Knowing Well,Being Well: well-being born of understanding: Shifts in Health Behaviors Amid the COVID-19 Pandemic

Prior to the pandemic, my friend and Iwent running together every morning at 5 am. Ourstreak ended in March 2020 when we decided it was no longer safe to run together given the spread of the coronavirus. My running routine deteriorated. I simply could not get out of bed that early without someone holding me accountable. However, because I now worked from home and no longer had to pick my kids up from school due to remote learning, I was able to start a new habit of afternoon walks while talking on the phone with friends. The pandemic had ended my running habit but had enabled a new healthy behavior.

My experience was certainly not unique. The coronavirus pandemic created a disruption that was so extreme it challenged well established health behaviors practically overnight. Across the U.S., there were closures, restrictions on travel, limited in-person gatherings, and stay-at-home orders. In addition, many experienced jolting employment and related economic changes including losing their job, being furloughed, reduced hours, new roles and responsibilities, and transitions to working from home. This disruption led to forced discontinuation of habits, such as going to gym, that people had been doing for years. At the same time, it also created a window of opportunity for the adoption of new behaviors given time saved from the reduction of in-person activities and commutes.

The habit discontinuity hypothesis suggests that when habits are broken in the face of major disruptions (such as those sparked by the pandemic), there is a window of opportunity for behavior change that is deliberately considered. ¹ This is because discontinuities that force an individual to alter behaviors concurrently prompt information seeking and create an open mindset for change. Consistent with this hypothesis, there is evidence that behavioral change interventions are more effective when delivered in the context of major disruptions to habits. For example, interventions encouraging public transportation are most effective on populations who had recently moved. ² It is thus interesting to consider how the policies and innovations spurred by the pandemic, such as those that enabled work-life balance and improved access to behavioral health treatment, were able to take advantage of this window of opportunity and lead to positive changes in behaviors and opportunities for resiliency.

In this edition of KWBW, four contributions examine how the coronavirus disruption influenced our health behaviors and spurred rapid innovation in policies and technology to address barriers exacerbated by the pandemic. Dr. Amell quantifies how the pandemic influenced health behaviors in the U.S. Using health risk assessment data collected from 2016 to 2021, Dr. Amell ³ found substantive increases in alcohol use, poor nutrition habits, physical inactivity, and indicators of mental health following the beginning of the pandemic. His results are more recent but consistent with previous published work documenting changes in health behaviors.^4,5

Drs. Kennedy ⁶ and Grander outline how the pandemic resulted in changes to sleep patterns and quality including atypical work schedules, increased screen time, and pandemic-related stress. Their review found evidence that the pandemic has resulted in later bed times and more sleeping hours. However, they found mixed evidence in changes to the quality of sleep, possibly indicating our sleep has been resilient in the face of lifestyle changes and public health concern.

Ms. Moss ⁷ discusses how the pandemic has provided a window of opportunity for positive change for women in the workforce in response to disruptions to the labor force. Dr. Moss highlights how the dramatic increases in unpaid labor experience by women are tied to new policies in support of family leave as an antidote to burnout. Further, the pandemic forced work from home arrangements out of safety concerns but also has enhanced understanding of the need for flexible work arrangements, leading many employers to continue flexible policies even when stay at home orders are lifted. Many of these changes may not have happened, or happened as rapidly, if it had not been for the pandemic exacerbating experiences of women and other caregivers in the workplace.

Drs. Satre and colleagues ⁸ describe how the pandemic has pressured innovation in treatment of behavioral health given the increase in anxiety, depression, and substance use disorder (SUD) and concern about safety associated with traditional in-person care. The authors show how mobile apps have facilitated participation in treatment among people who otherwise have limited access to care.

The bottom line across these contributions is that the pandemic has resulted in measurable changes to our health behaviors and new awareness, policies, and innovations to support mental health and work–life balance. Some new behaviors have been unhealthy—such as increased alcohol consumption—and some have been positive, including more sleep, more flexible work arrangements, and increased use of mobile technology for health improvement.

With the vaccine now widely available and pandemic restrictions eased, we are experiencing a second pandemic-related disruption as employers reopen the workplaces, schools return in person, the economy resumes, and social expectations mount. As opposed to the immediate effects from the coronavirus lockdown, the easing of pandemic restrictions has come at a time when chronic anxiety and stress has led to widespread burnout,^9,10 presenting a challenge to using the reopening as a window of opportunity to adopt new healthy behaviors or discontinue the unhealthy habits that we adopted during the lockdown. Further, it is not yet known whether policies that have enabled individuals to prioritize their health, including work from home and telehealth, will continue. Some policies that have supported the safety net including moratorium on evictions and increased unemployment amounts have already ended.^10,11

But what might be a lasting change for allis increased resilience. ¹² In the end, the pandemic has provided an acute awareness of the fragility of life and the importance of making the most of it.