Overall, the majority of the German population (around 52%-67%) did not report changes in their health behaviour with regard to smoking, alcohol consumption, and physical activity during the first COVID-19 restrictions in spring 2020 compared to the time immediately before. Nevertheless, significantly more respondents reported having smoked more than having smoked less. A comparable negative effect was seen concerning physical activity: more people reported having exercised less than more. About alcohol consumption, the result is different: here, slightly more respondents said they had reduced their alcohol consumption instead of increasing it. It seems that theses behavioural changes are associated with socioeconomic and sociodemographic characteristics such as education, age, gender and income of the respondents.
Our results are comparable with the current figures of the Federal Statistical Office: in the "corona year" 2020, the per capita consumption in Germany for various alcoholic beverages decreased (-5.4% for beer, -2.1% for sparkling wine and − 0.9% for spirits). As possible reasons, the experts cite a lack of drinking opportunities due to closed gastronomy and the absence of many festivities [41]. On the other hand, a total of €28.8 billion worth of tobacco products were taxed, 5.0% more than in the previous year (2019). Differentiated by the various tobacco products (cigarettes, cigars, pipe tobacco, fine cut), only for conventional cigarettes a small decrease of -1.1% was observed. The strongest increase was observed in pipe (+ 44.3%) and fine cut tobacco (+ 10.6%). The strong increase regarding fine cut is assumed to be due to the lack of availability of alternative low-priced cigarettes from other countries and the fact that people roll their own cigarettes [42].
We found associations between changes in all analysed health behaviours (smoking, alcohol drinking, and physical activity) and specific person characteristics, such as higher age, lower education level, and higher net household income. Comparable associations have also been found by other international research groups [28, 29, 31, 43]. As previous studies suggested, aspects such as stress, boredom and anxiety seem to negatively influence health behaviour change during country-specific COVID-19 restrictions [27, 28, 30, 31, 43].
Current studies report heterogeneous results about the change in smoking, drinking behaviour, and physical activity [27–34, 43–45]. Many of these studies were conducted as online surveys, and data were reported as being not representative for the general population of the respective countries. The objective was often to get an initial overview on trends in pandemic-related health behaviour changes. Besides, the duration of the restrictions, as well as the severity of the measures (e.g., curfews) in the specific countries, could influence the change of health behaviour.
Regarding tobacco consumption, our data showed that significantly more people increased (24%) than decreased (12%) their smoking behaviour during strict restrictions. Whereas in our study nearly 36% of the respondents changed their smoking behaviour, only 10.3% (increase 6.9%, decrease 3.4%) of the respondents in an Australian study (online survey, N = 1491) reported this [30]. Similar was reported by a group from Belgium: increase 7.4%, decrease 2.5% [28]. A different pattern was reported from Pakistan: of around 6000 interviewed smokers, 86% changed their smoking behaviour (increase 18%, decrease 68%) [33]. In contrast, a high increase (43%) in tobacco smoking was reported in a different study from Germany (N = 558) and was particularly observed among people with lower educational level or pandemic-related changes in the type of employment (leave of absence/home office) [39].
Positive health effects regarding alcohol consumption were reported during the COVID-19 restrictions: more people reported drinking less alcohol than more during this time. Findings from an Australian online survey are in line with our results (increase 26% (Australia) vs.13% (our study), decrease 18% vs. 20%) [30]. A large study from 21 European countries (N = 40064) also showed a decrease in alcohol consumption during the period of restrictions (April 24th -July 22nd 2020). In Germany, however, this decrease was less pronounced than in other European countries. The authors see possible reasons for this in the increase in alcohol consumption among women and people with risky consumption patterns [45]. However, other studies reported an amplified increase in alcohol consumption during the country-specific restrictions [28, 31, 39, 46]: an international online survey carried out from May to June 2020 (languages: Danish, Dutch, English, Finnish, French, German, Hungarian, Italian, Portuguese, and Spanish; N = 55811) revealed major changes in alcohol consumption: around 36% consumed (slightly) more alcohol, and 22% (slightly) less [46]. The motivational reasons for increased consumption include: boredom, lack of social contact and the lack of a daily structure [28], but also the increase in anxious, depressive behaviour and symptoms of stress [30].
In our study more people reported having exercised less than more during COVID-19 restrictions and can possibly be explained by a limited range of sport opportunities. Similar pattern was also found in further studies [30]. Compared with the results of our study, the proportion of less active people in Australis is lower (29.4% vs.48,9%). Studies from England [32], Belgium [29] and Italy [34] showed that the type of training (strength training, endurance training), the sport location (indoor-/outdoor-sport) the level of activity before restrictions (active vs. not active) [44], the type of sport (team sport vs. individual sport) [29], and the offer of online courses changed the behaviour of physical activity during this time. Reasons given were to have less time, to sit more and to lack the sporty character (competitive element, team sport) [29]. Maybe certain groups of people now have more time available due to the new circumstances or that online courses are increasingly offered and used [47] and can be an important aspect to maintained or even increased the level of physical activity during the restricted sport offers. A web-based survey conducted on May 2020 (12-29th ) among 5021 students of four German universities (mean age 24.4 years) stated, that 30.6% of the respondents reported an increase in vigorous physical activity and 19.3% a decrease [43]. Characteristics associated with a change in health behaviour were being female, younger age, being bored and having depression symptoms.
Our data help to identify and analyse the effects of the COVID-19 restrictions on the consumption of tobacco cigarettes, alcoholic beverages, and physical activity in the German population. Besides, our data complement the data from many other countries to generate as much knowledge as possible around the world. We were able to indicate that the restrictions in spring 2020 has consequences for the health behaviour of people living in Germany. It is positive that some people have used this time to improve their health behaviour, but for many (especially smokers) there are significant negative health consequences. Regarding physical activity, it would be interesting to differentiate between physical activities (strength training, team sports, other activities, etc.) to find out whether it would be possible and useful to switch to new formats (online courses) to counteract the decrease here.
The present study has some limitations. First, the survey period (June-August 2020) is a few months away from the interested period of our study (March-May 2020, as well as the time immediately before). It is possible that the respondents do not remember the past events exactly (recall bias). Second, data were assessed by self-reports. People may answer in a socially desirable way in such surveys, for example by reporting a lower alcohol and tobacco consumption, or higher physical activity. Third, we did not collect the precise level of behaviour change. Knowledge on the increase in daily cigarettes or alcoholic beverages, for example, may allow a deeper understanding on relevant changes. Another aspect is that no causal relationship between a change in health behaviour and the pandemic-related restrictions can be proven with the cross-sectional study design.
However, our study has strengths: besides a large and representative sample, another strength is the analysis of associations of health behaviour change with socioeconomic and sociodemographic characteristics.