Introduction
The recent Coronavirus Disease 2019 (COVID-19) pandemic has affected the mental
health of Canadians adversely
1,2
and as a result, both mental
health problems and substance use among adolescents have increased.
2,3
A recent study reported that
22.6% of Canadian adults increased their alcohol consumption, including 4.8% heavy
drinking, compared to their pre-pandemic alcohol consumption levels.
4
Moreover, the frequency of both alcohol and cannabis use among adolescents
has increased as well.
3
In the United States, retail sales of alcohol and tobacco increased by 34%
and 13% respectively during the early pandemic period compared to the pre-pandemic
time.
5
In addition, about half of adult cannabis users in Canada indicated that they
have increased their cannabis consumption during the pandemic.
6
There is limited evidence of changes in substance use among adolescents
2,3
and adults
4,6
in response to the COVID-19
pandemic in Canada. Exploring patterns of changes in substance use among youth and
young adults is crucial and may have implications for future burden of disease.
Materials and Methods
Study Population
Youth and young adults aged 16–25 living in Canada were eligible for the survey.
For this cohort, we recruited through Instagram and Facebook advertisements from
August 2020 to March 2021 using a variety of recruitment messages. Almost half
of each province's sample was recruited in October and November 2020. Overall,
7,745 participants completed the survey. Post-stratification weights were
developed from Census data, resulting in the exclusion of 94 participants with
incomplete demographic data and those who resided in Yukon, Northwest
Territories and Nunavut (total n = 7,651). The analytic sample
was restricted to 6,721 (87%) participants who reported using at least one of
cigarettes, e-cigarettes, alcohol or cannabis during past year.
Measures
Each participant was asked “How has the COVID-19 Pandemic influenced your use of
each of the following …? Increased, Decreased, Unchanged, Did not Use” for
cigarettes, e-cigarettes, cannabis, and alcohol. Participants were also asked
about their current use of cigarettes, e-cigarettes, cannabis, and alcohol.
Demographics (age in years, sex at birth, highest level of education completed,
marital status, parental status, and race) were self-reported.
Analysis
Percentages of participants who reported increases in their use of substances
were calculated among participants who reported use of at least one substance.
Bivariate associations between demographic characteristics of participants who
reported increases in use compared to those who reported decreases/no change
/did not use that substance were tested. Logistic regression was used to
identify independent demographic predictors of increases in use in any
substance. All analysis were conducted in Stata 14 using survey procedures and
poststratification weights.
Results
The unweighted sample was 21% male, 69% under 20 years old, and 74% White
(n = 7,651). The socio-demographic characteristics of the study
population are presented in the Supplementary material 1. Of the 6,721 participants
who reported
currently using substances in their lifetime, 59% reported increasing their use of
at least one substance, 55% reported increasing use of two or more substances.
Comparatively, only 16% of lifetime users reported reducing their use of any
substance.
Current daily users of substances were most likely to report increased use. Daily
cigarette smokers (81%), e-cigarettes vapers (75%), cannabis users (73%) and alcohol
users (72%) reported an increase in use. Reported net increases in use overall
(percent of users increasing use subtracting percent of users decreasing) during the
COVID-19 pandemic were observed for cigarettes (+16%), e-cigarettes (+37%), alcohol
(+19%) and cannabis (+47%).
Females, those with a university degree, and people married or living with a partner
were independent predictors of increased substance use (Table 1). Youth living in
British Columbia
and Prince Edward Island were more likely to report increased use compared to youth
in Ontario. Indigenous youth were most likely to report increased use, as well as
youth from South Asian and Latin American backgrounds, compared to nonvisible
minority youth. Youth from Chinese and Southeast Asian backgrounds were less likely
to report increased substance use.
Table 1.
Predictors of Increase in Substance Use Due to the Coronavirus Disease 2019
(COVID-19) Pandemic Among Youth and Young Adults Using at Least One
Substance (n = 6,721).
Characteristic
OR (95% CI)
Age
1.02
(0.93,1.12)
Sex (ref: male)
0.48***
(0.36,0.64)
Education (ref: less than high school)
0.60***
(0.49,0.73)
Race (ref: White)
Black
0.75
(0.35,1.61)
Chinese
0.17***
(0.07,0.38)
Filipino
0.45*
(0.22,0.92)
Indigenous
3.16**
(1.39,7.21)
Japanese
0.34*
(0.12,0.99)
Korean
1.55
(0.75,3.21)
Latin-Central-South American
2.90**
(1.49,5.64)
Southeast Asian
0.06***
(0.02,0.17)
South Asian
3.10**
(1.56,6.18)
West Asian
0.88
(0.45,1.73)
Another Background
1.5
(0.72,3.15)
Married (ref: Single)
5.00***
(3.54,7.06)
Parent/legal guardian of children (ref. no
children)
1.37
(0.57,3.31)
Province (ref. Ontario)
Alberta
1.01
(0.54,1.90)
British Columbia
3.34**
(1.34,8.34)
Manitoba
0.71
(0.38,1.31)
New Brunswick
0.03***
(0.01,0.05)
Newfoundland and labrador
1.82
(0.98,3.39)
Nova Scotia
1.06
(0.50,2.24)
Prince Edward Island
2.04*
(1.11,3.77)
Quebec
0.59
(0.30,1.17)
Askatchewan
0.63
(0.31,1.26)
Date of survey
1
(1.00,1.00)
Note: OR: exponentiated coefficients; CI: confidence
intervals.
*P < 0.05, **P < 0.01,
***P < 0.001.
Discussion
In this survey, most youth and young adults aged 16–25 years old in Canada who used
substances reported an increase in the use of one of more substances during the
COVID-19 pandemic. The fact that Ontario had a stricter lockdown measures than
British Columbia and Prince Edward Island during October and November 2020, when
half of the study participants were recruited, may contribute to the higher
likelihood of substance use among youth residing in the latter provinces. Use of any
substance long-term is associated with health risks, and the dramatic increase in
use may lead to tremendous health concerns without immediate action. This study did
not have representative sampling frame; however, post-stratification weights were
used to match the sample to the characteristics of the Canadian population.
Additionally, we did not evaluate the magnitude of the increases or decreases in
youth. Further research is needed to examine longitudinal changes in substance use
among youth and young adults over time.
Supplemental Material
sj-docx-1-cpa-10.1177_07067437211042132 - Supplemental material for
Perceived Impact of COVID on Smoking, Vaping, Alcohol and Cannabis Use Among
Youth and Youth Adults in Canada
Click here for additional data file.
Supplemental material, sj-docx-1-cpa-10.1177_07067437211042132 for Perceived
Impact of COVID on Smoking, Vaping, Alcohol and Cannabis Use Among Youth and
Youth Adults in Canada by Michael Chaiton, Jolene Dubray, Anasua Kundu and
Robert Schwartz in The Canadian Journal of Psychiatry