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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U. of C. Medicine's leader gears up for challenges

Nearly every morning, before 7 a.m., Dr. Kenneth Polonsky is dropped off near the Lakefront Trail on Chicago's South Side, a few steps from Lake Michigan.

He carries no briefcase, wears no suit and has no cup of coffee, the standard trappings of his executive contemporaries.

Instead — at least in the winter — he's covered in high-tech running gear, leaving only a small patch of skin around his eyes exposed to the weather. The outfit, he muses, must raise suspicions among cab drivers.

"It's 6:30 in the morning, it's dark and can be, maybe, 10 degrees outside," he says. "When I ask the driver to drop me by the side of (the road), they must think, 'What's going on with this guy? There's something funny here.'"

Twelve months a year, through heat waves, cold snaps, rain, sleet and snow, the top official at University of Chicago Medicine starts most mornings running 5 miles to work.

It's a routine that reflects lessons learned from decades of studying diabetes and treating patients with the disease and one he pairs with watching his diet "like a hawk." The daily run also is a vehicle for the cerebral 62-year-old M.D. to contemplate the challenges that lie ahead.

There are many, starting with the massive transformation of the way medical care is paid for and delivered as part of President Barack Obama's 2010 health care overhaul.

Polonsky also faces cuts to research funding that flows to the Pritzker School of Medicine through the National Institutes of Health and growing financial pressure from Illinois' Medicaid program, the federal-state health insurance program that serves a substantial percentage of the hospital's South Side patients.

All this while christening and trying to pay for a $700 million, 1.2 million-square-foot new hospital, a 10-story, boxy, modernist structure that towers above a campus better known for its ubiquitous, early-20th-century red-roofed Gothic buildings.

The hospital, dubbed the Center for Care and Discovery in the absence of a donor willing to lay down $50 million for naming rights, is scheduled to open Saturday.

With 240 private patient rooms, 28 supersize operating rooms and seven advanced imaging rooms, the hospital will specialize in neuroscience and the treatment of cancer and gastrointestinal diseases.

But even what is supposed to be a celebratory, clink-the-glasses moment for Polonsky and the university has been sullied by controversy.

An estimated 50 protesters entered the hospital on a Sunday afternoon in January, holding placards and using a megaphone to voice their displeasure that such a costly facility was not outfitted with a trauma unit.

University police with batons were videotaped shoving protesters to the ground. Four were arrested in the melee.

Polonsky said the system is re-evaluating its role in trauma care, "a legitimate question for discussion and debate and one we are looking at again in detail."

Managing this issue will be a major test of Polonsky's leadership in 2013 and will occur against the backdrop of the largest upheaval to the health care industry in a generation.

"We're in a really vulnerable situation at the moment; there's no question about it," Polonsky said of the shift under way in health care. "But that's one of the reasons I'm interested in my job. I believe I can impact a series of big issues."

Many people, he said, go through life wondering whether what they're doing is worthwhile or significant in the big picture of things.

"I'm very fortunate to never, ever have had that problem," Polonsky said.

A boy in South Africa

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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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Daley turns focus toward Gary

Richard M. Daley has kept a low profile since leaving office in 2011.

That doesn't mean he has lost interest in urban issues. The former mayor has turned his attention in a surprising direction, beyond Chicago's borders to one of the most intractable urban tragedies in America: the collapse of Gary, Ind.

"I always believe no part of America should be forgotten, and I think Gary has been forgotten," Daley said.

Daley is using his influence at the University of Chicago, where he is a distinguished senior fellow, to push a modest but growing amount of manpower toward Gary Mayor Karen Freeman-Wilson.

With guidance from Daley and Freeman-Wilson, University of Chicago graduate students are trying to figure out what to do with Gary's abandoned buildings and how to promote greater use of technology to help the city accomplish more with less, among other projects.

The hope is that the students will go on to help other cities after graduation. If successful, the U. of C.-Gary partnership could be replicated in other industrial towns grappling with decline.

Gary spans about 55 square miles, nearly a quarter of the size of Chicago. Yet the steel town's population has plummeted to an estimated 80,000, meaning the city has lost about half its people since 1960. The city's problems have mounted, including abandoned buildings and homes, sagging infrastructure and a declining budget to pay for services.

Outsiders have tried to fix Gary since at least the Lyndon B. Johnson administration. Freeman-Wilson, a former Indiana attorney general, judge and Harvard College and Harvard Law School graduate, has reinvigorated Gary's renewal efforts. And she's unafraid to ask for help.

Immediately after winning the 2011 Democratic primary, Freeman-Wilson called Daley for advice. They met, and Daley invited her to be the first guest speaker at his lecture series at the University of Chicago's Harris School of Public Policy, where Daley has a five-year appointment.

This quarter, 11 students from the university's public policy, business and social services schools are getting course credit for working on projects for Gary.

"It was Mayor Daley's idea," Freeman-Wilson said as she rode from a meeting on Chicago's West Side to Gary. "I had always envisioned getting the support and work from (University of Chicago Law School) alums, because there were issues around codes and things of that nature. It was not until the mayor came up with the idea of using students from the (Harris) School of Public Policy that I said, 'Oh yeah, that would work. That would work very well.'"

Daley does not teach a class at the University of Chicago. He runs an occasional lecture series.

Carol Brown, his last policy chief at City Hall, leads the program and the class, which is called the "Urban Revitalization Project: City of Gary, Ind." Grants from the Chicago-based Joyce and MacArthur foundations help pay administrative costs, including Brown's salary and that of a part-time assistant.

Last quarter's class was divided into three project teams. One team is cataloging Gary's abandoned buildings, which are magnets for crime and eyesores that further depress surrounding property values. Another is trying to recruit pro bono legal and consulting services for the city. And a third is trying to craft a strategy to clean up front stoops and empty lots one block at a time. This quarter's class also is tackling untapped funding opportunities and economic development.

Freeman-Wilson said a major benefit of the partnership is the fresh ideas from students "who aren't jaded by the limitations of government, whereas a 20-year employee might say, 'Oh, no, we can't do that in government because we don't have X, Y and Z.'"

Already their work has prompted more widespread use among Gary employees of a technology that stores and analyzes geographic data. City workers are now using the technology to map potholes, fallen tree limbs and illegal dump sites. That way work crews can be dispatched to neighborhoods where the problems are most severe.

"This partnership encourages urban planners to think broadly about regions instead of cities — greater Chicago instead of the city of Chicago," said Stephen Paul O'Hara, a historian at Xavier University who wrote a book about Gary.

The students operate as consultants. They gather best practices and ideas from cities around the country and then recommend a course of action. At the end of each 10-week quarter, students present their recommendations to Daley, Freeman-Wilson and their staffs. Their grades are based on those presentations and supporting reports.

"I will tell you, it never stops getting nerve-wracking," second-year graduate student Jocelyn Hare said of presenting to Daley. "But it gets easier."

Last spring, Hare, 32, responded to an email seeking student volunteers to conduct preliminary research to test the idea of a partnership. Hare then interned for the city of Gary during the summer. The Harris school paid her $15 an hour. She then enrolled in the first class in the fall and again this winter, when it was opened to graduate students outside of Harris for the first time.

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1 dead, 3 wounded in 90 minutes Friday night

Chicago police were flagged down by a man on the street as they responded to the sound of gunfire Friday night and found a woman lying on the ground, bleeding from gunshot wounds to her upper body.

She and three others were wounded between about 5:55 p.m. and 7:20 p.m. on the South and West sides, according to Chicago police, among a total of six people shot Friday afternoon and Saturday morning. 

The woman, whose age wasn't available, was shot in the 1100 block of North Pulaski Road, just a bit south of Division Street in the West Humboldt Park neighborhood about 7:05 p.m. Officers in the area heard the gunfire and headed toward it - that's when they were flagged down. 

The woman was talking when taken away in an ambulance but suffered a wound to her back and a second below her armpit and was pronounced dead at Mount Sinai Hospital. She may have been stepped on as people fled the scene, police said. 

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Four others survived shootings Friday night and Saturday morning. 

Before 3 a.m. a man was shot in the arm at a party in the 1100 block of South St. Louis Avenue in the Homan Square neighborhood. 

About 7:20 p.m., two men were shot in the 7800 block of South Merrill Avenue in the South Shore neighborhood. One was shot in the knee and the other in the ankle. The pair, 19 and 20, were at a party when someone crept up a gangway and opened fire, police said. 

The older was shot in the knee and the younger in the ankle, police said. It's not clear what hospitals they were taken to. 

About 5:55 p.m., a man sitting in his car near his home was shot in the leg by one of three guys who approached him on foot, police said. The 29-year-old was taken to Advocate Christ Medical Center, where his condition had stabilized.

Earlier Friday, a 17-year-old was shot in the hand in the 7800 block of South Morgan Street in the Gresham neighborhood.

Check back for more information.

pnickeas@tribune.com
Twitter: @peternickeas

lford@tribune.com
Twitter: @ltaford

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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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Illinois corporate tax credits swelled to $161 million 2011

When lawmakers raised taxes on Illinois residents and businesses, they also increased corporate income tax breaks for a select group of companies.

In 2011, businesses were eligible to claim about $161 million in tax credits — double from the prior year — mostly because of the increase to 5 percent from 3 percent in the state's personal income tax rate, which is a factor in determining the value of the incentives. The boost marked the largest increase in the Economic Development for a Growing Economy tax credit program, the state's main economic development program, since its creation in 1999.

Deere & Co., Boeing Co. and Caterpillar Inc., whose leader severely criticized lawmakers for tax hikes, were among dozens of companies that received more robust tax breaks. Some companies' deals also allowed them to be in line to receive tax incentives even while laying off workers or lowering wages.

The EDGE program allows a business to claim a credit against its corporate income tax liability if it agrees to create and/or retain jobs and make an investment in the state of at least $1 million, for companies with fewer than 100 workers, and at least $5 million for larger companies.

Once accepted into the program, which typically lasts 10 years, a company applies on an annual basis for a tax credit certificate, similar to a voucher, which it can claim when it files its taxes.

Marcelyn Love, a spokeswoman with the Department of Commerce and Economic Opportunity, which administers the program, said that under the tax credit program companies make investments and employ workers, practices that otherwise would not have occurred without the credits.

"Both the private investment and the increased employment significantly increase tax revenue collection for the state in excess of the credits given," Love said in an email. Far from adding to the tax burden, she added, these incentives actually generate revenue for the state. "Further, most of these tax credits pay for themselves within two years."

The certificates are the only way to gauge the potential cost and scope of the program, because tax filings are not public. The Tribune obtained the 2011 certificates data, the latest year available, under the state's Freedom of Information Act. Companies have as many as five years to redeem a certificate.

After a deal is finalized, a company has two years to meet its side of the bargain and begin applying for certificates. Thus, the increase in the total value of 2011 tax breaks is also the result of companies receiving certificates for the first time. For example, Ford Motor Co. began applying for its certificates in 2010 from a 2007 deal.

During Gov. Pat Quinn's administration, companies have received increasingly larger deals. Many have been for retaining jobs, according to a Tribune analysis. In 2011, Sears Holdings Corp. was offered a tax credit package worth $150 million over 10 years to keep its headquarters in the state and retain at least 4,250 full-time jobs. The company, which after the deal was announced revealed that it was closing 125 stores nationwide, has yet to apply for a certificate. Five of those stores were in Illinois. State officials have said that during a recession, when few jobs are created, it's important to focus on retaining workers.

Chris Brathwaite, a Sears spokesman, said the company's employment level at its headquarters is higher than the more than 6,000 jobs it had when the deal was approved, but he declined to provide figures.

In general, the value of a certificate equals the number of jobs created and/or retained, multiplied by wages tied to those jobs and the state's personal income tax rate.

That means companies that didn't add one worker and kept wages at the 2010 rate received a 67 percent boost to their 2011 corporate income tax break. Just like individuals, corporations also registered a tax rate increase in 2011. Lawmakers set the new corporate income tax rate at 7 percent, up from 4.8 percent. The increases in breaks partially offset that hike.

The formula under which companies become eligible to receive tax breaks was aimed at encouraging job creation and increasing employee wages. Still, the 2011 data revealed that some companies made deals to allow job cuts and still qualify for incentives, a practice known as "normal attrition."

A case in point is Motorola Mobility. For the past two years, Motorola Mobility has qualified for certificates worth a total of $22.6 million while slowly chipping away at its workforce. Late last year, the smartphone-maker, which was acquired by Google Inc. in May, announced it was laying off 20 percent of its global workforce. Locally, the company cut hundreds of workers, bringing its Illinois head count to about 2,300, a figure that would make it ineligible for a 2013 certificate unless it boosts its workforce before the end of the year.

The Department of Commerce and Economic Opportunity said the EDGE program played a crucial role in keeping Motorola Mobility in Illinois after it was acquired by Google. Its presence, the agency said, is drawing more technology investment and jobs to the state.

A state lawmaker wants the state to end the wiggle room practice, cap at $100 million the annual amount of tax breaks awarded and remove the investment bar so more small and medium-size businesses can qualify for breaks.

"Large multinationals are getting all the breaks," said Rep. Jack Franks, D-Marengo, adding that his focus is to modernize the program and increase accountability.

Franks' House Bill 1336 would also limit the length of the tax breaks to five years and require that companies pay workers at least the median salary of their occupation as determined by federal data. The bill also eliminates the provision requiring companies to make a capital investment in the state of at least $1 million or $5 million, depending on their size. And it creates a nine-member board to oversee the deals, with members appointed by the governor and approved by the state Senate.

Franks said that the Department of Commerce and Economic Opportunity shouldn't promote the program while also negotiating deals with companies, because it creates a conflict of interest.

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Well: Ask Well: Swimming to Ease Back Pain

Many people find that recreational swimming helps ease back pain, and there is research to back that up. But some strokes may be better than others.

An advantage to exercising in a pool is that the buoyancy of the water takes stress off the joints. At the same time, swimming and other aquatic exercises can strengthen back and core muscles.

That said, it does not mean that everyone with a case of back pain should jump in a pool, said Dr. Scott A. Rodeo, a team physician for U.S.A. Olympic Swimming at the last three Olympic Games. Back pain can have a number of potential causes, some that require more caution than others. So the first thing to do is to get a careful evaluation and diagnosis. A doctor might recommend working with a physical therapist and starting off with standing exercises in the pool that involve bands and balls to strengthen the core and lower back muscles.

If you are cleared to swim, and just starting for the first time, pay close attention to your technique. Work with a coach or trainer if necessary. It may also be a good idea to start with the breaststroke, because the butterfly and freestyle strokes involve more trunk rotation. The backstroke is another good option, said Dr. Rodeo, who is co-chief of the sports medicine and shoulder service at the Hospital for Special Surgery in New York.

“With all the other strokes, you have the potential for some spine hyperextension,” Dr. Rodeo said. “With the backstroke, being on your back, you don’t have as much hyperextension.”

Like any activity, begin gradually, swimming perhaps twice a week at first and then progressing slowly over four to six weeks, he said. In one study, Japanese researchers looked at 35 people with low back pain who were enrolled in an aquatic exercise program, which included swimming and walking in a pool. Almost all of the patients showed improvements after six months, but the researchers found that those who participated at least twice weekly showed more significant improvements than those who went only once a week. “The improvement in physical score was independent of the initial ability in swimming,” they wrote.

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Push for online sales taxes pick up steam in Congress

U.S. states could collect millions of dollars in online sales taxes, with members of both parties in Congress sponsoring legislation Thursday that would resolve states' decades-long struggle to tax businesses beyond their borders.

"Small businesses and states alike are suffering from the inability to collect due -- not new -- taxes from purchases made online," said Rep. Steve Womack, R-Ark., adding the legislation is a "bipartisan, bicameral, common-sense solution that promotes states' rights and levels the playing field for our Main Street businesses."

Legislation on the Amazon tax, named for the colossal Internet retailer, has languished for years.

In 1992 the Supreme Court decided the patchwork of state tax laws made it too difficult for online retailers to collect and remit sales taxes. So states can tax Internet only sales made by companies with a physical presence in the states. That means online retailers such as Amazon.com Inc. collect sales tax in some states and not in others.

The bills introduced on Thursday reconcile differences in legislation that the House of Representatives and Senate considered last year. The nearly identical details in the bills and strong bipartisan support mean the final bill could be sent to President Barack Obama this year.

Members of Congress recently assured state lawmakers they would pass a law in 2013.

In the last decade, Internet sales have gone from 1.6 percent of all U.S. retail sales to more than 5 percent, according to Commerce Department data, a proportion that will likely grow as shoppers make more purchases on handheld devices. In the third quarter of 2012,  "e-commerce" sales were $57 billion, the department said.

Large Internet retailers are worried the tax could drive up the cost of doing business. They would also have to create new systems and software to collect the surcharges, adding to their costs. Amazon said in July it prefers having the tax issue resolved at the federal level.

When the 2007-09 recession caused states' revenues to collapse, Republican and Democratic governors backed the tax as a financial solution that would not require federal aid.

A leader in the Republican party, Virginia Gov. Bob McDonnell went so far as to figure online tax revenue into his recent plan for overhauling the state's transportation funding.

"The revenue states are losing out on is legally owed, but because of a pre-Internet Supreme Court ruling, states aren't able to collect it," Sen. Deb Peters, R-S.D., said in a statement.

States and cities say they can recoup billions of dollars with the tax. Fitch Ratings estimates put the states' loss at $11 billion.

Some states are considering their own legislation. Florida is debating a bill that advocates say could bring the state more than $400 million.

Small retailers, meanwhile, have said the sales tax will will allow them to compete with massive online retailers.

"While store owners collect and remit state and local sales taxes their digital competitors are off the hook -- and benefiting because of it," said David French, the National Retail Federation's senior vice president for government relations, in a statement.

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Anxiety grows as Chicago Public Schools narrows closing list

After trimming the number of schools that could be closed to 129, Mayor Rahm Emanuel's school administration on Wednesday entered the latest and what is likely to be the most intense phase so far in trying to determine which schools should be shut.

Chicago Public Schools chief Barbara Byrd-Bennett is expected to pare the preliminary list before unveiling a final one at the end of March. She said administrators will determine which schools are saved in the coming weeks amid a final round of community meetings to hear arguments from parents, teachers and community groups about why their schools should stay open.

If a hearing Wednesday night in North Lawndale was any indication, CPS still has a long way to go to gain the public's trust.

"Our schools don't need to close," Dwayne Truss, vice chairman of CPS' Austin Community Action Council, said in front of hundreds of people packed inside a church auditorium in the West Side neighborhood. "CPS is perpetrating a myth that there's a budget crisis."

CPS initially said 330 of its schools are underenrolled, the chief criterion for closing. Members of a commission assembled to gather public input on the issue told CPS officials earlier this year that closing a large number of schools would create too much upheaval. The Tribune, citing sources, said the commission indicated a far smaller number should be closed than initially feared, possibly as few as 15.

CPS then started holding its own hearings and on Wednesday, while following many of the formal recommendations made by the Commission on School Utilization, said 129 schools still fit the criteria for closing.

The new number and the latest round of hearings sets the stage for the administration to counter questions about the district's abilities to close a large number of schools and the need to do so.

For many who have already turned up to school closing meetings, this final round of hearings will be even more critical. School supporters must show how they plan to turn around academic performance and build enrollment, and also make the case for any security problems that would be created by closing their school.

"We are prepared now to move to the next level of conversation with our community and discuss a list of approximately 129 schools that still require further vetting and further conversation," Bryd-Bennett said. "We are going to take these 129 and continue to sift through these schools."

In the past, political clout has played a role in the district's final decisions. Already this year, several aldermen have spoken out on behalf of schools in their wards.

On the Near Northwest Side, for instance, the initial list of 330 underused schools included about six in the 1st Ward. Ald. Proco "Joe" Moreno helped organize local school council members, school administrators and parents to fight any closing. He also took that fight to leaders in City Hall and within CPS' bureaucracy. Nearly all of the schools in the ward were excluded from the list of 129.

"It is effort and it's organizing and not just showing up at meetings and yelling. Anybody can do that," Moreno said. "Those schools that proactively work before those meetings and explain what they are doing, what they need and that they are willing to accept new students, that's when politics works.

"My responsibility in this juncture was to focus on these schools," he said. "I had to work on the inside, with CPS and with City Hall, and with my schools on the outside."

Most of the schools on the list of 129 are on the West, South and Southwest sides, many in impoverished neighborhoods that saw significant population loss over the last decade. Largely spared were the North and Northwest sides.

In all, more than 43,000 students attend those 129 schools on the preliminary list, according to CPS records.

The area with the most schools on the list is a CPS network (the district groups its schools in 14 networks) that runs roughly from Madison Street south to 71st Street and from the lake to State Street. The preliminary list includes 24 schools in that area.

The Englewood-Gresham network has the second-largest number, 19, while the Austin-North Lawndale network where Wednesday night's meeting was held still has 16 schools on the list.

CPS critics said the preliminary list is still too large to be meaningful and that the district's promise to trim it before March 31 is only a tactic to make the final number seem reasonable.

"They started out with such a far-fetched, exaggerated list of schools, many of which are nowhere near underutilized," said Wendy Katten, co-founder of the parent group Raise Your Hand. "They might appear to be looking like they're listening, but they're not. They have not done a thorough and substantive assessment of these schools."

Following the commission's recommendations, CPS last month removed high schools and schools performing at a high level academically from consideration. On Wednesday, the district said schools with more than 600 students or utilization rates of at least 70 percent have also been taken out of consideration for closing.

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