New analysis examining five unhealthy behaviors - smoking, excessive drinking, insufficient sleep, physical inactivity, obesity - finds more than 25 million American adults have multiple unhealthy behaviors (three or more).

United Health Foundation's America's Health Rankings® Spotlight: Impact of Unhealthy Behaviors, released today in partnership with Family Medicine for America's Health, finds that with just one unhealthy behavior, an adult's odds of poor health doubles, and the 25 million Americans with three or more unhealthy behaviors have 6.1 times greater risk of fair or poor health status than those with zero unhealthy behaviors.

The prevalence of multiple unhealthy behaviors is higher for adults living in central and south central states, including Indiana, Michigan, Alabama, Kentucky and Mississippi, according to the report. Conversely, adults living in Minnesota, as well as western states such as California, Oregon, Washington, Idaho, Utah, and Colorado, and New England states, including Massachusetts, Connecticut and Vermont, have a lower prevalence of multiple unhealthy behaviors.

Additional findings include:

  • Education and income levels have a "protective effect" on the likelihood of multiple unhealthy behaviors among adults aged 25 and older.
    • Nearly 20% of adults with an income of less than $25,000 a year have multiple unhealthy behaviors, compared with approximately 7% of adults with an income higher than $75,000.
    • More than 21% of adults who have not graduated from high school have three or more unhealthy behaviors, compared with only 5% of college graduates.
  • Prevalence of multiple unhealthy behaviors among adults aged 25 and older without a high school diploma varies widely by geography.
    • Although the percentage of college graduates with multiple unhealthy behaviors is relatively consistent across states, the percentage of adults who have not graduated from high school who have three or more unhealthy behaviors varies widely by state.
    • The widest gaps in the prevalence of multiple unhealthy behaviors between college graduates and those who have not graduated from high school exist in Michigan (25.5%), District of Columbia (24.8%) and Tennessee (24.5%).
    • The narrowest gaps are found in Nevada (7.8%), California (9.0%) and Illinois (10.2%).

    "This report shows dramatically that even a single unhealthy behavior can lead to poor health and that the impact only multiplies with additional behaviors. We support the care community in seeking ways to help people better manage the issues that hurt their health," said Ana Fuentevilla, M.D., chief medical officer of UnitedHealthcare Community & State.

    United Health Foundation's America's Health Rankings platform provides actionable, data-driven insights that people can use to inform change in their own communities.

    "These findings underscore the importance of taking action to reduce the prevalence of unhealthy behaviors and to help people better manage their health," said Glen R. Stream, M.D., M.B.I., president and board chair of Family Medicine for America's Health and sponsor of the Health is Primary campaign (HealthisPrimary.org). "We must pay particular attention to the 12% of adults with multiple unhealthy behaviors, as the report indicates that they are most at-risk for poor health. We know that access to primary care can help address these issues. Members of Family Medicine for America's Health are collaborating with partners like United Health Foundation to increase understanding of how to help reduce the prevalence of unhealthy behaviors, and to reiterate the need for providers to address the health of the whole person rather than view each behavior in isolation."

    The report analyzes data from the Behavioral Risk Factor Surveillance Survey, the largest health phone survey in the world. To read the report and other materials, including visual illustrations, visit: www.americashealthrankings.org/spotlight/unhealthybehaviors.