Covid-19 Stress, Smoking and Heavy Drinking Behaviors in University Students in Singapore

Aims: This study investigates multi-dimensional Covid-19 related stressors and the extent to which these stressors are related to young adult’s smoking and heavy alcohol use among university students in Singapore during the Covid-19 pandemic. Design/Setting/Participants: A total of 2,339 undergraduate students (862 male, 1309 female) in Singapore participated in an online survey. Measures: The Covid-19 Stressors Questionnaire (C19SQ) is a developmentally influenced, Covid-19 related stress scale, used alongside mental health measures (GAD & PHQ) and substance use. Structural equation modeling was used to model the association between four types of Covid-19 related stressors and past month smoking and heavy drinking while accounting for student mental health, family socio-economic status, gender and race/ethnicity. Findings: Stress related to Covid-19 social restrictions was associated with increased likelihood of heavy drinking and smoking behavior, whereas stress related to health concerns was associated with decreased likelihood of smoking and heavy drinking. Covid-19 related stressors related to resource constraints and future uncertainties were not associated with young adult substance use. Conclusions: Our finding that Covid-19 stressors related to Social Restrictions and Health Concerns were particularly salient for university student’s substance use, but in opposite directions, extend prior work by demonstrating that young adult substance use behavior is differentially impacted by specific types of Covid-19 stress and point to areas where public health and clinical intervention efforts can focus in the wake of the Covid-19 pandemic for this vulnerable population.