Preventing Substance Use in the Context of Poverty: Risk and Protection from Early Childhood to Early Adulthood

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ABSTRACT The COVID-19 pandemic has impacted the lives and well-being of people across the world. In the United States, different states have adopted different measures to limit the spread of COVID-19, but the impact of a slowed economy, increased social isolation, and the loss of typically-available support services has disproportionally affected racial and ethnic minorities, as well as those in disadvantaged socioeconomic groups. Tobacco, marijuana, alcohol, opioid, and illicit drug users are likely vulnerable to COVID-19 because of the effects of those substances on the respiratory and immune systems, and people who are in treatment or recovery from substance misuse may be at risk for relapse because of increased mental health issues and additional barriers to obtaining treatment and support. There are indications that substance use has increased because of the pandemic, but rigorous prospective studies have yet to be conducted. The Early Steps Multisite Study of diverse lower income families, recruited from three geographic areas across the country (Pennsylvania, Virginia, and Oregon), presents unique research opportunities during this pandemic. There is a wealth of data available on the Early Steps participants, including the history of substance use, social and health service utilization, and mental health of both primary caregiving adults (current Mage = 43.8; SD = 7.4) and youth (current Mage = 18.6; SD = 0.5). As the study design also included a randomized control trial of the Family Check-Up intervention, we can also test the potential protective effects of the intervention on COVID-19 related outcomes. We plan to administer two COVID-19 related surveys to Early Steps participants, at both 6 months post-COVID-19 (September of 2020) and at 12 months post-COVID-19 (March of 2021). Our first aim is to examine the effects of the COVID-19 pandemic on substance use, mental health, and service utilization (i.e., addiction treatment, access to health care) in both caregiving adults and their young adult children. We plan to test the extent to which a history of mental health problems among parents and young adults moderates the effects of COVID-19 on their substance use, and to test the extent to which service utilization at the 6-month assessment mediates the effects of COVID-19 on substance use at the 12-month assessment in adult caregivers and young adult children. We will examine differences by geographic location, race/ethnicity, biological sex, and income. We hypothesize that those with more service utilization at 6 months post-COVID- 19 will have less substance use at 12 months post-COVID-19. Our second aim is to examine the potential buffering effects of the Family Check-Up on substance use and mental health outcomes 6 and 12 months following the onset of COVID-19, with those families randomly assigned to the intervention expected to show lower levels of substance use, mental health problems, and greater service utilization. We also will examine moderators of potential FCU protective effects, including child, family, and community risk factors. These data can begin to illuminate the wide-ranging impact of COVID-19 on vulnerable populations.