Well: Health Effects of Smoking for Women

The title of a recent report on smoking and health might well have paraphrased the popular ad campaign for Virginia Slims, introduced in 1968 by Philip Morris and aimed at young professional women: “You’ve come a long way, baby.”

Today that slogan should include: “…toward a shorter life.” Ten years shorter, in fact.

The new report is one of two rather shocking analyses of the hazards of smoking and the benefits of quitting published last month in The New England Journal of Medicine. The data show that “women who smoke like men die like men who smoke,” Dr. Steven A. Schroeder, a professor of health and health care at the University of California, San Francisco, wrote in an accompanying editorial.

That was not always the case. Half a century ago, the risk of death from lung cancer among men who smoked was five times higher than that among women smokers. But by the first decade of this century, that risk had equalized: for both men and women who smoked, the risk of death from lung cancer was 25 times greater than for nonsmokers, Dr. Michael J. Thun of the American Cancer Society and his colleagues reported.

Today, women who smoke are even more likely than men who smoke to die of lung cancer. According to a second study in the same journal, women smokers face a 17.8 times greater risk of dying of lung cancer than women who do not smoke; men who smoke are at 14.6 times greater risk to die of lung cancer than men who don’t. Women who smoke now face a risk of death from lung cancer that is 50 percent higher than the estimates reported in the 1980s, according to Dr. Prabhat Jha of the Center for Global Health Research in Toronto and his colleagues.

After controlling for age, body weight, education level and alcohol use, the new analysis found something else: men and women who continue to smoke die on average 10 years sooner than those who never smoked.

Dramatic progress has been made in reducing the prevalence of smoking, which has fallen from 42 percent of adults in 1965 (the year after the first surgeon general’s report on smoking and health) to 19 percent in 2010. Yet smoking still results in nearly 200,000 deaths a year among people 35 to 69 years old in the United States. A quarter of all deaths in this age group would not occur if smokers had the same risk of death as nonsmokers.

The risks are even greater among men 55 to 74 and women 60 to 74. More than two-thirds of all deaths among current smokers in these age groups are related to smoking. Over all, the death rate from all causes combined in these age groups “is now at least three times as high among current smokers as among those who have never smoked,” Dr. Thun’s team found.

While lung cancer is the most infamous hazard linked to smoking, the habit also raises the risk of death from heart disease, stroke, pulmonary disease and other cancers, including breast cancer.

Furthermore, changes in how cigarettes are manufactured may have increased the dangers of smoking. The use of perforated filters, tobacco blends that are less irritating, and paper that is more porous made it easier to inhale smoke and encouraged deeper inhalation to achieve satisfying blood levels of nicotine.

The result of deeper inhalation, Dr. Thun’s report suggests, has been an increased risk of chronic obstructive pulmonary disease, or C.O.P.D., and a shift in the kind of lung cancer linked to smoking. Among nonsmokers, the risk of death from C.O.P.D. has declined by 45 percent in men and has remained stable in women, but the death rate has more than doubled among smokers.

But there is good news, too: it’s never too late to reap the benefits of quitting. The younger you are when you stop smoking, the greater your chances of living a long and healthy life, according to the findings of Dr. Jha’s international team.

The team analyzed smoking and smoking-cessation histories of 113,752 women and 88,496 men 25 and older and linked them to causes of deaths in these groups through 2006.

Those who quit smoking by age 34 lived 10 years longer on average than those who continued to smoke, giving them a life expectancy comparable to people who never smoked. Smokers who quit between ages 35 and 44 lived nine years longer, and those who quit between 45 and 54 lived six years longer. Even quitting smoking between ages 55 and 64 resulted in a four-year gain in life expectancy.

The researchers emphasized, however, that the numbers do not mean it is safe to smoke until age 40 and then stop. Former smokers who quit by 40 still experienced a 20 percent greater risk of death than nonsmokers. About one in six former smokers who died before the age of 80 would not have died if he or she had never smoked, they reported.

Dr. Schroeder believes we can do a lot better to reduce the prevalence of smoking with the tools currently in hand if government agencies, medical insurers and the public cooperate.

Unlike the races, ribbons and fund-raisers for breast cancer, “there’s no public face for lung cancer, even though it kills more women than breast cancer does,” Dr. Schroeder said in an interview. Lung cancer is stigmatized as a disease people bring on themselves, even though many older victims were hooked on nicotine in the 1940s and 1950s, when little was known about the hazards of smoking and doctors appeared in ads assuring the public it was safe to smoke.

Raising taxes on cigarettes can help. The states with the highest prevalence of smoking have the lowest tax rates on cigarettes, Dr. Schroeder said. Also helpful would be prohibiting smoking in more public places like parks and beaches. Some states have criminalized smoking in cars when children are present.

More “countermarketing” of cigarettes is needed, he said, including antismoking public service ads on television and dramatic health warnings on cigarette packs, as is now done in Australia. But two American courts have ruled that the proposed label warnings infringed on the tobacco industry’s right to free speech.

Health insurers, both private and government, could broaden their coverage of stop-smoking aids and better publicize telephone quit lines, and doctors “should do more to stimulate quit attempts,” Dr. Schroeder said.

As Nicola Roxon, a former Australian health minister, put it, “We are killing people by not acting.”

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Today's Economist: Nancy Folbre: Preschool Economics

Nancy Folbre is an economics professor at the University of Massachusetts, Amherst. She recently edited and contributed to “For Love and Money: Care Provision in the United States.“

Even a 4-year-old can understand the case for early-childhood education. It’s fun, you learn things, you make it easier for Mom and Dad to earn a decent living, and when you grow up you will be better able to earn a decent living yourself. At that point, you will start paying taxes that return the favor, helping finance the retirement and health care of the generation that invested in your education.

President Obama’s proposal to help states develop and expand high-quality early-education programs has won verbal support from across the political spectrum, including David Brooks. More tangible evidence of political viability comes from Oklahoma and Georgia, two traditionally red states that now provide universal voluntary preschool for 4-year-olds.

Still, conservative opposition remains fierce. The loudest complaint is that public programs have not been shown to be cost-effective. But a wealth of research by highly respected economists shows that well-designed, high-quality early-childhood education programs offer a positive payback. At National Public Radio you can listen to the University of Chicago economist James Heckman reiterate this point – as he has been doing for many years.

Timothy Bartik of the Upjohn Institute offers great running commentary on debates over technical issues (such as whether small, demonstrably successful programs can be effectively scaled up) at his Investing in Kids blog.

Academics aren’t the only ones on board. The U.S. Chamber of Commerce published a report last year explaining “Why Business Should Support Early-Childhood Education.”

But the case for a public commitment to early-childhood education extends well beyond any cost-benefit analysis of child outcomes. It would help parents meet their child-care needs and reconcile the conflicting demands of wage employment and family care.

As a report published by the Center for American Progress emphasizes, preschool enrollment rates are already high among 4-year-olds in particular. But high costs mean that participation is highest among the poor, who qualify for Head Start, and the affluent, who can afford to pay out of pocket.

Even parents who currently rely on informal child-care arrangements would benefit from more dependable public provision. Many are just one family member, friend or neighbor away from a child-care crisis that could endanger their jobs. At Forbes, Bryce Covert makes a case for emphasizing the positive employment impact of the proposed policy.

Women’s labor-force participation rates in the United States were once relatively high by international standards. In 1990, we ranked sixth among 22 countries of the Organization for Economic Cooperation and Development. By 2010, our rank had fallen to 17th. Francine Blau and Lawrence Kahn of Cornell University estimate that about 29 percent of the decrease in women’s labor-force participation relative to other countries is attributable to those countries’ adoption of more “family friendly” public policies than those in the United States.

Improvements in children’s future productivity and greater opportunities for productive employment for everyone will shape the future of the United States economy. Conservatives enjoy their strongest support among older white voters, many of whom have already raised their children.

Both young parents and young children are far more ethnically diverse than the population over age 65.

But as the journalist Ronald Brownstein points out in an article memorably titled “The Gray and the Brown,” the very structure of our social programs makes the generations dependent on one another:

Today’s minority students will represent an increasing share of tomorrow’s workforce and thus pay more of the payroll taxes that will be required to fund Social Security and Medicare benefits for the mostly white Baby Boomers. Many analysts warn that if the U.S. doesn’t improve educational performance among African-American and Hispanic children, who now lag badly behind whites in both high school and college graduation rates, the nation will have difficulty producing enough high-paying jobs to generate the tax revenue to maintain a robust retirement safety net.

These are linkages that voters sorely need to understand. In coming months both Social Security and Medicare are likely to withstand the budgetary pressures imposed by the threat of sequestration. On the other hand, programs directed at children – including support for early-childhood education – are likely to come under the deficit-cutting knife.

In the long run, that knife will cut both ways, bleeding our system of intergenerational transfers.

Which is one more reason why it’s important for President Obama and his supporters to wrestle it out of conservative hands.

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Blasts Across Baghdad Kill at Least 15 People

A wave of attacks targeting Shiite neighborhoods in Baghdad on Sunday killed at least 15 people and wounded more than 50, a security source confirmed.

Four car bombs exploded in Sadr City, targeting civilians in a market, at a bus station and on a major road, killing seven civilians and wounding more than 30 others, according to officials and a security source.

Car bombs also struck in Husseiniya, Al Ameen and Kamaliya, leaving a total of at least seven dead and 32 injured in those areas.

In the central Baghdad neighborhood of Karrada, close to the Babil Hotel, a roadside bomb killed one person and wounded five others.

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TV show with Pistorius' dead girlfriend airs

JOHANNESBURG (AP) — Reeva Steenkamp's last wish for her family before she was shot dead at boyfriend Oscar Pistorius' home was for them to watch her in a reality TV show that went on air in South Africa on Saturday night, two days after her killing.

Sharon Steenkamp, Reeva's cousin, told The Associated Press that the model and law graduate was "proud of being in the show" and reminded them in their last conversation to make sure that they watched it.

The South African Broadcasting Corp. aired the "Tropika Island of Treasure" program, showing the late Steenkamp — the victim of a Valentine's Day shooting at the home of Pistorius, the Olympic star and double-amputee athlete. She is laughing and smiling, and blowing a kiss toward the camera in Jamaica when it was filmed last year.

South Africans also saw her swimming in the ocean and watching people jump off a cliff and into the sea, shaking her head as they leaped.

SABC said it was dedicated to Steenkamp and displayed the words "Reeva Steenkamp 19 August 1983 - 14 February 2013" between images of a rose and a candle in a short tribute before the show aired. She was also seen blowing the kiss as she sat on a Jamaican beach and her name again appeared on screen with the years of her birth and death.

The country was rocked Thursday when news broke of Steenkamp's shooting death at the upscale house of the star athlete. Pistorius was arrested and charged with her murder and remains in custody in a police station. His family has strongly denied prosecutors' claims that he murdered her.

Steenkamp's family said earlier Saturday that it had not been contacted by either the SABC — South Africa's national broadcaster — or the show's producers for permission to air it, but were not opposed to it because Reeva wanted everyone to see it.

"Her last words to us personally were that she wants us to watch it," Sharon Steenkamp said, hours before the program was shown.

SABC aired the reality show on its main channel, which prominently featured Steenkamp.

The show's executive producer, Samantha Moon, said going ahead with the show "is what she would have wanted."

Steenkamp, a 29-year-old blonde model who graduated from law school, died after suffering four gunshot wounds, police said. Officers recovered a 9-mm pistol from Pistorius' house and quickly charged the Olympian with murder for Steenkamp's killing.

Pistorius will appear in court Tuesday for a bail hearing, something police have said they oppose. Prosecutors also say they will pursue upgraded charges of premeditated murder against him, which means the disabled icon and double-amputee runner could face a life sentence.

Steenkamp was known in South Africa for appearing in commercials and as a bikini-clad model in men's magazines.

Pistorius and Steenkamp met Nov. 4 at the Kyalami race track, which sits between Pretoria and Johannesburg and has been used for Grand Prix and Formula 1 races, said Justin Divaris, a mutual friend.

Divaris said his own girlfriend was a close friend to Steenkamp. Pistorius and Steenkamp immediately hit it off and decided in the spur of the moment to attend a sports award ceremony together the same night, Divaris said. At the time, Pistorius had been dating another woman and his personal life was constant fodder for gossip pages.

Later, however, problems may have started, as police have said there were previous domestic altercations at Pretorius' home in a gated community near South Africa's capital, Pretoria.

A Steenkamp family spokesman said late Friday that relatives still faced a long struggle to come to terms with her killing.

"I can't see the family getting over this shortly," said Reeva's uncle, Mike Steenkamp. "It's going to be a long, long-term reconciliation with a lot of things and issues."

Family members plan for a memorial service Tuesday for the model in Port Elizabeth, her hometown on South Africa's southern coast. Pistorius has a court appearance scheduled in Pretoria on the same day for his lawyers to argue that he can be released on bail.

Portions released earlier Saturday of the reality show, sponsored by a milk fruit drink, feature Steenkamp laughing and smiling on the beaches of Jamaica. Another portion shows her swimming with two dolphins, which tap her on the cheek with their snouts.

"I think the way that you go out, not just your journey in life, but the way that you go out and the way you make your exit is so important," Steenkamp says in the video. "You either made an impact in a positive or a negative way, but just maintain integrity and maintain class and just remain true to yourself.

"I'm going to miss you all so much and I love you very, very much."

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Associated Press writer Jon Gambrell contributed to this report.

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Gerald Imray can be reached at http://twitter.com/GeraldImrayAP

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Cuomo Bucks Tide With Bill to Lift Abortion Limits

ALBANY — Bucking a trend in which states have been seeking to restrict abortion, Gov. Andrew M. Cuomo is putting the finishing touches on legislation that would guarantee women in New York the right to late-term abortions when their health is in danger or the fetus is not viable.

Mr. Cuomo, seeking to deliver on a promise he made in his recent State of the State address, would rewrite a law that currently allows abortions after 24 weeks of pregnancy only if the pregnant woman’s life is at risk. The law is not enforced, because it is superseded by federal court rulings that allow late-term abortions to protect a woman’s health, even if her life is not in jeopardy. But abortion rights advocates say the existence of the more restrictive state law has a chilling effect on some doctors and prompts some women to leave the state for late-term abortions.

Mr. Cuomo’s proposal, which has not yet been made public, would also clarify that licensed health care practitioners, and not only physicians, can perform abortions. It would remove abortion from the state’s penal law and regulate it through the state’s public health law.

Abortion rights advocates have welcomed Mr. Cuomo’s plan, which he outlined in general terms as part of a broader package of women’s rights initiatives in his State of the State address in January. But the Roman Catholic Church and anti-abortion groups are dismayed; opponents have labeled the legislation the Abortion Expansion Act.

The prospects for Mr. Cuomo’s effort are uncertain. The State Assembly is controlled by Democrats who support abortion rights; the Senate is more difficult to predict because this year it is controlled by a coalition of Republicans who have tended to oppose new abortion rights laws and breakaway Democrats who support abortion rights.

New York legalized abortion in 1970, three years before it was legalized nationally by the Supreme Court in Roe v. Wade. Mr. Cuomo’s proposal would update the state law so that it could stand alone if the broader federal standard set by Roe were to be undone.

“Why are we doing this? The Supreme Court could change,” said a senior Cuomo administration official, who spoke on the condition of anonymity because the governor had not formally introduced his proposal.

But opponents of abortion rights, already upset at the high rate of abortions in New York State, worry that rewriting the abortion law would encourage an even greater number of abortions. For example, they suggest that the provision to allow abortions late in a woman’s pregnancy for health reasons could be used as a loophole to allow unchecked late-term abortions.

“I am hard pressed to think of a piece of legislation that is less needed or more harmful than this one,” the archbishop of New York, Cardinal Timothy M. Dolan, wrote in a letter to Mr. Cuomo last month. Referring to Albany lawmakers in a subsequent column, he added, “It’s as though, in their minds, our state motto, ‘Excelsior’ (‘Ever Upward’), applies to the abortion rate.”

National abortion rights groups have sought for years to persuade state legislatures to adopt laws guaranteeing abortion rights as a backup to Roe. But they have had limited success: Only seven states have such measures in place, including California, Connecticut and Maryland; the most recent state to adopt such a law is Hawaii, which did so in 2006.

“Pretty much all of the energy, all of the momentum, has been to restrict abortion, which makes what could potentially happen in New York so interesting,” said Elizabeth Nash, state issues manager at the Guttmacher Institute, a research group that supports abortion rights. “There’s no other state that’s even contemplating this right now.”

In most statehouses, the push by lawmakers has been in the opposite direction. The past two years has seen more provisions adopted at the state level to restrict abortion rights than in any two-year period in decades, according to the Guttmacher Institute; last year, 19 states adopted 43 new provisions restricting abortion access, while not a single significant measure was adopted to expand access to abortion or to comprehensive sex education.

“It’s an extraordinary moment in terms of the degree to which there is government interference in a woman’s ability to make these basic health care decisions,” said Andrea Miller, the president of NARAL Pro-Choice New York. “For New York to be able to send a signal, a hopeful sign, a sense of the turning of the tide, we think is really important.”

Abortion rights advocates say that even though the Roe decision supersedes state law, some doctors are hesitant to perform late-term abortions when a woman’s health is at risk because the criminal statutes remain on the books.

“Doctors and hospitals shouldn’t be reading criminal laws to determine what types of health services they can offer and provide to their patients,” said M. Tracey Brooks, the president of Family Planning Advocates of New York State.

For Mr. Cuomo, the debate over passing a new abortion law presents an opportunity to appeal to women as well as to liberals, who have sought action in Albany without success since Eliot Spitzer made a similar proposal when he was governor. But it also poses a challenge to the coalition of Republicans and a few Democrats that controls the State Senate, the chamber that has in the past stood as the primary obstacle to passing abortion legislation in the capital.

The governor has said that his Reproductive Health Act would be one plank of a 10-part Women’s Equality Act that also would include equal pay and anti-discrimination provisions. Conservative groups, still stinging from the willingness of Republican lawmakers to go along with Mr. Cuomo’s push to legalize same-sex marriage in 2011, are mobilizing against the proposal. Seven thousand New Yorkers who oppose the measure have sent messages to Mr. Cuomo and legislators via the Web site of the New York State Catholic Conference.

A number of anti-abortion groups have also formed a coalition called New Yorkers for Life, which is seeking to rally opposition to the governor’s proposal using social media.

“If you ask anyone on the street, ‘Is there enough abortion in New York?’ no one in their right mind would say we need more abortion,” said the Rev. Jason J. McGuire, the executive director of New Yorkers for Constitutional Freedoms, which is part of the coalition.

Members of both parties say that the issue of reproductive rights was a significant one in November’s legislative elections. Democrats, who were bolstered by an independent expenditure campaign by NARAL, credit their victories in several key Senate races in part to their pledge to fight for legislation similar to what Mr. Cuomo is planning to propose.

Republicans, who make up most of the coalition that controls the Senate, have generally opposed new abortion rights measures. Speaking with reporters recently, the leader of the Republicans, Dean G. Skelos of Long Island, strenuously objected to rewriting the state’s abortion laws, especially in a manner similar to what the governor is seeking.

“You could have an abortion up until the day the child would be born, and I think that’s just wrong,” Mr. Skelos said. He suggested that the entire debate was unnecessary, noting that abortion is legal in New York State and saying that is “not going to be changed.”

The Senate Democratic leader, Andrea Stewart-Cousins of Yonkers, who is the sponsor of a bill that is similar to the legislation the governor is drafting, said she was optimistic that an abortion measure would reach the Senate floor this year.

“New York State’s abortion laws were passed in 1970 in a bipartisan fashion,” she said. “It would be a sad commentary that over 40 years later we could not manage to do the same thing.”

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Wrestling Group’s President Quits After Olympic Omission

PHUKET, Thailand (AP) — The president of the international wrestling federation has quit in the wake of the IOC's decision to remove the sport from the 2020 Olympics.

Raphael Martinetti's resignation was announced Saturday at the FILA executive committee meeting in Phuket. The Swiss had been in the position since 2002.

On Tuesday, the executive board of the International Olympic Committee dumped wrestling from its guaranteed berth in future Summer games, forcing the sport to compete for a spot on the program.

U.S.A. Wrestling executive director Rich Bender said Martinetti's departure "provides international wrestling with an opportunity to change and improve," giving the sport a chance "to create a fresh new relationship" with the IOC.

Wrestling will still be on the program at the 2016 Olympics in Rio de Janeiro.

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Judge sets May trial date for Kardashian divorce

LOS ANGELES (AP) — Kim Kardashian has a due date for her baby and now a trial date for her divorce from NBA player Kris Humphries.

A judge on Friday set a May 6 trial for the reality TV star who wants to end her marriage before July, when her child with Kanye West is due.

Kardashian filed for divorce on Oct. 31, 2011, after she and Humphries had been married just 72 days. Their lavish, star-studded nuptials were recorded and broadcast by E! Entertainment Television.

The trial is expected to last three to five days and could reveal details about Kardashian's reality show empire, which includes "Keeping Up With the Kardashians" and several spinoffs.

Two judges determined Friday that Humphries' lawyers had adequate time to prepare for the trial.

Humphries wants the marriage annulled based on his claim that Kardashian only married him for the sake of her show.

She denies that allegation and says the case should be resolved through what would be her second divorce.

Humphries' attorney Marshall Waller asked for a delay until basketball season is over.

But Superior Court Judge Scott Gordon refused, saying firefighters, police officers, truck drivers and others have to miss work for trials, and Humphries must do the same if necessary.

Waller filed paperwork Thursday to withdraw from the case but didn't mention that development in court and refused to answer any questions about the document on Friday.

Waller said he was still hoping to obtain and review 13,000 hours of footage from Kardashian's reality shows to try to prove the fraud claim but noted he does not yet have an agreement to receive the footage.

Kardashian's lawyer said her client was ready for trial.

"Let's get this case dispensed with," attorney Laura Wasser said.

Humphries has provided a deposition in the case, as have West and Kardashian family matriarch Kris Jenner.

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Anthony McCartney can be reached at http://twitter.com/mccartneyAP

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Livestrong Tattoos as Reminder of Personal Connections, Not Tarnished Brand

As Jax Mariash went under the tattoo needle to have “Livestrong” emblazoned on her wrist in bold black letters, she did not think about Lance Armstrong or doping allegations, but rather the 10 people affected by cancer she wanted to commemorate in ink. It was Jan. 22, 2010, exactly a year since the disease had taken the life of her stepfather. After years of wearing yellow Livestrong wristbands, she wanted something permanent.

A lifelong runner, Mariash got the tattoo to mark her 10-10-10 goal to run the Chicago Marathon on Oct. 10, 2010, and fund-raising efforts for Livestrong. Less than three years later, antidoping officials laid out their case against Armstrong — a lengthy account of his practice of doping and bullying. He did not contest the charges and was barred for life from competing in Olympic sports.

“It’s heartbreaking,” Mariash, of Wilson, Wyo., said of the antidoping officials’ report, released in October, and Armstrong’s subsequent confession to Oprah Winfrey. “When I look at the tattoo now, I just think of living strong, and it’s more connected to the cancer fight and optimal health than Lance.”

Mariash is among those dealing with the fallout from Armstrong’s descent. She is not alone in having Livestrong permanently emblazoned on her skin.

Now the tattoos are a complicated, internationally recognized symbol of both an epic crusade against cancer and a cyclist who stood defiant in the face of accusations for years but ultimately admitted to lying.

The Internet abounds with epidermal reminders of the power of the Armstrong and Livestrong brands: the iconic yellow bracelet permanently wrapped around a wrist; block letters stretching along a rib cage; a heart on a foot bearing the word Livestrong; a mural on a back depicting Armstrong with the years of his now-stripped seven Tour de France victories and the phrase “ride with pride.”

While history has provided numerous examples of ill-fated tattoos to commemorate lovers, sports teams, gang membership and bands that break up, the Livestrong image is a complex one, said Michael Atkinson, a sociologist at the University of Toronto who has studied tattoos.

“People often regret the pop culture tattoos, the mass commodified tattoos,” said Atkinson, who has a Guns N’ Roses tattoo as a marker of his younger days. “A lot of people can’t divorce the movement from Lance Armstrong, and the Livestrong movement is a social movement. It’s very real and visceral and embodied in narrative survivorship. But we’re still not at a place where we look at a tattoo on the body and say that it’s a meaningful thing to someone.”

Geoff Livingston, a 40-year-old marketing professional in Washington, D.C., said that since Armstrong’s confession to Winfrey, he has received taunts on Twitter and inquiries at the gym regarding the yellow Livestrong armband tattoo that curls around his right bicep.

“People see it and go, ‘Wow,’ ” he said, “But I’m not going to get rid of it, and I’m not going to stop wearing short sleeves because of it. It’s about my family, not Lance Armstrong.”

Livingston got the tattoo in 2010 to commemorate his brother-in-law, who was told he had cancer and embarked on a fund-raising campaign for the charity. If he could raise $5,000, he agreed to get a tattoo. Within four days, the goal was exceeded, and Livingston went to a tattoo parlor to get his seventh tattoo.

“It’s actually grown in emotional significance for me,” Livingston said of the tattoo. “It brought me closer to my sister. It was a big statement of support.”

For Eddie Bonds, co-owner of Rabbit Bicycle in Hill City, S.D., getting a Livestrong tattoo was also a reflection of the growth of the sport of cycling. His wife, Joey, operates a tattoo parlor in front of their store, and in 2006 she designed a yellow Livestrong band that wraps around his right calf, topped off with a series of small cyclists.

“He kept breaking the Livestrong bands,” Joey Bonds said. “So it made more sense to tattoo it on him.”

“It’s about the cancer, not Lance,” Eddie Bonds said.

That was also the case for Jeremy Nienhouse, a 37-year old in Denver, Colo., who used a Livestrong tattoo to commemorate his own triumph over testicular cancer.

Given the diagnosis in 2004, Nienhouse had three rounds of chemotherapy, which ended on March 15, 2005, the date he had tattooed on his left arm the day after his five-year anniversary of being cancer free in 2010. It reads: “3-15-05” and “LIVESTRONG” on the image of a yellow band.

Nienhouse said he had heard about Livestrong and Armstrong’s own battle with the cancer around the time he learned he had cancer, which alerted him to the fact that even though he was young and healthy, he, too, could have cancer.

“On a personal level,” Nienhouse said, “he sounds like kind of a jerk. But if he hadn’t been in the public eye, I don’t know if I would have been diagnosed when I had been.”

Nienhouse said he had no plans to have the tattoo removed.

As for Mariash, she said she read every page of the antidoping officials’ report. She soon donated her Livestrong shirts, shorts and running gear. She watched Armstrong’s confession to Winfrey and wondered if his apology was an effort to reduce his ban from the sport or a genuine appeal to those who showed their support to him and now wear a visible sign of it.

“People called me ‘Miss Livestrong,’ ” Mariash said. “It was part of my identity.”

She also said she did not plan to have her tattoo removed.

“I wanted to show it’s forever,” she said. “Cancer isn’t something that just goes away from people. I wanted to show this is permanent and keep people remembering the fight.”

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DealBook: Confidence on Upswing, Mergers Make Comeback

The mega-merger is back.

For the corporate takeover business, the last half-decade was a fallow period. Wall Street deal makers and chief executives, brought low by the global financial crisis, lacked the confidence to strike the audacious multibillion-dollar acquisitions that had defined previous market booms.

Cycles, however, turn, and in the opening weeks of 2013, merger activity has suddenly roared back to life. On Thursday, Berkshire Hathaway, the conglomerate run by Warren E. Buffett, said it had teamed up with Brazilian investors to buy the ketchup maker H. J. Heinz for about $23 billion. And American Airlines and US Airways agreed to merge in a deal valued at $11 billion.

Those transactions come a week after a planned $24 billion buyout of the computer company Dell by its founder, Michael S. Dell, and private equity backers. And Liberty Global, the company controlled by the billionaire media magnate John C. Malone, struck a $16 billion deal to buy the British cable business Virgin Media.

“Since the crisis, one by one, the stars came into alignment, and it was only a matter of time before you had a week like we just had,” said James B. Lee Jr., the vice chairman of JPMorgan Chase.

Still, bankers and lawyers remain circumspect, warning that it is still too early to declare a mergers-and-acquisitions boom like those during the junk bond craze of 1989, the dot-com bubble of 1999 and the leveraged buyout bonanza of 2007. They also say that it is important to pay heed to the excesses that developed during these moments of merger mania, which all ended badly.

A confluence of factors has driven the recent deals. Most visibly, the stock market has been on a tear, with the Standard & Poor’s 500-stock index this week briefly hitting its highest levels since November 2007. Higher share prices have buoyed the confidence of chief executives, who now, instead of retrenching, are looking for ways to expand their businesses.

A number of clouds that hovered over the markets last year have also been removed, eliminating the uncertainty that hampered deal making. Mergers and acquisitions activity in 2012 remained tepid as companies took a wait-and-see approach over the outcome of the presidential election and negotiations over the fiscal cliff. The problems in Europe, which began in earnest in 2011, shut down a lot of potential transactions, but the region has since stabilized.

“When we talk to our corporate clients as well as the bankers, we keep hearing them talk about increased confidence,” said John A. Bick, a partner at the law firm Davis Polk & Wardwell, who advised Heinz on its acquisition by Mr. Buffett and his partners.

Mr. Bick said that mega-mergers had a psychological component, meaning that once transactions start happening, chief executives do not want to be left behind. “In the same way that success breeds success, deals breed more deals,” he said.

A central reason for the return of big transactions is the mountain of cash on corporate balance sheets. After the financial crisis, companies hunkered down, laying off employees and cutting costs. As a result, they generated savings. Today, corporations in the S.& P. 500 are sitting on more than $1 trillion in cash. With interest rates near zero, that money is earning very little in bank accounts, so executives are looking to put it to work by acquiring businesses.

The private equity deal-making machine is also revving up again. The world’s largest buyout firms have hundreds of billions of dollars of “dry powder” — money allotted to deals in Wall Street parlance — and they are on the hunt. The proposed leveraged buyout of Dell, led by Mr. Dell and the investment firm Silver Lake Partners, was the largest private equity transaction since July 2007, when the Blackstone Group acquired the hotel chain Hilton Worldwide for $26 billion just as the credit markets were seizing up.

But perhaps the single biggest factor driving the return of corporate takeovers is the banking system’s renewed health. Corporations often rely on bank loans for financing acquisitions, and the ability of private equity firms to strike multibillion-dollar transactions depends on the willingness of banks to lend them money.

For years, banks, saddled by the toxic mortgage assets weighing on their balance sheets, turned off the lending spigot. But with the housing crisis in the rearview mirror and economic conditions slowly improving, banks are again lining up to provide corporate loans at record-low interest rates to finance acquisitions.

The banks, of course, are major beneficiaries of megadeals, earning big fees from both advising on the transactions and lending money to finance them. Mergers and acquisitions in the United States total $158.7 billion so far this year, according to Thomson Reuters data, more than double the amount in the same period last year. JPMorgan, for example, has benefited from the surge, advising on four big deals in recent weeks, including the Dell bid and Comcast’s $16.7 billion offer for the rest of NBCUniversal that it did not already own.

Mr. Buffett, in a television interview last month, declared that the banks had repaired their businesses and no longer posed a threat to the economy. “The capital ratios are huge, the excesses on the asset aside have been largely cleared out,” said Mr. Buffett, whose acquisition of Heinz will be his second-largest acquisition, behind his $35.9 billion purchase of a majority stake in the railroad company Burlington Northern Santa Fe in 2009.

While Wall Street has an air of giddiness over the year’s start, most deal makers temper their comments about the current environment with warnings about undisciplined behavior like overpaying for deals and borrowing too much to pay for them.

Though private equity firms were battered by the financial crisis, they made it through the downturn on relatively solid ground. Many of their megadeals, like Hilton, looked destined for bankruptcy after the markets collapsed, but they have since recovered. The deals have benefited from an improving economy, as well as robust lending markets that allowed companies to push back the large amounts of debt that were to have come due in the next few years.

But there are still plenty of cautionary tales about the consequences of overpriced, overleveraged takeovers. Consider Energy Future Holdings, the biggest private equity deal in history. Struck at the peak of the merger boom in October 2007, the company has suffered from low natural gas prices and too much debt, and could be forced to restructure this year. Its owners, a group led by Kohlberg Kravis Roberts and TPG, are likely to lose billions.

Even Mr. Buffett made a mistake on Energy Future Holdings, having invested $2 billion in the company’s bonds. He admitted to shareholders last year that the investment was a blunder and would most likely be wiped out.

“In tennis parlance,” Mr. Buffett wrote, “this was a major unforced error.”

Michael J. de la Merced contributed reporting.

A version of this article appeared in print on 02/15/2013, on page A1 of the NewYork edition with the headline: Confidence on Upswing, Mergers Make Comeback.

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Kim Kardashian makes another bid to end marriage

LOS ANGELES (AP) — Kim Kardashian's divorce case is returning to court Friday with her attorney urging a speedy end to her marriage to NBA player Kris Humphries.

Lawyers for the pregnant reality star and the Brooklyn Nets power forward disagree over a timetable for a trial to end the marriage, which Humphries wants annulled.

Kardashian is asking a judge to order a trial as soon as possible. Humphries wants the case to remain on hold until the basketball season ends.

Setting a trial date may be complicated by a filing Thursday by one of Humphries' attorneys to leave the case, citing "irreconcilable differences" with Humphries. The attorney, Marshall Waller, had stated in recent court filings that he was still seeking evidence from several companies that produce Kardashian's reality shows to try to prove their fraud claims.

Kardashian's attorney Laura Wasser has repeatedly sought a trial date so that the marriage can be ended and denies that the couple's televised marriage was based on false pretenses.

The model is due to give birth in July to a child conceived with her boyfriend Kanye West. Each side accuses the other of trying to use Kardashian's pregnancy for a legal advantage.

"It appears from (Kardashisan's) moving papers that what is really going on here is that an 'urgency' in the form of an apparently unplanned pregnancy ... is perceived by (Kardashian) as an opportunity to gain a litigation advantage by trying to force this court to prematurely set this matter for trial," Waller wrote in a court filing earlier this month.

"(Humphries) to his great discredit thinks that because (Kardashian) is now pregnant he can exert some leverage over (her) knowing that she wants to be divorced," Wasser wrote.

Kardashian filed for divorce on Dec. 31, 2011 after 72 days of marriage. The pair was married in a star-studded ceremony that was televised by E! Entertainment Television.

The case has already drawn in West, the producers of "Keeping Up With the Kardashians," and Kardashian family matriarch Kris Jenner.

Superior Court Judge Stephen Moloney will determine Friday how the case will proceed. He has previously said the case should be ready for trial early this year.

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Anthony McCartney can be reached at http://twitter.com/mccartneyAP

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