Background: Given the potential for increased substance use during COVID-19, we examined (1) young adults’ changes in cigarette, e-cigarette, marijuana, and alcohol use from pre- to during COVID-19; and (2) related risk/protective factors. These findings could inform intervention efforts aimed at curbing increases in substance use during periods of societal stress. Methods: We analyzed Wave 3 (W3; September–December 2019) and Wave 4 (W4; March–May 2020) from the Vape shop Advertising, Place characteristics and Effects Surveillance (VAPES), a 2-year, five-wave longitudinal study of young adults across six metropolitan areas. We examined risk/protective factors (i.e. adverse childhood experiences [ACEs], depressive symptoms, resilience) in relation to changes in past 30-day substance use frequency. Results: In this sample (N = 1084, Mage=24.76, SD = 4.70; 51.8% female; 73.6% White; 12.5% Hispanic), W3/W4 past 30-day use prevalence was: 29.1% cigarettes (19.4% increased/26.4% decreased), 36.5% e-cigarettes (23.2% increased/28.6% decreased), 49.4% marijuana (27.2% increased/21.2% decreased), and 84.8% alcohol (32.9% increased/20.7% decreased). Multivariate regressions indicated that, greater increases were predicted by: for e-cigarettes, greater ACEs; and for alcohol, greater depression. Among those with low resilience, predictors included: for e-cigarettes, greater depression; and for marijuana, greater ACEs. Conclusions: Interventions to reduce substance use during societal stressors should target both risk and protective factors, particularly resilience.

Significance The emergence of heated tobacco products (HTPs) in the US marks a critical time for identifying those most likely to use, particularly among young adults. Methods We analyzed Fall 2019 data from a longitudinal study of young adults (ages 18-34; n=2,375, Mage=24.66±4.68) in 6 US cities, 24.1% of whom used cigarettes and 32.7% e-cigarettes. We assessed HTP awareness, use, and sources, as well as perceived risk, social acceptability, and likelihood of future use. Results In this sample, 9.7% (n=230) heard of HTPs, 3.5% (n=84) ever used them, and 2.4% (n=56) reported past-year purchases (tobacco shops, 66.1%; traditional retailers, 60.7%; online, 39.3%; IQOS specialty stores, 35.7%). In multivariable analyses, having heard of HTPs correlated with being older, male, and current cigarette and e-cigarette users; among those ever hearing of them, using HTPs correlated with being non-Hispanic and current cigarette and e-cigarette users. Greater likelihood of future use correlated with being older, male, sexual minority, non-Hispanic, and current cigarette and e-cigarette users. Among past-month users (n=78), the average number of days used was 5.48 (SD=5.54). Past-month cigarette and e-cigarette users, respectively, who tried HTPs were more likely to report consistent or more frequent use of their respective product than a year ago (p’s<.001). HTPs were perceived as less addictive than cigarettes, smokeless tobacco, and e-cigarettes, and less harmful and more socially acceptable than other tobacco products except e-cigarettes and hookah. Conclusions The relatively positive perceptions of HTPs and access via various channels underscores potential penetration of HTPs among US young adults.

Given the global impact of coronavirus disease 2019 (COVID-19) on mental and physical health, we examined young adults’ changes in mental health, intimate relationship quality, alcohol use and weight-related behaviors during COVID-19 and their correlates (depressive symptoms, resilience, social context and COVID-19-related factors). We analyzed data from a longitudinal study of 1082 young adults across six metropolitan areas (Mage = 24.76 ± 4.70; 51.8% female; 73.6% White and 12.5% Hispanic), using multivariate linear regressions for continuous outcomes (magnitude of mental health impact) and logistic regressions for categorical outcomes (decreased relationship quality, physical activity and nutrition and increased alcohol use and sedentary behavior). Of five negative mental health impacts assessed, participants reported experiencing an average of 3.54 (SD = 5.46), experiencing more correlated with increased childcare responsibilities and lower resilience. Additionally, 23.6% of those in relationships experienced negative relationship impact, 41.3% increased alcohol use, 47.2% decreased physical activity, 74.0% were more sedentary and 34.7% experienced poorer nutrition, all of which was predicted by greater depressive symptoms. Additionally, lower resilience predicted negative relationship impact and poorer nutrition and social context/roles correlated with various outcomes (e.g. relationships and alcohol use). Interventions to reduce negative health behaviors given societal stressors should address key psychosocial and situational factors, including depressive symptoms and resilience.