Chapter 5.2 · The rich person's vice

Health behaviors, person by person

Among adults, the share who binged on alcohol in the past month was 13.3% in the lowest of five household income bands and 20.4% in the highest, while smoking, obesity and physical inactivity were each less common in the highest band.

Author: Vishal Singh
Affiliation: NYU Stern
Published: 9 October 2026

The share of adults who binged on alcohol in the past month was 13.3% (95% CI 13.0% to 13.5%) in the lowest of five household income bands and 20.4% (95% CI 20.3% to 20.6%) in the highest. Current smoking, obesity and physical inactivity were each lower in the highest band, at 8.5%, 28.4% and 13.6%. 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 pooled file holds 4,790,742 interviews with adults in the states and the District of Columbia, and the binge drinking estimates by income band rest on 3,336,677 of them, because the question was not asked in 2014 and some adults gave no income. The rise in binge drinking is an average over groups that differ. The difference between the highest band and the lowest is 8.6 points among non-Hispanic White adults and 10.3 among Hispanic adults, and 0.5 (95% CI −0.3 to 1.2) 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 5.1, Health behaviors and the supply of care follows the same behaviors across census tracts with modeled estimates, and a tract value cannot show whether the adults who drink in a tract are the ones with high incomes (ecological inference). 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 weights, and every 95% interval uses the survey's strata and sampling units. No cell rests on fewer than 30 respondents, and no respondent-level row is published.

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

A binge is 5 or more drinks on one occasion for a man, or 4 or more for a woman, at least once in the past 30 days.[2] The question is in the survey from 2015, so binge estimates cover 10 years and the other measures cover 11. Across the 5 income bands the share of adults who binged rises at every step, from 13.3% (95% CI 13.0% to 13.5%) in the lowest band to 20.4% (95% CI 20.3% to 20.6%) in the highest, a difference of 7.2 (95% CI 6.9 to 7.5) points (Figure 1). The other three behaviors fall at every step. Current smokers, adults who have smoked at least 100 cigarettes in their lives and now smoke every day or some days,[1] are 25.7% (95% CI 25.4% to 25.9%) of adults in the lowest band and 8.5% (95% CI 8.4% to 8.6%) in the highest, a difference of 17.2 (95% CI 16.9 to 17.4) points. Obesity, a body mass index of 30 or more from self-reported height and weight, goes from 36.0% to 28.4%, a difference of 7.6 (95% CI 7.2 to 7.9) points, and the share who did no leisure-time physical activity in the past month goes from 38.2% to 13.6%, a difference of 24.6 (95% CI 24.3 to 24.9) points.

The lowest band is household income under $20,000 a year and the highest is $75,000 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: the highest band held 30.2% of the respondents who gave an income in 2014 and 46.1% in 2024. Part of that shift is a step at the 2021 change in the question, when the lowest band went from 15.8% of respondents who gave an income in 2020 to 11.8% in 2021, a larger one-year drop than in any earlier year. A further 19.4% (95% CI 19.3% to 19.5%) of adults did not know their household income or declined to give it, and they are not in any band.

Figure 1

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

Percent of adults in the states and DC with each behavior, by household income band, BRFSS 2015 to 2024 for binge drinking and 2014 to 2024 for the other three, with 95% confidence intervals

Show data

Data for Binge drinking rose from 13.3% to 20.4% of adults across the five income bands while smoking, obesity and inactivity fell
Behavior	Income band	Percent of adults	Lower limit of the 95% interval	Upper limit of the 95% interval	Respondents
Binge drinking	Under $20K	13.3	13.0	13.5	450,791
Binge drinking	$20K to $35K	14.6	14.4	14.8	614,141
Binge drinking	$35K to $50K	16.2	15.9	16.4	464,109
Binge drinking	$50K to $75K	17.6	17.4	17.9	553,063
Binge drinking	$75K or more	20.4	20.3	20.6	1,254,573
Binge drinking	Under $20K	12.5	12.0	12.9	121,580
Binge drinking	$20K to $35K	13.8	13.4	14.1	222,223
Binge drinking	$35K to $50K	14.8	14.4	15.2	176,553
Binge drinking	$50K to $75K	16.3	16.0	16.6	221,026
Binge drinking	$75K to $100K	18.2	17.8	18.6	184,694
Binge drinking	$100K to $150K	19.7	19.4	20.1	193,860
Binge drinking	$150K to $200K	21.3	20.7	21.8	87,864
Binge drinking	$200K or more	22.1	21.5	22.6	93,005
Current smoking	Under $20K	25.7	25.4	25.9	531,816
Current smoking	$20K to $35K	20.1	19.9	20.3	707,394
Current smoking	$35K to $50K	16.5	16.2	16.7	529,537
Current smoking	$50K to $75K	13.6	13.4	13.8	624,088
Current smoking	$75K or more	8.5	8.4	8.6	1,392,590
Current smoking	Under $20K	23.4	22.9	23.9	126,031
Current smoking	$20K to $35K	18.1	17.8	18.5	229,441
Current smoking	$35K to $50K	14.6	14.3	15.0	181,626
Current smoking	$50K to $75K	12.1	11.8	12.4	226,612
Current smoking	$75K to $100K	9.7	9.4	10.0	189,175
Current smoking	$100K to $150K	7.8	7.6	8.1	198,439
Current smoking	$150K to $200K	6.1	5.8	6.4	89,948
Current smoking	$200K or more	4.3	4.0	4.6	95,390
Obesity	Under $20K	36.0	35.7	36.3	512,939
Obesity	$20K to $35K	34.5	34.2	34.7	687,969
Obesity	$35K to $50K	33.4	33.1	33.7	516,714
Obesity	$50K to $75K	33.0	32.7	33.2	609,779
Obesity	$75K or more	28.4	28.3	28.6	1,365,694
Obesity	Under $20K	37.9	37.3	38.5	121,701
Obesity	$20K to $35K	36.8	36.4	37.3	223,523
Obesity	$35K to $50K	35.7	35.2	36.2	177,690
Obesity	$50K to $75K	35.4	35.0	35.8	222,115
Obesity	$75K to $100K	34.0	33.5	34.5	185,249
Obesity	$100K to $150K	33.4	32.9	33.8	194,989
Obesity	$150K to $200K	30.1	29.5	30.8	88,636
Obesity	$200K or more	23.2	22.7	23.8	94,433
No leisure-time physical activity	Under $20K	38.2	37.9	38.5	537,736
No leisure-time physical activity	$20K to $35K	32.2	32.0	32.5	718,497
No leisure-time physical activity	$35K to $50K	26.1	25.8	26.3	536,832
No leisure-time physical activity	$50K to $75K	21.1	20.8	21.3	632,292
No leisure-time physical activity	$75K or more	13.6	13.5	13.7	1,411,844
No leisure-time physical activity	Under $20K	39.4	38.8	40.0	131,164
No leisure-time physical activity	$20K to $35K	33.4	33.0	33.8	238,962
No leisure-time physical activity	$35K to $50K	27.2	26.7	27.6	188,133
No leisure-time physical activity	$50K to $75K	21.3	21.0	21.7	233,764
No leisure-time physical activity	$75K to $100K	17.5	17.1	17.9	194,948
No leisure-time physical activity	$100K to $150K	13.5	13.2	13.9	204,250
No leisure-time physical activity	$150K to $200K	10.9	10.5	11.4	92,704
No leisure-time physical activity	$200K or more	8.1	7.7	8.5	98,299

Binge drinking is the one line that rises from the lowest band to the highest, and the other three lines fall at every step. Each line plots the weighted share of adults with the behavior in each band; the bands around the lines are 95% confidence intervals, narrow because every cell holds hundreds of thousands of respondents. The rise is an average: the race and ethnicity tab of the within-groups figure shows where it is absent. The second view splits the highest band into four for 2021 to 2024, the years in which BRFSS recorded those categories.Note: Respondents who did not know their household income or declined to give it are left out of the bands, 19.4% of adults. The five bands group the income categories that BRFSS used in every year. The categories are in nominal dollars, so the highest band holds 30.2% of respondents who gave an income in 2014 and 46.1% in 2024, and part of that shift is a step at the 2021 change in the income question.Note: Intervals are 95% confidence intervals from the survey's stratum and primary sampling unit (design-based, Taylor linearization). No cell rests on fewer than 30 respondents. The survey is a repeated cross-section of adults in the states and the District of Columbia; Guam, Puerto Rico and the Virgin Islands are not included.Note: Every measure is self-reported by telephone. Estimates describe the people who answered, and BRFSS geography stops at the state, so they say nothing about tracts.Source: BRFSS 2014-2024 public-use files (binge drinking from 2015), weighted (BRFSS final weight) with design-based intervals

For 2021 to 2024 the highest band can be divided into four, and the second view of Figure 1 shows them. Across those four bands binge drinking rises from 18.2% (95% CI 17.8% to 18.6%) to 22.1% (95% CI 21.5% to 22.6%) and smoking falls from 9.7% to 4.3%. Obesity falls most between the two highest bands, from 30.1% to 23.2%.

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, and 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 groups, education levels and states, and does not appear 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. Figure 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) points at ages 18 to 29 and by 2.6 (95% CI 2.3 to 2.9) points at 65 and older, where the rate goes from 4.4% to 6.9%. Within each education level the rate also rises with income, by 12.7 (95% CI 11.1 to 14.2) points among adults who did not finish high school and 3.5 (95% CI 2.9 to 4.1) among college graduates.

Figure 2

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

Percent of adults who binged in the past month by household income band within age group, education level, and race and ethnicity, BRFSS 2015 to 2024

In each age group binge drinking is higher in the highest income band than in the lowest, by 10.2 points at ages 18 to 29 and 65 and older

Adults who binged in the past month (%)

Every panel rises from left to right, and the rise is steepest in the two younger groups. Each line plots the weighted share of adults in the age group who binged, with 95% confidence intervals; all panels share one vertical scale, so the oldest group looks flat although it too rises, from 4.4% to 6.9%.

Show data

Data for The rise in binge drinking with income holds within age groups and education levels and differs by race and ethnicity, By age group
Age group	Income band	Percent of adults	Lower limit of the 95% interval	Upper limit of the 95% interval	Respondents
18 to 29	Under $20K	22.3	21.7	23.0	53,527
18 to 29	$20K to $35K	24.7	24.1	25.2	75,758
18 to 29	$35K to $50K	26.6	26.0	27.3	55,347
18 to 29	$50K to $75K	28.5	27.9	29.2	58,025
18 to 29	$75K or more	32.5	32.0	33.0	98,374
30 to 44	Under $20K	15.7	15.2	16.2	68,510
30 to 44	$20K to $35K	18.4	17.9	18.9	93,637
30 to 44	$35K to $50K	21.0	20.5	21.6	74,973
30 to 44	$50K to $75K	23.2	22.7	23.7	102,182
30 to 44	$75K or more	25.9	25.6	26.2	294,181
45 to 64	Under $20K	11.3	11.0	11.7	162,187
45 to 64	$20K to $35K	12.6	12.2	13.0	170,206
45 to 64	$35K to $50K	14.1	13.6	14.5	134,364
45 to 64	$50K to $75K	14.5	14.1	14.9	186,248
45 to 64	$75K or more	16.9	16.7	17.1	540,009
65 and older	Under $20K	4.4	4.2	4.6	163,483
65 and older	$20K to $35K	4.9	4.7	5.1	270,018
65 and older	$35K to $50K	5.2	5.0	5.5	195,888
65 and older	$50K to $75K	6.0	5.8	6.3	202,563
65 and older	$75K or more	6.9	6.7	7.1	311,719

The age and education panels show the highest band above the lowest in every group, and the race panel shows the rise in some groups and not in others. Each tab plots weighted shares of adults with 95% confidence intervals.Note: Respondents who did not know their household income or declined to give it are left out of the bands, 19.4% of adults. The five bands group the income categories that BRFSS used in every year. The categories are in nominal dollars, so the highest band holds 30.2% of respondents who gave an income in 2014 and 46.1% in 2024, and part of that shift is a step at the 2021 change in the income question.Note: Intervals are 95% confidence intervals from the survey's stratum and primary sampling unit (design-based, Taylor linearization). No cell rests on fewer than 30 respondents. The survey is a repeated cross-section of adults in the states and the District of Columbia; Guam, Puerto Rico and the Virgin Islands are not included.Note: Age groups, education levels and race and ethnicity groups are the BRFSS calculated categories. The four education levels are no high school diploma, a high school diploma, some college or technical school, and a college or technical school degree. Race and ethnicity has five groups; the Hispanic group may be of any race.Source: BRFSS 2015-2024 public-use files, weighted (BRFSS final weight) with design-based intervals

The education lines cross. In the lowest band, college graduates binge more often than adults who did not finish high school (15.2% against 11.7%), and in the highest band less often (18.7% against 24.4%). 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% to 21.7%, a difference of 8.6 (95% CI 8.3 to 8.9) points, and among Hispanic adults the difference is 10.3 (95% CI 9.3 to 11.2) points. Among multiracial non-Hispanic adults it is 5.5 (95% CI 3.7 to 7.3) points. Among Black non-Hispanic adults the rate is 13.3% in the lowest band and 13.8% in the highest, a difference of 0.5 (95% CI −0.3 to 1.2) points whose interval includes zero, and among adults of another race, non-Hispanic, the difference is 1.0 (95% CI 0.0 to 2.1) points. The pooled difference of 7.2 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 51 of the 51 jurisdictions, the states and the District of Columbia, and its interval is above zero in 51 (Figure 3). It runs from 2.7 (95% CI 1.6 to 3.7) points in Utah to 13.1 (95% CI 10.7 to 15.5) points in the District of Columbia. The smoking difference is below zero, with an interval below zero, in 51 as well, from 9.1 (95% CI 8.2 to 9.9) points lower in California to 29.9 (95% CI 27.2 to 32.6) points lower in Alaska. In the tract regressions of Chapter 5.1, 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) points.

Figure 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

Rate in the highest household income band minus the rate in the lowest, percentage points of adults, by state and the District of Columbia, BRFSS 2015 to 2024 for binge drinking and 2014 to 2024 for smoking

Show data

Data for Binge drinking is higher in the highest income band than in the lowest in all 51 jurisdictions, and smoking is lower in all 51
Measure	State	Difference (points)	Lower limit of the 95% interval	Upper limit of the 95% interval	Respondents in the two bands
Binge drinking	Alabama	5.1	3.8	6.5	22,132
Binge drinking	Alaska	4.7	2.3	7.1	18,795
Binge drinking	Arizona	5.2	3.9	6.6	37,600
Binge drinking	Arkansas	4.3	2.5	6.1	17,920
Binge drinking	California	6.0	4.9	7.0	45,940
Binge drinking	Colorado	6.7	5.5	7.9	44,591
Binge drinking	Connecticut	6.2	4.9	7.5	43,306
Binge drinking	Delaware	7.0	5.2	8.8	15,780
Binge drinking	District of Columbia	13.1	10.7	15.5	18,026
Binge drinking	Florida	7.5	6.1	8.9	52,789
Binge drinking	Georgia	5.2	3.8	6.6	27,715
Binge drinking	Hawaii	3.6	2.1	5.0	34,030
Binge drinking	Idaho	6.4	4.7	8.0	19,584
Binge drinking	Illinois	6.7	5.2	8.1	25,131
Binge drinking	Indiana	8.5	7.3	9.7	36,284
Binge drinking	Iowa	11.2	9.9	12.6	33,575
Binge drinking	Kansas	6.5	5.4	7.6	51,800
Binge drinking	Kentucky	10.2	8.7	11.8	22,343
Binge drinking	Louisiana	10.6	9.1	12.0	19,904
Binge drinking	Maine	6.3	4.9	7.8	39,103
Binge drinking	Maryland	5.7	4.4	6.9	68,318
Binge drinking	Massachusetts	8.4	7.0	9.7	36,575
Binge drinking	Michigan	8.1	7.0	9.3	38,454
Binge drinking	Minnesota	8.4	7.4	9.4	67,343
Binge drinking	Mississippi	7.7	6.2	9.2	18,082
Binge drinking	Missouri	9.6	8.1	11.0	29,469
Binge drinking	Montana	6.1	4.6	7.7	23,613
Binge drinking	Nebraska	10.6	9.4	11.7	53,614
Binge drinking	Nevada	7.9	5.6	10.1	11,971
Binge drinking	New Hampshire	9.6	7.8	11.4	25,428
Binge drinking	New Jersey	6.4	4.8	8.0	34,305
Binge drinking	New Mexico	4.6	3.1	6.1	22,177
Binge drinking	New York	7.5	6.7	8.4	95,165
Binge drinking	North Carolina	7.0	5.6	8.3	18,903
Binge drinking	North Dakota	7.6	5.6	9.6	22,318
Binge drinking	Ohio	7.5	6.3	8.8	47,777
Binge drinking	Oklahoma	6.7	5.4	8.0	21,765
Binge drinking	Oregon	5.8	4.4	7.1	22,172
Binge drinking	Pennsylvania	8.2	6.7	9.7	21,333
Binge drinking	Rhode Island	7.1	5.4	8.9	23,732
Binge drinking	South Carolina	9.4	8.2	10.7	34,360
Binge drinking	South Dakota	5.2	2.6	7.8	23,776
Binge drinking	Tennessee	8.1	6.6	9.7	18,485
Binge drinking	Texas	7.4	5.9	8.8	47,898
Binge drinking	Utah	2.7	1.6	3.7	46,474
Binge drinking	Vermont	6.1	4.3	7.9	27,137
Binge drinking	Virginia	5.4	4.1	6.6	38,022
Binge drinking	Washington	5.9	4.9	6.8	74,985
Binge drinking	West Virginia	7.9	6.7	9.2	21,040
Binge drinking	Wisconsin	7.7	5.9	9.5	27,748
Binge drinking	Wyoming	4.7	2.5	6.8	16,577
Current smoking	Alabama	−23.1	−24.6	−21.7	25,862
Current smoking	Alaska	−29.9	−32.6	−27.2	21,314
Current smoking	Arizona	−15.4	−16.7	−14.1	43,911
Current smoking	Arkansas	−26.5	−28.3	−24.6	20,251
Current smoking	California	−9.1	−9.9	−8.2	51,083
Current smoking	Colorado	−18.7	−19.8	−17.5	50,721
Current smoking	Connecticut	−17.0	−18.3	−15.6	47,952
Current smoking	Delaware	−17.8	−19.8	−15.9	17,868
Current smoking	District of Columbia	−22.7	−24.9	−20.5	20,541
Current smoking	Florida	−14.9	−16.2	−13.6	58,131
Current smoking	Georgia	−18.5	−19.9	−17.1	31,002
Current smoking	Hawaii	−14.3	−15.6	−13.0	37,541
Current smoking	Idaho	−18.5	−20.1	−16.9	21,900
Current smoking	Illinois	−15.3	−16.8	−13.8	27,952
Current smoking	Indiana	−23.1	−24.3	−21.8	41,592
Current smoking	Iowa	−20.5	−21.9	−19.2	37,013
Current smoking	Kansas	−24.1	−25.3	−23.0	57,589
Current smoking	Kentucky	−27.5	−29.2	−25.8	26,966
Current smoking	Louisiana	−19.1	−20.7	−17.6	23,376
Current smoking	Maine	−26.8	−28.2	−25.4	43,531
Current smoking	Maryland	−17.2	−18.6	−15.8	76,105
Current smoking	Massachusetts	−16.3	−17.7	−14.9	43,965
Current smoking	Michigan	−25.2	−26.4	−23.9	42,477
Current smoking	Minnesota	−18.9	−19.9	−17.9	75,694
Current smoking	Mississippi	−19.1	−20.7	−17.5	20,273
Current smoking	Missouri	−26.1	−27.6	−24.6	32,584
Current smoking	Montana	−26.3	−27.9	−24.8	26,674
Current smoking	Nebraska	−18.7	−19.8	−17.6	62,552
Current smoking	Nevada	−15.7	−18.1	−13.4	13,704
Current smoking	New Hampshire	−26.5	−28.6	−24.4	28,302
Current smoking	New Jersey	−12.0	−13.6	−10.3	41,041
Current smoking	New Mexico	−15.7	−17.0	−14.3	26,116
Current smoking	New York	−12.1	−12.9	−11.2	101,119
Current smoking	North Carolina	−19.5	−21.1	−17.9	22,204
Current smoking	North Dakota	−17.1	−19.0	−15.2	25,970
Current smoking	Ohio	−26.6	−27.9	−25.3	52,993
Current smoking	Oklahoma	−23.9	−25.3	−22.4	25,772
Current smoking	Oregon	−21.3	−22.8	−19.9	24,599
Current smoking	Pennsylvania	−20.2	−21.8	−18.6	26,060
Current smoking	Rhode Island	−16.0	−17.7	−14.4	27,026
Current smoking	South Carolina	−20.6	−21.9	−19.3	39,654
Current smoking	South Dakota	−20.9	−23.4	−18.4	26,826
Current smoking	Tennessee	−25.2	−26.9	−23.5	20,741
Current smoking	Texas	−11.2	−12.5	−10.0	55,625
Current smoking	Utah	−13.3	−14.4	−12.2	53,042
Current smoking	Vermont	−22.9	−24.6	−21.3	30,207
Current smoking	Virginia	−19.2	−20.5	−17.9	42,791
Current smoking	Washington	−19.2	−20.3	−18.1	80,378
Current smoking	West Virginia	−28.5	−29.9	−27.1	23,595
Current smoking	Wisconsin	−20.2	−21.9	−18.5	31,091
Current smoking	Wyoming	−19.9	−22.1	−17.8	19,130

For binge drinking every dot lies right of zero and every interval does too; the second view shows smoking, where every dot lies left of zero. Each dot is the weighted rate in the highest of the five income bands minus the weighted rate in the lowest, with a 95% confidence interval; rows are sorted by the estimate.Note: Respondents who did not know their household income or declined to give it are left out of the bands, 19.4% of adults. The five bands group the income categories that BRFSS used in every year. The categories are in nominal dollars, so the highest band holds 30.2% of respondents who gave an income in 2014 and 46.1% in 2024, and part of that shift is a step at the 2021 change in the income question.Note: Intervals are 95% confidence intervals from the survey's stratum and primary sampling unit (design-based, Taylor linearization). No cell rests on fewer than 30 respondents. The survey is a repeated cross-section of adults in the states and the District of Columbia; Guam, Puerto Rico and the Virgin Islands are not included.Source: BRFSS 2014-2024 public-use files (binge drinking from 2015), weighted (BRFSS final weight) with design-based intervals

The difference is positive in each of the 10 survey years from 2015 to 2024, with an interval above zero in 10 of them. The yearly differences run from 6.7 (95% CI 5.8 to 7.7) points in 2024 to 8.3 (95% CI 7.3 to 9.2) 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) points for 2015 to 2020 and 7.5 (95% CI 7.0 to 8.0) 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% in the lowest band to 24.3% in the highest, and women's rises from 9.7% to 15.8% (Figure 4). The difference between men and women is between 8.5 (95% CI 8.2 to 8.8) and 9.2 (95% CI 8.7 to 9.6) 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) in the lowest band to 1.5 (95% CI 1.5 to 1.6) in the highest, and stays above one.

Figure 4

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

Percent of adults who binged in the past month by sex and household income band, BRFSS 2015 to 2024, with 95% confidence intervals

Show data

Data for Men binge drink more than women in every income band, by 8.5 to 9.2 points
Measure	Sex	Income band	Percent of adults	Lower limit of the 95% interval	Upper limit of the 95% interval	Respondents
Binge drinking	Men	Under $20K	18.3	17.9	18.7	170,518
Binge drinking	Men	$20K to $35K	19.6	19.3	20.0	253,196
Binge drinking	Men	$35K to $50K	20.5	20.2	20.9	211,271
Binge drinking	Men	$50K to $75K	22.1	21.7	22.4	265,095
Binge drinking	Men	$75K or more	24.3	24.1	24.5	657,924
Binge drinking	Women	Under $20K	9.7	9.4	9.9	280,085
Binge drinking	Women	$20K to $35K	10.5	10.2	10.7	360,747
Binge drinking	Women	$35K to $50K	11.9	11.6	12.2	252,750
Binge drinking	Women	$50K to $75K	13.0	12.7	13.3	287,884
Binge drinking	Women	$75K or more	15.8	15.6	16.0	596,461
Obesity	Men	Under $20K	31.1	30.7	31.6	198,642
Obesity	Men	$20K to $35K	31.3	31.0	31.7	291,809
Obesity	Men	$35K to $50K	32.0	31.6	32.4	242,454
Obesity	Men	$50K to $75K	32.8	32.5	33.2	300,974
Obesity	Men	$75K or more	30.9	30.7	31.1	733,927
Obesity	Women	Under $20K	39.7	39.4	40.1	314,114
Obesity	Women	$20K to $35K	37.3	37.0	37.7	395,965
Obesity	Women	$35K to $50K	34.9	34.5	35.3	274,183
Obesity	Women	$50K to $75K	33.2	32.8	33.5	308,724
Obesity	Women	$75K or more	25.3	25.1	25.6	631,594
Current smoking	Men	Under $20K	29.5	29.1	29.9	200,372
Current smoking	Men	$20K to $35K	23.1	22.8	23.4	291,391
Current smoking	Men	$35K to $50K	18.9	18.6	19.3	240,761
Current smoking	Men	$50K to $75K	15.7	15.5	16.0	298,532
Current smoking	Men	$75K or more	9.8	9.7	10.0	728,129
Current smoking	Women	Under $20K	22.8	22.5	23.1	331,241
Current smoking	Women	$20K to $35K	17.5	17.2	17.7	415,794
Current smoking	Women	$35K to $50K	14.0	13.7	14.3	288,686
Current smoking	Women	$50K to $75K	11.4	11.2	11.7	325,465
Current smoking	Women	$75K or more	6.9	6.8	7.0	664,260

Both lines rise across the bands and stay about the same distance apart. The second view shows obesity, where the women's line falls and crosses the men's line, and the third shows smoking, where both lines fall and move closer. Lines plot weighted shares of adults with 95% confidence intervals.Note: Respondents who did not know their household income or declined to give it are left out of the bands, 19.4% of adults. The five bands group the income categories that BRFSS used in every year. The categories are in nominal dollars, so the highest band holds 30.2% of respondents who gave an income in 2014 and 46.1% in 2024, and part of that shift is a step at the 2021 change in the income question.Note: Intervals are 95% confidence intervals from the survey's stratum and primary sampling unit (design-based, Taylor linearization). No cell rests on fewer than 30 respondents. The survey is a repeated cross-section of adults in the states and the District of Columbia; Guam, Puerto Rico and the Virgin Islands are not included.Source: BRFSS 2014-2024 public-use files (binge drinking from 2015), weighted (BRFSS final weight) with design-based intervals

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) points (39.7% against 31.1%), and less often in the highest, by 5.6 (95% CI 5.2 to 5.9) points (25.3% against 30.9%), 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) points in the lowest band to 2.9 (95% CI 2.7 to 3.1) in the highest.

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

Figure 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) points for men and 6.2 (95% CI 5.8 to 6.5) for women, a difference between the sexes of 0.1 (95% CI −0.4 to 0.7) points whose interval includes zero. For obesity the difference is −14.4 (95% CI −14.8 to −13.9) points for women and −0.2 (95% CI −0.7 to 0.3) for men, and the men's interval includes zero. The women's difference is 14.2 (95% CI 13.5 to 14.8) points steeper than the men's. Smoking is steeper for men, with a difference of −19.7 (95% CI −20.1 to −19.3) points against −15.9 (95% CI −16.2 to −15.6) for women, which is 3.8 (95% CI 3.2 to 4.3) points steeper. For fair or poor health the two differences are close, at −29.7 for men and −30.6 for women.

Figure 5

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

Rate in the highest household income band minus the rate in the lowest, percentage points of adults, by measure and sex, BRFSS 2014 to 2024 (binge drinking 2015 to 2024)

Women
Men

Show data

Data for The obesity difference between the highest and the lowest income band is −14.4 points for women and −0.2 for men
Measure	Sex	Difference (points)	Lower limit of the 95% interval	Upper limit of the 95% interval	Respondents in the two bands
Binge drinking	Women	6.2	5.8	6.5	876,546
Binge drinking	Men	6.0	5.6	6.5	828,442
Current smoking	Women	−15.9	−16.2	−15.6	995,501
Current smoking	Men	−19.7	−20.1	−19.3	928,501
Obesity	Women	−14.4	−14.8	−13.9	945,708
Obesity	Men	−0.2	−0.7	0.3	932,569
Diabetes	Women	−11.8	−12.1	−11.5	1,006,571
Diabetes	Men	−8.5	−8.9	−8.2	952,929
No leisure-time physical activity	Women	−25.7	−26.1	−25.3	1,009,313
No leisure-time physical activity	Men	−22.6	−23.1	−22.1	939,848
Fair or poor health	Women	−30.6	−31.0	−30.3	1,023,026
Fair or poor health	Men	−29.7	−30.2	−29.3	952,294

The women's and men's dots are far apart for obesity and close together for binge drinking and for fair or poor health, and only binge drinking lies right of zero. Each dot is the weighted rate in the highest of five income bands minus the weighted rate in the lowest, with a 95% confidence interval.Note: Respondents who did not know their household income or declined to give it are left out of the bands, 19.4% of adults. The five bands group the income categories that BRFSS used in every year. The categories are in nominal dollars, so the highest band holds 30.2% of respondents who gave an income in 2014 and 46.1% in 2024, and part of that shift is a step at the 2021 change in the income question.Note: Intervals are 95% confidence intervals from the survey's stratum and primary sampling unit (design-based, Taylor linearization). No cell rests on fewer than 30 respondents. The survey is a repeated cross-section of adults in the states and the District of Columbia; Guam, Puerto Rico and the Virgin Islands are not included.Note: Obesity is a body mass index of 30 or more from self-reported height and weight. Diabetes is a diagnosis reported by the respondent: prediabetes counts as no diabetes, and respondents with diabetes only during pregnancy are left out of the denominator. Fair or poor health is the respondent's rating of general health.Source: BRFSS 2014-2024 public-use files (binge drinking from 2015), weighted (BRFSS final weight) with design-based intervals

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 (Figure 6). Among adults who did not finish high school the rate is 28.0% in the lowest band and 23.2% in the highest, a difference of 4.8 (95% CI 3.4 to 6.2) points, and it does not fall at every step. Among college graduates it goes from 13.6% to 4.4%, a difference of 9.1 (95% CI 8.7 to 9.6) points. Across all incomes the rate is 24.7% among adults who did not finish high school and 5.8% among college graduates.

Figure 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

Percent of adults who currently smoke by education level and household income band, BRFSS 2014 to 2024

0.030.0

A grid of smoking rates with four education levels as rows and five household income bands as columns. The rates are highest in the top row, adults who did not finish high school, where they fall least from the lowest band to the highest, and lowest in the bottom row, college graduates, where they fall from the lowest band to the highest.
Education	Under $20K	$20K to $35K	$35K to $50K	$50K to $75K	$75K or more
Did not finish high school	28.0, interval 27.5 to 28.5, n = 107,166	24.6, interval 24.0 to 25.2, n = 69,781	23.9, interval 22.9 to 25.0, n = 23,739	26.4, interval 25.1 to 27.8, n = 13,858	23.2, interval 21.9 to 24.5, n = 15,060
High school graduate	27.2, interval 26.8 to 27.6, n = 208,946	21.7, interval 21.3 to 22.0, n = 268,241	19.2, interval 18.8 to 19.6, n = 162,535	17.8, interval 17.4 to 18.2, n = 143,885	14.5, interval 14.2 to 14.8, n = 181,529
Some college	24.4, interval 23.9 to 24.8, n = 144,056	19.1, interval 18.8 to 19.5, n = 224,209	16.4, interval 16.0 to 16.8, n = 174,273	14.2, interval 13.9 to 14.5, n = 193,584	10.9, interval 10.7 to 11.1, n = 309,247
College graduate	13.6, interval 13.1 to 14.1, n = 70,037	10.9, interval 10.6 to 11.2, n = 143,684	8.4, interval 8.2 to 8.7, n = 168,202	7.0, interval 6.8 to 7.2, n = 272,154	4.4, interval 4.4 to 4.5, n = 885,429

Show data

Data for 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
band	conf_high	conf_low	education	estimate	n
Under $20K	28.48	27.47	Did not finish high school	27.97	107,166
$20K to $35K	25.20	23.98	Did not finish high school	24.59	69,781
$35K to $50K	24.96	22.91	Did not finish high school	23.92	23,739
$50K to $75K	27.78	25.07	Did not finish high school	26.40	13,858
$75K or more	24.51	21.90	Did not finish high school	23.18	15,060
Under $20K	27.62	26.84	High school graduate	27.23	208,946
$20K to $35K	21.99	21.34	High school graduate	21.66	268,241
$35K to $50K	19.63	18.85	High school graduate	19.24	162,535
$50K to $75K	18.15	17.37	High school graduate	17.76	143,885
$75K or more	14.85	14.19	High school graduate	14.52	181,529
Under $20K	24.80	23.91	Some college	24.35	144,056
$20K to $35K	19.46	18.81	Some college	19.13	224,209
$35K to $50K	16.75	16.04	Some college	16.39	174,273
$50K to $75K	14.54	13.92	Some college	14.23	193,584
$75K or more	11.09	10.66	Some college	10.87	309,247
Under $20K	14.06	13.15	College graduate	13.60	70,037
$20K to $35K	11.21	10.56	College graduate	10.88	143,684
$35K to $50K	8.70	8.18	College graduate	8.44	168,202
$50K to $75K	7.19	6.79	College graduate	6.99	272,154
$75K or more	4.54	4.37	College graduate	4.45	885,429

Smoking falls from top to bottom in every income band, and falls from left to right except in the top row: adults who did not finish high school smoke at 28.0% in the lowest band and 23.2% in the highest, while college graduates go from 13.6% to 4.4%. Each cell is a weighted share of adults, and the number printed is the estimate.Note: Respondents who did not know their household income or declined to give it are left out of the bands, 19.4% of adults. The five bands group the income categories that BRFSS used in every year. The categories are in nominal dollars, so the highest band holds 30.2% of respondents who gave an income in 2014 and 46.1% in 2024, and part of that shift is a step at the 2021 change in the income question.Note: Intervals are 95% confidence intervals from the survey's stratum and primary sampling unit (design-based, Taylor linearization). No cell rests on fewer than 30 respondents. The survey is a repeated cross-section of adults in the states and the District of Columbia; Guam, Puerto Rico and the Virgin Islands are not included.Note: Current smoking is at least 100 cigarettes in a lifetime and smoking every day or some days now. Education is the level the respondent completed; college includes technical school.Source: BRFSS 2014-2024 public-use files, weighted (BRFSS final weight) with design-based intervals

Men smoke more than women, 16.5% of men against 12.8% of women, but the difference depends on race and ethnicity (Figure 7). It is 1.7 (95% CI 1.6 to 1.9) points among White non-Hispanic adults and 8.1 (95% CI 7.7 to 8.5) among Hispanic adults, with Black non-Hispanic adults at 7.0 (95% CI 6.5 to 7.4), adults of another race, non-Hispanic, at 5.9 (95% CI 5.4 to 6.4) and multiracial non-Hispanic adults at 3.3 (95% CI 2.2 to 4.4). Across the five groups, men's rates run from 13.5% (95% CI 13.1% to 14.0%) to 21.9% (95% CI 21.2% to 22.7%) and women's from 7.6% (95% CI 7.4% to 7.9%) to 18.6% (95% CI 17.9% to 19.4%), 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% and Hispanic women at 7.6%, against 16.3% and 15.8% for men. Men's rate is above women's in all 25 cells of race and ethnicity by income band, with an interval above zero in 25.

Figure 7

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

Percent of adults who currently smoke by sex within five race and ethnicity groups, BRFSS 2014 to 2024, with 95% confidence intervals

Women
Men

Show data

Data for Men smoke more than women by 1.7 points among non-Hispanic White adults and 8.1 among Hispanic adults
group	hi_m	hi_w	lo_m	lo_w	men	n_m	n_w	women
White, non-Hispanic	16.37	14.61	16.13	14.41	16.25	1,553,398	1,898,894	14.51
Black, non-Hispanic	20.61	13.54	19.84	12.99	20.22	134,857	211,073	13.26
Other race, non-Hispanic	13.98	7.97	13.12	7.34	13.55	107,849	107,257	7.65
Multiracial, non-Hispanic	22.67	19.37	21.15	17.88	21.90	44,344	48,941	18.62
Hispanic	16.11	7.88	15.42	7.41	15.76	161,479	185,066	7.64

The men's dots fall in a narrower band than the women's dots, so the size of the gap follows the women's rates. Each dot is the weighted share of adults who smoke, and the last column gives men's rate minus women's rate in percentage points.Note: Intervals are 95% confidence intervals from the survey's stratum and primary sampling unit (design-based, Taylor linearization). No cell rests on fewer than 30 respondents. The survey is a repeated cross-section of adults in the states and the District of Columbia; Guam, Puerto Rico and the Virgin Islands are not included.Note: Groups are those BRFSS defines: White, Black, another race and multiracial adults are non-Hispanic, and Hispanic adults may be of any race. The Hispanic and other-race groups each combine populations whose smoking differs.Source: BRFSS 2014-2024 public-use files, weighted (BRFSS final weight) with design-based intervals

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

Causal evidenceNatural experiment: size of lottery winnings among winners

Lottery winnings, smoking and drinking

The comparisons above cannot say whether more income changes what a person drinks or smokes. Apouey and Clark studied this with a British household panel in which respondents reported winnings from the national lottery, football pools and other gambling. Winners differ from non-winners in who plays, so they compared larger winners with smaller ones, on the argument that the amount won is largely outside the player's control.[9] Larger winnings were associated with more smoking and with more frequent social drinking, meaning going out for a drink at a pub or club. The paper reports a positive effect of winnings on mental health and no significant effect on self-assessed general health.[9]

The study covers gambling windfalls among British adults in the 1990s and 2000s. Its drinking outcome is how often a person goes out for a drink, not binge drinking, and it does not estimate what a lasting difference in household income of the size between the BRFSS bands would do in the United States. The BRFSS comparisons in this chapter are descriptive.

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% 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% of respondents who gave an income in 2024 against 30.2% 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 5.1, 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 6.3, Overdose, alcohol and suicide is outside what BRFSS can show.

Data sources

BRFSSCDC Behavioral Risk Factor Surveillance System public-use files, 2014-2024, adults in the 50 states and the District of Columbia; binge drinking asked from 2015Years: 2014-2024 · Weights: BRFSS final weight with stratum and primary sampling unit (design-based estimates) · License: Public domain (CDC)

All data sources

Methods

These estimates compare adults interviewed in successive annual surveys. Survey weights account for how the sample represents the covered population, and the uncertainty calculation uses the survey design. Different questions and income comparisons use different eligible subsets; the interviews do not follow the same adults over time. The public files locate a respondent no more finely than the state, so none of these comparisons is a neighborhood comparison.

Who was interviewed

Estimates use the CDC Behavioral Risk Factor Surveillance System (BRFSS) public-use files for 2014 to 2024, 4,874,919 respondents in all, of whom 4,790,742 are adults in the 50 states and the District of Columbia; the 84,177 respondents in Guam, Puerto Rico and the Virgin Islands are left out.

The survey is a repeated cross-section, not a panel, and its geography stops at the state (metro status is missing for most respondents).

Figure explained here: Figure 3

What the behavior measures mean

Binge drinking is the BRFSS calculated variable for five or more drinks for men or four or more for women on one occasion in the past 30 days.

Current smoking, obesity (BMI of 30 or more from self-reported height and weight), no leisure-time physical activity, fair or poor health and race and ethnicity are BRFSS calculated variables; diabetes is a reported diagnosis, prediabetes counts as no diabetes, and diabetes only during pregnancy leaves the denominator.

Figures explained here: Figure 5 and Figure 7

Which years each question covers

Binge drinking is in the files from 2015, so its estimates cover 2015 to 2024 and the other measures cover 2014 to 2024.

Making income bands comparable

Household income was recorded in eight categories through 2020 and in eleven from 2021, which split the top category. The five bands group categories that exist in every year (under $20,000, $20,000 to $34,999, $35,000 to $49,999, $50,000 to $74,999, $75,000 or more) and the eight-band view uses the 2021 to 2024 categories. Respondents who did not know or refused to give income are left out of the bands.

Gradients are the rate in the highest income band minus the rate in the lowest. The 2021 change in the income question is checked by estimating the binge difference separately for 2015 to 2020 and 2021 to 2024.

Figures explained here: Figure 1 and Figure 4

Weights and uncertainty

Every estimate is a weighted share with the BRFSS final weight, computed on the full frame with the group or domain as a subpopulation, so that strata and sampling units outside a group keep their place in the variance.

A cell is published only with 30 or more respondents. Strata with a single sampling unit are merged with a neighbor in the same state and year.

Intervals are 95% intervals from Taylor linearization with the survey's strata (made year-specific) and primary sampling units; shares use a logit interval, differences a normal interval.

In the public files each respondent is a primary sampling unit, so two groups of respondents are independent and the standard error of a difference of two group estimates is the two standard errors added in quadrature; the build checks this against the design-based gap estimator to within 0.03%.

References

Centers for Disease Control and Prevention (2023). Calculated Variables in the 2022 BRFSS Data File. Behavioral Risk Factor Surveillance System, technical documentation, 29 September 2023. www.cdc.gov/brfss/annual_data/2022/pdf/2022-calculated-variables-version4-508.pdf
Bohm, Michele K.; Liu, Yong; Esser, Marissa B.; Mesnick, Jessica B.; Lu, Hua; Pan, Yi; Greenlund, Kurt J. (2021). Binge Drinking Among Adults, by Select Characteristics and State - United States, 2018. MMWR Morbidity and Mortality Weekly Report 70(41): 1441-1446. doi:10.15585/mmwr.mm7041a2
Collins, Susan E. (2016). Associations Between Socioeconomic Factors and Alcohol Outcomes. Alcohol Research: Current Reviews 38(1): 83-94. doi:10.35946/arcr.v38.1.11
Keyes, Katherine M.; Hasin, Deborah S. (2008). Socio-economic status and problem alcohol use: the positive relationship between income and the DSM-IV alcohol abuse diagnosis. Addiction 103(7): 1120-1130. doi:10.1111/j.1360-0443.2008.02218.x
Sobal, Jeffery; Stunkard, Albert J. (1989). Socioeconomic status and obesity: A review of the literature. Psychological Bulletin 105(2): 260-275. doi:10.1037/0033-2909.105.2.260
McLaren, L. (2007). Socioeconomic Status and Obesity. Epidemiologic Reviews 29: 29-48. doi:10.1093/epirev/mxm001
Lopez, A. D.; Collishaw, N. E.; Piha, T. (1994). A descriptive model of the cigarette epidemic in developed countries. Tobacco Control 3(3): 242-247. doi:10.1136/tc.3.3.242
Pampel, Fred C. (2006). Global Patterns and Determinants of Sex Differences in Smoking. International Journal of Comparative Sociology 47(6): 466-487. doi:10.1177/0020715206070267
Apouey, Benedicte; Clark, Andrew E. (2015). Winning big but feeling no better? The effect of lottery prizes on physical and mental health. Health Economics 24(5): 516-538. doi:10.1002/hec.3035

How to cite

@misc{singh2026healthbehaviorspersonbyperson,
  author = {Singh, Vishal},
  title = {Health behaviors, person by person},
  year = {2026},
  url = {https://vishalsingh.org/zipcode/health-behaviors-person-by-person},
  note = {In ZIP Code Destiny. Published 9 October 2026.}
}

Same question at another grain

These chapters take up the same axis with a different unit of analysis.

Health behaviors and income
- Chapter 5.1, Health behaviors and the supply of care Neighborhoods