The reports are in. The United Health Foundation has ranked the top 10 healthiest states of America, most of which are repeat winners from last year. Hawaii took home its fourth consecutive win as number one in 2015, while Washington managed to rise into the nation’s healthiest states, and North Dakota fell below top 10 standards this year.

Although obesity and diabetes saw an increase this year, physical inactivity, cigarette smoking, and preventable hospitalizations saw a decrease. The nation is upping their game when it comes to living a more active lifestyle. However, the work is not over. More people need to seek healthier habits so that obesity takes a downward trend in the future.

The United Health Foundation has issued an annual report for the past 26 years, and it looks at four groups of "health determinants": behavior, policy, community and environment, and clinical care. Here are the 10 healthiest states.

10. Nebraska

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Nebraska has remained steady in its ranking, reclaiming the number 10 spot in 2015.

9. Washington

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Washington surprised many by increasing from last year’s number 13 ranking, to number nine this year due to a decrease of cardiovascular and cancer deaths.

8. Colorado

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Colorado’s serene outdoors make activities such as hiking, mountain biking, and skiing commonly practiced sports for its healthy citizens.

7. Utah

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Low smoking and diabetes rates are some of the prime contributors to Utah’s consistently high ranking in health.

6. Connecticut

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Connecticut focuses many of its health efforts early, with a high prevalence of immunizations and low premature death rate.

5. New Hampshire

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One of the many New England states in the top 10 this year, New Hampshire has risen in the ranks along with their immunization rates for both children and adolescents.

4. Minnesota

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This Midwestern state has a low rate of cardiovascular related fatalities and medically uninsured citizens.

3. Massachusetts

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Another New England contender, Massachusetts’ low percentage in obesity has led to decreases in preventable hospitalizations, cardiovascular deaths, and cancer deaths.

2. Vermont

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Runner up since 2012, Vermont has a low violent crime rate and infant mortality rate.

1. Hawaii

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Taking the number one spot for its fourth year in a row, Hawaii continually makes strides in low obesity rates, high immunization rates, decreases in preventable hospitalizations, and for those uninsured. The beauty of Hawaii’s islands could also account for the slim amount of poor mental health days taken.

The least healthy states.

While New England and many Midwestern states remain in America’s top tier of health, Southern states including Alabama, Mississippi, and Louisiana continually rank at the opposite end. High obesity and diabetes rates, in addition to increased crime, poverty, and an uninsured population all factor into the lower rankings.

Over the past 25 years in the U.S., technological and medical advancements have caused an overall decrease in mortality rates such as premature deaths, infant mortality, cardiovascular deaths, and cancer deaths. Yet un-ignorable influences including poverty, smoking, and inactivity lay at the foundation of rising obesity and diabetes rates in America. View the full 2015 report here.