Findings Behaviors | 2023 Health Of Women And Children Report

Executive Brief Introduction National HighlightsFindingsHealth Outcomes Social and Economic Factors Clinical Care Behaviors State RankingsAppendixMeasures Table – Women Measures Table – Children Data Source Descriptions MethodologyState Summaries

US Summary

2023 Health of Women and Children Report – Executive Brief 2023 Health of Women and Children Report 2023 Health of Women and Children Report – State Summaries 2023 Health of Women and Children Report – Concentrated Disadvantage County-Level Maps 2023 Health of Women and Children Report – Measures Table 2023 Health of Women and Children Report – Infographics 2023 Health of Women and Children Report – Report Data (All States)

Behaviors | Nutrition and Physical Activity
Among women of reproductive age, fruit and vegetable intake decreased and the percentage of physically inactive women declined. The long-term successes in reducing smoking and teen birth rates have continued. 
Fruit and Vegetable Consumption
Diets high in fruits and vegetables reduce the risk of many chronic diseases such as Type 2 diabetes, obesity, heart disease and stroke. Consuming fruits and vegetables three or more times daily is associated with a lower overall mortality risk.
Significant changes over time. Nationally, the percentage of women ages 18-44 who reported consuming two or more fruits and three or more vegetables daily decreased 20% from 12.2% to 9.8% between 2017 and 2021. Fruit and vegetable consumption decreased in nine states, led by 60% in Mississippi (9.5% to 3.8%), 59% in Oregon (15.7% to 6.5%) and 56% in Idaho (16.0% to 7.0%). The prevalence decreased among some income, educational attainment, racial/ethnic and age groups. By group, the largest decreases were 39% among women with an income of $50,000-$74,999 (14.5% to 8.8%), 31% among college graduates (15.7% to 10.9%), 23% among white women (12.8% to 9.9%) and 21% among women ages 35-44 (13.5% to 10.7%).
Disparities. Fruit and vegetable consumption varied significantly by geography, age and income in 2021. The prevalence was: 
4.4 times higher in Vermont (16.8%) than Mississippi (3.8%). Higher among women ages 35-44 (10.7%) than women ages 18-24 (8.1%) and higher among women with an income of $75,000 or more (11.7%) than women with an income of $50,000-$74,999 (8.8%).
Note: Data were not available for Florida. The estimates for women ages 25-34 (10.1%) were not significantly different from the other age groups based on non-overlapping 95% confidence intervals; the same was true for the three lowest annual household income groups.


Physical Inactivity
Physical inactivity, or a sedentary lifestyle, can increase the risk of several health consequences such as cardiovascular disease, hypertension, cancer, obesity, diabetes and premature death.
Significant changes over time. Nationally, the percentage of women ages 18-44 who reported doing no physical activity or exercise other than their regular job in the past 30 days decreased 7% from 22.6% to 21.1% between 2018-2019 and 2020-2021. The prevalence decreased among some educational attainment, racial/ethnic and age groups. By group, the largest decreases were 14% among college graduates (13.2% to 11.4%), 12% among white women (17.8% to 15.7%) and 8% among women ages 35-44 (24.2% to 22.2%).
Disparities. Physical inactivity varied by educational attainment, income, geography, race/ethnicity and age group in 2020-2021. The prevalence was:
3.6 times higher among women with less than a high school education (41.0%) than college graduates (11.4%).
3.0 times higher among women with an annual income less than $25,000 (34.9%) than women with an income of $75,000 or more (11.6%).
2.0 times higher in Mississippi (27.4%) than Vermont (13.6%).
1.9 times higher among Hispanic (29.5%) than white (15.7%) women 
Higher among women ages 35-44 (22.2%) than women ages 18-24 (19.5%). 
Note: The estimates for Hispanic and Black (28.2%) women were not significantly different from each other based on non-overlapping 95% confidence intervals, the same was true for white, multiracial (16.4%) and Hawaiian/Pacific Islander (21.5%) women. The estimates for women ages 25-34 (21.2%) were not significantly different from the estimates for women ages 18-24 or ages 35-44.
Behaviors | Smoking and Tobacco Use
Despite large declines in smoking among women of reproductive age, the 12.1% prevalence is still nearly double Healthy People 2030’s goal to reduce current smoking among adults to 6.1%.

Smoking
Smoking cigarettes is the leading cause of preventable death in the U.S. It is responsible for more than 480,000 American deaths yearly, including nearly 201,800 women.
Significant 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 decreased 15% from 14.3% to 12.1% between 2018-2019 and 2020-2021, exceeding the decrease in last year’s report. Despite this progress, the current prevalence remains higher than the Healthy People 2030 target of 6.1%. The prevalence of smoking decreased in six states, led by 32% in Maryland (11.6% to 7.9%) and 31% in both Delaware (17.8% to 12.2%) and Oregon (16.6% to 11.5%). The prevalence decreased among some age, educational attainment and one racial/ethnic group. By group the largest decreases were 34% among women ages 18-24 (9.2% to 6.1%), 19% among college graduates (5.9% to 4.8%) and 14% among white women (18.0% to 15.4%).
Disparities. The prevalence of smoking varied significantly by race/ethnicity, educational attainment, geography, income, age and metropolitan status in 2020-2021. The prevalence was:
7.7 times higher among American Indian/Alaska Native (25.3%) than Asian (3.3%) women.
4.7 times higher among women with less than a high school education (22.5%) than college graduates (4.8%).
4.4 times higher in West Virginia (26.2%) than California (5.9%).
3.5 times higher among women with an annual income less than $25,000 (24.0%) than women with an income of $75,000 or more (6.9%).
2.5 times higher among women ages 35-44 (15.4%) than women ages 18-24 (6.1%).
1.9 times higher among women living in non-metropolitan (20.2%) areas than metropolitan (10.9%) areas.
Note: The estimates for women with less than a high school education and high school graduates (22.3%) were not significantly different from each other based on non-overlapping 95% confidence intervals.
Related Measure: Smoking During Pregnancy
Nationally, the percentage of women who reported smoking cigarettes during pregnancy decreased 16% from 5.5% to 4.6% between 2020 and 2021, exceeding the decrease in the 2022 Health of Women and Children Report. In 2021, approximately 168,100 U.S. women reported smoking during pregnancy, a decrease of 31,500 women compared with 2020. Smoking during pregnancy decreased at a rate greater than or equal to the nation in 33 states and the District of Columbia, led by 28% in Vermont (13.1% to 9.4%), 27% in Connecticut (3.3% to 2.4%) and 26% in Delaware (7.0% to 5.2%). Smoking during pregnancy was 22.8 times higher in West Virginia (18.2%) than California (0.8%).
Related Measure: E-Cigarette Use 
Nationally, 8.8% of women ages 18-44 reported that they had used e-cigarettes or other electronic vaping products at least once in their lifetime and currently use daily or some days in 2020-2021. The prevalence was 2.7 times higher in Kentucky (15.5%) than California and Maryland (both 5.8%). The District of Columbia (4.0%) had the lowest prevalence. It also varied significantly by age, educational attainment, race/ethnicity, income, and metropolitan status.

Related Measure: Electronic Vapor Product Use - Youth 
Nationally, the percentage of high school students who reported using an electronic vapor product in the past 30 days significantly decreased 45% from 32.7% to 18.0% between 2019 and 2021. In 2021, approximately 16,100 high school students reported using an electronic vapor product, a decrease of 3,300 students compared with before the COVID-19 pandemic in 2019. Electronic vapor use decreased significantly in 16 states, led by 61% in Connecticut (27.0% to 10.6%) and 52% in both Hawaii (30.6% to 14.8%) and New Hampshire (33.8% to 16.2%). Assessing the 43 states with data, electronic vapor use was 2.8 times higher in West Virginia (27.5%) than Utah (9.7%).
Note: Minnesota, Oregon, Washington, Wyoming and D.C. did not participate in the 2019 or 2021 Youth Risk Behavior Surveillance System. In addition, data were missing for Alaska, California and Florida in 2021 and Delaware, Florida and Indiana in 2019.

Behaviors | Sexual Health
Teen Births
Substantial social, economic and health costs are associated with teen pregnancy and childrearing. Teen mothers are more likely to drop out of high school and experience unemployment.
Changes over time. Nationally, the teen birth rate decreased 10% from 15.4 to 13.9 births per 1,000 females ages 15-19 between 2020 and 2021, continuing a long-term downward trend and exceeding the decrease between 2019 and 2020. In 2021, there were approximately 147,000 births among U.S. teens, a decrease of 11,100 births compared with 2020. The teen birth rate decreased 10% or more in 19 states and the District of Columbia, led by 26% in Maine (10.6 to 7.8 births per 1,000 females ages 15-19) and 18% in Idaho (14.6 to 12.0), Illinois (13.6 to 11.1) and New Hampshire (6.6 to 5.4). During the same period, the rate decreased 15% among Asian teens (2.0 to 1.7) and 10% among Black (24.2 to 21.7), Hispanic (23.5 to 21.1) and white (10.3 to 9.3) teens.
Disparities. The teen birth rate varied by race/ethnicity and geography in 2021. The rate was:
14.1 times higher among American Indian/Alaska Native (23.9 births per 1,000 females ages 15-19) than Asian (1.7) teens.
4.9 times higher in Arkansas (26.5) than New Hampshire (5.4). 