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Sexual Health
The reduction in the teen birth rate is a national success; however, significant disparities by race/ethnicity and geography persist.
Teen Births
Substantial social, economic and health costs are associated with teen pregnancy and child-rearing. Teenage childbearing is associated with lower educational attainment, which may limit the teen’s future economic opportunities. The children of teen mothers have a higher risk of mental health issues, aggression and behavior problems, academic difficulties and continuous delinquent behavior as well as becoming teen mothers themselves. Teen mothers may experience stigma in health care settings, schools and their communities.
Changes over time. Nationally, the teen birth rate decreased 66% from 40.2 to 13.6 births per 1,000 females ages 15-19 between 2008 and 2022. The rate has met the Healthy People 2030 target of 31.4 pregnancies per 1,000 females ages 15-19 years. However, the decline has slowed in recent years, decreasing 2% (from 13.9) between 2021 and 2022.
Between 2008 and 2022, the teen birth rate decreased the same as or more than the national change in 30 states and the District of Columbia, led by: 76% in both New Hampshire (19.1 to 4.6 births per 1,000 females ages 15-19) and the District of Columbia (51.1 to 12.5), 74% in both California (37.9 to 9.8) and Utah (34.6 to 9.0), and 73% in Colorado (40.5 to 11.1).
Disparities. The teen birth rate varied by race/ethnicity and geography in 2022. The rate was:
- 13.1 times higher among American Indian/Alaska Native (22.2 births per 1,000 females ages 15-19) than Asian (1.7) teenagers.
Smoking and Tobacco Use
The reduction in the smoking rate is a national success. However, disparities persist, and new methods of nicotine delivery are becoming more common.
Smoking*
Cigarettes are responsible for more than 480,000 deaths yearly, making smoking the leading cause of preventable death and disease in the United States. Smoking can affect nonsmokers as well; exposure to secondhand smoke is responsible for more than 19,000 deaths every year. Smoking damages nearly every organ and can cause heart disease, stroke, diabetes and multiple types of cancer, as well as respiratory conditions such as emphysema and chronic bronchitis. More than 16 million Americans live with a disease caused by smoking. Quitting smoking can have profound benefits on current and long-term health at any age, leading to an enhanced quality of life.
Changes over time. Nationally, the percentage of adults who reported smoking at least 100 cigarettes in their lifetime and currently smoke daily or some days decreased 59% (from 29.5%**) since the first Annual Report and decreased 43% from 21.2% to 12.1% of adults between 2011 and 2023. Recently, smoking decreased 14% between 2022 and 2023. Despite progress, the prevalence remains higher than the Healthy People 2030 target to reduce smoking to 6.1% of adults.
Between 2011 and 2023, smoking decreased:
- 48% among multiracial (31.0% to 16.0%), 47% among Black (23.1% to 12.2%), 42% among white (20.8% to 12.0%), 41% among Asian (9.0% to 5.3%), 40% among Hispanic (15.9% to 9.5%) and 30% among American Indian/Alaska Native (30.3% to 21.2%) adults.
During this time frame, smoking decreased in all 48 states with data and the District of Columbia, led by: 53% in both the District of Columbia (20.8% to 9.8%) and Rhode Island (20.0% to 9.5%), 52% in Maryland (19.1% to 9.1%) and 51% in Connecticut (17.1% to 8.4%).
Disparities. Smoking varied significantly by education, race/ethnicity, geography, income, disability status, age, metropolitan status, gender, sexual orientation and veteran status in 2023. The prevalence was:
- 4.8 times higher among adults with less than a high school education (21.5%) than college graduates (4.5%).
- 4.0 times higher among American Indian/Alaska Native (21.2%) than Asian (5.3%) adults.
- 3.0 times higher among adults with an annual household income less than $25,000 (21.9%) compared with adults with incomes of $75,000 or more (7.3%).
- 2.6 times higher among adults who have difficulty with self-care (22.8%) and adults who have independent living difficulty (22.8%) compared with adults without a disability (8.8%).
- 1.5 times higher among adults living in nonmetropolitan areas (16.4%) than in metropolitan areas (10.6%).
- 1.3 times higher among men (13.0%) than women (9.9%).
- 1.2 times higher among adults who have served in the U.S. armed forces (13.0%) than adults who have not served (11.2%).
*No data were available for Kentucky or Pennsylvania in 2023.
**U.S. HHS, Office of the Surgeon General, Reducing the Health Consequences of Smoking: 25 Years of Progress: A Report of the Surgeon General, 1989 (data year 1985).
***Sexual orientation data were based on responses to the question, “Which of the following best represents how you think of yourself?” Responses of lesbian or gay, gay, bisexual or something else were summed and classified as “LGBQ+.”
Note: The values for American Indian/Alaska Native and Hawaiian/Pacific Islander (14.7%) adults may not differ significantly based on overlapping 95% confidence intervals. The same is true for adults with independent living difficulty, adults who have difficulty with self-care, adults who have difficulty with cognition (20.6%) and adults with difficulty seeing (20.0%).
Related Measure: E-Cigarette Use*
Electronic cigarettes, also called e-cigarettes or vapes, are electronic devices that use heat to make an aerosol that the user inhales. In recent years, there has been an increase in the popularity of e-cigarettes, especially among youth.
Changes over time. Nationally, there was no change (7.7%) in 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 between 2022 and 2023. E-cigarette use was 11.8 times higher among those ages 18-44 (13.0%) compared with those age 65 and older (1.1%).