The American Lung Association has handed out a few high grades to Sonoma County, Rohnert Park and Sebastopol for restrictions on second-hand smoke.
But the county overall fared dismally in the State of Tobacco Control 2011, a "report card" produced annually by the national organization.
Cloverdale, Cotati and Sonoma all earned "overall tobacco control grades" of F this year, as did two-thirds of California cities, the report says.
Grades of D were passed out to Healdsburg, Petaluma, Santa Rosa and Windsor.
California as a whole earned two F's and and a D as well, despite its early leadership in adopting smoke-free workplaces in the 1990s. It did retain an "A" in the "Smokefree Air" category.
The Lung Association considers four factors in grading the nation's states: tobacco control and prevention spending, smoking restrictions, cigarette taxes and coverage for smoking cessation assistance.
Counties and municipalities are judged in three areas: smoke-free outdoor air, smoke-free multi-unit housing and reduced tobacco sales.
Sonoma County was highlighted for bringing its Smokefree Outdoor Air mark up from an F to a B, the result of the board to supervisors' adoption of an anti-smoking package that includes bans on smoking in outdoor dining areas and service areas such as ATMs, ticket lines, bus stops and taxi stands outside city boundaries.
Prohibitions on smoking in apartments, condominiums and other multi-unit housing brought the county's grade for Smokefree Housing from D to A.
The unincorporated county's overall grade for tobacco control was B, the same as Sebastopol's and Rohnert Park's.