Looking to bum a smoke? You’ve got the best chances in Kentucky and West Virginia, where more than a quarter of the adult population smokes.

Looking for a beer buddy? Nearly a quarter of North Dakota and Wisconsin residents report either excessive or chronic drinking.

Those are some of the results from the annual America’s Health Rankings report, issued by the United Health Foundation, which finds massive disparities in health behavior and outcomes in states around the country.

The healthiest states in America are mostly in the Northeast: Massachusetts, Connecticut, Vermont and New Hampshire score top rankings, while Hawaii is the single healthiest state in the nation, the report finds. It is Hawaii’s fifth consecutive year in the top spot.

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The least healthy states are almost entirely in the South. Mississippi, Louisiana, Arkansas, Alabama, Oklahoma, Kentucky, Tennessee, West Virginia, South Carolina and Georgia are the 10 least-healthy states in the nation.

The report examines a bevy of health behaviors and outcomes including everything from smoking, drinking and drug-related deaths to high school graduation rates, air pollution and the amount of fruit the average adult consumes per day.

The least-healthy states show both short- and long-term health challenges. Mississippi residents have the lowest access to medical and dental care and some of the highest obesity, smoking and physical inactivity rates in the nation, signs that the current population is at risk of chronic or acute health problems. The state also has some of the highest percentages of children in poverty and lowest rates of immunization, hinting at health problems ahead for the next generation.

Hawaii residents, on the other hand, have some of the best access to healthcare, among the fewest number of uninsured adults and much lower than average obesity, smoking and inactivity rates.

Nationally, Americans are showing short- and long-term improvements in some areas of healthy behavior, and backsliding in others.

The prevalence of smoking among American adults is down 41 percent since the United Health Foundation began its rankings in 1990, and 17 percent in the past four years alone. Preventable hospitalizations have dropped 35 percent in the past decade, and the number of Americans without insurance is down 35 percent since 2011, just after the Affordable Care Act was signed into law.

But the number of drug deaths has increased by 4 percent in the past year alone. States with the highest number of drug deaths include West Virginia, New Mexico, Kentucky, Utah and Rhode Island, all states hit hard by the ongoing opioid crisis.

Americans are also notably heavier than they were when the foundation began its annual surveys. In 1990, just 11.6 percent of American adults were considered obese; in 2016, that number had jumped to 29.8 percent, a 157 percent increase.

More than 1 in 5 adults reported either binge drinking — defined as four or more drinks in a night for women, five or more for men — or chronic drinking in 10 states, mostly in the upper Midwest: North Dakota, Wisconsin, Alaska, Montana, Illinois, Minnesota, Iowa, Hawaii, Nebraska and Michigan.

Tobacco-producing states like Kentucky, West Virginia, Arkansas, Mississippi and Missouri have the highest smoking rates in the nation. Fewer than 1 in 10 Utah residents smoke, and only 11.7 percent of Californians smoke; California voters passed a tax hike in November that will add $2 to the cost of a pack of cigarettes.

The highest obesity rates are also mostly in the South: More than a third of adults in Louisiana, West Virginia, Mississippi, Alabama, Kentucky, Arkansas, Kansas, Oklahoma and Tennessee are obese. Only 20 percent of Colorado adults qualify as obese, the lowest rate in the nation.

Coloradans are also the most physically active, followed by Western states like Oregon, Washington, California and Utah, where residents reported fewer days of physical inactivity. More than a third of adults in Mississippi and Arkansas reported no physical activity other than their regular jobs in the past 30 days.

See how your state ranks here.