Changes in alcohol, tobacco, cannabis, and other substance use and its association with mental health during the COVID-19 pandemic among sexual minority men in Eastern European and Central Asian countries.

The COVID-19 pandemic had a particularly negative impact on mental wellbeing of vulnerable individuals, such as sexual minority men (SMM) living in Eastern Europe and Central Asia (EECA), where the social-political climate may be restrictive for SMM. Alcohol, tobacco, and other drugs (ATOD) use may be another factor contributing to exacerbated mental health among SMM in this region. Secondary analyses were conducted using data collected as part of the COVID-19 disparities survey from active users of Hornet, a popular geo-social networking app for SMM in late 2020. Using a subset of SMM living in EECA (n = 3209) and pre-validated scales (AUDIT-C and PHQ-4), we used multivariable logistic regression models to examine the relationship between changes in participants' use of ATOD and their mental wellbeing. Based on AUDIT-C, 35.1 % SMM screened for alcohol use disorder (AUD), 18.6 % reported an increase in alcohol use since the pandemic began. Over 30 % screened for depressive symptoms and anxiety based on PHQ-4 (30.4 % and 30.7 %, respectively). In multivariable models, AUD was significantly associated with screening positive for depressive symptoms and anxiety. Other factors associated with mental distress included lower socioeconomic status, unemployment, ethnic minority identity, IPV victimization, and financial and economic vulnerability. Cross-sectional data cannot be used to infer causality. Our results support the needs for integrated substance use reduction and mental health services tailored for SMM in EECA. Programs aimed at promoting mental wellbeing among SMM in EECA must consider both interpersonal and structural barriers. • Sexual minority men (SMM) reported increase in alcohol and tobacco (ATOD) use since the COVID-19 pandemic began. • SMM in Eastern Europe and Central Asia (EECA) reported high rate of mental distress, especially compared with other regions. • COVID-19 pandemic vulnerability contribute to worsening mental health of SMM when mental health service utilization was low. [ABSTRACT FROM AUTHOR]