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US SummaryAppendixMeasures Table – WomenMeasures Table – ChildrenData Source DescriptionsMethodology
AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUS SummaryAppendixMeasures Table – WomenMeasures Table – ChildrenData Source DescriptionsMethodologySleep Health & Smoking and Tobacco Use
Sleep health and cigarette smoking improved among women of reproductive age.
Women
Insufficient Sleep
Insufficient sleep has been recognized as a threat to public health. Sleep is critical to such basic functions as cognitive processing, mood regulation, blood sugar level and immune system response. Insufficient sleep can lead to serious health problems, including cancer, depression, diabetes, hypertension, obesity and heart attack.
- Changes over time. Nationally, the percentage of women ages 18-44 who reported sleeping, on average, fewer than seven hours in a 24-hour period significantly decreased 7% from 36.1% to 33.4% between 2018 and 2020. In 2020, more than 19.2 million women in the U.S. reported insufficient sleep, a decrease of roughly 1.5 million women since 2018. Insufficient sleep significantly decreased 21% in Oregon (36.0% to 28.5%) and 13% in New York (39.0% to 33.9%). Some age, education, income and racial/ethnic subpopulations experienced significant decreases in insufficient sleep. The prevalence significantly decreased 14% among women ages 18-24 (33.5% to 28.7%), 11% among college graduates (31.5% to 28.1%), 9% among women with an annual household income of $75,000 or more (32.2% to 29.2%) and 5% among white women (34.3% to 32.5%).‡
- Disparities. Insufficient sleep among women was highest in West Virginia (41.1%) and lowest in Alaska (25.3%) in 2020. The prevalence varied the most by race/ethnicity,* with the prevalence among Black women (43.7%) 1.6 times higher compared with Asian women (26.7%). Insufficient sleep also significantly varied by education, income, age and metropolitan status.
Smoking
As the leading cause of preventable death in the U.S., cigarette smoking is responsible for the deaths of more than 480,000 Americans every year, including 201,770 women. Smoking damages nearly every organ and may affect reproductive health. Women who smoke are more likely to have reduced fertility, go through menopause at a younger age and experience adverse birth outcomes, including miscarriage and sudden infant death syndrome (SIDS).
- Changes over time. Nationally, the percentage of women ages 18-44 who reported smoking at least 100 cigarettes in their lifetime and currently smoke daily or some days significantly decreased 11%, from 15.0% to 13.4%, between 2017-2018 and 2019-2020, and 23% (from 17.4%) since 2013-2014. In 2019-2020, nearly 7.2 million women in the U.S. reported smoking cigarettes, a decrease of more than 1 million since 2017-2018. Smoking significantly decreased 20% in West Virginia from 33.8% to 26.9% since 2017-2018. During this time, some age, racial/ethnic and education subpopulations experienced significant decreases in smoking. By group, the largest decreases were 21% among women ages 18-24 (10.0% to 7.9%), 12% among white women (19.0% to 16.7%) and 11% among women with some post-high school education (20.6% to 18.3%).‡
- Disparities. Smoking among women was 4.1 times higher in West Virginia (26.9%), the state with the highest value in 2019-2020, compared with Utah (6.5%), the state with the lowest value. The prevalence varied the most by race/ethnicity, education and income and also significantly varied by age and metropolitan status. When considering groups with the highest versus the lowest prevalences, smoking was 5.9 times higher among American Indian/Alaska Native women (27.6%) compared with Asian women (4.7%); approximately 4.2 times higher among women with a high school diploma or GED degree (23.8%) and those with less than a high school education (22.9%) compared with college graduates (5.5%); and 3.5 times higher among women with an annual household income less than $25,000 (25.3%) compared with those with an income of $75,000 or more (7.3%).‡
Smoking During Pregnancy
- Changes over time. Nationally, the percentage of live births in which the mother reported smoking cigarettes during pregnancy decreased 8% from 6.0% to 5.5% between 2019 and 2020, and 35% (from 8.4%) since 2014. In 2020, 199,584 women with a recent live birth in the U.S. reported smoking cigarettes during pregnancy, 22,504 fewer women than in 2019.
- Disparities. Smoking during pregnancy was 21.4 times higher in West Virginia (21.4%), the state with the highest value in 2020, compared with California (1.0%), the state with the lowest value.
E-cigarette Use
- Estimate in 2020. Nationally, 7.6% of women ages 18-44 reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days.
- Disparities. Out of the 38 states with data, e-cigarette use among women was highest in Kentucky (12.6%) and lowest in Illinois (4.3%) in 2020. The prevalence varied the most by race/ethnicity;** it was 3.3 times higher among white women (10.4%) compared with Asian women (3.2%). The prevalence also significantly varied by age, education and income.
Nutrition and Physical Activity & Sexual Health
Among children, food sufficiency improved and physical activity worsened. The teen birth rate continued to decrease, but large disparities persist by race/ethnicity and across states.
Children
Food Sufficiency
Access to sufficient food is critical for proper nutrition and health. Children are particularly susceptible to the negative impacts of food insecurity because their brains and bodies are still developing. Food insecurity among children is associated with negative health outcomes such as asthma, anxiety and depression.
- Changes over time. Nationally, the percentage of children ages 0-17 whose caregiver reported that their household could always afford to eat good nutritious meals in the past 12 months significantly increased 6% from 68.1% to 71.9% between 2018-2019 and 2020-2021. During 2020-2021, 50.5 million children were food-sufficient, an increase of 1.9 million children since 2018-2019. Food sufficiency significantly increased in seven states, led by 14% in both West Virginia (59.4% to 67.7%) and Montana (65.2% to 74.3%).
- Disparities. Food sufficiency among children was highest in Massachusetts (81.5%) and lowest in Mississippi (59.9%) in 2020-2021.
Physical Activity
Regular physical activity in children and adolescents is associated with improved bone health, weight status, cognition, cardiovascular and muscular fitness, as well as reduced risk of depression. Exercise also increases the chances of living a longer and healthier life, and children who engage in regular physical activity are more likely to become physically active adults.
- Changes over time. Nationally, the percentage of children ages 6-17 whose caregiver reported that they were physically active at least 60 minutes every day in the past week significantly decreased 8% from 22.3% to 20.5%, equating to a drop of nearly 1 million children between 2018-2019 and 2020-2021.
- Disparities. Physical activity among children was highest in North Dakota (29.8%) and lowest in Nevada (13.9%).
Related Health Outcome: Overweight or Obesity - Youth
- Changes over time. Nationally, the percentage of children ages 10-17 who were overweight or had obesity for their age based upon reported height and weight significantly increased 8% from 31.0% to 33.5%, affecting about 10.7 million youth in 2020-2021. This was an increase of nearly 830,000 since 2018-2019.
- Disparities. Overweight or obesity among youth was highest in Mississippi (41.4%) and lowest in Wyoming (24.3%) in 2020-2021.
Teen Births
Substantial health, social and economic costs are associated with teen pregnancy and childrearing. Teen mothers are significantly more likely to drop out of high school and face unemployment.
- Changes over time. Nationally, the teen birth rate decreased 8% from 16.7 to 15.4 births per 1,000 females ages 15-19 between 2019 and 2020, continuing a downward trend. In 2020, there were 158,043 births among teens in the U.S., equating to 13,631 fewer teen births since 2019. The teen birth rate decreased 10% or more in 18 states, led by 19% in Montana (16.3 to 13.2). During the same time period, the rate increased 16% in Maine (9.1 to 10.6).
- Disparities. The teen birth rate was 4.6 times higher in Mississippi (27.9 births per 1,000 females ages 15-19), the state with the highest rate in 2020, compared with Massachusetts (6.1), the state with the lowest rate. The rate varied significantly by race/ethnicity.
Unintended Pregnancy
- Changes over time. Nationally, the percentage of women with a recent live birth who did not want to become pregnant or wanted to become pregnant later decreased 7% from 30.6% to 28.5% between 2019 and 2020. Unintended pregnancy significantly decreased 19% in Mississippi from 47.1% to 38.3%.
‡ Education and income subpopulations are among women ages 25-44.
*The prevalence did not significantly differ among Black, Hawaiian/Pacific Islander (40.1%), other race and American Indian/Alaska Native (both 37.4%) women. It also did not differ among Asian, Hispanic (30.5%) and other race women.
**The prevalence did not significantly differ among white, American Indian/Alaska Native (10.3%) and multiracial (8.6%) women. It also did not differ among Asian, Hispanic (3.5%), Black (4.6%) and American Indian/Alaska Native women.