Exploring factors related to alcohol and substance use during the COVID-19 pandemic: a post-hoc analysis from the Korea youth risk behavior web-based survey

Despite the significance of the COVID-19 pandemic’s effect on life, only a few previous studies have been conducted on youth substance use during the era of the COVID-19 pandemic. Thus, we aimed to determine the change in alcohol and substance use by the familial-, social, and individual-associated risk factors among Korean adolescents, comparing the pre-and during COVID-19 pandemic period. Data on 1,109,776 Korean adolescents aged 13 to 18 years from 2005 to 2021 were obtained in a nationwide, large-scale, and serial study. This study was conducted to compare the risk factors of alcohol and substance use for overall years and the transitional effect of the COVID-19 pandemic. Among one million adolescents during the pandemic (2019 versus 2021), lower school grades (ratio of odds ratio [ROR], 1.172; 95% CI, 1.075-1.279), male (ROR, 1.098; 95% CI, 1.008-1.197), lower educational levels of parents (ROR, 1.116; 95% CI, 1.002-1.215), and lower economic levels (ROR, 1.341; 95% CI, 1.026-1.754) were more pronounced and significant among alcohol users compared to the pre-pandemic period (2019 versus 2021). During the pandemic, higher school grades (ROR, 1.561; 95% CI, 1.166-2.090) and former smoking (ROR, 1.969; 95% CI, 1.290-3.003) were more pronounced and significant among substance users than in the pre-pandemic period. Over a million adolescents’ national data were used in this study to investigate changes in alcohol and drug use according to risk factors. Moreover, we compared how they were affected by the COVID-19 pandemic by comparing the change in risk factors in the pre-pandemic (2019) and pandemic periods (2021). The outcomes of this study suggest a complex interaction between a multitude of factors that influence adolescent alcohol and substance use.