How the pandemic impacted teens’ substance use and physical activity

For teens, the pandemic led to a number of changes, most notably more time at home and more time spent with the family. A study in JAMA Pediatrics looked at the impact of stay-at-homes during the pandemic on the substance use and physical activity habits of teens in Northern California.1

The researchers used a cohort study involving 9th and 10th grade students who attended 8 public high schools in Northern California. The prevalence of substance use, i.e. after 30 days of use of cigarettes, other tobacco, cannabis and alcohol, as well as physical activity (active 5 days/week active) were compared at baseline, from March 2019 to February 2020, and thereafter on, which was 6 months later.

There were 1006 adolescents who participated at baseline and also completed the 6-month follow-up. Researchers found e-cigarette use decreased from baseline to 6 months of follow-up completed before home orders (17.3% [89 of 515] up to 11.3% [58 of 515]; McNemar χ2 = 13.54; exact P < .001) and 6 months follow-up completed after home orders (19.9% [96 of 482] up to 10.8% [52 of 482]; McNemar χ2 = 26.16; exact P < .001), but the difference was not statistically different between groups responding before versus after home ordering (difference-in-difference adjusted odds ratio, 0.84; 95% CI, 0.47-1.52; P = . 58). However, they noticed differences when it came to physical activity. For teens who completed follow-up before staying at home, levels of physical activity remained unchanged from baseline (53.7% [279 of 520] up to 52.9% [275 of 520]; McNemar χ2 = 0.09; exact P = .82), but a sharp decrease between baseline and follow-up was observed when follow-up occurred after home orders were entered (54.0% [261 of 483] up to 38.1% [184 of 483]; McNemar χ2 = 30.72; exact P < .001), indicating a pronounced difference (difference-in-difference adjusted odds ratio, 0.49; 95% CI, 0.35-0.69; P < .001). With other tobacco products, cannabis, and alcohol, the adolescents reported no significantly different use before or after home ordering.

The researchers concluded that there was a decrease in e-cigarette use in the cohort, but this was unrelated to the stay-at-home population. The use of other agents was persistent, indicating that clinicians still need to provide prevention and cessation support. The decline in physical activity should also be addressed by clinicians with recommendations for safe physical activity and by encouraging them to resume physical activity.


1. Chaffee B, Cheng J, Couch E, Hoeft K, Halpern-Felsher B. Substance use and physical activity of adolescents before and during the COVID-19 pandemic. JAMA Pediatrician. 2021;175(7):715. doi:10.1001/jamapediatrics.2021.0541

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