Constellations of Depressive Symptoms, Substance Use, and Risky Sexual Behavior Among Higher Education Students: A Moderated Mediation Analysis of Mask-Wearing Practice During COVID-19

Mental health and substance use emerged as critical factors associated with health risk behaviors during the COVID-19 pandemic, and its importance has only grown in the post-pandemic period, particularly among priority groups like higher education students. To enhance our understanding of how mental health and substance use factors interact with preventive measures like mask-wearing to affect risky sexual behaviors (RSBs), our study examined the associations between depressive symptoms, substance use, and RSBs among college and university students in the United States. We specifically aimed to assess the impact of mask-wearing on the association between depressive symptoms, binge drinking and marijuana use, and RSBs during the pandemic. Data were collected through nonprobability sampling from 835 students at five universities via an online survey conducted between July and August 2020. Using the PROCESS macro, we analyzed the mediating effects of binge drinking and marijuana use on the association between depressive symptoms and RSBs (Model 4), as well as the moderating effect of mask-wearing on the association between depressive symptoms, binge drinking and marijuana use, and RSBs. Our findings revealed that mask-wearing significantly moderated the combined association between depressive symptoms, marijuana use, binge drinking, and RSBs. As we navigate the post-pandemic period, it is crucial for existing programs addressing health risk behaviors to consider the direct and indirect associations between mental health and substance use. Understanding these protective and health risk behaviors is essential for informing targeted prevention and intervention efforts in the post-pandemic landscape.