Covid-19 stress, smoking and heavy drinking behaviors in university students in Singapore

Abstract

Aims: Undertaken in Singapore during the COVID-19 pandemic, this cross-sectional study investigates multi-dimensional COVID-19 related stressors and the extent to which these stressors are related to university students’ smoking and heavy alcohol use. Design/Setting/Participants: An analytical sample of 2,171 undergraduate students (862 male, 1309 female) in Singapore participated in an online survey. Measures: The COVID-19 Stressors Questionnaire (C19SQ) is a COVID-19 related stress scale that considers the developmental period of emerging adulthood and was administered alongside mental health measures (Generalized Anxiety Disorder 7-Item and Patient Health Questionnaires) and substance use items. Structural equation modeling was used to model the association between four types of COVID-19 related stressors: resource constraints, future uncertainty, health concerns, and social restrictions, and past-month smoking and heavy drinking while accounting for student mental health, parental education, gender and race/ethnicity. Results: COVID-19 Social Restriction stress was associated with an increased likelihood of heavy drinking and smoking behavior, whereas COVID-19 Health Concern stress was associated with decreased likelihood of smoking and heavy drinking. COVID-19 stress related to resource constraints and future uncertainties was not associated with young adult substance use. Conclusions: Our finding that stress related to the social restrictions of COVID-19 was associated with more substance use suggests that clinical intervention efforts should target the pandemic-related consequences of social isolation and loneliness in young adults. Our finding that stress related to concerns about the health of oneself or one’s family was protective against substance use highlight areas where public health prevention can focus in the wake of the COVID-19 pandemic for young adults.