workplaces.

nother aspect of where we’re headed with COVID. Tobacco is lethal enough that we are willing to restrict smokers’ personal freedoms—but only to a degree. As deadly as COVID is, some people won’t get vaccinated, no matter what, and both the vaccinated and unvaccinated will spread disease to others.

anti-COVID actions, much like anti-smoking policies, will be limited not by their effectiveness but by the degree to which they are politically palatable.

Without greater vaccination, living with COVID could mean enduring a yearly death toll that is an order of magnitude higher than the one from flu.

this, too, might come to feel like its own sort of ending. Endemic tobacco use causes hundreds of thousands of casualties, year after year after year, while fierce public-health efforts to reduce its toll continue in the background. Yet tobacco doesn’t really feel like a catastrophe for the average person.

Losing a year or two from average life expectancy only bumps us back to where we were in … 2000.

We still care for smokers when they get sick, of course, and we reduce harm whenever possible. The health-care system makes $225 billion every year for doing so—paid out of all of our tax dollars and insurance premiums

Hospitals have a well-honed talent for transforming any terrible situation into a marketable “center of excellence.”

But we shouldn’t forget the most important reason that the coronavirus isn’t like the flu: We’ve never had vaccines this effective in the midst of prior influenza outbreaks, which means we didn’t have a simple, clear approach to saving quite so many lives. Compassionate conversations, community outreach, insurance surcharges, even mandates—I’ll take them all. Now is not the time to quit.

Juul is the logical extension of the Silicon Valley growth-hacking playbook: Design a flawless product, add a dopamine response, stir in some influencers and watch your product, game or app go viral.

Consider the outcry last week when TechCrunch reported that Facebook had been paying people (including teens) $20 a month to download an app that monitors a user’s mobile and web activity. Apple, long a privacy advocate and favored troll of Facebook, reacted swiftly by cutting off “Facebook Research” and the company’s internal apps. Tech Twitter, however, seemed largely perplexed: In the future, won’t we all sell our data rather than give it away for free?

If Silicon Valley was once converging on a moral cohesion of sorts — where progressive values and wokemanship acted as a loose ethical framework — it’s now becoming harder to avoid the varying ethical debates concerning privacy, addiction and growing geopolitical discord.

For the virtuous founders avoiding addictive products and invasive data-gathering, even they have to worry about who’s getting on their equity ownership table.

founders have to wonder whether that seemingly diverse venture capital fund is backed by regimes where women, minorities and dissidents are killed for expressing themselves.

of course, the morality of a company often depends on the morality of the people in charge

they’re also used as talking points by politicians who are working to make it more difficult for the EPA and other federal agencies to use science in their regulatory decision-making, under the guise of basing policy on “sound science.” Science’s virtues are being wielded against it.

The sound science tactic exploits a fundamental feature of the scientific process: Science does not produce absolute certainty. Contrary to how it’s sometimes represented to the public, science is not a magic wand that turns everything it touches to truth. Instead, it’s a process of uncertainty reduction, much like a game of 20 Questions.

“Our criticisms are founded in a confidence in science,” said Steven Goodman, co-director of the Meta-Research Innovation Center at Stanford and a proponent of open science. “That’s a fundamental difference — we’re critiquing science to make it better. Others are critiquing it to devalue the approach itself.”

alls to base public policy on “sound science” seem unassailable if you don’t know the term’s history. The phrase was adopted by the tobacco industry in the 1990s to counteract mounting evidence linking secondhand smoke to cancer.

What distinguishes the two calls for transparency is intent: Whereas the “open science” movement aims to make science more reliable, reproducible and robust, proponents of “sound science” have historically worked to amplify uncertainty, create doubt and undermine scientific discoveries that threaten their interests.

Delay is a time-tested strategy. “Gridlock is the greatest friend a global warming skeptic has,” said Marc Morano, a prominent critic of global warming research

While insisting that they merely wanted to ensure that public policy was based on sound science, tobacco companies defined the term in a way that ensured that no science could ever be sound enough. The only sound science was certain science, which is an impossible standard to achieve.

“Doubt is our product,” wrote one employee of the Brown & Williamson tobacco company in a 1969 internal memo. The note went on to say that doubt “is the best means of competing with the ‘body of fact’” and “establishing a controversy.” These strategies for undermining inconvenient science were so effective that they’ve served as a sort of playbook for industry interests ever since

Doubt merchants aren’t pushing for knowledge, they’re practicing what Proctor has dubbed “agnogenesis” — the intentional manufacture of ignorance. This ignorance isn’t simply the absence of knowing something; it’s a lack of comprehension deliberately created by agents who don’t want you to know,

In the hands of doubt-makers, transparency becomes a rhetorical move. “It’s really difficult as a scientist or policy maker to make a stand against transparency and openness, because well, who would be against it?

But at the same time, “you can couch everything in the language of transparency and it becomes a powerful weapon.” For instance, when the EPA was preparing to set new limits on particulate pollution in the 1990s, industry groups pushed back against the research and demanded access to primary data (including records that researchers had promised participants would remain confidential) and a reanalysis of the evidence. Their calls succeeded and a new analysis was performed. The reanalysis essentially confirmed the original conclusions, but the process of conducting it delayed the implementation of regulations and cost researchers time and money.

Any given study can rarely answer more than one question at a time, and each study usually raises a bunch of new questions in the process of answering old ones. “Science is a process rather than an answer,” said psychologist Alison Ledgerwood of the University of California, Davis. Every answer is provisional and subject to change in the face of new evidence. It’s not entirely correct to say that “this study proves this fact,” Ledgerwood said. “We should be talking instead about how science increases or decreases our confidence in something.”

which has received funding from the oil and gas industry. “We’re the negative force. We’re just trying to stop stuff.”

these ploys are getting a fresh boost from Congress. The Data Quality Act (also known as the Information Quality Act) was reportedly written by an industry lobbyist and quietly passed as part of an appropriations bill in 2000. The rule mandates that federal agencies ensure the “quality, objectivity, utility, and integrity of information” that they disseminate, though it does little to define what these terms mean. The law also provides a mechanism for citizens and groups to challenge information that they deem inaccurate, including science that they disagree with. “It was passed in this very quiet way with no explicit debate about it — that should tell you a lot about the real goals,” Levy said.

in the 20 months following its implementation, the act was repeatedly used by industry groups to push back against proposed regulations and bog down the decision-making process. Instead of deploying transparency as a fundamental principle that applies to all science, these interests have used transparency as a weapon to attack very particular findings that they would like to eradicate.

Now Congress is considering another way to legislate how science is used. The Honest Act, a bill sponsored by Rep. Lamar Smith of Texas,3The bill has been passed by the House but still awaits a vote in the Senate. is another example of what Levy calls a “Trojan horse” law that uses the language of transparency as a cover to achieve other political goals. Smith’s legislation would severely limit the kind of evidence the EPA could use for decision-making. Only studies whose raw data and computer codes were publicly available would be allowed for consideration.

It might seem like an easy task to sort good science from bad, but in reality it’s not so simple. “There’s a misplaced idea that we can definitively distinguish the good from the not-good science, but it’s all a matter of degree,” said Brian Nosek, executive director of the Center for Open Science. “There is no perfect study.” Requiring regulators to wait until they have (nonexistent) perfect evidence is essentially “a way of saying, ‘We don’t want to use evidence for our decision-making,’

ost scientific controversies aren’t about science at all, and once the sides are drawn, more data is unlikely to bring opponents into agreement.

objective knowledge is not enough to resolve environmental controversies. “While these controversies may appear on the surface to rest on disputed questions of fact, beneath often reside differing positions of value; values that can give shape to differing understandings of what ‘the facts’ are.” What’s needed in these cases isn’t more or better science, but mechanisms to bring those hidden values to the forefront of the discussion so that they can be debated transparently. “As long as we continue down this unabashedly naive road about what science is, and what it is capable of doing, we will continue to fail to reach any sort of meaningful consensus on these matters,”

The dispute over tobacco was never about the science of cigarettes’ link to cancer. It was about whether companies have the right to sell dangerous products and, if so, what obligations they have to the consumers who purchased them.

Similarly, the debate over climate change isn’t about whether our planet is heating, but about how much responsibility each country and person bears for stopping it

While researching her book “Merchants of Doubt,” science historian Naomi Oreskes found that some of the same people who were defending the tobacco industry as scientific experts were also receiving industry money to deny the role of human activity in global warming. What these issues had in common, she realized, was that they all involved the need for government action. “None of this is about the science. All of this is a political debate about the role of government,”

These controversies are really about values, not scientific facts, and acknowledging that would allow us to have more truthful and productive debates. What would that look like in practice? Instead of cherry-picking evidence to support a particular view (and insisting that the science points to a desired action), the various sides could lay out the values they are using to assess the evidence.

For instance, in Europe, many decisions are guided by the precautionary principle — a system that values caution in the face of uncertainty and says that when the risks are unclear, it should be up to industries to show that their products and processes are not harmful, rather than requiring the government to prove that they are harmful before they can be regulated. By contrast, U.S. agencies tend to wait for strong evidence of harm before issuing regulations

the difference between them comes down to priorities: Is it better to exercise caution at the risk of burdening companies and perhaps the economy, or is it more important to avoid potential economic downsides even if it means that sometimes a harmful product or industrial process goes unregulated?

But science can’t tell us how risky is too risky to allow products like cigarettes or potentially harmful pesticides to be sold — those are value judgements that only humans can make.

“This is particularly nefarious because social media companies influence how people think and behave without them even being aware of it. This has far-reaching adverse consequences on the functioning of democracy, particularly on the integrity of elections.”

There is a possibility that once lost, people who grow up in the digital age will have difficulty in regaining it. This may have far-reaching political consequences.”

Soros warned of an “even more alarming prospect” on the horizon if data-rich internet companies such as Facebook and Google paired their corporate surveillance systems with state-sponsored surveillance – a trend that’s already emerging in places such as the Philippines.

“This may well result in a web of totalitarian control the likes of which not even Aldous Huxley or George Orwell could have imagined,”

“The internet monopolies have neither the will nor the inclination to protect society against the consequences of their actions. That turns them into a menace and it falls to the regulatory authorities to protect society against them,

He also echoed the words of world wide web inventor Sir Tim Berners-Lee when he said the tech giants had become “obstacles to innovation” that need to be regulated as public utilities “aimed at preserving competition, innovation and fair and open universal access”.

Earlier this week, Salesforce’s chief executive, Marc Benioff, said that Facebook should be regulated like a cigarette company because it’s addictive and harmful.

In November, Roger McNamee, who was an early investor in Facebook, described Facebook and Google as threats to public health.

In recent years, the tobacco industry has joined forces with certain civil rights activists, among them the Rev. Al Sharpton, who according to the California Department of Public Health, visited Black communities in the state, raising fear that a menthol ban would give the police an excuse to stop and frisk more Black individuals. Mr. Sharpton also helped to defeat a ban in New York.

Last month, Trump also signed a bill into law that raised the legal age for buying tobacco products to 21 from 18.

It’s easy to take the zipper for granted today, but before it was invented, getting (and staying) dressed involved securing clothing with ropes, ties, buttons or other fasteners.

After years of attempts, Bell achieved his goal of transmitting sound over a wire, and on March 7, 1876, obtained his first U.S. Patent for a device he labeled as “Improvement on Telegraphy”—now better known as the telephone.

The first World’s Fair to take place in the United States was held in Philadelphia in 1876, and also celebrated the 100th anniversary of the country’s founding.

Then, in 1893, inventor Whitcomb L. Judson received a patent for his “clasp locker” shoe fastener, and immediately partnered with businessman Colonel Lewis Walker to launch the Universal Fastener Company and manufacture his invention

Along with the zipper, the Garis-Cochran Dishwashing Machine was also first introduced to the public at the 1893 Chicago World’s Fair, in a display drawing crowds curious about the contraption capable of thoroughly washing and drying 240 dishes in two minutes. The crowd-pleasing exhibit was more than a decade in the making. In 1883, Ohio entrepreneur Josephine Garis Cochran grew frustrated with the amount of time it took to clean up after dinner parties, reportedly saying, “If nobody else is going to invent a dishwashing machine, I’ll do it myself.” And she did.

One of the biggest challenges that arose during the early days of electricity was getting it from the power source to an individual device. By the 1880s, entire houses were being wired for electricity, but electrical appliances had to be connected to the home’s main power source directly, posing serious safety risks to members of the household.

April 30, 1939, New York City: This is the scene viewed on the television receivers in the metropolitan area, as the National Broadcasting Company inaugurated the first regular television service to the American public telecasting the ceremonies marking the opening of the New York World's Fair. Bettmann via Getty Images

May 1, 1939 saw another television milestone: the launch of a regular television broadcast schedule on the National Broadcasting Company (NBC), which was owned by RCA.

Fairgoers could take what was advertised as “America’s first television tour” (presented by NBC), where they would learn about the history of the medium, as well as the science and engineering that made its broadcast possible.

In the age of smartphones, it’s easy to identify the touchscreen demonstration at the World’s Fair as a significant technological turning point, but according to Jack Neely, executive director of the Knoxville History Project and crowd controller at the World’s Fair, that wasn’t apparent at the time. “It was...one of those things you had to look fast to notice,” Neely told the University of Tennessee Daily Beacon in a 2017 interview.

Doris knew nothing about raising children, nor much cared. The witheringly wry, worldly heiress was among the most celebrated women of her day, a six-foot glamour queen hounded by paparazzi, who brushed elbows with every midcentury icon from Jackie Kennedy to Elvis Presley, pronouncing Greta Garbo "boring" and, after dating Errol Flynn, theorizing that bisexual men made the best lovers: "I should know," she declared. "I've done exhausting research on the subject." As a child – and sole inheritor of her father Buck's $100 million fortune – she'd become famous as "the richest little girl in the world." She'd been raised by nannies in a chilly, silent Fifth Avenue mansion, with her parents taking little part in her upbringing; family lore holds that her father, on his deathbed in 1925, told 12-year-old Doris, "Trust no one." Now saddled with her pesky nephew Walker, watching him toss ketchup-covered tampons into her pool, Doris Duke regarded him with pity. He was desperate for love and attention, much like herself as a child. But Doris had her own fabulous life to live, and so she shipped Walker off to boarding school. "We were all too self-centered to be bothered with a problem child," she would later tell her cousin Angier St. George Biddle "Pony" Duke.

His grandmother's will had stipulated that if Walker left no heirs, upon his death his trust would be funneled into the Duke Endowment, a $2.8 billion foundation established by Buck Duke that nourishes, among other institutions, Duke University. The idea repulsed Walker: The very name that had given him such unearned bounty also stood for everything he felt he'd been deprived. "He despised Duke!" says longtime friend Mike Todd. "Duke University, Duke Foundation – everything Duke, he hated."

At school the twins had trouble connecting with classmates, few of whom were allowed over to the Inmans' mansion a second time after gaping at the guns, the explicit art and sometimes an eyeful of Walker, who preferred to be nude. Other kids went to summer camp, but the Inmans went to Abu Dhabi to bid millions at auctions; to Japan, where their father introduced them to friends who were supposedly yakuza; to Fiji, where Dad praised them as they dined on poisonous puffer fish. There were getaways aboard the Devine Decadence, which was docked in New Zealand. One day toward the end of second grade, when their father had yanked them out of school without warning, they told themselves it was for the best.

The past three years have been a struggle for the twins as they've grappled with their past. Before they were able to live with Daisha, they were sent to the Wyoming Behavioral Institute. The twins were suicidal, uncooperative and dangerously underweight. Therapist Jennifer Greenup had never seen such extreme emotional deprivation before. "If even a quarter of what they said happened to them happened, they are severely traumatized children," says Greenup, adding, "Their symptoms are real. Whether it's paranoia, lack of trust or hostility." Eventually the kids were able to move in with Daisha and began bonding, a triumph unto itself. But although they've taken positive steps, Greenup says the scale of their trauma is so great that she can't gauge their progress: "I can't say they're progressing well, because there's nothing to compare it to," she admits.

As for the kids' own plans, Patterson seems to hope for a quiet life. "I hope I don't have to live alone. But I actually don't mind. I'll just sit at Greenfield, fishing by my dad's little tomb, just talking about life," he says. "You can't trust anyone," he adds mournfully, repeating the words he learned from his father, which Walker learned from his aunt Doris, which she learned from her father, Buck Duke.

201 to 250: “Very Unhealthy.” Throat-clearing brings up a lot of phlegm. The sun looks dim through the haze, like a 30-watt bulb. This must be the way sun looks from Mars, you figure. 251 to 500: “Hazardous.” You can taste the air the moment you wake up, even though you are inside your apartment and the windows are closed. Your cat’s fur smells funny. Outside, the world seems muffled, and the tickle in your throat extends down into your lungs and rests there like a tiny gremlin. You plan a trip to Tokyo or any city outside China.

Above 500: Yes, it actually goes beyond the scale. In Beijing, these are called “crazy bad” days

In the U.S., on the worst day in the worst city—usually somewhere in California—the AQI is typically about 125.

Expats and increasingly Chinese often wouldn’t let their small children outside if the AQI was more than 150. Schools called off games at around 200. I wouldn’t jog above 165, and Deb thought I was crazy for running at that level. When you breathe more deeply, the tiniest particles,─the ones that can do the most damage,─can lodge more deeply in your lungs.

On a day when the AQI reached 746, as it did in January 2013, I couldn’t decide whether the sky over Beijing looked more like it was filled with the smoke from an encroaching forest fire or like the residue of a giant cigarette butt.

Some people left Beijing, which tied for 21st out of 199 Chinese cities for bad air, for Shanghai, which was tied for 121st in the bad-air rankings