Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey

Abstract

Background Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. Objective The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered 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 web-based survey was administered to a convenience sample recruited through Amazon’s Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 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, electronic cigarettes, cannabis, stimulants, and nonmedical 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 likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. Results The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8%) men, 543 (50.1%) women, 12 (1.1%) other gender identity, 742 (68.5%) White individuals, 267 (24.6%) Black individuals, and 276 (25.5%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=–0.24, 95% CI –0.44 to –0.05) and nonusers (B=–0.57, 95% CI –0.76 to –0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=–0.16, 95% CI –0.30 to –0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. Conclusions In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors.

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region

“…This suggests that a binational policy response to COVID-19 is warranted beyond the closure of the U.S.-Mexico border. We did not observe substance use behaviors, such as smoking, vaping, or use of specific drugs such as opiates or stimulants to be associated with an elevated risk of SARS-CoV-2 infection, as others have hypothesized [9]. Instead, we observed that circumstances in the risk environment, notably sex work and incarceration, were independently associated with higher SARS-CoV-2 seroprevalence.…”

“…In a telephone survey of active and former drug injectors in Baltimore, Maryland, compared to former substance users, those who were actively using substances were less likely to report social distancing, which could increase their risk of acquiring SARS-CoV-2 [ 7 ]. In an online survey of adults residing in the Northeastern U.S., daily users of opioids and alcohol were less likely to adhere to COVID-19 related stay-at-home orders, and stimulant users were more likely to report having tested positive for SARS-CoV-2 [ 9 ]. There are also reports that the COVID-19 pandemic has interrupted global drug supplies as well as harm reduction and addiction treatment services, which could alter drug use patterns [ 10 , 11 ].…”

Infection preventive behaviors and its association with perceived threat and perceived social factors during the COVID-19 pandemic in South Korea: 2020 community health survey

“…· Did you wear a mask if it is difficult to keep a distance of more than two meters between people outdoors? Li et al [ 31 ] Graupensperger et al [ 36 ] Monnig et al [ 37 ] Social distancing · Did you maintain a two-meter distance between people for your health? · Did you refrain from going outside/meetings/events?…”

“…COVID-19 preventive behaviors were based on the guidelines of World Health Organization, Centers for Disease Control and Prevention, and prior literature [ 31 , 36 , 37 ]. Three items are assessed with eight questions: hand washing, wearing a mask, and social distancing.…”

Medical Mistrust, Perceived Discrimination, and Race: a Longitudinal Analysis of Predictors of COVID-19 Vaccine Hesitancy in US Adults

“…This study was a cross-sectional online survey administered to a sample recruited on Amazon’s Mechanical Turk (MTurk) platform by the Center for Addiction & Disease Risk Exacerbation (CADRE) at Brown University School of Public Health. Recruitment details for the baseline sample, collected from June 18 through July 19, 2020, have been described previously [ 22 ]. A follow-up survey was conducted in May 2021 for participants who completed the baseline survey with additional questions regarding COVID-19 vaccine hesitancy and beliefs regarding healthcare systems and practices.…”