Abstract
ObjectivesTo provide baseline cohort descriptives and assess change in health behaviours since the UK COVID‐19 lockdown.DesignA prospective cohort (N = 1,044) of people recruited online, purposively targeting vulnerable populations.MethodsAfter a baseline survey (April 2020), participants completed 3 months of daily ecological momentary assessments (EMA). Dietary, physical activity, alcohol, smoking, vaping and substance use behaviours collected retrospectively for the pre‐COVID‐19 period were compared with daily EMA surveys over the first 30 days during early lockdown. Predictors of behaviour change were assessed using multivariable regression models.Results30% of the cohort had a COVID‐19 at risk health condition, 37% were classed as deprived and 6% self‐reported a mental health condition. Relative to pre‐pandemic levels, participants ate almost one portion of fruit and vegetables less per day (vegetables mean difference −0.33, 95% CI −0.40, −0.25; fruit −0.57, 95% CI −0.64, −0.50), but showed no change in high sugar portions per day (−0.03, 95% CI −0.12, 0.06). Participants spent half a day less per week doing ≥30 min of moderate to vigorous physical activity (−0.57, 95% CI −0.73, −0.40) but slightly increased days of strength training (0.21, 95% CI 0.09, 0.34), increased alcohol intake (AUDIT‐C score change 0.25, 95% CI 0.13, 0.37), though did not change smoking, vaping or substance use behaviour. Worsening health behaviour change was associated with being younger, female and higher body mass index.ConclusionsThe cohort reported worsening health behaviours during early lockdown. Longer term changes will be investigated using further waves of data collection.
Highlights
Worsening health behaviours were associated with being younger, female, and having a high BMI. Health behaviours such as alcohol (Griswold et al, 2018), tobacco and substance use (NHS, 2018), dietary choices (Steel et al, 2018), and physical activity (Reiner, Niermann, Jekauc, & Woll, 2013) have direct impacts on immediate and long-term health outcomes and together account for almost half of all-cause years of life lost in the United Kingdom (Murray et al, 2013)
In addition to being potentially important determinants of contracting and surviving viral infections such as COVID-19, and severity of symptoms, much of the severe pathogenesis of COVID-19 disease progression is known to be linked to a hyperinflammatory immune response (‘cytokine storm’), which may be negatively impacted by poorer patterns of health behaviours (Sinha, Matthay, & Calfee, 2020)
Looking at the three key subgroups focused on, 30% had a COVID-19 atrisk health condition, 38% were from higher deprivation neighbourhoods, and 6% had a self-reported mental health issue
Summary
Health behaviours such as alcohol (Griswold et al, 2018), tobacco and substance use (NHS, 2018), dietary choices (Steel et al, 2018), and physical activity (Reiner, Niermann, Jekauc, & Woll, 2013) have direct impacts on immediate and long-term health outcomes and together account for almost half of all-cause years of life lost in the United Kingdom (Murray et al, 2013). The initial ’lockdown’ measures imposed in the United Kingdom and many countries worldwide swiftly enforced significant changes and constraints on daily living, such as social distancing and limits on people leaving their homes, that are very likely to have impacted profoundly on enacted health behaviours. There are already indications worldwide that social measures have significantly impacted health behaviours such as dietary choices (Deschasaux-Tanguy et al, 2020) and well-being (Lades, Laffan, Daly, & Delaney, 2020). There has been less focus on health behaviours compared with mental health (Arora & Grey, 2020)
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