When it comes to healthy living, the Tar Heel State has some work to do. North Carolina is the 33rd healthiest state in America, according to the 29th annual report from the United Health Foundation. The report, "America's Health Rankings," was published Thursday and looks at 35 health markers that seek to evaluate how healthy a state really is. This includes indicators involving behaviors, community and environment, policy, clinical care and health outcomes.

North Carolina performed best in its low prevalence in excessive drinking and worst in its uninsured rate and incidence of chlamydia. Here's a complete breakdown: Overall ranking: 33rd

33rd Behaviors: 22nd

22nd Community and environment: 30th

30th Policy: 38th

38th Clinical care: 37th

37th Health outcomes: 37th The healthiest state in the nation is, once again, Hawaii, the researchers found. Hawaii ranked in the top 10 in all five categories, and in the top five in four of them.

"Hawaii regains the title of healthiest state this year, after dropping to No. 2 in 2017," the report said. "This is Hawaii's ninth year in the No. 1 spot since 1990 when the health rankings were first published.The state has been No. 1 four of the past five years." Hawaiians have a low prevalence of obesity at 23.8 percent for adults, even as the national rate climbed to more than 30 percent for the first time.

"Obesity continues to be a leading cause of cardiovascular disease and cancer — chronic diseases that are contributing to premature death rates," the report said. (For more news like this, find your local Patch here. If you have an iPhone, click here to get the free Patch iPhone app; download the free Patch Android app here.) The state also has a low prevalence of smoking at 12.8 percent and benefits from lower levels of air pollution compared to the rest of the country.

Overall, the healthiest states were located in the Northeast, though a few were in the Midwestand West.

Here are the top 10 healthiest states:

Hawaii Massachusetts Connecticut Vermont Utah New Hampshire Minnesota Colorado Washington New York Meanwhile, the least healthy states were located in the South, with the notable exceptions of Indiana (No. 41) and Ohio (No. 40). Louisiana ranked dead last in the country, supplanting Mississippi for the dubious honor. Louisiana, which ranked last in both behaviors and community and environment, had the highest prevalence of children in poverty at 28 percent — the national average is 18.4 percent — and a high prevalence of adult smokers at 18.4 percent. Furthermore, 36.2 percent of Louisianans are obese compared to 31.3 percent nationwide. The researchers noted the state has the "greatest opportunity for improvement," but it won't be easy — there's a large health gap even between 50th ranked Louisiana and the 48th ranked state, Alabama.