Understanding longitudinal relationships between COVID-19 pandemic outcomes and alcohol use and problems from 2019 to 2020 and 2021 for the U.S. population and vulnerable groups.

ABSTRACT The COVID-19 (C19) pandemic has upended American lives with far-reaching consequences for health and well-being, and has disproportionately impacted racial/ethnic minorities and other vulnerable communities. Studies from the early pandemic period have observed increases in alcohol use and heavy drinking, and these behaviors and their consequences on physical and mental health are expected to persist well after the pandemic subsides. Thus far, however, there is a dearth of nationally-representative, longitudinal data on the pandemic's effects on alcohol and drug use and mental health that build on baseline pre-pandemic data. The Alcohol Research Group and its P50 Alcohol Research Center have conducted a series of National Alcohol Surveys (NAS) for forty years. We conducted the 14th edition of the NAS (N14) beginning in 2019 and completed it on April 20, 2020, and in early 2021 we conducted a NAS COVID supplement survey (N14C) as a follow-up of N14 (baseline) respondents. With this rapid-response R01 application we are proposing to conduct a 3rd wave of data collection of N14 and N14C respondents (termed N14C2) to build a nationally-representative cohort with 3 survey time-points. With pre-C19 data from the first wave of data collection, N14, and two follow-up surveys covering the first (N14C) and second (N14C2) years following initial efforts to control C19 spread in the US, we will be able to rigorously assess the financial, social, and health impacts of the C19 pandemic on alcohol and other drug (AOD) use and problems. We will investigate the potential impact of increased alcohol use on the course of consequences of the pandemic, such as job loss, social contact and mental health outcomes. We also propose to examine alcohol use and C19-related precautionary behaviors such social distancing, and vaccination uptake. We will contextualize the analysis by including geocoded data linked to our survey data to allow us to examine these associations in relation to relevant C19-related state policies, available alcohol purchasing options, and other area conditions that may affect AOD use and problems. Finally, we propose to apply mixed methods to understand in depth alcohol use experiences during the pandemic and perceived need, barriers, facilitators and plans for seeking support among heavy drinkers in subgroups disproportionately affected by the pandemic, namely Blacks, Latinos, and sexual minorities. To accomplish this we plan to recruit a purposive subsample for semi-structured qualitative interviews following the N14C2 survey. Taken together, this project will identify and characterize those at an increased risk of developing AOD problems, poor mental health, and prolonged C19 impacts, and determine features of environments including regulations that increase or mitigate these risks, aiming to inform modifiable interventions and policies.