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The COVID-19 pandemic had many unprecedented secondary outcomes resulting in various mental health issues leading to substance use as a coping behavior. The extent of changes in substance use in a US sample by nativity has not been previously described.
This study aimed to design a web-based survey to assess the social distancing and isolation issues exacerbated by the COVID-19 pandemic to describe substance use as a coping behavior by comparing substance use changes before and during the pandemic.
A comprehensive 116-item survey was designed to understand the impact of COVID-19 and social distancing on physical and psychosocial mental health and chronic diseases. Approximately 10,000 web-based surveys were distributed by Qualtrics LLC between May 13, 2021, and January 09, 2022, across the United States (ie, continental United States, Hawaii, Alaska, and territories) to adults aged ≥18 years. We oversampled low-income and rural adults among non-Hispanic White, non-Hispanic Black, Hispanic or Latino, and foreign-born participants. Of the 5938 surveys returned, 5413 (91.16%) surveys were used after proprietary expert review fraud detection (Qualtrics) and detailed assessments of the completion rate and the timing to complete the survey. Participant demographics, substance use coping behaviors, and substance use before and during the pandemic are described by the overall US resident sample, followed by US-born and foreign-born self-reports. Substance use included the use of tobacco, e-cigarettes or nicotine vapes, alcohol, marijuana, and other illicit substances. Marginal homogeneity based on the Stuart-Maxwell test was used to assess changes in self-reported substance use before and during the pandemic.
The sample mostly included White (2182/5413, 40.31%) and women participants (3369/5406, 62.32%) who identified as straight or heterosexual (4805/5406, 88.88%), reported making ≥US $75,000 (1405/5355, 26.23%), and had vocational or technical training (1746/5404, 32.31%). Similarities were observed between the US-born and the foreign-born participants on increased alcohol consumption: from no alcohol consumption before the pandemic to consuming alcohol once to several times a month and from once to several times per week to every day to several times per day. Although significant changes were observed from no prior alcohol use to some level of increased use, the opposite was also observed and was more pronounced among foreign-born participants. That is, there was a 5.1% overall change in some level of alcohol use before the pandemic to no alcohol use during the pandemic among foreign-born individuals, compared with a 4.3% change among US-born individuals.
To better prepare for the inadvertent effects of public health policies meant to protect individuals, we must understand the mental health burdens that can precipitate into substance use coping mechanisms that not only have a deleterious effect on physical and mental health but also exacerbate morbidity and mortality in a disease like COVID-19.
The COVID-19 pandemic, as of March 2022, has >456 million recorded cases and 6 million reported deaths worldwide [
Coping strategies provide the ability to manage external and internal demands, given an individual’s resources [
Statistics for June 2020, when compared with 2019, as reported by the Centers for Disease Control and Prevention [
The effects of social distancing and isolation early in the pandemic were compounded by multiple issues associated with access to health, mental health, and related telehealth services [
Further research is needed to understand the multiple and varying sociodemographic and socioeconomic factors to fill this gap. In addition, there is a critical need to include both US-born and foreign-born individuals in substance use research during the COVID-19 pandemic as these studies are still limited. A limited number of studies have reported mixed findings, that is, increased and decreased substance use during the pandemic [
Our study
The target population comprised adults aged ≥18 years residing in the United States. The US resident sample included both US-born and foreign-born participants. Qualtrics LLC was contracted to facilitate the recruitment and distribution of the web-based survey to both US-born and foreign-born racial and ethnic groups. The US-born racial and ethnic groups included Hispanic or Latino, White, Black, Asian, American Indian and Alaskan Native, and Native Hawaiian and Pacific Islander participants. Foreign-born racial and ethnic groups included African, Middle Eastern, Hispanic or Latino, and Asian participants. Qualtrics then used proprietary consumer panels to randomly sample White participants that matched demographic characteristics with other racial and ethnic groups. We oversampled adults with low income (<US $25,000 annual household income) who resided in rural areas (self-reported and cross-referenced with zip codes already collected by Qualtrics) among non-Hispanic White, non-Hispanic Black, Hispanic, and foreign-born participants. The survey was available only in English.
A total of 10,000 surveys were distributed between May 13, 2021, and January 09, 2022. The initial surveys received by Qualtrics were assessed via expert review fraud detection to prevent multiple submissions and detect “bots” to protect the integrity of the data. After the assessment, 5938 surveys were received by the research team from Qualtrics. Information Management Services, Inc, a research support firm that provides analytic services, was given the task to clean and manage the deidentified survey data.
To improve study integrity, initial data cleaning by the Information Management Services included flagging surveys based on the completion rate and the timing to complete the survey. Participants were flagged and removed from the analysis if they completed <80% of the survey based on 102 questions after accounting for skip pattern items or took <5 minutes to complete the survey. In total, 125 surveys were removed at this stage, giving us 5813. Our study ended with a total of 5413 surveys based on the completed responses in the social distancing module of the
Qualtrics recruited study participants, and web-based informed consent was provided before the survey. Participants were asked to participate in a voluntary research study titled
The research protocol for this study was reviewed by the NIH, Intramural Research Program Institutional Review Board, Human Research Protection Program, and Office of Human Subjects Research Protections and received an exemption on December 23, 2020 (IRB#000308). The NIH, Intramural Research Program Institutional Review Board, Human Research Protection Program, and Office of Human Subjects Research Protections determined that our protocol did not involve human participants and was excluded from the institutional review board review.
All sociodemographic items were self-reported and allowed for either the selection of multiple categories or provided a free response if they selected a blank or other category. Nativity was categorized by country of birth as either US born or foreign born. US-born nativity was based on respondents’ self-reported births in the 48 contiguous states, Washington, the District of Columbia, Alaska, Hawaii, and other US territories such as Puerto Rico. Foreign-born nativity was based on respondents’ self-reported births occurring in another country outside the United States based on the US birth classification. Racial and ethnic categories included selecting ≥1 of the following options: White, Black or African American, Asian, American Indian or Alaskan Native, Hawaiian or Pacific Islander, African, Middle Eastern, and multiracial or multiethnic. If respondents selected ≥2 racial or ethnic groups, they were classified as multiracial and multiethnic. Gender categories included men, women, nonbinary, transgender people, and others. Sexual orientation included straight or heterosexual, lesbian, gay, bisexual, and other. The lesbian and gay categories were combined. Age was self-reported starting from 18 to ≥85 years. Age categories were then constructed as follows: 18 to 35 years, 36 to 55 years, and 56 to ≥85 years. Annual household income was reported as <US $25,000, US $25,000 to US $34,999, US $35,000 to US $49,999, US $50,000 to US $74,999, and US ≥$75,000. Educational attainment was categorized by self-reported highest schooling that included (1) less than high school or General Language Development (ie, did not attend school; elementary education, 6 years or less; more than elementary to junior high school; or some high school), (2) high school diploma or General Language Development, (3) some college or vocational or technical schooling, (4) bachelor’s degree, and (5) master’s degree or above (ie, master’s degree or doctoral, professional, or postgraduate degree). Employment status was assessed using multiple survey items. Current employment (ie, employed, self-employed, unpaid or voluntary work, apprenticeship or vocational training, disabled, caretaker or looking after family or home, in school, retired, or unemployed) and if considered an essential worker (ie, no or yes). Unemployed or nontraditional work was categorized as being disabled, a caretaker or looking after family or home, in school, retired, or unemployed. Nonessential workers were categorized as not considered an essential worker and employed, self-employed, unpaid or voluntary work, or apprenticeship or vocational training. Essential workers were categorized as being considered an essential worker and employed, self-employed, unpaid or voluntary work, or apprenticeship or vocational training.
Coping behaviors for social distancing and isolation during the COVID-19 pandemic were assessed by asking questions regarding substance use in the social distancing module of the survey. Questions specific to exclusively using the following substances to cope were used: cigarettes or vaping, increased alcohol use, marijuana use, and illicit substance use. To assess cases of substance use during the pandemic, we asked “During the past month, how often did you” (1) smoke cigarettes or other tobacco products for tobacco use, (2) smoke e-cigarettes or other nicotine vaping products, (3) have a drink containing alcohol for alcohol use, (4) use marijuana, and (5) use illicit drugs. Illicit drugs were defined as other substances that were not previously listed (ie, tobacco, nicotine, alcohol, or marijuana) and could include but not be limited to opiates, hallucinogens, cocaine, or amphetamines. A follow-up control question was used for each aforementioned question category that asked, “Compared to before the pandemic, this is or was... .” Responses to each question had the following levels: not at all, once during the month, several times a month, once a week, several times a week, almost every day or every day, and several times a day. Responses were collapsed to (1) not at all, (2) once to several times per month, (3) once to several times per week, and (4) every day to several times per day.
Descriptive statistics of survey sample sociodemographics and substance use behaviors during the COVID-19 pandemic were assessed by the nativity of respondents, that is, US born and foreign born. Descriptives for the overall survey sample before and during the pandemic were assessed, followed by a more detailed assessment by nativity. A Stuart-Maxwell test was used to examine whether substance use before the COVID-19 pandemic was equal to substance use during the pandemic among survey respondents. If significant differences were found in substance use, we tested for differences based on participant self-reported nativity. The Stuart-Maxwell test is an ideal nonparametric test to examine asymptotic symmetry and marginal homogeneity on matched-pair controls (ie, before the COVID-19 pandemic) and cases (ie, during the COVID-19 pandemic) with various discrete levels of substance use (ie, not at all, once several times per month, once to several times per week, and every day to several times per day). All analytical procedures were conducted using Stata/MP (version 16.1; StataCorp LLC). All analytical files are available upon reasonable request.
The overall sample was primarily racially and ethnically White, Black or African American, and Hispanic or Latin. Most of the participants self-reported as women (3369/5406, 62.32%); were straight or heterosexual (4805/5406, 88.88%); had a household annual income of US ≥$75,000 (1405/5355, 26.23%); had some college, vocational, or technical training (1746/5404, 32.31%); and were unemployed or participated in nontraditional work (2401/5405, 44.42%). The age of the sample was between 18 and 35 years (1839/5119, 35.92%) and 36 and 55 years (1971/5119, 38.5%). The sample self-reported primarily using the following substances in the following order based on proportion: marijuana use (109/5404, 2.02%), increased alcohol use (87/5404, 1.61%), e-cigarette or nicotine vape (83/5404, 1.54%), and illicit substance use (24/5404, 0.44%). A more detailed breakdown of the sociodemographic profiles and substance use by nativity is shown in
In
The foreign-born sample’s substance use before the COVID-19 pandemic indicated tobacco use every day to several times per day (94/1179, 7.97%), e-cigarettes or nicotine vapes once to several times per month (75/1176, 6.38%), alcohol once to several times per month (356/1187, 29.99%), marijuana once to several times per month (62/1170, 5.3%), and other illicit substances once to several times per month (44/1180, 3.73%). The same foreign-born sample during the COVID-19 pandemic, if reporting substance use, used tobacco every day to several times per day (67/860, 7.79%), e-cigarettes or nicotine vapes once to several times per week (39/857, 4.55%), alcohol once to several times per month (242/860, 28.14%), marijuana once to several times per month (41/855, 4.79%), and other illicit substances once to several times per month (24/852, 2.82%).
Sample descriptives.
Participant characteristics | US born (n=4166), n (%) | Foreign born (n=1247), n (%) | Total (n=5413), n (%) | |
|
||||
|
White | 2053 (49.28) | 129 (10.34) | 2182 (40.31) |
|
Black or African American | 1024 (24.58) | 181 (14.51) | 1205 (22.26) |
|
Hispanic or Latino | 551 (13.23) | 435 (34.88) | 986 (18.22) |
|
Asian | 217 (5.21) | 338 (27.11) | 555 (10.25) |
|
American Indian or Alaska Native | 137 (3.29) | 8 (0.64) | 145 (2.68) |
|
Hawaiian or Pacific Islander | 47 (1.13) | 14 (1.12) | 61 (1.13) |
|
African | 28 (0.67) | 26 (2.09) | 54 (1) |
|
Middle Eastern | 7 (0.17) | 21 (1.68) | 28 (0.52) |
|
Multiracial or multiethnic | 102 (2.45) | 95 (7.62) | 197 (3.64) |
|
||||
|
Man | 1493 (35.88) | 412 (33.09) | 1905 (35.24) |
|
Woman | 2589 (62.22) | 780 (62.65) | 3369 (62.32) |
|
Nonbinary | 17 (0.41) | 24 (1.93) | 41 (0.76) |
|
Transgender people | 10 (0.24) | 8 (0.64) | 18 (0.33) |
|
Other | 52 (1.25) | 21 (1.69) | 73 (1.35) |
|
||||
|
Straight or heterosexual | 3728 (89.96) | 1077 (87) | 4805 (89.28) |
|
Lesbian or gay | 148 (3.57) | 49 (3.96) | 197 (3.66) |
|
Bisexual | 226 (5.45) | 83 (6.7) | 309 (5.74) |
|
Other | 42 (1.01) | 29 (2.34) | 71 (1.32) |
|
||||
|
18 to 35 | 1417 (35.5) | 476 (42.24) | 1893 (36.98) |
|
36 to 55 | 1579 (39.55) | 392 (34.78) | 1971 (38.5) |
|
56 to ≥85 | 996 (24.95) | 259 (22.98) | 1255 (24.52) |
|
||||
|
<US $25,000 | 1029 (24.96) | 274 (22.22) | 1303 (24.33) |
|
US $25,000 to $34,999 | 645 (15.65) | 174 (14.11) | 819 (15.29) |
|
US $35,000 to $49,999 | 638 (15.48) | 195 (15.82) | 833 (15.56) |
|
US $50,000 to $74,999 | 755 (18.32) | 240 (19.46) | 995 (18.58) |
|
US ≥$75,000 | 1055 (25.59) | 350 (28.39) | 1405 (26.24) |
|
||||
|
Less than high school | 221 (5.31) | 99 (7.97) | 320 (5.92) |
|
High school or general education diploma | 1008 (24.22) | 237 (19.08) | 1245 (23.04) |
|
Some college, vocational or technical | 1451 (34.86) | 295 (23.75) | 1746 (32.31) |
|
Bachelor’s degree | 1031 (24.77) | 375 (30.19) | 1406 (26.02) |
|
Master’s degree or above | 451 (10.84) | 236 (19) | 687 (12.71) |
|
||||
|
Unemployed or nontraditional work | 1819 (43.7) | 582 (46.82) | 2401 (44.42) |
|
Nonessential worker | 1300 (31.23) | 393 (31.62) | 1693 (31.32) |
|
Essential worker | 1043 (25.06) | 268 (21.56) | 1311 (24.26) |
|
||||
|
Other coping behaviors | 3895 (93.63) | 1206 (96.94) | 5101 (94.39) |
|
E-cigarette or nicotine vape use | 75 (1.8) | 8 (0.64) | 83 (1.54) |
|
Increased alcohol use | 68 (1.63) | 19 (1.53) | 87 (1.61) |
|
Marijuana use | 99 (2.38) | 10 (0.8) | 109 (2.02) |
|
Illicit substance use | 23 (0.55) | 1 (0.08) | 24 (0.44) |
Substance use before and during the COVID-19 pandemic.
|
Before the COVID-19 pandemic (n=5130), n (%) | During the COVID-19 pandemic (n=3802), n (%) | |
|
|||
|
Not at all | 3418 (67.26) | 2612 (69.32) |
|
Once to several times per month | 366 (7.2) | 232 (6.16) |
|
Once to several times per week | 358 (7.04) | 260 (6.9) |
|
Every day to several times per day | 940 (18.5) | 664 (17.62) |
|
|||
|
Not at all | 4017 (79.31) | 3028 (80.7) |
|
Once to several times per month | 363 (7.17) | 219 (5.84) |
|
Once to several times per week | 352 (6.95) | 269 (7.17) |
|
Every day to several times per day | 333 (6.57) | 236 (6.29) |
|
|||
|
Not at all | 2140 (42.04) | 1625 (43.02) |
|
Once to several times per month | 1563 (30.71) | 1051 (27.83) |
|
Once to several times per week | 1083 (21.28) | 814 (21.55) |
|
Every day to several times per day | 304 (5.97) | 287 (7.6) |
|
|||
|
Not at all | 3778 (74.92) | 2857 (76.15) |
|
Once to several times per month | 460 (9.12) | 313 (8.34) |
|
Once to several times per week | 334 (6.62) | 246 (6.56) |
|
Every day to several times per day | 471 (9.34) | 336 (8.96) |
|
|||
|
Not at all | 4470 (88.29) | 3342 (89.26) |
|
Once to several times per month | 225 (4.44) | 136 (3.63) |
|
Once to several times per week | 216 (4.27) | 148 (3.95) |
|
Every day to several times per day | 152 (3) | 118 (3.15) |
Substance use before and during the COVID-19 pandemic by US-born and foreign-born participants.
|
US born (n=5130), n (%) | Foreign born (n=3802), n (%) | ||||
|
Before the COVID-19 pandemic | During the COVID-19 pandemic | Before the COVID-19 pandemic | During the COVID-19 pandemic | ||
|
||||||
|
Not at all | 2456 (62.93) | 1903 (65.35) | 962 (81.59) | 710 (82.56) | |
|
Once to several times per month | 299 (7.66) | 191 (6.56) | 67 (5.68) | 41 (4.77) | |
|
Once to several times per week | 302 (7.74) | 218 (7.49) | 56 (4.75) | 42 (4.88) | |
|
Every day to several times per day | 846 (21.68) | 600 (20.6) | 94 (7.97) | 67 (7.79) | |
|
||||||
|
Not at all | 3017 (77.58) | 2277 (78.54) | 1000 (85.03) | 752 (87.75) | |
|
Once to several times per month | 288 (7.41) | 183 (6.31) | 75 (6.38) | 37 (4.32) | |
|
Once to several times per week | 298 (7.66) | 231 (7.97) | 54 (4.59) | 39 (4.55) | |
|
Every day to several times per day | 286 (7.35) | 208 (7.17) | 47 (4) | 29 (3.38) | |
|
||||||
|
Not at all | 1554 (39.82) | 1190 (40.74) | 586 (49.37) | 436 (50.7) | |
|
Once to several times per month | 1207 (30.92) | 812 (27.8) | 356 (29.99) | 242 (28.14) | |
|
Once to several times per week | 894 (22.91) | 680 (23.28) | 189 (15.92) | 134 (15.58) | |
|
Every day to several times per day | 248 (6.35) | 239 (8.18) | 56 (4.72) | 48 (5.58) | |
|
||||||
|
Not at all | 2761 (71.29) | 2107 (72.63) | 1017 (86.92) | 752 (87.95) | |
|
Once to several times per month | 398 (10.28) | 273 (9.41) | 62 (5.30) | 41 (4.8) | |
|
Once to several times per week | 294 (7.59) | 221 (7.62) | 40 (3.42) | 26 (3.04) | |
|
Every day to several times per day | 420 (10.84) | 300 (10.34) | 51 (4.36) | 36 (4.21) | |
|
||||||
|
Not at all | 3380 (86.96) | 2551 (88.09) | 1094 (92.71) | 793 (93.07) | |
|
Once to several times per month | 181 (4.66) | 112 (3.87) | 44 (3.72) | 24 (2.82) | |
|
Once to several times per week | 196 (5.04) | 131 (4.52) | 20 (1.69) | 19 (2.23) | |
|
Every day to several times per day | 130 (3.34) | 102 (3.52) | 22 (1.86) | 16 (1.88) |
Using the Stuart-Maxwell test of asymptotic symmetry and marginal homogeneity, we found significant differences in alcohol use in the overall sample (
Then, we assessed differences in substance use before and during the pandemic by nativity and found them to be significantly different between US-born and foreign-born individuals (
As seen in
Alcohol use before the COVID-19 pandemic compared with during the pandemica.
Before the COVID-19 pandemic | During the COVID-19 pandemic | ||||
|
Not at all, n (∆%) | Once to several times per month, n (∆%) | Once to several times per week, n (∆%) | Every day to several times per day, n (Δ%) | Total |
Not at all | 1432 (N/Ab) | 64 (1.71) | 22 (0.59) | 4 (0.11) | 1522 |
Once to several times per month | 126 (3.37) | 826 (N/A) | 136 (3.64) | 15 (0.40) | 1103 |
Once to several times per week | 29 (0.77) | 127 (3.40) | 611 (N/A) | 84 (2.25) | 851 |
Every day to several times per day | 12 (0.32) | 21 (0.56) | 40 (1.07) | 182 (N/A) | 255 |
Total | 1599 (N/A) | 1038 (N/A) | 809 (N/A) | 285 (N/A) | 3731 |
aSymmetry (asymptotic) was based on
bN/A: not applicable (as these are the references to compare and contrast contributions to symmetry).
Contribution to symmetry χ2 from alcohol use before and during the COVID-19 pandemic.
Change | Before or during COVID-19 | Overall |
US born |
Foreign born |
Not at all | Once to several times per month | 20.2 (3) | 13.3 (3) | 7.4 (3) |
Not at all | Once to several times per week | 1.0 (3) | 0.1 (3) | 1.7 (3) |
Not at all | Every day to several times per day | 4.0 (3) | 2.6 (3) | 2.0 (3) |
Once to several times per month | Once to several times per week | 0.3 (3) | 0.1 (3) | 0.6 (3) |
Once to several times per month | Every day to several times per day | 1.0 (3) | 0.0 (3) | 3.8 (3) |
Once to several times per week | Every day to several times per day | 15.6 (3) | 13.2 (3) | 2.6 (3) |
Alcohol use before the COVID-19 pandemic compared with during the pandemic among US-born participantsa.
Before the COVID-19 pandemic | During the COVID-19 pandemic | ||||
|
Not at all, n (Δ%) | Once to several times per month, n (Δ%) | Once to several times per week, n (Δ%) | Every day to several times per day, n (Δ%) | Total |
Not at all | 1049 (N/Ab) | 51 (1.77) | 17 (0.59) | 4 (0.14) | 1121 |
Once to several times per month | 95 (3.28) | 630 (N/A) | 113 (3.91) | 12 (0.42) | 850 |
Once to several times per week | 19 (0.66) | 109 (3.77) | 518 (N/A) | 64 (2.22) | 710 |
Every day to several times per day | 10 (0.34) | 11 (0.38) | 29 (1.00) | 157 (N/A) | 207 |
Total | 1173 (N/A) | 801 (N/A) | 677 (N/A) | 237 (N/A) | 2888 |
aMarginal homogeneity based on Stuart-Maxwell
bN/A: not applicable (as these are the references to compare and contrast contributions to symmetry).
Alcohol use before the COVID-19 pandemic compared with during the pandemic among foreign-born participantsa.
Before the COVID-19 pandemic | During the COVID-19 pandemic | ||||
|
Not at all, n (Δ%) | Once to several times per month, n (Δ%) | Once to several times per week, n (Δ%) | Every day to several times per day, n (Δ%) | Total |
Not at all | 383 (N/Ab) | 13 (1.5) | 5 (0.6) | 0 (0) | 401 |
Once to several times per month | 31 (3.7) | 196 (N/A) | 23 (2.7) | 3 (0.4) | 253 |
Once to several times per week | 10 (1.2) | 18 (2.1) | 93 (N/A) | 20 (2.4) | 141 |
Every day to several times per day | 2 (0.2) | 10 (1.2) | 11 (1.3) | 25 (N/A) | 48 |
Total | 426 (N/A) | 237 (N/A) | 132 (N/A) | 48 (N/A) | 843 |
aMarginal homogeneity based on Stuart-Maxwell test
bN/A: not applicable (as these are the references to compare and contrast contributions to symmetry).
We assessed changes in the use of combustible tobacco, e-cigarette and nicotine vape, alcohol, marijuana, and other illicit substances. Although use of alcohol was found to have significant changes before and during the pandemic in our overall sample, we did not observe significant changes in the use of tobacco, e-cigarette and nicotine vape, marijuana, or other illicit substances (
Although we found that significant changes were observed from no prior alcohol use to some level of increased use, we also observed the opposite in both the US-born and foreign-born groups. The decrease in alcohol use was slightly more pronounced among foreign-born participants. That is, there was a 5.1% overall change in some level of alcohol use before the pandemic to no alcohol use during the pandemic among foreign-born participants, compared with a 4.3% change among US-born participants. In our findings, the largest shift was not associated with increased alcohol use but with decreased alcohol use. This decrease in substance use may also be indicative of isolation [
The use of both licit and illicit substances can have deleterious effects not only on mental health but also on physiological health and physical functioning, as well as damage organ systems that can increase morbidity and mortality from COVID-19 [
When specifically seeking to understand the differences in alcohol use between US-born and foreign-born participants during the COVID-19 pandemic, the available studies were limited. Overall, when foreign-born immigrants were assessed for substance use during the pandemic, they reported less substance use when compared with their US-born counterparts [
Nevertheless, decreased alcohol use may be observed in our sample owing to a wide range of socioeconomic status factors such as low income and unemployment and environmental factors such as access and scarcity [
Our findings at this stage may indicate small percentage changes but may reveal the ideal point of intervention to mitigate the effect of use disorders. Moreover, we must acknowledge the synergetic effects of mental health and physiological health, especially in the context of COVID-19. As such, the extremes of general alcohol consumption and use disorders must continue to be monitored not only for concomitant health effects, such as alcohol-associated liver disease and mortality [
Our study had some limitations. First, although the survey was anonymous, the possibility of bias in recall and responses must be considered. There is a possible recall bias from self-reports, as we asked about behaviors before COVID-19 owing to the data collection starting in May 2021 and ending in January 2022. This may be magnified by asking sensitive questions concerning substance use behaviors before and during the pandemic, increasing the response bias. Second, the data were obtained from a cross-sectional survey that provided a descriptive analysis of substance use change in a large US sample. However, this sample is not representative of the United States. Moreover, because this was a cross-sectional sample, we could not discern causality or temporal directionality. The data and descriptive analysis provided a solid foundation for further examination and identification of substance use patterns across a diverse US sample.
Pandemics are predicted to increase in frequency in the near future. To better prepare for the indirect effects of public health policies meant to protect the health of individuals, we must also prepare for their indirect effects on mental health and related coping mechanisms. Substance use affects both physical and mental health and will therefore require a multimodal approach to efficiently and effectively address and intervene on the deleterious effects, especially for underserved and underrepresented communities.
Full study comparisons of substance use prior to and during the pandemic.
National Institutes of Health
The efforts of KV, FAMI, and FW were supported by the Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily reflect the views of the National Institutes of Health.
FAMI and FW were responsible for the concept and design. FAMI and KV were responsible for the acquisition, analysis, or interpretation of data and drafting of the manuscript. FAMI, KV, and FW were responsible for critical revision of the manuscript for important intellectual content. FAMI was responsible for statistical analysis. FW was responsible for providing administrative, technical, or material support and supervision.
None declared.