Worried about Wrinkles, Gray Hair? Just Wait

As one gets older, the list of potential health and beauty complaints grows. AARP has done a yeoman's job of documenting those complaints, then surveying older Americans to find out how concerned they are about each one. There are lots of complaints. This is just a partial list...

Gray hair, wrinkles, yellowing teeth, hunched back, age spots, jowls/double chin, gastrointestinal issues, trouble sleeping, snoring, constipation, joint pain, tinnitus, hearing loss, shortness of breath, incontinence, waking from sleep to go to the bathroom, loss of teeth, loss of mobility, Alzheimer's/dementia, and perhaps worst of all—losing a sense of humor.

The good news is this: the older you get, the less you worry about these things. In fact, worries about health and beauty seem to peak in what could be called middle age. People in their fifties worry more about aging than do those in their sixties. People in their sixties worry more than those in their seventies. And so it goes. Maybe. The survey did not include respondents aged 80 or older. 

Want some examples of how worries fade away with age? Well, let's have a look at those wrinkles. Nearly one in four people in their fifties (24 percent) say they are very/extremely concerned about wrinkles. Among people in their sixties, only 14 percent are very/extremely concerned about wrinkles. The worried share drops to just 9 percent among the oldest people surveyed—those aged 70 to 79. 

The same pattern occurs on a whole range of health and beauty issues, including some of the most serious such as Alzheimer's/dementia. A substantial 27 percent of people aged 50 to 59 are very/extremely concerned about getting dementia. Among 60-to-69-year-olds, the figure is 19 percent, and it drops to just 16 percent among people in their seventies.

Concerns about losing one's sense of humor also wither with age. Among fiftysomethings, 18 percent are very/extremely concerned about losing their sense of humor, with the majority of fiftysomethings having at least some concern. In contrast, among people aged 70 to 79, only 6 percent are very/extremely concerned about losing their sense of humor. The 60 percent majority of the oldest respondents are "not at all" concerned about losing their funny bone. 

Source: AARP, Health Worries Lessen with Age?

Stressful Life Events Are More Common among Children in Rural/Nonmetro Areas

A substantial percentage of the nation's school children have experienced stressful life events, according to an analysis by the National Center for Health Statistics. Using data from the 2019 National Health Interview Survey, the NCHS estimated the percentage of children aged 5 to 17 who had ever experienced one or more of the following stressful life events, as reported by an adult (usually a parent) who responded to the following questions...

• Has the child ever been the victim of violence or witnessed violence in his/her neighborhood?
• Has the child ever lived with a parent or guardian who served time in jail or prison?
• Did the child ever live with anyone who was mentally ill or severely depressed?
• Did the child ever live with anyone who had a problem with alcohol or drugs?

The findings are not what you might expect. On every measure, children who live in rural areas and small towns outside of metropolitan areas are more likely than those in small/medium metros, suburbs of large metros, or cities of large metros to have experienced stressful events.

Overall, 6.8 percent of children aged 5 to 17 had ever been exposed to violence in their neighborhood. Among children in rural/nonmetropolitan areas, 8.2 percent had been exposed to violence in their neighborhood versus 7.8 percent of children in small/medium metros, 6.3 percent of those in the cities of large metros, and 5.2 percent of those in the suburbs of large metros. 

Among school-aged children, 6.5 percent had ever lived with a parent/guardian who had served time in jail or prison. Again, the children most likely to have experienced this stress are those in rural/nonmetropolitan areas (9.4 percent), followed by children in small/medium metropolitan areas (8.0 percent), cities of large metro areas (5.1 percent), and suburbs of large metros (4.5 percent). 

A substantial 9.2 percent of children have ever lived with someone who was mentally ill or severely depressed. The figure ranges from a high of 12.0 percent for children in rural/nonmetropolitan areas to a low of 6.8 percent among children in the cities of large metropolitan areas. 

Fully 9.7 percent of children have ever lived with someone who had a problem with alcohol or drugs. The figure ranges from a high of 13.7 percent among children in rural/nonmetropolitan areas to a low of 7.3 percent among children living in cities of large metropolitan areas.

Source: National Center for Health Statistics, Disparities in Stressful Life Events among Children Aged 5–17 Years: United States, 2019

Oh My Aching Back

It's a common refrain and for good reason. Millions of Americans have back pain, according to the National Center for Health Statistics—not just 1 or 2 million but tens of millions. More than 80 million, in fact.

In 2019, The NCHS asked a representative sample of Americans aged 18 or older this question: "Over the past 3 months, how much have you been bothered by back pain? Would you say not at all, a little, a lot, or somewhere in between?" A substantial 39 percent reported having had a little to a lot of back pain. 

Percent with back pain in past 3 months

Aged 18 to 29: 28%

Aged 30 to 44: 35%

Aged 45 to 64: 44%

Aged 65-plus: 46%

And that's not all. Almost as many adults (36.5 percent) reported having pain in their hips, knees, or feet in the past three months, including 50 percent of people aged 65 or older. Thirty-one percent reported having pain in their hands, arms, or shoulders. 

Overall, the 59 percent majority of Americans aged 18 or older reported being in pain in the past three months. 

Source: National Center for Health Statistics, Back, Lower Limb, and Upper Limb Pain among U.S. Adults, 2019

Mushrooming Trouble

This is no joke, according to the CDC. Each year, 7,500 mushroom incidents are reported to poison control centers in the United States. To get a better handle on the problem, the CDC analyzed data on emergency department visits and hospitalizations due to poisonous mushrooms. Here are some of the findings...

• In 2016, there were 1,328 emergency department visits and 100 hospitalizations associated with "accidental poisonous mushroom ingestion." 
• 41% of those who visited an emergency department after ingesting poisonous mushrooms were children under the age of 18. 
• Males accounted for 63% of those who visited an emergency department after ingesting poisonous mushrooms. 
• The 37% plurality of emergency department visits occurred in the West.
• Among those diagnosed with ingesting poisonous mushrooms during 2016–18, 36% had gastrointestinal symptoms, 18% neurological/behavioral symptoms, and 17% cardiac symptoms.
• 8% of those diagnosed with ingesting poisonous mushrooms were involved with hallucinogenic drug use.

"Given the potential severity and preventable nature of most poisonous mushroom ingestions, wild mushrooms should not be consumed unless identified by an expert," the CDC concludes.

Source: CDC, Health Care Utilization and Outcomes Associated with Accidental Poisonous Mushroom Ingestions—United States, 2016–2018

Covid Stress Is Making Us Sick

The coronavirus is having a negative impact on the mental health of Americans, according to the Kaiser Family Foundation Health Tracking Poll. In July, the 53 percent majority of adults said their mental health was being negatively impacted by the pandemic—the highest share recorded in Kaiser's tracking poll and 14 percentage points higher than in May.

Those most likely to say their mental health is suffering are women (57 percent), young adults aged 18 to 29 (62 percent), Blacks (68 percent), and those who are having financial difficulties because of the pandemic (71 percent).

The worry and stress due to the coronavirus pandemic is also affecting our physical wellbeing. Most Americans have experienced at least one of of these ailments because of the stress...

In the past two months, have you experienced any of the following due to worry or stress related to the coronavirus outbreak?
36% have had trouble falling asleep, staying asleep, or sleeping too much
32% have experienced a poor appetite or overeating
18% have had difficulty controlling their temper
18% have had frequent headaches or stomachaches
12% have increased their alcohol or drug use
12% have had their chronic conditions worsen

Overall, the 52 percent majority of the public has experienced at least one of these health problems in the past two months.

Source: Kaiser Family Foundation, KFF Health Tracking Poll—July 2020

Winter is the Cold Season

It's not just folklore but fact. Colds are more common in winter than in the summer, according to the 2018 National Health Interview Survey. When Americans were asked whether they had experienced a head or chest cold in the past two weeks, 16.6 percent said yes in the winter months of January through March. Only 7 percent said yes in the summer months of July through September...

Percent with a head/chest cold in the past two weeks
16.6% in the winter (January-March)
  8.5% in the spring (April-June)
  7.0% in the summer (July-September)
13.7% in the fall (October-December)

In every season, children under age 18 were most likely to have had a cold. In the winter, more than 20 percent of children had experienced a cold in the past two weeks. In every season, people aged 65 or older were least likely to have had a cold.

Source: CDC, Morbidity and Mortality Weekly Report, Percentage of Person Who Had a Cold in the Past 2 Week, by age Group and Calendar Quarter—National Health Interview Survey, United States, 2018

New Orleans Has Highest Prevalence of Covid-19

The prevalence of Covid-19 varies greatly by metropolitan area, according to an analysis by Joe Cortright the director of City Observatory, a web site and think tank devoted to urban analysis. Among the 53 metropolitan areas with populations of 1 million or more, the number of reported Covid-19 cases per 100,000 population ranges from a low of 16.4 in Minneapolis-St. Paul to a high of 692.6 in New Orleans. The median among large metro areas is 51 cases per 100,000 population. Here are the 12 metros with the highest Covid-19 prevalence rates as of April 5...

Number of reported Covid-19 cases per 100,000 population, as of April 5, 2020
1. New Orleans: 692.6
2. New York: 441.6
3. Detroit: 297.4
4. Boston: 190.8
5. Indianapolis: 141.1
6. Seattle: 137.6
7. Philadelphia: 126.4
8. Chicago: 116.3
9. Miami: 113.4
10. Buffalo: 104.0
11. Nashville: 101.6
12: Milwaukee: 89.8

Metros with a relatively low prevalence of Covid-19 today should not rest on their laurels. More cases are coming. In just one week, the rate in Indianapolis nearly tripled, climbing from 51.0 on March 29 to the 141.1 of April 5. Miami's rate more than doubled during the week, rising from 46.2 to 113.4.

In Wisconsin, where Milwaukee has the 12th highest rate of Covid-19 among the nation's large metros, the primary election is being held today. Many voters will have to choose between voting in-person or not voting at all. Yesterday, the U.S. Supreme Court ruled against extending the deadline for receipt of Wisconsin's mail-in ballots, which many voters have yet to receive.

Source: City Observatory, Joe Cortright, Covid-19 Prevalence by Metro Area

Growing Coronavirus Alarm Noted in Surveys

Rising concerns about coronavirus are being captured by survey researchers while they are in the field. According to Pew Research Center survey fielded from March 10 to March 16, the percentage of Americans who believe coronavirus is major threat to the health of the U.S. population climbed from 42 percent in the first two days of the survey period (March 10-11) to 55 percent in the final three days (March 14-16). The percentage who believe coronavirus is a major threat to their personal financial situation grew from 29 to 40 percent during the time span.

Gallup, too, is noting the rising alarm. When Gallup asked respondents whether they are avoiding going to public places such as stores or restaurants, only 30 percent of those queried on March 13-15 said yes. The figure jumped to 54 percent among those asked the same question on March 16-19.

"In the span of a week," Gallup reports, "Americans have gone from tepid adoption of social distancing to majorities engaging in nearly every major practice advocated by government and health officials."

Percent of adults taking each action to stem the spread of coronavirus, March 16-19 (and percentage point increase since March 13-15
79% are avoiding going to events with large crowds (+20)
75% are avoiding travel by airplane, bus, subway, or train (+20)
57% are cancelling or postponing travel plans (+18)
52% are stocking up on food, medical, and cleaning supplies (+13)
54% are avoiding going to public places (+24)
46% are voiding small gatherings such as with family or friends (+23)

Despite the growing seriousness of the pandemic in the minds of Americans, Gallup reports "there is a long way to go to approach full compliance." While 53 percent of respondents say they have mostly or completely isolated themselves from people outside their household, 21 percent say they are only partially isolated, and 27 percent say they have done little or nothing to avoid contact with people outside their household.

Source: Gallup, Americans Rapidly Answering the Call to Isolate, Prepare

Who's Afraid of a Pandemic?

Way back in 2018, before The Age of Social Distancing, the threat of a pandemic barely registered in the public's mind. Pandemic ranked a lowly 32 on the list of events most frightening to Americans, according to the Chapman University Survey of American Fears. Only 39 percent of the public was afraid or very afraid of a major epidemic. Higher on the list of fears were such events as widespread civil unrest (43 percent), economic/financial collapse (49 percent), high medical bills (53 percent), and not having enough money for the future (57 percent).

If asked about our fears today, pandemic is likely to have moved to the top of the list. That's what a recent Gallup survey shows. When Gallup asked respondents how concerned they were about the coronavirus on February 3-16, only 36 percent said they were somewhat/very concerned. When Gallup asked again a month later, from March 2 through March 13, a much larger 60 percent were somewhat/very concerned. The March survey ended five days ago. At that time, there were around 2,500 coronavirus cases in the U.S. Today there are 6,500. San Francisco Bay area residents have been ordered to shelter in place and New York City is considering doing the same. When Gallup asks about coronavirus again in April, it's not much of a stretch to assume well more than 60 percent will be concerned.

Fear of the coronavirus pandemic is sure to be fueling other fears as well. It's likely many more Americans today than in 2018 are afraid of economic collapse, not having enough money, high medical bills, and civil unrest.

Source: Gallup, U.S. Coronavirus Concerns Surge, Government Trust Slides; and Chapman University, America's Top Fears 2018

Who Wears a Fitness Tracker?

One in five Americans (19 percent) wears a fitness tracker, such as a Fitbit or Apple Watch, according to a Gallup survey. Women are more likely than men to wear a fitness tracker—21 versus 16 percent. Not surprisingly, young adults are more likely to do so than their elders...

Currently wear a fitness tracker
Aged 18 to 34: 28%
Aged 35 to 54: 22%
Aged 55-plus: 10%

Younger women are especially likely to wear a fitness tracker. Among adults under age 50, fully 31 percent of women and 21 percent of men wear a tracker. The figures among women and men aged 50 or older are 13 and 10 percent, respectively.

Source: Gallup, One in Five U.S. Adults Use Health Apps, Wearable Trackers

Childhood Trauma Worsens Health

The 61 percent majority of American adults report having endured at least one adverse childhood experience, according to the CDC. This finding is based on a unique set of questions about adverse childhood experiences added to the Behavioral Risk Factor Surveillance System surveys in 25 states in 2015–2017. Eight types of adverse experiences were tallied by the survey—three types of abuse (physical, emotional, and/or sexual), and five problems with household members (substance abuse, incarceration, mental illness, parental divorce, or intimate partner violence).

Percent of adults reporting at least one adverse childhood experience, by age
Total, 18-plus: 61.0%
Aged 18 to 24: 70.5%
Aged 25 to 34: 69.5%
Aged 35 to 44: 65.0%
Aged 45 to 54: 62.5%
Aged 55 to 64: 58.9%
Aged 65-plus: 47.9%

Younger people are much more likely than older adults to report at least one adverse childhood experience. In part, this is because the experience of parental divorce is much greater for younger than older adults. Another reason for the difference by age is the greater willingness of younger adults to call out abuse and admit to family problems.

Thirty-nine percent of adults reported no adverse childhood experiences, 23 percent reported one, 22 percent reported two or three, and 16 percent reported four or more. Those who report four or more adverse childhood experiences also report greater health and socioeconomic problems than those who faced less adversity, the CDC found.  "Adverse childhood experiences are associated with leading causes of morbidity and mortality and with poor socioeconomic outcomes in adulthood," concludes the report.

Source: CDC, Vital Signs: Estimates Proportion of Adult Health Problems Attributable to Adverse Childhood Experiences and Implications for Prevention—25 States, 2015–2017

The Risks of Rabies

Rabies is one of the most fearsome and feared diseases. More than 99 percent fatal, the symptoms of those infected with rabies are so frightening that some scholars surmise they gave rise to the vampire and zombie horror genres.

Fortunately, rabies deaths in the United States are rare these days, with an average of only two people dying from rabies each year, according to the CDC. But many other countries are struggling to bring rabies under control. Globally, human rabies killed 59,000 in 2018 alone.

Dog bites were once the cause of most human rabies in the U.S. The incidence of human rabies has declined because we are vigilant about vaccinating our dogs against rabies and have done so since 1947. Other countries have not made as much progress with dog vaccinations, and the CDC wants Americans to be aware of this danger. Since 1960, there have been 36 human rabies cases in the U.S. caused by dog bites received while people were traveling internationally. "Increased awareness of rabies while traveling abroad is needed," warns the CDC.

Today, bats are the primary cause of rabies in the U.S. Of the 89 cases of human rabies originating in the U.S. between 1960 and 2018, the bat variant accounted for 62 percent. But most bats do not have rabies. Of bats submitted for testing, 94 percent were free of rabies, notes the CDC, which cautions that the "widespread killing of bats is not recommended to prevent rabies."

If treated before symptoms appear, rabies can be prevented. Each year, 55,000 Americans avail themselves of PEP—the lifesaving treatment for those who have been bitten or scratched by a wild animal. "Understanding the need for timely administration of PEP (post exposure prophylaxis) to prevent death is critical," concludes the CDC.

Source: CDC, Vital Signs: Trends in Human Rabies Deaths and Exposures—United States, 1938–2018

Growing Health Disparities by Educational Attainment

Education leads to better health for reasons not fully understood. An Urban Institute study takes a closer look at health disparities by educational attainment and trends over time. Using data from the National Health Interview Survey, the researchers examine the self-reported health of people aged 19 to 64, dividing the population into two groups—those with at least some college education and those with no college experience...

Percent of 19-to-64-year-olds with fair or poor health, 2017
Any college: 6.8%
No college: 16.8%

Percent of 19-to-64-year-olds with an activity limitation, 2017
Any college: 8.3%
No college: 17.2%

Percent of 19-to-64-year-olds who are obese, 2017
Any college: 29.3%
No college: 36.0%

Percent of 19-to-64-year-olds with moderate/severe psychological distress, 2017
Any college: 9.8%
No college: 15.9%

Health disparities by educational attainment have not only persisted for decades, the researchers find, but in many cases they are growing. Take activity limitations, for example. In 1999, there was a 6.2 percentage-point gap in the percentage with an activity limitation by educational attainment—14.4 percent of those with no college education versus 8.3 percent of those with any college experience. By 2017, the gap had grown to 8.9 percentage points because a larger share of the less educated (17.2 percent) reported an activity limitation. "Less-educated adults from all racial, ethnic, and geographic groups we studied have seen declines in health over time," the researchers conclude.

Source: Urban Institute, Education and Health: Long-Term Trends by Race, Ethnicity, and Geography, 1997–2017

27% Say They Have a Pre-existing Condition

Only 27 percent of Americans aged 18 or older say they have a pre-existing condition, according to a Gallup poll. Among people aged 65 or older, just 38 percent say they have such a condition. These unrealistically low figures show that the public either doesn't understand the meaning of "pre-existing condition" or is afraid to admit they have one—even to a pollster. Government data show that a much larger share of Americans have what could be considered a pre-existing condition. For example...

• 40% of people aged 18 or older are obese, according to the National Health and Nutrition Examination Survey. 
• 57% of people aged 65 or older have hypertension, according to the National Health Interview Survey. 
• 67% of people aged 65 or older have taken three or more prescription drugs in the past month, according to the National Health and Nutrition Examination Survey.

Clearly, millions more Americans have pre-existing conditions than are willing to admit it, including the majority of older Americans. Why, then, is there any debate at all about whether health insurance companies should be prohibited from denying coverage because of a person's medical history?

Source: Gallup, One in Four U.S. Adults Say They Have a Pre-Existing Condition

Millions of Americans Practice Yoga

There's a reason you see so many people walking down the street with yoga mats. Millions of Americans practice yoga, according to a National Center for Health Statistics report. The NCHS regards yoga as a "complementary" medicine—meaning a form of alternative medicine for health and wellness. Every now and then it surveys the population to determine just how many people practice (or "use") yoga. An increasing number of them, it seems. In 2017, a substantial 14.3 percent of adults aged 18 or older had used yoga in the past 12 months—more than 35 million people. This figure is up from 9.5 percent in 2012. The use of yoga varies by demographic characteristic, of course...

• 20 percent of women practice yoga versus 9 percent of men.
• Yoga is most popular among younger adults. In the 18-to-44 age group, 18 percent practiced yoga in the past 12 months. The figure was 12 percent among 45-to-64-year-olds, and 7 percent among people aged 65 or older. 
• 17 percent of non-Hispanic Whites practiced yoga in the past 12 months. The figure was 9 percent among Blacks and 8 percent among Hispanics.

The practice of yoga has become more mainstream, the NCHS concludes.

Source: National Center for Health Statistics, Use of Yoga, Meditation, and Chiropractors among U.S. Adults Aged 18 and Over

15% of High School Students Report Concussion in Past Year

Among the nation's high school students, 15 percent report having experienced at least one concussion during the past year, according to the 2017 Youth Risk Behavior Survey. Concussion is defined as "when a blow or a jolt to the head causes problems such as headaches, dizziness, being dazed or confused, difficulty remembering or concentrating, vomiting, blurred vision, or being knocked out."

Seventeen percent of boys and 13 percent of girls report a concussion in the past year. The prevalence of concussion varies greatly by the number of sports played...

Percent of high school students with at least one concussion in the past year
Play no sports: 7.6%
Play one sport: 16.7%
Play two sports: 22.9%
Play three+ sports: 30.3%

Source: CDC, Self-Reported Concussions from Playing a Sport or Being Physically Active among High School Students—United States, 2017

20% of Older Americans Have Diabetes

Diabetes has become a common health condition among older Americans, according to the National Center for Health Statistics. Overall, 8.8 percent of Americans aged 18 or older had been diagnosed with diabetes as of the first half of 2017, up from 5.3 percent two decades ago in 1997. The percentage with diabetes rises steeply with age...

Percent diagnosed with diabetes, January–September 2017
Aged 18 to 44:   2.8%
Aged 45 to 54:   9.6%
Aged 55 to 64: 15.7%
Aged 65-plus:  19.6%

One factor behind the rise of diabetes is growing obesity. The percentage of adults who are obese (defined as having a body mass index of 30 kg/m² or higher) climbed from 19 percent in 1997 to 31 percent in the first half of 2017. But this estimate of obesity is conservative because it is based on self-reported rather than measured heights and weights. When self-reporting, inches are gained and pounds are shed. According to a 2015–16 NCHS survey of measured heights and weights, a stunning 40 percent of American adults are obese.

Source: National Center for Health Statistics, Early Release of Selected Estimates Based on Data from the January—September 2017 National Health Interview Survey

Does Delayed Retirement Increase Inequality?

With defined-benefit pensions a thing of the past for most retirees, many older Americans are working longer to allow their retirement savings and Social Security benefits to grow. But will the rising labor force participation of older Americans result in greater income inequality? It already is, according to an analysis by Richard W. Johnson of the Urban Institute. His study examines the growing economic polarization between older Americans healthy enough to delay retirement and continue to work and older Americans whose poor health prevents them from working longer.

Analyzing data from the Health and Retirement Study, a longitudinal survey of Americans aged 50 or older, Johnson's analysis compared the health and economic status of people aged 63 to 65 in 2014 with their counterparts in 1996. Over the time period, the health of people in their early sixties worsened...

• A larger share of 63-to-65-year-olds reported having health-related work limitations in 2014 (31.8 percent) than in 1996 (28.5 percent).
• The trend is most pronounced among the least educated—those who never attended college. Among 63-to-65-year-olds who never attended college, 42.3 percent had health-related work limitations in 2014, up from 33.6 percent in 1996. 
• Among 63-to-65-year-olds who had attended college, 25.5 percent had health-related work limitations, up from 19.6 percent in 1996.

Older Americans with health-related work limitations are falling behind as the healthy work longer and add to their retirement incomes, Johnson finds. Between 1996 and 2014, he says, gains in real, median household income among people in their early sixties were limited to those in robust health. "As older adults have delayed retirement and worked longer, the impact of health status in late working life on retirement income has grown," Johnson concludes. "These finding are particularly concerning as evidence mounts that health status at midlife and older ages is worsening and health disparities by income and education are growing."

Source: Urban Institute, Delayed Retirement and the Growth in Income Inequality at Older Ages

47% Took Prescription Drug in Past 30 Days

Nearly half of Americans (47%) took at least one prescription drug in the past 30 days, according to the 2011–14 National Health and Nutrition Examination Survey. The use of prescription drugs rises with age to more than 90 percent of people aged 65 or older...

Percent who took at least one prescription drug in past 30 days
Under age 18: 21.5%
Aged 18 to 44: 37.1%
Aged 45 to 64: 69.0%
Aged 65-plus: 90.6%

The use of multiple prescription drugs is becoming more common, especially among people aged 65 or older. Overall, 21.5 percent of Americans took three or more prescription drugs in the past 30 days in 2011–14, up from 11.8 percent who did so two decades earlier in 1988–94. Among people aged 65 or older, 67 percent took three or more prescription drugs in the past month, up from 31 percent in 1988–94.

Source: National Center for Health Statistics, Health, United States, 2016

Health Status by Rural-Urban County Classification

The larger and more dense the urban county, the greater the percentage of residents who practice healthy habits, according to a study by the CDC. The habits examined by the CDC were smoking, drinking (moderately or not at all), maintaining normal body weight, meeting aerobic physical activity recommendations, and getting enough sleep. While differences by type of county were not large, they were statistically significant...

Percent of resident who practice at least 4 of 5 healthy behaviors, by county type
Large metropolitan center counties: 31.7%
Large fringe metropolitan counties: 30.2%
Median metropolitan counties: 30.5%
Small metropolitan counties: 29.5%
Micropolitan counties: 28.8%
Rural counties: 27.0%

Even after controlling for demographic characteristics, the pattern is the same. "Evidence-based strategies to improve the health-related behaviors of persons living in rural areas in the United States should be widely implemented," the report concludes.

Source: CDC, Health-Related Behaviors by Urban-Rural County Classification—United States, 2013