Substance use, COVID-19 infection, positive coping, and psychological distress among African American women: A mediation model

Background Substance use has been a maladaptive response to psychological distress related to COVID-19, particularly among African American women facing intersecting vulnerabilities. Positive coping may counteract the distress-induced substance use, yet limited African American research examined these pathways. Objectives This study examined associations of COVID-19 infection and positive coping with substance use among African American women, in which psychological distress was a mediator. Methods A total of 262 African American women in rural South Carolina completed surveys assessing their demographics, health-related covariates, COVID-19 infection status, psychological distress (anxiety, depression, PTSD), positive coping (reframing, humor, acceptance, religion), and substance use (smoking product use, prescription drug misuse and alcohol use). Results Plurality (56.1%) reported a history of COVID-19 infection. Alcohol was the most commonly used substance (25.2%), followed by smoking products (7.3%-8.0%), and prescription drugs (5.7%-6.5%). Structural equation modeling indicated that psychological distress mediated the associations of COVID-19 infection with smoking product use (indirect effect = 0.05, p  = .032) and prescription drug misuse (indirect effect = 0.07, p  = .017), and the associations of positive coping with smoking product use (indirect effect = − 0.07, p  = .026) and prescription drug misuse (indirect effect = − 0.08, p  = .006). Positive coping was associated with alcohol use (β = –.18, p  = .003), but the indirect effects were not significant. Conclusion COVID-19 infection elevates the risk for substance use through psychological distress, while positive coping is a protective factor. Substance use interventions should attend to pandemic-induced distress and highlight culturally grounded coping strategies.