A Survey of Modern Life:
Health Behaviors, Everyday Life and Popular Products
A new set of surveys found that most Americans aren’t getting enough healthy behavior in their everyday lives — and the products they love might be part of the problem.
- 57.2% of U.S. adults are getting less than the recommended seven hours of sleep per night;
- 61.3% are getting less than an hour per day of physical activity from activities such as housework, yard work, commuting, or running errands;
- 54.1% are spending less than two hours per week with friends (in person, or by phone or video chat);
- 58.8% are spending less than an hour a day outdoors;
- 41.9% eat home-cooked meals four or fewer nights per week; and
- 59.5% are spending more time looking at screens (TV, phone, computer) for personal use than they do in routine physical activity, socializing with friends, or being outdoors combined.
Fielded by Building H, a project to build health into everyday life, the surveys examined the influences of popular products and services such as video streaming, food delivery services, automobiles, rideshare services, mapping services and mobile gaming on these behaviors, finding that they are often negative. Survey respondents also believe that companies should take responsibility for the impacts of their products and services on their customers’ health.
The findings suggest the need to focus greater attention on the role that these and other products and services that pervade our everyday lives play in shaping lifestyles and to identify opportunities to facilitate healthier behaviors.
Introduction:
Though the COVID-19 pandemic has launched a worldwide effort to address infectious disease, those at greatest risk are individuals who struggle with chronic diseases, such as heart disease, diabetes, and obesity. Their high prevalence — nearly half of Americans live with heart disease; 42.4% live with obesity and one in 10 has diabetes — has contributed to the relatively high COVID-19 death rate in the U.S.¹ These chronic conditions are often termed “lifestyle diseases” due to their association with a series of health behaviors including diet, physical activity and smoking tobacco.
Entire industries focus on the need to shift these behaviors: the diet and weight management industry is estimated at nearly $200B per year,² fitness clubs are a $35B industry³ and U.S. residents spend an additional $5B per year on fitness equipment.⁴ Rather than focusing on individuals, Building H focuses on the conditions that promote unhealthy behaviors and asks questions like: how do the routines of everyday life affect these behaviors and how are these routines shaped by popular products and services across industries such as food, transportation, entertainment and technology?
Building H developed a set of 10 surveys of American adults that looked at the prevalence of five important health-related behaviors and one unhealthy behavior, use of selected consumer products and services, and attitudes toward corporate responsibility for health impacts.
Questions across two general surveys asked about sleep, physical activity, spending time with friends, getting outdoors, and eating patterns. Additional surveys assessed the impact of different types of products and services — video streaming, mobile gaming, ride-hailing, food and grocery delivery services — on different health behaviors.
The surveys were conducted using Google Consumer Surveys in December, 2020. Sample sizes varied from 500 to 1000 adults (18 years or older) in the U.S. for the product/service surveys; the general surveys each had 5,000 respondents. Samples were chosen to represent the U.S. population distribution across ages, genders, races, and geographic regions.
Results:
Prevalence of health-related behaviors
An average of 54.7% of U.S. residents reported low amounts of five different healthy behaviors:
- 57.2% of respondents get less than the recommended seven or more hours of sleep a night and 31.4% get less than six hours.
- 61.3% reported getting less than an hour per day of physical activity from activities such as housework, yard work, commuting, or running errands; 37.5% reported getting less than 30 minutes a day of such activity; and 15.4% less than 15 minutes.
- In terms of social activity, 54.1% reported spending less than two hours per week with friends (in person, or by phone or video chat); 29.4% reported less than one hour per week.
- 58.8% of respondents reported spending less than an hour a day outdoors, with 18.3% reporting less than 15 minutes a day.
- 41.9% of Americans eat home-cooked meals four or fewer nights per week; 16.4% only do so one-two nights per week.
The surveys also asked about a common behavior — using TV, computer, phone and other screens — that can generally be considered a competitor to these healthy behaviors. Among respondents, 59.5% said that they spend 3 or more hours a day looking at screens (TV, phone, computer) for personal (i.e. not work) reasons, and 37% reported spending five or more hours. In other words, a majority of American adults spend more time looking at screens (for personal use — not even including work use) than they do in routine physical activity, socializing with friends, or being outdoors combined.
Use of selected consumer products and services
The surveys examined the impact of selected categories of products and services on health behaviors.
Video Streaming
Use of video streaming services such as Netflix or Hulu inhibits sleeps. 54.7% of people report that using those services limits their sleep one or more nights per week; 36.1% report impact on sleep two or more nights per week. The impact is, unsurprisingly, related to the volume of usage: 37.0% of those reporting watching more than four hours of video streaming per day also reported it limiting their sleep more than five nights per week, as compared with 7.3% of all streaming users and 1.5% of users reporting less than two hours per day of streaming.
Food Delivery Services
The use of services for meal delivery and meal prep is associated with less cooking at home. Users of delivery services such as DoorDash and GrubHub; takeout and delivery service Domino’s; online grocery deliveries services such as Instacart; and meal kit delivery services such as Hello Fresh or Blue Apron (which in theory should make it easier to cook) were all less likely to report cooking dinner five or more nights per week than the general population.
Car Ownership and Rideshare Services
Car owners tend to drive (or be driven) short distances more than non-owners. 56.4% of car owners reported that they normally drive to destinations less than half a mile away, as compared with 36.2% of people who don’t own or lease a car. Car owners are 1.56 times more likely than non-owners to use a car to travel this short distance. That ratio persists at a distance of half a mile to one mile, for which 75.1% of car owners drive, versus 48.4% of those who don’t have a car.
Ride share services such as Uber and Lyft showed a slight impact on car ownership. 5.2% of rideshare users either chose not to purchase a car (or an additional car) because of the availability of the services; an additional 4.3% reported that they considered not buying a car or additional car; and 12.8% reports never having owned a car. The remaining 77.6% indicated that the services had no effect on their car ownership.
Mapping Services
Mapping services like Google Maps, Apple Maps and Waze have seemingly small influence on users’ choices of transportation mode (which, in turn, can affect health). 73.8% indicate that these services have not led to increases in the use of any mode; 84.7% report no associated decreases in use of any mode. (15.9% did note an increase in driving personal vehicles, as compared to 4.5% indicating an increase in walking — the next most likely mode to increase.) 51.1% of maps users indicated that they use the services to search for places to eat at least sometimes, indicating a potential for these services to affect eating patterns, depending on how search results are presented.
Mobile Gaming
Mobile gaming has some impact on both sleep and social connection. 37.2% of mobile games users report that their game play limited their sleep one or more nights per week. Mobile game play appears to be relatively social: 38.2% of users reported playing with others “usually” or “always” and an additional 21.3% played with others “sometimes.” 20.4% reported making new friends by playing mobile games in the past year.
Attitudes toward corporate responsibility for health impacts
Finally, the survey asked respondents whether they believe that companies should bear any responsibility for the impact their products have on the health of their customers: 30.7% said “a lot of responsibility,” 41.6% said “some responsibility” and 14.3% said “none at all.” The remainder were unsure.
Discussion:
Our surveys sought to understand consumers’ health-related behaviors, their use of products and services and the impact of these on health-related behaviors, and attitudes toward corporate responsibility for health impacts. The results reinforce, and in some cases deepen, existing concerns about health behaviors. Sleep is of particular concern. There is a lack of consistent, national trend data on sleep, but the 57.2% of adults in our sample reporting less than seven hours per night (what the CDC defines as “short sleep”) is considerably higher than what was reported in CDC’s most recent published data, from 2014, which showed only 35.2% of adults reporting less than seven hours per night.⁵ The figure is particularly troubling given the association of short sleep and a number of significant health conditions, including obesity, diabetes, heart disease and depression.⁶
The numbers for social connection — with the majority of U.S. adults reporting spending less than two hours a week with friends — are alarming, particularly in light of recent research showing the protective effects social connection can have on a whole host of conditions, ranging from inflammation,⁷ to heart disease and strokes,⁸ to depression⁹ and even to mortality in general.¹⁰ The social distancing requirements resulting from the COVID-19 pandemic could well be a confounder, but these survey items specifically included time spent talking on telephone or video calls, as well as time spent in person.
For physical activity, the survey did not focus on workouts, or exercise for the sake of exercising, but rather on activity that came from the course of everyday life — from household work, errands, and commuting. The low numbers — over 60% getting less than an hour and 15% less than 15 minutes a day — show how far the U.S. has slipped into an essentially sedentary lifestyle by default, with the fitness industry stepping in as a way to compensate.
Outdoor time is rarely measured at a population level, so it’s difficult to assess trends, but increasing research that shows benefits — in terms of reduced stress, lower heart rates and blood pressure, improved immune function and more¹¹ ¹² ¹³ — suggests that it merits greater focus.
The surveys did not delve into people’s diets — focusing instead on eating patterns — and used cooking dinner at home, which has been shown to yield healthier meals than typically purchased at either full-service restaurants or fast food outlets,¹⁴ ¹⁵ as a proxy for healthier diets. (Cooking dinner also confers other benefits such as more physical activity and social connection, if done collaboratively.) The survey results suggest that while most Americans still cook (or eat home-cooked meals) five or more nights a week, many people are now cooking less often than not. These data are consistent with gradual shifts toward greater spending on food away from home and fewer meals served at home being home-cooked.
Taken together, the picture looks fairly bleak: we’re not sleeping enough; we’re getting little physical activity or outdoor time in the course of our days; we’re spending precious little time with friends; and our eating patterns are drifting toward less healthy options. We are, however, spending more time watching screens — television, computer and phone — outside of work. While screen time is a coarse variable — it can encompass both beneficial and harmful activities — it is interesting by comparison, especially given that it is often a substitute, or competitive activity, for more healthy pursuits. To the degree that time is a factor in limiting healthy behaviors, the role of screen time in occupying people’s time has to be of concern.
The surveys showed that a number of the products and services that we use in our everyday lives influence these health behaviors. Video streaming and, to a lesser extent, mobile gaming are clearly identified as limiting sleep for many of their users. Car ownership, unsurprisingly, is associated with a greater likelihood of driving short distances instead of using more active, healthier transportation modes. Mapping and directions apps have slight influences on choices of transportation modes, but they lead to using automobiles more than often than alternative modes. The availability of rideshare services is having a small effect on car ownership (reducing it slightly).
The surveys of users of food services yielded some counterintuitive findings. It would be expected that users of food delivery apps like DoorDash and GrubHub or takeout/delivery outlets like Domino’s would cook dinner less frequently than non-users. However, users of grocery delivery services like Instacart and meal kit services like Hello Fresh or Blue Apron also reported eating home-cooked meals less often than the general public, which is surprising given that they both facilitate the acquisition of ingredients for cooking and one is specifically designed to simplify and speed up the cooking process. Time might be the common factor — that users of these services are generally pressed for time and therefore less likely to make the time for cooking than those who do not use the services.
Conclusion:
From a systems perspective, it would appear from our surveys that there are several industries — notably food, transportation, entertainment and tech — that are influencing everyday lifestyles, which have become largely unhealthy. There are other industries — diet and weight management, fitness, and parts of digital health — that exist to compensate for these unhealthy lifestyles. And then, of course, there is the health care industry that treats the conditions that result from these lifestyles.
While much attention has focused on the role of personal responsibility in health behavior, the potential for tools to help individuals exercise that responsibility, and, increasingly, the socioeconomic factors that also influence behavior — there has been little focus on the role that popular, everyday products and services play in shaping behavior and thus shaping health. According to our surveys, people expect companies to take responsibility in this area — more than 70% of respondents in our sample believe companies have “a lot” or “some” responsibility for the health impact of their products. The harms of everyday products might not be singular and dramatic, like those that come from smoking tobacco; indeed they are not always harms. However, the accumulated negative effects across many product categories, across the population, on behaviors such as sleep, physical activity, eating patterns, social interaction and spending time outdoors, are deeply significant and warrant far greater attention. That increased focus could lead to design changes and other product innovations that facilitate healthier lifestyles.
Acknowledgments:
Thomas Goetz, Sara Singer, Carlo Martinez and Brittany Sigler all contributed to the conceptualization and development of the surveys; Carlo Martinez contributed data analysis; Sara Singer provided valuable editing.
Other reports in this series:
Notes:
¹ Centers for Disease Control and Prevention, COVID-19 website, People at Increased Risk / People with Certain Medical Conditions, accessed March 25, 2021.
² Allied Market Research, Global Weight Loss and Weight Management Diet Market, 2021–2027. June, 2020.
³ Wellness Creative Co. Fitness Market Size, Revenue & Growth 2021 [+ Research Report], January, 2021.
⁴ Statista. Fitness equipment in the U.S. — Statistics & Facts, February, 2021.
⁵ Centers for Disease Control and Prevention, Data and Statistics — Sleep and Sleep Disorders, accessed March 25, 2021
⁶ Ibid.
⁷ Ye Luo et al. “Loneliness, Health, and Mortality in Old Age: A National Longitudinal Study.” Social Science & Medicine. Volume 74, Issue 6, March 2012, pp. 907–914.
⁸ Nicole Valtorta. “Loneliness and Social Isolation as Risk Factors for Coronary Heart Disease and Stroke: Systematic Review and Meta-Analysis of Longitudinal Observational Studies.” Heart 2016; 102:1009–1016.
⁹ Ye Luo, et al.
¹⁰ Julianne Holt-Lunstad et al. “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review.” Perspectives on Psychological Science. Vol 10, Issue 2, 2015.
¹¹ Yoshifumi Miyazaki et al. “Preventive Medical Effects of Nature Therapy.” Nihon Eiseigaku Zasshi. 2011 Sep; 66(4):651–6.
¹² Qing Li. “Effect of Forest Bathing Trips on Human Immune Function.” Environmental Health and Preventive Medicine. 2010 Jan; 15(1): 9–17.
¹³ Gen Xiang Mao. “Effects of Short-Term Forest Bathing on Human Health in a Broad-Leaved Evergreen Forest in Zhejiang Province, China.” Biomedical and Environmental Sciences. 2012 Jun; 25(3):317–24.
¹⁴ Julia Wolfson and Sara Bleich. “Is Cooking at Home Associated with Better Diet Quality or Weight-Loss Intention?” Public Health Nutrition, Volume 18, Supplement 8 June 2015 , pp. 1397–1406.
¹⁵ Junxiu Liu et al. “Quality of Meals Consumed by US Adults at Full-Service and Fast-Food Restaurants, 2003–2016: Persistent Low Quality and Widening Disparities.” The Journal of Nutrition, Volume 150, Issue 4, April 2020, pp. 873–883.
