Date of Conferral



Doctor of Public Health (DrPH)


Public Health


Shanna Barnett


Early e-cigarette use by youth has the capacity to create an early addiction to nicotine, increasing the risk of life-long dependency and the possible development of multiple cardiovascular and pulmonary diseases. Reinforced by the socioecological model, the purpose of this study was to determine if academic performance is associated with e-cigarette use among teenagers and young people and if the presence of adverse childhood events (e.g., cyberbullying in school and/or the presence of homelessness) mediated this association. This study included all respondents (N = 1,401) from the state of Nevada who answered the 2019 National Youth Risk Behavior Survey. Binary logistic regression determined that there was a positive association between academic performance and e-cigarette use (p = < .001). Students who reported mostly grades of F (p = .003, OR .219, 95% CI [.080, 5.422]) had a higher likelihood of using e-cigarettes. Mediation analysis with regression determined that the presence of cyberbullying had a direct effect on this relationship (B = -.027, p = .003, 95% CI [-.045, -.009]); however, it did not mediate this relationship (z = -.083, p = .407). The results of this study revealed positive associations between academic performance and e-cigarette among 17- and 18-year-olds, those reporting male sex, individuals of multiple races (non-Hispanic), and individuals unsure of their grades. These results can help improve current policy and public health programs related to low academic performance and cyberbullying. This evidence revealed critical identifiers to e-cigarette use among teenagers and young people. Implications for positive social change include the possible reduction of current and/or future smoking-behaviors.