One in six 14-17 year-olds (16.3%) have tested positive for COVID-19. Understanding the factors that confer
increased risk is imperative given adolescents’ vulnerable developmental stage. One particularly salient risk
factor may be alcohol use, both because intense alcohol use negatively impacts immune system functioning
and sleep patterns, and also because consuming alcohol with others could lead to lowered inhibitions that
result in reduced social distancing. COVID-19 also may be impacting the way in which adolescents consume
alcohol, potentially with life-long consequences. Understanding how pandemic experiences have affected the
frequency and intensity of alcohol use is necessary for ensuring sufficient treatment supports for youth. It also
is crucial to know how alcohol may affect the COVID-19 disease course, including the severity and long-term
impact on somatic and mental health.
The pandemic also has reified long-standing health inequities. Indeed, data overwhelming suggest that
Black/African American and Hispanic people are significantly more likely to acquire COVID-19, and to have a
worse disease course. The same is true for people who identify as a sexual and gender minority (SGM).
Before the pandemic, high school-aged SGM youth reported higher rates of alcohol use than non-SGM youth,
whereas rates were similar for Hispanic and White youth and significantly lower for Black/African American
youth. Ensuring that we understand how pandemic experiences and alcohol together may be conferring risk
similarly and differently for these minority adolescent populations is fundamental to addressing disparities.
In response to RFA-AA-21-002, we propose to recruit and survey 2,500 14-18 year-olds, 500 of whom will
have tested positive for COVID-19 in the past 3 months and 2,000 of whom will have never tested positive for
COVID-19. Using procedures successfully implemented by the research team previously, adolescents will be
recruited on social media and surveyed online. This will afford a national scope while empowering youth to
engage in this sensitive survey topic where and when it is safe for them. Youth who have tested positive for
COVID-19 at baseline will be asked to retrospectively report their disease severity, progression, and outcomes,
as well as their current COVID-19-related symptoms. Both youth who have been positive and those who are
negative for COVID-19 will provide information about their past and current alcohol use, as well as past and
current COVID-protective and -risk behaviors. All youth then will be prospectively followed for 24 months. They
will complete comprehensive online surveys at 6-, 12-, 18- and 24-months, and brief, monthly surveys that
query the key exposures and outcomes in the in-between months. Our main exposures will be 1) alcohol use in
the past 30 days, 2) binge drinking in the past 30 days, and 3) alcohol use disorder. Our main outcome
measures will be: 1) COVID-19 acquisition; 2) the extent of and 3) length to which symptoms are experienced.
Findings will have both short- and long-term impact on the public health response to this and future pandemics.
