Author ORCID Identifier

Date of Award

Summer 8-8-2023

Degree Type


Degree Name

Doctor of Philosophy (PhD)


Public Health

First Advisor

Christine E. Stauber, PhD, MS

Second Advisor

David L. Ashley, PhD

Third Advisor

Wanzhe Zhu, PhD


The U.S. Centers for Disease Control and Prevention (CDC) reported that, in the United States, tobacco product use is the prominent cause of avoidable disease, disability, and death in the year 2017.While tobacco use has severe public health consequences, it has been difficult to fully understand the behaviors surrounding this preventable public health challenge. Introduced in 2011, the Population Assessment of Tobacco and Health (PATH) Study’s purpose is to influence the Food and Drug Administration's regulatory activities via the Family Smoking Prevention and Tobacco Control Act (TCA). The PATH study is a longitudinal cohort study examining tobacco use and behavior in adolescents and adults. The purpose of this dissertation is to examine use and behavior for tobacco products over time and examine both initiation and switching of products. In our analysis, we found that demographically, those who initiated or consistently used smokeless products over time were white and male while those who used traditional combustible products varied more in terms of racial makeup. With smokeless and traditional combustible products, most participants chose to use tobacco products with moderate nicotine levels, regardless of previous exposure in a prior study wave. There was very little evidence of product switching that resulted in increased tar/nicotine content differences among the population we studied. Younger participants were using electronic cigarettes in greater proportions than adults and as opposed to traditional combustible products. We also found that the rate of nicotine metabolism was not related to frequency of e-cigarette use or type of product. These results provide insight into ways in which prevention strategies can be targeted to groups that are more likely to initiate and stay using tobacco products.


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