Content uploaded by Shadrack Frimpong
Author content
All content in this area was uploaded by Shadrack Frimpong on Feb 07, 2022
Content may be subject to copyright.
Content uploaded by Francis Arthur-Holmes
Author content
All content in this area was uploaded by Francis Arthur-Holmes on Feb 06, 2022
Content may be subject to copyright.
Research Article
The correlates of substance use among older adults in Ghana
during the COVID-19 pandemic
Prince Peprah
1 , Francis Arthur-Holmes
2 , Williams Agyemang-Duah
3
, Shadrack O. Frimpong
4 , Akwasi A. Gyimah
5
, Faustina Kovor
6
1 Center for Primary Health care and Equity, University of New South Wales, Sydney, Australia; Social Policy Research Centre, University of New South
Wales, Sydney, Australia, 2 Department of Sociology and Social Policy, Lingnan University, Tuen Mun, Hong Kong, 3 Department of Geography and
Planning, Queen's University, Kingston, Ontario, Canada, 4 Department of Public Health and Primary Care, University of Cambridge, United Kingdom,
5 Department of Sociology and Gerontology, Miami University, Oxford, United States of America, 6 Department of Planning, Kwame Nkrumah
University of Science and Technology, Kumasi, Ghana
Keywords: COVID-19, substance use, Ghana, older adults
https://doi.org/10.29392/001c.31592
Journal of Global Health Reports
Vol. 6, 2022
Background
Evidence suggests that substance use remains one of the negative consequences of the
coronavirus (COVID-19) pandemic among older adults. However, not much is known
about the prevalence and associated factors of substance use during the COVID-19
pandemic in Ghana.
Methods
Using data from a survey on coronavirus-related health literacy conducted in the Ashanti
Region of Ghana among 474 older adults aged 50 years or above, we performed
multivariable logistic regression analysis to assess demographic, socio-economic and
health-related correlates of alcohol and tobacco use.
Results
We recorded a prevalence of 11.4% alcohol use and 6.8% of tobacco smoking, in addition
to 16% prevalence of tobacco smoking and/or alcohol intake during the pandemic. After
adjusting for the demographic and socio-economic factors, male participants had higher
odds of substance use than their female counterparts. Older adults with tertiary education
and those who rated their wealth status as poor had a lower odds of substance use than
their counterparts.
Conclusions
Our [ndings have implications for designing programs and policies to limit substance use
among older adults during the COVID-19 pandemic and possible future disease outbreaks.
Globally, the Coronavirus (COVID-19) pandemic has
emerged as a public health challenge that health systems
are grappling with. Existing evidence shows that the pan-
demic has resulted in signi[cant health, economic and po-
litical crisis.1 Various global, regional and local reports have
demonstrated that COVID-19 has placed an additional bur-
den on the health systems providing care for patients in-
fected with the virus.2,3 The pandemic has also caused the
diversion of health resources from other healthcare needs
and services to COVID-19 control and treatment.2,4,5 Since
the declaration of COVID-19 as a pandemic on 11 March
2020 by the World Health Organisation, countries around
the world have implemented a host of policies and stringent
measures, including lockdowns, wearing of face masks, clo-
sure of national borders and limitations on public gathering
to control the spread of the pandemic.6
The pandemic and its accompanied mitigating measures
have several policy implications, especially in older popu-
lation health and wellbeing. Evidence suggests that older
populations are at a higher risk of being infected or dying
from the disease, either directly by exposure to the virus or
indirectly by measures taken to mitigate the virus’ health
and economic effects on the aged population.7 Indeed, the
lockdown and social-distancing measures have severely im-
pacted older adults’ health through isolation, loneliness
and depression.8,9 As Satre et al.10 noted, “older people al-
ready are vulnerable to the detrimental effects of isolation
and face disproportionate adverse consequences from social
distancing and shelter-in-place guidelines, which may trig-
ger or worsen anxiety, depression, substance use, and other
psychiatric disorders”.
In the face of the pandemic and associated restrictions,
various studies have reported that many older adults have
resorted to substance use, especially alcohol and tobacco, to
relieve anxiety and other personal burdens.11–13 Notwith-
standing, inappropriate use of substances, particularly alco-
Peprah P, Arthur-Holmes F, Agyemang-Duah W, Frimpong SO, Gyimah AA, Kovor F. The
correlates of substance use among older adults in Ghana during the COVID-19
pandemic. Journal of Global Health Reports. 2022;6:e2022001.
hol and tobacco, leads to chronic health conditions, includ-
ing medical, functional and psychiatric problems for older
adults.10,14 For example, several studies have shown that
excessive drinking is associated with cancers, cardiovascu-
lar disease, cirrhosis, pancreatitis and gastrointestinal dis-
orders.15–20
In Ghana, substance use such as alcohol and cigarettes
among older adults remains moderately high with an alco-
hol per capita of 10 L, especially the locally brewed bev-
erages.21 In a recent large scale study using data among
3533 Ghanaians aged 50 years and older from the Study on
global ageing and adult health (SAGE), the prevalence of
lifetime alcohol consumption (history of ever consuming al-
cohol) was 22.8%. Of these, 93.7% had consumed alcohol
within seven days and 100% within 30 days before the study.
Among current drinkers, the prevalence of hazardous drink-
ing was 6.2%, and non-hazardous drinking was 93.8%. The
prevalence of lifetime alcohol use was signi[cantly higher
in men than women.21 In another study using nationally
representative data from the SAGE study, the overall preva-
lence of current daily smokers among older adults in Ghana
was 7.6%. Tobacco use (i.e. ever used tobacco) was associ-
ated with older males, older adults residing in rural loca-
tions, and older adults who used alcohol.22 The study also
reported that regional differences existed in tobacco use;
the three northern regions (Upper East, Northern and Upper
West) had higher proportions of tobacco use among older
adults in Ghana.22
Compared to the general population in Ghana and older
adults in some middle and high-income countries, studies
suggest that the prevalence of substance use among older
adults in Ghana is relatively low.23–28 However, this trend
of substance use among older adults in Ghana is worrying,
especially during this current pandemic period. This is be-
cause studies suggest that alcohol and tobacco use remain
one of the common coping strategies for stress, anxiety and
depression associated with the pandemic.10–12,29,30 It was
argued that the disproportionately high rates of COVID-19
health complications and mortality among older adults
prompted negative responses such as excessive alcohol
drinking and tobacco smoking.30 Moreover, older people
are already vulnerable to the detrimental effects of the
COVID-19 response, such as social distancing and shelter-
in-place guidelines, which may inadvertently trigger or
worsen stress, social isolation, loneliness and depression,
which are directly associated with harmful health behav-
iours as substance use.11,31–33 For example, a recent survey
of adults across Canada found that stress was a major con-
tributing factor among those who reported increased alco-
hol use during the pandemic.34
In line with the preceding evidence, older adults in
Ghana may also tend to use drugs, alcohol and tobacco
and, in some instances, abuse its use, which has conse-
quences for their health. However, the prevalence and cor-
relates of substance use among the older population during
the COVID-19 pandemic remain unknown in Ghana. Draw-
ing on a cross-sectional survey in Ghana, we examine sub-
stance use prevalence and its correlations among older
adults during the COVID-19 pandemic. This study adds to
the growing body of evidence seeking to inform healthcare
providers and social workers on how best to provide support
services and programmes for older adults to adopt a positive
response to the pandemic. This would go a long way in
preparing healthcare providers and other key stakeholders
who seek to improve the health of older populations to
develop evidence-based programmes against substance use
to relieve stress, depression and anxiety during and post-
COVID-19 pandemic.
METHODS
SAMPLE AND DATA
This paper was generated from a larger study on coron-
avirus-related health literacy (CHL) conducted between 12
September 2020 and 15 October 2020 in the Ashanti Region
of Ghana. The CHL survey was carried out in the Ashanti
Region because the region houses the highest percentage
(17.5%) of older adults in Ghana coupled with their diverse
cultural, social and economic characteristics.35 The CHL
survey employed a cross-sectional design to determine CHL
among older adults from the Ashanti Region of Ghana. Con-
sidering the World Health Organization’s (WHO) study on
Global Ageing and Adult Health in [ve developing coun-
tries, including Ghana, we conceptualize an older person as
an individual who has attained a minimum of 50 years.36
Before the actual data collection, we conducted a pilot study
to test the survey questions. Participants who took part in
the pilot study were not part of the original survey partici-
pants. The outcome from the pilot study was used to modify
the survey questions and outline.
This study presents part of a larger study that examined
CHL among older adults during the COVID-19 pandemic
in Ghana. Cluster and simple random sampling techniques
were used to select the participants from [ve communities
in the Ashanti Region of Ghana. We used a conservative
prevalence of 40% (because the actual prevalence of CHL
was unknown in Ghana/or the study areas) among older
adults in Ghana. Employing Lwanga and Lemeshow37 for-
mula for sample size calculation for health research with an
alpha value of 0.05, a minimum sample size of 369 was de-
termined but considering a 35% nonresponse rate, the [nal
sample size was approximately 498. Out of the 498 partici-
pants targeted, 487 met the inclusion criteria. Of these eli-
gible respondents, 13(2.67%) declined to participate in the
study yielding a sample size of 474, representing a response
rate of 97.33%.
The data collection instrument used for the study was a
questionnaire. The questionnaire was developed in English
and later read in the local language (Twi) to ensure better
understanding and quality control. We translated the ques-
tionnaire into Twi by considering the World Health Organi-
zation guidelines for assessments of data collection instru-
ments.38 We established the validity of the questionnaire
by undertaking a detailed review of related literature on
the subject matter to check for language clarity, simplicity,
and consulting experts in health literacy, [nancial support,
and substance use, which is consistent with previous stud-
ies.38,39
Five research assistants from the Department of Plan-
ning at the Kwame Nkrumah University of Science and
Technology (KNUST) of Ghana were recruited and trained to
The correlates of substance use among older adults in Ghana during the COVID-19 pandemic
Journal of Global Health Reports 2
assist in the data collection process. The training of the re-
search assistants lasted a day. The data collection exercise
was monitored and supervised to ensure quality control.
The administration of each questionnaire lasted between 25
and 30 minutes.
Given that the research was conducted to assist welfare
institutions and health authorities in improving older
adults’ health during the COVID-19 pandemic, ethical is-
sues were considered. First, the study was approved by the
various municipal health directorates in which the study
was conducted. In line with the ethical principles, after go-
ing through the research proposal and survey instruments,
the Municipal Health Research Team granted permission
for data collection in the study setting. Secondly, the re-
search participants were briefed on the purpose of the study
and their informed consent (oral and written) was obtained.
The research participation was voluntary; therefore, the
study participants were free to opt-out of the study when
they deemed necessary. Con[dentiality was also ensured
throughout the entire research process. Very importantly,
the research was conducted to provide empirical evidence
to assist policymakers and planners in improving the well-
being and welfare of older adults during the COVID-19 pan-
demic as there is not much data on substance use during
the COVID-19. However, to conduct further analysis of the
data to determine the factors associated with substance use
among older adults during the pandemic, approval was
granted by the Municipal Health directorates.
MEASURES
OUTCOME VARIABLE
In this study, substance use during the COVID-19 pandemic
was de[ned as “started using and/or has increased in the
frequency and quantity of alcohol and/or tobacco since the
emergence of COVID-19 in Ghana”. Thus, substance use
was the dependent variable in this study. Substance use
was measured as a dichotomous variable indicating "Not
started using and/or increased in alcohol and/or tobacco =0)
or “started using and/or increased alcohol and/or tobacco
use =1)” during the COVID-19 pandemic.
EXPOSURE VARIABLES
The predictor variables were age (years) (1=50-69 years, 2=
70-79, 3= 80 or above), gender (1=female, 2= male ), marital
status ( 1=married, 2=single), education ( 1=none, 2= basic,
3=secondary, 4=tertiary), wealth status (1=average, 2= poor,
3= rich), employment status (1=yes, 0= no), religion (
1=Christian, 2= non-Christian), ethnicity (1= Akan, 2= non-
Akan), health status ( 1=good, 2= poor), income (GH¢) (1=
≤ 500, 2= ˃500) and chronic non-communicable diseases
(1=yes, 0=no). Details about the measurement, conceptual-
ization and justi[cation of the study variables have been
reported elsewhere.39–46 Gender, marital status, employ-
ment status, chronic non-communicable diseases, ethnic-
ity, religion, health status and income were measured as
dichotomous variables. Age was measured as ranked vari-
able, wealth status and education were measured as nomi-
nal variables.
ANALYTICAL FRAMEWORK
Descriptive and inferential statistics were used to analyze
the data. Descriptive statistics such as percentages and fre-
quencies were used to describe the background characteris-
tics and prevalence of substance use during the COVID-19
pandemic among older adults. We used inferential statistics
such as binary logistic regression embedded in the Statis-
tical Package for the Social Sciences (version 20) software
to estimate demographic, socio-economic and health-re-
lated factors associated with substance use among older
adults during the COVID-19 pandemic in Ghana. We per-
formed multivariable logistic regression analysis to inves-
tigate the demographic, socio-economic and health-related
factors associated with substance use during the COVID-19
pandemic.
Using one model, we estimated the factors associated
with substance use among older adults during the
COVID-19 pandemic. Previous studies used the omnibus
chi-square tests of model coef[cients, Hosmer and
Lemeshow Test, and proportion of correction classi[cation
to measure the model [tness.39,40,46 The robustness of the
models was measured, and the outcomes are as follows.
The homogeneity outcome (P>0.05) of the Hosmer and
Lemeshow test shows that the model [ts the data well. The
Omnibus Tests of Model Coef[cients shows a signi[cant
difference between the based model (without explanatory
variables) and the current model with explanatory variables
(P<0.05) having 84% proportion of correct classi[cation. All
tests were considered signi[cant at a p-value of 0.05 or less.
RESULTS
SOCIO-DEMOGRAPHIC AND MEDICAL CHARACTERISTICS
OF THE RESPONDENTS
The participants’ demographic, socio-economic, and med-
ical characteristics are shown in Table 1. We found that
80.8% of the participants were aged 50-59 years. The ma-
jority of the participants (66.7%) were females, 58% were
married, and 44.1% had basic education. Most of the par-
ticipants (61.6%) rated their wealth status as average; 87%
earned a monthly income of ˃GH¢500, 67.7% were em-
ployed, 83.1% were Christians, and 87.8% were Akans. In
addition, about 86% of the participants rated their health
status as good, and 32.3% had been diagnosed with chronic
non-communicable diseases (NCDs) (Table 1).
PREVALENCE OF SUBSTANCE USE AMONG OLDER
ADULTS DURING COVID-19 PANDEMIC
We estimated the prevalence of substance use among older
adults during the COVID-19 pandemic. We found that 6.8%
of the participants consumed tobacco products (Tawa, cig-
arettes, cigars, pipes, chewing tobacco, or snuff powder)
during the COVID-19 pandemic. Also, 11.4% of the partic-
ipants consumed alcohol during the COVID-19 pandemic.
The study revealed that 16% consumed alcohol and/or to-
bacco (substance use) during the COVID-19 pandemic
(Table 2).
The correlates of substance use among older adults in Ghana during the COVID-19 pandemic
Journal of Global Health Reports 3
Table 1. Demographic, socio-economic and medical characteristics of the respondents (n=474)
Variables Category N %
/-?-)9:
69)*6=-
-5,-9 -4)3-
)3-
)91;)3:;);<: )991-,
$15/3-
,<+);165)33-=-3 65-
):1+
%-9;1)9?
$-+65,)9?
'-)3;0:;);<: =-9)/-
"669
#1+0
4736?4-5;$;);<: (-:
6
#-31/165 091:;1)5
65091:;1)5
;051+1;? 2)5
652)5
-)3;0:;);<: 66,
"669
65;03?15+64-@ B
09651+ : (-:
6
Table 2. Prevalence of substance use among older adults during COVID-19 pandemic
&)91)*3-: );-/69? 6<5;
%6*)++6+65:<47;165,<915/!&7)5,-41+ 6
(-:
%6;)3
3+6063+65:<47;165,<915/!&7)5,-41+ 6
(-:
%6;)3
3+6063)5,69;6*)++6+65:<47;165,<915/!&7)5,-41+ (-:
6
%6;)3
PREDICTORS OF SUBSTANCE USE AMONG OLDER
ADULTS DURING COVID-19 PANDEMIC
The study found that gender, education and wealth status
were signi[cantly associated with substance use among the
participants. After adjusting for the demographic and socio-
economic factors, male participants were 1.1 times more
likely to use substances than female counterparts (adjusted
odds ratio, AOR=1.11, 95% con[dence interval, 95%
CI=0.16-.1.20, P<0.05). Older adults with tertiary education
were 0.239 times less likely to use substances than their
counterparts (AOR=0.24, 95% CI=0.07-0.79, P=0.019). Simi-
larly, older adults who rated their wealth status as poor were
0.380 times less likely to use substances than their counter-
parts (AOR=0.38, 95% CI=0.18-0.79, P=0.010) (Table 3).
The correlates of substance use among older adults in Ghana during the COVID-19 pandemic
Journal of Global Health Reports 4
Table 3. Multivariable Logistic Regression Analysis on factors in0uencing substance use among older adults
during COVID-19 pandemic
Variables Substance use
AOR 95% C.I. for AOR P-value
Age (years)
9-.
-
69)*6=- -
Gender
-4)3-9-.
Male
Marital Status
)991-,9-.
$15/3-
Education
65-9-.
):1+
%-9;1)9?
$-+65,)9?
Wealth Status
=-9)/-9-.
Poor
#1+0
Employment Status
(-:9-.
No
Religion
091:;1)59-.
65091:;1)5
Ethnicity
2)59-.
652)5
Health Status
66,9-.
"669
Income (GH¢)
≤ 500 (ref)
˃500
Chronic NCDs
(-:#-.
No
Model Fitting Information
!451*<:01$8<)9-%-:;:6.6,-36-.C+1-5;:7=)3<-
6:4-9)5,-4-:06>%-:;7=)3<-
"96769;1656.699-+;165+3)::1C+);165
Italic values indicate signi[cance of P value (P < 0.05)
CI= Con[dence Interval; AOR= Adjusted Odd Ratio
* P < 0.05.
The correlates of substance use among older adults in Ghana during the COVID-19 pandemic
Journal of Global Health Reports 5
DISCUSSION
KEY FINDINGS
In this cross-sectional study involving 474 participants, we
aimed to examine the prevalence of substance use and as-
sociated factors among older adults amid the ongoing
COVID-19 pandemic in Ghana. The results showed a rela-
tively moderate prevalence of substance use – consumed al-
cohol and/or tobacco (16%) among older adults during the
COVID-19 pandemic in Ghana. The results also showed that
demographic and socio-economic factors, particularly gen-
der, education and wealth status, were associated with sub-
stance use. Males were likely to report the use of alcohol
and/or tobacco compared to females. Older adults with ter-
tiary education and within poor wealth status were less
likely to consume alcohol and/or smoke tobacco than their
counterparts with primary and secondary education and
within average and rich wealth quintile.
POSSIBLE INTERPRETATION IN RELATION TO PREVIOUS
STUDIES
Our study offers evidence that the pandemic directly affects
the risk of substance use, particularly alcohol drinking and
tobacco smoking among older populations.12,46,47 This
[nding is consistent with a representative panel survey of
5,412 adults in the USA in which 13.3% of the participants
had started or increased substance use during the
COVID-19 pandemic.48 Moreover, in an anonymously-com-
pleted online self-report survey among 13,829 adults in
Australia, Tran et al49 found that about one in [ve adults
had been drinking more alcohol since the emergence of the
pandemic than they used to do. In another study of 1684
Australians aged 18–65 years, participants had increased
both their frequency and quantity of alcohol consumption
during the pandemic.50
Several reports from the media and other sources suggest
that sales and consumption of alcohol and tobacco in-
creased in some parts of Canada and the USA at the begin-
ning of the pandemic.51–53 Despite these results, the stud-
ies were not conducted in sub-Saharan Africa (SSA). These
results cannot be compared to our study because the set-
tings have distinct cultural, social and economic situations
that either promote or hinder substance use. Thus, the cur-
rent [ndings may not provide a complete understanding
of substance use during the pandemic. To the best of our
knowledge, this is the [rst study to establish the prevalence
of substance use and associated factors among older adults
during the COVID-19 pandemic in SSA speci[cally Ghana.
Alcohol and tobacco use remain common coping strate-
gies for stress, anxiety and depression associated with the
pandemic.10–12,29,50 Macdonald et al.29 argued that the dis-
proportionately high rates of COVID-19 health complica-
tions and mortality among older adults prompted negative
responses such as excessive alcohol drinking and tobacco
smoking. More senior people already are vulnerable to the
detrimental effects of the COVID-19 response, such as so-
cial distancing and shelter-in-place guidelines, which may
inadvertently trigger or worsen stress, social isolation,
loneliness and depression, which are directly associated
with harmful health behaviours such as substance
use.11,30–32 For example, a recent survey of adults across
Canada found that stress was a major contributing factor
among those who reported increased alcohol use during the
pandemic.33
However, alcohol and tobacco use are associated with
several chronic medical conditions common in older adults,
such as liver disease.54 Furthermore, growing evidence sug-
gests that substance use puts older adults at a greater risk
of COVID-19 related symptoms since severe alcohol con-
sumption and tobacco use associated with reduced immu-
nity to viral infections.55 For example, data from China,
where the COVID-19 [rst emerged, show that 32% of Chi-
nese COVID-19 patients with a history of smoking (smokers
and ex-smokers) had a severe form of COVID-19 pneumonia
at the time of hospitalization compared to 15% of non-
smokers.56 In addition, 16% of smokers required hospital-
ization in intensive care units, compared to 5% of non-
smokers.56 In another study from China on patients
diagnosed with COVID-19-associated pneumonia, 27% of
smokers’ health worsened (including death) within two
weeks of hospitalization, compared to 3% of non-smok-
ers.57 The conclusion is that since alcohol and tobacco-re-
lated immune system impairment increases susceptibility
to pneumonia and other infectious diseases, minimizing al-
cohol and tobacco consumption is critical for older adults
during the pandemic.10,58
Our [ndings show that socio-demographic and economic
factors are important in alcohol and tobacco use among
older adults during the pandemic. Males experienced a sig-
ni[cantly greater risk of substance use than their female
counterparts. In contrast, older adults with tertiary educa-
tion and within the poor wealth category who experienced
signi[cantly lesser risk of the substance may not appear as a
surprise but has policy implications. The gender difference
may relate well to how males and females respond differ-
ently to challenging situations. It is known that men con-
sume alcohol and tobacco more than women,44 and exces-
sive substance use among men is believed to increase as
a response to stress, especially in times of economic cri-
sis.50,58
Moreover, the reduced income and [nancial support for
older males may in\uence them to resort to alcohol and/or
tobacco to manage their [nancial stress.31 Consistent with
our [ndings, previous studies have also found an associa-
tion between wealth status and risk of substance use dur-
ing the pandemic.11,12 Older adults with higher income are
more likely to consume more alcohol and tobacco during
the pandemic than those who are poor. On the other hand,
older adults with tertiary education are less likely to use a
substance during the pandemic. This could be attributed to
the fact that they are more likely to know the adverse effects
of substance use on both their physical and mental health.
IMPLICATIONS FOR POLICY AND RESEARCH
The [ndings of the study have several implications for pol-
icy formulation and research. First, our results that 16% of
the older adults included in the study used alcohol and/or
cigarette during the COVID-19 pandemic in Ghana suggests
that many older adults in Ghana are likely to consume al-
cohol and/or tobacco to cope with the stress and burdens
The correlates of substance use among older adults in Ghana during the COVID-19 pandemic
Journal of Global Health Reports 6
associated with the pandemic. Given that excessive sub-
stance use can affect older adults’ psychological and phys-
ical health, our study offers health authorities and other
stakeholders evidence on the prevalence of substance use
among older adults in Ghana. Having access to this evidence
can aid the development of evidence-informed programmes
and measures by health authorities and other stakeholders
to support older adults who are resorting to substance use
during the current pandemic.
Secondly, this study provides essential [ndings to com-
munity-based organizations that offer different pro-
grammes involving medication and behavioural therapy to
older adults during the COVID-19 pandemic. Our study has
revealed the socio-demographic and economic characteris-
tics of older adults who are more and/or less likely to use
a substance during the COVID-19 pandemic in Ghana. This
study provides evidence to show that older adults who are
males with limited education and high income were more
likely to increase substance use. This [nding implies that
measures and programmes to support older adults in Ghana
to reduce or stop substance use should particularly target
older adults with these demographic and economic charac-
teristics.
This study also provides [ndings that can inform stake-
holders and appropriate authorities to promote education
and awareness of substance use among older adults during
the COVID-19 pandemic. Our [ndings can indicate the gen-
eral situation of substance use among older adults during
the COVID-19 pandemic in Ghana.
In addition, this study contributes to literature and dis-
cussion on substance use among older adults. Our [ndings
also imply that a nationally-representative study on sub-
stance use during the COVID-19 pandemic in Ghana is re-
quired to provide national data and evidence to inform and
guide policies and programmes.
LIMITATIONS
Regardless of the strengths of this study, some limitations
need to be remarked. The [rst limitation of the study is the
sampling strategy. The data are self-report and not diag-
nostic, which means recall and social desirability bias may
occur. Previous studies conducted in the same and sim-
ilar settings have noted measurement bias due to social
desirability. Most people like to present themselves in a
favourable light and do not respond honestly in sur-
veys.35,36,39
Also, given the study’s cross-sectional nature, the data
can only estimate associations and not causal relationships.
These and other limitations may affect the veracity of the
[ndings that limit the representation and generalizability
of the results. However, we controlled for major con-
founders, including socio-demographic factors in the
analysis, though residual confounding remains challenging
that may be common to all observational studies.
CONCLUSIONS
This study offers insights into alcohol consumption and to-
bacco use among older adults during the COVID-19 pan-
demic in Ghana. Our study provides evidence that some
older adults have resorted to alcohol and/or tobacco as a re-
sponse to the pandemic. Demographic and socio-economic
factors, particularly gender, education and wealth status,
played a role in substance use among older adults during
the pandemic. Although the prevalence of substance use
among older Ghanaian adults was relatively moderate, our
[ndings reveal that the COVID-19 pandemic had con-
tributed to older Ghanaian adults’ use of substances such
as alcohol, with potentially harmful implications for their
physical and psychological health. Consequently, social as-
sistance and kindship care provided to older adults should
be intensi[ed to avert any potential health implications.
ACKNOWLEDGEMENTS
We thank our research assistants for assisting us in the data
collection process. Further, we thank our study participants
for providing us with the needed data for the successful
completion of the study.
FUNDING
The authors did not receive any speci[c funding for this
work.
AUTHORSHIP CONTRIBUTIONS
The authors completed the Uni[ed Competing Interest
form at http://www.icmje.org/disclosure-of-interest/
(available upon request from the corresponding author) and
declare no con\icts of interest.
COMPETING INTERESTS
Authors declare that they have no competing interests.
CORRESPONDENCE TO:
Shadrack Osei Frimpong, MS, MPH., Department of Public
Health and Primary Care, University of Cambridge, Forvie
Site, Robinson Way, Cambridge CB2 0SR UK.
Submitted: October 25, 2021 GMT, Accepted: December 09,
2021 GMT
%01:1:)567-5)++-::)9;1+3-,1:;91*<;-,<5,-9;0-;-94:6.;0-9-);1=-64465:;;91*<;1655;-95);165)31+-5:-
(&1->;01:31+-5:-A:3-/)3,--,);0;;7+9-);1=-+64465:69/31+-5:-:*?)5,3-/)3+6,-);0;;7+9-);1=-+64
465:69/31+-5:-:*?3-/)3+6,-.69469-15.694);165
The correlates of substance use among older adults in Ghana during the COVID-19 pandemic
Journal of Global Health Reports 7
REFERENCES
1. Greer SL, King EJ, da Fonseca EM, Peralta-Santos
A. The comparative politics of COVID-19: The need to
understand government responses. Global Public
Health. 2020;15(9):1413-1416. doi:10.1080/1744169
2.2020.1783340
2. Folegatti PM, Ewer KJ, Aley PK, et al. Safety and
immunogenicity of the ChAdOx1 nCoV-19 vaccine
against SARS-CoV-2: a preliminary report of a phase
1/2, single-blind, randomized controlled trial. The
Lancet. 2020;396(10249):467-478. doi:10.1016/s014
0-6736(20)31604-4
3. World Health Organization. Global Health
Observatory data repository, Non-communicable
diseases, Mortality. Accessed June 22, 2020. http://ap
ps.who.int/gho/data/node.main.A859?lang=en
4. Arthur-Holmes F, Agyemang-Duah W. Reaching
older adults during the COVID-19 pandemic through
social networks and Social Security Schemes in
Ghana: Lessons for considerations. Journal of
Gerontological Social Work. 2020;63(6-7):699-701. do
i:10.1080/01634372.2020.1764689
5. Arthur-Holmes F, Akaadom MKA, Agyemang-Duah
W, Abrefa Busia K, Peprah P. Healthcare concerns of
older adults during the COVID-19 outbreak in Low-
and Middle-Income Countries: Lessons for Health
Policy and Social Work. Journal of Gerontological
Social Work. 2020;63(6-7):717-723. doi:10.1080/01634
372.2020.1800883
6. Givens JW, Mistur E. The Sincerest Form of
Flattery: Nationalist Emulation during the COVID-19
Pandemic. Journal of Chinese Political Science.
2020;26(1):213-234. doi:10.1007/s11366-020-09702-7
7. Heymann DL, Shindo N. COVID-19: What is next
for public health? The Lancet.
2020;395(10224):542-545. doi:10.1016/s0140-6736(2
0)30374-3
8. Gyasi RM. COVID-19 and mental health of older
Africans: an urgency for public health policy and
response strategy. Int Psychogeriatr.
2020;32(10):1187-1192. doi:10.1017/s1041610220003
312
9. Peprah P, Gyasi RM. Stigma and COVID‐19 crisis:
A wake‐up call. Int J Health Plann Mgmt.
2020;36(1):215-218. doi:10.1002/hpm.3065
10. Satre DD, Hirschtritt ME, Silverberg MJ, Sterling
SA. Addressing problems with alcohol and other
substances among older adults during the COVID-19
pandemic. The American Journal of Geriatric
Psychiatry. 2020;28(7):780-783. doi:10.1016/j.jagp.20
20.04.012
11. Wardell JD, Kempe T, Rapinda KK, et al. Drinking
to cope during COVID‐19 pandemic: The role of
external and internal factors in coping motive
pathways to alcohol use, solitary drinking, and
alcohol problems. Alcohol Clin Exp Res.
2020;44(10):2073-2083. doi:10.1111/acer.14425
12. Neill E, Meyer D, Toh WL, et al. Alcohol use in
Australia during the early days of the COVID‐19
pandemic: Initial results from the COLLATE project.
Psychiatry Clin Neurosci. 2020;74(10):542-549. doi:1
0.1111/pcn.13099
13. Kuerbis A, Sacco P, Blazer DG, Moore AA.
Substance abuse among older adults. Clinics in
Geriatric Medicine. 2014;30(3):629-654. doi:10.1016/
j.cger.2014.04.008
14. Sterling SA, Palzes VA, Lu Y, et al. Associations
between medical conditions and alcohol consumption
levels in an adult primary care population. JAMA
Netw Open. 2020;3(5):e204687. doi:10.1001/jamanetw
orkopen.2020.4687
15. Lembke A, Bradley KA, Henderson P, Moos R,
Harris AHS. Alcohol screening scores and the risk of
new-onset gastrointestinal illness or related
hospitalization. Journal of General Internal Medicine.
2014;26(7):777-782. doi:10.1007/s11606-011-1688-7
16. Samokhvalov AV, Rehm J, Roerecke M. Alcohol
consumption as a risk factor for acute and chronic
pancreatitis: a systematic review and a series of
meta-analyses. EBioMedicine. 2015;2(12):1996-2002.
doi:10.1016/j.ebiom.2015.11.023
17. Hadland SE, Xuan Z, Blanchette JG, Heeren TC,
Swahn MH, Naimi TS. Alcohol policies and alcoholic
cirrhosis mortality in the United States. Prev Chronic
Dis. 2015;12(E117). doi:10.5888/pcd12.150200
18. Ricci C, Wood A, Muller D, et al. Alcohol intake in
relation to non-fatal and fatal coronary heart disease
and stroke: EPIC-CVD case-cohort study. BMJ.
2018;361. doi:10.1136/bmj.k934
19. Peng Q, Chen H, Huo JR. Alcohol consumption
and corresponding factors: A novel perspective on the
risk factors of esophageal cancer. Oncology Letters.
2016;11(5):3231-3239. doi:10.3892/ol.2016.4401
The correlates of substance use among older adults in Ghana during the COVID-19 pandemic
Journal of Global Health Reports 8
20. Praud D, Rota M, Rehm J, et al. Cancer incidence
and mortality attributable to alcohol consumption.
Int J Cancer. 2016;138(6):1380-1387. doi:10.1002/ijc.2
9890
21. Tachi K, Tetteh J, Yawson AE, Agyei-Nkansah A,
Archampong T. Alcohol consumption and fruits and
vegetable intake among older adults in Ghana: a
cross-sectional survey based on WHO-SAGE Wave 2
data. BMJ Nutrition, Prevention & Health.
2020;3(2):220. doi:10.1136/bmjnph-2020-000102
22. Yawson AE, Baddoo A, Hagan-Seneadza NA, et al.
Tobacco use in older adults in Ghana:
Sociodemographic characteristics, health risks and
subjective wellbeing. BMC Public Health.
2013;13(1):979. doi:10.1186/1471-2458-13-979
23. Herbeth B, Samara A, Stathopoulou M, Siest G,
Visvikis-Siest S. Alcohol consumption, beverage
preference, and diet in middle-aged men from the
STANISLAS study. J Nutr Metab. 2012;2012:1-6. doi:1
0.1155/2012/987243
24. Li YC, Jiang B, Zhang M, et al. Vegetable and fruit
consumption among Chinese adults and associated
factors: a nationally representative study of 170,847
adults. Biomed Environ Sci. 2017;30:863-874. doi:10.3
967/bes2017.117
25. Franchini B, Poínhos R, Klepp KI, Vaz de Almeida
MD. Fruit and vegetables: intake and socio-
demographic determinants among Portuguese
mothers. Ann Nutr Metab. 2013;63(1-2):131-138. do
i:10.1159/000351987
26. Shield KD, Parry C, Rehm J. Chronic diseases and
conditions related to alcohol use. Alcohol Res.
2013;35:155-173.
27. Osei-Bonsu E. Prevalence of alcohol consumption
and factors in\uencing alcohol use among the youth
in Tokorni-Hohoe, Volta region of Ghana. SJPH.
2017;5(3):205-214. doi:10.11648/j.sjph.20170503.18
28. Addo J, Cook S, Galbete C, et al. Differences in
alcohol consumption and drinking patterns in
Ghanaians in Europe and Africa: the RODAM study.
PLoS ONE. 2018;13(11):e0206286. doi:10.1371/journa
l.pone.0206286
29. Monahan C, Macdonald J, Lytle A, Apriceno M,
Levy SR. COVID-19 and ageism: How positive and
negative responses impact older adults and society.
American Psychologist. 2020;75(7):887-896. doi:10.103
7/amp0000699
30. Callinan S, Smit K, Mojica‐Perez Y, D’Aquino S,
Moore D, Kuntsche E. Shifts in alcohol consumption
during the COVID‐19 pandemic: Early indications
from Australia. Addiction. 2020;116(6):1381-1388. do
i:10.1111/add.15275
31. Tran TD, Hammarberg K, Kirkman M, Nguyen
HTM, Fisher J. Alcohol use and mental health status
during the [rst months of COVID-19 pandemic in
Australia. Journal of Affective Disorders.
2020;277:810-813. doi:10.1016/j.jad.2020.09.012
32. Keyes KM, Hatzenbuehler ML, Hasin DS. Stressful
life experiences, alcohol consumption, and alcohol
use disorders: the epidemiologic evidence for four
main types of stressors. Psychopharmacology.
2011;218(1):1-17. doi:10.1007/s00213-011-2236-1
33. Wang C, Pan R, Wan X, et al. Immediate
psychological responses and associated factors during
the initial stage of the 2019 coronavirus disease
(COVID-19) epidemic among the general population
in China. International Journal of Environmental
Research and Public Health. 2020;17(5):1729. doi:10.3
390/ijerph17051729
34. Canadian Centre on Substance Use and Addiction.
Canadians under 54 Drinking More While at Home Due
to COVID-19 Pandemic. Accessed December 20, 2020.
https://ccsa.ca/canadians-under-54-drinkingmore-wh
ile-home-due-COVID-19-pandemic
35. Gyasi RM, Adam AM, Phillips DR. Financial
inclusion, Health-Seeking behavior, and health
outcomes among older adults in Ghana. Res Aging.
2019;41(8):794-820. doi:10.1177/0164027519846604
36. Biritwum RB, Mensah G, Minicuci N, et al.
Household characteristics for older adults and study
background from SAGE Ghana Wave 1. Global Health
Action. 2013;6(1):20096. doi:10.3402/gha.v6i0.20096
37. Lwanga SK, Lemeshow S. Sample Size
Determination in Health Studies: A Practical Manual.
World Health Organization; 1991. https://doi.org/10.2
307/2290547
38. Üstun TB, Chatterji S, Mechbal A, Murray CJL,
WHS collaborating groups. WHO translation
guidelines quality assurance in surveys: Standards,
guidelines and procedures, (Chapter X). Published
online 2005.
39. Agyemang-Duah W, Owusu-Ansah JK, Peprah C.
Factors in\uencing healthcare use among poor older
females under the Livelihood Empowerment Against
Poverty Programme in Atwima Nwabiagya District,
Ghana. BMC Res Notes. 2019;12(1):1-6. doi:10.1186/s
13104-019-4355-4
The correlates of substance use among older adults in Ghana during the COVID-19 pandemic
Journal of Global Health Reports 9
40. Agyemang-Duah W, Peprah C, Arthur-Holmes F.
Predictors of healthcare utilization among poor older
people under the livelihood empowerment against
poverty programme in the Atwima Nwabiagya District
of Ghana. BMC Geriatr. 2020;20(1):1-11. doi:10.1186/
s12877-020-1473-8
41. Agyemang-Duah W, Adei D, Oduro Appiah J, et al.
Communication barriers to formal healthcare
utilization and associated factors among poor older
people in Ghana. Journal of Communication in
Healthcare. 2021;14(3):216-224. doi:10.1080/1753806
8.2020.1859331
42. Gyasi RM, Phillips DR. Demography, socio-
economic status and health services utilization
among older Ghanaians: implications for health
policy. Ageing Int. 2020;45(1):50-71. doi:10.1007/s121
26-018-9343-9
43. Gyasi RM, Phillips DR, Buor D. The role of a
health protection scheme in health services
utilization among community-dwelling older persons
in Ghana. The Journals of Gerontology: Series B.
2020;75(3):661-673. doi:10.1093/geronb/gby082
44. Bourne PA. Dichotomizing poor self-reported
health status: Using secondary cross-sectional survey
data for Jamaica. North American journal of medical
sciences. 2009;1(6):295. doi:10.4297/najms.2009.6295
45. Fonta CL, Nonvignon J, Aikins M, Nwosu E,
Aryeetey GC. Predictors of self-reported health
among the elderly in Ghana: a cross sectional study.
BMC Geriatr. 2017;17(1):1-15. doi:10.1186/s12877-01
7-0560-y
46. Oduro Appiah J, Agyemang-Duah W, Fordjour AA,
Adei D. Predicting [nancial barriers to formal
healthcare utilization among poor older people under
the Livelihood Empowerment Against Poverty
programme in Ghana. GeoJournal. Published online
July 9, 2020:1-15. doi:10.1007/s10708-020-10255-8
47. Brooks SK, Dunn R, Amlôt R, Rubin GJ, Greenberg
N. A systematic, thematic review of social and
occupational factors associated with psychological
outcomes in healthcare employees during an
infectious disease outbreak. Journal of Occupational &
Environmental Medicine. 2018;60(3):248-257. doi:10.1
097/jom.0000000000001235
48. Wu P, Liu X, Fang Y, et al. Alcohol abuse/
dependence symptoms among hospital employees
exposed to a SARS outbreak. Alcohol and Alcoholism.
2008;43(6):706-712. doi:10.1093/alcalc/agn073
49. Czeisler MÉ, Lane RI, Petrosky E, et al. Mental
health, substance use, and suicidal ideation during
the COVID-19 pandemic - United States, june 24–30,
2020. Morb Mortal Wkly Rep. 2020;69(32):1049-1057.
doi:10.15585/mmwr.mm6932a1
50. Tran TD, Hammarberg K, Kirkman M, Nguyen
HTM, Fisher J. Alcohol use and mental health status
during the [rst months of COVID-19 pandemic in
Australia. Journal of Affective Disorders.
2020;277:810-813. doi:10.1016/j.jad.2020.09.012
51. BACtrack. Coronavirus is causing a dramatic shift
in the drinking habits of Americans on lockdown.
Accessed December 20, 2020. https://www.bactrack.c
om/pages/coronavirus-COVID-19-causing-dramatics
hift-alcohol-drinking-habits-americans-lockdown
52. Benzie R. LCBO reporting its sales have gone up
during the COVID-19 crisis. Accessed December 20,
2020. https://www.thestar.com/politics/provicial/202
0/04/23/lcbo-reporting-itssales-have-gone-up-durin
g-the-COVID-19-crisis.html
53. Carey A. Coronavirus: CBA report reveals what
we’re buying during pandemic. Accessed December
20, 2020. https://www.news.com.au/[nance/business/
retail/coronavirus-cbareport-reveals-what-were-buyi
ng-during-pandemic/news-story/5004b6810d69cdbcc
73ac7789e24460d
54. Roerecke M, Vafaei A, Hasan OSM, et al. Alcohol
consumption and risk of liver cirrhosis: a systematic
review and meta-analysis. Am J Gastroenterol.
2019;114(10):1574-1586. doi:10.14309/ajg.000000000
0000340
55. Barr T, Helms C, Grant K, Messaoudi I. Opposing
effects of alcohol on the immune system. Progress in
Neuro-Psychopharmacology and Biological Psychiatry.
2016;65:242-251. doi:10.1016/j.pnpbp.2015.09.001
56. Guan WJ, Ni ZY, Hu Y, et al. Clinical
characteristics of coronavirus disease 2019 in China.
New England Journal of Medicine.
2020;382(18):1708-1720. doi:10.1016/j.jemermed.202
0.04.004
57. Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The
reproductive number of COVID-19 is higher
compared to SARS coronavirus. Journal of Travel
Medicine. 2020;1-4. doi:10.1093/jtm/taaa021
58. Cattaruzza MS, Zagà V, Gallus S, D’Argenio P,
Gorini G. Tobacco smoking and COVID-19 pandemic:
old and new issues. A summary of the evidence from
the scienti[c literature. Acta Bio Medica Atenei
Parmensis. 2020;91(2):106-112. doi:10.23750/abm.v91
i2.9698
The correlates of substance use among older adults in Ghana during the COVID-19 pandemic
Journal of Global Health Reports 10
