Multifaceted Impacts of the COVID-19 Pandemic: Smoking, Influenza Vaccine Uptake, and Respiratory Mortality
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Authors
Williams, Danika Mahal
Issue Date
2025
Type
Dissertation
Language
en_US
Keywords
COVID-19 , Emergency Preparedness , Health Policy Implications , Health Risk Factors , Influenza Vaccines , Social Determinants of Health
Alternative Title
Abstract
The COVID-19 pandemic fundamentally altered public health dynamics, impacting disease transmission, healthcare utilization, and mortality outcomes. This dissertation examines three interrelated aspects of the pandemic’s effects: (1) behavioral risk factors influencing COVID-19 hospitalization, (2) factors affecting influenza vaccine uptake among caregivers, and (3) excess pneumonia and influenza (P&I) mortality patterns. Using a social determinants of health framework, this research explores how individual behaviors, preventive practices, and systemic disparities collectively shaped health outcomes during the pandemic.The first study assesses the association between smoking and COVID-19 hospitalization by integrating individual and regional factors. Employing a retrospective cohort design with surveillance data using multilevel regression models to quantify how smoking status and community characteristics influenced hospitalization risk. The findings provide insight into the complex relationship between smoking and COVID-19 severity, addressing inconsistencies observed in early pandemic studies.
The second study investigates influenza vaccine uptake among caregivers during the pandemic. Using Behavioral Risk Factor Surveillance System (BRFSS) data, multivariable logistic regression models evaluate how sociodemographic characteristics, health-related factors, and risk perceptions affected vaccination decisions. The study examines whether pandemic-driven risk awareness led to increased caregiver vaccination rates, contributing to improved public health strategies.
The third study analyzes shifts in P&I mortality trends using death certificate data from the Nevada Vital Records Office. A zero-inflated negative binomial regression model estimated expected and excess P&I mortality during the pandemic, stratifying results by age, sex, race/ethnicity, and geographic location. The findings reveal significant deviations from pre-pandemic mortality trends, underscoring disparities in healthcare access and disease burden across different populations.
Collectively, these studies provide a comprehensive assessment of how the COVID-19 pandemic influenced respiratory disease outcomes and preventive health behaviors. By utilizing individual and population-level factors incorporating a social determinants of health perspective, this research highlights critical gaps in public health response and offers actionable insights for future emergency preparedness. The findings emphasize the necessity of targeted interventions that address both individual behaviors and systemic inequities, ensuring more equitable health outcomes in future health crises.