The COVID-19 (C-19) pandemic has drastically changed life in the US, starting in March 2020 with stay-at-home orders for much of the population and mass closures of businesses, including on-premise alcohol outlets. To date, off-premise alcohol sales have been maintained in most states, and delivery and to-go options temporarily expanded. Alcohol sales in March 2020 were substantially higher than expected, indicating consumers increased home alcohol stocks, and potentially consumption. By June 2020, bars and restaurants have re-opened in many states with varying distancing restrictions, prompting concerns of virus spread through congregation. The focus of this Center Project was originally on analyses of selected major causes of illness, injury, disability and death where significant racial/ethnic and socioeconomic disparities are evident in the US and which are substantially alcohol-related. The proposed revision Aims will focus on changes in drinking patterns, substance use and mental health measures from before to during the COVID-19 restriction period, associations between drinking patterns and COVID-19 risk behaviors and behavioral health care need, access and utilization with attention to racial/ethnic and socioeconomic disparities. The 2019-2020 National Alcohol Survey (N14) completed fielding on April 20, 2020 with 80% of cases collected before March 2020 and included web survey respondents recruited through address-based sampling (ABS; n=5,176) and telephone respondents recruited through random digit dialing (RDD; n=1,323). We propose to re-survey 1,500 N14 ABS and RDD respondents with a follow-up instrument, N14C, focused on drinking, substance use, and COVID-19 risk behaviors and attitudes in the COVID-19 period. This longitudinal design allows us to build on the rich lifecourse data and pre-COVID-19 measures collected in N14, integrating new questions on recent substance use behaviors and problems, physical and mental health, and COVID-19-related risk behaviors, attitudes and impacts, including job loss and financial insecurity. N14C questions on alcohol and drug use and related problems will reference appropriate C-19 period timeframes, including during stay-at-home orders (closed period) and during phased reopening (open period). Changes in alcohol and drug use, co-use and problems will be assessed through comparisons with N14 responses. N14C questions will include drinking motives and alcohol purchasing, as well as COVID-19 risk behaviors such as mask wearing, hand washing and congregating in groups of non-household members. Updated geocoding information of area characteristics and policies, such as bar closures and expanded delivery, will be utilized, allowing policy analyses utilizing within-person, pre-post comparisons to assess impacts on alcohol use and problems. Measures of an individual's pre-existing health conditions, including diabetes, hypertension and heart disease, will facilitate analyses of factors expected to raise the risk of COVID-19 impacts and measures of depression and anxiety symptoms and discrimination will be utilized for important and timely analyses focused on mental health, stress, and discrimination experiences related to COVID-19 impacts.

PUBLIC HEALTH RELEVANCE Proposed analyses will provide urgently needed information changes in drinking patterns, substance use, co- use and mental health during the COVID-19 pandemic, predictors of these change and disparities in these changes and risk factors. Analyses will also evaluate predictors of COVID-19 risk and risk reduction behaviors such as mask wearing, hand washing and congregating in groups of non-household members with a focus on alcohol and other substance use. Further, study results will identify groups with increased needs for behavioral health care, including for alcohol use disorders, and factors associated with access, delay and receipt of such care including relevant policy and insurance measures.