Behavioral Risk Factors and Adherence to Preventive Measures: Evidence From the Early Stages of the COVID-19 Pandemic

Abstract

Behavioral risk factors, such as smoking, excessive alcohol consumption, physical inactivity, obesity, and unhealthy food intake are added risk factors for severe outcomes ofCOVID-19infections.Preventivemeasurestoavoidinfectionsarethereforeparticularly important for individuals engaging in behavioral risk factors. We seek to determine whether behavioral risk factors (BRFs) play a significant role in the adherence to preventive COVID-19 measures in a population aged 50 and above. The SHARE wave 8 (Survey of Health, Ageing and Retirement in Europe) and SHARE COVID-19 Survey served as the database, resulting in an analytical sample of 17,588 respondents from 23 European countries plus Israel. Of these 36.04% engaged in at least one BRF and 16.68% engaged in 3 or more BRFs. Multilevel logistic regressions revealed that engagement in one BRF was significantly associated with less adherence to hygiene preventive measures, i.e., hand-sanitizing, hand-washing and covering coughs and sneezes (OR: 0.86; 95% CI: 0.78; 0.94), as was engagement in two BRFs (OR: 0.85; 95% CI: 0.74; 0.97) and three or more BRFs (OR: 0.72; 95% CI: 0.59; 0.88). No such associationwasfoundbetweenengagementinBRFsandadherencestosocialisolation preventivemeasures,i.e.,avoidingmeetingmorethanfivepeople,visitingothersorgoing shopping, or regulated preventive measures, i.e., wearing a mask and keeping physical distance. The found association was also stronger when three or more BRFs were engagedin(1vs.3BRFs: χ2 =3.43,p=0.06;2vs.3BRFs: χ2 =6.05;p=0.01).The study gives insight into the protective behavior of a population with inherent vulnerability during a global health emergency. It lays the foundation for follow-up research about the evolution of adherence to preventive measures as the pandemic progresses and about long-term behavioral changes. In addition, it can aide efforts in increasing preventive compliance by raising awareness of the added risk behavioral risk factors pose.