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Tobacco Use Among Youth

While cigarette and cigar use has declined among youth in recent years, this decline has been countered by increases in the use of hookahs and electronic cigarettes. Exposure to secondhand smoke is harmful to all people. It is associated with numerous health problems and is especially harmful to infants and children because their respiratory, immune and nervous systems are still developing.

National and state findings

In 2018-2019, 4.0% of youth ages 12-17 reported using a tobacco product (including cigarettes, smokeless tobacco, cigars or pipe tobacco) in the past month. Tobacco use rates among youth were highest in West Virginia (8.1%), Montana (7.6%) and Wyoming (7.2%); they were lowest in Hawaii (2.2%), California (2.6%) and Utah (2.7%). Youth tobacco use rates decreased 22% from 5.1% in 2016-2017 and 46% from 7.4% in 2013-2014.

Additional related findings

  • Despite the success in reducing tobacco product use in youth, 32.7% of high school students in 2019 reported using an electronic vapor product in the past 30 days, ranging from 9.7% of high school students in Utah to 35.7% in West Virginia, among the 43 states with data.
  • In 2019-2020, 14.0% of children ages 0-17 lived in a household where someone used cigarettes, cigars or pipe tobacco. Household smoke decreased 10% nationally from 15.5% in 2016-2017. The percentage of children exposed to household smoke was highest in West Virginia (26.7%), Arkansas (23.5%) and Kentucky (21.0%); it was lowest in Utah (3.8%), Washington (7.2%) and California and New York (both 8.6%).

Smoking Among Women

Smoking cigarettes is the leading cause of preventable death and disease in the United States. Among women, smoking can affect reproductive health, and smoking during pregnancy has been linked to poor health outcomes for infants, including preterm birth, low birthweight and sudden infant death syndrome.

National and state findings

In 2018-2019, 14.3% of women ages 18-44 reported smoking at least 100 cigarettes in their lifetime and currently smoke daily or some days, equaling roughly 7.7 million women nationally. Smoking rates were highest in West Virginia (29.7%), Kentucky (28.8%) and Arkansas (22.8%); they were lowest in Utah (6.6%), California (7.4%), the District of Columbia (10.0%) and Texas (10.5%). The smoking rate declined 7% nationally from 15.3% in 2016-2017; it also fell 22% in Mississippi from 24.3% to 18.9%, the only state with a significant decline. Smoking among women has been trending downward since the first Health of Women and Children Report — dropping 18% from 17.4% in 2013-2014.

Subpopulation findings

The prevalence of smoking among women varied by race and ethnicity, educational attainment and income. Except for Hawaiian/Pacific Islander women and women who identify their race as other, smoking rates were significantly different among all racial and ethnic groups; rates were highest among American Indian/Alaska Native women and lowest among Asian women. Among women ages 25-44, high school graduates (24.4%) had a smoking rate 4.1 times higher than college graduates (5.9%), and those with a household income of less than $25,000 annually (26.0%) had a rate 3.3 times higher than women with an income of $75,000 or more (7.8%).

Additional related findings

Smoking also declined among pregnant women. In 2019, 6.0% of mothers reported smoking cigarettes during pregnancy, an 8% decrease from 6.5% in 2018 and a 29% drop from 8.4% in 2014. Smoking during pregnancy was highest in West Virginia (23.0%), Kentucky (15.3%) and Wyoming (13.6%); it was lowest in California (1.1%), Hawaii (2.2%), the District of Columbia (2.3%) and Texas (2.4%).

Physical Activity

Regular exercise is an essential element of living a healthy life. People who engage in regular physical activity benefit from healthier outcomes such as reduced risk of heart disease, some types of cancer and diabetes, as well as improved self-esteem, academic performance and cognitive function.

National and state findings

In 2019, 21.5% of women ages 18-44 in the U.S., or roughly 10.4 million women, met the federal physical activity guidelines of 150 minutes of moderate or 75 minutes of vigorous aerobic activity and two days of muscle strengthening per week in the past 30 days. Exercise among women was highest in Vermont (31.8%), Montana (28.4%) and Florida (26.4%); it was lowest in Oklahoma (13.8%), Kentucky (15.9%) and Missouri (16.3%).
Among U.S. children ages 6-17, 20.6% were physically active in the past week at least 60 minutes daily in 2019-2020, a 9% decrease from 2017-2018 (22.6%). Physical activity was highest among children in North Dakota (31.4%), Wyoming (30.7%) and Alaska (28.0%); it was lowest in Texas (14.1%), Nevada (14.6%) and Arizona (15.0%).

Subpopulation findings

Exercise among women varied by educational attainment and age. Exercise rates increased with each increase in education level among women ages 25-44. The percentage was lower among women ages 35-44 (20.1%) and 25-34 (21.2%) than those ages 18-24 (23.9%).


Sleep is critical for cognitive and emotional health, as well as supporting healthy immune, hormonal and metabolic systems. Chronic insufficient sleep in adults is associated with an increased risk of chronic diseases, obesity and depression. In children, adequate sleep prevents poor mental health, attention problems, injuries, obesity and diabetes.

National and state findings

In 2018, 36.1% of U.S. women ages 18-44 reported sleeping, on average, fewer than the recommended seven hours in a 24-hour period. Insufficient sleep was highest in Tennessee (44.5%), Arkansas (42.6%) and West Virginia (42.5%); it was lowest in South Dakota (27.3%), Minnesota (28.4%) and Montana (29.6%).
In 2019-2020, 66.1% of children ages 6-17 in the U.S. slept the recommended number of hours on most weeknights. The prevalence of adequate sleep was highest in Minnesota (77.0%), Utah (76.6%) and Vermont (73.5%); it was lowest in Louisiana (54.6%), Mississippi (55.2%) and Arkansas (56.7%).

Subpopulation findings

In 2018, insufficient sleep varied by age, race and ethnicity, educational attainment and income. Women ages 18-24 (33.5%) had a lower rate of insufficient sleep than those ages 25-34 (37.1%) and 35-44 (37.0%). Asian (32.7%), Hispanic (33.0%) and white (34.3%) women had lower insufficient sleep rates compared with multiracial women (44.7%), Black women (46.6%) and those who identify their race as other (51.0%). Among women ages 24-44, those with less than a high school education (31.7%) and college graduates (31.5%) had lower rates, compared with high school graduates (41.0%) and those with some college education (43.1%). Women ages 25-44 with an annual household income of $75,000 or more (32.2%) reported lower rates of insufficient sleep than women in the lower income groups.
Between 2016 and 2018, insufficient sleep rates increased in certain age and racial and ethnic groups: 35% among women ages 35-44 (27.5% to 37.0%) and 68% among those who identify their race as other (30.4% to 51.0%).

Teen births

Substantial health, social and economic costs are associated with teen pregnancy. Teen mothers are more likely to drop out of high school and face unemployment, plus their children are more likely to have worse educational and health outcomes than children born to older mothers.

National and state findings

In 2019, the U.S. teen birth rate was 16.7 per 1,000 females ages 15-19, representing nearly 172,000 births. Teen birth rates were highest in Arkansas (30.0), Mississippi (29.1) and Louisiana (27.8); they were lowest in New Hampshire (6.6), Massachusetts (6.9) and Vermont (7.6). Between 2018 and 2019 teen births declined 4% from 17.4 to 16.7 births per 1,000. Since 2013, the teen birth rate has declined 37% nationally from 26.4 births per 1,000. All states and the District of Columbia have shared in this success, with declines of 25% or more during this period.

Subpopulation findings

Teen birth rates were 7.6 times higher in American Indian/Alaska Native (28.2) than Asian/Pacific Islander (3.7) teens. Since 2013, teen birth rates have declined 50% among Asian/Pacific Islander (7.4 to 3.7), 39% among Hispanic (41.6 to 25.3), 38% among white (18.5 to 11.4), 36% among American Indian/Alaska Native (44.4 to 28.2) and 34% among Black (38.7 to 25.6) teens.

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