Author ORCID Identifier

https://orcid.org/0000-0001-5477-3007

Semester

Spring

Date of Graduation

2025

Document Type

Dissertation

Degree Type

PhD

College

Eberly College of Arts and Sciences

Department

Psychology

Committee Chair

Melissa Blank

Committee Co-Chair

Nicholas Turiano

Committee Member

Nicholas Turiano

Committee Member

Kathleen Morrison

Committee Member

Brittney Keller-Hamilton

Abstract

Rates of traditional tobacco use have reached a century-level low though not universally with some vulnerable populations continuing high rates of tobacco use, such as those located in geographically isolated areas of the United States (US). Rural populations experience a unique set of challenges (i.e., decreased access to health promoting resources, high density of tobacco retailers, increased pro-tobacco advertising) that compound to produce a “cumulative disadvantage” ultimately increasing their risk of tobacco use. To curb and prevent tobacco use, tobacco control policies, such as excise taxes, can be implemented. At least one study suggests tobacco control policies are less effective in rural populations, but prior research has neglected the potential intersectional approach of rurality, tobacco control policies, and tobacco use behaviors. Thus, the present study used an intersectional approach to examine changes in three tobacco products (cigarettes, smokeless tobacco, and electronic cigarettes) by 4-level urbanization as a function of changes in excise cigarette taxes. Using a nationally representative dataset including 94,641 observations between 2013-2019, Generalized Linear Mixed Effects Models (GLMMs) revealed results in line with prior studies (i.e., rural populations more likely than urban to use cigarettes and smokeless tobacco). Few significant moderation effects (i.e., advertising exposure, harm perceptions, income) were revealed when considering variables known to differ between rural and urban populations. Finally, census region appears to account for some tobacco use differences seen by urbanization level. Continued work is needed utilizing an intersectional approach to understand nuanced tobacco risk factors that may exist for different urbanization levels along with the how to best conceptualize “rurality” for tobacco research.

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