How the pandemic impacted teens’ substance use and physical activity


With increased time with the family and less opportunity to engage in sports or other physical activities, the pandemic seemed likely to alter substance use as well as physical activity. A study provides insight.

For teenagers, the pandemic led to a number of changes, particularly increased time in the home and more time spent with family. An investigation in JAMA Pediatrics looked at how the stay-at-home orders during the pandemic impacted the substance use and physical activity habits of teenagers in Northern California.1

The investigators used a cohort study that involved 9th and 10th grade students who attended 8 public high schools in Northern California. Prevalence of substance use, which was past 30-day use of cigarettes, other tobacco, cannabis, and alcohol as well as physical activity (active ≥5 days/week) were compared at baseline, from March 2019 to February 2020, and follow-up, which was 6 months later.

There were 1006 adolescents who were enrolled at the baseline and also completed the 6-month follow-up. Investigators found that e-cigarette use declined from baseline to 6-month follow-up completed before stay-at-home orders (17.3% [89 of 515] to 11.3% [58 of 515]; McNemar χ2 = 13.54; exact P < .001) and 6-month follow-up completed after stay-at-home orders (19.9% [96 of 482] to 10.8% [52 of 482]; McNemar χ2 = 26.16; exact P < .001), but the difference was not statistically different between groups who responded before versus after stay-at-home orders (difference-in-difference adjusted odds ratio, 0.84; 95% CI, 0.47-1.52; P = .58). However, they noted differences when it came to physical activity. For teenagers who completed the follow-up before stay-at-home orders, the measure of physical activity remained unchanged from baseline (53.7% [279 of 520] to 52.9% [275 of 520]; McNemar χ2 = 0.09; exact P = .82), but a sharp decrease was noted between baseline and follow-up when the follow-up occurred after stay-at-home orders were put into place (54.0% [261 of 483] to 38.1% [184 of 483]; McNemar χ2 = 30.72; exact P < .001), indicating a pronounce 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 did not report meaningfully different use before or after stay-at-home orders.

The investigators concluded that there was a reduction in e-cigarette use in the cohort, but this not connected to the stay-at-home orders. Other substance use was persistent, which indicates clinicians should still be providing prevention and cessation support. The decline in physical activity should also be addressed by clinicians with recommendations for safe physical activities as well as by providing encouragement to resume physical activities.


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

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