The ACSM's report, published as part of its American Fitness Index program, cited, among other things, the poor diet of residents, low levels of physical fitness, higher incidences of obesity, diabetes, and cardiovascular disease than the national average, low access to recreational facilities like swimming pools and baseball diamonds, the paucity of parks and low investment by the city in their development, the high percentage of households below the poverty level, and the lack of state-mandated physical education curriculum as contributing factors.