Long Beach and Los Angeles took the top two spots as the worst in the nation when it comes to air quality, according to a report that included the 100 most populated cities in the country by the national chapter of the American College of Sports Medicine.

The annual American Fitness Index breaks down many things to give us a peek into people’s health habits and the opportunities their communities provide to remain healthy. They measure many things—a city’s physical activity rate, park space, active transportation—but this year added four new categories of measurement: a city’s Bike Score (Long Beach sits in the Top 50 in the nation), pedestrian fatalities (there have been over 20 this year in Long Beach), Complete Streets policy (recent projects like Broadway give our city a boost here), and air quality.

That last one? The worst in the nation, sharing the same score as Los Angeles.

In fact, California and Arizona shared the 10 worst cities in the nation: Gilbert, Phoenix, Scottsdale, Chandler and Mesa, all in Arizona; and Glendale, Riverside, and Bakersfield rounded off the rest of the worst.

“Unfortunately, poor air quality has been shown to discourage physical activity, especially among people with respiratory limitations,” wrote lead author Dr. Barbara Ainsworth of Arizona State University. “Geography, weather, automobile use, and industrial emissions all play a role in a city’s air quality. Local policies and practices like car-free days and events, maintaining or upgrading city vehicles, quality checks on automobile exhaust, and better control of industrial emissions can help mitigate harmful air pollution that impacts all residents.”

Despite advances, we know that California is not meeting the emission goals it has set forth statewide—and we have long known that the L.A.-Long Beach metro has consistently ranked as the worst in the state for years, with marginalized communities bearing the brunt of the effects of that pollution.

Another report released earlier this year from New York University’s Marron Institute of Urban Management has shown that, while nationwide deaths due to smog have decreased, the L.A.-Long Beach metro has seen an increase in deaths related to ozone emissions. If paired with the second-worst area in the nation in terms of pollution, the Riverside-San Bernardino metro, these two areas are responsible for 89% of pollution-related deaths in California. This makes the Long Beach-L.A. region the worst for smog-related deaths.

And while data from multiple sources confirm our lack of air quality, when it comes to our city’s overall ranking on the fitness index, Long Beach fared much better, sitting in the Top 20 (#18) of the “fittest” cities in the nation.

To see Long Beach’s rankings card that directly compares it to the nation’s #1 city, Arlington, Virginia, click here. To compare Long Beach to every other city ranked in the report, click here.

Brian Addison is a columnist and editor for the Long Beach Post. Reach him at [email protected] or on social media at Facebook, Twitter, Instagram, and LinkedIn.