Health behaviors, person by person

The share of adults who binged on alcohol in the past month was 13.3% (95% CI 13.0% to 13.5%)13.3% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 13.0% to 13.5%n450,791 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the lowest of five household income bands and 20.4% (95% CI 20.3% to 20.6%)20.4% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 20.3% to 20.6%n1,254,573 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the highest. Current smoking, obesity and physical inactivity were each lower in the highest band, at 8.5%8.5% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 8.4% to 8.6%n1,392,590 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS, 28.4%28.4% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 28.3% to 28.6%n1,365,694 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS and 13.6%13.6% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 13.5% to 13.7%n1,411,844 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: no leisure-time physical activity in the past 30 daysPeriodBRFSS 2014-2024SourceBRFSS. The estimates come from the Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey that CDC runs with state health departments, pooled over survey years from 2014 to 2024.[1] The rise in binge drinking is an average over groups that differ. The difference between the highest band and the lowest is 8.68.6 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 8.3 to 8.9n1,319,140 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationWhite non-Hispanic adults in the 50 states and the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points among non-Hispanic White adults, 10.310.3 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 9.3 to 11.2n119,344 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationHispanic adults in the 50 states and the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS among Hispanic adults and 0.5 (95% CI −0.3 to 1.2)0.5 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI −0.3 to 1.2n120,974 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationBlack non-Hispanic adults in the 50 states and the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS among non-Hispanic Black adults.

The BRFSS files also hold interviews in Guam, Puerto Rico and the Virgin Islands. They are outside every estimate in this chapter, which describes adults in the states and the District of Columbia.

Chapter 7.1, Health behaviors and the supply of care follows the same behaviors across census tracts with modeled estimatesModeled estimateA figure produced by a statistical model instead of a direct count or measurement, usually for small areas where direct data are thin, borrowing strength from surveys, neighboring areas or other data. Neighboring areas can share errors, so single extremes call for caution., and a tract value cannot show whether the adults who drink in a tract are the ones with high incomes (ecological inferenceEcological inferenceDrawing conclusions about individuals from data about places or groups. A pattern across counties need not hold for the people inside them.). A survey that asks each adult about drinking and household income can. The cost is place, because BRFSS locates a respondent by state and, for some respondents, by metro status, and nowhere finer. Every estimate below is a share of respondents weighted with the survey's survey weightsSurvey weightsNumbers attached to survey respondents that say how many people in the population each one represents, so that results describe the whole population and not only the people who answered., and every 95% interval uses the survey's strata and sampling units. No cell rests on fewer than 3030 count in a definitionEstimanddefinition: the smallest number of respondents behind any published cellWeightsnone (definition)Populationthe smallest number of respondents behind any published cellPeriod2014-2024SourceBRFSS respondents, and no respondent-level row is published.

Binge drinking rises with household income while smoking, obesity and inactivity fall

A binge is 55 count in a definitionEstimanddefinition: drinks on one occasion that make a binge for menWeightsnone (definition)Populationdrinks on one occasion that make a binge for menPeriod2014-2024SourceBRFSS or more drinks on one occasion for a man, or 44 count in a definitionEstimanddefinition: drinks on one occasion that make a binge for womenWeightsnone (definition)Populationdrinks on one occasion that make a binge for womenPeriod2014-2024SourceBRFSS or more for a woman, at least once in the past 3030 count in a definitionEstimanddefinition: days in the period the binge drinking question coversWeightsnone (definition)Populationdays in the period the binge drinking question coversPeriod2014-2024SourceBRFSS days.[2] The question is in the survey from 2015, so binge estimates cover 1010 survey yearsEstimanddefinition: the binge drinking question is in the files from 2015Weightsnone (count)PopulationBRFSS public-use filesPeriod2015-2024SourceBRFSS years and the other measures cover 1111 survey yearsEstimanddefinition: survey years 2014 to 2024Weightsnone (count)PopulationBRFSS public-use filesPeriod2014-2024SourceBRFSS.

The pooled file holds 4,790,7424,790,742 respondentsEstimandcount of interviews in the public-use filesWeightsnone (count)Populationadults in the 50 states and the District of ColumbiaPeriod2014-2024SourceBRFSS interviews with adults in the states and the District of Columbia. The binge drinking estimates by income band rest on 3,336,6773,336,677 respondentsEstimandcount of respondents behind the five binge drinking estimates by income bandWeightsnone (count)Populationadults in the 50 states and the District of Columbia with an income band and an answer to the binge drinking questionPeriodBRFSS 2015-2024SourceBRFSS of them, because the question was not asked in 2014 and some adults gave no income.

Across the 55 income bandsEstimanddefinition: five bands common to all yearsWeightsnone (count)Populationhousehold income bands used in the chapterPeriod2014-2024SourceBRFSS income bands the share of adults who binged rises at every step, from 13.3% (95% CI 13.0% to 13.5%)13.3% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 13.0% to 13.5%n450,791 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the lowest band to 20.4% (95% CI 20.3% to 20.6%)20.4% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 20.3% to 20.6%n1,254,573 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the highest, a difference of 7.2 (95% CI 6.9 to 7.5)7.2 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 6.9 to 7.5n1,705,364 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest and lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points (Table 1).

The other three behaviors fall at every step. Current smokers, adults who have smoked at least 100100 count in a definitionEstimanddefinition: the lifetime cigarettes that make a smokerWeightsnone (definition)Populationthe lifetime cigarettes that make a smokerPeriod2014-2024SourceBRFSS cigarettes in their lives and now smoke every day or some days,[1] are 25.7% (95% CI 25.4% to 25.9%)25.7% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 25.4% to 25.9%n531,816 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the lowest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS of adults in the lowest band and 8.5% (95% CI 8.4% to 8.6%)8.5% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 8.4% to 8.6%n1,392,590 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS in the highest, a difference of 17.2 (95% CI 16.9 to 17.4)17.2 percentage points of adults, lower in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 16.9 to 17.4n1,924,406 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest and lowest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS points.

Obesity, a body mass index of 3030 count in a definitionEstimanddefinition: the body mass index at which an adult counts as obeseWeightsnone (definition)Populationthe body mass index at which an adult counts as obesePeriod2014-2024SourceBRFSS or more from self-reported height and weight, goes from 36.0%36.0% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 35.7% to 36.3%n512,939 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the lowest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS to 28.4%28.4% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 28.3% to 28.6%n1,365,694 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS, a difference of 7.6 (95% CI 7.2 to 7.9)7.6 percentage points of adults, lower in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 7.2 to 7.9n1,878,633 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest and lowest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS points. The share who did no leisure-time physical activity in the past month goes from 38.2%38.2% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 37.9% to 38.5%n537,736 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the lowest of five household income bands: no leisure-time physical activity in the past 30 daysPeriodBRFSS 2014-2024SourceBRFSS to 13.6%13.6% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 13.5% to 13.7%n1,411,844 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: no leisure-time physical activity in the past 30 daysPeriodBRFSS 2014-2024SourceBRFSS, a difference of 24.6 (95% CI 24.3 to 24.9)24.6 percentage points of adults, lower in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 24.3 to 24.9n1,949,580 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest and lowest of five household income bands: no leisure-time physical activity in the past 30 daysPeriodBRFSS 2014-2024SourceBRFSS points.

The lowest band is household income under $20,000$20,000 dollars of annual household incomeEstimanddefinition: income band edgeWeightsnone (definition)Populationupper limit of the lowest income bandPeriod2014-2024SourceBRFSS a year and the highest is $75,000$75,000 dollars of annual household incomeEstimanddefinition: income band edgeWeightsnone (definition)Populationlower limit of the highest income bandPeriod2014-2024SourceBRFSS or more. BRFSS recorded income in eight categories through 2020 and in eleven from 2021, which split the top category, so the five bands merge the categories that did not change and keep the highest band whole across the break. The bands are in nominal dollars, and the highest band held 30.2%30.2% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; share in the highest of five bands (bands are in nominal dollars)Interval95% CI 29.9% to 30.5%n386,053 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who reported a household income bandPeriod2014SourceBRFSS of the respondents who gave an income in 2014 and 46.1%46.1% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; share in the highest of five bands (bands are in nominal dollars)Interval95% CI 45.7% to 46.4%n364,440 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who reported a household income bandPeriod2024SourceBRFSS in 2024.

Part of that shift is a step at the 2021 change in the question, when the lowest band went from 15.8%15.8% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; share in the lowest of five bands (bands are in nominal dollars)Interval95% CI 15.4% to 16.1%n316,015 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who reported a household income bandPeriod2020SourceBRFSS of respondents who gave an income in 2020 to 11.8%11.8% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; share in the lowest of five bands (bands are in nominal dollars)Interval95% CI 11.6% to 12.1%n338,675 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who reported a household income bandPeriod2021SourceBRFSS in 2021, a larger one-year drop than in any earlier year. A further 19.4% (95% CI 19.3% to 19.5%)19.4% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; the share who did not know or refused to give a household income, or left it blankInterval95% CI 19.3% to 19.5%n4,790,742 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of ColumbiaPeriodBRFSS 2014-2024SourceBRFSS of adults did not know their household income or declined to give it, and they are not in any band.

Table 1. Binge drinking rose from 13.3% to 20.4% of adults across the five income bands while smoking, obesity and inactivity fell

For 2021 to 2024 the highest band can be divided into four, and the second view of Table 1 shows them. Across those four bands binge drinking rises from 18.2% (95% CI 17.8% to 18.6%)18.2% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 17.8% to 18.6%n184,694 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the $75,000 to $99,999 band: binge drinking in the past 30 daysPeriodBRFSS 2021-2024SourceBRFSS to 22.1% (95% CI 21.5% to 22.6%)22.1% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 21.5% to 22.6%n93,005 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the $200,000 or more band: binge drinking in the past 30 daysPeriodBRFSS 2021-2024SourceBRFSS and smoking falls from 9.7%9.7% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 9.4% to 10.0%n189,175 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the $75,000 to $99,999 band: current cigarette smokingPeriodBRFSS 2021-2024SourceBRFSS to 4.3%4.3% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 4.0% to 4.6%n95,390 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the $200,000 or more band: current cigarette smokingPeriodBRFSS 2021-2024SourceBRFSS. Obesity falls most between the two highest bands, from 30.1%30.1% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 29.5% to 30.8%n88,636 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the $150,000 to $199,999 band: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2021-2024SourceBRFSS to 23.2%23.2% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 22.7% to 23.8%n94,433 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the $200,000 or more band: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2021-2024SourceBRFSS.

A rise in drinking with income appears in surveys from other settings. A review of studies of socioeconomic status and alcohol concluded that people of higher status drink similar or greater amounts, while people of lower status bear more of the consequences.[3] In a national survey of 2001 and 2002, the prevalence of alcohol abuse by the DSM-IV definition rose with income while alcohol dependence fell with it. The abuse result came from the hazardous use criterion, mostly driving after drinking.[4] BRFSS measures the quantity drunk on one occasion and does not measure consequences, so it cannot say who bears the harm.

The rise holds within age, education and state, not among non-Hispanic Black adults

Adults in different income bands differ in age, schooling and race, so a rise across pooled bands could come from who is in the bands. Table 2 repeats the comparison inside groups. In each of four age groups the rate is higher in the highest band than in the lowest, by 10.2 (95% CI 9.4 to 11.0)10.2 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 9.4 to 11.0n151,901 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia ages 18 to 29: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points at ages 1818 count in a definitionEstimanddefinition: the youngest age in the survey and in the youngest groupWeightsnone (definition)Populationthe youngest age in the survey and in the youngest groupPeriod2014-2024SourceBRFSS to 2929 count in a definitionEstimanddefinition: the oldest age in the youngest groupWeightsnone (definition)Populationthe oldest age in the youngest groupPeriod2014-2024SourceBRFSS and by 2.6 (95% CI 2.3 to 2.9)2.6 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 2.3 to 2.9n475,202 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia ages 65 and older: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points at 6565 count in a definitionEstimanddefinition: the youngest age in the oldest groupWeightsnone (definition)Populationthe youngest age in the oldest groupPeriod2014-2024SourceBRFSS and older. In the oldest group the rate goes from 4.4%4.4% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 4.2% to 4.6%n163,483 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia ages 65 and older in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS to 6.9%6.9% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 6.7% to 7.1%n311,719 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia ages 65 and older in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS. Within each education level the rate also rises with income, by 12.7 (95% CI 11.1 to 14.2)12.7 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 11.1 to 14.2n102,750 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who did not finish high school: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points among adults who did not finish high school and 3.5 (95% CI 2.9 to 4.1)3.5 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 2.9 to 4.1n859,753 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who graduated from college or technical school: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS among college graduates.

Table 2. The rise in binge drinking with income holds within age groups and education levels and differs by race and ethnicity

The education lines cross. In the lowest band, college graduates binge more often than adults who did not finish high school (15.2%15.2% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 14.6% to 15.8%n60,504 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who graduated from college or technical school in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS against 11.7%11.7% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 11.3% to 12.2%n89,482 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who did not finish high school in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS), and in the highest band less often (18.7%18.7% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 18.5% to 18.8%n799,249 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who graduated from college or technical school in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS against 24.4%24.4% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 23.0% to 26.0%n13,268 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who did not finish high school in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS). At a given income, then, schooling does not move binge drinking in one direction, and a single measure of socioeconomic status that combined income and schooling would hide the crossing.

The race and ethnicity tab shows a rise that is not shared by every group. Among White non-Hispanic adults the rate goes from 13.0%13.0% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 12.8% to 13.3%n275,676 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationWhite non-Hispanic adults in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS to 21.7%21.7% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 21.5% to 21.8%n1,043,464 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationWhite non-Hispanic adults in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS, a difference of 8.6 (95% CI 8.3 to 8.9)8.6 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 8.3 to 8.9n1,319,140 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationWhite non-Hispanic adults in the 50 states and the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points, and among Hispanic adults the difference is 10.3 (95% CI 9.3 to 11.2)10.3 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 9.3 to 11.2n119,344 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationHispanic adults in the 50 states and the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points. Among multiracial non-Hispanic adults it is 5.5 (95% CI 3.7 to 7.3)5.5 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 3.7 to 7.3n35,796 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationmultiracial non-Hispanic adults in the 50 states and the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points.

Among Black non-Hispanic adults the rate is 13.3%13.3% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 12.8% to 13.8%n61,641 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationBlack non-Hispanic adults in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the lowest band and 13.8%13.8% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 13.2% to 14.3%n59,333 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationBlack non-Hispanic adults in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the highest, a difference of 0.5 (95% CI −0.3 to 1.2)0.5 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI −0.3 to 1.2n120,974 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationBlack non-Hispanic adults in the 50 states and the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points whose interval includes zero. Among adults of another race, non-Hispanic, the difference is 1.0 (95% CI 0.0 to 2.1)1.0 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 0.0 to 2.1n86,080 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults of another race, non-Hispanic in the 50 states and the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points.

The pooled difference of 7.27.2 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 6.9 to 7.5n1,705,364 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest and lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points therefore averages groups in which the rise is large with groups in which it is absent or small, so the pattern behind this chapter's label belongs to White, Hispanic and multiracial adults. The survey cannot say why the groups differ. The review cited above lists race and ethnicity among the factors that moderate the link between socioeconomic status and alcohol use.[3]

The rise is also not the product of a few states. Comparing the highest band with the lowest within each state, the difference in binge drinking is above zero in 5151 states and the District of ColumbiaEstimandcount of jurisdictions where the binge drinking rate is higher in the highest income band than in the lowestWeightsnone (count)Populationthe 50 states and the District of ColumbiaPeriodBRFSS 2015-2024SourceBRFSS of the 5151 states and the District of ColumbiaEstimandcount of jurisdictions in the analysisWeightsnone (count)Populationthe 50 states and the District of ColumbiaPeriod2014-2024SourceBRFSSNoteGuam, Puerto Rico and the Virgin Islands are in the BRFSS files and outside the analysis. jurisdictions, the states and the District of Columbia, and its interval is above zero in 5151 states and the District of ColumbiaEstimandcount of jurisdictions where the 95% interval of that difference is above zeroWeightsnone (count)Populationthe 50 states and the District of ColumbiaPeriodBRFSS 2015-2024SourceBRFSS (Table 3). It runs from 2.7 (95% CI 1.6 to 3.7)2.7 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% interval; the jurisdiction with the smallest differenceInterval95% CI 1.6 to 3.7n46,474 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in Utah: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points in Utah to 13.1 (95% CI 10.7 to 15.5)13.1 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% interval; the jurisdiction with the largest differenceInterval95% CI 10.7 to 15.5n18,026 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points in the District of Columbia.

The smoking difference is below zero, with an interval below zero, in 5151 states and the District of ColumbiaEstimandcount of jurisdictions where the 95% interval of the smoking difference (highest minus lowest income band) is below zeroWeightsnone (count)Populationthe 50 states and the District of ColumbiaPeriodBRFSS 2014-2024SourceBRFSS as well, from 9.1 (95% CI 8.2 to 9.9)9.1 percentage points of adults, lower in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% interval; the jurisdiction with the smallest differenceInterval95% CI 8.2 to 9.9n51,083 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in California: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS points lower in California to 29.9 (95% CI 27.2 to 32.6)29.9 percentage points of adults, lower in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% interval; the jurisdiction with the largest differenceInterval95% CI 27.2 to 32.6n21,314 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in Alaska: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS points lower in Alaska. In the tract regressions of Chapter 7.1, Health behaviors and the supply of care, Maryland is the one state with a negative estimate for binge drinking, and its interval includes zero. Among Maryland's respondents the difference is 5.7 (95% CI 4.4 to 6.9)5.7 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 4.4 to 6.9n68,318 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in Maryland: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points.

Table 3. Binge drinking is higher in the highest income band than in the lowest in all 51 jurisdictions, and smoking is lower in all 51

The difference is positive in each of the 1010 survey yearsEstimanddefinition: the binge drinking question is in the files from 2015Weightsnone (count)PopulationBRFSS public-use filesPeriod2015-2024SourceBRFSS survey years from 2015 to 2024, with an interval above zero in 1010 survey yearsEstimandcount of survey years in which the 95% interval of the binge drinking difference (highest minus lowest income band) is above zeroWeightsnone (count)Populationadults in the 50 states and the District of ColumbiaPeriodBRFSS 2015-2024SourceBRFSS of them. The yearly differences run from 6.7 (95% CI 5.8 to 7.7)6.7 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% interval; the survey year with the smallest differenceInterval95% CI 5.8 to 7.7n182,498 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia, survey year 2024: binge drinking in the past 30 daysPeriod2024SourceBRFSS points in 2024 to 8.3 (95% CI 7.3 to 9.2)8.3 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% interval; the survey year with the largest differenceInterval95% CI 7.3 to 9.2n164,332 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia, survey year 2022: binge drinking in the past 30 daysPeriod2022SourceBRFSS points in 2022, and those two intervals overlap. The difference is also similar on either side of the 2021 change in the income question, at 7.3 (95% CI 6.9 to 7.6)7.3 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% interval; before and after BRFSS changed its income question in 2021Interval95% CI 6.9 to 7.6n1,024,361 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest and lowest of five household income bands: binge drinking in the past 30 daysPeriod2015-2020SourceBRFSS points for 2015 to 2020 and 7.5 (95% CI 7.0 to 8.0)7.5 percentage points of adults, higher in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% interval; before and after BRFSS changed its income question in 2021Interval95% CI 7.0 to 8.0n681,003 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest and lowest of five household income bands: binge drinking in the past 30 daysPeriod2021-2024SourceBRFSS points for 2021 to 2024.

Men binge drink more than women in every income band, by about the same number of points

Men's binge drinking rate rises from 18.3%18.3% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 17.9% to 18.7%n170,518 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the lowest band to 24.3%24.3% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 24.1% to 24.5%n657,924 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the highest, and women's rises from 9.7%9.7% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 9.4% to 9.9%n280,085 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS to 15.8%15.8% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 15.6% to 16.0%n596,461 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS (Table 4).

The difference between men and women is between 8.5 (95% CI 8.2 to 8.8)8.5 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 8.2 to 8.8n1,254,385 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the income band with the smallest difference: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS and 9.2 (95% CI 8.7 to 9.6)9.2 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 8.7 to 9.6n613,943 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the income band with the largest difference: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points in every band, so the lines stay about the same distance apart. As both rates rise by a similar number of points, the ratio of men's rate to women's falls from 1.9 (95% CI 1.8 to 2.0)1.9 ratio of rates, men to womenEstimandratio of two weighted shares from different groups of respondents, log-scale interval from the two standard errors in quadratureInterval95% CI 1.8 to 2.0n450,603 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the lowest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the lowest band to 1.5 (95% CI 1.5 to 1.6)1.5 ratio of rates, men to womenEstimandratio of two weighted shares from different groups of respondents, log-scale interval from the two standard errors in quadratureInterval95% CI 1.5 to 1.6n1,254,385 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS in the highest, and stays above one.

Table 4. Men binge drink more than women in every income band, by 8.5 to 9.2 points

Obesity shows a different pattern by sex. Women are more often obese than men in the lowest band, by 8.6 (95% CI 8.0 to 9.2)8.6 percentage points of adults, higher among women than among menEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 8.0 to 9.2n512,756 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the lowest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS points (39.7%39.7% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 39.4% to 40.1%n314,114 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women in the lowest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS against 31.1%31.1% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 30.7% to 31.6%n198,642 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men in the lowest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS). They are less often obese in the highest band, by 5.6 (95% CI 5.2 to 5.9)5.6 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 5.2 to 5.9n1,365,521 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS points (25.3%25.3% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 25.1% to 25.6%n631,594 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women in the highest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS against 30.9%30.9% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 30.7% to 31.1%n733,927 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men in the highest of five household income bands: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS), as women's rate falls across the bands and men's does not. Smoking falls with income for both sexes and the difference narrows, from 6.7 (95% CI 6.2 to 7.2)6.7 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 6.2 to 7.2n531,613 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the lowest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS points in the lowest band to 2.9 (95% CI 2.7 to 3.1)2.9 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 2.7 to 3.1n1,392,389 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia in the highest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS in the highest.

The slope with income differs by behavior and, for obesity, by sex

Table 5 sets the rate in the highest band against the rate in the lowest for six measures, separately for women and men. Binge drinking is the only measure that is higher in the highest band, and it is higher by 6.0 (95% CI 5.6 to 6.5)6.0 percentage points of adults, richest minus poorest of five income bandsEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 5.6 to 6.5n828,442 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points for men and 6.2 (95% CI 5.8 to 6.5)6.2 percentage points of adults, richest minus poorest of five income bandsEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 5.8 to 6.5n876,546 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS for women, a difference between the sexes of 0.1 (95% CI −0.4 to 0.7)0.1 percentage points, women's difference between the highest and the lowest income band minus men'sEstimanddifference between the women's and the men's income-band differences; standard errors added in quadrature (disjoint groups of respondents)Interval95% CI −0.4 to 0.7n1,704,988 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia: binge drinking in the past 30 daysPeriodBRFSS 2015-2024SourceBRFSS points whose interval includes zero.

For obesity the difference is −14.4 (95% CI −14.8 to −13.9)−14.4 percentage points of adults, richest minus poorest of five income bandsEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI −14.8 to −13.9n945,708 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS points for women and −0.2 (95% CI −0.7 to 0.3)−0.2 percentage points of adults, richest minus poorest of five income bandsEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI −0.7 to 0.3n932,569 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS for men, and the men's interval includes zero. The women's difference is 14.2 (95% CI 13.5 to 14.8)14.2 percentage points steeper for women than for men (richest minus poorest band, women's difference minus men's, sign reversed)Estimanddifference between the women's and the men's income-band differences; standard errors added in quadrature (disjoint groups of respondents)Interval95% CI 13.5 to 14.8n1,878,277 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia: obesity (BMI 30 or more, self-reported height and weight)PeriodBRFSS 2014-2024SourceBRFSS points steeper than the men's.

Smoking is steeper for men, with a difference of −19.7 (95% CI −20.1 to −19.3)−19.7 percentage points of adults, richest minus poorest of five income bandsEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI −20.1 to −19.3n928,501 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS points against −15.9 (95% CI −16.2 to −15.6)−15.9 percentage points of adults, richest minus poorest of five income bandsEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI −16.2 to −15.6n995,501 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS for women, which is 3.8 (95% CI 3.2 to 4.3)3.8 percentage points steeper for men than for women (richest minus poorest band, women's difference minus men's)Estimanddifference between the women's and the men's income-band differences; standard errors added in quadrature (disjoint groups of respondents)Interval95% CI 3.2 to 4.3n1,924,002 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS points steeper. For fair or poor health the two differences are close, at −29.7−29.7 percentage points of adults, richest minus poorest of five income bandsEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI −30.2 to −29.3n952,294 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men: fair or poor self-rated healthPeriodBRFSS 2014-2024SourceBRFSS for men and −30.6−30.6 percentage points of adults, richest minus poorest of five income bandsEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI −31.0 to −30.3n1,023,026 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women: fair or poor self-rated healthPeriodBRFSS 2014-2024SourceBRFSS for women.

Table 5. The obesity difference between the highest and the lowest income band is −14.4 points for women and −0.2 for men

Reviews of the literature report an inverse association between socioeconomic status and obesity in high-income countries,[5, 6] and the earlier of the two found it most clearly among women.[5] The survey shows the same sex difference for income in the United States over 2014 to 2024. The obesity rate of men is nearly the same in the lowest and highest bands, and the rate of women is not.

Smoking separates by education and, between the sexes, by race and ethnicity

The smoking rate is highest among adults with the least schooling and the lowest income, and the table of rates by schooling and income shows a row in which the rate falls least with income (Table 6). Among adults who did not finish high school the rate is 28.0%28.0% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 27.5% to 28.5%n107,166 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who did not finish high school in the lowest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS in the lowest band and 23.2%23.2% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 21.9% to 24.5%n15,060 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who did not finish high school in the highest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS in the highest, a difference of 4.8 (95% CI 3.4 to 6.2)4.8 percentage points of adults, lower in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 3.4 to 6.2n122,226 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who did not finish high school: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS points, and it does not fall at every step.

Among college graduates it goes from 13.6%13.6% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 13.1% to 14.1%n70,037 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who graduated from college or technical school in the lowest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS to 4.4%4.4% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 4.4% to 4.5%n885,429 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who graduated from college or technical school in the highest of five household income bands: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS, a difference of 9.1 (95% CI 8.7 to 9.6)9.1 percentage points of adults, lower in the highest income bandEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 8.7 to 9.6n955,466 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who graduated from college or technical school: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS points. Across all incomes the rate is 24.7%24.7% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 24.4% to 25.0%n301,438 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who did not finish high school: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS among adults who did not finish high school and 5.8%5.8% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 5.8% to 5.9%n1,783,216 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who graduated from college or technical school: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS among college graduates.

Table 6. Smoking is 28.0% among adults who did not finish high school in the lowest income band and 4.4% among college graduates in the highest

Men smoke more than women, 16.5%16.5% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 16.4% to 16.6%n2,049,062 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS of men against 12.8%12.8% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 12.7% to 12.9%n2,492,615 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS of women, but the difference depends on race and ethnicity (Table 7). It is 1.7 (95% CI 1.6 to 1.9)1.7 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 1.6 to 1.9n3,452,292 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationWhite non-Hispanic adults: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS points among White non-Hispanic adults and 8.1 (95% CI 7.7 to 8.5)8.1 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 7.7 to 8.5n346,545 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationHispanic adults: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS among Hispanic adults, with Black non-Hispanic adults at 7.0 (95% CI 6.5 to 7.4)7.0 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 6.5 to 7.4n345,930 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationBlack non-Hispanic adults: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS, adults of another race, non-Hispanic, at 5.9 (95% CI 5.4 to 6.4)5.9 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 5.4 to 6.4n215,106 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults of another race, non-Hispanic: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS and multiracial non-Hispanic adults at 3.3 (95% CI 2.2 to 4.4)3.3 percentage points of adults, higher among men than among womenEstimanddesign-based difference between two weighted shares of respondents, Taylor-linearized 95% intervalInterval95% CI 2.2 to 4.4n93,285 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationmultiracial non-Hispanic adults: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS.

Across the five groups, men's rates run from 13.5% (95% CI 13.1% to 14.0%)13.5% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; the lowest rate of the five race and ethnicity groupsInterval95% CI 13.1% to 14.0%n107,849 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men and of another race, non-Hispanic: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS to 21.9% (95% CI 21.2% to 22.7%)21.9% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; the highest rate of the five race and ethnicity groupsInterval95% CI 21.2% to 22.7%n44,344 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men and multiracial non-Hispanic: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS and women's from 7.6% (95% CI 7.4% to 7.9%)7.6% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; the lowest rate of the five race and ethnicity groupsInterval95% CI 7.4% to 7.9%n185,066 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women and Hispanic: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS to 18.6% (95% CI 17.9% to 19.4%)18.6% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; the highest rate of the five race and ethnicity groupsInterval95% CI 17.9% to 19.4%n48,941 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women and multiracial non-Hispanic: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS, with multiracial non-Hispanic adults highest for both sexes. Women's rates differ more across groups than men's, so the size of the difference follows the women's rates.

White women smoke at 14.5%14.5% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 14.4% to 14.6%n1,898,894 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women and White non-Hispanic: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS and Hispanic women at 7.6%7.6% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 7.4% to 7.9%n185,066 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are women and Hispanic: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS, against 16.3%16.3% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 16.1% to 16.4%n1,553,398 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men and White non-Hispanic: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS and 15.8%15.8% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% intervalInterval95% CI 15.4% to 16.1%n161,479 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who are men and Hispanic: current cigarette smokingPeriodBRFSS 2014-2024SourceBRFSS for men. Men's rate is above women's in all 2525 cellsEstimandcount of cells: five groups by five income bandsWeightsnone (count)Populationrace and ethnicity by income band cellsPeriodBRFSS 2014-2024SourceBRFSS cells of race and ethnicity by income band, with an interval above zero in 2525 cellsEstimandcount of cells where the 95% interval of the smoking difference between men and women is above zeroWeightsnone (count)Populationrace and ethnicity by income band cellsPeriodBRFSS 2014-2024SourceBRFSS.

Table 7. Men smoke more than women by 1.7 points among non-Hispanic White adults and 8.1 among Hispanic adults

Cross-national work describes the difference between the sexes in smoking as a stage in the spread of cigarettes, which reach men before women.[7, 8] The pattern across groups here fits that account, but one survey period cannot show a diffusion over time.

Evidence on whether income changes drinking and smoking

What these data cannot show

Every measure in this chapter is reported by the respondent in a telephone interview, so the estimates describe what adults say. Respondents may under-report their drinking and their weight, and the data cannot show whether that differs by income, sex or race. The 2024 survey year is provisional. The intervals reflect the survey's sampling design and weights. They do not cover the adults who could not be reached or declined to take part, or the 19.4%19.4% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; the share who did not know or refused to give a household income, or left it blankInterval95% CI 19.3% to 19.5%n4,790,742 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of ColumbiaPeriodBRFSS 2014-2024SourceBRFSS of adults who gave no household income and are left out of every band.

The data are a repeated cross-section, not a panel. A person in the highest band and a person in the lowest are different people, so the gradients say how behavior differs across incomes and not how it changes when one person's income changes. The bands are household income in nominal dollars, not adjusted for household size or for prices. The highest band holds 46.1%46.1% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; share in the highest of five bands (bands are in nominal dollars)Interval95% CI 45.7% to 46.4%n364,440 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who reported a household income bandPeriod2024SourceBRFSS of respondents who gave an income in 2024 against 30.2%30.2% percent of adultsEstimanddesign-based weighted share of respondents, Taylor-linearized 95% interval; share in the highest of five bands (bands are in nominal dollars)Interval95% CI 29.9% to 30.5%n386,053 respondentsWeightsBRFSS final weight (xllcpwt); stratum and primary sampling unit for the intervalPopulationadults in the 50 states and the District of Columbia who reported a household income bandPeriod2014SourceBRFSS in 2014, and part of that shift is a step at the 2021 change in the income question, so pooling the years mixes survey years with different bands. The binge drinking difference between the highest band and the lowest is similar before and after that change. Income, age, schooling and race are related. The age, education and race and ethnicity panels compare within one of them at a time and only for binge drinking, and the other figures are not age-adjusted.

The groups are those BRFSS defines. The Hispanic group may be of any race, and the other-race group combines populations whose drinking and smoking differ. Binge drinking is a measure of quantity on one occasion, and a person who binges once in a month is counted with a person who binges every week. BRFSS locates respondents by state and, for some respondents, by metro status, which is missing for a large share of respondents and is not used here, so the results say nothing about neighborhoods. The person-level results here and the tract-level results of Chapter 7.1, Health behaviors and the supply of care come from different measures, survey responses in one and modeled estimates in the other, so neither confirms the other. Whether the drinking measured here relates to the alcohol-related deaths mapped in Chapter 8.2, Overdose, alcohol and suicide is outside what BRFSS can show.