Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Apr 1, 2021
Date Accepted: Sep 21, 2021
Date Submitted to PubMed: Sep 30, 2021
Associations of Substance Use with Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: A Survey Study
ABSTRACT
Background:
Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk in substance users are not well understood.
Objective:
To evaluate whether alcohol or other drug use is associated with adherence to CDC guidelines for COVID-19 mitigation. Pre-registered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome.
Methods:
A cross-sectional online survey was administered to a convenience sample recruited through the MTurk platform from June 18-July 19, 2020. Individuals 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past-7-day use of alcohol, cigarettes, e-cigarettes, cannabis, stimulants, and non-medical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were COVID-19 testing and test result.
Results:
The sample included 1,101 individuals (mean age = 40.87 13.44; 50.1% male, 49.1% female, 0.7% other gender identity). Daily opioid users reported lower CDC guideline adherence than non-daily users (B = -0.23, 95% CI [-.42, -0.04], p = .019) and non-users (B = -0.57, 95% CI [-0.76, -0.37], p <.001). Daily alcohol drinkers reported lower adherence than non-daily users (B = -0.18, 95% CI [-0.33, -0.05], p = .010). Non-daily alcohol drinkers reported higher adherence than non-drinkers (B = 0.10, 95% CI [0.02, 0.18], p = .010). Daily opioid use related to greater odds of COVID-19 testing, and daily stimulant use related to greater odds of a positive test.
Conclusions:
In a regionally specific, racially and ethnically diverse convenience sample, adults who engaged in riskier substance use behaviors also reported lower CDC guideline adherence, as well as greater odds of COVID-19 testing and infection. These results accounted for sociodemographic covariates. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors. Clinical Trial: not applicable
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