Author ORCID Identifier


Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Lucy Popova, PhD

Second Advisor

Claire A. Spears, PhD

Third Advisor

Dennis E. Reidy, PhD


Tobacco use is a leading public health emergency, with an annual death toll in the United States (US) of nearly 500,000 people. In addition, the US has recently experienced several other public health emergencies. This includes the COVID-19 pandemic, the epidemic of youth e-cigarette use, and the declaration of racism as a public health crisis.

Certain populations are at higher risk for harm associated with tobacco use, such as youth and young adults, those with low socioeconomic status, certain racial and ethnic minoritized groups, and those who live with mental illness. The COVID-19 pandemic has highlighted these inequities. Further research is needed on the relationship between racism and discrimination and tobacco use, youth e-cigarette use in the context of outbreaks, and support of nicotine reduction policies, which can significantly reduce the burden of tobacco-related disease.

Through three distinct yet related studies, these topics were explored. The first study is a qualitative examination of youth e-cigarette use trajectories in the context of COVID-19. We found that youth progress from initiation via family and friends, to social use with family and friends, then to addiction, at which point social use does not matter anymore. The second study assessed the association of experiences of racism and discrimination and smoking behaviors in the context of COVID-19, finding that those who experienced racism and discrimination are more likely to both make a serious quit attempt and to relapse, compared to those who had no experiences of racism or discrimination. The final study looked at support for nicotine reduction in cigarettes and e-cigarettes. We found support for nicotine reduction in both cigarettes and e-cigarettes among participants from four countries.

The purpose of this dissertation was to address the research questions related to tobacco use, with a particular focus on populations at higher risk for harms associated with tobacco use, in the context of COVID-19, which will help reduce the public health burden associated with tobacco use among those who are the most vulnerable, during the time of infectious disease outbreaks and public health emergencies.


File Upload Confirmation


Available for download on Wednesday, April 09, 2025