Financial insecurity, health problems, strenuous work hours, and long commute times can all contribute to stress. In the United States, none of these stressors are especially rare. And while some level of stress can act as a motivator and have a positive impact, beyond that stress has mostly negative consequences.

The already relatively high stress levels in the United States are even worse in some cities. To highlight how stress levels can vary geographically, 24/7 Wall St. reviewed the percentage of adults in U.S. metro areas reporting daily stress from research partnership Gallup-Healthways Well-Being Index.

Chico, California leads the nation with over 50% of adults reporting daily stress. Salt Lake City, Utah rounds out our list of 15 cities with 45% of adults experiencing stress for a large part of every day. For reference, 40% of adults nationwide report regular stress.

Click here to see America’s 15 most stressed out cities.

A recent American Psychological Association survey found lower-income households are significantly more likely to experience stress than other households overall. During the recession and even after the recovery, money and finances remained a top source of stress across the country. According to the APA research, 72% of Americans feel stressed about money on a monthly basis.

The poverty rate in seven of the 15 most stressed-out cities is higher than the national rate of 14.7%.

Financial concerns lead many adults to put off health care, increasing the severity and cost of medical issues down the road. Stress is a compounding factor, as chronically stressed individuals are at a significantly greater risk of cardiovascular disease and other maladies. Either by increasing the risk of cardiovascular disease, triggering a heart attack, or as a result of coping strategies such as overeating or smoking, regular stress can lead directly to serious health problems. These issues in turn can become stressful hindrances to daily activity.

In nine of the 15 most stressed-out cities, adults are more likely than adults nationwide to report sub-optimal levels of health.

A recent National College Health Assessment study found approximately half of U.S. college students struggled with overwhelming anxiety over the past year. The findings can help explain the prevalence of college towns on this list.

Just over 7% of people nationwide are currently enrolled in college or graduate school. In nine of the 15 most stressed cities, the percentage of residents enrolled in postsecondary institutions is greater than the national share.

Click here to read our methodology.

These are the 15 most stressed out cities.