Environmental Hazards


Living young means living smart. And that means planning ahead to avoid situations that can cause ageing. Simple decisions like choosing the nonsmoking section of a restaurant or having safe sex help you to stay young. Accidents and unintentional poisonings are the third leading killer in the United States. Even though we don't equate traffic, domestic, or work-related accidents with ageing, they can temporarily or permanently disable you and cause a decline in your quality of life. In RealAge terms, accidents will age you. Environmental toxins—whether from cigarettes, pesticides, or air pollution— are major contributors to cancers and other diseases. Learn to be proactive in spotting potential dangers before they make you older. Whether it's quitting smoking, avoiding drugs, or having safe sex—lots of it!—you can help keep yourself young. Learning how to live safely in the world around you will make your RealAge as much as twelve years younger.

No surprises: Smoking makes you get old fast. Indeed, smoking can add eight years to your RealAge. Secondhand smoke causes ageing, too. Just one hour in a smoke-filled room is the equivalent of smoking four cigarettes. Whatever the source, smoke increases your risk of heart and lung disease, weakens your immune system, and is a proven carcinogen. If you're a smoker, learn tricks that can help motivate you to quit once and for all. Celebrating 'year-younger' parties, taking walks at lunchtime, and making bets with other 'quitters' can help you resist the urge. Learn how to manage the roller coaster of stopping and starting while on your way to becoming smoke-free. The Real Age benefit of quitting smoking: You get back seven of the eight years that smoking has taken from you. Heavy exposure to secondhand smoke can age you almost seven years, too.

Difficulty rating: Most difficult

Eighty percent of all accidents are avoidable. Taking proper safety precautions in everything you do, whether at home or on the job, can help make your RealAge one to six years younger.

Difficulty rating: Moderately easy

What, you ask, do seat belts and helmets have to do with staying younger? By taking routine safety precautions, like wearing a seat belt when driving, or wearing a helmet when biking, you can make your RealAge 0.6 to 3.4 years younger. Although avoiding accidents has nothing to do with biologic ageing per se, it has a lot to do with the length and quality of our lives.

Difficulty rating: Quick fix

Air pollution, exposure to toxic chemicals, and living in houses with high levels of radon or asbestos can increase your cancer risk to the level of someone five to ten years older. Learn how to recognize potential environmental hazards and how to avoid exposure to toxins that can make your RealAge 2.8 years older.

Difficulty rating: Moderately difficult

Sex and drugs, the symbols of wild youth, can keep us young or make us old, Fast. By enjoying sex within the confines of a mutually monogamous relationship or practicing safe sex during casual sexual encounters— avoiding high-risk partners and knowing their sexual histories, and always using a condom, and using it correctly—you can make your RealAge as much as 0.9 years younger. Better still, having lots of sex may prevent ageing even more. Having sex more than once a week, the national average, can reduce your RealAge, too. Although these data are preliminary, several studies indicated that having sex frequently is associated with a RealAge that is two to eight years younger. By not using drugs and seeking counseling if drug use is a problem, you can make your RealAge more than eight years younger.


Difficulty rating: Moderately easy to difficult

Anything that keeps you healthy keeps you young. You don't exist outside the world but in it, and everything with which you come in contact affects the rate at which you age. The three leading causes of death and disability are arterial ageing; immune system ageing; and environmental hazards, such as accidents and unintentional injuries. It is easy to understand how damaging your arteries or weakening your immune system may make you older. But how do preventing accidents, avoiding environmental hazards, and reducing the risk of injuries keep you young?

Environmental factors affect your health and the length of your life much more than inherited genetics do. Your environment consists of everything that is not the body itself: the air you breathe, the city or town you live in, the food you eat, and the people you know. Learning to navigate through the world around you so it doesn't harm you is one of the keys to staying young. And that means using some common sense.

Although we don't tend to think about things like wearing seat belts or bicycle helmets as factors related to ageing, I think they should be regarded as such. The ageing caused by accidents isn't cumulative but sudden. Many accidents, particularly auto accidents, are fatal—and these fatalities can often be avoided. This is the kind of  'instant ageing' all of us hope to avoid. An injury from an accident can trigger a chain reaction in which you give up other Age Reduction strategies as well. For instance, you get into a car accident. Because you don't wear your seat belt, you injure your back. That prevents you from staying active and exercising. When you quit exercising, you gain weight, so your cholesterol and stress levels increase and your arteries begin to show signs of age. The injury prevents you from keeping active and involved. All of a sudden, you are living the life of someone much older. Just because you forgot to buckle that seat belt.

The same is true for toxins in the environment around us. Whether it's cigarette smoke in the office or radon in your home, these toxins can lead to increased ageing. Avoiding exposure to known carcinogens, whether they are pesticides or asbestos, can help keep you young longer. Not smoking, abusing drugs, or having unprotected sex are all behaviors you can adopt to keep yourself from ageing too fast. By choosing to protect yourself against the risks you face in the world around you, you are building your own youth-protection plan.

Tobacco:- Where There's Smoke, There's Fire

Not even the tobacco companies deny it: Smoking kills. There is not a soul who doesn't know smoking is bad for health, not a soul who doesn't know that it causes cancer and lung disease. Smoking can be blamed for nearly half the premature deaths each year, more than four hundred thousand. Smoking remains the greatest public health hazard we face.

Even if it doesn't kill you, smoking will make you older. A lot older. The effects are not something that show up thirty years down the line. Smoking makes you older right now. Today. You see it as new wrinkles in your face; tobacco smoke ages the skin prematurely. You notice it as shortness of breath; smoking decreases the amount of oxygen that gets to your cells, causing them to age faster than they should, causing emphysema and a high incidence of respiratory illnesses. You also feel it as a loss of stamina and energy. Smoking damages your cardiovascular system, causing high blood pressure and clogging of the arteries.

If you look at the American population as a whole, smoking makes us more than 250 million years older than we need to be. At 350 billion dollars in settlements, the tobacco industry is getting off cheap. If we valued each year of life lost to cigarettes at fifty thousand dollars, the tobacco companies would owe us fifty times that amount. If you're a smoker and have a pack-a-day habit, stop right here and add eight years to your RealAge. Think you're fifty? How does fifty-eight sound? Think you're forty? Try forty-eight on for size. Even if you smoke just four cigarettes a day, barely any at all, your RealAge is 2.6 years older. Even if you don't smoke, but live with a smoker or work in a smoke-filled environment just four hours a day, your RealAge is almost seven years older.

To start smoking is easy, to quit is hard. Cigarettes are both physiologically and psychologically addictive, and the habit is very hard to kick. That's why nearly one out of three Americans smoke—some 33 percent of men and 28 percent of women—continue to smoke despite the warnings and despite repeated attempts to quit.

If everyone stopped smoking tomorrow, 30 percent of all cancer-related deaths, 30 percent of all cardiovascular disease-related deaths, and 24 percent of all pneumonia and influenza-related deaths would be eliminated. Unfortunately, it's not easy. Of the 50 million Americans who smoke, 70 percent want to quit, and more than a third of them try each year. Only about 3 percent actually succeed.

Why? In large part, because of the highly addictive nature of cigarettes. But that is only part of it. We often see the risk of cigarettes as something far off in the future. 'It may hurt me some day, but what's one more cigarette today?' smokers often say. That's the wrong way to think about it. Thinking about the diseases or risks associated with smoking makes the job of quitting too onerous.

Instead, start thinking about smoking as a choice—a choice you make about how fast you will age. Every cigarette you smoke is a choice you make to get older faster. Every cigarette you don't smoke—every time you fight that urge and win—is a choice you make to get younger.

As I mentioned in Chapter 1, 1 first developed the RealAge concept to help a friend quit smoking. Those eight extra years caused by smoking were enough to make him sit up and take notice, and he kicked the habit. In the past thirteen years, Simon has gone from a RealAge that was fourteen years older than his calendar age (when all factors, including smoking, were considered) to one that is five years younger than his calendar age. Back then, he was forty-nine with a RealAge of sixty-three; now he's sixty-two with a RealAge of fifty-seven. And the effect: He lives younger now than he did thirteen years ago, with much more vigor and energy than he ever could have imagined. If you are a smoker and give up the habit, you will get younger, too. 

Miraculously, the effects of smoking are largely reversible. Although smoking a pack a day makes a person eight years older in RealAge, the cessation of smoking can win back seven of those years. The net effect of being a former smoker is that a person is only about one year older in RealAge. And the benefits of not smoking start almost immediately. Within just twelve hours of quitting, the body begins to get younger. Carbon monoxide levels decrease, and the blood can carry more oxygen to the cells in the body. In only a few weeks, damaged nerve endings in the mouth and throat begin to regenerate, and the bronchial tubes begin to open.

Go just two months without a puff and you can celebrate your first year-younger party. After five months, you pass the point where you feel worse because you quit, since the nicotine cravings subside, and you start feeling better overall. The immune system will show signs of being stronger. You will be at a lower risk of getting colds and other kinds of respiratory tract infections. The gain: two years younger. Within eight months, your lungs will be clearer and your stamina will increase. After one year of not smoking, you will be three years younger. How's that for a New Year's resolution? Three years younger in just one year. In two years, your risk of having a heart attack and stroke will decrease considerably, and after five smoke-free years, your level of arterial ageing will return almost to that of people who have never smoked. The risk of developing cancer and other forms of immune system ageing will equal the average risk of nonsmokers. Another way of saying it is this: If you give up a pack-a-day habit, you will become a year younger (and can celebrate year-younger parties) at two, five, eight, thirteen, twenty-two, thirty-two, and sixty months from the time you quit.

When Mary Jane came to run the library in my department, she had been a smoker for thirty-five years. Her smoking habit was causing her enormous harm. She was asthmatic, diabetic, and sixty pounds overweight. Her once-an-hour run for a smoke outside had slowed to a walk, with lots of pauses to catch her breath. She also routinely missed more than her allotted number of sick days, suffering recurrent bouts of upper respiratory tract infections.

As often as she considered the idea of quitting, she couldn't actually quit. Many mornings she'd say, 'I'm never going to smoke again.' Usually by the next day, she'd be puffing away again. Then she found she needed to have a major operation. Her diabetes and asthma were both out of control, and her health was in a crisis state. Finally, she decided she had to quit. 'In life you have to make choices. I had to make the choice: Was I going to live or die? When you realize that the alternative is dying, quitting's not that hard.'

Mary Jane had her doctor prescribe nicotine patches and pills that helped ease her cravings. She walked a lot. She avoided situations in which she knew she might encounter smokers.

Giving up smoking was one of the hardest things Mary Jane ever had to do. Those first few months were especially difficult. Today, she hasn't even had a puff in more than three years. No longer smoking made her RealAge six years younger. And this is not even the best part. She's also managed to get her diabetes and asthma under control, and she lost sixty-five pounds. 'I feel one hundred percent better,' she told me proudly. 'I can't imagine going back to smoking again.'

We celebrated Mary Jane's first year-younger party just two months after she smoked her last cigarette. A year later, at her third year-younger party, the department gave Mary Jane some of those days she used to take as sick days as vacation days—her reward for all the new energy she was putting into her job and for sticking to her commitment to kick the habit once and for all.

Beyond the Smoke Screen: How Smoking Ages You

If you're a smoker, you don't want to hear preaching. You know it's bad for you. Maybe you've even tried to quit. Most of all, you're tired of the self-righteous attitude that nonsmokers can have. I don't blame you. My intent isn't to preach, but to give you the facts and let you decide. That's how I've helped seventeen of the last eighteen smokers I've worked with kick the habit. I'll simply present the studies and explain scientifically how smoking ages you. The choice to quit is yours, and all the credit for quitting will be yours, too. The whole point of RealAge is that the age you are—how young you are and can be—is in large part controlled by you.

So, what are the facts? How, exacdy, does smoking cause the body to age? Smoking affects the whole body, ageing all of its major systems and organs. It causes arterial and heart disease and is responsible for more than 80 percent of all deaths from heart disease in those under fifty. And, of course, as we all know, it causes cancer, lung disease, and emphysema. In addition, smokers have more colds, cases of pneumonia, and other infections than do nonsmokers.

Smoking and Cardiovascular Disease

To understand the physiologic effects of tobacco smoke, let's consider one example—cardiovascular disease. For decades, doctors have known that smokers suffer considerably more heart attacks than nonsmokers. Heavy smokers are ten times the risk of a heart attack as nonsmokers. Studies have reported that as many as 40 percent of all stroke victims are smokers. How exactly does smoking cause cardiovascular ageing?

Cigarettes contain more than four thousand identifiable contaminants besides nicotine, which is generally considered to be the addictive component in tobacco. Since cigarette smoke increases carbon monoxide levels in the blood, the delivery of oxygen to the heart and other tissues decreases. Cigarette smoke also inhibits the ability of the breathing tubes to clear secretions properly, increasing the number of infections.

As I discussed in the chapter on arterial ageing, the elasticity of the arteries (their ability to dilate) is directly tied to their youthfulness. The more elastic your arteries, the younger you are. Components of tobacco smoke inhibit the ability of the arteries to dilate. When exposed to the contaminants in cigarette smoke, the arteries are unable to expand properly and remain unnecessarily narrow, a condition that increases the likelihood that they will become clogged. Why does this happen? Scientists speculate that the toxins in cigarette smoke damage the lining of the arteries (the endothelium) and may inhibit the body's production of the chemical component that allows the arteries to expand when the flow of blood increases—for example, when you're exercising. Even in 'passive smokers'—people who don't smoke but are often exposed to secondhand smoke—the ability of the arteries to dilate is less than 50 percent of that in people who are never exposed to tobacco smoke. But this is just the beginning.

To make matters worse, smoking also increases the amount of atherosclerotic plaque, the fatty buildup that clogs arteries. Exposure to the toxins in cigarette smoke makes the platelets in the blood more prone to clotting. As if all that were not enough, studies have found that plaques are more likely to rupture suddenly in smokers than in nonsmokers. If a plaque ruptures, it can create a rough surface on which a clot can form or flow through the bloodstream, potentially causing a heart attack or stroke. In addition, the nicotine in cigarette smoke, when present in the bloodstream, raises blood pressure, significantly affecting the rate at which the arteries age. For reasons that are unclear, smoking reduces the level of HDL ('healthy') cholesterol in your bloodstream.

One study found that women who smoked a pack and a half a day had five to seven times the risk of heart attack as women who had never smoked. But don't kid yourself: No level of smoking is safe. Even women who smoked only one to four cigarettes a day had a risk of heart attack that was 2 times higher than that of nonsmokers. Keep in mind that the impact of cigarette smoking is not gender specific: Both men and women suffer from the arterial ageing smoking causes.

Smoking and Cancer

Then, of course, there's cancer. Lung cancer is the most common cause of deaths from cancers, accounting for 34 percent of the fatal cancers in men and 18 percent of the fatal cancers in women. Smoking can be blamed for nearly 90 percent of all lung cancers in the United States and more than 130,000 deaths from lung cancer deaths annually. Among the four thousand chemical compounds that are commonly found in cigarettes, more than 40 percent are known to interact directly with DNA to cause genetic changes that lead to cancer.

Many of the components of tobacco smoke are oxidants, which increase the number of free radicals in the body. Free radicals, you will remember, are the waste products of 'oxidant' metabolism that have extra or unbalanced electrons that damage our organs and DNA. These free radicals accelerate ageing by causing premature cellular ageing and by promoting cancers. Exposure even to low amounts of cigarette smoke can measurably increase the amount of free-radical damage to the DNA within your cells. For example, in animal studies, dogs that were exposed to the smoke of just one cigarette—not enough to increase their heart rates, blood pressure, or other physiologic measures—had twice the amounts of free-radical damage as dogs not exposed to cigarette smoke. Hamsters exposed to the secondhand smoke equivalent of just six cigarettes a day had twice the number of antioxidant enzymes in their lungs—an indication that their bodies were gearing up to repair significant free-radical damage.

Tobacco ages the immune system in two ways. First, it contains toxins that damage DNA, causing cancers. And, as I mentioned in Chapter 5, two protective systems fight ageing of the immune system and cancer in particular. Smoking knocks both of those systems out of kilter, making the immune system less vigilant about catching cancers. And it is not just lung cancer. Smoking increases the risk of mouth, throat, kidney, and bladder cancers, as well. A Danish study found that women who had smoked for more than thirty years were 60 percent more likely to develop breast cancer than nonsmokers.

Some people seem to be more susceptible than others to the carcinogenic effect of smoke because they have higher levels of specific enzymes that activate the carcinogens contained in smoke. Nitrosamines, by-products of cigarette smoking, interact with the body's own enzymes to create a new chemical that is highly carcinogenic, or damaging to DNA. Some people have much more or much less of the human acetylator enzyme that helps the body remove certain carcinogens from the body. The people who produce less of this enzyme than others, called 'slow acetylators,' are predisposed to breast cancer, as well as other kinds of cancer. Don't bank on the fact that you may have better genes for fighting cancer. The ingestion of any tobacco products, whether through smoking, chewing, or inhaling secondhand smoke, increases immune system ageing.

Smoking and Emphysema

To add to the list of dangers associated with smoking, it is also the primary cause of emphysema, the premature ageing of the lungs. More than 2 million people in the United States (and possibly many more than that) suffer from emphysema, the fourth leading cause of death in the United States. Emphysema occurs when the air sacs in the lungs die. Scientists have long suspected that emphysema is caused by an autoimmune response, a chemical reaction in the smoker's body that causes the body to kill its own lung cells and air sacs. Normally, the immune response is well gauged to react to the low-level assaults of everyday living. The immune system habitually kills off single cells that show signs of distress. When the lungs are exposed to the constant irritation of cigarette smoke, this normally protective system overreacts. When many, many cells show signs of distress, the body begins to kill off its air sacs en masse. And when many of the cells needed for taking in oxygen and expelling carbon dioxide are gone, the smoker is barely able to breathe.

Smoking and Other Ageing Effects

As if cardiovascular disease, cancer, and emphysema were not enough, smoking has been tied to other kinds of ageing effects as well. For example, since smokers have a decreased immunity to disease, they suffer many more respiratory infections. Smokers were more than twice as likely as non-smokers to become impotent or unable to experience orgasm, and report reduced sexual pleasure. Heavy smoking also leads to an increase in macular degeneration, an eye disease commonly associated with old age, at a rate more than 2V2 times that of nonsmokers. Smokers are twice as likely to get diabetes, and diabetics age at twice the normal rate if the disease is not properly managed (see Chapter 12). For people with mild thyroid disorders (more than 10 percent of Americans), heavy smoking can trigger failure of the thyroid gland, seriously raising cholesterol levels and further accelerating arterial ageing.

Unfortunately, smoking amplifies other risk factors disproportionately. For example, in families with a history of heart and arterial disease, smokers have fifteen times the risk of heart attack as nonsmokers from the same families. When people with high cholesterol levels are compared, the smokers have thirty-five times the rate of heart attacks as the nonsmokers. Alcohol and cigarettes are another deadly combination: People who drink alcohol and smoke are at a much higher risk of mouth, throat, and liver cancers than people who do either one or the other. Alcohol causes the body to make enzymes that metabolize tobacco smoke into highly carcinogenic substances.

Not a very pleasant picture, is it? By triggering all these responses in the body, cigarette smoking is triggering an ageing response. Most of what I have just described is probably a restatement of facts you already know, but there is still the big sticking point that keeps most smokers smoking: How do you beat the addiction?

No More Cigarette 'Buts': Kicking the Habit

If you are really serious about quitting, this book is probably just the beginning. Or, better said, one more beginning. For most smokers, quitting is an on-again, off-again routine. You stop. You struggle with it for a few days, weeks, or months. Then the craving gets you, and you decide, 'What's one cigarette?' You light up, and you're back to square one, a smoker once again. Since this book is about the effects of ageing, rather than the techniques for beating an addiction, I am not going to go into all the details here. There are many, many services and information sources that help smokers quit—everything from high-priced inpatient clinics to free support groups at community centers. If you are serious about quitting, talk to your physician, search for smoking-ces-sation programs and support groups in your area, buy a few books about kicking the habit, and consider nicotine patches or chewing gum and pills to help ease your cravings. Different methods work better for different people. Thinking about quitting in terms of ageing may be just the ticket for you: Eight years is a lot of time to give up to just one habit.

There is no question that cigarettes are psychologically and physiologically addictive. For example, laboratory mice used in smoking studies learn what times of day they will be exposed to smoke and race expectantly to the side of the cage where the smoke comes out at the appointed hour. They need their smoke! To be fair, it's hard for me even to imagine what it's like to quit since I've never been a smoker. But having watched friends and my patients struggle through it, I know that it's a major battle. People who successfully quit and stay away from cigarettes deserve a lot of credit.

Years of research on cigarette smoking have brought us closer to understanding the biochemical processes by which the body becomes addicted to nicotine. Brairi-scan studies have shown that smoking triggers a release of dopamine in the brain. Dopamine, a chemical that dulls the body's response to pain and makes you feel pleasure, is involved in everything from muscle control to emotional state. Many addictive drugs, including cocaine and even caffeine, trigger a dopamine reaction, too. The more you smoke, the more your body adjusts to a higher level of dopamine release. These elevated levels become your body's normal state. When you quit, the body goes into withdrawal. The question is, How can you beat the cravings long enough for your body to readjust to its smoke-free state?

If you are a typical smoker, you will quit smoking. Again. And again. And again. You will kick the habit, start up anew, and then have to kick it all over. Almost no one can quit in one try. But don't become disheartened—just keep trying. One of the problems with quitting is that at first you feel worse. For the first several weeks, you feel intense cravings and, since nicotine is a stimulant, rather sluggish. After a few weeks, those feelings will subside. Just stick to your guns.

Only 2 percent of smokers can successfully quit the first time. Using nicotine patches doubles the success rate to 4 percent. One study found that combining the patch with anticraving pills boosted the effectiveness to almost 60 percent. In my own practice, the success rate has been much higher—seventeen of the last eighteen patients who tried to quit did so. Many had been pack-a-day smokers for a decade or more. By combining the patch and the pills with RealAge planning, they stopped smoking and started getting younger. (For my patients, I prescribe bupropion—100 mg of the slow-release formula of Wellbutrin, twice daily, the dosage adjusted to body weight. Three days later, I advise them to apply a nicotine patch, throw away all cigarettes and cigarette items, and begin additional exercise. Talk to your doctor about the best regimen for you.)

If you are a smoker, don't try to quit 'cold turkey.' See your doctor and develop a plan. Ease the physiologic cravings by getting patches and pills and ease the psychologic urge to smoke by developing a support system that will keep you away from cigarettes. And don't forget to include 'year-younger' parties in your plan: You need to celebrate your successes.

Changing little day-to-day habits can make quitting easier. For example, increasing the amount of exercise you get helps reduce the craving for cigarettes. Avoid environments where smokers congregate and, instead, frequent places where smoking is prohibited—museums, libraries, or theaters. Regimented programs provided by smoking-cessation clinics and community support groups give some people the willpower and supportive environment they need to stop smoking.

Smoking and the Weight Gain Blues

One of the biggest fears that people have about quitting smoking is the weight gain that often follows. On average, men gain about ten pounds within six months of quitting, and women, about eight pounds. Weight gain should be the least of your worries. The risk of smoking is far greater than the risk of being overweight. And the weight gain is often temporary. For example, women commonly lose six of the eight pounds that they gained in the first six months within the next eighteen months. With careful planning you can prevent the weight gain altogether. Here are some tips:

Chew sugarless gum. It can help ease the oral cravings.

Have lots of chopped vegetables and low-fat snacks on hand. Popcorn without butter is good to munch on. Fruits, especially small ones like grapes or berries, are another great snack.

Integrate regular exercise and walking into your daily routine. It will help fight the cigarette urge, as well as help keep off the weight.

Don't quit smoking during the holidays. All that rich food will only increase the temptation to overeat.

Find something to do with your hands. Many smokers find comfort in having something to hold. Buy yourself a bunch of desk gadgets or other objects to fiddle with and divert all that nervous energy.

When you feel the temptation to smoke, close your eyes and take a deep breath. Remember all the reasons you quit smoking in the first place. Keep a list of those reasons and add the new benefits of being a reformed smoker to the list as you discover them: more energy, fewer colds, years younger.

Don't downplay your accomplishment. Reward yourself for quitting. You deserve those year-younger parties. Buy yourself a present or give yourself a special treat. Being smoke-free is something to celebrate.

Other tips: Stay busy. It will help keep your mind off cigarettes. Also, throw away all cigarettes and smoking paraphernalia. Avoid coffee, alcohol, and other drinks or food you associate with smoking. Instead, drink lots of water, fruit juices, and herbal teas. Eating small meals instead of one big one keeps blood sugar levels constant, which helps quell the nicotine craving. Avoid behaviors and situations you associate with smoking. If you used to smoke after meals, try to do something else at that time—take a walk, do the dishes. Do positive things that boost your self-image. Go to the dentist and have your teeth cleaned. Have your smoky-smelling clothes cleaned at the dry cleaners. Reward yourself.

If you start smoking again, don't become disheartened. It's not a catastrophe, just a temporary setback. Remember that each time you quit, the easier it will be to quit the next time. And each time you'll get closer to your goal.

One final note: It's never too late to quit In fact, the older you get, the more important it becomes to quit. Smoking causes relatively more ageing among smokers aged forty to seventy-five than younger ones. Smoking is to ageing what putting the gas pedal to the floor is to driving. Smokers in their fifties have more than seventeen times the risk of having a major health event than smokers in their thirties because the rate of smoking-induced ageing has accelerated. That acceleration is measurable at least through age seventy-five. (Beyond that age, there may not be enough smokers still living to say with any accuracy what happens to ageing.) Even if you've smoked for ten, fifteen, or twenty years—or especially if you have—you should quit. Do not think, 'Well, I've smoked this long, why quit now?' Quit now, precisely because you've smoked this long.

Cigar Smoking

Cigars have become the new chic. In the past several years, cigar smoking has tripled in the United States; more than 3 billion cigars were sold in 1996 alone. Cigar bars are opening all over the country as baby boomers take up a habit that was once reserved for the 'old fogy' set.

Since cigar smokers smoke less frequently and do not inhale to the same degree, they believe they are at a lower risk than cigarette smokers. But they are wrong. Cigars are a particularly dangerous form of tobacco. They produce more carbon monoxide and more particulate matter than cigarettes do. Just like cigarettes, they produce benzoapyrene, hydrogen cyanide, and ammonia. Cigars produce more particulate matter, making them more dangerous, not just for the smoker, but for those around him or her as well. Cigars produce a more toxic form of secondhand smoke than cigarettes, so don't think that sitting in that cigar bar without smoking is not doing you harm. Although cigar smokers claim not to inhale, this claim is often untrue. Most former cigarette smokers continue to inhale when they take up the cigar habit.

Cigar smokers are at greater risk of cancers of the lip, mouth, pharynx, and esophagus than cigarette smokers and at about six times the risk of nonsmok-ers. Such cancers are often fatal and, even when nonfatal, can age and disfigure you. No comments, please, about long-lived cigar smokers like Winston Churchill or George Burns. Although we don't know why these people lived so long (good genes or good habits), we do know that other cigar smokers, such as Babe Ruth and Ulysses S. Grant, died young from throat cancers caused by cigar smoking. Smoking one cigar a day makes your RealAge 2.6 years older. Smoking five cigars a day makes your RealAge eight years older.

Passive Smoking

You should not tolerate an environment in which you are exposed to passive smoke. If you live with a smoker, ask that person to go outside to smoke. You'll be giving the message that it's time to quit. Although it may feel like you're being intolerant or uncaring, what you're really saying is that you care enough to make it a whole lot of hassle to smoke. Remember, you're not doing you or your partner any good when you become the passive recipient of that person's smoking habit.

If people smoke around you at work, talk to them to see if there is a way for them to smoke somewhere far away from you. Generally, a solution can be worked out. If your office doesn't have a provision to ensure that you are not exposed to secondhand smoke, talk to your boss or office manager about implementing some kind of policy to ensure a smoke-free environment. If there appears to be no solution to the workplace smoking problem, talk to your local board of public health or Better Business Bureau to find out if there is a city or state no-smoking ordinance. The federal Americans with Disabilities Act requires employers to provide a work environment that will accommodate employees having a variety of disabilities. That means employers must provide a smoke-free environment if they have employees who have either asthma or allergies to smoke.

If you work in certain environments—restaurants or bars, for example—it may be hard to avoid secondhand smoke. See about installation of air filters that recycle the air and decrease particulate matter. This will be good not only for you, but for all the customers, even the smokers.

To minimize your exposure to secondhand smoke, avoid smoke-filled bars, and at restaurants ask to sit in the no-smoking section. Many hotel chains now offer no-smoking rooms, and car rental companies offer no-smoking cars. If you spend more than four hours a day in a smoke-filled environment, your RealAge may be as much as 6.9 years older.


Smokeless Tobacco

Dip, chew, spit? More than 5 million Americans use smokeless tobacco, and its use is on the rise. Over the past twenty-five years, its use has increased tenfold, making it the fastest-growing segment of the tobacco market.

Many tobacco users think they are avoiding the risk of tobacco by using it in its smokeless form, as snuff or chewing tobacco. They are wrong. Although the risk of lung cancer is lower among people who use chew or snuff, the risk of other cancers is considerably higher.

Smokeless tobacco causes mouth and throat cancers, dental problems, cardiovascular disease, and nicotine addiction, just like smoking does. And just like smoking, it's hard to kick the habit. In fact, the amount of nicotine and other chemicals found in the blood of people who chew is even higher than that found in the blood of smokers.