Overall, our findings indicate that adult remote Alaska residents are relying on positive coping strategies to contend with additional stress brought into their lives by the COVID-19 pandemic. We examined coping strategies and household stress across three time points during the pandemic among residents of remote Alaska communities. Personal care remained the most commonly reported coping strategy, with religious activities increasing over time, possibly due to increased desire and/or access to online opportunities. Subsistence activities also increased across survey waves, which may be due to such activities (fishing, hunting, berry picking) being more common during the spring (survey wave 2), and summer (reflected in survey wave 3). Furthermore, while alcohol and marijuana use remained relatively consistent over time, nicotine use increased. These results indicate that sustained stress may lead to use of nicotine as a coping strategy for a greater number of individuals, which is consistent with other findings in the US [eg. 32]. However, due to the unique and specific nature of both subsistence activities in Alaska and the novelty of the COVID-19 pandemic, these deductions are not verifiable without additional retrospective data collection but are nevertheless highly plausible.

Personal care, in this study, was defined by engaging in healthy behaviours such as healthy eating and sufficient hydration, exercising, adequate sleep, as well as relaxing and engaging in meditative practices. Greater measures of healthy ways of life, personal hygiene, and relaxation practices such as these have been associated with higher reported wellbeing and reduced stress, indicating that these are helpful ways of reducing pandemic-related tension across different cultures including Germany, Lebanon, and the US [6,21,22,31–33].

While these activities may be more difficult to engage in given more crowded living conditions, limited access to water, and other barriers present in remote communities, they still ranked the highest among coping strategies, possibly further indicating the high value placed on them in this population. Similarly, social activities are connected to increased feelings of support and positively predict engagement in other positive coping strategies in the context of the pandemic, therefore potentially providing additional stress relief. Analogous patterns have been observed among Latinx communities in the US [6], study participants in Pakistan, India, and Saudi Arabia [34], England [35], and Australia [36].

In this study, social activities were reported significantly more frequently among female compared to male survey respondents in survey 3 (March 2021), indicating that women may utilise this coping strategy more often. Religious activities, including praying alone and with others and contacting a pastor or priest, is positively correlated with support and connection, as well as “placing worries in God’s hands”; all of which provide stress relief and additional support among diverse populations including US, European, and East Asian countries [6,24,34,37]. In addition, approximately 50% of respondents reported contacting a professional health care provider as a coping strategy, which has been shown to be a less common, but still important strategy for maintaining wellbeing during the pandemic [19,23,34]. Given our findings and others related to the pandemic reviewed above, remote Alaska residents are commonly engaging in coping strategies associated with greater support, connection, healthy practices, and seeking professional health care support.

Participating in subsistence and traditional Alaska Native activities such as hunting, fishing, and harvesting foods from the land and water were also revealed to be a frequently used coping strategy by study participants. We are unaware of any other study that has identified these specific activities as coping strategies during the pandemic in other geographic areas, pointing to the idea that this may be an important and relatively unique source of stress relief available to remote Alaska residents. However, these activies are in line with the recommended interventions by Shamblaw et al. to improve effective coping during COVID 19 by emphasising self-efficacy and connectedness. (2021). Indeed, prior research in the Yukon-Kuskokwim region of Alaska has demonstrated the protective effects of engaging in traditional activities for both physical and mental health before the pandemic [16]. Interestingly, among survey 1 respondents (November – December 2020), subsistence/traditional activities were reported significantly more among men compared to women, which may indicate that this coping strategy is more accessible and/or more desired among men compared to other coping mechanisms that showed no difference across gender. In addition, people in the 25–54-year-old age group were significantly more likely to report participating in subsistence activities compared to people in all other age groups in survey 2 (March 2021), which indicates that this age group is more likely to engage in these activities compared to older or younger adults. Other studies conducted during the pandemic, including in the US, Africa, Europe, and East Asia, have also shown the importance for men and women of spending time outside in gardens, parks, or other green spaces for improved wellbeing and helping unwind from additional pressures brought on by the pandemic [34,38,39].

Substance use including alcohol, nicotine, and marijuana, was among the least-frequently reporting coping strategies, only slightly surpassing seeking professional health counselling. This finding is in line with studies among other populations that have also reported increased use of alcohol, nicotine, and other substances as a coping strategy, which found up to 29% increase in alcohol use during the early pandemic [26,40]. In addition, analysing these data across gender and age revealed some variation between groups. In contrast to prior studies that found increased alcohol consumption among women [27,41] or men [26] during the pandemic, no difference between genders was found in terms of alcohol use or other substances. Regardless of age and gender differences, the fact that substance use was one of the least commonly reported coping strategies may be related to protective factors that rural communities can confer, including greater social support, interaction, and community attachment [19].

Further demonstrating the comparatively lower use of substances as a coping mechanism among older adults, older people were less likely to report using alcohol or other substances as a coping strategy compared to younger age categories. These results are similar to those found in studies during the pandemic, where young adults (18–34 years) reported greater alcohol use compared to older adults [27]. However, this may differ by population as evidenced by Pollard and colleagues finding an increase in alcohol use among those age 30–59 in the US (2020). And although this study asked about increased substance use, not substance misuse, these findings do reflect the overall pattern of alcohol use disorder being the lowest among adults 65 years of age and above in the US [29]. These differences between age groups suggest that public health efforts related to curtailed substance use as a coping strategy be targeted towards adults aged 55 years and below and identifies older age as a potential protective factor for utilising substances in times of increased stress.

The identification of coping strategies used among remote Alaskan residents is particularly important considering our findings that demonstrate increased family and household stress among approximately half of survey respondents. Previous studies have found that the pandemic is accompanied by multifaceted changes to family environment and dynamics, many of which led to increased stress and tension due to more limited resources, limited household space, long periods of confinement, increased caregiving demands, decreased, patience, and increased frustration [6,34,42]. These findings like those reported here with participants reporting greater household stress since the onset of the pandemic, with these patterns generally decreasing between winter 2020 and fall of 2021. Conversely, although reported at relatively low rates (<10%), more severe indicators of household stress, including reports of adults spanking or hitting children, or adults hitting, harming, or throwing things at other adults in the home increased across this same time, potentially indicating the cumulative effects of pandemic-related stress. Increases in intimate partner violence have been reported in other populations during the pandemic as well and associated with restricted access to resources and use of negative coping mechanisms such as excessive alcohol consumption [6,43,44].

This study had a number of limitations. Although the survey data collected over three time periods provides snapshots of coping strategies used and household stress patterns, each wave had different participants so conclusions about change over time should take that into consideration. Moreover, survey 1 had a small number of participants, which could potentially skew the results in some ways. These online surveys were potentially not available to some individuals, especially those in possibly some of the most vulnerable groups (e.g. non-English speakers, people without reliable internet, older adults). In addition, data were only collected from individuals 18 years old and above, and therefore does not capture potentially major impacts on children and adolescents. And, although providing contact information was voluntary (so survey could be anonymous), people may be more likely to report positive coping strategies. Women were also overrepresented among survey participants, which is a common sampling bias pattern [45]. This may be because a higher percentage of women use Facebook, which was the primary mode of recruitment for the study [46], or because fewer men respond to study recruitment in general [47,48]. In order to encourage a more representative sample for future studies, the authors would suggest specifically targeting underrepresented demographics (e.g. men) through Facebook ads, as well as distributing the survey through community contacts, city and Tribal government websites, and other more targeted online and in-person groups. The choice to recruit on Facebook was made on advice of key informants and community stakeholders with prior knowledge of the efficacy of various forms of survey distribution; knowledge that should be sought after and leveraged when possible. The present study was limited by time and the urgency of collecting timely data on the evolving COVID-19 pandemic, and the necessity of online distribution for ensuring safety of participants and study personnel. Finally, while informative, the study sample is not wholly representative of all remote Alaska residents and should therefore be interpreted and utilised with that taken into consideration.