Indiana ranks as the 41st healthiest state in the nation, according to an annual study. The ranking by America's Health Rankings is the same as 2013, citing a high prevalence of obesity and physical inactivity, as well as high levels of air pollution as “challenges” to the state's health. Strengths included a low incidence of infectious disease, a low percentage of children in poverty and high immunization coverage among teens. Over the past two years, the study shows smoking decreased by 3.7 percent in Indiana, with 21.9 percent of Hoosiers reporting as smokers. Since the 2013 study, binge drinking and children living in poverty have also decreased.