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National In the past year, the percentage of adults who reported smoking at least 100 cigarettes in their lifetime and who currently smoke decreased 6 percent from 17.5 percent to 17.1 percent of adults. In the past five years, the prevalence of smoking decreased 23 percent from 21.2 percent of adults to 17.1 percent. Nationally, smoking prevalence is significantly higher (based on nonoverlapping 95 percent confidence intervals) in men than women, as well as in adults aged 25 and older without a high school degree compared with those with higher levels of education. In the past five years, the prevalence of smoking decreased the most among adults aged 18 to 44 compared with adults aged 45 to 64 and adults aged 65 and older.
State In the past five years, adult smoking declined in all 50 states decreasing significantly in 39 states and the District of Columbia. Figure 4 shows the largest percentage point decreases in prevalence of smoking between 2012 and 2017 occurred in Oklahoma (26.1 percent to 19.6 percent), Nevada (22.9 percent to 16.5 percent) and Rhode Island (20.0 percent to 14.4 percent). The smallest decreases in the past five years occurred in New Hampshire and Tennessee.
Nevada, Illinois and Wisconsin experienced the largest five-year decrease in smoking prevalence among adults aged 25 and older without a high school degree (Figure 5). Conversely, Tennessee, Maine and North Dakota experienced the largest five-year increase in smoking prevalence among adults aged 25 and older without a high school degree. Similarly, in the past five years West Virginia, South Dakota and North Dakota experienced the largest increase in the prevalence of smoking among adults aged 25 and older with a household income less than $25,000.
Some states have smaller disparities in smoking prevalence compared with the nation. California, Massachusetts and Texas have a prevalence of smoking that is similar among adults aged 25 and older without a high school degree, with a high school degree and with some college. These states rank in the top 10 for smoking prevalence. Smoking among those with a college degree, however, remains significantly lower than those with other educational levels in all states and the District of Columbia.

National Air pollution, measured as the average exposure of the general public to particulate matter of 2.5 microns or less in size, has decreased yearly since America’s Health Rankings started tracking it in 2003 (Figure 6). In the past five years, the level of air pollution decreased 18 percent from 10.5 to 8.6 micrograms of fine particles per cubic meter. In the past 10 years, the level of air pollution decreased 30 percent from 12.2 micrograms of fine particles per cubic meter to 8.6.
State Between 2012 and 2017, the largest decreases in air pollution occurred in California (15.3 micrograms of fine particles per cubic meter to 11.7), Arkansas (10.8 to 7.2), West Virginia (11.2 to 7.7), Indiana (13.1 to 9.7) and Hawaii (8.9 to 5.9) (Figure 7). Air pollution in Alaska increased from 6.0 to 8.7 micrograms of fine particles per cubic meter. Nevada and Arizona also experienced small increases.

National The percentage of children younger than 18 who live in households at or below the poverty threshold decreased for the second consecutive year (Figure 8). Children in poverty decreased 9 percent from 19.7 percent to 18.0 percent of children in the past year, and it decreased 15 percent in the past two years. The percentage of children in poverty, however, is 14 percent above its 25-year low of 15.8 percent of children in 2002.
State Between 2012 and 2017, the percentage of children in poverty in the District of Columbia, Indiana, New Mexico and Nevada decreased 9 percentage points or more (Figure 9). During the same time period, the largest increases in the percentage of children in poverty occurred in North Dakota, Alaska and Mississippi.

National In the past five years, the percentage of the population that does not have health insurance privately, through an employer or through the government decreased 44 percent from 16.0 percent to 9.0 percent (Figure 10). This decline coincides with the enactment of the Affordable Care Act.
State In the past five years, the largest percentage point decline in the percentage of uninsured occurred in California, New Mexico, Nevada, Arkansas and Louisiana (Figure 11). The smallest changes occurred in Maine and Massachusetts, two states that already had low percentages of uninsured compared with other states in 2012.

National The preventable hospitalization rate ― defined as ― the number of discharges for ambulatory care-sensitive conditions per 1,000 Medicare enrollees aged 65 and older, has decreased annually since 2008 at a rate of approximately 3.3 percent per year (Figure 12). The rate declined 1 percent in the past year from 49.9 to 49.4 discharges per 1,000 Medicare enrollees.
State Over the past five years, the largest decreases in the preventable hospitalization rate occurred in Louisiana, Kentucky, Tennessee, West Virginia and Ohio, all states with a higher rate than the nation in both 2012 and in 2017 (Figure 13). Hawaii maintains its No. 1 rank in this measure despite no notable change in the preventable hospitalization rate since 2012.

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