The American Lung Association gave Arizona some poor marks Wednesday on its new report card on tobacco prevention.
The state is one of only a few that does not have a tobacco licensing system.
"So, we actually don't know who is selling tobacco, how many retailers there are," said JoAnna Strother, senior director of advocacy for the association. "It's really important to know that because we want to catch those bad actors that continue to sell tobacco products to our minors."
About 13% of Arizona adults smoke, according to the American Lung Association's latest report card. That's about one point better than the country as a whole but a higher percentage than in neighboring California, Utah and Colorado.
The American Lung Association gave Arizona an F on funding anti-smoking programs, noting that funding is far below levels recommended by the Centers for Disease Control and Prevention.
The state also gets an F for not regulating flavored tobacco products and for its tobacco taxes.
Strother said the association is also concerned by efforts at the state capitol to stop cities and towns from regulating flavored products at the local level.
Meanwhile, the state only gets a C for access to cessation services.
But Arizona got at least one A grade — that is for its smoke-free air laws.