JMIR Publications

ABSTRACT

Background:

The Covid-19 pandemic had many unprecedented secondary outcomes resulting in various mental health issues leading to substance use coping behaviors. The extent of substance use changes in a US sample by nativity have not been previously described.

Objective:

Our aim was to design an online survey to assess the mental health issues exacerbated by the Covid-19 pandemic to describe substance use coping behaviors, as well as substance use changes prior to and during the pandemic.

Methods:

A comprehensive 116-item survey to understand the impact of Covid-19 and social distancing on physical and psychosocial mental health and chronic diseases was designed. Approximately 10,000 online surveys were distributed by Qualtrics LLC between 13 May 2021 and 09 January 2022 across the US (i.e., continental US, Hawaii, Alaska, and territories) to adults 18 and older. We oversampled low income and rural adults among non-Hispanic White, non-Hispanic Black, Hispanic/Latino adults, and foreign-born participants. Of the 5,938 surveys returned, 5,413 surveys were used after Qualtrics proprietary expert review fraud detection, and detailed assessments of completion rate and timing to complete the survey. Participant demographics, substance use coping behaviors, and substance use prior to and during the pandemic are described by the overall US resident sample, followed by US born and foreign-born self-report. Substance use included tobacco use, e-cigarettes/vaping, alcohol use, marijuana use, and other illicit substance use. Marginal homogeneity based on Stuart-Maxwell test was used to assess changes in self-reported substance use prior to and during the pandemic.

Results:

The sample was mostly White (40.3%), women (62.3%), straight/heterosexual (89.3%), making ≥$75,000 (26.2%), with vocational/technical training (32.3%), unemployed/nontraditional work (44.4%). Significant changes were found in alcohol use self-reports the overall sample. Significant changes were also observed among US born and foreign-born samples. Similarities were observed between US born and foreign-born participants on increased alcohol use from: (1) no alcohol use prior to the pandemic to using alcohol once to several times a month; and (2) once to several times per week to everyday to several times per day. While significant changes were observed from no prior alcohol use to some level of increased use, the inverse was observed as well and more pronounced among foreign-born participants. That is, there was a 5.1% overall change in some level of alcohol use prior to the pandemic to no alcohol use during the pandemic among foreign born, compared to the 4.3% change among US born.

Conclusions:

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 exacerbate morbidity and mortality to disease like Covid-19.