Knowledge, beliefs, mental health, substance use, and behaviors related to the COVID-19 pandemic among US adults: a national online survey

Ralph J. DiClemente, Ariadna Capasso, Shahmir H. Ali, Abbey M. Jones, Joshua Foreman, Yesim Tozan

Research output: Contribution to journalArticlepeer-review


AIM: Given the need for data to inform public health messaging to mitigate the COVID-19 pandemic, this national survey sought to assess the state of COVID-19-related knowledge, beliefs, mental health, substance use changes, and behaviors among a sample of U.S. adults.

SUBJECT AND METHODS: In the period March 20-30, 2020, we collected data on COVID-19-related knowledge, awareness and adoption of preventive practices, depression and anxiety (Patient Health Questionnaire-4), stress (Impact of Event Scale-6), pessimism, and tobacco and alcohol use. Differences between age groups (18-39 years, 40-59 years and ≥ 60 years) were tested using Pearson's chi-squared tests or ANOVAs; associations between drinking and smoking and depression, anxiety, and stress were tested using adjusted logistic regression models.

RESULTS: Approximately half of the sample ( N Total  = 6391) were 50-69 years old and 58% were female. COVID-19 knowledge (mean = 12.0; SD = 1.2) and protective practice awareness (mean = 9.1; SD = 0.8) were high. Among respondents, 44% had a score consistent with depression and anxiety (PHQ-4 score ≥ 6), and 52% reported high stress scores (≥ median of 1.33). COVID-19-related anxiety and depression were associated with increased drinking (AOR = 1.79; 95% CI = 1.49, 2.15) and smoking (AOR = 2.17; 95% CI = 1.64, 2.88). High stress scores were also associated with increased drinking (AOR = 1.80; 95% CI = 1.49, 2.17, p  < 0.001) and smoking (AOR = 1.75; 95% CI = 1.31, 2.33).

CONCLUSIONS: In spite of high knowledge levels, important gaps were identified. High prevalence of poor mental health outcomes and associated increases in drinking and smoking warrant ongoing risk communications tailoring to effectively disseminate information and expanding psychosocial services, particularly via telehealth, to mitigate the negative mental health impact of COVID-19.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10389-021-01564-4.

Original languageEnglish (US)
Pages (from-to)2069-2079
Number of pages11
JournalZeitschrift fur Gesundheitswissenschaften
Issue number8
StatePublished - Aug 2022


  • Alcohol use
  • COVID-19
  • Novel coronavirus
  • Risk communications
  • Smoking
  • United States

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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