Racial and ethnic disparities in lifestyle changes during the COVID-19 pandemic: Exploring the socioeconomic and psychosocial mechanisms

ABSTRACT

Background: Obesity, physical inactivity, excessive alcohol consumption, and poor diet are all modifiable risk factors for cancer. These unhealthy behaviors are disproportionally concentrated in racial and ethnic minorities and these disparities may have been exacerbated during the COVID-19 pandemic. This study examined racial and ethnic disparities in weight gain and other undesirable lifestyle changes during the COVID-19 pandemic and explored mechanisms underlying these lifestyle disparities. Methods: We used data from the 2020 Health, Ethnicity and Pandemic Study, a national survey representative of US households conducted in October 2020. Racial and ethnic minorities were oversampled. Participants were asked to report lifestyle behaviors before and during the COVID-19 pandemic. We examined two outcomes in this study weight gain and experiencing any undesirable lifestyle changes (i.e., reduced exercise time, increased alcohol drinking, or increased fast-food meal consumption). The primary exposure was race-ethnicity (non-Hispanic (NH) white, NH black, Hispanic, NH Asian, NH other race). Four sets of mediators were examined socioeconomic status (education, household income, and undesirable job changes), family and friend social relationship change, perceived and experienced racism, and psychological distress. Weighted multivariable logistic regression models were performed. Mediation effects were examined with variance decomposition method. Results: A total of 2,709 participants were included in our sample. Compared with white respondents, black (OR = 1.71;p < 0.001) and Hispanic respondents (OR = 2.17;p < 0.001) were more likely to experience weight gain, controlling for age and sex. Among the hypothesized mediators, undesirable job changes during the pandemic, experiencing worse family relationship, and higher levels of psychological distress were all linked to higher odds of weight gain, but none of these variables played a salient role in mediating the black-white and Hispanic-white disparities in weight gain during the pandemic. As to the odds of experiencing undesirable lifestyle changes, black (OR = 1.76;p < 0.001), Hispanic (OR = 2.12;p < 0.001), and Asian respondents (OR = 1.42;p < 0.01) all exhibited disadvantages relative to white respondent. These disadvantages were largely attributable to perceived racism toward one's own group and psychological distress for all three minority groups. Conclusions: Racial and ethnic minorities were more likely to experience unhealthy lifestyle changes relative to white individuals during the pandemic in the United States, which can be partly attributable to higher levels of perceived racism and psychological distress. The long-term effects of racial/ethnic disparities of lifestyle change during the pandemic on cancer prevention warrant further research.