Top

Published in:

01-12-2021 | COVID-19 | Research

Lifestyle habits of adults during the COVID-19 pandemic lockdown in Cyprus: evidence from a cross-sectional study

Authors: Ourania Kolokotroni, Maria C. Mosquera, Annalisa Quattrocchi, Alexandros Heraclides, Christiana Demetriou, Elena Philippou

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

The COVID-19 pandemic and the widespread adoption of virus control measures have inevitably disrupted efforts to address lifestyle risk factors for non-communicable diseases (NCD). This study aimed to explore the effects of COVID-19 lockdown on all lifestyle medicine pillars, namely diet, physical activity, sleep, stress, social support and use of risky substances.

Methods

This was a cross-sectional study on a convenient sample of adults who resided in Cyprus during the Spring 2020 lockdown. Participants completed an anonymous online questionnaire comprised of six validated tools regarding the following lifestyle behaviours before and during lockdown: adherence to the Mediterranean diet, physical activity, stress and social support levels, sleep pattern and use of risky substances such as smoking and alcohol. Paired before and during lockdown comparisons for each lifestyle pillar were undertaken using Wilcoxon Signed-Rank test and Bowker symmetry Test where response was numerical (non-parametric data) and categorical respectively. Furthermore, stratified analyses for sociodemographic characteristics were performed.

Results

Out of 745 participants, 74% were female and median age was 39 years. Overall participants reported significantly higher perceived stress score (22 v 25, p < 0.01), lower social support score (71 v 68, p < 0.001), and worse sleep quality score (4 v 5, p < 0.01) during lockdown. Mediterranean diet (MD) adherence was moderate and increased significantly only in those practicing religious fasting (score of 6 v 7, p < 0.01). Total minutes spent sitting increased (120 v 180, p < 0.01) although overall physical activity score did not significantly change. Smoking intensity increased during lockdown whilst frequency of alcohol consumption decreased (p_trend = 0.03 and < 0.01, respectively).

Conclusion

Various lifestyle factors were adversely affected by the COVID-19 lockdown in Cyprus. Evidence from this study supports development of holistic lifestyle interventions during and following the pandemic to reduce short and long-term NCD risks by building on lifestyle behaviour strengths and addressing longstanding and emerging gaps and needs.

Available only for authorised users

Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157–60. https://doi.org/10.23750/abm.v91i1.9397.CrossRefPubMedPubMedCentral

Kumaresan J, Bolaji B, Kingsley JP, Sathiakumar N. Is the COVID-19 pandemic an opportunity to advance the global noncommunicable disease agenda? Int J Noncommun Dis. 2020;5(2):43.CrossRef

Nyberg ST, Singh-Manoux A, Pentti J, Madsen IE, Sabia S, Alfredsson L, et al. Association of Healthy Lifestyle with years Lived without Major Chronic Diseases. JAMA Intern Med. 2020;180(5):760–8. https://doi.org/10.1001/jamainternmed.2020.0618.CrossRefPubMed

Vardavas CI, Nikitara K. COVID-19 and smoking: a systematic review of the evidence. Tob Induc Dis. 2020;18. https://doi.org/10.18332/tid/119324.

Hamer M, Kivimäki M, Gale CR, Batty GD. Lifestyle risk factors, inflammatory mechanisms, and COVID-19 hospitalization: a community-based cohort study of 387,109 adults in UK. Brain Behav Immun. 2020;87:184–7. https://doi.org/10.1016/j.bbi.2020.05.059.CrossRefPubMedPubMedCentral

Reddy RK, Charles WN, Sklavounos A, Dutt A, Seed PT, Khajuria A. The effect of smoking on COVID-19 severity: a systematic review and meta-analysis. J Med Virol. 2021;93(2):1045–56. https://doi.org/10.1002/jmv.26389.CrossRefPubMed

Seidu S, Gillies C, Zaccardi F, Kunutsor SK, Hartmann-Boyce J, Yates T, et al. The impact of obesity on severe disease and mortality in people with SARS-CoV-2: A systematic review and meta-analysis. Endocrinol Diabet Metabol. 2021;4(1):e00176.

Ren X. Pandemic and lockdown: a territorial approach to COVID-19 in China, Italy and the United States. Eurasian Geogr Econ. 2020:1–12. https://doi.org/10.1080/15387216.2020.1860786.

Stanton R, To QG, Khalesi S, Williams SL, Alley SJ, Thwaite TL, et al. Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and Alcohol use in Australian adults. Int J Environ Res Public Health. 2020;17(11):4065. https://doi.org/10.3390/ijerph17114065.CrossRefPubMedCentral

10.

Giustino V, Parroco AM, Gennaro A, Musumeci G, Palma A, Battaglia G. Physical activity levels and related energy expenditure during COVID-19 quarantine among the Sicilian active population: a cross-sectional online survey study. Sustainability. 2020;12(11):4356. https://doi.org/10.3390/su12114356.CrossRef

11.

Scarmozzino F, Visioli F. Covid-19 and the subsequent lockdown modified dietary habits of almost half the population in an Italian sample. Foods. 2020;9(5):675. https://doi.org/10.3390/foods9050675.CrossRefPubMedCentral

12.

Stockwell S, Trott M, Tully M, Shin J, Barnett Y, Butler L, et al. Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review. BMJ Open Sport Exerc Med. 2021;7(1):e000960. https://doi.org/10.1136/bmjsem-2020-000960.CrossRefPubMed

13.

Pérez-Rodrigo C, Gianzo Citores M, Hervás Bárbara G, Ruiz-Litago F, Casis Sáenz L, Arija V, et al. Patterns of Change in dietary habits and physical activity during lockdown in Spain due to the COVID-19 pandemic. Nutrients. 2021;13(2):300. https://doi.org/10.3390/nu13020300.CrossRefPubMedPubMedCentral

14.

Jahrami H, BaHammam AS, Bragazzi NL, Saif Z, Faris M, Vitiello MV. Sleep problems during the COVID-19 pandemic by population: a systematic review and meta-analysis. J Clin Sleep Med. 2021;17(2):299–313. https://doi.org/10.5664/jcsm.8930.CrossRefPubMedPubMedCentral

15.

Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912–20. https://doi.org/10.1016/S0140-6736(20)30460-8.CrossRefPubMedPubMedCentral

16.

Zhao X, Lan M, Li H, Yang J. Perceived stress and sleep quality among the non-diseased general public in china during the 2019 coronavirus disease: a moderated mediation model. Sleep Med. 2020;77:339–45.CrossRefPubMedPubMedCentral

17.

Casagrande M, Favieri F, Tambelli R, Forte G. The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population. Sleep Med. 2020;75:12–20. https://doi.org/10.1016/j.sleep.2020.05.011.CrossRefPubMedPubMedCentral

18.

Castillo CC. Analysis of the stress, anxiety and healthy habits in the Spanish Covid-19 confinement. Health Sci J. 2020;14(2):707.

19.

Balanzá-Martínez V, Kapczinski F, de Azevedo CT, Atienza-Carbonell B, Rosa AR, Mota JC, et al. The assessment of lifestyle changes during the COVID-19 pandemic using a multidimensional scale. Rev Psiquiatr Salud Ment. 2021;14(1):16–26. https://doi.org/10.1016/j.rpsm.2020.07.003.CrossRef

20.

López-Bueno R, Calatayud J, Casaña J, Casajús JA, Smith L, Tully MA, et al. COVID-19 confinement and health risk behaviors in Spain. Front Psychol. 2020;11:1426. https://doi.org/10.3389/fpsyg.2020.01426.CrossRefPubMedPubMedCentral

21.

Guthrie GE. What is lifestyle medicine? Am J Lifestyle Med. 2018;12(5):363–4. https://doi.org/10.1177/1559827618759992.CrossRefPubMedPubMedCentral

22.

Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. Prev Med. 2012;55(3):163–70. https://doi.org/10.1016/j.ypmed.2012.06.017.CrossRefPubMed

23.

Quattrocchi A, Mamais I, Tsioutis C, Christaki E, Constantinou C, Koliou M, et al. Extensive testing and public health interventions for the control of COVID-19 in the Republic of Cyprus between march and may 2020. J Clin Med. 2020;9(11):3598. https://doi.org/10.3390/jcm9113598.CrossRefPubMedCentral

24.

García-Conesa M, Philippou E, Pafilas C, Massaro M, Quarta S, Andrade V, et al. Exploring the validity of the 14-item Mediterranean diet adherence screener (MEDAS): a cross-National Study in seven European countries around the Mediterranean region. Nutrients. 2020;12(10):2960. https://doi.org/10.3390/nu12102960.CrossRefPubMedCentral

25.

Papathanasiou G, Georgoudis G, Papandreou M, Spyropoulos P, Georgakopoulos D, Kalfakakou V, et al. Reliability measures of the short international physical activity questionnaire (IPAQ) in Greek young adults. Hell J Cardiol. 2009 August 01;50(4):283–94.

26.

Kotronoulas GC, Papadopoulou CN, Papapetrou A, Patiraki E. Psychometric evaluation and feasibility of the Greek Pittsburgh sleep quality index (GR-PSQI) in patients with cancer receiving chemotherapy. Support Care Cancer. 2011;19(11):1831–40. https://doi.org/10.1007/s00520-010-1025-4.CrossRefPubMed

27.

Katsarou A, Panagiotakos D, Zafeiropoulou A, Vryonis M, Skoularigis I, Tryposkiadis F, et al. Validation of a Greek version of PSS-14; a global measure of perceived stress. Cent Eur J Public Health. 2012;20(2):104–9. https://doi.org/10.21101/cejph.a3698.CrossRefPubMed

28.

Nicolaou C, Koula C, Papathanassoglou E. Cross-cultural applicability of the Medical Outcomes Study—social support survey as a measure of perceived social support among Greek-Cypriot Mothers. Alaska: 20th IEA World congress of epidemiology; 2014.

29.

Saunders JB, Aasland OG, Babor TF, De La Fuente Juan R, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88(6):791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x.CrossRefPubMed

30.

Ammar A, Trabelsi K, Brach M, Chtourou H, Boukhris O, Masmoudi L, et al. Effects of home confinement on mental health and lifestyle behaviours during the COVID-19 outbreak: insight from the “ECLB-COVID19” multi countries survey. Nutrients. 2020;12(6):1583.

31.

Sarri KO, Linardakis MK, Bervanaki FN, Tzanakis NE, Kafatos AG. Greek orthodox fasting rituals: a hidden characteristic of the Mediterranean diet of Crete. Br J Nutr. 2004;92(2):277–84. https://doi.org/10.1079/BJN20041197.CrossRefPubMed

32.

Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attinà A, Cinelli G, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):1–15.CrossRef

33.

Sidor A, Rzymski P. Dietary choices and habits during COVID-19 lockdown: experience from Poland. Nutrients. 2020;12(6):1657. https://doi.org/10.3390/nu12061657.CrossRefPubMedCentral

34.

Rodríguez-Pérez C, Molina-Montes E, Verardo V, Artacho R, García-Villanova B, Guerra-Hernández EJ, et al. Changes in dietary Behaviours during the COVID-19 outbreak confinement in the Spanish COVIDiet study. Nutrients. 2020;12(6):1730. https://doi.org/10.3390/nu12061730.CrossRefPubMedCentral

35.

Maugeri G, Castrogiovanni P, Battaglia G, Pippi R, D'Agata V, Palma A, et al. The impact of physical activity on psychological health during Covid-19 pandemic in Italy. Heliyon. 2020;6(6):e04315. https://doi.org/10.1016/j.heliyon.2020.e04315.CrossRefPubMedPubMedCentral

36.

Lesser IA, Nienhuis CP. The impact of COVID-19 on physical activity behavior and well-being of Canadians. Int J Environ Res Public Health. 2020;17(11):3899. https://doi.org/10.3390/ijerph17113899.CrossRefPubMedCentral

37.

El-Zoghby SM, Soltan EM, Salama HM. Impact of the COVID-19 pandemic on mental health and social support among adult Egyptians. J Community Health. 2020 August 01;45(4):689–95. https://doi.org/10.1007/s10900-020-00853-5.CrossRefPubMedPubMedCentral

38.

Xiao H, Zhang Y, Kong D, Li S, Yang N. Social capital and sleep quality in individuals who self-isolated for 14 days during the coronavirus disease 2019 (COVID-19) outbreak in January 2020 in China. Med Sci Monit. 2020;26:e923921.PubMedPubMedCentral

39.

Tull MT, Edmonds KA, Scamaldo K, Richmond JR, Rose JP, Gratz KL. Psychological outcomes associated with stay-at-home orders and the perceived impact of COVID-19 on daily life. Psychiatry Res. 2020;289:113098.CrossRefPubMedPubMedCentral

40.

Groarke JM, Berry E, Graham-Wisener L, McKenna-Plumley PE, McGlinchey E, Armour C. Loneliness in the UK during the COVID-19 pandemic: cross-sectional results from the COVID-19 psychological wellbeing study. PLoS One. 2020;15(9):e0239698. https://doi.org/10.1371/journal.pone.0239698.CrossRefPubMedPubMedCentral

41.

Probst T, Budimir S, Pieh C. Depression in and after COVID-19 lockdown in Austria and the role of stress and loneliness in lockdown: a longitudinal study. J Affect Disord. 2020;277:962–3. https://doi.org/10.1016/j.jad.2020.09.047.CrossRefPubMedPubMedCentral

42.

Cellini N, Canale N, Mioni G, Costa S. Changes in sleep pattern, sense of time and digital media use during COVID-19 lockdown in Italy. J Sleep Res. 2020:e13074.

43.

Fluharty M, Taylor AE, Grabski M, Munafò MR. The association of cigarette smoking with depression and anxiety: a systematic review. Nicotine Tobacco Res. 2016;19(1):3–13.CrossRef

44.

Klemperer EM, West JC, Peasley-Miklus C, Villanti AC. Change in tobacco and electronic cigarette use and motivation to quit in response to COVID-19. Nicotine Tobacco Res. 2020;22(9):1662–3. https://doi.org/10.1093/ntr/ntaa072.CrossRef

45.

Yach D. Tobacco use patterns in five countries during the COVID-19 lockdown. Nicotine Tob Res. 2020;22(9):1671–2. https://doi.org/10.1093/ntr/ntaa097.CrossRefPubMedPubMedCentral

46.

Institute of Alcohol Studies. Alcohol consumption during the COVID-19 pandemic in the UK. Second IAS briefing. Available at: https://movendi.ngo/wp-content/uploads/2020/10/IAS-2nd-Briefing-on-alcohol-consumption-during-COVID-19-in-UK.pdf. Accessed Dec 2020.

47.

Alcohol Change UK. Research: Drinking in the UK during Lockdown and Beyond. Available at: https://alcoholchange.org.uk/blog/2020/drinking-in-the-uk-during-lockdown-and-beyond. Accessed Dec 2020.

48.

Cyprus Statistical Service. Demographic Statistics. 2019. Available at: https://www.mof.gov.cy/mof/cystat/statistics.nsf/All/6C25304C1E70C304C2257833003432B3/$file/Demographic_Statistics_Results-2019-EN-301120.pdf?OpenElement.

49.

Oberndorfer M, Dorner T, Brunnmayr M, Berger K, Dugandzic B, Bach M. Equally Affected? Health-Related and Socioeconomic Adversities of the COVID-19 Pandemic in Vienna; 2020.

Title: Lifestyle habits of adults during the COVID-19 pandemic lockdown in Cyprus: evidence from a cross-sectional study
Authors: Ourania Kolokotroni
Maria C. Mosquera
Annalisa Quattrocchi
Alexandros Heraclides
Christiana Demetriou
Elena Philippou
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: COVID-19
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-10863-0

At a glance: The STEP trials

Springer Medicine

Lifestyle habits of adults during the COVID-19 pandemic lockdown in Cyprus: evidence from a cross-sectional study

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Excess of all-cause mortality is only partially explained by COVID-19 in Veneto (Italy) during spring outbreak

Mental health outcomes of a pilot 2-arm randomized controlled trial of a HIV-prevention program for South African adolescent girls and young women and their female caregivers

Socio-environmental and psychosocial predictors of smoking susceptibility among adolescents with contrasting socio-cultural characteristics: a comparative analysis

Co-design of a digital dietary intervention for adults at risk of type 2 diabetes

The road beyond licensing: the impact of a driver licensing support program on employment outcomes for Aboriginal and Torres Strait Islander Australians

Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change