Having relocated to a lesser populated part of the country , from a city , I can believe that for those that live in large cities , especially the sprawling Western cities , air pollution from cars IS affecting your children . Respiratory problems at an early age , will only increase . Doctors in Phoenix flat out tell parents to MOVE , because its only going to get worse , and sense its environmental ( crappy big city ), there is not much they can do about it . Typical of AZ state government , instead of requiring CA emission standards for Maricopa County ( after all , the ONLY place its a serious problem in the state , is Phoenix ) , they do nothing . Like many things , first , one has to acknowledge that there is a problem , before one can take steps to correct the problem . Thats one state I wont miss . I would also believe that the lack of exercise and poor diet of many middle aged men , is a factor , doesn’t seem so much for people in their 30’s , but I see it a lot in people in their late 40’s onward . They just seem to stop being physically active , even though there is no obvious reason not to . It would be interesting to me to see a study about middle age in a rural vs. urban setting . The city doesnt exactly provide motivation to go outside and exercise , quite the opposite , it makes a person want to become a shut in . You have to force yourself to go , because just getting there is unpleasant . I would also venture to say , that people in big cities probably do drink more , vs. those in a less stressful environment .