Laura Ungar of The (Louisville) Courier-Journal spent a year assessing the health of Kentucky's residents, finding that "Kentucky is one of the sickest states in America, a place where too many people die too soon, and many who live endure decades of illness and pain." Bad health habits ingrained in the state's culture, including high tobacco use, along with poverty, combine to make the state a "perfect storm" for health. "Poverty is at the center, tied to everything from nutrition to health habits to the medical care people receive. Kentucky has 43 of the nation's 340 persistently poor rural counties. Only Mississippi, which ranks neck and neck with Kentucky on an index of health measures, has more." The report includes loads of graphics describing the state's condition.