Changes in Alcohol Use in Adults and Consequences During the COVID-19 Pandemic in the U.S.

As stay-at-home orders began in some U.S. states as a strategy to mitigate the transmission of coronavirus disease 2019 (COVID-19), Nielsen reported a 54% increase in national alcohol sales for the week ended March 21, 2020, compared to 1 year earlier; Online sales increased by 262% compared to 2019 (1).

Three weeks later, the World Health Organization warned that alcohol use during the pandemic could exacerbate health concerns and risky behaviors (2).

This study examines changes in alcohol use at the individual level and the consequences associated with adult alcohol use in the U.S., as well as demographic disparities, from before to during the COVID-19 pandemic.

Methods

In this research study, data was collected using the RAND Corporation American Life Panel (ALP), a nationally representative panel with a probabilistic sample of 6,000 participants aged 18 and older who speak English or Spanish; The data are weighted to correspond to a range of national demographic characteristics (3).

 Panel members provide informed consent annually, online. All procedures have been approved by the RAND Corporation's Human Affairs Protection Committee.

A sample of 2,615 ALP members aged 30 to 80 years was invited to participate in the baseline survey (wave 1), which closed after 6 weeks (April 29 to June 9, 2019) with 1771 completions.

Wave 2 data was collected from May 28 to June 16, 2020, several months after the widespread implementation of social distancing associated with COVID-19.

This study followed the American Association for Public Opinion Research (AAPOR) guideline for survey studies.

The survey completion rate for wave 2 was 58.9% of all wave 1 invitations.

The ALP is made up of individuals recruited from various sources over more than 10 years and an accurate standardized response rate is difficult to calculate.

Based on survey completion rates of 56.6%, a previous estimate of the average cumulative response rate of ALP is 9% (4).

Comparisons before and during the COVID-19 pandemic were made on the number of days of any alcohol use and binge drinking (defined as 5 or more drinks for men and 4 or more drinks for women in a few hours) and average number of drinks consumed in the last 30 days.

The brief 15-item problem inventory (5) assessed adverse consequences associated with alcohol use in the past 3 months (e.g., "I took foolish risks when I drank").

Comparisons were made in general and between self-reported sex, age, and race/ethnicity. Significant changes were assessed based on whether the 95% CI around the change from wave 1 to wave 2 included 0. Analyses include weights.

Findings

The current analytical sample includes 1540 adults (825 of them were in the 30-59 age group; and 883 were women) from the baseline survey who, approximately 1 year later, completed the wave 2 survey.

The frequency of alcohol consumption increased (1) overall, 0.74 days (95% CI, 0.33-1.15 days), representing a 14% increase from baseline of 5.48 days in 2019; (2) for women, 0.78 days (95% CI, 0.41-1.15 days), representing a 17% increase from the 2019 baseline of 4.58 days; (3) for adults aged 30 to 59 years, 0.93 days (95% CI, 0.36-1.51 days), an increase of 19%; and (4) for non-Hispanic white individuals, 0.66 days (95% CI, 0.14 to 1.17 days), a 10% increase from the 2019 baseline of 6.46 days (Table 2).

On average, alcohol was consumed 1 more day per month by 3 out of 4 adults. For women, there was also a significant increase of 0.18 days of heavy drinking (95% CI, 0.04-0.32 days), from a 2019 baseline of 0.44 days, which represents a 41% increase from baseline.

This equates to an increase from 1 day to 1 in 5 women. For women, there was a mean increase in the Short Inventory of Problems scale of 0.09 (95% CI, 0.01-0.17 items), from the 2019 mean baseline of 0.23, representing a 39% increase, which is indicative of increased alcohol-related problems regardless of level of consumption for nearly 1 in 10 women.

Discussion

These data provide evidence of changes in alcohol use and associated consequences during the COVID-19 pandemic.

In addition to a number of negative physical health associations, excessive alcohol use can lead to worsening existing mental health issues, such as anxiety or depression (6), which may be on the rise during COVID-19.

Population-level changes for women, youth, and non-Hispanic white individuals highlight that health systems may need to educate consumers through print or online media about increased alcohol use during the pandemic and identify factors associated with susceptibility and resilience to the impacts of COVID-19.

Limitations of the study include that the measures are self-reported, which may be subject to social desirability bias.

In addition, not all baseline responders completed wave 2, although non-responders did not differ significantly from those who completed on any of the outcome measures at baseline.

However, these results suggest that it may be necessary to examine whether increases in alcohol use persist while the pandemic continues, and whether physical and psychological well-being are subsequently affected.

References:

1. The Nielsen Company. Rebalancing the 'COVID-19 Effect' on alcohol sales. Published May 7, 2020. Accessed August 27, 2020. https://www.nielsen.com/us/en/insights/article/2020/rebalancing-the-covid-19-effect-on-alcohol-sales/

2. World Health Organization. Alcohol does not protect against COVID-19; access should be restricted during lockdown. Published April 14, 2020. Accessed August 27, 2020. https://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/news/news/2020/04/alcohol-does-not-protect-against-covid-19-access-should-be-restricted-during-lockdown

3. Pollard  M, Baird  M. The RAND American Life Panel: technical description. 2017. RAND Corporation website. Accessed June 6, 2020. https://www.rand.org/pubs/research_reports/RR1651.html

4. Gutsche  T, Kapteyn  A, Meijer  E, Weerman  A.  The RAND Continuous 2012 Presidential Election Poll.   Public Opin Q. 2014;78:233-254. Doi:10.1093/poq/nfu009Google ScholarCrossref

5. Miller  WR, Tonigan  JS, Longabaugh  R.  The Drinker Inventory of Consequences (DrInC): An Instrument for Assessing Adverse Consequences of Alcohol Abuse. US Dept Health and Human Services, Public Health Service, National Institutes of Health; 1995. doi:10.1037/e563232012-001

6. Foulds  JA, Adamson  SJ, Boden  JM, Williman  JA, Mulder  RT.  Depression in patients with alcohol use disorders: systematic review and meta-analysis of outcomes for independent and substance-induced disorders.   J Affect Disord. 2015;185:47-59. doi:10.1016/j.jad.2015.06.024 PubMedGoogle ScholarCrossref

Article authored by Michael S. Pollard, PhD; Joan S. Tucker, PhD; Harold D. Green Jr, PhD, published in JAMA Netw Open. 2020; 3(9):e2022942. doi:10.1001/jamanetworkopen.2020.22942

Source: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770975