Author ORCID Identifier


Date of Award

Summer 8-9-2022

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Lucy Popova

Second Advisor

Terri Pigott

Third Advisor

Claire Spears


Reducing the burden of tobacco and drug use in the United States (U.S.) is a public health priority. Certain populations are at higher risk of harms associated with tobacco and cannabis use, including youth and people with mental health issues. For tobacco, adults with symptoms of serious psychological distress (SPD) smoke at higher rates than those without SPD. Youth who use tobacco have a greater lifetime risk of serious disease, such as lung cancer compared to youth who do not initiate tobacco use. Some research has shown that cannabis use is associated with risk to youth, including changes in neurodevelopment.

Through three distinct, yet related studies, these topics were explored. The first study was a systematic review and meta-analysis of longitudinal studies looking at the association between cannabis use and depression. We found that the odds of developing depression for cannabis users was 1.36 (95% CI: 1.06, 1.52) compared to non-user controls. The second study took a qualitative approach to explore modification behaviors among adolescent electronic nicotine delivery system (ENDS) users. Our study found that youth are making modifications that are both intended and unintended by the manufacturer. Among our sample, the most mentioned modifications were to the e-liquids. The final paper looked at quit intentions among smokers with SPD through quantitative analyses. For our sample of 1,004 adult smokers, those with SPD were significantly more likely to report intentions to quit smoking and seek counseling than smokers without SPD, controlling for covariates.

The purpose of this dissertation was to address the research questions related to tobacco and cannabis use with special focuses on youth and on mental health with the goal to help reduce the public health burden associated with tobacco and drug use, especially among those who are most vulnerable.

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