With a fourth of Texans going without health insurance and a quarter of children living in poverty, Texas is among the worst states in a new ranking of Americans’ overall health.

The state ranked No. 46, down from No. 37 last year, according to the annual report. The study — dubbed America’s Health Rankings — is produced by the UnitedHealth Foundation, the American Public Health Association and Partnership for Prevention.

Among the findings in Texas:

Twenty-five percent of children live in poverty, up from 22 percent last year.

Texas has a low prevalence of smoking, although it edged up to 19.3 percent.

Immunization coverage has improved in recent years. So has the infant mortality rate.

The state has a low rate of cancer deaths, at 186.3 per 100,000 people.

Texas’ overall poor result reflects the state’s ongoing problems with access to affordable health insurance and to healthcare, said Kathryn Cardarelli, director of the Center for Community Health at the University of North Texas Health Science Center in Fort Worth.

"It reflects a lack of prioritization at the state level for health," she said. "If we don’t make significant changes now, we’re headed down a path where I don’t see these rankings for Texas getting any better."

Among her suggestions: Sign up more eligible low-income children for health coverage through Medicaid and the Children’s Health Insurance Program; push for municipal bans on smoking; and promote workplace-based exercise and wellness programs.

Overall, the nationwide study found that Americans’ health has failed to improve for four consecutive years.

Vermont was ranked the healthiest state for the second time in a row. Louisiana fared worst.