COVID-19 pandemic effects on emotional health and substance use among urban American Indian and Alaska Native people

Cole Haskins, Carolyn Noonan, Richard MacLehose, Dedra Buchwald, Spero M. Manson

Research output: Contribution to journalArticlepeer-review


Objective: The COVID-19 pandemic has disproportionately affected American Indian and Alaska Native (AI/AN) people, who experience a 3.2 times higher age-adjusted rate of hospitalization and nearly double the attributed deaths compared to non-Hispanic Whites. We examined pandemic effects on emotional health and substance use in urban AI/AN people. Methods: From January–May 2021 we collected cross-sectional data from 642 patients seen at five health organizations serving primarily AI/AN people in urban settings. The outcomes are self-reported, cross-sectional changes in emotional health and substance use since pandemic onset. Exposures of interest include infection history, COVID-19 risk perception, pandemic-related life disruption, and feared effects on AI/AN culture. Poisson regression was used to model adjusted multivariate associations. Results: Since pandemic onset, 46% of participants reported worsened emotional health; 20% reported increased substance use. Very or extremely disruptive pandemic experiences and increasing reported feared pandemic effects on culture were associated with worse pandemic emotional health [adjusted Prevalence Ratio 1.84; 95% CI 1.44, 2.35 and 1.11; 95% CI 1.03, 1.19], respectively. COVID-19 infection and risk perception were not associated with emotional health after adjustment for other factors. The primary exposures were not associated with change in substance use. Conclusions: The COVID-19 pandemic has impacted the emotional health of urban AI/AN people. The finding that poor emotional health is associated with pandemic-related threats to AI/AN culture may signal a protective role for community and cultural resources. This warrants further study as exploratory analysis did not find hypothesized effect modification according to strength of affiliation with AI/AN culture.

Original languageEnglish (US)
Article number111424
JournalJournal of Psychosomatic Research
StatePublished - Sep 2023

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.


  • American Indian and Alaska Native people
  • COVID-19
  • Culture
  • Emotional health
  • Pandemic
  • Substance use

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural


Dive into the research topics of 'COVID-19 pandemic effects on emotional health and substance use among urban American Indian and Alaska Native people'. Together they form a unique fingerprint.

Cite this