Health Risk Behaviors Measure Definitions

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Binge drinking among adults
Population All Adults
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who report having ≥ 5 drinks (men) or ≥ 4 drinks (women) on ≥ 1 occasion during the previous 30 days. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Past 30 days
Summary In 2018, the age-standardized binge drinking prevalence among adults was 17.4% (1). Binge drinking prevalence was significantly higher among men (22.5%) than among women (12.6%) and was highest among non-Hispanic White adults (19.7%), those with annual household incomes of $75,000 or more (21.4%), those who were never married (18.5%) or were divorced/separated/widowed (19.4%), and veterans (20.9%) (1). Binge drinking prevalence was significantly higher among adults with a college degree (18.9%) than among adults with less than a high school diploma (14.9%) (1). States with higher binge drinking prevalence estimates clustered in the Midwest and Northeast. Binge drinking is associated with many health problems including unintentional injuries, violence, sexually transmitted diseases, poor pregnancy outcomes, fetal alcohol spectrum disorders, and chronic diseases (e.g., high blood pressure, cancer) (2). Evidence-based alcohol policies, such as those recommended in the Community Guide, can be effective in preventing excessive alcohol use, including binge drinking (3).
Notes The measure does not convey the frequency or intensity of binge drinking or the specific amount of alcohol consumed, both of which affect the risks of alcohol-related harms.
Related Objectives or Recommendations Healthy People 2030 objective: SU-10. Reduce the proportion of people aged 21 years and over who engaged in binge drinking in the past month.
  1. Bohm MK, Liu Y, Esser MB, et al. Binge drinking among adults, by select characteristics and state — United States, 2018. MMWR Morb Mortal Wkly Rep. 2021;70(41):1441–1446. doi: https://doi.org/10.15585/mmwr.mm7041a2.
  2. National Center for Chronic Disease Prevention and Health Promotion. Binge Drinking. Centers for Disease Control and Prevention. Updated November 14, 2022. Accessed April 3, 2023. https://www.cdc.gov/alcohol/excessive-drinking-data/index.html .
  3. Community Preventive Services Task Force. Excessive Alcohol Consumption. The Community Guide. Accessed April 3, 2023. https://www.thecommunityguide.org/topics/excessive-alcohol-consumption.html.
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Current cigarette smoking among adults
Population All Adults
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who report having smoked ≥ 100 cigarettes in their lifetime and currently smoke every day or some days. The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Current
Summary More than 480,000 deaths each year are attributed to cigarette smoking and exposure to tobacco smoke, making it the leading preventable cause of death in the United States (1). In 2020, 12.5% of adults currently smoked cigarettes (2). Smoking increases the risk of heart disease, stroke, multiple types of cancer, and chronic lung disease (3). Quitting smoking is beneficial to health at any age, reduces the risk of premature death, and can add as much as 10 years to life expectancy (3, 4).
Notes This measure does not convey the lifetime or current number of cigarettes smoked. Each of these factors can affect the risk of acquiring chronic disease from smoking cigarettes. Additionally, the indicator does not measure intent or attempts to quit smoking among smokers or exposure to secondhand smoke among nonsmokers.
Related Objectives or Recommendations Healthy People 2030 objective: TU-02. Reduce current cigarette smoking in adults.
  1. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2014. https://www.ncbi.nlm.nih.gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf.
  2. Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco product use among adults – United States, 2020. MMWR Morb Mortal Wkly Rep. 2022;71(11):397–405. doi: https://doi.org/10.15585/mmwr.mm7111a1.
  3. Office of the Surgeon General. 2010 Surgeon General’s Report: How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease. US Dept of Health and Human Services; 2010. https://www.ncbi.nlm.nih.gov/books/NBK53017/pdf/Bookshelf_NBK53017.pdf.
  4. Office of the Surgeon General. Smoking Cessation: A Report of the Surgeon General. US Dept of Health and Human Services; 2020. https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf.
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No leisure-time physical activity among adults
Population All Adults
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability of having no leisure-time physical activity (reporting ‘No’ to the question: “During the past month, other than your regular job, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?”). The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Past month
Summary Regular physical activity can improve the health and quality of life of Americans of all ages, regardless of the presence of a chronic disease or disability (1). Among adults and older adults, physical activity can lower the risk of early death, coronary heart disease, stroke, high blood pressure, type 2 diabetes, breast and colon cancer, falls, and depression (1). The second edition of the Physical Activity Guidelines for Americans states that adults should move more and sit less throughout the day. Some physical activity is better than none. Adults who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits (1). Despite the benefits, in 2021, 23.7% of adults reported engaging in no leisure-time physical activity (2).
Notes This measure captures information only about non-occupational physical activity.
Related Objectives or Recommendations Healthy People 2030 objective: PA-01. Reduce the proportion of adults who do no physical activity in their free time.
  1. U.S. Department of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. U.S. Department of Health and Human Services; 2018. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf.
  2. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity. Data, Trend and Maps. Centers for Disease Control and Prevention; 2022. https://www.cdc.gov/nccdphp/dnpao/data-trends-maps/index.html.
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Short sleep duration among adults
Population All Adults
Model-based measure A multi-level regression and post-stratification approach was applied to BRFSS and ACS data to compute a detailed probability among adults who report usually getting insufficient sleep duration (<7 hours, on average, during a 24-hour period) (1). The probability was then applied to the detailed population estimates at the appropriate geographic level to generate the prevalence. The 95% confidence interval was derived using Monte Carlo simulation. Detailed methods are available here.
Measure Type Prevalence (crude and age-adjusted)
Time Period of Case Definition Average 24-hour period
Summary In 2020, 35% of United States adults reported insufficient sleep duration (<7 hours for those aged ≥18 years, on average, during a 24-hour period) (2). Insufficient sleep duration is associated with an increased risk of a number of chronic conditions—such as obesity, diabetes, hypertension, heart disease, stroke, anxiety, and depression (1). Insufficient sleep duration can also cause motor vehicle crashes, industrial errors, and medical errors causing substantial injury and disability each year (1,3). Keeping a consistent sleep schedule, establishing a relaxing bedtime routine, and limiting bright light exposure in the evenings are some of the ways to improve sleep (4).
Notes This measure does not convey variation in sleep duration (for instance, weekday vs. weekend sleep) or quality of sleep. Both might affect the risk for chronic disease. Indicator does not identify specific sleep problems, such as sleep disordered breathing, which are associated with different chronic conditions. This measure is part of the rotating core and is administered in even years.
Related Objectives or Recommendations Healthy People 2030 objective: SH-03. Increase the proportion of adults who get enough sleep duration.
  1. Watson NF, Badr MS, Belenky G, et al. Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep. 2015;38(6):843–844. doi: https://doi.org/10.5665/sleep.4716.
  2. Centers for Disease Control and Prevention. Sleep and sleep disorders. Data and statistics: Adults. Accessed October 26, 2022. https://www.cdc.gov/sleep/data-and-statistics/Adults.html.
  3. Institute of Medicine (US) Committee on Sleep Medicine and Research. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. PMID: 20669438.
  4. American Academy of Sleep Medicine. Sleep education. Healthy sleep habits. Accessed October 26, 2022.https://sleepeducation.org/healthy-sleep/healthy-sleep-habits/.
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