Health behaviours of young adults during the outbreak of the Covid-19 pandemic – a longitudinal study

A retrospective-pre-post survey study was performed from 24 March 2020 to 11 April 2020 (a period of 19 days) using an online questionnaire survey method. The survey began 12 days after the pandemic was announced at the site of the study, i.e. between weeks 2 and 4 of obligatory lockdown, which entailed significant restriction of movement. Only participants in early adulthood (aged from 18 to 34 years) of Polish nationality resident in south-east Poland throughout the pandemic period were recruited in the study. The snowball sampling method was used. Questions in the online-survey were connected with health-behaviours in the pre-COVID-19 (recall) and COVID-19 periods. The pre-COVID-19 period was defined as the period 1 week before the mandatory quarantine, and the COVID-19 period as the period of 1 week before completion of the questionnaire. Participation in the study was voluntary and anonymous. At the beginning of the online survey, participants after reading all of the information about the study gave informed consent by clicking the option “Yes”. The study as well as the proposed method of obtaining consent were approved by the Ethics Committee of Rzeszów University (ref. no. 2/02/2019).

Data published by Statistical Office confirm that around 250,000 adults aged from 18 to 34 years live in south-eastern Poland. Assuming a confidence level of 95%, and a 5% margin of error, the required sample size should cover at least 384 participants. A completed survey was received from 690 respondents. Of those respondents, 184 were excluded from the study due to failure to meet the eligibility criteria (place of residence: south-eastern Poland, age from 18 to 34 years, lack of chronic comorbidities, lack of another health burden i.e. pregnancy, condition after surgery, musculoskeletal injury). The final study group consisted of 506 subjects.

Another important pillar of human health is rational nutrition based on nutritious food products, full of vitamins (e.g. A, C, D and E) and trace elements (e.g. zinc, selenium, iron), which support the immune system and many other physiological processes [19]. A period of isolation is associated with high psychological pressure. This situation carries the risk of people eating larger amounts of food at a higher frequency, as well as changing the preferred products in their diet [20]. This is confirmed by Zachary’s results, in which as many as 52% of respondents increased their food intake in response to stress, and 73% ate when they felt bored during quarantine [21]. This thesis was also confirmed by our own results, as the respondents changed some food preferences, e.g. in the case of sweets and cereal products. Various directions of changes were observed (both increasing and decreasing), but when analysing the group as a whole, consumption was similar in both periods. It was different in the case of alcohol and fats, where a significant increase in their consumption has been confirmed. Similarly, Flaudias observed that stress related to the lockdown and social isolation increased the risk of problematic eating behaviours among young people e.g. binge eating disorder and dietary restriction [22]. The international ECLB-COVID19 electronic survey confirms that food consumption and meal patterns were more unhealthy during home confinement, but in contrast with our own study, alcohol consumption decreased significantly [23]. Rehm draws attention to two potential main mechanisms of the possible impact of Covid-19 on alcohol use. The first is the model of increased alcohol consumption, mainly among men, associated with greater stress, loss of work and a change in the lifestyle that had been pursued so far. Some studies show up to six times higher alcohol consumption during the pandemic among male than female respondents [24]. The second model assumes reduced alcohol consumption due to reductions in income and the closing of on-premise consumption sites [25].

Abbas emphasizes the problem of widespread obesity during the Covid-19 pandemic, which results, among others, from lower physical activity during restrictions and consumption of more energy-dense foods that are rich in fat and sugar. Although no relationship between health behaviours and BMI was found in our study, similar behavioural patterns were observed. Increased stress associated with the pandemic adversely affects the brain areas responsible for the ability to self-regulate that are needed to control health behaviours, including nutrition and physical activity, which are the basis for controlling weight. Stress reduces the desire for physical activity, strengthens the tendency to eat more food and disturbs sleep by shortening its length. All these factors contribute to the development of obesity, which has been a global problem for many years, including among the populations of children, adolescents and young adults [26].

One of the key health-promoting behaviours that improves physical fitness but also supports mental health is physical activity (PA) and avoidance of sedentary behaviour (SB) [27]. From the point of view of the current epidemiological situation, PA is even more important than before, because in addition to improving physical and mental condition, it stimulates immune mechanisms [28]. Exercise has been shown to reduce anxiety and depression symptoms, as well as improve self-esteem and cognitive function [29]. Huang’s extensive meta-analysis confirms that mentally passive SBs increase the risk of depression [30].

Just 150 min of moderate-to-vigorous intensity aerobic physical activity per week (MVPA) or a minimum of 10,000 steps/day, bring positive benefits to young adults’ health, and these recommendations sill apply during the pandemic [31, 32]. The initial period of the pandemic significantly reduced the frequency with which people left their homes and the time they spent in recreational places, such as swimming pools, gyms, fitness clubs, parks and playgrounds, making it significantly more difficult for them to be active. The Covid-19 pandemic has promoted sedentary behaviour, as the possibilities of being active are limited and, if they are available at all, they are associated with fear of infection and an attitude of withdrawal. In this context, the pandemic creates highly adverse conditions with a risk of long-term consequences [33]. The results of our own study confirmed a significant decrease in PA and a simultaneous increase in SB among young adults. In the young adult population of the south-eastern region of Poland, adverse changes were found particularly among younger people and females. Using the overall IPAQ indicator, there was a significant decrease from 8752.5 MET min/week (pre-pandemic period) to 6174.6 MET min/week (during the pandemic). In the case of the time declared to have been spent on SB, a significant increase was recorded from 240 min (4 h) to 300 min (5 h). Zachary obtained results from an online survey method, which shows that adults during quarantine spent an average of 4.8 h per day watching TV or playing video games and 2.5 h per day on a computer (in total about 7.3 h per day of SB) and that they accumulate 2.7 h per week of PA [21]. The international ECLB-COVID19 electronic survey also confirmed that home confinement had a negative effect on all PA intensity levels (vigorous, moderate, walking and overall), and daily sitting time increased from 5 to as much as 8 h per day [22].

Currently, little is known about the effect of PA on the susceptibility to SARS-CoV-2 infection. However, it is emphasized that disruption of daily exercise routines and reduction of the current daily PA may increase predisposition to viral infections and comorbidities, i.e. heart disease, type 2 diabetes, obesity and hypertension, which significantly worsen the course of a Covid-19 infection [34]. PA is recommended in the fight against the negative effects of the pandemic at every stage, including in the future, because it enhances the efficacy of vaccines [35, 36]. It is recommended that during the pandemic people of all ages try to be as active as possible, and the safest form is moderate intensity exercise performed at home, using applications or online videos with instructors [37‐39].

Hygiene and the quality of sleep are important elements of everyday functioning, and so special attention is paid to them in modern times. It turns out that providing the right amount of sleep and stable sleeping times are necessary for the smooth functioning of the immune system and circadian hormonal rhythm, which are extremely important during a pandemic. Using the PSQI scale, the study group noted a significant decrease in sleep quality during the pandemic and an increase in the value of the PSQI global score from 7.00 to 9.00. Casagrande reports that the group she studied had lower sleep quality during the pandemic, where the PSQI global score was 5.69, compared to general data from Curcio of 4.00. Female subjects had a higher risk of sleep disorders. The results of our own study obtained higher results than both of those authors, therefore the sleep quality of the studied group was even lower [40, 41]. Romero-Blanco observed that the worsening of sleep quality occurred mainly in the subgroups: female, first-year students and second-year students [42]. Luciano pointed out that hours sitting per day was higher among young adults who were sleeping less than 7 h per night during the pandemic [43].

The results for smokers are debatable. The more the people surveyed smoked, the less noticeable was their deterioration in sleep quality, as opposed to non-smokers and those who smoke less often, who more often showed worse sleep. This result can be explained by the fact that despite the fact that smoking negatively affects health, during the pandemic it played an anti-stress role, which was associated with relatively better quality of sleep. Different results were obtained by Liao, where the PSQI global score for smokers was 4.72 and for non-smokers 4.11, which indicated worse quality of smokers’ sleep [44]. The contradictory research results should be explained by the completely different conditions caused by the pandemic and altered human responses during this period. In the Liao study, people from all age groups participated, starting from adolescents 12–17 years old, where as many as 6.6% of this group smoked, while in the age group 18 to 29 years old - 36.9%. These rates were much higher than in our own study, where there were 9.5% regular smokers among the respondents. Patterson reports that sleep disorders are often seen in people who have given up smoking, as many as 43% of whom report insomnia, and even up to 80% report some kind of sleep disorder, thus confirming the strong relationship between cigarette smoking and sleep quality [45].

The work also addresses an important aspect of the feeling of generalized anxiety among young adults, which increased significantly during the pandemic, especially in people with lower level of education. In the study conducted by Ahmed, as many as one-third of the respondents (37.6%) reported lower perceived mental well-being, and most was reported by young people between 21 and 30 years of age. Similarly, in the case of having different levels of anxiety and depression, it was young people who more often had problems with their mental state than older people [20]. In our own study, people who experienced higher generalized anxiety spent much more time sedentarily, i.e. they were sitting for much longer, primarily watching TV and browsing the Internet on a tablet or a mobile phone. Specialist recommendations seek to limit the viewing of current news about the pandemic on TV, which, due to the huge amount of overwhelming information, adversely affects people’s mental state. As confirmed by our own research, this also had an impact, worsening the quality of sleep, especially for people who experience high generalized anxiety. In our study, the overall score on the GAD 7 scale in the pre-pandemic period was 3.63 points, while during the pandemic it increased to 6.70 points, which indicates a worsening of symptoms. In the Casagrande study, the generalized anxiety of respondents during the pandemic was 7.61 on the GAD 7 scale, and was significantly higher compared to general data from Löwe, which was 2.95. Although the respondents came from different age groups, it was judged that females between 18 and 30 years of age were most at risk of anxiety. This confirms that young adults are a vulnerable group that suffered many negative effects of the pandemic [15, 41].

In recent decades, modern health behaviours of young adults have largely departed from the adopted recommendations. The presence of the Covid-19 pandemic reinforces abnormal health behaviour patterns that are already common among young people and significantly increases their anxiety. Orders to prevent the spread of Covid-19 disease create even more difficult conditions for the improvement of health-related behaviours among the young population. It should be taken into account that poor health habits, both in the context of physical and mental health, may aggravate other existing public health problems. The young population conducting unhealthy lifestyles is linked not only with a higher risk of non-communicable disease (NCD) but also of Covid-19 hospital admission [46]. That is why it is so important in this particular period to emphasize even more the importance of shaping people’s health behaviours, with particular attention being paid to the young population.

The presented study was completed shortly after the beginning of the outbreak of the pandemic and comes from only one region of Poland. One of the limitations was the inability to use objective research methods, requiring direct contact with the subject, during an ongoing pandemic. However, the study used the most common and standardized questionnaires, which are recognized survey methods. The presented data describe the subjective feelings of the respondents, and information from before and during the pandemic period is obtained using the recall method. The study may go further to cover other important threads of health behaviour during the pandemic, i.e. a thorough analysis of smoking or oral health, dental check-ups, medical screenings or risky driving.