Of the state's 10 largest cities, Bakersfield and Anaheim were the only ones to score an F in the American Lung Association's State of Tobacco Control 2014 report.
The report, released Wednesday, tracks progress on key tobacco control policies at the city, county, state and federal levels, and assigns grades in four key areas: tobacco prevention and control spending, smoke-free air, cigarette taxes and cessation coverage. The grades are based on tobacco control laws and regulations in effect as of Jan. 2, 2014.
Several local health officials said they weren't surprised by Bakersfield's poor showing, but Kern County Public Health Services Director Matt Constantine said, "I sure hope an F is not as good as we can get. We have to do everything we can do to address how smoking affects our health."
About 19.4 percent of Kern County adults smoked in 2012, according to Kern County Public Health Services. That's compared with 12 percent of adults statewide.
Among the county's youth, 14.2 percent smoked as of 2010, the most recent data available.
Constantine said the county is working to combat that by, among other things, sending youth decoys into retail stores to test compliance with laws against selling tobacco products to children.
Last year, 71 of the 525 stores licensed to sell tobacco products failed that test, he said.
The goal, of course, is to prevent people from becoming addicted in the first place and reducing long-term health problems such as cancer and cardiovascular disease, Constantine said.
Heart disease is the leading cause of death in Kern County, and smoking contributes to it, he said.
There is certainly a corelation between good public health policies and a healthier population, which is why the American Lung Association monitors them, said Vanessa Marvin, state director of advocacy for the American Lung Association.
"These grades definitely represent real health consequences," she said.
But the news isn't entirely bleak for Kern County.
Although the highest overall grade in Kern was a C for Tehachapi, there were a few bright spots in individual categories.
California City, Delano, McFarland, Tehachapi, Wasco and unincorporated Kern County all got As in the category of reducing sales of tobacco products.
The American Lung Association's Marvin also praised Tehachapi for passing an ordinance against smoking in city parks, which raised its overall grade to a C.
The Kern County Board of Supervisors is discussing a similar policy at county parks that would limit smoking to parking lots.
But the county's overall performance was depressing.
California City, Delano, McFarland, Wasco and unincorporated Kern County were given Ds.
Every other city in Kern County flunked.
The American Lung Association slammed Bakersfield and most of the county's other cities for failing to protect outside air at outdoor dining areas, entryways and work sites, for having too few nonsmoking housing units and for robust sales of tobacco products, including near schools and parks.
"We continue to look to the leadership of these communities, and we really hope they will find a way to create some solutions to those problems," Marvin said.