Executive BriefIntroductionNational HighlightsKey FindingsSocial and Economic FactorsPhysical EnvironmentClinical CareBehaviorsHealth OutcomesInternational ComparisonState SummariesAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingUS SummaryAppendixMeasures TableData Source DescriptionsThe Team
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.
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:
- 10% among adults ages 25 and older with an annual household income of $75,000 or more (33.2% to 30.0%).
- 10% among adults ages 25 and older who graduated from college (30.5% to 27.5%).
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:
- Hawaiian/Pacific Islander adults (46.2%), 1.5 times higher than among Asian (30.5%) and white (30.6%) adults. Insufficient sleep was significantly higher among Hawaiian/Pacific Islander, Black (43.6%), multiracial (39.5%) and American Indian/Alaska Native (38.2%) adults than Asian, white and Hispanic (32.1%) adults.
Smoking and Tobacco 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.
- 38% among adults ages 18-44 (6.9% to 9.5%).
- 35% among Hispanic adults (3.1% to 4.2%).
- 32% among adults ages 25 and older who graduated from college (1.9% to 2.5%).
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:
- 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%).
- 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%).
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.