Kentucky is the 45th healthiest state in the U.S., according to a recent report analyzing the health of the nation. The report, America’s Health Rankings, attributes Kentucky’s low marks to, among other issues, a high prevalence of smoking, obesity, a high rate of cancer deaths, and a high rate of drug deaths.

The report was produced by United Health Foundation, a nonprofit focused on the health and the well-being of communities.

Kentucky ranked 44th last year.