Hawai'i has lost its distinction as the healthiest state in the nation, according to a new report by America's Health Rankings.

The report ranked Hawai'i No. 4, behind Vermont, Utah and Massachusetts. Hawai'i was No. 1 last year and No. 3 in 2007.

Although the state dropped a few spots this year, state Department of Health officials remained pleased with the high ranking.

"With these reports, we continue to do well," said Alice Silbanuz, public education coordinator with the department's Healthy Hawai'i Initiative. "We always rank within the top five when this report has come out in the past, so we're staying in that top tier compared to other states. But definitely there's a lot of work that still needs to be done."

The Healthy Hawai'i Initiative is working to increase physical activity among residents, as well as promoting healthy eating while decreasing tobacco use, Silbanuz said. The program also has partnered with other agencies and communities to promote a healthy lifestyle, she said.

The America's Health Rankings report authors said Hawai'i continues to do well in terms of smoking rates (15.4 percent of the population), low levels of air pollution (4.8 micrograms of fine particulates per cubic meter, few uninsured residents (7.7 percent of the population), and a low prevalence of obesity (23.1 percent of the population).

It also noted the state has strong public health funding ($220 per person), ready availability of primary care physicians (149.4 per 100,000 people), and low rates of deaths from cancer and cardiovascular disease (230.7 deaths per 100,000 people).

But the report said the state still has work to do when it comes to binge drinking (18.1 percent of the population) and reducing the percentage of children in poverty (14.3 percent).

Hawai'i also did worse compared with 2008 in infectious disease cases per 100,000 people, immunization coverage and prenatal care.

The survey says it is the longest-running annual assessment of the nation's health on a state-by-state basis. The report is published jointly by United Health Foundation, the American Public Health Association and Partnership for Prevention.

The Hawai'i-specific report can be seen at www.americashealthrankings.org/yearcompare/2008/2009/HI.aspx.