From 9/11 Through COVID-19: Mass Disaster and Alcohol

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The role of mass disaster as a risk factor for increased alcohol use is not well understood and has emerged as a top public health priority in the context of the COVID-19 pandemic. Early reports suggest that the COVID-19 pandemic has substantially affected alcohol use. Yet, to effectively understand the degree to which exposure to the pandemic, and specific dimensions of that experience, affect an individual’s alcohol use requires data collected pre-disaster, in real time (as opposed to relying on retrospective reporting). This includes: their past alcohol use and related risk factors, prior disaster exposure at varying ages, differing degrees of exposure severity to the same mass disaster, prior mental health and contextual factors. Such a study also requires prospective, repeated assessments, during and following COVD-19, of their alcohol use and related risk factors. By meeting these criteria, the current study offers a unique opportunity to utilize COVD-19 as a natural experiment to explore the impact of exposure to mass disaster on alcohol use over time. New York City (NYC) was the U.S. epicenter of the COVID-19 Pandemic in March, 2020. The first confirmed case in NYC was identified on March 1, 2020, and the first COVID-19 death on March 14, 2020. On March 20th, a shelter in place order was mandated. Simultaneously, liquor stores and home delivery of alcohol were deemed an “essential service", along with grocery stores and hospitals. The proposed study will draw on participants in our Stress & COVID Study (N=866), who reside in the NYC Metropolitan Area, and have already been assessed six times since 2007 (3 pre-COVID and 3 during) for their exposure to mass disaster (9/11 and COVID-19), alcohol use, mental health and family/contextual factors. Having access to those six prior waves of data, this study will add three new prospective waves of data collection (2022-2027) in a subset of that cohort and will investigate post COVID-19 alcohol use behaviors in detail. The overarching goal of this study is to investigate how alcohol use is impacted long-term by the COVID-19 pandemic, taking extensive data on pre-pandemic alcohol use, mental health and prior trauma exposure into account. Using the wealth of information available on each individual prior to COVID-19, in combination with this prospective examination (2022-2027) of alcohol use, mental health and other substance use, as well as unique features of their pandemic experience, we will determine the specific impact of mass disaster on alcohol use. Our findings will have substantial clinical public health implications for mitigating long-term harm from the current pandemic, while deepening our understanding of how mass disaster affects alcohol use behaviors. This study’s results are urgently needed to provide evidence on whether a population-level increase in alcohol use and alcohol use problems was a temporary increase or whether it is an unintended long-term residual outcome of the combination of COVID-19 and deeming alcohol to be essential during shelter-in-place order. Our estimates will inform policymakers and provide new insight into the impact of mass disasters on alcohol use over time, which will be critical in developing sound public health policy.