This dissertation uses fundamental cause theory to understand how providers, essential staff, and Black, Hmong, and Latinx community members perceive the oral health and tobacco environment in a rural region of California’s Central Valley. According to Link and Phelan, fundamental cause theory states that certain social conditions, mechanisms, and “factors that put people at risk of risk” remain persistently associated with health disparities over historical time despite changes in diseases and health interventions. Using ethnography and qualitative in-depth interviews with Central Valley residents, I identify and elaborate on the social conditions and variable mechanisms that may be responsible for the persistent tobacco-related oral health in the region. Social conditions explored include: poverty, rurality, and exposure.