Personal Health: Quitting Smoking for Good

Few smokers would claim that it’s easy to quit. The addiction to nicotine is strong and repeatedly reinforced by circumstances that prompt smokers to light up.

Yet the millions who have successfully quit are proof that a smoke-free life is achievable, even by those who have been regular, even heavy, smokers for decades.

Today, 19 percent of American adults smoke, down from more than 42 percent half a century ago, when Luther Terry, the United States surgeon general, formed a committee to produce the first official report on the health effects of smoking. Ever-increasing restrictions on where people can smoke have helped to swell the ranks of former smokers.

Now, however, as we approach the American Cancer Society’s 37th Great American Smokeout on Thursday, the decline in adult smoking has stalled despite the economic downturn and the soaring price of cigarettes.

Currently, 45 million Americans are regular smokers who, if they remain smokers, can on average expect to live 10 fewer years. Half will die of a tobacco-related disease, and many others will suffer for years with smoking-caused illness. Smoking adds $96 billion to the annual cost of medical care in this country, Dr. Nancy A. Rigotti wrote in The Journal of the American Medical Association last month. Even as some adult smokers quit, their ranks are being swelled by the 800,000 teenagers who become regular smokers each year and by young adults who, through advertising and giveaways, are now the prime targets of the tobacco industry.

People ages 18 to 25 now have the nation’s highest smoking rate: about 34 percent counted in the National Survey on Drug Use and Health in 2010 reported smoking cigarettes in the previous month. I had to hold my breath the other day as dozens of 20-somethings streamed out of art gallery openings and lighted up. Do they not know how easy it is to get hooked on nicotine and how challenging it can be to escape this addiction?

Challenging, yes, but by no means impossible. On the Web you can download a “Guide to Quitting Smoking,” with detailed descriptions of all the tools and tips to help you become an ex-smoker once and for all.

Or consult the new book by Dr. Richard Brunswick, a retired family physician in Northampton, Mass., who says he’s helped hundreds of people escape the clutches of nicotine and smoking. (The printable parts of the book’s provocative title are “Can’t Quit? You Can Stop Smoking.”)

“There is no magic pill or formula for beating back nicotine addiction,” Dr. Brunswick said. “However, with a better understanding of why you smoke and the different tools you can use to control the urge to light up, you can stop being a slave to your cigarettes.”

Addiction and Withdrawal

Nicotine beats a direct path to the brain, where it provides both relaxation and a small energy boost. But few smokers realize that the stress and lethargy they are trying to relieve are a result of nicotine withdrawal, not some underlying distress. Break the addiction, and the ill feelings are likely to dissipate.

Physical withdrawal from nicotine is short-lived. Four days without it and the worst is over, with remaining symptoms gone within a month, Dr. Brunswick said. But emotional and circumstantial tugs to smoke can last much longer.

Depending on when and why you smoke, cues can include needing a break from work, having to focus on a challenging task, drinking coffee or alcohol, being with other people who smoke or in places you associate with smoking, finishing a meal or sexual activity, and feeling depressed or upset.

To break such links, you must first identify them and then replace them with other activities, like taking a walk, chewing sugar-free gum or taking deep breaths. These can help you control cravings until the urge passes.

If you’ve failed at quitting before, try to identify what went wrong and do things differently this time, Dr. Brunswick suggests. Most smokers need several attempts before they can become permanent ex-smokers.

Perhaps most important is to be sure you are serious about quitting; if not, wait until you are. Motivation is half the battle. Also, should you slip and have a cigarette after days or weeks of not smoking, don’t assume you’ve failed and give up. Just go right back to not smoking.

Aids for Quitting

Many if not most smokers need two kinds of assistance to become lasting ex-smokers: psychological support and medicinal aids. Only about 4 percent to 7 percent of people are able to quit smoking on any given attempt without help, the cancer society says.

All 50 states and the District of Columbia have free telephone-based support programs that connect would-be quitters to trained counselors. Together, you can plan a stop-smoking method that suits your smoking pattern and helps you avoid common pitfalls.

Online support groups and Nicotine Anonymous can help as well. To find a group, ask a local hospital or call the cancer society at (800) 227-2345. Consider telling relatives and friends about your intention to quit, and plan to spend time in smoke-free settings.

More than a dozen treatments can help you break the physical addiction to tobacco. Most popular is nicotine replacement therapy, sold both with and without a prescription. The Food and Drug Administration has approved five types: nicotine patches of varying strengths, gums, sprays, inhalers and lozenges that can curb withdrawal symptoms and help you gradually reduce your dependence on nicotine.

Two prescription drugs are also effective: an extended-release form of the antidepressant bupropion (Zyban or Wellbutrin), which reduces nicotine cravings, and varenicline (Chantix), which blocks nicotine receptors in the brain, reducing both the pleasurable effects of smoking and the symptoms of nicotine withdrawal. Combining a nicotine replacement with one of these drugs is often more effective than either approach alone.

Other suggested techniques, like hypnosis and acupuncture, have helped some people quit but lack strong proof of their effectiveness. Tobacco lozenges and pouches and nicotine lollipops and lip balms lack evidence as quitting aids, and no clinical trials have been published showing that electronic cigarettes can help people quit.

The cancer society suggests picking a “quit day”; ridding your home, car and workplace of smoking paraphernalia; choosing a stop-smoking plan, and stocking up on whatever aids you may need.

On the chosen day, keep active; drink lots of water and juices; use a nicotine replacement; change your routine if possible; and avoid alcohol, situations you associate with smoking and people who are smoking.

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This post has been revised to reflect the following correction:

Correction: November 16, 2012

An earlier version of this column stated imprecisely the rate of smoking among young adults. According to the National Survey on Drug Use and Health, in 2010 about 34 percent of people ages 18 to 25 smoked cigarettes in the month before the survey -- not daily. (About 16 percent of them reported smoking daily, according to the survey.)

This post has been revised to reflect the following correction:

Correction: November 14, 2012

An earlier version of this column misstated the rate of smoking among young adults. According to the National Survey on Drug Use and Health, in 2010 about 34 percent of people ages 18 to 25 smoked cigarettes, not 40 percent. (That is the share of young adults who use tobacco products of any kind, according to the survey.)

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Industrial Production Declines

WASHINGTON — Hurricane Sandy depressed industrial output in the United States in October, while production of machinery and equipment in particular declined sharply, reflecting a more cautious outlook among businesses, the Federal Reserve said Friday.

Industrial production fell 0.4 percent last month, after a 0.2 percent gain in September, the Fed said. Excluding the hurricane’s impact, output at the nation’s factories, mines and utilities would have risen about 0.6 percent.

Factory output, the most important component, fell 0.9 percent and would have been unchanged without the storm, the Fed said. Utility output dipped 0.1 percent, while mining, which includes oil and gas production, rose 1.5 percent.

Manufacturing has weakened since spring, in part because companies have scaled back purchases of long-lasting goods that signal investment plans. That trend appeared to continue in October: machinery production fell 1.9 percent, while production of electrical equipment, appliances and components declined 1.4 percent.

Many businesses are worried about tax increases and federal spending cuts that will take effect in January unless Congress reaches a budget deal before then. Most economists predict the economy will suffer a recession in the first half of 2013 if lawmakers and President Obama can’t come to an agreement..

Hurricane Sandy also hurt the economy, although most economists expect the storm’s impact to fade in the coming weeks. The storm hit the Northeast on Oct. 29 and disrupted businesses from North Carolina to Maine.

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Palestinian Rockets Kill Three Israelis and Trigger Air Sirens in Tel Aviv

KIRYAT MALACHI, Israel — Israel and Hamas widened their deadly conflict over Gaza on Thursday, as militants fired dozens of rockets — including one that killed three civilians in an apartment block in this small southern Israeli town — and two longer-range rockets aimed at Tel Aviv, causing no harm but triggering the first air raid warning there set off by incoming fire from Gaza. The death toll in Gaza from Israeli airstrikes rose to at least 19, including five children and a pregnant teenager.

There was no sign that either side was prepared to dial back the confrontation that has threatened a new war in the Middle East, despite entreaties for restraint by world leaders including President Obama and Ban Ki-moon, the United Nations secretary general, who planned a visit there in coming days. If anything, the Israelis intensified their attacks on Gaza after the Tel Aviv scare and made new moves toward a possible ground invasion.

The Israeli deaths were the first since Israel’s military launched ferocious aerial assaults on Wednesday to stop the chronic rocket fire from Gaza, the Palestinian coastal enclave controlled by Hamas, the militant Palestinian group.

The Israel Defense Forces said in a cryptic statement that one of the two longer-range rockets aimed at Tel Aviv landed but did not hit the ground — meaning that it likely crashed into the Mediterranean Sea — and that the other appeared to have landed far outside the city. Exact locations were not specified.

But the Tel Aviv air raid warnings — which residents of Israel’s largest metropolis had not heard except for drills or malfunctions since Saddam Hussein’s Scuds threatened them in the first Persian Gulf War, more than two decades ago — were a reminder of their vulnerability to an attack from Gaza, less than 40 miles away. They also underscored Israel’s stated reason for seeking to destroy the missile-launching sites in Gaza.

Ehud Barak, the minister of defense, said the targeting of Tel Aviv and the scope of the Palestinian rocket fire “represents an escalation, and there will be a price for that escalation that the other side will have to pay.”

Mr. Barak also dropped a further hint that planning for a ground invasion of Gaza had begun, saying he had instructed the army to broaden its draft of reservists to “be prepared for any kind of development if and when it will be required.” Israeli officials said 30,000 reservists could be called, and heavy machinery and tanks rumbled south along Israeli roads leading to Gaza on Thursday in preparation for a possible invasion.

The Israel Defense Forces said that within hours of the Tel Aviv air raid warning, they had attacked 70 underground rocket-launching sites in Gaza, and “direct hits were confirmed.” There were also unconfirmed reports that Israeli rockets had struck near Gaza’s Rafah crossing into Egypt, forcing the Egyptians to close it.

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Brig. Gen. Yoav Mordechai, a spokesman for the Israel Defense Forces, said its aerial assaults had hit more than 200 sites in Gaza by late Thursday, and “we’ll continue tonight and tomorrow.” He also said militants in Gaza had fired about 300 rockets into southern Israel and at least 100 more had been intercepted by Israel’s Iron Dome antimissile defense system.

The Israeli aerial assault on Gaza that began on Wednesday was the most intense military operation by Israel in Gaza since an invasion four years ago.

The regional perils of the situation sharpened as President Mohamed Morsi of Egypt warned that his country stood by the Palestinians against what he termed Israeli aggression, echoing similar condemnation on Wednesday.

“The Egyptian people, the Egyptian leadership, the Egyptian government and all of Egypt is standing with all its resources to stop this assault, to prevent the killing and the bloodshed of Palestinians,” Mr. Morsi said in nationally televised remarks before a crisis meeting of senior ministers. He also instructed his prime minister to lead a delegation to Gaza on Friday and said he had contacted President Obama to discuss strategies to “stop these acts and doings and the bloodshed and aggression.”

Isabel Kershner reported from Kiryat Malachi, Israel, and Rick Gladstone from New York. Reporting was contributed by Fares Akram from Gaza, Rina Castelnuovo from Kiryat Malachi, Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman from Jerusalem and Alan Cowell from Paris.

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Critic’s Notebook: Nintendo’s Wii U, With New Touch-Screen Controller

Tony Cenicola/The New York Times

The Wii U, which is to be released on Sunday, includes the new Wii U GamePad, a roughly 10-by-5-inch touch-screen controller.

The Wii U is Nintendo’s capitulation to the screen, the tyrant of the digital age. As the follow-up to the original Wii — the nearly 100-million-selling, get-off-your-couch console that upended the video game industry six years ago — the Wii U does not deliver the sensation that its predecessor unleashed, the sense that something new had been wrought upon this earth. It was not always routine for grandparents and grandchildren to gather in front of the television to wield plastic sticks and pretend to bowl.

Instead, the Wii U feels like an accommodation to the new mode of living that Apple’s iPhone and iPad have introduced. That lifestyle was evoked by a New Yorker cover this summer that featured family members posing for a beach vacation snapshot while engrossed in their personal devices.

The Wii U, which is to be released on Sunday, works with the motion-control remotes you probably already own from the original Wii, and it plays most of the original games. What’s new — beyond high-definition graphics and some Internet-enabled features that won’t be turned on until Sunday — is the Wii U GamePad, a roughly 10-by-5-inch touch-screen controller. With a six-inch display surrounded by thumbsticks, buttons and triggers, the GamePad is the offspring of an iPad Mini and a traditional video game controller.

In its marketing buildup to the Wii U introduction, Nintendo emphasized the benefits of two-screen gaming, particularly competitions in which the player with the GamePad sees something different from what the other players watch on the television. In so doing, Nintendo played down a simpler concept, one more easily understood by casual players and Apple fans: the touch screen.

By merging touch-screen gaming with a video game system that is designed to live next to your TV set rather than be carried around in your pocket or purse, Nintendo is not merely acceding to the cultural tide. It is also trying — valiantly, perhaps quixotically — to stem it. After creating a world in which we are no longer bowling alone (because we are all Wii-bowling together), Nintendo is seeking to invent a new way for us to commune with our screens. The company’s hope is that the Wii U will bring families together in their living rooms for touch-screen gaming rather than leave them isolated with their tablets and smartphones.

Touch has always been a part of gaming, of course, because the physical interaction between player and device is central to the medium. But in recent years the growing complexity of the standard controller has become an obstacle for new players who did not grow up adapting to each iteration: the shift from one button to two buttons to four, or from one joystick to a directional pad to two thumbsticks and a directional pad — not to mention triggers and bumpers and start and select buttons. Easy, right?

Simplicity was a large part of the broad appeal of the first Wii, and though playing with the Wii U is not quite as uncomplicated as standing up and waving your arms around, the touch screen is straightforward compared with the controllers used with an Xbox 360 or a PlayStation 3. Selecting songs in Sing Party, a karaoke game published by Nintendo, is done by swiping through tiles on the GamePad’s touch screen and then tapping the song you want. The same goes for Ubisoft’s Just Dance 4, with the added wrinkle that a player can use the touch screen to choose dance moves, midsong, for the other players to perform.

In Balloon Trip Breeze, one of the mini-games bundled on the Nintendo Land anthology that comes with the $350 Wii U deluxe edition, the player uses a stylus to make quick swipes — familiar to anyone who has played Angry Birds or Fruit Ninja — to make a character pop balloons on the television. In Takamaru’s Ninja Castle, another Nintendo Land game, similar swipes hurl martial arts stars at cartoonish cutouts. In Pikmin Adventure, from the same disc, enemies are defeated by tapping on them as they appear on the GamePad screen. In Yoshi’s Fruit Cart players scrawl a path on the touch screen and then watch a character follow it on television.

The touch screen also allows the GamePad to morph swiftly into a TV remote control; you can adjust the volume on your set or quickly check the score of a football game without reaching for a separate device. And if you like what you see on cable, or if you want to allow someone else to watch TV in the same room, you can switch from playing a game of New Super Mario Bros. U on television to watching it unfold on your GamePad.

As that last trick indicates, the GamePad is more than just a touch screen, and Nintendo Land provides a sketch of other possibilities. The camera inside the GamePad is used in the game Octopus Dance to project the player’s genuine, human face onto the television, a merger of the virtual with the corporeal that goes by the name “augmented reality.”

Lightly blowing into the GamePad’s microphone in Donkey Kong’s Crash Course turns a windmill that moves a cart skyward. The GamePad can be used as a viewfinder in Metroid Blast and the Legend of Zelda: Battle Quest to target enemies for destruction. And in some other Nintendo Land games, characters can be moved by turning or tilting or lifting the GamePad into the air, another technique borrowed from mobile and tablet gaming.

Equally promising, if not more so, are the possibilities the GamePad presents for intensive, single-player gaming. In Ubisoft’s ZombiU, the GamePad transforms, if not eliminates, some of the metaphors gamers are accustomed to: The map is no longer a tiny icon in the lower-right corner of your television, nor a menu that must be reached by punching a sequence of buttons. It is something you hold in your hands and look down at, something that draws your attention away from the world (of zombies) around you.

Your inventory — the items you carry — also becomes less abstract as you peer into your GamePad to see what’s in your backpack and then physically move, say, a pistol into your hand by sliding it with your finger into an open slot. Similarly, digging through lockers, file cabinets and suitcases in the game world becomes closer to a genuine interaction.

Then again, when the first Wii console felt new, as with Microsoft’s Kinect more recently, many decreed that motion controls would be swiftly and widely integrated into long, narrative games. Surely the intuitive interface of Wii Sports would be merged with storytelling ambition. By and large, that didn’t happen. So, spoiler alert: I have no idea what the Wii U augurs, or whether it will permanently alter how we play, alone or together.

But it’s a pretty nice present.

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I Was Misinformed: The Time She Tried Viagra

I have noticed, in the bragging-rights department, that “he doesn’t need Viagra” has become the female equivalent of the male “and, I swear, she’s a real blonde.” Personally, I do not care a bit. To me, anything that keeps you happy and in the game is a good thing.

But then, I am proud to say, I was among the early, and from what I gather, rare female users.

It happened when the drug was introduced around 1998. I was 50, but after chemotherapy for breast cancer — and later, advanced ovarian cancer — I was, hormonally speaking, pretty much running on fumes. Whether this had diminished my sex drive I did not yet know. One may have Zorba-esque impulses when a cancer diagnosis first comes in; but a treatment that leaves you bald, moon-faced and exhausted knocks that out of your system pretty fast.

But by 1998, the cancer was gone, my hair was back and I was ready to get back in the game. I was talking to an endocrinologist when I brought up Viagra. This was not to deal with the age-related physical changes I knew it would not address, it was more along the feminist lines of equal pay for equal work: if men have this new sex drug, I want this new sex drug.

“I know it’s supposed to work by increasing blood flow,” I told the doctor, “But if that’s true for men, shouldn’t it be true for women, too?”

“You’re the third woman who asked me that this week,” he said.

He wrote me a prescription. I was not seeing anyone, so I understood that I would have to do both parts myself, but that was fine. I have a low drug threshold and figured it might be best the first time to fly solo. My memory of the directions are hazy: I think there was a warning that one might have a facial flush or headaches or drop dead of a heart attack; that you were to take a pill at least an hour before you planned to get lucky, and, as zero hour approached, you were supposed to help things along by thinking beautiful thoughts, kind of like Peter Pan teaching Wendy and the boys how to fly.

But you know how it is: It’s hard to think beautiful thoughts when you’re wondering, “Is it happening? Do I feel anything? Woof, woof? Hello, sailor? Naaah.”

After about an hour, however, I was aware of a dramatic change. I had developed a red flush on my face; I was a hot tomato, though not the kind I had planned. I had also developed a horrible headache. The sex pill had turned into a bad joke: Not now, honey, I have a headache.

I put a cold cloth on my head and went to sleep. But here’s where it got good: When I slept, I dreamed; one of those extraordinary, sensual, swimming in silk sort of things. I woke up dazed and glowing with just one thought: I gotta get this baby out on the highway and see what it can do.

A few months later I am fixed up with a guy, and after a time he is, under the Seinfeldian definition of human relations (Saturday night date assumed) my official boyfriend. He is middle aged, in good health. How to describe our romantic life with the delicacy a family publication requires? Perhaps a line from “Veronika, der Lenz ist da” (“Veronica, Spring Is Here”), a song popularized by the German group the Comedian Harmonists: “Veronika, der Spargel Wächst” (“Veronica, the asparagus are blooming”). On the other hand, sometimes not. And so, one day, I put it out there in the manner of sport:

“Want to drop some Viagra?” I say.

Here we go again, falling into what I am beginning to think is an inevitable pattern: lying there like a lox, or two loxes, waiting for the train to pull into the station. (Yes, I know it’s a mixed metaphor, but at least I didn’t bring in the asparagus.) So there we are, waiting. And then, suddenly, spring comes to Suffolk County. It’s such a presence. I’m wondering if I should ask it if it hit traffic on the L.I.E. We sit there staring.

My reaction is less impressive. I don’t get a headache this time. And romantically, things are more so, but not so much that I feel compelled to try the little blue pills again.

Onward roll the years. I have a new man in my life, who is 63. He does have health problems, for which his doctor prescribes an E.D. drug. I no longer have any interest in them. My curiosity has been satisfied. Plus I am deeply in love, an aphrodisiac yet to be encapsulated in pharmaceuticals.

We take a vacation in mountain Mexico. We pop into a drugstore to pick up sunscreen and spot the whole gang, Cialis, Viagra, Levitra, on a shelf at the checkout counter. No prescription needed in Mexico, the clerk says. We buy all three drugs and return to the hotel. I try some, he tries some. In retrospect, given the altitude and his health, we are lucky we did not kill him. I came across an old photo the other day. He is on the bed, the drugs in their boxes lined up a in a semi-circle around him. He looks a bit dazed and his nose is red.

Looking at the picture, I wonder if he had a cold.

Then I remember: the flush, the damn flush. If I had kids, I suppose I would have to lie about it.

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I Was Misinformed: The Time She Tried Viagra

I have noticed, in the bragging-rights department, that “he doesn’t need Viagra” has become the female equivalent of the male “and, I swear, she’s a real blonde.” Personally, I do not care a bit. To me, anything that keeps you happy and in the game is a good thing.

But then, I am proud to say, I was among the early, and from what I gather, rare female users.

It happened when the drug was introduced around 1998. I was 50, but after chemotherapy for breast cancer — and later, advanced ovarian cancer — I was, hormonally speaking, pretty much running on fumes. Whether this had diminished my sex drive I did not yet know. One may have Zorba-esque impulses when a cancer diagnosis first comes in; but a treatment that leaves you bald, moon-faced and exhausted knocks that out of your system pretty fast.

But by 1998, the cancer was gone, my hair was back and I was ready to get back in the game. I was talking to an endocrinologist when I brought up Viagra. This was not to deal with the age-related physical changes I knew it would not address, it was more along the feminist lines of equal pay for equal work: if men have this new sex drug, I want this new sex drug.

“I know it’s supposed to work by increasing blood flow,” I told the doctor, “But if that’s true for men, shouldn’t it be true for women, too?”

“You’re the third woman who asked me that this week,” he said.

He wrote me a prescription. I was not seeing anyone, so I understood that I would have to do both parts myself, but that was fine. I have a low drug threshold and figured it might be best the first time to fly solo. My memory of the directions are hazy: I think there was a warning that one might have a facial flush or headaches or drop dead of a heart attack; that you were to take a pill at least an hour before you planned to get lucky, and, as zero hour approached, you were supposed to help things along by thinking beautiful thoughts, kind of like Peter Pan teaching Wendy and the boys how to fly.

But you know how it is: It’s hard to think beautiful thoughts when you’re wondering, “Is it happening? Do I feel anything? Woof, woof? Hello, sailor? Naaah.”

After about an hour, however, I was aware of a dramatic change. I had developed a red flush on my face; I was a hot tomato, though not the kind I had planned. I had also developed a horrible headache. The sex pill had turned into a bad joke: Not now, honey, I have a headache.

I put a cold cloth on my head and went to sleep. But here’s where it got good: When I slept, I dreamed; one of those extraordinary, sensual, swimming in silk sort of things. I woke up dazed and glowing with just one thought: I gotta get this baby out on the highway and see what it can do.

A few months later I am fixed up with a guy, and after a time he is, under the Seinfeldian definition of human relations (Saturday night date assumed) my official boyfriend. He is middle aged, in good health. How to describe our romantic life with the delicacy a family publication requires? Perhaps a line from “Veronika, der Lenz ist da” (“Veronica, Spring Is Here”), a song popularized by the German group the Comedian Harmonists: “Veronika, der Spargel Wächst” (“Veronica, the asparagus are blooming”). On the other hand, sometimes not. And so, one day, I put it out there in the manner of sport:

“Want to drop some Viagra?” I say.

Here we go again, falling into what I am beginning to think is an inevitable pattern: lying there like a lox, or two loxes, waiting for the train to pull into the station. (Yes, I know it’s a mixed metaphor, but at least I didn’t bring in the asparagus.) So there we are, waiting. And then, suddenly, spring comes to Suffolk County. It’s such a presence. I’m wondering if I should ask it if it hit traffic on the L.I.E. We sit there staring.

My reaction is less impressive. I don’t get a headache this time. And romantically, things are more so, but not so much that I feel compelled to try the little blue pills again.

Onward roll the years. I have a new man in my life, who is 63. He does have health problems, for which his doctor prescribes an E.D. drug. I no longer have any interest in them. My curiosity has been satisfied. Plus I am deeply in love, an aphrodisiac yet to be encapsulated in pharmaceuticals.

We take a vacation in mountain Mexico. We pop into a drugstore to pick up sunscreen and spot the whole gang, Cialis, Viagra, Levitra, on a shelf at the checkout counter. No prescription needed in Mexico, the clerk says. We buy all three drugs and return to the hotel. I try some, he tries some. In retrospect, given the altitude and his health, we are lucky we did not kill him. I came across an old photo the other day. He is on the bed, the drugs in their boxes lined up a in a semi-circle around him. He looks a bit dazed and his nose is red.

Looking at the picture, I wonder if he had a cold.

Then I remember: the flush, the damn flush. If I had kids, I suppose I would have to lie about it.

Read More..

DealBook: In a Switch, Investors Are Buying European Bank Bonds

LONDON — European bank debt, once an investment pariah, is suddenly popular.

In recent weeks, money managers have been readily buying the new bonds of the region’s financial institutions, deals that just months ago would have seemed unpalatable. Bank of Ireland, which received a bailout in 2010, sold $1.3 billion of bonds on Tuesday and found strong demand. It was the largest offering by an Irish bank without a government guarantee in almost three years.

The gradual thawing of the capital markets is a good sign for the region’s banks. In the midst of the crisis, institutions, especially in troubled economies like Ireland and Portugal, have been struggling to raise money from private investors. The latest deals will help bolster banks’ capital levels and strengthen their balance sheets.

But the bonds could leave investors exposed, especially given the precarious situation in Europe. The sovereign debt crisis continues to weigh on the economy. The financial markets remain volatile. And profit at the region’s banks is flagging.

“It’s a great time to be issuing high-yield debt but not to be investing in it,” said Robin Doumar, managing partner at the private equity firm Park Square Capital.

For now, bondholders are taking comfort in the policy makers’ response to the sovereign debt crisis.

In late August, the European Central Bank began an unlimited bond-buying program aimed at lowering countries’ borrowing costs and breathing life into local economies. By essentially offering a blank check to help Europe’s troubled governments, policy makers calmed short-term fears that some of the region’s banks might need to be bailed out, reviving interest in the companies’ bonds.

“The biggest driver of demand has been the policy responses from the European Central Bank,” said Melissa Smith, head of European high-grade debt capital markets at JPMorgan Chase in London. “It’s provided stability as policy makers have stated their commitment to preserving the euro zone.”

With interest rates at record lows, European bank debt looks especially appealing to investors.

On Thursday, the British bank Barclays sold $3 billion of 10-year bonds at 7.6 percent. The Portuguese lender Banco Espírito Santo recently issued $958 million worth of debt at 5.9 percent.

By comparison, a 10-year Treasury is paying 1.8 percent. Germany has offered a negative yield on some of its sovereign debt maturities this year.

Even the yields on junk bonds, the risky corporate debt that pays high interest rates, are coming down as investors pile into such securities. The average yield is now just 5.8 percent, according to a Bank of America Merrill Lynch index. Historically, they have paid 10 percent or even more.

“There’s been a huge contraction,” said Robert Ellison, head of European debt capital markets for financial institutions at UBS in London.

The industry has been quick to capitalize on investors’ desperate hunt for returns. Banks in Europe have issued a combined $318 billion of unsecured debt so far this year, almost triple the amount raised by their American counterparts, according to the data provider Dealogic.

The capital markets are being discerning. This year, well-financed companies in Northern Europe, like Nordea Bank of Sweden, have been able to sell the largest lots of bonds at relatively reasonable rates. Smaller banks, particularly in Southern Europe, have had to offer investors better rates to win support for their bond deals.

Even so, it is a stark contrast from almost a year ago. With the capital markets paralyzed, the European Central Bank then had to step in to stabilize the banks, offering $1.3 trillion in short-term, low-cost loans to financial companies.

As they find renewed interest from private investors, European banks can more easily raise money, fortifying their balance sheets in case of unexpected losses. At regulators’ behest, financial institutions in the region have been increasing their capital levels.

But bond investors, in their thirst for yield, may be overlooking signs of potential trouble.

Barclays, for instance, sold a controversial type of debt, known as contingent convertible bonds. With these so-called CoCo bonds, investors can be wiped out if the bank’s capital falls below a certain threshold. While Barclays’ balance sheet is in good shape, bondholders’ willingness to accept such conditions highlights the risks in the market. Traditional bondholders can usually recoup at least some of their principal even if a company goes bankrupt.

At the same time, many European financial institutions are still in fragile shape. The Bank of Ireland, in which the Irish government still has a small stake, is struggling to divest itself of many risky loans that it made before the financial crisis. Portugal’s economy is also expected to contract 3 percent this year, which will probably depress the earnings of Banco Espírito Santo.

The question for investors is whether the reward is worth the risk.

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Israelis Launch Major Assault on Gaza, Killing Hamas Commander

GAZA — Israel on Wednesday launched one of the most ferocious assaults on Gaza since its invasion four years ago, hitting at least 20 targets in aerial attacks that killed the top military commander of Hamas, drew strong condemnation from Egypt and escalated the risks of a new war in the Middle East.

The Israelis coupled the intensity of the airstrikes with the threat of another ground invasion and warnings to all Hamas leaders in Gaza to stay out of sight or risk the same fate as the Hamas military commander, Ahmed al-Jabari, who was killed in a pinpoint airstrike as he was traveling by car down a Gaza street. “We recommend that no Hamas operatives, whether low level or senior leaders, show their faces above ground in the days ahead,” the Israel Defense Forces said in a Twitter message.

The ferocity of the airstrikes, which Israel called Operation “Pillar of Defense” in response to repeated rocket attacks by Gaza-based Palestinian militants, provoked rage in Gaza, where Hamas said the airstrikes amounted to war and promised a harsh response. It quickly launched dozens of rockets into southern Israel, including several that struck the city of Beersheba, shattering windows and damaging cars but causing no injuries.

Civil-defense authorities in Israel, anticipating retaliation, raised alert levels early in the day and told residents in southern Israel to take precautions. Many remained indoors or congregated in bomb shelters.

The Hamas-run Health Ministry in Gaza said the Israeli attacks had killed at least five others besides Mr. Jabari, including a baby and a 7-year-old girl, and had wounded at least 40.

The abrupt escalation in hostilities between Israel and Hamas, the militant organization regarded by Israel as a terrorist group sworn to Israel’s destruction, came amid rising tensions between Israel and all of its Arab neighbors. Israel has faced growing lawlessness on its border with the Sinai, including cross-border attacks. It recently fired twice into Syria, which is caught in a civil war, after munitions fell in the Israeli-occupied Golan Heights, and it has absorbed rocket fire from Gaza, which has damaged homes and frightened the population.

Israeli officials had promised a robust response to the rocket fire, but for the moment, at least, opted against a ground invasion and instead chose airstrikes and targeted killings.

The Israeli attacks especially threatened to further complicate Israel’s fragile relations with Egypt, where the Islamist-led government of President Mohamed Morsi, reversing a policy of ousted predecessor Hosni Mubarak, had established closer ties with Hamas and had been acting as a mediator to restore calm between Israel and Gaza-based militant groups.

In the first crisis in Israeli-Egyptian relations since Mr. Morsi came to power, he called the Israeli actions “wanton aggression on the Gaza Strip.” He ordered Egypt’s ambassador to Israel to return home, summoned the Israeli ambassador to protest, and called for emergency meetings of both the United Nations Security Council and the Arab League over the Gaza attacks. Egyptian state media said Foreign Minister Mohamed Amr had “warned Israel against the consequences of escalation and the negative reflections it may have on the security and stability of the region.”

Mr. Morsi’s Freedom and Justice Party, which was founded by the Muslim Brotherhood, posted a video on its Web site of what was described as the burned body of a Palestinian child said to have been killed in the Israeli attacks, in what appeared to be a deliberate attempt to inflame passions. His party also issued a statement saying: “The wanton aggression against Gaza proves that Israel has yet to realize that Egypt has changed and that the Egyptian people who revolted against oppression will not accept assaulting Gaza.”

A spokesman for Hamas, Fawzi Barhoum, said the Israelis had “committed a dangerous crime and broke all redlines,” and that “the Israeli occupation will regret and pay a high price.”

Military officials in Israel, which announced responsibility for the death of Mr. Jabari, later said in a statement that their forces had carried out additional airstrikes in Gaza targeting what they described as “a significant number of long-range rocket sites” owned by Hamas that had stored rockets capable of reaching 25 miles into Israel. The statement said the airstrikes had dealt a “significant blow to the terror organization’s underground rocket-launching capabilities.”

Yisrael Katz, a minister from Israel’s governing Likud Party, issued a statement saying that the operation had sent a message to the Hamas political leaders in Gaza “that the head of the snake must be smashed. Israel will continue to kill and target anyone who is involved in the rocket attacks.”Hamas and medical officials in Gaza said both Mr. Jabari and a companion were killed by the airstrike on his car in Gaza City. Israeli news media said the companion was Mr. Jabari’s son, but there was no immediate confirmation.

Fares Akram reported from Gaza, and Isabel Kershner from Jerusalem. Reporting was contributed by Mayy El Sheikh and David D. Kirkpatrick from Cairo, Gabby Sobelman in Jerusalem, Rina Castelnuovo in Beersheba, Israel, and Rick Gladstone from New York.

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App Smart: News360, Edge Extended, Need for Speed and Other Great Android Apps

Tablets are changing computing, there’s no doubt. I realized this when I saw my 2-year-old son pick up an iPad and master its basic controls, including discovering a child’s app, in about half an hour. The iPad led the way into this brave new world more or less alone at first. It has taken until now for the sheer pressure of innovation inside Apple’s rivals to lead to some great Android-based tablets finally making a mark.

If you’re a new owner of one of these, you’ll be happy to know that there’s many an app that will simultaneously thrill you, inform you and welcome you into the world of tablet computing.

For a great news experience, the free app News360 has to be one of the better news-aggregating ones I’ve seen on any platform. When you first open the app, you are presented with a long list of topics that it can aggregate for your convenience into different categories, from arts through science to zombies.

The app uses this profile to grab news from the Web and present it to you within its elegant interface. This is dominated by picture-based “tiles” for each news article the app collects. Each tile tells you the appropriate category, where the news item came from and when. Tapping on one of these tiles takes you to a new page that contains a screen grab of the original online source, alongside the text the app has collected from the article.

The pleasure of News360 is that you can either satisfy your curiosity by tapping on a link to read the original article or decide you have learned enough and navigate on. You can also mark the article as interesting, save it for reading offline — perhaps on a commute — or share it on a social network. These controls are also accessible from the initial “tiles” screen, where you flip over an article’s tile to see the controls. The flip is accompanied by a very pleasing animation. It’s just a little graphical touch, but small details like this make an app great fun.

Part of the fun of having a new tablet is showing off its graphical prowess. Games are a great way to do this. I’ve had immense fun with Edge Extended (about $3 on Google Play). In this game, you play a multicolored cube that you roll around a blocky terrain to collect targets. You swipe your finger on the screen to make the cube flop onto its faces to move. There are all the classic elements of collecting points, avoiding pitfalls, activating switches and so on. But despite its graphical simplicity, the app is swift-paced and very satisfying; it even gave me that sensation of falling from a height in some of its trickier parts.

If you really want to impress people with your tablet’s screen, then you’ll probably get a kick out of a game like Need for Speed Most Wanted ($7 on Google play). It’s a racing game that uses motion to control steering and simple tap controls to brake, slide the car in a drift or turn on a nitrous turbo boost. True to the “Most Wanted” title, you race on regular roads, not racetracks, and can get in trouble with the police. This app has all the typical racing fun, along with the ability to earn points that unlock better cars and so on. But the standout feature is the attractiveness of the graphics, and the image rendering even includes reflections of passing buildings in puddles. It’s really eye-popping, and it even works on a diminutive tablet like the Nexus 7.

If racing’s not your thing, you may like SoulCraft THD instead. In this hack-and-slash role-playing game, you control your character from above as it fights its way through a fantasy landscape of dungeons and cities. As on a standard computer action game, you can earn spells and improve your character’s powers.

The game is “freemium” so it’s free to download and play, but you have to make in-game purchases with real money to advance quickly. The graphics are slick, but don’t expect the kind of detailed rendering you would see on a gaming PC.

If you want to make your pals who own iPads jealous, turn on an animated background. This shows off the computing power of your tablet and Android’s skills, too.

Right now my tablet is rocking the seasonal Autumn Tree Live Wallpaper, which is $1. You can control all sorts of aspects of the app, including what type of trees wave their autumnal leaves in the wind, and it’s delightful. It’s also something that a stock iPad absolutely can’t do.

Have fun, but here’s a big reminder for you: Not all Android tablets will play nicely with all tablet apps, and some features depend on installing the latest edition of the operating system.

Quick Calls

Fresh and free on Android and iOS is a highly unusual “experimental” game, Curiosity. It’s a cube with faces made of millions of smaller cubes. Players all around the world hack away at these by tapping on their devices. A single prize is hidden inside an unknown number of layers. It’s weirdly fun to play ... One of the earliest and slickest apps for Windows 8/RT devices is the official Wikipedia app (free), which shows the online encyclopedia in its most elegant, graphical format yet.

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Personal Health: Quitting Smoking for Good

Few smokers would claim that it’s easy to quit. The addiction to nicotine is strong and repeatedly reinforced by circumstances that prompt smokers to light up.

Yet the millions who have successfully quit are proof that a smoke-free life is achievable, even by those who have been regular, even heavy, smokers for decades.

Today, 19 percent of American adults smoke, down from more than 42 percent half a century ago, when Luther Terry, the United States surgeon general, formed a committee to produce the first official report on the health effects of smoking. Ever-increasing restrictions on where people can smoke have helped to swell the ranks of former smokers.

Now, however, as we approach the American Cancer Society’s 37th Great American Smokeout on Thursday, the decline in adult smoking has stalled despite the economic downturn and the soaring price of cigarettes.

Currently, 45 million Americans are regular smokers who, if they remain smokers, can on average expect to live 10 fewer years. Half will die of a tobacco-related disease, and many others will suffer for years with smoking-caused illness. Smoking adds $96 billion to the annual cost of medical care in this country, Dr. Nancy A. Rigotti wrote in The Journal of the American Medical Association last month. Even as some adult smokers quit, their ranks are being swelled by the 800,000 teenagers who become regular smokers each year and by young adults who, through advertising and giveaways, are now the prime targets of the tobacco industry.

People ages 18 to 25 now have the nation’s highest smoking rate: about 34 percent, according to the 2010 National Survey on Drug Use and Health. I had to hold my breath the other day as dozens of 20-somethings streamed out of art gallery openings and lighted up. Do they not know how easy it is to get hooked on nicotine and how challenging it can be to escape this addiction?

Challenging, yes, but by no means impossible. On the Web you can download a “Guide to Quitting Smoking,” with detailed descriptions of all the tools and tips to help you become an ex-smoker once and for all.

Or consult the new book by Dr. Richard Brunswick, a retired family physician in Northampton, Mass., who says he’s helped hundreds of people escape the clutches of nicotine and smoking. (The printable parts of the book’s provocative title are “Can’t Quit? You Can Stop Smoking.”)

“There is no magic pill or formula for beating back nicotine addiction,” Dr. Brunswick said. “However, with a better understanding of why you smoke and the different tools you can use to control the urge to light up, you can stop being a slave to your cigarettes.”

Addiction and Withdrawal

Nicotine beats a direct path to the brain, where it provides both relaxation and a small energy boost. But few smokers realize that the stress and lethargy they are trying to relieve are a result of nicotine withdrawal, not some underlying distress. Break the addiction, and the ill feelings are likely to dissipate.

Physical withdrawal from nicotine is short-lived. Four days without it and the worst is over, with remaining symptoms gone within a month, Dr. Brunswick said. But emotional and circumstantial tugs to smoke can last much longer.

Depending on when and why you smoke, cues can include needing a break from work, having to focus on a challenging task, drinking coffee or alcohol, being with other people who smoke or in places you associate with smoking, finishing a meal or sexual activity, and feeling depressed or upset.

To break such links, you must first identify them and then replace them with other activities, like taking a walk, chewing sugar-free gum or taking deep breaths. These can help you control cravings until the urge passes.

If you’ve failed at quitting before, try to identify what went wrong and do things differently this time, Dr. Brunswick suggests. Most smokers need several attempts before they can become permanent ex-smokers.

Perhaps most important is to be sure you are serious about quitting; if not, wait until you are. Motivation is half the battle. Also, should you slip and have a cigarette after days or weeks of not smoking, don’t assume you’ve failed and give up. Just go right back to not smoking.

Aids for Quitting

Many if not most smokers need two kinds of assistance to become lasting ex-smokers: psychological support and medicinal aids. Only about 4 percent to 7 percent of people are able to quit smoking on any given attempt without help, the cancer society says.

All 50 states and the District of Columbia have free telephone-based support programs that connect would-be quitters to trained counselors. Together, you can plan a stop-smoking method that suits your smoking pattern and helps you avoid common pitfalls.

Online support groups and Nicotine Anonymous can help as well. To find a group, ask a local hospital or call the cancer society at (800) 227-2345. Consider telling relatives and friends about your intention to quit, and plan to spend time in smoke-free settings.

More than a dozen treatments can help you break the physical addiction to tobacco. Most popular is nicotine replacement therapy, sold both with and without a prescription. The Food and Drug Administration has approved five types: nicotine patches of varying strengths, gums, sprays, inhalers and lozenges that can curb withdrawal symptoms and help you gradually reduce your dependence on nicotine.

Two prescription drugs are also effective: an extended-release form of the antidepressant bupropion (Zyban or Wellbutrin), which reduces nicotine cravings, and varenicline (Chantix), which blocks nicotine receptors in the brain, reducing both the pleasurable effects of smoking and the symptoms of nicotine withdrawal. Combining a nicotine replacement with one of these drugs is often more effective than either approach alone.

Other suggested techniques, like hypnosis and acupuncture, have helped some people quit but lack strong proof of their effectiveness. Tobacco lozenges and pouches and nicotine lollipops and lip balms lack evidence as quitting aids, and no clinical trials have been published showing that electronic cigarettes can help people quit.

The cancer society suggests picking a “quit day”; ridding your home, car and workplace of smoking paraphernalia; choosing a stop-smoking plan, and stocking up on whatever aids you may need.

On the chosen day, keep active; drink lots of water and juices; use a nicotine replacement; change your routine if possible; and avoid alcohol, situations you associate with smoking and people who are smoking.

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This post has been revised to reflect the following correction:

Correction: November 14, 2012

An earlier version of this column misstated the rate of smoking among young adults. According to the 2010 National Survey on Drug Use and Health, about 34 percent of people ages 18 to 25 smoke cigarettes, not 40 percent. (That is the share of young adults who use tobacco products of any kind, according to the survey.)

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