FACTORS ASSOCIATED WITH INCREASE IN ALCOHOL CONSUMPTION DURING FIRST MONTHS OF COVID-19 PANDEMIC AMONG ONLINE SOCIAL MEDIA USERS IN RUSSIA

The significant proportion of the Russian population are active online social media users. Changes in alcohol consumption in this target group during the COVID-19 pandemic remain understudied. The aim of this survey was to investigate changes in alcohol consumption and factors associated with the increase in alcohol use among online social media users in Russia during the first months of the COVID-19 pandemic. An online survey was conducted among 1,518 users of online social networking services popular in Russia from June to September 2020. The survey revealed that 35.4% of men and 25.6% of women started drinking more frequently during the first months of the pandemic; 24.9% of men and 17.7% of women increased their usual consumption (volume) of alcohol on a typical drinking occasion, whereas 28.5% of men and 27.9% of women increased the frequency of heavy episodic drinking. Adjusted binary logistic regression analysis revealed a positive association between the increase in the frequency of alcohol consumption and the following factors: age from 18 to 29 years (OR: 1.710; 95% CI: 1.002–2.917), severe restrictions in everyday private life (OR: 3.127; 95% CI: 1.011–9.675) and severe negative professional or financial consequences due to the spread of SARS-CoV-2 (OR: 2.247; 95% CI: 1.131–4.465). The odds of an increase in the frequency of heavy episodic drinking were more than twice higher (OR: 2.329; 95% CI: 1.001–5.428) among those who had experienced severe negative consequences of the pandemic to their professional and financial situation. Higher typical frequency and usual consumption (volume) of alcohol on a typical drinking occasion and higher typical frequency of heavy episodic drinking before the pandemic were positively significantly associated with the increase in these parameters of alcohol consumption during the first months of the pandemic. In times of large- scale epidemics and public health crises, it is advisable to consider the possibility of implementing screening and brief interventions, including via online social media, to prevent problems associated with alcohol use.

ВЕСТНИК РГМУ | 6, 2021 | VESTNIKRGMU.RU Decisive action taken to counter COVID-19 in Russia and worldwide during the first months of the pandemic slowed the spread of SARS-CoV-2 infection, but it also had a significant impact on many other aspects of life. During the nationwide Russian lockdown, implemented in the second quarter of 2020, the official unemployment rate grew by 2.1%, reaching 6.4%, and the real disposable income of the population fell by 8.4% in comparison with the same period in 2019 [1]. Income reduction and complete loss of income were reported by 61% and 13.5% of the population, respectively; 9.8% of the Russian population lost their jobs [2]. According to recent studies investigating the impact of COVID-19 restrictions across countries, the rates of depression, anxiety and stress among some population groups, especially among women, young adults and people with chronic diseases, have increased [3,4]. In times of crisis, some turn to alcohol to cope with psychoemotional stress; this can heighten the risk of adverse short-term and long-term health effects and negative social consequences [5,6]. Increased substance use following large-scale disasters is often the sign of people adopting a self-medicating strategy to deal with emotional distress [7][8][9]. Research warns that the COVID-19 pandemic may lead to a medium-and long-term increase in alcohol consumption, especially among men [10]. Early studies into the effects of the pandemic have discovered an association between poor overall mental health and increased alcohol use [11]. According to a study conducted in Canada, stress was the third most common (44%) cause of drinking during the pandemic. In the USA, psychological distress caused by the pandemic was associated with increased frequency of alcohol use in both men and women [12]. Research demonstrates that while some proportion of the adult population are increasing their alcohol consumption during the pandemic, an equal proportion are cutting down on alcohol, and 50-70% of the population are not changing their level of alcohol consumption [11,13]. Because changes in alcohol consumption during the current pandemic may have serious long-term social and economic implications for individuals, groups of people and society as a whole [14,15], there is a need to monitor these changes and analyze the contributing factors that come forward during a large-scale crisis.
In Russia, online social networking services are actively used by the significant proportion of the population. This opens up a possibility to rapidly assess alcohol consumption among Russian residents and remotely (i. e., via the Internet) implement brief interventions aimed at preventing health problems and other adverse outcomes associated with alcohol use. The aim of this study was to assess changes in alcohol consumption and the factors associated with the increase in alcohol use in the first months of the COVID-19 pandemic among online social media users in Russia in order to explore the possibility of delivering screening and preventive interventions, including those implemented via the Internet, aimed at identifying and preventing alcohol-related problems during large-scale epidemics and public health crises.

METHODS
An anonymous online survey was conducted from June 18 to September 30, 2020 among users of online social media popular in Russia (Odnoklassniki, VKontakte, Facebook and Twitter). The following inclusion criteria were applied: age ≥ 18 years, being an Internet user with or without a user account in the online social media mentioned above, informed consent to participate in the anonymous confidential online survey. Non-inclusion criteria: permanent residence of the respondent outside Russia. Exclusion criteria: refusal to participate or have one's personal data processed at any stage of the study, inconsistent contradictory answers to the questions included in the survey. Any participant could refuse to participate at any stage of the study. The link to the survey was posted in the online social media in various groups, on popular pages and in the news feed. The survey was adapted from the pan-European study of alcohol use during the COVID-19 pandemic [10] and modified to assess alcohol consumption behaviors in the 3 months preceding the survey. A few original questions were added to the questionnaire to assess consumption of unrecorded alcohol, such as the homemade alcohol (samogon, homemade wine, braga), alcohol brought from abroad, falsified and counterfeit alcoholic beverages, alcohol-containing liquids not intended for drinking, and other types of unrecorded alcohol. Changes in alcohol use during the first months of the pandemic were assessed from changes in the amount and frequency of alcohol consumption and the frequency of heavy episodic drinking defined as 6 or more drinks or 60g of pure ethanol on a single occasion. Statistical analysis included calculation of descriptive statistics and estimation of the proportion of respondents stratified by sociodemographic or other characteristics who had reduced or increased the frequency of drinking or the amount of alcohol consumed. We also assessed associations between the increase in drinking frequency / amount of consumed alcohol during the first months of the pandemic (dependent variables) and the sociodemographic factors, typical frequency of drinking, the typical amount of consumed alcohol, and the typical frequency of heavy episodic drinking in the past 12 months preceding the pandemic, the perceived strength of COVID-19-associated restrictions in public and everyday private life, stress, negative impact of the pandemic on professional and financial situation, and other adverse consequences of the pandemic (independent variables). The presence, direction, strength and statistical significance of the associations were assessed using unadjusted and adjusted binary logistic regression analysis. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated as measures of association. Data processing and statistical analysis were conducted in SPSS v.22 (Chicago, IL; USA).

RESULTS
Of 1,518 respondents, 57.9% were women and 42.1% were men. The majority of the respondents (87.1%) had had an alcoholic drink at least once in 12 months preceding the study (Table 1). Over half of the respondents (55.9%) were 30-49 years old and almost two-thirds had attended and/or completed higher education (63.8%). More men than women lived in larger settlements (р = 0.010) and higher-income households (р < 0.001). During the first months of the pandemic, their income had changed or fallen less often than that of women (р = 0.014). The usual frequency of drinking, the number of standard drinks consumed on a typical occasion, the frequency of heavy episodic drinking, and the proportion of persons consuming unrecorded alcohol were higher among men than among women (р < 0.001). Overall, the male respondents reported they had encountered restrictions in public (р = 0.007) and everyday private (р = 0.003) life less often than women. However, almost a quarter of men (23.2%) and a third of women (30.8%) said they had encountered severe restrictions in public life, whereas one-fifth of men (19.9%) and a quarter of women (25.4%) reported having faced severe restrictions in their everyday private life during the first months of the pandemic. Men had experienced the negative effects of the pandemic on their professional or financial situation significantly less frequently than women (р = 0.005). Only 30.4% of men and 23.5% of women reported they had experienced no negative effects on their professional or financial situation. The pandemic BULLETIN OF RSMU | 6, 2021 | VESTNIKRGMU.RU was a source of stress for 50.4% of men and 69.5% of women (р < 0.001). A history of confirmed SARS-CoV-2 infection in a respondent, their family or close friends was reported by 21.9% of the participants, with no significant differences by sex (Table 1). In the first months of the pandemic, 35.4% of men and 25.6% of women had used alcohol more frequently than before the pandemic; 24.9% of men and 17.7% of women had increased usual consumption (volume) of alcohol on a typical drinking occasion; the frequency of heavy episodic drinking had increased in 28.5% of men and 27.9% of women.
Results of unadjusted and adjusted logistic regression analysis are shown in Tables 2-4.
Factors associated with the increase in the frequency of alcohol consumption during the first months of the pandemic After adjustment for confounders, positive statistically significant associations between the increase in the frequency of alcohol consumption during the first months of the pandemic and the following factors were identified: age of 18-29 years (OR: 1.710; 95% CI: 1.002-2.917), higher typical frequency of alcohol use before the pandemic (from OR: 3.190, 95% CI: 1.887-5.392 for consumption 2-4 times a months, to OR: 18.727, 95% CI: 9.639-36.383 for consumption more than 2-3 times a month), higher usual consumption (volume) of alcohol on a typical drinking occasion before the pandemic (from OR: 1.941, 95% CI: 1.244-3.029 to OR: 2.234, 95%CI: 1.180-4.233), heavy episodic drinking with a frequency of once a month (OR: 2/061; 95% CI: 1.157-3.671) and once a week before the pandemic (OR: 2.012; 95% CI: 1.081-3.746), severe restrictions in everyday private life due to SARS-CoV-2 containment measures (OR: 3.127; 95% CI: 1.011-9.675) and severe negative consequences of the pandemic to the professional or financial situation (OR: 2.247; 95% CI: 1.131-4.465, Table 2).
Factors associated with the increase of the usual consumption (volume) of alcohol on a typical drinking occasion during the first months of the pandemic Positive statistically significant associations were identified between the increase of the usual consumption (volume) of Note: * -significance of differences between the groups was assessed using χ 2 -test for heterogeneity; ** -among alcohol drinkers (those who consumed alcohol at least once in the past 12 months).      Note: * -respondents who had never drunk 6 or more alcoholic drinks on a single occasion in the past 12 months were excluded from the analysis.

DISCUSSION
The associations revealed in our study are corroborated by other research works conducted in various countries during the first months of the pandemic. Specifically, in an Israeli study male sex was associated with increased consumption of beer and strong liquors [16], whereas in another study conducted in Canada male sex, stress, the feelings of isolation and hopelessness were associated with increased frequency of alcohol use in the first months of the pandemic [17]. In a UK study, stress caused by the pandemic was associated with the rise in hazardous drinking [18]. High levels of anxiety and stress caused by the pandemic led to the increase in alcohol use in Australia, France and Canada [17,19,20]. A few studies investigated changes in alcohol consumption in the general population unstratified by pandemic-related factors. Thus, a French publication reported an increase in total alcohol consumption during the lockdown [20]; by contrast, alcohol use in Greece and Spain during the lockdown was declining [21,22]. However, in Greece and Spain the decline was less pronounced among stressed individuals and those with low or middle income. Compared to the prepandemic level, alcohol was purchased in larger quantities during the lockdown by Russian [23,24] and UK households [25]. During the first months of the pandemic, retail alcohol sales were on the rise in the US [26]. A global study investigating changes in the availability and use of psychoactive drugs and alcohol during the pandemic reported a 71% increase in alcohol consumption across the world [27]. However, according to another large-scale study, alcohol consumption in the general population decreased in most European countries, including Russia, during the first months of the pandemic, mostly due to the reduction in the frequency of heavy episodic drinking [22].
Our study discovered a significant increase in 3 key parameters of alcohol consumption during the first months of the pandemic among those individuals who initially had consumed alcohol in larger quantities and more frequently.
These key parameters include the frequency of drinking, the usual consumption (volume) of alcohol on a typical drinking occasion and the frequency of heavy episodic drinking. These findings suggest polarization of alcohol use, i. e. a situation when alcohol consumption grows among those who drink more at baseline and declines among those who typically drink less. This is consistent with the results of another online survey conducted in the general adult population of Russia [28]. The associations established in our study between the increase in the frequency of alcohol use/ heavy episodic drinking and such COVID-19-related factors as severe restrictions of everyday private life and the negative consequences of the pandemic to professional or financial situation uncover a new aspect or mechanism associated with stress which drives changes in drinking behaviors during the pandemic. Our findings go in line with the stress-associated patterns reported by the studies mentioned above and are consistent with previously reported changes in drinking behavior among Russians determined by certain sociodemographic characteristics, environmental factors and stress in times of socioeconomic and public health crises [29].
A potential limitation of this study might be the insufficient representativeness of the surveyed sample of online social media users in Russia. However, the size of this selection bias is likely small, because the survey was conducted among the users of social networking services highly popular in Russia and because the sociodemographic characteristics of the respondents were generally the same as those of the vast majority of online social media users in Russia. Besides, the consistency of the established patterns and associations with the results of other studies suggests that the probability of our results not being the consequence of selection bias is high. Another limitation of this study is that changes in alcohol consumption were assessed without differentiating between recorded and unrecorded alcohol. Therefore, additional analysis is needed to investigate changes in the consumption of unrecorded alcohol [30], considering its fairly high availability in Russia during the COVID-19 pandemic [31].

CONCLUSIONS
During the first months of the COVID-19 pandemic, over onethird of male and quarter of female online social media users in Russia increased the frequency of drinking. One in four men and one in five women increased their usual consumption (volume) of alcohol on a typical drinking occasion, and about one-third of men and women engaged in heavy episodic drinking more frequently than before the pandemic. Increased alcohol consumption during the first months of the pandemic was associated with male sex, younger age, severe restrictions imposed on everyday private life and severe negative consequences of the pandemic to the professional or financial situation. Further research is needed to investigate the possibility of implementing screening and brief interventions via online social media to prevent problems associated with alcohol use during large-scale epidemics and public health crises.