County-Level COVID-19 Policy Comprehensiveness and Adult Behavioral Health during 2021 : County-Level COVID-19 Policy...

Area of Science:

• Public Health
• Epidemiology
• Health Policy

Background:

• Worsening behavioral health trends observed in the USA since 2020.
• Potential influence of local policies on these trends and health disparities.
• Limited research systematically documenting county-level COVID-19 policymaking and its health impacts.

Purpose of the Study:

• To empirically investigate the association between county-level COVID-19 policies and adult behavioral health outcomes.
• To link a novel county policy database with national health survey data.
• To assess the impact of policy comprehensiveness on substance use and psychological distress.

Main Methods:

• Linked the US COVID-19 County Policy Database (2020-2021) with the 2021 National Survey on Drug Use and Health (N=25,600).
• Created policy comprehensiveness scores across overall, containment/closure, economic, and public health domains.
• Analyzed associations with substance use (alcohol, marijuana, illicit drugs, vaping) and psychological distress, adjusting for covariates and county fixed effects.

Main Results:

• Increases in overall policy comprehensiveness and domain-specific comprehensiveness were not associated with behavioral health outcomes.
• Stratified analyses indicated some subgroup variability in associations across sex, race/ethnicity, education, and urbanicity.
• Established the feasibility of linking policy and health data for county-level analysis.

Conclusions:

• County-level COVID-19 policies, as measured, did not demonstrate a significant association with adult behavioral health outcomes during 2020-2021.
• Further research is necessary to fully understand the nuanced impacts of local policies on behavioral health.
• Findings highlight the utility and challenges of using novel policy databases for public health research.