Nevada notched failing grades for its tobacco control policies in the latest report card from the American Lung Association.

In the group’s 18th annual scorecard released Wednesday, Nevada received “F” grades for tobacco prevention and cessation funding, tobacco taxes, access to cessation services and restricting tobacco to people over the age of 21. It received a “C” for smoke-free air.

The state is not alone in its low scores, however — only eight states got higher than an “F” from the group on tobacco prevention spending, and about two-thirds of states failed for tobacco tax rates.

“We're just really not doing enough,” JoAnna Strother, the association’s senior director of advocacy, said in an interview on Thursday. “We're not pushing it enough to have these policies protect public health. So they just don't go far enough in terms of what we know is evidence-based to help people quit smoking and youth to not start.”

The low grades come in spite of a relatively active 2019 legislative session on the issue, including the passage of a tax on vaping products that will largely direct revenue toward tobacco prevention activities. The new tax and existing funds from a settlement with tobacco companies means Nevada will have $3.4 million a year to spend on prevention activities — a boost, but still far from the federal recommendation of $30 million in spending per year.

Nevada’s per-pack cigarette tax is $1.80 after a $1 increase in 2015, but the state still failed on that ranking. Only Washington, D.C., where total cigarette taxes hover near $5 per pack, earned an “A.”

“It's falling below the national averages,” Strother said about Nevada’s cigarette tax rate. “We're looking for significant increases. And the reason why we want them significant is because that's what helps to improve public health.”

State lawmakers also proposed but ultimately canned measures to raise the tobacco purchase age to 21, but that change was approved nationwide by Congress and signed into law by President Donald Trump in December.

“So now what they’ll be looking for states to do is to comply with the federal law,” Strother said. “I believe that's something that we'll be eager to work on with legislators, is making sure that that enforcement mechanism is in place so that we can actually catch retailers who continue to sell to people under the age of 21.”

Smoking has garnered more attention in the last year amid a precipitous rise in the rate of young people vaping and a rash of deaths and hospitalizations from vaping-related illness. The scorecard pegs Nevada’s adult tobacco use rate at 23 percent and its youth tobacco use rate at 21 percent.