The COVID-19 pandemic impacted the lives and well-being of people across the world. In the United States, different states adopted different measures to limit the spread of COVID-19, but the impact of a slowed economy, increased social isolation, and the loss of typically-available support services disproportionally affected racial and ethnic minorities, as well as those in disadvantaged socioeconomic groups.

Tobacco, marijuana, alcohol, opioid, and illicit drug users are vulnerable to COVID-19 because of the effects of those substances on the respiratory and immune systems. There are indications that substance use increased because of the pandemic, but data from rigorous prospective studies is limited.

The longitudinal Early Steps Multisite Study of diverse lower income families, recruited from three geographic areas across the country (Pennsylvania, Virginia, and Oregon), presented a unique research opportunity to examine the effects of the pandemic on mental health and substance use.