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Sleep Health

Insufficient Sleep

Sleep is critical for brain and body functions, including cognition and emotion, as well as for the immune, hormonal and metabolic systems. Insufficient sleep is associated with chronic diseases such as cancer, depression, diabetes, hypertension and obesity.

Nationally, the percentage of adults who reported sleeping, on average, fewer than seven hours in a 24-hour period decreased 6% from 34.5% to 32.3% between 2018 and 2020. This is the lowest prevalence since America’s Health Rankings started tracking this measure. In 2020, more than 83.4 million adults reported insufficient sleep.
Insufficient sleep significantly decreased in 18 states and the District of Columbia between 2018 and 2020, led by 16% in Tennessee (40.0% to 33.7%), 15% in New York (38.6% to 32.9%) and 14% in both New Jersey (37.6% to 32.3%) and the District of Columbia (34.8% to 30.1%).
Between 2018 and 2020, insufficient sleep significantly decreased among all racial and ethnic groups except Hawaiian/Pacific Islander adults, all income levels except adults ages 25 and older with an annual household income of $50,000-$74,999, all education levels, both genders and all age groups. By group, the largest decreases were:
In 2020, insufficient sleep was highest in Hawaii (39.4%), West Virginia (39.2%) and Kentucky (38.6%); it was lowest in Colorado (26.8%), Minnesota (27.0%) and South Dakota (28.1%).
In 2020, insufficient sleep varied most by race and ethnicity, but also significantly varied by age, income, education and gender. The percentage was higher among:

Smoking and Tobacco Use

E-cigarette Use*

* Data were available for 38 states in 2020. National value is the median of the 38 states with data.
In recent years, there has been an increase in the popularity of electronic cigarettes, more commonly referred to as e-cigarettes. E-cigarettes typically deliver the highly addictive compound nicotine and often contain other harmful additives such as cancer-causing chemicals, small particles that can go deep into lungs and flavoring chemicals linked to serious lung disease and lung injury.

Nationally, the percentage of adults who reported using e-cigarettes or other electronic vaping products at least once in their lifetime and now use daily or some days increased 13% from 4.6% to 5.2% between 2017 and 2020. This equaled nearly 7.0 million adults in 2020.
E-cigarette use significantly increased in four states between 2017 and 2020: 55% in Nebraska (3.8% to 5.9%), 41% in both Connecticut (3.2% to 4.5%) and Utah (5.1% to 7.2%) and 36% in Minnesota (3.6% to 4.9%).
Between 2017 and 2020, e-cigarette use significantly increased among adults ages 18-44, Hispanic and white adults, adults with the highest levels of education and income, and both genders. By group, the largest increases were:
Of the 38 states with data in 2020, e-cigarette use was highest in Utah (7.2%), Tennessee (6.9%), and Nevada, Kentucky and Idaho (all 6.7%); it was lowest in Illinois (3.4%), Maryland (3.8%) and South Dakota (3.9%).
In 2020, e-cigarette use varied most by age and race and ethnicity, but also significantly varied by gender, education and income. The percentage was higher among:
  • Adults ages 18-44 (9.5%), 10.6 times higher than among adults ages 65 and older (0.9%). E-cigarette use was significantly lower with each increase in age group.
  • Hawaiian/Pacific Islander adults (9.1%), 2.8 times higher than among Black adults (3.3%). E-cigarette use was also significantly higher among multiracial (8.4%) and American Indian/Alaska Native (7.3%) adults and significantly lower among Black (3.3%), Asian (3.7%) and Hispanic (4.2%) adults than all other racial and ethnic groups except for adults who identified their race as other (6.2%).
  • Males (6.3%) than females (4.3%).
  • Adults ages 25 and older with lower levels of education than college graduates (2.5%).
  • Adults ages 25 and older with lower levels of income than those with an annual household income of $75,000 or more (3.7%).
Related Findings
This increase in e-cigarette use contrasts the long-term success in lowering cigarette smoking rates, which recently decreased 9% nationally from 17.1% to 15.5% of adults between 2017 and 2020.

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