Substance Use Among Youth During the COVID-19 Pandemic: a Systematic Review

Addiction Medicine Treatment Utilization by Race/Ethnicity Among Adolescents With Substance Use Problems Before Versus During the COVID-19 Pandemic

PURPOSE

To examine changes in addiction medicine treatment utilization during the COVID-19 pandemic among adolescents (aged 13-17 years) and differences by race/ethnicity.

METHODS

We compared treatment initiation (overall and telehealth), engagement, and 12-week retention between insured adolescents with substance use problems during pre-COVID-19 (March to December 2019, n = 1,770) and COVID-19 (March to December 2020, n = 1,177) using electronic health record data from Kaiser Permanente Northern California.

RESULTS

Compared to pre-COVID-19, odds of treatment initiation, overall (adjusted odds ratio [95% confidence interval] = 1.42 [1.21-1.67]), and telehealth (5.98 [4.59-7.80]) were higher during COVID-19, but odds of engagement and retention did not significantly change. Depending on the outcome, Asian/Pacific Islander, Black, and Latino/Hispanic (vs. White) adolescents had lower treatment utilization across both periods. Changes in utilization over time did not differ by race/ethnicity.

DISCUSSION

Addiction medicine treatment initiation increased among insured adolescents during the pandemic, especially via telehealth. Although racial/ethnic disparities in treatment utilization persisted, they did not worsen.

Youth Aggression and Peer Victimization as Predictors of Adolescent Alcohol and Marijuana Use: A Longitudinal Analysis of Youth with Aggressive Behavior Problems

Youth who are behaviorally aggressive and victimized by their peers comprise a significant population with specific risks and vulnerabilities relative to substance use. The goals of the current study were to examine the roles that youth aggression and peer victimization play in determining the timing of alcohol and marijuana use initiation and the frequency of use 5-years later in a sample of at-risk, aggressive youth. 360 youth (Mage= 10.17 years; 65% boys, 35% girls; 78.1% African American, 20.3% Caucasian, 1.4% Hispanic, and 0.3% other) recruited for a prevention program for at-risk youth were followed for 5 years (4th - 9th grade). Cox PH regressions were conducted to predict timing of alcohol and marijuana use initiation. Zero-inflated negative binomial regressions were used to predict frequency of alcohol and marijuana use 5 years later. Results showed that peer victimization inferred decreased risk of alcohol use initiation. However, this effect was only observed for youth with relatively moderate, and low levels of aggression. Findings suggest that differences in youth aggression and victimization interact to predict distinct outcomes, suggesting the need for a more comprehensive approach when working with aggressive youth who have experienced peer victimization.

Impact of the COVID-19 Pandemic on Swedish Adolescents' Mental Health, Psychosocial Functioning, Risk Behaviours, and Victimisation: Gender Differences and Implications

The COVID-19 pandemic has shown varying effects on adolescents' mental health, psychosocial functioning, risk behaviours, and victimisation. This study aims to examine the changes reported by a sample of Swedish adolescents (N = 1607) at the end of the first year of the pandemic in relation to these factors. Data were collected with an electronic survey between September 2020 and February 2021, targeting upper-secondary high school students (aged 15-19 years). The results indicate a relatively low overall impact of the pandemic on Swedish upper-secondary school students, with notable gender differences. Compared to adolescent women, a higher percentage of adolescent men reported experiencing elevated levels of anxiety, depression, sleep disturbances, anger, and increased illicit drug use as consequences of the pandemic. In contrast, women demonstrated an increase in several salutogenic behaviours. Victimisation rates generally decreased during this period. These findings underscore the importance of heightened awareness among professionals within schools, social services, and healthcare settings regarding the distinct challenges encountered by a larger portion of adolescent men during the COVID-19 pandemic in Sweden.

Factors Associated With the Changes in Smoking and Electronic cigarette use in Adolescents During the COVID-19 Pandemic: A Longitudinal Analysis

PURPOSE

Explore the factors associated with the changes in smoking and electronic cigarette (e-cigarette) use and susceptibility among adolescents during the COVID-19 pandemic.

METHODS

We surveyed a cohort of students (7th-12th grade) from private schools in Guatemala. Baseline (May-September 2019) was conducted in-person and follow-up (June-November 2020) online during the lockdown. Separate Generalized Estimating Equations logistic models regressed current smoking (n = 3,729), current e-cigarette use (n = 3,729), smoking susceptibility among never-smokers (n = 2,596), and susceptibility to e-cigarette use among never-users (n = 1,597) on online ad exposure, visiting stores, social network smoking/e-cigarette use, substance use (alcohol, marihuana, and cigarette or e-cigarette), perceived harm of using cigarettes/e-cigarettes, sociodemographic characteristics, and survey wave. Interactions were assessed between time and ad exposures, friends smoking and e-cigarette use.

RESULTS

Frequency of store visits, exposure to online ads, and the use of cigarette and e-cigarette lowered at follow-up. Online e-cigarette ads, having family and friends who smoke, and current e-cigarette use increased the likelihood of being a current smoker. Frequent exposure to online e-cigarette ads, having family who use e-cigarettes, and being a current smoker were associated with higher likelihood of current e-cigarette use. Exposure to either online ads or having friends that smoke or use e-cigarettes, increased susceptibility to using either product. Interaction results showed that high exposure to online e-cigarette ads overtime increased the susceptibility to use e-cigarettes.

DISCUSSION

Exposure to online ads and friends and family cigarette and e-cigarette use increased adolescent consumption and susceptibility during the pandemic.

Examining enduring effects of COVID-19 on college students' internalizing and externalizing problems: A four-year longitudinal analysis

BACKGROUND

College students' mental health has been a vital concern for researchers, policymakers, administrators, and educators since before the pandemic, and it is crucial to identify the extent to which the pandemic affected college students' mental health.

METHODS

The current study utilized data repeatedly collected over more than four years (2017-2022) from N = 355 students enrolled at a large public research university in the Midwestern US. The data collection period coincided with the COVID-19 pandemic's onset, facilitating systematic examination of whether and how college students' trajectories (i.e., level and slopes) of depressive symptoms, social anxiety, general disinhibition, callous aggression, and problematic alcohol use changed as the pandemic progressed. Across seven waves, surveys assessed multiple outcome and predictor domains. Multilevel growth curve modeling was used to analyze all outcomes.

RESULTS

Depression symptoms peaked mid-pandemic, whereas social anxiety first declined then continued rising. General disinhibition and callous aggression showed non-significant changes in trajectories. Problematic alcohol use decreased continuously with no significant pandemic-associated effects in the best-fitting model.

LIMITATIONS

An important limitation is reliance on a sample from a single campus utilizing self-reported, non-clinical assessments. Another important limitation is the lack of location information from participants during the acute COVID-19 phase.

CONCLUSIONS

Reported longitudinal analyses expand upon findings from previous limited repeated-measures and cross-sectional studies. In terms of clinical significance, some of the most harmful COVID-19 effects to mental health may be long-lasting and cumulative, making them difficult to detect in shorter-term or cross-sectional studies. Altogether, findings demonstrate complex changes in students' mental health that may have ongoing effects on well-being during key developmental stages.

Substance use and adolescent mental health during the COVID-19 pandemic in Brazil: a longitudinal approach

OBJECTIVE

To describe the changes in alcohol and drug use by Brazilian adolescents during the COVID-19 pandemic (April-August 2021), and to analyze the relationship between alcohol use changes and psychiatric symptomatology.

METHODS

A secondary analysis with a longitudinal approach was performed with data from a cluster-randomized controlled trial, conducted in 73 public middle schools in three Brazilian cities, to evaluate the effectiveness of a drug use prevention program. The sample included 535 students (61% girls; Mage = 15.2 years). Data were collected pre-intervention (February-March 2019), after 9 months (November-December 2019), and after 26 months (April-August 2021), when the students were in their first year of high school. The authors analyzed drug use prevalence (alcohol, binge drinking, tobacco, inhalants, marijuana, cocaine, and crack) in a lifetime, past year, and past month periods, and the association between alcohol use change subsamples with psychiatric symptoms. Logistic regressions were adjusted by sex, age, socioeconomic status, city, and group (control and intervention).

RESULTS

The present findings suggest that the COVID-19 pandemic led to a decrease in past-year substance use and in past-month substance use frequency, despite the gradually increased (but decelerating) prevalence of lifetime use. However, some adolescents initiated, maintained, or increased the frequency of their alcohol use. Mainly, they were more likely to present behavioral problems, as well as symptoms of inattentive hyperactivity, and peer and emotional problems.

CONCLUSIONS

Despite the extensive decline in substance use during the pandemic period, these results suggest an association between previous mental health conditions and behavioral risk factors, leading to increased alcohol consumption and behavioral disorders manifestations.

An Examination of Bidirectional Associations Between Alcohol Use and Internalizing Symptoms Among Adolescents During the COVID-19 Pandemic

PURPOSE

This study explores the bidirectional association between internalizing symptoms and alcohol use over three years of the COVID-19 pandemic to examine whether alcohol consumption is associated with higher internalizing symptoms in the next year and vice versa.

METHODS

We used linked data from a sample of 2,136 secondary school students who participated in three consecutive waves (2019-2020 [T1], 2020-2021 [T2], and 2021-2022 [T3]) of the Cannabis use, Obesity, Mental health, Physical activity, Alcohol use, Smoking, and Sedentary behaviour study during the pandemic. A random-intercept cross-lagged panel model was used to characterize reciprocal linear relations between internalizing symptoms and alcohol use.

RESULTS

The findings suggest that students who reported higher levels of alcohol use at T1 experienced increased levels of depression and anxiety in the subsequent year (T2). However, this association was not observed from T2 to T3. Throughout the three-year period, depression and anxiety were not associated with later alcohol use. In males, alcohol use at T1 was a predictor of higher internalizing symptoms at T2 but not from T2 to T3.

DISCUSSION

These results suggest time-sensitive impacts and notable gender differences in the relationship between internalizing symptoms and alcohol use over the pandemic. Given the complexity of impacts, ongoing evaluation of the impact of the pandemic on youth health behaviours is necessary to elucidate these unfolding relationships, especially as the pandemic continues to affect various psychosocial risk factors.

Accidental substance-related acute toxicity deaths among youth in Canada: a descriptive analysis of a national chart review study of coroner and medical examiner data

INTRODUCTION

Substance-related acute toxicity deaths (ATDs) are a public health crisis in Canada. Youth are often at higher risk for substance use due to social, environmental and structural factors. The objectives of this study were to understand the characteristics of youth (aged 12-24 years) dying of accidental acute toxicity in Canada and examine the substances contributing to and circumstances surrounding youth ATDs.

METHODS

Data from a national chart review study of coroner and medical examiner data on ATDs that occurred in Canada between 2016 and 2017 were used to conduct descriptive analyses with proportions, mortality rates and proportionate mortality rates. Where possible, youth in the chart review study were compared with youth in the general population and youth who died of all causes, using census data.

RESULTS

Of the 732 youth who died of accidental acute toxicity in 2016-2017, most (94%) were aged 18 to 24 years. Youth aged 20 to 24 who were unemployed, unhoused or living in collective housing were overrepresented among accidental ATDs. Many of the youth aged 12 to 24 who died of accidental acute toxicity had a documented history of substance use. Fentanyl, cocaine and methamphetamine were the most common substances contributing to death, and 38% of the deaths were witnessed or potentially witnessed.

CONCLUSION

The findings of this study point to the need for early prevention and harm reduction strategies and programs that address mental health, exposure to trauma, unemployment and housing instability to reduce the harms of substance use on Canadian youth.

Mental Telehealth Utilization Patterns Among High School Students from Racial and Ethnic Minority Backgrounds Affected by Violence and Substance Use

BACKGROUND

Recent data show high school students from racial and ethnic minority (REM) backgrounds in the United States confront a twofold challenge, marked by the highest rates of firearm-related homicides since 1994 and increased youth substance use. The pandemic increased online and telehealth usage opportunities for at-risk REM youth. Therefore, this study investigated (1) the frequency and prevalence of co-occurring youth violence and substance use among REM adolescents, (2) racial/ethnic, age, and natal sex (as gender data was not collected) differences in patterns and trends in co-occurring youth violence and substance use among REM adolescents, and (3) the relationship between these syndemic issues and REM adolescent mental telehealth use during the pandemic.

METHODS

Data was sourced from a nationally representative sample of U.S. 9th-12th students (n = 3241) who completed the CDC's 2021 Adolescent and Behavioral Experiences Survey (ABES). Using univariate (frequency distribution), bivariate (Pearson's chi-squared test), and multivariate logistic regression models, we examined seven violence victimization outcomes, four violence perpetration outcomes, two family violence outcomes, and six substance use outcomes and their associations with telehealth use for mental health (dependent variable) among REM adolescents.

RESULTS

This sample was primarily female (50.7%), Black or African American (48.3%), Hispanic or Latinx (20.6%), and identified as straight or heterosexual (69.5%). The study found significant sex-based differences in violence perpetration/victimization, substance use, and telehealth use for mental health. In general, mental telehealth use was significantly associated with substance use among REM adolescents (cigarette smoking, vaping, alcohol, marijuana, prescription meds, and illicit drug use) (p-value = .001). Mental telehealth use was also significantly associated with all peer and family violence outcomes (p < 0.001). Controlling for covariates, gun carrying was associated with 4.8 times higher odds of using mental telehealth. Students in a physical fight or carrying a weapon (gun, knife, or club) on school property had 2.45 times and 8.09 times the odds of utilizing mental telehealth. Bullied students were 2.5 times more likely to use mental telehealth (p-value < 0.05). Illicit drug use (cocaine, heroin, methamphetamines, and ecstasy) was associated with a higher likelihood of mental telehealth use (AOR = 1.3, p-value = .05).

CONCLUSION

Our results suggest crucial insights for shaping violence and substance use prevention strategies, with implications for the future of online and telehealth behavioral services. Mental telehealth help-seeking emerges as a crucial avenue for supporting adolescents affected by violence and substance use, especially when they face obstacles to accessing traditional services. It can work in tandem with in-person services to address these challenges.

Genetic and environmental influence on alcohol intent and alcohol sips among U.S. children-Effects across sex, race, and ethnicity

INTRODUCTION

Alcohol intent (the susceptibility to initiating alcohol use) and alcohol sips (the initiation of alcohol) in youth are a multifactorial puzzle with many components. This research aims to examine the connection between genetic and environmental factors across sex, race and ethnicity.

METHODS

Data was obtained from the twin hub of the Adolescent Brain Cognitive Development (ABCD) study at baseline (2016-2018). Variance component models were conducted to dissect the additive genetic (A), common (C) and unique environmental (E) effects on alcohol traits. The proportion of the total alcohol phenotypic variation attributable to additive genetic factors is reported as heritability (h2).

RESULTS

The sample (n = 1,772) included an approximately equal male-female distribution. The 886 same-sex twin pairs were 60.4% dizygotic (DZ), 39.6% monozygotic (MZ), 65.4% non-Hispanic Whites, 13.9% non-Hispanic Blacks, 10.8% of Hispanics with a mean age of 121.2 months. Overall, genetic predisposition was moderate for alcohol intent (h2 = 28%, p = .006) and low for alcohol initiation (h2 = 4%, p = 0.83). Hispanics (h2 = 53%, p < .0001) and Blacks (h2 = 48%, p < .0001) demonstrated higher alcohol intent due to additive genetic factors than Whites (h2 = 34%, p < .0001). Common environmental factors explained more variation in alcohol sips in females (c2 = 63%, p = .001) than in males (c2 = 55%, p = .003). Unique environmental factors largely attributed to alcohol intent, while common environmental factors explained the substantial variation in alcohol initiation.

CONCLUSION

Sex and racial/ethnic disparities in genetic and environmental risk factors for susceptibility to alcohol initiation can lead to significant health disparities. Certain populations may be at greater risk for alcohol use due to their genetic and ecological factors at an early age.

"An escape from the isolation": Youth thoughts about the impact of COVID-19 on adolescent sexual behavior and alcohol use

INTRODUCTION

The COVID-19 pandemic likely affected adolescent sexual behaviors and alcohol use, although how is not well understood.

METHOD

Youth were sampled from the national, online longitudinal Growing up with Media study. They responded via text messaging to open-ended questions about how the COVID-19 pandemic may have impacted the sexual behavior and alcohol use of adolescents. Conventional content analysis summarized open-ended responses.

RESULTS

416 responses were analyzed from 335 participants (aged 15-30, US residents), 81 of whom provided data for both topics. Participants suggested that the pandemic affected some youths' sexual health precautions (increased and varying) and attitudes about sex (positive and negative). They discussed how adolescents met partners during the pandemic, including increased use of online platforms. Participants also suggested researchers investigate sexual risk in the realm of COVID-19 transmission and the practice of "safe sex." Many participants believed adolescents were drinking alcohol more as a result of the pandemic, both alone and with friends; however, others perceived adolescents were drinking less. Participants proposed researchers investigate adolescent drinking habits during the pandemic, as well as how this compares to before the pandemic and the type and quantity of alcohol consumed.

CONCLUSIONS

Young people believe adolescent sexual relationships and drinking behaviors changed due to the pandemic, though how varied. Future research could examine the contexts and individual differences that shape these varying behaviors. Overall, this study highlights the importance of directly asking youth about their pandemic experiences and the diversity of views on how the pandemic has influenced adolescent behavior.

Predictors and Correlates of Positive Urine Drug Screening in a Retrospective Cohort Analysis of Child and Adolescent Psychiatry Inpatients Throughout the COVID-19 Pandemic

BACKGROUND AND OBJECTIVES

Youth substance use is associated with significant psychological, neurological, and medical complications. Risk factors for substance use among children and adolescents in the general population include peer and/or parental substance use, certain psychiatric illnesses (eg, Attention-Deficit/Hyperactivity Disorder, depression), and history of maltreatment. Co-occurring substance use and psychiatric illness have been associated with increased suicidality, but few prior studies have characterized substance use among child/adolescent inpatients. As such, it remains unclear how substance use contributing to acute psychiatric presentations has changed since the start of the COVID-19 pandemic.

METHODS

This is a retrospective cohort study of 816 unique child/adolescent psychiatry inpatients with urine drug screening (UDS) results from a diverse urban setting. Charts of patients hospitalized between June 1, 2018 and November 30, 2021 were reviewed for sociodemographic characteristics, indication for admission, psychiatric history, hospital course, treatment plan, and discharge diagnosis. Differences in sociodemographic and clinical characteristics, such as age, race, and diagnoses, between patients with and without positive UDS were explored throughout various periods of the COVID-19 pandemic. Descriptive and comparative statistics were performed, as well as a logistic regression model to identify the predictors of positive UDS.

RESULTS

Of the study sample, 18% had a positive UDS. Older age, diagnosis of impulsive or behavioral disorder, and a history of violence were found to be predictors of positive UDS. Asian/South Asian or Hispanic/LatinX race and history of a developmental or intellectual disability were found to be negative predictors. The frequency of positive UDS in this population did not change based on COVID-19.

DISCUSSION AND CONCLUSIONS

Multiple factors may predispose children and adolescents to substance use. Though no impact of COVID-19 was found in this sample, longer-term studies are needed.

SCIENTIFIC SIGNIFICANCE

This study identifies independent predictors of active substance use in the child and adolescent psychiatric inpatient population.

Hospital Admissions for Abusive Head Trauma Before and During the COVID-19 Pandemic

Importance

Several studies have demonstrated a decrease in the occurrence of child abuse in the US since the start of the COVID-19 pandemic. This finding has generated concern for missed cases due to the initial lockdowns and lack of childcare resources. Determining the association of the pandemic on hospitalizations for severe forms of abuse is essential to focus preventive efforts.

Objective

To examine trends in abusive head trauma (AHT) before and during the COVID-19 pandemic.

Design, Setting, and Participants

Retrospective, multicenter, repeated cross-sectional study, conducted January 1, 2016, through April 30, 2022, with data from tertiary care children's hospitals and contributors to the Pediatric Health Information System. Data were obtained for 2380 hospitalizations of children younger than 5 years with International Classification of Diseases, Tenth Revision, Clinical Modification codes for both abuse and head trauma.

Main Outcomes and Measures

Monthly hospitalizations were analyzed using interrupted time-series analysis. Hospitalization severity (eg, intensive care unit stay) and clinical characteristics (subdural hemorrhages and retinal hemorrhages) were compared before and after the start of the pandemic.

Results

We identified 2380 hospitalizations due to AHT (median age, 140 [IQR, 75.0-325.5] days) from 45 hospitals. The mean (SD) monthly incidence of AHT was 34.3 (5.8) before the COVID-19 pandemic compared with 25.6 (4.2) during COVID-19 (a 25.4% decrease). When the pre-COVID-19 and during COVID-19 periods were compared, there were no significant differences in severity or clinical characteristics. On interrupted time-series analysis, there was a significant decrease in the number of monthly hospitalizations (-8.1; 95% CI, -12.41 to -3.72; P < .001) in the first month of the pandemic. In the subgroup of children younger than 1 year, there was a significant decrease in monthly hospitalizations at the onset of the pandemic (-8.2; 95% CI, -12.02 to -4.43; P < .001) followed by a significant temporal increase across the COVID-19 period (P = .01).

Conclusions and Relevance

The findings of this cross-sectional study suggest there was a significant decrease in monthly hospitalizations for AHT following the start of the pandemic in March 2020. Although there was no corresponding increase in hospitalization severity, the decrease during the pandemic may have been transient, as monthly hospitalizations for children younger than 1 year increased significantly over time during COVID-19, after the initial decrease.

Differing impact of the COVID-19 pandemic on youth mental health: combined population and clinical study

BACKGROUND

Identifying youths most at risk to COVID-19-related mental illness is essential for the development of effective targeted interventions.

AIMS

To compare trajectories of mental health throughout the pandemic in youth with and without prior mental illness and identify those most at risk of COVID-19-related mental illness.

METHOD

Data were collected from individuals aged 18-26 years (N = 669) from two existing cohorts: IMAGEN, a population-based cohort; and ESTRA/STRATIFY, clinical cohorts of individuals with pre-existing diagnoses of mental disorders. Repeated COVID-19 surveys and standardised mental health assessments were used to compare trajectories of mental health symptoms from before the pandemic through to the second lockdown.

RESULTS

Mental health trajectories differed significantly between cohorts. In the population cohort, depression and eating disorder symptoms increased by 33.9% (95% CI 31.78-36.57) and 15.6% (95% CI 15.39-15.68) during the pandemic, respectively. By contrast, these remained high over time in the clinical cohort. Conversely, trajectories of alcohol misuse were similar in both cohorts, decreasing continuously (a 15.2% decrease) during the pandemic. Pre-pandemic symptom severity predicted the observed mental health trajectories in the population cohort. Surprisingly, being relatively healthy predicted increases in depression and eating disorder symptoms and in body mass index. By contrast, those initially at higher risk for depression or eating disorders reported a lasting decrease.

CONCLUSIONS

Healthier young people may be at greater risk of developing depressive or eating disorder symptoms during the COVID-19 pandemic. Targeted mental health interventions considering prior diagnostic risk may be warranted to help young people cope with the challenges of psychosocial stress and reduce the associated healthcare burden.

Sex differences among children, adolescents and young adults for mental health service use within inpatient and outpatient settings, before and during the COVID-19 pandemic: a population-based study in Ontario, Canada

OBJECTIVES

The pandemic and public health response to contain the virus had impacts on many aspects of young people's lives including disruptions to daily routines, opportunities for social, academic, recreational engagement and early employment. Consequently, children, adolescents and young adults may have experienced mental health challenges that required use of mental health services. This study compared rates of use for inpatient and outpatient mental health services during the pandemic to pre-pandemic rates.

DESIGN

Population-based repeated cross-sectional study.

SETTING

Publicly delivered mental healthcare in primary and secondary settings within the province of Ontario, Canada.

PARTICIPANTS

All children 6-12 years of age (n=2 043 977), adolescents 13-17 years (n=1 708 754) and young adults 18-24 years (n=2 286 544), living in Ontario and eligible for provincial health insurance between March 2016 and November 2021.

PRIMARY OUTCOME MEASURES

Outpatient mental health visits to family physicians and psychiatrists for: mood and anxiety disorders, alcohol and substance abuse disorders, other non-psychotic mental health disorders and social problems. Inpatient mental health visits to emergency departments and hospitalisations for: substance-related and addictive disorders, anxiety disorders, assault-related injuries, deliberate self-harm and eating disorders. All outcomes were analysed by cohort and sex.

RESULTS

During the pandemic, observed outpatient visit rates were higher among young adults by 19.01% (95% CI: 15.56% to 22.37%; 209 vs 175 per 1000) and adolescent women 24.17% (95% CI: 18.93% to 29.15%; 131 vs 105 per 1000) for mood and anxiety disorders and remained higher than expected. Female adolescents had higher than expected usage of inpatient care for deliberate self-harm, eating disorders and assault-related injuries.

CONCLUSIONS

Study results raise concerns over prolonged high rates of mental health use during the pandemic, particularly in female adolescents and young women, and highlights the need to better monitor and identify mental health outcomes associated with COVID-19 containment measures and to develop policies to address these concerns.

Declines in Adolescent Substance Use After the COVID-19 Pandemic Onset: The Role of Initiation in Grades 7 and 9

PURPOSE

To examine if the record declines in adolescent substance use after the onset of the COVID-19 pandemic resulted from reduced levels of initiation, defined as any lifetime use.

METHODS

We analyzed data from the nationally representative, cross-sectional, annual Monitoring the Future surveys of eighth, 10th, and 12th grade students from 2019 to 2022. Measures included past 12-month use of cannabis, nicotine vaping, and alcohol as well as self-reported grade of initiation of each substance. Analyses are based on randomly selected subsamples of students who received questions on both prevalence and grade of first use, resulting in a total sample size of 96,990 students.

RESULTS

Levels of the past 12-month substance use were markedly lower after the onset of the pandemic, in 2021 and 2022. In eighth and 10th grade, levels were at least one-third lower for cannabis and nicotine vaping and 13%-31% lower for alcohol. In 12th grade, the decreases ranged from 9% to 23%. Lower levels of initiation in seventh grade in 2020-2021 accounted for half or more of the overall prevalence decreases in eighth grade in 2021- 2022. Lower levels of initiation in ninth grade in 2020-2021 accounted for 45% or more of the overall prevalence decreases in 10th grade in 2021-2022. Declines in 12th grade substance use prevalence were not consistently linked to lower initiation in earlier grades.

DISCUSSION

Much of the declines in overall prevalence of adolescent substance use after the onset of the COVID-19 pandemic trace back specifically to declines in substance use initiation in seventh and ninth grades.

Pediatric Mental Health Emergencies During 5 COVID-19 Waves in New York City

OBJECTIVES

To describe the proportion of pediatric mental health emergency department (MH-ED) visits across 5 COVID-19 waves in New York City (NYC) and to examine the relationship between MH-ED visits, COVID-19 prevalence, and societal restrictions.

METHODS

We conducted a time-series analysis of MH-ED visits among patients ages 5 to 17 years using the INSIGHT Clinical Research Network, a database from 5 medical centers in NYC from January 1, 2016, to June 12, 2022. We estimated seasonally adjusted changes in MH-ED visit rates during the COVID-19 pandemic, compared with predicted prepandemic levels, specific to each COVID-19 wave and stratified by mental health diagnoses and sociodemographic characteristics. We estimated associations between MH-ED visit rates, COVID-19 prevalence, and societal restrictions measured by the Stringency Index.

RESULTS

Of 686 500 ED visits in the cohort, 27 168 (4.0%) were MH-ED visits. The proportion of MH-ED visits was higher during each COVID-19 wave compared with predicted prepandemic trends. Increased MH-ED visits were seen for eating disorders across all waves; anxiety disorders in all except wave 3; depressive disorders and suicidality/self-harm in wave 2; and substance use disorders in waves 2, 4, and 5. MH-ED visits were increased from expected among female, adolescent, Asian race, high Child Opportunity Index patients. There was no association between MH-ED visits and NYC COVID-19 prevalence or NY State Stringency Index.

CONCLUSIONS

The proportion of pediatric MH-ED visits during the COVID-19 pandemic was higher during each wave compared with the predicted prepandemic period, with varied increases among diagnostic and sociodemographic subgroups. Enhanced pediatric mental health resources are essential to address these findings.

Impact of COVID-19 on the mental health of children and young people: an umbrella review

BACKGROUND

Over the past 3 years, a multitude of studies have highlighted the impact of the COVID-19 pandemic on the mental health of children and young people (CYP). In this umbrella review, we synthesise global evidence on the impact of COVID-19 on the mental health of CYP from existing systematic reviews with and/or without meta-analysis.

METHODS

Adopting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we evaluated 349 citations and identified 24 eligible reviews with medium to high methodological quality to be reviewed narratively.

RESULTS

Most of the reviews reported a high prevalence of anxiety disorders, depression, suicidal behaviour, eating disorders and other mental health problems. Most studies that used data at multiple time points indicate a significant increase in mental health problems in CYP, particularly in females and older adolescents.

CONCLUSIONS

Multipronged psychosocial care services, policies and programmes are needed to alleviate the burden of mental health problems in CYP as a consequence of the COVID-19 pandemic and associated global health measures.

PROSPERO REGISTRATION NUMBER

CRD42021276312.

Assessment of Obsessive Thoughts About COVID-19 in 7 Latin American Countries: Structure and Measurement Invariance of the Obsession With COVID-19 Scale

The present study aimed to evaluate the measurement invariance of the Obsession with COVID-19 Scale (OCS) among seven Latin American countries: Bolivia, Brazil, Cuba, El Salvador, Guatemala, Paraguay, and Uruguay. Although the OCS has been used in several countries and languages, there is a need for approaches that better integrate the cross-cultural equivalence of the scale. A total of 3185 people participated in the study. The results indicated the presence of a unidimensional structure and good reliability indices for the OCS in each country. The alignment method indicated that the OCS is an invariant measure of COVID-19 obsession among the populations of seven Latin American countries. The findings based on IRT analysis indicated that all OCS items had adequate discrimination and difficulty parameters. The findings contribute to the understanding of the internal structure of the scale in different countries at the same time, something that has been pending evaluation.

Mental Health and Contraceptive Knowledge in High Schoolers: Comparing Remote and In-Person Learning during COVID-19

Background and Objectives: In response to the COVID-19 pandemic's effects on education, this study delves into the behavioral, mental health, and sexual education characteristics of high school students during 2020-2021 and 2022-2023. Materials and Methods: We evaluated a variety of factors, including substance use, academic performance, sexual activities, mental health support, pandemic-related anxiety levels, and quality of life indicators using standardized instruments such as the SF-36, GAD-7, and WHOQOL-BREF. Furthermore, we addressed specific questions concerning contraception and sexual education during this period. Results: The questionnaires were filled in by 44 students in 2020-2021 and 41 students in 2022-2023. Significant findings included a noteworthy increase in COVID-19 vaccination rates, from 18.2% in 2020-2021 to 39.0% in 2022-2023 (p = 0.033), enhanced perceptions of mental health support during remote learning, from 7.1% to 20.0% (p = 0.044), and a rise in students partaking in reproductive health discussions from 10.7% to 25.0% (p = 0.046). Additionally, there was a marked decline in anxiety regarding the transition back to in-person learning (p = 0.048). Health surveys, such as the SF-36, signaled improvements in both physical and mental health over the years (p = 0.046 and p = 0.019, respectively), while the GAD-7 scores depicted a considerable reduction in anxiety symptoms (p = 0.038). The WHOQOL-BREF results also highlighted a significant uptick in students' mental well-being in 2022-2023 (p = 0.039). Conclusions: As the COVID-19 pandemic ended, high school students exhibited shifts in behavior, health, and education over four academic years, particularly in areas of contraceptive knowledge and mental health outcomes. The pronounced enhancements in vaccination rates, perceptions of mental health support, participation in health conversations, and overall mental wellness emphasize the adaptability and resilience of students in these tumultuous periods, and a general increase in contraceptive knowledge and quality of life during the end of the pandemic.

Prevalence of sleep disturbance among adolescents with substance use: a systematic review and meta-analysis

PURPOSE

Sleep disturbance has become a major challenge among adolescents worldwide. Substance use is among the most common factors contributing to sleep disturbance. This systematic review and meta-analysis examined the prevalence and categories of sleep disturbance among adolescents with substance use.

METHODS

We comprehensively searched for relevant studies published in the following databases from inception to August 2022: CINHAL (via EBSCOhost), PubMed, Scopus, Ovid Medline, Embase, ProQuest, and Web of Science. Data analysis was performed using Comprehensive Meta-Analysis version 3 software. We used a random-effects model to pool prevalence rates with 95% confidence intervals (CIs). Forest plots and p values for the Cochran Q statistic were used to evaluate heterogeneity among studies. Subgroup and meta-regression analyses were performed to compare the groups and identify the sources of heterogeneity.

RESULTS

We examined 18 studies that reported insomnia, hypersomnolence, sleep-related breathing disorders as sleep disturbances among adolescents with the use of alcohol, smoking, marijuana, and coffee. The total sample was 124,554. The overall prevalence rate of sleep disturbance was 29% (95% CI: 0.201-0.403). Subgroup analysis revealed that the prevalence rates of insomnia and hypersomnolence were higher among alcohol users (31%; 95% CI: 0.100-0.654) and smokers (46%; 95% CI: 0.232-0.700). The study design and method of assessment groups were the significant moderators that showed the source of variation in the included studies.

CONCLUSION

Sleep disturbance is highly prevalent among adolescents with substance use. Insomnia and hypersomnolence are more prevalent among alcohol users and smokers, respectively. On the basis of our findings, health-care providers can develop effective targeted interventions to reduce substance use, prevent sleep disturbance, and promote healthy sleep habits among adolescents.

Pandemic-Related Changes in the Prevalence of Early Adolescent Alcohol and Drug Use, 2020-2021: Data From a Multisite Cohort Study

PURPOSE

Evaluate changes in early adolescent substance use from May 2020 to May 2021 during the coronavirus disease 2019 pandemic using data from a prospective nationwide cohort: the Adolescent Brain Cognitive Development Study.

METHODS

In 2018-2019, 9,270 youth aged 11.5-13.0 completed a prepandemic assessment of past-month alcohol and drug use, then up to seven during-pandemic assessments between May 2020 and May 2021. We compared the prevalence of substance use among same-age youth across these eight timepoints.

RESULTS

Pandemic-related decreases in the past-month prevalence of alcohol use were detectable in May 2020, grew larger over time, and remained substantial in May 2021 (0.3% vs. 3.2% prepandemic, p <.001). Pandemic-related increases in inhalant use (p = .04) and prescription drug misuse (p < .001) were detectable in May 2020, shrunk over time, and were smaller but still detectable in May 2021(0.1%-0.2% vs. 0% pre-pandemic). Pandemic-related increases in nicotine use were detectable between May 2020 and March 2021 and no longer significantly different from prepandemic levels in May 2021 (0.5% vs. 0.2% prepandemic, p = .09). There was significant heterogeneity in pandemic-related change in substance use at some timepoints, with increased rates among youth identified as Black or Hispanic or in lower-income families versus stable or decreased rates among youth identified as White or in higher-income families.

DISCUSSION

Among youth ages 11.5-13.0 years old, rates of alcohol use remained dramatically reduced in May 2021 relative to prepandemic and rates of prescription drug misuse and inhalant use remained modestly increased. Differences remained despite the partial restoration of prepandemic life, raising questions about whether youth who spent early adolescence under pandemic conditions may exhibit persistently different patterns of substance use.

Interpersonal and Intimate Violence in Mexican Youth: Drug Use, Depression, Anxiety, and Stress during the COVID-19 Pandemic

The COVID-19 pandemic may have increased interpersonal and intimate violence, harmful use of alcohol and other drugs (AODs), and mental health problems. This study uses a valid path model to describe relationships between these conditions of young Mexicans during the second year of the pandemic. A sample of 7420 Mexicans ages 18 to 24-two-thirds of whom are women-completed the Life Events Checklist, the Alcohol, Smoking, and Substance Involvement Screening Test, the Major Depressive Episode Checklist, the Generalized Anxiety Scale, and the Post-traumatic Stress Disorder (PTSD) Checklist. Young Mexicans reported higher rates of victimization and perpetration of interpersonal and intimate violence and mental health symptomatology than those noted pre- and in the first year of the pandemic. The harmful use of AOD rates were similar to those reported by adolescents before. The findings suggest asymmetric victimization and perpetration of intimate violence by gender (with women at a higher risk). More men than women have engaged in the harmful use of AODs (except for sedatives, which more women abuse). More women than men were at risk of all mental health conditions. The path model indicates that being a victim of intimate violence predicts the harmful use of tobacco, alcohol, cocaine, and sedatives, depression, anxiety, and specific PTSD symptoms (such as re-experimentation and avoidance symptoms). Being a victim of interpersonal violence resulted in severe PTSD symptoms (including avoidance, negative alterations in cognition-mood, and hyperarousal signs). The harmful use of sedatives predicted depressive symptoms. Men's victimizing intimate violence model contrasted with that of women, which included being the victim of interpersonal violence and severe PTSD symptoms. The high school youth model had three paths: victimizing intimate violence, victimizing interpersonal abuse, and sedative use, which predicted depression. Our findings could serve as the basis for future studies exploring the mechanisms that predict violence to develop cost-effective preventive programs and public policies and to address mental health conditions during community emergencies.

The impact of COVID-19 and associated public health restrictions on trends in police-recorded violence in an English police force area

BACKGROUND

The COVID-19 pandemic, and associated public health measures, had a marked impact on a number of health and wellbeing outcomes, including alcohol use and violence. Current literature presents a mixed view of the impact of the pandemic on violence trends. The current study utilises police offence data from a region of northern England to examine the impact of lockdowns, and subsequent relaxation of restrictions, on trends in violent offences.

METHODS

Time series analyses using seasonal auto-regressive integrated moving average (SARIMA) modelling was used to investigate the impacts of the COVID-19 public health measures on weekly offence trends from April 1 2018 to March 20 2021. Additionally, pre-pandemic data were used to forecast expected trends had the pandemic not occurred. These expected trends were then compared to actual data to determine if the average levels of violence were outside the forecasted expectations. Overall violence and six subtypes (violence with and without injury, sexual offences including rape, domestic violence, and alcohol-related violent offences) were examined.

RESULTS

Overall, the observed trend in police recorded violent offences demonstrated fluctuating patterns in line with commencement and easing of public health restrictions. That is, offence numbers declined during lockdowns and increased after relaxation of restrictions. However, the majority of observed values fell within the expected range. This broad pattern was also found for subtypes of violent offences.

CONCLUSIONS

While violent crime trends demonstrated fluctuations with lockdowns, and subsequent easing of restrictions, these changes were not demonstrably larger than expected trends within this English region, suggesting that a sustained amplification in violence was not observed within this data. However, it is important to acknowledge the high levels of violence reported in this region across the study period, which should be used as a key driver for investing in long-term approaches to violence prevention. Given the extent of unreported violence generally, and that victims/survivors may come into contact with other support services (without reporting to the police), it is vital that policy and practice decisions take a holistic approach, considering a broad range of data sources.

Smoking among Brazilian adolescents during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

The social distancing measures during the coronavirus disease 2019 (COVID-19) pandemic resulted in mental suffering among adolescents, leading to risky consumption of psychoactive substances such as tobacco.

OBJECTIVE

To analyze the factors associated with tobacco use among adolescents during the COVID-19 social distancing period in Brazil.

DESIGN AND SETTING

Cross-sectional study used data from ConVid Adolescentes survey in Brazil.

METHODS

Tobacco use was assessed before and during social distancing. The explanatory variables investigated were sex, age, race/skin color, type of school, maternal education, region of residence, adherence to social restriction measures, number of close friends, sleep quality during the pandemic, mood, passive smoking, use of alcoholic beverages during the pandemic, sedentary behavior, and physical activity. A logistic regression model was used for the data analysis.

RESULTS

Tobacco use by adolescents did not change during the pandemic (from 2.58% to 2.41%). There was a higher chance of tobacco use among adolescents aged between 16 and 17 years, self-reported black ones, residing in the South and Southeast regions, reported feeling sad and loneliness, had sleeping problems that worsened, were using alcoholic beverages during the pandemic, and were passive smokers at home. Adolescents whose mothers had completed high school or higher, had strict social restrictions, and increased their physical activity during the pandemic had a lower chance of tobacco use.

CONCLUSION

Tobacco uses during the COVID-19 pandemic was higher in vulnerable groups, such as black adolescents and those with mental suffering.

Alcohol, cannabis, and nicotine use have distinct associations with COVID-19 pandemic-related experiences: An exploratory Bayesian network analysis across two timepoints

BACKGROUND

Substance use trends during the COVID-19 pandemic have been extensively documented. However, relatively less is known about the associations between pandemic-related experiences and substance use.

METHOD

In July 2020 and January 2021, a broad U.S. community sample (N = 1123) completed online assessments of past month alcohol, cannabis, and nicotine use and the 92-item Epidemic-Pandemic Impacts Inventory, a multidimensional measure of pandemic-related experiences. We examined links between substance use frequency, and pandemic impact on emotional, physical, economic, and other key domains, using Bayesian Gaussian graphical networks in which edges represent significant associations between variables (referred to as nodes). Bayesian network comparison approaches were used to assess the evidence of stability (or change) in associations between the two timepoints.

RESULTS

After controlling for all other nodes in the network, multiple significant edges connecting substance use nodes and pandemic-experience nodes were observed across both time points, including positive- (r range 0.07-0.23) and negative-associations (r range -0.25 to -0.11). Alcohol was positively associated with social and emotional pandemic impacts and negatively associated with economic impacts. Nicotine was positively associated with economic impact and negatively associated with social impact. Cannabis was positively associated with emotional impact. Network comparison suggested these associations were stable across the two timepoints.

CONCLUSION

Alcohol, nicotine, and cannabis use had unique associations to a few specific domains among a broad range of pandemic-related experiences. Given the cross-sectional nature of these analyses with observational data, further investigation is needed to identify potential causal links.

Alcohol and Other Substance Use Before and During the COVID-19 Pandemic Among High School Students - Youth Risk Behavior Survey, United States, 2021

Adolescence is a critical phase of development and is frequently a period of initiating and engaging in risky behaviors, including alcohol and other substance use. The COVID-19 pandemic and associated stressors might have affected adolescent involvement in these behaviors. To examine substance use patterns and understand how substance use among high school students changed before and during the COVID-19 pandemic, CDC analyzed data from the nationally representative Youth Risk Behavior Survey. This report presents estimated prevalences among high school students of current (i.e., previous 30 days) alcohol use, marijuana use, binge drinking, and prescription opioid misuse and lifetime alcohol, marijuana, synthetic marijuana, inhalants, ecstasy, cocaine, methamphetamine, heroin, and injection drug use and prescription opioid misuse. Trends during 2009-2021 were assessed using logistic regression and joinpoint regression analyses. Changes in substance use from 2019 to 2021 were assessed using prevalence differences and prevalence ratios, stratified by demographic characteristics. Prevalence of substance use measures by sexual identity and current co-occurring substance use were estimated using 2021 data. Substance use prevalence declined during 2009-2021. From 2019 to 2021, the prevalence of current alcohol use, marijuana use, and binge drinking and lifetime use of alcohol, marijuana, and cocaine and prescription opioid misuse decreased; lifetime inhalant use increased. In 2021, substance use varied by sex, race and ethnicity, and sexual identity. Approximately one third of students (29%) reported current use of alcohol or marijuana or prescription opioid misuse; among those reporting current substance use, approximately 34% used two or more substances. Widespread implementation of tailored evidence-based policies, programs, and practices likely to reduce risk factors for adolescent substance use and promote protective factors might further decrease substance use among U.S. high school students and is urgently needed in the context of the changing marketplaces for alcohol beverage products and other drugs (e.g., release of high-alcohol beverage products and increased availability of counterfeit pills containing fentanyl).

Covid-19 Shelter-in-Place, Modified Reopening Orders, and Order Compliance Impact on Adolescent Alcohol Use and Drinking Contexts in California: A Longitudinal Analysis

This study evaluated how Shelter-in-Place (SIP), modified reopening orders, and self-reported compliance with these orders have affected adolescent alcohol frequency and quantity of use across contexts during the COVID-19 pandemic. Materials and Methods: Differences-in-differences (DID) models and multi-level modeling analyses were conducted on longitudinal data collected as part of a larger study on alcohol among adolescents in California. 1,350 adolescents at baseline contributed 7,467 observations for a baseline and 5 six-month follow-up surveys. Analytic samples ranged from 3,577-6,245 participant observations based on models. Alcohol use outcomes included participant frequency (days) and quantity (number of whole drinks) of alcohol use in past 1-month and past 6-month periods. Context-specific alcohol use outcomes included past 6-month frequency and quantity of use at: restaurants, bars/nightclubs, outside, one’s own home, another’s home, and fraternities/sororities. Participant self-reported compliance with orders in essential business/retail spaces and at outdoor/social settings were also assessed. Results: Our DID results indicated that being under a modified reopening order was associated with decreases in past 6-month quantity of alcohol use (IRR=0.72, CI=0.56-0.93, p<0.05). Higher self-reported compliance with SIP orders related to social outdoor/social settings was associated with decreases in overall drinking frequency and quantity as well as decreased frequency and quantity of alcohol use in all contexts in the past six months. Compliance with SIP orders impacting essential businesses and retail spaces was associated with decreased frequency and quantity of use at other’s home and outdoors. Conclusions: Results suggest that SIP and modified reopening policies may not directly affect adolescent alcohol use or drinking contexts, and that individual compliance with such orders may be a protective factor for alcohol use.

Effect of the COVID-19 pandemic on adolescent mental health and substance use up to March, 2022, in Iceland: a repeated, cross-sectional, population-based study

BACKGROUND

Poor mental health in the first year of the COVID-19 pandemic has been well documented in adolescents; however, less is known about the longer-term effect of the pandemic. We aimed to examine adolescent mental health and substance use as well as covariates associated with these outcomes 1 year or more into the pandemic.

METHODS

A nationwide sample of adolescents aged 13-18 years enrolled in school in Iceland were invited to complete surveys administered during October-November or February-March, 2018, October-November, 2020, February-March or October-November, 2021, and February-March 2022. The survey was in Icelandic for all administrations and offered to adolescents aged 13-15 years in English in 2020 and 2022 and in Polish in 2022. Surveys assessed depressive symptoms (Symptom Checklist-90); mental wellbeing (Short Warwick Edinburgh Mental Wellbeing Scale); and the frequency of cigarette smoking, e-cigarette use, and alcohol intoxication. Covariates comprised age, gender, and migration status as determined by language spoken at home, level of social restrictions based on residency, parental social support, and sleep duration (≥8 h nightly). Weighted mixed-effect models were used to determine the effect of time and the covariates on mental health and substance use. The main outcomes were assessed in all participants with more than 80% of the necessary data, and multiple imputation was used to handle missing data. Bonferroni corrections were used to adjust for multiple testing and analyses were considered significant at a p value of <0·0017.

FINDINGS

64 071 responses were submitted and analysed between 2018 and 2022. Elevated depressive symptoms and worsened mental wellbeing across girls and boys aged 13-18 years were observed to have been maintained up to 2 years into the pandemic (p>0·0017). Alcohol intoxication initially decreased during the pandemic but increased again as social restrictions eased (p<0·0001). No changes were observed in cigarette smoking and e-cigarette use during the COVID-19 pandemic. Higher levels of parental social support and an average sleep duration of 8 h or more per night were associated with mental health better outcomes and less substance use (p<0·0001). Social restrictions and migration background were inconsistently associated with the outcomes.

INTERPRETATION

Population-level prevention targeting adolescent depressive symptoms should be prioritised in health policy in the wake of COVID-19.

FUNDING

Icelandic Research Fund.

The Impact of COVID-19 Confinement on Substance Use and Mental Health in Portuguese Higher Education Students

The mental health of higher education students is a constant concern, and the pandemic situation caused by COVID-19 has intensified this concern. The social measures imposed to control and minimize the disease have led, among other things, to the reconfiguration of higher education students' academic life habits, which has naturally altered their emotional balance, mental health, and substance abuse. This cross-sectional, descriptive, and correlational study assesses the influence of higher education students' personal characteristics on their (self-reported) use of addictive substances (alcohol, tobacco, drugs, and pharmaceutical drugs) before and during their first compulsory confinement in Portugal, as well as its relationship with mental health. An online questionnaire was applied between 15 April and 20 May 2020, to students from various study cycles of higher education institutions in one region of Portugal (northern area of Alentejo), which included the Mental Health Inventory in its reduced version (MHI-5) and questions (constructed by the authors) on personal characterization and on the use of addictive substances before and during confinement. The convenience sample included 329 mostly female health care students between the ages of 18 and 24. In our results, we found a statistically significant decrease in tobacco, alcohol, and drug use; however, there was an increase in tobacco use among older students and an increase in anxiolytic use among students with higher academic achievement and among students who exhibited more active social behavior in the period prior to confinement. Students who took anxiolytics during confinement had higher MHI-5 scores and students who used the most addictive substances during confinement had lower MHI-5 scores than the other students.

Mobile App-Based Coaching for Alcohol Prevention among Adolescents: Pre-Post Study on the Acceptance and Effectiveness of the Program "MobileCoach Alcohol"

BACKGROUND

At-risk alcohol use, particularly binge drinking, is widespread among adolescents and young adults in most Western countries. MobileCoach Alcohol is a mobile app-based program for alcohol prevention that provides individualized coaching using a conversational agent. The current study tested the acceptance, use, and evaluation of this newly developed program and explored its potential effectiveness.

METHODS

Longitudinal pre-post study among upper secondary and vocational school students in Switzerland. Within the MobileCoach Alcohol prevention program, a virtual coach motivated participants to deal with alcohol sensitively, and provided feedback on alcohol use and strategies to resist alcohol for a period of 10 weeks. Information was provided in weekly dialogs, within contests with other participants, and interactive challenges. By means of a follow-up survey after the end of the 10-week program, indicators of the use, acceptance, and effectiveness of the program were examined.

RESULTS

Between October 2020 and July 2022, the program was advertised in upper secondary and vocational schools. Recruiting schools and school classes was difficult due to the COVID-19 containment measures in place during this period. Nevertheless, the program could be implemented in 61 upper secondary and vocational school classes with a total of 954 participating students. Three out of four students who were present in the school classes participated in the MobileCoach Alcohol program and the associated study. Online follow up assessment at week 10 was completed by 272 program participants (28.4%). Based on program use and evaluations by the participants, the overall acceptance of the intervention was good. The proportion of students who engaged in binge drinking was significantly reduced from 32.7% at baseline to 24.3% at follow up. Furthermore, the longitudinal analyses revealed decreases in the maximum number of alcoholic drinks consumed on an occasion and the mean number of standard drinks per month, whereas self-efficacy to resist alcohol increased between baseline and follow up.

CONCLUSIONS

The mobile app-based MobileCoach Alcohol program proved to be an attractive intervention, in which the majority of students were interested when proactively recruited at school classes. It allows for individualized coaching in large groups of adolescents and young adults and is promising for reducing at-risk alcohol use.

Cannabis use, abuse and dependence during the COVID-19 pandemic: a scoping review

The interaction between cannabis use or addiction and SARS-COV-2 infection rates and COVID-19 outcomes is obscure. As of 08/01/2022 among 57 evaluated epidemiological/clinical studies found in Pubmed-database, most evidence for how cannabis use patterns were influenced by the pandemic was given by two systematic reviews and 17 prospective studies, mostly involving adolescents. In this age group, cannabis use patterns have not changed markedly. For adults, several cross-sectional studies reported mixed results with cannabis use having increased, decreased or remained unchanged. Two cross-sectional studies demonstrated that the severity of adults´ cannabis dependence was either increased as a consequence of increasing cannabis use during the pandemic or not changed. Regarding the effect of cannabis use on COVID-19 outcomes, we found only five retrospective/cross-sectional studies. Accordingly, (i) cannabis use did not impact mild COVID-19 symptoms; (ii) cannabis using individuals experienced more COVID-19-related hospitalizations; (iii) cannabis using veterans were associated with reduced SARS-COV-2 infection rates; (iv) frequent cannabis use was significantly associated with COVID-19 mortality, and (v) cannabis dependents were at higher risk of COVID-19 breakthrough after vaccination. It should be outlined that the validity of these retrospective/cross-sectional studies (all self-reports or register/e-health-records) is rather low. Future prospective studies on the effects of cannabis use on SARS-COV-2 infection rates and COVID-19 outcomes are clearly required for conclusive risk-benefit assessments of the role of cannabis on users' health during the pandemic. Moreover, substance dependence (including cannabis) is associated with (often untreated) somatic comorbidity, which severity is a proven key risk factor for worse COVID-19 outcomes.

Substance Use and Psychological Distress in Mexican Adults during COVID-19 Pandemic: A Cross-Sectional Study

OBJECTIVES

This observational cross-sectional study examined changes in substance use during the coronavirus disease 2019 (COVID-19) pandemic in the Mexican population and evaluated whether depression or anxiety was associated with these new consumption patterns.

METHODS

An online survey was distributed to the general population. Participants were questioned about their demographics, situation during the COVID-19 pandemic, and substance consumption patterns. The Patient Health Questionnaire-9 for depression and the Coronavirus Anxiety Scale were used.

RESULTS

A total of 866 individuals completed the survey. The mean scores for the Patient Health Questionnaire-9 and Coronavirus Anxiety Scale were 8.89 ± 6.20 and 3.48 ± 3.22, respectively. The preferred substances were alcohol (19%), tobacco (16.5%), and marijuana (5.6%). Consumption of alcohol (p = 0.042) significantly increased during the pandemic and it was higher in women than in men (p = 0.040).

CONCLUSIONS

Substance use patterns were affected by the pandemic, with an increase in the number of users and consumption rate, as well as the reported psychiatric symptoms.

Impact of the COVID-19 pandemic on alcohol or drug use symptoms and service need among youth: a cross-sectional sample from British Columbia, Canada

BACKGROUND

Concerns about youth alcohol and drug use have risen since the declaration of the global COVID-19 pandemic due to the pandemic's impact on known risk and protective factors for substance use. However, the pandemic's immediate and long-term impact on youths' substance use patterns has been less clear. Thus, this study sought to determine how the COVID-19 pandemic impacted alcohol or drug use and its risk and protective factors among youth accessing integrated youth services.

METHODS

We conducted a repeated cross-sectional study of patient-reported outcomes data collected between May 2018 and February 2022 among youth (n = 6022) ages 10-24 accessing a provincial network of integrated youth services in Canada. The main exposure of interest was the COVID-19 pandemic (March 2020 - February 2022) compared with a pre-pandemic period (May 2018 - February 2020). As measured by the Global Appraisal of Individual Needs - Short Screener, outcomes included the average number of past month alcohol or drug use symptoms and past month likelihood of service need for alcohol/drug use (moderate/high vs. low need). Interrupted time series (ITS) examined change in average monthly alcohol/drug use symptoms between the pre- and pandemic periods. Stratified multivariable logistic regression investigated how the pandemic modified the effects of established risk/protective factors on likelihood of alcohol/drug use service need.

RESULTS

Fifty-percent of youth met the criteria for moderate/high likelihood of alcohol/drug use service need, with the odds being 2.39 times (95% confidence interval = 2.04, 2.80) greater during the pandemic compared to the pre-pandemic period. Results from the ITS indicated significant immediate effects of the pandemic on monthly substance use symptoms (p = 0.01). Significant risk/protective factors for service need included exposure to violence, engagement in meaningful activities, and self-rated physical and mental health; and the direction of their effects remained consistent across pandemic and pre-pandemic periods.

CONCLUSIONS

This study demonstrated that the COVID-19 pandemic corresponded with increased alcohol or drug use among youth accessing integrated services. This signals an urgent need for increased clinical capacity in existing youth services and policies that can respond to risk/protective factors for substance use earlier.

The association between social factors and COVID-19 protective behaviors and depression and stress among midwestern US college students

PURPOSE

The aim of this cross-sectional study was to examine the relationship between social factors and COVID-19 protective behaviors and two outcomes: depressive and perceived stress symptoms.

METHODS

In September 2020, 1,064 randomly selected undergraduate students from a large midwestern university completed an online survey and provided information on demographics, social activities, COVID-19 protective behaviors (i.e., avoiding social events and staying home from work and school), and mental health symptoms. Mental health symptoms were measured using the Center for Epidemiological Studies Depression-10 questionnaire for depression and the Perceived Stress Scale-10 for stress symptoms.

RESULTS

The results showed respondents who were males and also the respondents who were "hanging out" with more people while drinking alcohol reported significantly lower depressive symptoms and lower stress symptoms. On the contrary, staying home from work or school "very often" was associated with higher stress symptoms, compared with "never/rarely" staying home from work/school. Similarly, having a job with in-person interaction was also associated with increased stress.

CONCLUSIONS

These findings suggest that lack of social engagement was associated with depression and stress symptoms among college students during the COVID-19 pandemic. Planning social activities that align with recommended safety precautions, as well as meet students' social needs, should be an important priority for higher education institutions.

Swedish High School Students' Drug and Alcohol Use Habits throughout 2020

This study describes gender-specific patterns in alcohol and drug use among Swedish high school students throughout 2020 and questions the current cutoffs for identifying addiction in this population. From September 2020 to February 2021, 1590 Swedish upper secondary high school students (mean age 17.15 years, age range 15-19 years, 39.6% male, and 60.4% female) completed the anonymous, electronic survey of the Mental and Somatic Health without borders study. The respondents reported their substance use habits during the previous 12 months using the Drug Use Disorders Identification Test (DUDIT) and Alcohol Use Disorders Identification Test (AUDIT). They also answered questions about changes in their alcohol and illegal drug use habits after the COVID-19 outbreak. No gender differences were detected in the prevalence and degree of alcohol use. Compared to female adolescents, significantly more male adolescents used drugs (and to a significantly higher degree, although with a small effect size). Substance use problems peaked in females at age 17 and in males at age 18. The COVID-19 outbreak affected alcohol consumption and illegal drug use in male and female adolescents similarly. For both genders, of those who used illegal drugs, over 40% reported increased use after the outbreak. Our results reinforce previous suggestions of the narrowing of gender differences in Swedish adolescents' risk behaviors and challenge the previously validated gender-specific cutoffs for the AUDIT and DUDIT. An improved understanding of the impacts of gender diversity and evolving gender roles and norms on behaviors and mental health is warranted.

Remote Screening for Alcohol, Smoking, and Substance Involvement by Sex, Age, Lockdown Condition, and Psychological Care-Seeking in the Primary Care Setting during the COVID-19 Pandemic in México

The COVID-19 pandemic has created a psychoactive substance use crisis in many countries, including México. Remote valid tools to identify high-risk groups in need for treatment are a prerequisite for cost-effective interventions in primary care settings. To determine the validity and correlates of the remote applications of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) with sex, age, and psychological care-seeking, offered remotely in primary settings, during the COVID-19 pandemic in Mexico, a total sample of 19,109 Mexicans, with an average age of 34.38 years (SD = 12.28, range = 18-80), 65.8% of whom were women (n = 12,578), 29.6% in lockdown (5,660), 39.8% in partial lockdown (7,611), 30.60% not in lockdown (5,838), and 14.75% of whom were seeking psychological care (n = 2,819), completed ASSIST through a programmed Web application. The dimensionality of the scale to verify construct validity evidence was achieved through a confirmatory factor analysis model (CFA). We represented the distribution of subjects by sex, age, lockdown condition, and psychological care-seeking, based on their lifetime consumption in 2021. We also compared the total distribution by consumption risk level and recommended type of intervention, psychological care-seeking, and age. The tool included ten dimensions (one for each substance, such as tobacco use), confirmed through the CFA. In general, our findings indicated that men reported high lifetime psychoactive substance use and risky drug use levels. A high percentage of 18 to 19-year-old women reported lifetime tobacco and alcohol use. Additionally, a high number of all-age women reported lifetime sedative and opioid use. Also, a high proportion of partially lockdown participants reported lifetime drug use. Moreover, a high percentage of subjects seeking psychological care were at a moderate and high risk of drug use, which required brief or intensive treatment. Our findings indicate that it was possible to validate the factor structure of the programmed ASSIST for remote use. More men than women reported high lifetime psychoactive substance use and risky levels because of their consumption. At the same time, younger women reported similar and even higher lifetime tobacco, alcohol, and cocaine use than same-age men. More all-age women reported lifetime use of sedatives than all-age men. More all-age partially lockdown participants reported lifetime use of drugs. In general, subjects at greater risk and those requiring psychological care are more likely to seek care. Community and primary care screening will make it possible to implement effective early interventions to reduce the substance use risks associated with health emergencies. Future studies are required to determine the diagnosis of substance use disorders to evaluate the cut-off points in the screening test to discriminate between the presence and absence of symptoms and evaluate the effect of remote psychological care.

Impact Potpourri: A Multimethod Survey Study on Youth Substance Use During COVID-19

BACKGROUND

Given the important implications of youth substance use, it is essential to document and describe changes in substance use during the coronavirus disease 2019 pandemic.

METHODS

This multimethod survey study examines the impacts of the coronavirus disease 2019 pandemic on youth substance use among 149 Canadian youth who were using substances at a mid-pandemic period. Participants were 21.9 years of age on average (SD=2.2), including 99 girls/young women, 42 boys/young men, and 8 transgender or nonbinary individuals. The majority were Caucasian and born in Canada. Qualitative and quantitative findings are reported, with thematic analysis combined with descriptive and inferential statistical analyses.

RESULTS

Qualitatively, many youth reported increases or shifts in their substance use over the course of the pandemic. Youth reported using substances with limited numbers of peers, with family, or alone. Many reported using substances out of boredom and to cope. While legal substances remained highly accessible, illegal substances were reported to be more difficult to acquire and less trustworthy. Spending had increased. Quantitative findings suggested alcohol use has decreased, but other substance use has remained stable in the sample as a whole, although for each substance, some youth reported increases.

DISCUSSION

Despite minimal quantitative change, qualitative findings show that some youth increased their use of some substances during the pandemic, decreased others, changed their motivation to use, and decreased in safety behaviors. Youth-serving organizations should be aware of individual differences, the changing context of substance use, and the potential long-term impacts.

Perceptions of and adherence to early COVID-19-related restrictions and associations with substance use among youth in Canada

INTRODUCTION

As a largely social behaviour, substance use may have decreased for some youth overall in Canada during the COVID-19 pandemic; however, continued use may indicate nonadherence to pandemic-related restrictions and social distancing measures. In a sample of Canadian adolescents (aged 12-19 years), our objective was to examine how substance use (cannabis, binge drinking, cigarettes, vaping) is associated with perceptions of, and adherence to, early COVID-19-related public health measures, taking into consideration sociodemographic factors.

METHODS

Cross-sectional data were retrieved from online data collected during Year 8 of the COMPASS school-based study, during the early months of the COVID-19 pandemic (May-July 2020) in British Columbia, Ontario and Quebec. We fitted two models using generalized estimating equations to examine how substance use was associated with separate measures of (1) perceptions of, and (2) adherence to early COVID-19 restrictions.

RESULTS

In our sample, 10% of adolescents perceived COVID-19 restrictions as too weak and 14% perceived them as too strict. Nearly half (46%) reported taking restrictions very seriously, and 5% did not take them seriously at all. Binge drinking, cigarette use and vaping were associated with perceptions that restrictions were too strict and with nonadherence. However, adolescents who used cannabis were less likely to perceive COVID-19-related restrictions as too strict.

CONCLUSION

This study highlights the association of adolescent substance use with perceptions of, and adherence to, COVID-19-related public health restrictions in Canada. Our findings emphasize a need for continual monitoring of substance use behaviours during the COVID-19 pandemic to better characterize adolescent risk and further inform targeted public health strategies accordingly.

Association of Residence Type on Smoking in South Korean Adolescents during the COVID-19 Pandemic: Findings from a National Survey

The closure of schools due to the COVID-19 pandemic has forced adolescents to stay home. These disruptions, as well as a significant decrease in social access, have impacted smoking behavior. This study identified the association between the adolescents' type of residence and tobacco product use. A cross-sectional study (using data from the Korea Youth Risk Behavior Web-based Survey) examined 3774 students in 2019 (pre-pandemic) and 2575 students in 2020 (during the pandemic). The participants were South Korean middle and high school students aged 13-19 years. Using multinomial logistic regression, it was shown that adolescents who lived alone or in a boarding house had a higher risk of being an e-cigarette smoker compared with those who lived with family or relatives (OR = 6.49, CI = 2.06-20.45). Living in a dormitory or orphanage also increased the risk of dual tobacco use compared with living with family (OR = 2.09, 95% CI = 1.13-3.84). With the advent and continuation of the COVID-19 pandemic, this effect became more significant in 2020 than in 2019. Our findings support the theory that residential differences affect adolescent smoking behavior and highlight the importance of integrated smoking bans and educational programs to control adolescent smoking.

E-Cigarette Use Is Associated with Increased Psychological Distress among Youth: A Pooled Cross-Sectional Analysis of State-Level Data from 2019 and 2021

A crisis of worsening youth mental health in recent years across the United States has created alarm among health professionals. As a result, health professionals have sought to improve methods of identifying youth in need of treatment services. Cigarette, cannabis, and alcohol use each consistently serve as behavioral markers of risk for youth mental health problems. Despite the recent growth of electronic cigarette (e-cigarette) use among youth, few studies have examined whether e-cigarettes follow the same associational pattern with mental health problems in the context of other substance use. Additionally, the COVID-19 pandemic may have altered the associations between youth substance use and mental health problems due to both reduced overall use and increased mental health problems after the onset of the pandemic. The current study examined associations between youth substance use and psychological distress before and after the onset of the COVID-19 pandemic using two state-representative samples of youth in grades 8, 10, and 12 from 2019 (N = 58,689) and 2021 (N = 46,823) from Utah. Pooled cross-sectional linear and negative binomial regression models clustered by grade, stratified by school district, and weighted to represent population characteristics estimated associations between recent e-cigarette, combustible cigarette, cannabis, and heavy alcohol use and two measures of psychological distress-depressive symptoms and mental health treatment needs. After controlling for sociodemographic factors and recent uses of other substances, results indicated that psychological distress increased from 2019 to 2021 and that recent e-cigarette, combustible cigarette, cannabis, and heavy alcohol use were each significantly associated with increased levels on both measures of psychological distress. Compared to other substances, e-cigarette use showed the strongest standardized associations. The association of e-cigarette use with depressive symptoms strengthened significantly from 2019 to 2021. Given the youth mental health crisis paired with the widespread adoption of e-cigarettes, health professionals should consider recent e-cigarette use an increasingly important behavioral marker for risks of mental health problems among youth. Results suggest that future research studies examining the temporal ordering of substance use and mental health among youth should include e-cigarettes.

Temporal trends in alcohol, cannabis, and simultaneous use among 12th-grade U.S. adolescents from 2000 to 2020: Differences by sex, parental education, and race and ethnicity

BACKGROUND

Simultaneous use of alcohol and cannabis to enhance each other's effect can cause potential harm. Time trends are diverging in adolescent use of alcohol, which is declining, and cannabis, which is increasing among certain subgroups. However, little is known about trends in their simultaneous and non-simultaneous use. Racial and socioeconomic disparities are emerging in cannabis use, which may portend consequences to public health.

METHODS

The 2000 to 2020 Monitoring the Future surveys included approximately 38,000 U.S. 12th-grade students with information on simultaneous use and pertinent demographic factors. A 5-level alcohol/cannabis measure included past-year simultaneous use (i.e., alcohol and cannabis use at the same time), non-simultaneous alcohol and cannabis use, alcohol-use-only, cannabis-use-only, and no use. Multinomial logistic regressions estimated associations (adjusted relative risk ratios; aRRR) with time period (2000 to 2004, 2005 to 2009, 2010 to 2014, 2015 to 2020). Models were adjusted and included interactions with sex, race/ethnicity, and parental education.

RESULTS

Between 2000 and 2020, simultaneous alcohol/cannabis use among 12th graders decreased from 24.4% to 18.7%. From 2015 to 2020 compared to 2000 to 2004, the odds of simultaneous use (adjusted relative risk ratio (aRRR) vs. no use = 0.57, 95% CI [0.50, 0.66]) and alcohol-use-only (aRRR = 0.55, 95% CI [0.49, 0.61]) decreased, while cannabis-use-only odds increased (aRRR = 2.59, 95% CI [1.87, 3.59]). Notably, the prevalence of cannabis-use-only more than doubled from 2011 to 2019. The odds of simultaneous use, alcohol-use-only, and non-simultaneous use of alcohol and cannabis declined more rapidly among males than females, whereas the odds for cannabis-use-only increased faster for females than males. Increases in cannabis-use-only were faster for non-white adolescents.

CONCLUSION

Simultaneous use of alcohol and cannabis is declining among U.S. adolescents, but the decline is slower among females than males. Declines in simultaneous use are largely concomitant with historical declines in alcohol use, indicating that a continued focus on reducing alcohol use among adolescents and young adults has extended benefits to other adolescent substance use. However, cannabis use without any reported past-year alcohol use more than doubled in the last decade, a concerning trend.

Adolescents' Alcohol Use and Related Expectancies before and during the Early COVID-19 Pandemic: Evidence from the Nationwide MyLife Study

INTRODUCTION

We examined a range of alcohol use indicators among Norwegian adolescents before and during the early COVID-19 pandemic.

METHODS

We examined two cohorts of Norwegian 16-year-olds from the nationwide MyLife study who entered high school in fall 2020 (i.e., COVID-19 pandemic cohort; n = 915) and fall 2019/18 (i.e., prepandemic cohort; n = 1,621). Through e-surveys, adolescents reported their past year drinking frequencies and quantities (generating the Alcohol Use Disorders Identification Test-Concise; AUDIT-C scores) and completed Social Facilitation (SF) and Tension Reduction (TR) subscales of the Alcohol Outcome Expectancies Scale. Cohort differences across these outcomes were examined with linear and modified Poisson regression models.

RESULTS

There were no cohort differences in the proportion of adolescents who reported drinking in the past year or in drinking/binge drinking frequencies. However, alcohol quantities consumed on a typical drinking day were 1/3 of a drink greater in the COVID-19 cohort than in the prepandemic cohort; aIRR (95% CI) = 1.13 (1.02-1.25). These consumption differences compounded into significantly greater AUDIT-C scores (aIRR [95% CI] = 1.16 [1.02-1.32]) and positive AUDIT-C screens (31.2% vs. 26.4%; aRR [95% CI] = 1.21 [1.07-1.36]) in the COVID-19 cohort. In terms of alcohol-related expectancies, there were no SF differences, but the COVID-19 cohort reported significantly greater TR expectancies; b (95% CI) = 0.11 (0.02-0.20).

CONCLUSION

Despite the 2020 lockdown, Norwegian adolescents who started high school during the first pandemic year did not differ from their prepandemic peers in terms of how many of them drank, how often they drank, or in prosocial expectations they had of alcohol use. However, they consumed greater alcohol quantities per drinking day, had greater AUDIT-C scores, and reported greater tension reduction expectations of alcohol use. These results underscore the value of examining adolescents' alcohol-related behaviors during the COVID-19 pandemic above and beyond the basic drinking prevalence and frequencies.