Topeka ? Kansas had the greatest decline in health in the nation during the last year, according to a study released Monday.

In the new study, Kansas ranked 23rd in the nation, down from No. 16 in 2006, and the state’s overall score dropped more than any other state.

The findings are part of the 18th annual America’s Health Rankings conducted by the United Health Foundation, which seeks greater access to health care.

“This year’s study confirms that health reform proposals need favorable consideration in order to improve Kansas health,” said Roderick Bremby, secretary of the Kansas Department of Health and Environment.

In the past year, the prevalence of smoking in Kansas has increased from 17.8 percent of the population to 20 percent, the study said.

In addition, the number of obese Kansans increased from 23.9 percent to 25.9 percent, while the rate of uninsured increased from 10.3 percent to 12.3 percent.

Kansas also has a low childhood immunization rate, a growing number of children born into poverty, a 43rd ranking in seatbelt usage and limited access to primary care, officials noted.

Recommendations before the Legislature would address some of the concerns raised in the study.

Those include an increase in the cigarette tax, a statewide ban on smoking in public places and improved tobacco cessation programs.

In addition, lawmakers will consider promoting healthy foods in schools and increasing physical education.

Nationally, the healthiest states were Vermont, Minnesota, Hawaii, New Hampshire and Connecticut. The bottom five states were Tennessee, Oklahoma, Arkansas, Louisiana and Mississippi.

Missouri ranked No. 35; Nebraska, No. 10; and Colorado, No. 16.