No one under 21 would be able to buy cigarettes in New York City, under a new proposal announced Monday that marks the latest in a decade of moves to crack down on smoking in the nation's largest city.

New York City Council Speaker Christine Quinn discussed details of a proposed law that would raise the minimum age for tobacco purchases from 18 to 21. City Health Commissioner Dr. Thomas Farley, some of Quinn's fellow City Council members and health advocates were to join her.

Under federal law, no one under 18 can buy tobacco anywhere in the country, but some states and localities have raised it to 19. Texas lawmakers recently tried to increase the minimum age to 21, but the plan stalled.

Public health advocates say a higher minimum age discourages, or at least delays, young people from starting smoking and thereby limits their health risks. But opponents of such measures have said 18-year-olds, legally considered adults, should be able to make their own decisions about whether or not to smoke.

Some communities, including Needham, Mass., have raised the minimum age to 21, but New York would be the biggest city to do so.

"With this legislation, we'll be targeting the age group at which the overwhelming majority of smokers start," Quinn said.

Officials say 80 percent of NYC smokers started before age 21, and an estimated 20,000 New York City public high school students now smoke. While it's already illegal for many of them to buy cigarettes, officials say this measure would play a key role by making it illegal for them to turn to slightly older friends to buy smokes for them. The vast majority of people who get asked to do that favor are between 18 and 21 themselves, city officials say.

"We know that enforcement is never going to be perfect," but this measure should make it "much harder" for teens to get cigarettes, Farley said.

The Richmond, Va.-based Altria Group Inc., parent company of Philip Morris USA, which makes the top-selling Marlboro brand, had no immediate comment, said spokesman David Sutton. He previously noted that the company supported federal legislation that in 2009 gave the Food and Drug Administration the power to regulate tobacco products, which includes various retail restrictions.

Under Mayor Michael Bloomberg and the health commissioners he has appointed, including Farley, New York has rolled out a slate of anti-smoking initiatives.

Bloomberg, a billionaire who has given $600 million of his own money to anti-smoking efforts around the world, began taking on tobacco use in the city shortly after he became mayor in 2002.

Over his years in office, the city — at times with the council's involvement — helped impose the highest cigarette taxes in the country, barred smoking at parks and on beaches and conducted sometimes graphic advertising campaigns about the hazards of smoking.

Last month, the Bloomberg administration unveiled a proposal to keep cigarettes out of sight in stores until an adult customer asks for a pack, as well as stopping shops from taking cigarette coupons and honoring discounts.

Bloomberg's administration and public health advocates praise the initiatives as bold moves to help people live better. Adult smoking rates in the city have fallen from 21.5 percent in 2002 to 14.8 percent in 2011, Farley has said.

But the measures also have drawn complaints, at least initially, that they are nannyish and bad for business.

Several of New York City's smoking regulations have survived court challenges. But a federal appeals court said last year that the city couldn't force tobacco retailers to display gruesome images of diseased lungs and decaying teeth.

Quinn, a leading Democratic candidate to succeed Bloomberg next year, has often been perceived as an ally of his.

Bloomberg also has pushed a number of other pioneering public-health measures, such as compelling chain restaurants to post calorie counts on their menus, banning artificial trans fats in restaurants, and attempting to limit the size of sugary drinks. A court struck down the big-beverage rule last month, but the city is appealing and Bloomberg has urged voluntary compliance in the meantime.

While Bloomberg has led the way on many anti-smoking initiatives, this one arose from the City Council, Farley said. City Councilman James Gennaro, who lost his mother to lung cancer after she smoked for decades, has been a particularly strong advocate.

Related:

Smokers have worse colon cancer prognosis

AP

Terrie Hall, a 52-year-old throat cancer survivor, lost her voice box.

Government health officials launched the second round of a graphic ad campaign Thursday that is designed to get smokers off tobacco, saying they believe the last effort convinced tens of thousands to quit.

The ads feature sad, real-life stories: There is Terrie, a North Carolina woman who lost her voice box. Bill, a diabetic smoker from Michigan who lost his leg. And Aden, a 7-year-old boy from New York, who has asthma attacks from secondhand smoke.

"Most smokers want to quit. These ads encourage them to try," said Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.

The CDC campaign cost $48 million and includes TV, radio and online spots as well as print ads and billboards.

The spending comes as the agency is facing a tough budget squeeze, but officials say the ads should more than pay for themselves by averting future medical costs to society. Smoking is the leading cause of preventable illness and death in the United States. It's responsible for the majority of the nation's lung cancer deaths and is a deadly factor in heart attacks and a variety of other illnesses.

Last year's similar $54 million campaign was the agency's first and largest national advertising effort. The government deemed it a success: That campaign triggered an increase of 200,000 calls to quit lines. The CDC believes that likely prompted tens of thousands of smokers to quit based on calculations that a certain percentage of callers do actually stop.

Like last year, the current 16-week campaign spotlights real people who were hurt and disfigured by smoking. Terrie Hall, a 52-year-old throat cancer survivor makes a repeat performance. She had her voice box removed about a dozen years ago.

AP

The new campaign focuses more toward the impact smokers have on others.

In last year's ad there's a photo of her as a youthful high school cheerleader. Then she is seen more recently putting on a wig, inserting false teeth and covering the hole in her neck with a scarf. It was, by far, the campaign's most popular spot, as judged by YouTube viewings and Web clicks.

In a new ad, Hall addresses the camera, speaking with the buzzing sound of her electrolarynx. She advises smokers to make a video of themselves now, reading a children's book or singing a lullaby. "I wish I had. The only voice my grandson's ever heard is this one," her electric voice growls.

One difference from last year: The new campaign tilts more toward the impact smokers have on others. One ad features a Kentucky high school student who suffers asthma attacks from being around cigarette smoke. Another has a Louisiana woman who was 16 when her mother died from smoking-related causes.

The return of the campaign is already being applauded by some anti-smoking advocates, who say tobacco companies spend more on tobacco product promotion in a week than the CDC spends in a year.

After decades of decline, the adult smoking rate has stalled at roughly 20 percent in recent years. Advocates say the campaign provides a necessary jolt to a weary public that has been listening to government warnings about the dangers of smoking for nearly 50 years.

"There is an urgent need to continue this campaign," said Matthew Myers, president of the Campaign for Tobacco-Free Kids, in a statement.

It would seem like a bad time for the CDC to be buying air time — the agency is facing roughly $300 million in budget cuts as part of the government's sequestration cuts in federal spending. However, the ad money comes not from the CDC's regular budget but from a special $1 billion public health fund set up years ago through the Affordable Care Act. The fund has set aside more than $80 million for CDC smoking prevention work.

Frieden argues that the ads are extremely cost-effective — spending about $50 million a year to save potentially tens of thousands of lives.

"We're trying to figure out how to have more impact with less resources," he said.

The ads direct people to call 1-800-QUIT-NOW. PlowShare Group, of Stamford, Conn., is again the advertising company that put the ads together.

Related:

Star of 'Voicebox' anti-smoking ads dies after 20-year cancer battle

Why young smokers should quit before turning 44

By Rachael Rettner
MyHealthNewsDaily

A proposed bill in Oregon to make the possession of cigarettes illegal is well-intended, but from a practical standpoint, it's unlikely to happen, bioethicists and public health experts say.

The ban, sponsored by State Rep. Mitch Greenlick of Portland, would make nicotine a controlled substance, and says possessing more than 0.1 milligrams would be illegal, punishable by a year in prison or a $6,250 fine. Exceptions would be made for people who had a doctor's prescription for the drug,   according to the bill.

Tobacco clearly takes a significant toll on the lives of Americans, causing 450,000 premature deaths each year, and drastic measures should be taken to eliminate the habit from our lives, including, some say, banning cigarettes. But others argue that, in today's society, such a goal is overly idealistic, and would be extremely difficult to implement.

"As someone who's looking out for public health, I think it’s a great thing," said Dr. Bradley Flansbaum, a hospitalist at Lenox Hill Hospital in N.Y. "Knowing that tobacco is public enemy No. 1 in preventive illness...I don’t think I can endorse smoking for any reason," Flansbaum said.

However, "Politically, it's going to be a tough if not impossible sell," Flansbaum said.

In 2009, the Food and Drug Administration banned the manufacture and distribution of flavored cigarettes, such as chocolate and cherry, over concerns that the products encouraged youth smoking. However, banning all cigarette products is a different matter entirely. Barriers to passing such a ban include the power of big tobacco companies, the cost of enforcing such a law, and the rise of a black market for cigarettes, experts say.

"Once you have a substance out there like tobacco in wide use it's hard to turn around and make it illegal," said Arthur Caplan, a bioethicist at New York University School of Medicine's Division of Medical Ethics, "You can certainly tax it, you can certainly stigmatize it," and educate against its use.  But ban it?  "In reality, it's not going to happen," Caplan said.

"Smoking has been around too long, and the industries that profit from it are huge and will fight to the end," Caplan said.

Rosalie Liccardo Pacula, co-director of the Drug Policy Research Center at the RAND Corp., a nonprofit research organization, said she was surprised to hear of the bill. "The policy would require an enormous cost to enforce if it is to have any teeth, which most states are not in a position to absorb," Pacula said.

However, others argued such barriers should not deter the action.

"That's really the ultimate goal — to have the world free from the death and destruction it causes," said Dr. Amy Lukowski, clinical director of Health Initiatives Programs for the National Jewish Health Center in Denver. "How we do that? That's the million-dollar question." Although anti-smoking policies have made strides in reducing the number of people who smoke, "I think we have to do something drastic about this," Lukowski said. "[It's] taking the lives of Americans every day." Indeed, a study published today (Jan. 24) in the New England Journal of Medicine found that smoking takes at least 10 years off a person's life.

"I think we should try," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine. "What's possible begins with what we try to do. I think there is a strong argument for never allowing another child to become addicted to tobacco," Katz said. "This would never be approved for sale today, and we should get rid of it."

• 10 Do's and Don'ts to Reduce Your Risk of Cancer
• Quitting Smoking Lengthens Women's Lives
• 10 Medical Myths that Just Won't Go Away

Nicotine may help tune up the brains of seniors suffering from mild memory loss, a new study shows.

Researchers found that seniors suffering from mild cognitive impairment, or MCI, could boost their memories with a nicotine patch, according to the study published in Neurology.

The patches also led to improvements in attention and mental processing. But these effects weren’t as strong as the impact on memory, said study co-author Dr. Paul Newhouse, a professor of psychiatry and director of the Center for Cognitive Medicine at Vanderbilt Medical Center. “The take-home message for this is that nicotine may be helpful in those with early signs of memory loss,” Newhouse said.

MCI is considered to be a precursor to Alzheimer’s disease, bringing similar, though less severe, symptoms such as mild memory loss, slowed thinking and attention problems. Currently, there are no medications approved to treat those symptoms.

Experts suspect that in MCI, just as in Alzheimer’s disease, there is deterioration and death of nerve cells in the brain that make a critical chemical messenger called acetylcholine. As levels of the neurotransmitter drop, memory and other mental functions decline.

Nicotine has just the right shape to mimic acetylcholine and fit snugly into some of the same receptors that the neurotransmitter does.  

Newhouse and his colleagues followed 67 seniors with MCI for six months. Half the study volunteers wore a nicotine patch, while the others wore a placebo patch. The seniors, who were aged 55 and older, were tested for declines in memory and other mental skills at the beginning of the study. They were retested at three months and again at six months into the study.

At the end of the study, volunteers who had worn a patch saw improvements in memory of 46 percent. Those who were treated with placebos declined by about 26 percent over the same period of time.

The nicotine may simply be improving symptoms and not helping with the actual disease, Newhouse said. But there has been some research suggesting that nicotine might actually offer some protection to the cells being damaged by Alzheimer’s.

Dr. Frank Leone was surprised to see that the low doses of nicotine in patches were enough to tune up people’s brains. “I think it’s pretty cool,” said Leone, an associate professor of medicine and director of the comprehensive smoking treatment program at the University of Pennsylvania.

It does make sense that nicotine might help, Leone said. "Nicotine is a mild stimulant and presumably any stimulant has the ability to activate a person’s brain and to potentially improve cognition."

The Vanderbilit research is limited and needs to be replicated in larger studies before doctors should start prescribing patches to alleviate MCI, Leone said. Fortunately, smoking cessation programs have shown that patches can be used safely for years.

While patches haven’t been shown to be addictive, epidemiologist Steven Stellman has some words of caution for healthy adults who might try to use the patch to tune up their brains, rather than just kicking cigarettes.

"Nicotine is the addicting ingredient in cigarettes,” said Stellman, professor at the Mailman School of Public Health at Columbia University. “People become addicted because nicotine gives them pleasure. "

More like this:

1 in 10 smokers hides it from the doctor

by Rachael Rettner
MyHealthNewsDaily

About one in 10 smokers say they don't reveal to their doctors that they light up, according to a new survey.

This could equate to more than 6 million smokers in the United States, the researchers said.

The findings are important because health care providers "play a critical role in reaching smokers with appropriate messages and resources for quitting," said Cheryl G. Healton, president and chief executive officer of Legacy, the organization that conducted the study, which advocates prevention of youth smoking and helping people to quit.

"It becomes a missed public health opportunity if [smokers] do not talk to doctors and nurses about smoking and quitting," Healton said.

The reluctance of some smokers to discuss their smoking may be due to the increasing social stigma surrounding the habit. Of those who kept their smoking a secret from their doctors, 42 percent said it was because they felt ashamed, according to the survey.

Increased public health efforts to ban smoking in public places and create smoke-free workplaces may unintentionally lead smokers to feel marginalized, and less willing to discuss smoking with their physicians, Healton said.

Doctors should be aware of this problem, and be provided with tools to help them better communicate with their patients about smoking cessation, the researchers said.

Smoking stigma

The findings are based on a nationally representative survey (completed online) of 3,146 smokers or former smokers in the United States.

• Eighty-seven percent said they inform their health care provider about their habit, while 13 percent said they did not.
• Smokers who kept their smoking a secret from their doctor were more likely to be light smokers, and to have tried to quit in the last 30 days, compared to those who did admit their habit.
• Fifty-three percent of all smokers said they feel comfortable talking about their smoking, but just 24 percent sought help from their health care provider during their last attempt to quit.
• Two-thirds of those who said they did not disclose their smoking status to their health care provider said they did not want to be lectured about their smoking.
• More than half of smokers (53 percent) perceived medium to high levels of stigma related to being a smoker. Thirty-five percent of smokers kept their smoking secret from their health care provider said they perceived high levels of stigma, compared with 14 percent of those who informed their provider.

Speaking to patients

Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in N.Y., said sometimes smokers don't speak with their doctors about their smoking because doctors simply don't ask.

"The doctor has to ask about smoking history," Horovitz said. And if the patient doesn't tell the truth, "you can often smell it on their clothes or their breath, and so you have to confront them," Horovitz said. "It's the physician's job to elicit this from the patient," he said.

Horovitz said he recommends that doctors set a date for smokers to quit, and when that date arrives, ask whether they've cut down, or need some help.

Legacy has created guidelines that Healton said may help health care providers conduct conversations about smoking and quitting. The guidelines advise doctors to ask every patient if they smoke, and to be positive and encouraging when advising smokers to quit.

"This initiative aims to educate physicians and nurse practitioners to broach the subject proactively, without lecturing or judgment," Healton said.

The survey was funded in part by the pharmaceutical company Pfizer.

Pass it on: About 6 million smokers in the United States keep their habit a secret from their doctors.

More from MyHealthNewsDaily

11 Tips to Lower Stress

7 Weirdest Medical Conditions

Who Still Smokes? Smokers in the U.S. Today (Infographic)