Purpose of Review To review the literature on the trends in substance use among youth during the coronavirus SARS-CoV-2 (COVID-19) pandemic. Recent Findings The pandemic has given rise to concerns about the mental health and social well-being of youth, including its potential to increase or exacerbate substance use behaviors. This systematic review identified and included 49 studies of use across alcohol, cannabis, tobacco, e-cigarettes/vaping, and other drugs, and unspecified substances. The majority of studies across all categories of youth substance use reported reductions in prevalence, except in the case of other drugs and unspecified drug and substance use, which included three studies that reported an increase in use and three studies that reported decrease in use. Summary Overall, the results of this review suggest that the prevalence of youth substance use has largely declined during the pandemic. Youth substance use in the post-pandemic years will require monitoring and continued surveillance.

Background Young people who experience higher levels of social support from their schools and families have been shown to be less likely to develop symptoms of negative mental health outcomes such as depression and anxiety.1–4 This raises questions concerning how young people's stress and psychological changes due to the COVID‐19 pandemic as well as social support during this time have affected their overall mental health. The aim of this study was to assess the association between sources of parental‐ and school‐level social support and youth perceptions of COVID‐19‐related emotional impact on mental health among early adolescent girls and boys in Appalachia. Methods Using linear regression, we analyzed the first and third wave of survey data from the larger parent study (Young Mountaineer Health Study) cohort, collected in 20 middle schools throughout West Virginia in the fall of 2020 and fall of 2021 (N = 1349, mean age: 11.5, response rate: 80.7%). Results Approximately half of participants reported knowing someone that had been sick with COVID‐19. Those experiencing higher levels of perceived COVID‐19‐related emotional impact reported greater levels of depression, anxiety, and anger. Both parental and school‐level social support were associated with better mental health outcomes. Conclusions Early adolescent perceptions of COVID‐19‐related emotional impact were associated with depression, anxiety, and anger and moderated by social support at home and in school among 11‐12‐year‐old youth in Appalachia.

Background Alcohol use impairs psychosocial and neurocognitive development and increases the vulnerability of youth to academic failure, substance use disorders, and other mental health problems. The early onset of alcohol use in adolescents is of particular concern, forecasting substance abuse in later adolescence and adulthood. To date, evidence suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to the early onset of alcohol use. Objective The objective of the Young Mountaineer Health Study is to investigate the influence of contextual and health behavior variables on the early onset of alcohol use among middle school–aged youth in resource-poor Appalachian rural communities. Methods This is a program of prospective cohort studies of approximately 2200 middle school youth from a range of 20 rural, small town, and small city (population <30,000) public schools in West Virginia. Students are participating in 6 waves of data collection (2 per year) over the course of middle school (sixth to eighth grades; fall and spring) from 2020 to 2023. On the basis of an organizational arrangement, which includes a team of local data collection leaders, supervising contact agents in schools, and an honest broker system to deidentify data linked via school IDs, we are able to collect novel forms of data (self-reported data, teacher-reported data, census-linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school. Results In the spring of 2021, 3 waves of student survey data, 2 waves of data from teachers, and a selection of archival school records were collected. Student survey wave 1 comprised 1349 (response rate 80.7%) participants, wave 2 comprised 1649 (response rate 87%) participants, and wave 3 comprised 1909 (response rate 83.1%) participants. The COVID-19 pandemic has had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system have proven vitally important in mitigating the potentially far greater negative impact of the pandemic on our data collection processes. Conclusions The Young Mountaineer Health Study will use a large data set to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Furthermore, the program will test hypotheses regarding contextual factors (eg, parenting practices and neighborhood collective efficacy) that protect youth from community disadvantage and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. Data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic in 2020 and 2021. International Registered Report Identifier (IRRID) DERR1-10.2196/40451

BACKGROUND Alcohol use impairs psychosocial and neurocognitive development and increases youth vulnerability to academic failure, substance use disorder and other mental health problems. Early adolescent alcohol use onset is of particular concern, forecasting substance abuse in later adolescence and adulthood. Evidence to date suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to early onset of alcohol use. OBJECTIVE The objective of the Young Mountaineer Health Study (YMHS) is to investigate the influence of contextual and health behavior variables on early onset of alcohol use among middle school-aged youth in resource-poor Appalachian rural communities. METHODS This is a program of prospective cohort studies of ~2,200 middle school youth from a range of twenty rural, small town, and small city (< 30k) public schools in West Virginia. Students participate in 6 waves of data collection (2 per year), over the course of middle school (6th- 8th grades, fall and spring). Based on an organizational arrangement which includes a team of local data collection leaders, supervising contact agents in schools, and an “honest broker” system to de-identify data linked via school IDs, we have been able to collect novel forms of data (self-report, teacher-report, census linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school. RESULTS To date, three waves of student survey data, two waves of teacher data, and a selection of archival school records have been collected. Student survey Wave 1: N = 1,349 (response rate = 80.7%), Wave 2: N = 1,649 (response rate = 87.0%), and Wave 3: N = 1,909 (response rate = 83.1%). The COVID-19 pandemic had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system has proven vitally important in mitigating a potentially far greater negative impact of the pandemic on our data collection processes. CONCLUSIONS The YMHS will employ a large dataset to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Further, the program will test hypotheses regarding contextual factors (e.g., parenting practices, neighborhood collective efficacy) that protect youth from community disadvantage, and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. So far, data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic. Data quality checking, preliminary analyses, and manuscript preparations are currently under way. CLINICALTRIAL N/A