The COVID-19 pandemic had significant public health implications with severe economic and social consequences globally. Thus, this study aimed at evaluating the changes in various lifestyle habits during the COVID-19 pandemic among a sample of Lebanese adults.
Our results have shown that the COVID-19 pandemic, particularly the lockdown period, has profoundly affected LHBs, highlighting unfavorable lifestyle changes in dietary habits, physical activity (length and type), sleep (duration and quality), and psychological health (irritability, stress, and anxiety).
Several sociodemographic factors were associated with changes in lifestyle and behaviors, including gender. Expectedly, women exhibited significantly lower LHBC-17 scores than men; women and men might not equally experience the negative repercussions of long lockdown periods, fear of infection, frustration, boredom, financial loss, and stigma related to the COVID-19 pandemic. Previous work has demonstrated that Lebanese women had higher stress, anxiety, and post-traumatic stress symptoms than men [38]. As families were confined at home, the domestic chores workload on women has considerably increased, which could have consumed them physically. They had to assume their children homeschooling and secure a “state of tranquility” for learning children or partners, working remotely from home, at least during the total lockdown [39] [40–42]. Thus, lack of energy and time would reduce their ability to improve their habits and behaviors.
Other sociodemographic factors such as being a Lebanese permanent resident and worrying about the economic situation were associated with unfavorable lifestyle changes, whereas having a job and living in an urban region were significantly associated with positive changes. Such results can be explained by the economic hardship that adds to the sanitary crisis in Lebanon. Indeed, Lebanon is witnessing an unprecedented economic crisis and was recently downgraded from a high-income to upper-middle-income country by the World Bank [43]. This critical financial situation was amplified with the inability to control the exchange rates of USD versus Lebanese Pounds that dramatically skyrocketed in less than a year and has led to massive demonstrations, strikes, and temporary bank closures [44] [45]. Hence, Lebanese residents, particularly the unemployed or those worrying about their financial situation, cannot introduce good practices and afford healthy products; they would exhibit a limited and weakened motivation to change habits positively and enhance a healthy lifestyle.
As for the general health-related factors, an increased BMI and gaining weight during COVID-19 were significantly associated with lower LHBC-17 scores. Almost one-third of our sample reported weight gain, in agreement with previous findings showing that 31% of 1012 subjects reported weight gain since lockdown due to COVID-19 began in the United Arab Emirates [30]. Several other studies, including Lebanese ones, had demonstrated weight gain during the COVID-19 home confinement [2, 25, 46–48], likely due to boredom, anxiety, and stress reactions to COVID-19 leading to changes in eating habits, such as increased consumption of highly energetic foods (rich in sugar and fat) [49].
Our results revealed increased smoking among participants. Studies on changes in tobacco use during the pandemic have yielded controversial results [22, 50, 51]; some studies have reported increased tobacco use [52], while others have recorded decreased smoking [50]. Smokers usually intensify their consumption as a coping mechanism during the pandemic, given its detrimental consequences on mental health [53].
When exploring COVID-19-related factors, our results revealed that most participants reported a longer screen time, in line with previous findings [54–57], showing a 65–70% increase in screen time during the COVID-19 pandemic [54, 56]. This increase is explained by the imposed lockdown, where most people had to work or study from home and thus were more likely to spend long screen periods reading, homeschooling, playing, meeting, or watching movies [57]. In our study, participants who reported spending more time per day using electronic devices during the COVID-19 lockdown had significantly lower LHBC-17 scores. A report published by the WHO pointed out that young people, as in our study, might be particularly vulnerable to the harms of excessive screen time, including misinformation about COVID-19, cyberbullying, gaming disorder, and unhealthy sedentary lifestyles [58]. Previous studies have also reported these changes in dietary habits and lifestyle behaviors during the pandemic [9, 30, 48, 59, 60].
Surprisingly, in addition to the longer screen time reported during the COVID-19 pandemic, our results also revealed a slight increase in leisure time healthy physical activities. Moreover, participants who already had better well-being and overall health and those who did not report changes in their physical and mental health during COVID-19 had higher LHBC-17 scores, thus positive lifestyle changes. Similarly, increased physical activity was also described in a study among 1807 participants from the Middle East and North Africa (MENA) region, showing higher physical activity, better health status, and higher mental well-being scores [61]. However, a recent meta-analysis of 66 studies found opposite results, reflected by decreased physical activity and increased sedentary behaviors during the COVID-19 pandemic [62]. One explanation could be that during the period of data collection, the Lebanese government had not imposed strict mobility restrictions, and most of the young participants were able to dodge the vigilance of authorities to go out and continue their daily outdoor sports activities.
Our results revealed that participants who reported having physical and mental health affected by the lockdown had lower LHBC-17 scores, consistent with the findings of a study among Lebanese adults showing that the fear of COVID-19 coupled with economic hardship was associated with higher stress and anxiety [26]. This psychological distress could considerably affect health behaviors, as previously described [63, 64]. Most studies have demonstrated that higher depression, anxiety, and stress were significantly associated with negative changes in physical activity, sleep, smoking, and alcohol consumption [63]. Health-promotion strategies should be implemented to assess negative changes in physical or mental health and maintain as much as possible positive health-related behaviors, particularly in young populations [58].
Limitations and strength
Our study has several limitations related to its cross-sectional design and data collection process. Even though our sample was weighted to adjust for the over or under-representation of gender and Governorate distribution, our population consisted mainly of young people with a university level of education, thus expected to have high computer literacy and internet access. Therefore, our results might not be generalized to the whole population. Moreover, a possible information bias could be likely since the questionnaire was self-administered, with no possibility for clarifying confusing questions.
However, despite these limitations, to the best of our knowledge, this study is the first to evaluate the effect of sociodemographic features, general health-related behaviors, and COVID-19-related factors on lifestyle changes among the general Lebanese population, almost a year after the COVID-19 outbreak. Furthermore, the use of a standardized questionnaire with validated scales with very good to excellent reliability is likely to reduce possible information bias.