5 States with Highest Prevalence of Unhealthy Habits


Pharmacists in states with the highest incidence of smoking, excessive drinking, insufficient sleep, physical inactivity, and obesity should make a point to discourage all patients from partaking in unhealthy habits.

Pharmacists in states with the highest incidence of smoking, excessive drinking, insufficient sleep, physical inactivity, and obesity should make a point to discourage all patients from partaking in unhealthy habits.

The United Health Foundation recently released a report called “America’s Health Rankings Spotlight: Impact of Unhealthy Behaviors,” which is the second of 4 planned reports for 2016 focused on important health markers among US adults.

According to the current report, 72% of US adults have at least 1 unhealthy behavior, while 12% of the country (more than 25 million adults) has 3 or more unhealthy behaviors.

Source: United Health Foundation

The report focused on the impact of multiple unhealthy behaviors on a person’s health status, as well as public health overall.

“Traditionally, population risk behaviors are reported at the individual level,” the report read. “However, just like diseases, the combination of multiple unhealthy behaviors, even though they are often highly correlated, presents a different challenge for improving public health compared with examining the same behaviors in isolation.”

The report authors argued that focusing efforts on individuals with multiple unhealthy behaviors may present the greatest opportunity to improve public health, and pharmacists are well placed to pinpoint patients who may have them.

Let’s see how your state stacks up against others.


The 5 states with the highest number of smokers are West Virginia, Kentucky, Arkansas, Tennessee, and Louisiana.

Despite aggressive antismoking campaigns spanning several decades, >21% of adults in 11 states are self-reported smokers.

Source: United Health Foundation

Smoking cessation might be the ideal target for pharmacists, as the US Centers for Disease Control and Prevention (CDC) reported that an estimated 70% of adult smokers in the United States want to quit tobacco. Pharmacists can recommend OTC remedies for patients wishing to quit without a prescription, since studies have shown that these products can be equally as effective as prescription ones.

Patients should be advised that the combination of smoking cessation medications and counseling is more effective for smoking cessation than either medication or counseling alone.

Excessive Drinking

The top 5 states by number of adults who report excessive drinking are North Dakota, Wisconsin, Iowa, Alaska, and Nebraska.

Source: United Health Foundation

For women, excessive drinking is defined as 4 or more alcoholic drinks in 1 sitting, or more than 1 drink per day on average. For men, 5 or more drinks in 1 sitting or an average of more than 2 drinks per day is considered excessive drinking.

Excessive drinking is one of the leading causes of premature death in the United States. Some of the major health concerns associated with drinking include fetal damage, liver diseases, high blood pressure, and cardiovascular diseases.

Pharmacists should counsel patients about the general dangers of excessive drinking, but they should also take the time to emphasize the message for patients taking prescriptions that fall into medication classes affected by alcohol consumption, including antibiotics, OTC fever and pain medications, rheumatoid arthritis drugs, and stimulants.

Insufficient Sleep

The top 5 states by number of adults who don’t get enough sleep are Hawaii, Kentucky, Georgia, Maryland, and Alabama. Across the 5 individualized unhealthy behaviors, insufficient sleep was the most prevalent among US adults (34.2%).

Source: United Health Foundation

The CDC has called the propensity among US adults to skip sleep a “national epidemic.”

Sleep is a crucial determinant for overall health and wellbeing, and adults who sleep less than 7 hours each night face a higher likelihood of suffering from chronic diseases such as obesity, diabetes, cancer, hypertension, and depression, as well as acute conditions like the common cold. Sleep-deprived adults are also more likely to have lower quality of life and productivity levels.

In cases where patients may have insomnia, pharmacists can offer counseling on both lifestyle changes and pharmacological remedies such as benzodiazepine sedative-hypnotics and melatonin receptor agonists.

Physical Inactivity

The top 5 by states by number of sedentary adults are Mississippi, Arkansas, Louisiana, West Virginia, and Oklahoma. For the purposes of the study, physical inactivity was defined as no physical activity outside of work.

Source: United Health Foundation

Pharmacists can remind patients that physical inactivity increases their risk for developing cardiovascular disease, type 2 diabetes, hypertension, obesity, certain cancers, depression, and premature death.

Notably, data show that this particular unhealthy behavior had the strongest association with self-reported fair or poor health status, suggesting that patients are aware of the detrimental effects of being sedentary.


The top 5 states by number of obese patients are Mississippi, Louisiana, West Virginia, Tennessee, and South Carolina.

Source: United Health Foundation

Obesity presents one of the greatest public health challenges in the United States. Data from CDC show that more than 33% of the population is currently obese.

Pharmacists who live in states with the leading number of overweight and obese patients may want to consider providing weight-loss counseling services.

There are also several counseling points that pharmacists can share with patients taking weight-loss medications. For example, pharmacists can educate patients taking liraglutide that they can expect the dosage of their once-daily injections to gradually increase over a span of 5 weeks.

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