CHAPTER 2

Review of Related Literature

This chapter presents the relevant literature and studies that we, the researchers, considered in
strengthening the importance of the present study. It also presents the synthesis of the art to
fully understand the research for better comprehension of the study.

Body Mass Index

COVID-19 disease is caused by a novel coronavirus (SARS-COV-2) that emerged in

the Wuhan province of china. The first documented human infection was reported in
December 2019 and since then, the disease has spread at an unprecedented speed and
magnitude to become the greatest healthcare concern of the twenty-first century. Even with
the implementation of major interventions to contain the spread of the disease, COVID-19
has progressed worldwide resulting in significant morbidity and mortality. As of October 5,
2020, the total number of infected patients stands at 35 million resulting in more than a
million deaths. As a consequence, intense efforts are on to understand the epidemiology and
pathobiology of this disease. High body mass index (BMI) has particularly been found to be a
strong indicator of disease severity in patients younger than 60 years of age (Mohammed et
al., 2021).

The preventive strategies designed to minimize the virus transmission by remaining at

home, being isolated, and keeping social distance, which would substantially reform people’s

lifestyle, physical activity, eating habits, etc. Consequently, those measures might create a

disturbance in weight management and overweight. Therefore, how the COVID-19 pandemic

has changed the physical activities of individuals and its impacts on the Body Mass Index

(BMI) is explored herein. Results showed that the prevalence of overweight was 30.5%

‘before’ the COVID-19 pandemic, which increased to 34.9% ‘during’ the pandemic; that

means 4.4% of the participants significantly gained weight after the pandemic inception.

There was no significant role of socio-demographic (e.g., gender, age, current residence,

occupation) or physical activity-related factors (e.g., unavailability of outdoor space, not

performing regular physical exercise, exercising with a partner) in changing the BMI status

after the pandemic inception. However, following a proper diet plan during the COVID-19

pandemic was observed to decrease BMI status significantly. The present study suggests that

a minor portion of the participants reported increasing their overweight status after the

pandemic inception, whereas having a proper diet plan during the pandemic can significantly

decrease BMI status. Therefore, the importance of the appropriate diet plan should be

considered while implementing any policies. (Akter et al., 2022).

A study on the direction of the association between body fatness and self-reported
screen time in Dutch adolescents resulted in that time spent watching television predicted
changes in body mass index. Computer utilization time was significantly predicted to
increase skinfolds in boys and girls and BMI in girls alone. Body fatness did not predict any
variation in screen time. Other studies also indicated that the frequency of meal intake
contributed to the development of obesity. Another study result revealed that half of Brits
(47%) had put on weight since their nation started in lockdown. Despite the severity and
health consequences of the COVID-19 outbreak is instigating wider conversations around the
nation’s health as well as the importance of a balanced lifestyle. The primary purpose of this
prospective study was to assess the changes in body weight, BMI, physical activity, and
lifestyle and their association with COVID-19 lockdown among the university students.
Though half of the students maintain the same BMI in lockdown, the students increased BMI
which was associated with physical and lifestyle factors. Interestingly, among the students
who reduced weight may be attributed by reduced intake of fast and fried food during the
COVID-19 lockdown. Poor physical activity was reported by many students and most of
them using a sedentary lifestyle. (Jalal et al., 2021)

Dietary Changes

The relationship between stress and emotional eating is well established. Previous

studies have shown an association between stress and the amount of food consumed. It has

been shown that people under stress crave more high fat and high sugar foods, since the body

under stress requires more energy to function. In addition, the body increases storage of
abdominal fat. It has been hypothesized that the increase in unstructured time and the

psychological impact resulting from the enforced quarantine might induce changes in dietary

habits and lifestyle. Therefore, the primary aim of a recent study was to investigate the effects

of the COVID-19 outbreak during the lockdown on eating habits and other health-related

behaviours among adults in Kuwait. Second is to examine the demographic variation in

eating habits and lifestyle. The present findings seem to be consistent with other research that

has observed changes in dietary habits and lifestyle behaviours during the pandemic.

Unhealthy meal patterns were detected in the study, such as skipping breakfast and late-night

snackin. Both behaviours are likely associated with overweight and obesity (Husain et al.,

2020).

Consistent with the literature, this research found skipping breakfast was common

among participants. It was noticed that the rate of skipping breakfast remained consistent,

with a slight increase during the pandemic. Possible explanations for this behaviour include a

lack of time, intentionally skipping breakfast to cut calories and a lack of appetite. However,

other possible explanations for skipping breakfast during COVID-19 include staying up late,

which leads to late-night snacking, and oversleeping during the day.

A study among 19,687 Japanese women that found a significant association between a

late dinner or bedtime snack and skipping breakfast, as well as an association of this

behaviour with overweight and obesity. Despite the recommendation to reduce the intake of

fats, sugar and salt during COVID-19 and avoid irregular snacking, chocolate, nuts and crisps

were reported to be the most commonly consumed snacks, and these are loaded with sugar,

fat and salt (Okada et al., 2020). A similar finding was reported, who found that half of the

participants of an Italian sample showed an increase in the consumption of both sweet and

salty comfort foods during COVID-19. These results may be explained by the fact that

feelings of boredom, anxiety and stress (likely heightened due to quarantine, as shown in the
results) lead to higher consumption of energy-dense foods that are high in sugar and fat

(Scarmozzino and Visioli 2020).

Similar findings were also reported which found that many people over-eat sugary

and salty comfort foods for snacking due to stress induced by quarantine and that this habit

may increase the risk of developing obesity. Furthermore, it has been demonstrated that there

was a strong association between weight gain and self-reported anxiety/depression among

patients during the pandemic (Muscogiuri et al., 2020).

Furthermore, a study detected a significant reduction in the frequency of fast-food

consumption. It seems possible that this rise in home cooking is related to attempts to occupy

the increased free time resulting from quarantine. Another explanation is that people wanted

to eat healthier in reaction to the spread of COVID-19 and thus resorted to home cooking

more frequently. Finally, it could be related to the reduced consumption of fast-food as a

result of fears regarding the transmission of COVID-19, whether it be from unhygienic

practices at restaurants or from the delivery driver. However, it is difficult to conclude that

people ate more healthily during the pandemic just because they reported consuming more

home cooked meals, especially if unhealthy foods were still in circulation.

Regarding food choices within the five main food groups assessed in this study, there

were no significant changes in terms of red meat, chicken, type of fat, milk, bread, fruit and

vegetables, before and during the pandemic, except in the case of fish and seafood. A study

also observed low consumptions of fish during the lockdown among the Chinese population.

This result was expected and can be explained by the fact that the fish markets in Kuwait

were closed on April 2020 as a precautionary measure and so there was a lack of availability

of fresh fish and seafood due to the absence of working fisherman during this period. In
addition, it is often preferred to consume fish and seafood fresh, which may have further

contributed to the reduction in their consumption (by Zhao et al., 2020).

Although the consumption of fruits and vegetables is recommended to support the

immune system especially during the pandemic, however, the results of this study show that

more than 70% of the participants did not reach the minimum portions of fruits and

vegetables recommended by the USDA of 5 portions a day. This result is in line with findings

from other studies that reported a low consumption of fruits and vegetables among Kuwaiti

adults such as the EMAN study and KNNS. These results are likely related to a lack of

awareness of the current recommendation for the consumption of fruits and vegetables

(unpublished data). A finding from two cross-sectional questionnaire studies among the UK’s

population found an association between low knowledge of details of the 5-a-day

recommendation and low consumption of fruits and vegetables. In addition, another possible

explanation is a predisposition towards energy-dense foods that are high in sugar and fat for

snacking, as shown in the results. Moreover, the limited availability of fruits and vegetables

and restricted food store opening hours due to quarantine during the pandemic could have

caused a reduction in the consumption of fruits and vegetables. The reduction in the

consumption of fresh juice can possibly be explained by the negative impact of the pandemic

on the availability of fruit and vegetables, since Kuwait has very limited agricultural

production, particularly in terms of fruit. Moreover, fresh fruit and vegetables have short

shelf lives. In addition, making fresh juice requires a larger amount of fruit and vegetables

than when simply eating them. Another possible explanation is the limited access to grocery

shopping, as elaborated on above (Husain & Ashkanani 2020).

Sleeping Pattern

The COVID-19 pandemic has led to significant changes in daily routines and lifestyle

worldwide and mental health issues have emerged as a consequence. Sleep disturbances have

affected a substantial proportion of the general population during the COVID-19 pandemic

lockdown. These are significantly associated with a self-assessed impact on mental health,

but may also be related to suspect COVID-19 status, changes in habits and self-isolation. In

the current pandemic, the effects of isolation have been described in cohorts from China and

Italy, with poor quality sleep and comorbid psychological disturbances being identified as

significant issues. A current study therefore hypothesised that the COVID-19 pandemic and

the public lockdown significantly impacted on sleep in the general population. They

compared suspected COVID-19 with non-COVID-19, and tested whether there was an

association with mental health impact. In order to survey current sleep problems, the British

Sleep Society (BSS) initiated the National Early Detection Screening for the COVID-19

pandemic. The majority of respondents described an altered sleep pattern and almost half of

the studied population felt sleepier than prior to the lockdown. Reported problems included

dozing off unintentionally in the day, disrupted sleep, difficulties falling/staying asleep and

later bedtimes. Over a quarter of all respondents reported an increased alcohol intake during

the lockdown. Furthermore, those self-isolating reported more insomnia/disrupted sleep,

daytime symptoms, abnormal behaviours in sleep and symptoms of restless legs compared to

those not self-isolating. Keyworkers reported fewer sleep alterations than others. In those

with suspected COVID-19, nightmares and abnormal sleep rhythm were more common. A

reported impact on mental health was most strongly associated with more difficulties falling

asleep, sleep disruption, nightmares and daytime sleepiness. A change in sleep pattern was

associated with medication use, ongoing COVID-19 symptoms and mental health impact, and

it was negatively associated with age, male gender and general health (Carbonell et al., 2020).
 Though there is some evidence on how the COVID-19 pandemic has affected the

behavior of students, there is little known about how behaviors differ between students and

non-students. Thus, the aim of the current study was to examine differences in the sleep

patterns, sexual activity, screen use, and food intake of students and non-students during the

COVID-19 pandemic. We hypothesize that the pandemic had a greater effect on sleep

patterns, sexual behavior, screen time, and food intake for students when compared to non-

students. Understanding the ways in which stressful life conditions and public health

emergencies have differential impact on students’ lives may help in tailoring appropriate and

early intervention for students. Also, the information might be valuable for policy makers

when developing preparedness and strategic plans during future pandemics. The observed

changes in sleep pattern and increase in screen use by students have been previously reported.

A significant deterioration in sleep quality of students during the pandemic may be due to late

night browsing on social media, chatting, and checking online news from mobile devices as

well as the increased use of screens for educational purposes, which is also associated with

late night use of electronic devices. The significant increase in exposure to screens may lead

to longer waking hours and reduce sleep duration as a result of blue light emitted from mobile

screens, inhibiting melatonin production. This adjusts the sleep-wake cycle with a resultant

increase in stresses, depression and negative emotions. Our observation that students reported

changes in sleep pattern and increases in screen use may make the explanations proffered by

prior studies applicable to our study findings. Studies conducted before the pandemic

indicated that changes in sleep pattern increase as age increase, contradicting the findings of

this study. No association between changes in sleep and age was observed (Ellakany et al.,

2022).
 These findings may have significant implications for the years after the pandemic.

Students may have increased risk for multiple cardio metabolic risk and neurocognitive

impairment resulting from deterioration of sleep. Increase in screen use may have

implications on physical (overweight/obesity, abdominal adiposity, increased body mass

index), behavioral (sleeping problems, unhealthy dietary behavior, more sedentary activities

and insufficient physical activity), and psychosocial (aggressive behavior, social-emotional

delay, hyperactivity-inattention, emotional symptoms, prosocial behavior, peer problems, and

conduct problems) health with negative effects (Ellakany et al., 2022).

Home confinement, prolonged traumas, and substantial changes in routines are all

associated with sleep disruption. Their impact may be drastic, yet may depend on the

intersection of prior sleep history, lifestyle, sociodemographic/socioeconomic influences, and

regional/policy-level factors. Sleep problems in response to the COVID-19 pandemic are

high in prevalence (17.4%-57.2%), as are psychological symptoms. Problems included poorer

sleep quality, increased insomnia symptoms, and delayed bed and wake times, which were

most common among youth, women, and individuals with high pandemic-related stress and

poor social support. Prior studies were confined to a single country, and most did not assess

pre-pandemic sleep patterns. Stress has also been implicated in poor sleep quality and

disrupted sleep (Sanford et al., 2014). The COVID-19 pandemic has been linked to poor

sleep quality in China (Xiao et al., 2020) and Italy (Casagrande et al., 2020), with over half of

Italian respondents experiencing poor sleep quality. However, in Spain, the quality of

respondents’ sleep seemed to improve as the lockdown progressed (López-Bueno et al.,

2020). Critically, poor sleep quality has been linked to negative emotions and mood (Baglioni

et al., 2010).

A recent survey by SleepStandards, titled, “Sleep Habits Post Quarantine in the US

(2020),” sought to examine sleep habits both before and after lockdown measures caused by
the pandemic. The survey polled 1015 Americans between the ages of 18 and 79 (55%

female; 13.4% generation Z; 51.6% millennial; 9.9% baby boomer). Survey findings

included:

 53% indicated they spend less time sleeping than before the pandemic

 67% believe their sleep was healthier before the beginning of lockdown

 98% have developed new sleep problems post-lockdown

 68% feel stress or find it hard to sleep, even after lockdown measures were lifted

Moreover, differentiating sleep habits among generations were reported, with generation Z

(18-22 years old) and millenials (23-38 years old) going to bed later than any other

generation after quarantine. This could have major implications for younger people,

particularly adolescents as insomnia has been noted to be a prevalent issue in this age group.

Sleep health interventions in response to pandemics and other crises are limited, as is

research on such interventions. During the COVID-19 pandemic, relevant societies developed

recommendations for how to avoid sleep disturbances and promote sleep health. Such

messaging is yet to be widely disseminated, and its implementation formally evaluated.

Certain groups are testing solutions to screening and addressing acute sleep complaints using

smartphone applications and web-based approaches. These delivery methods of current,

evidence-based behavioral sleep interventions are particularly relevant during pandemics and

are generally accessible. Our results may assist in identifying at-risk groups, and facilitating

the development of personalized intervention that target distinct sleep profiles, which may

vary in the intensity of therapy required within a stepped care model and depend upon the

chronicity of the sleep problems. Based upon our results, the dissemination and

implementation of such interventions in future research could consider adapting according to

demographic and household/family factors, and sleep history (Petrov et al., 2021).
Leisure Activity

Social distancing policies have been implemented around the world to reduce the

spread of coronavirus disease 2019 (COVID-19). These measures have included temporary

restrictions on mass gatherings and the closure of public facilities, limiting the pursuit of

leisure activities such as travel while allowing more time for at-home pursuits, including

creative activities such as gardening and painting. Previous research has demonstrated the

benefits of physical activity for psychological well-being during COVID-19, but less

attention has been given to the potential benefits of creative pursuits, such as arts and music.

Outdoor recreation provides important recreational ecosystem services (e.g. stress relief,

socialization, nature appreciation, etc.) through physical interaction with the natural world

(Scholte et al. 2019). In times of crisis or disaster, outdoor recreation also provides an

important means of coping (Rung et al. 2011; Samuelsson et al. 2020).

The COVID-19 pandemic presents an unprecedented global health crisis (Stier,

Berman and Bettencourt 2020). Limitations to travel across all scales—from intercontinental

tourism to stay-at-home orders—have brought significant stress to the global community

(Bao et al. 2020). Though necessary to thwart the spread of the virus, diminished or restricted

access to settings that facilitate outdoor recreation reduce a community’s capacity to cope

with crisis, especially for the outdoor enthusiast subculture—those who are highly dependent

on outdoor recreation as a means of leisure (Outdoor Industry Association, 2015). Such

necessary restrictions to access have also complicated the role parks and outdoor recreation

play in the promotion of psychological and physiological recovery during crisis (Rung et al.

2011; Samuelsson et al. 2020). Loss of access to outdoor recreation opportunities inhibits

individuals’ abilities to engage with restorative natural environments and escape the pressures

of the crisis (Rung et al. 2011; Samuelsson et al. 2020). It is therefore imperative that

officials and planners have access to information concerning changes to outdoor recreation
behaviors (De Valck et al. 2016). With challenge comes stress and the need for reprieve. Our

findings indicate that urban outdoor enthusiasts are disproportionately impacted by the

recreational burden of the pandemic—reducing their participation, changing their recreation

settings, and reducing backcountry recreation to greater degrees than residents of rural areas.

Put another way, those most directly impacted by the pandemic (Stier, Berman and

Bettencourt 2020) have also experienced the greatest impact on their ability to cope with the

pandemic.

Focusing on leisure actives, a web survey in Spain found a large increase in legacy

media and social media consumption, except for watching TV and listening to the radio. In

particular, evidence reported a significant growth in video calls or exchange of messages with

friends and relatives, the use of platforms such as Netflix and social media text-based groups

such as WhatsApp (Aymerich-Franch, 2020). In general, the activities more often carried out

during lockdown were working, studying, cooking, watching movies/streamed TV, social

media/video calling, reading, physical exercise and house cleaning and tidying (Aymerich-

Franch, 2020). Overall, there is little doubt that global lockdown due to the spread of

COVID-19 has profoundly affected leisure choices, activities and companions. How this has

changed among young people, however, is a partially unexplored topic; to what extent

different socio-economic conditions have fostered different levels of adaptation to restrictions

is an issue little investigated in relation to youth leisure. Given the centrality of leisure in

young people’s lives and its vital role in the definition of identities and the development of

relationships, it is certainly worthy of analysis. In this respect, one study reveals that the

respondents differ in their spirit of adaptation: Some have significantly changed their daily

habits, while others have maintained or changed them to a lesser extent. Young people in

particular have significantly re-negotiated their lifestyles and have resorted to a greater

articulation of their enforced leisure, especially in unstructured activities, through social

media. Despite the frustration of being unable to be active as young people, which led to an

increase in time for lazing around and sleeping, young people seem to be more resilient than

adults, probably thanks to their confidence with digital tools, which created opportunities for

staying in contact with friends and being engaged in entertainment activities (Panarese et al.,

2021).

One study is the first to describe the effects of government COVID-19 related

‘lockdown restrictions’ in April/May compared to pre-lockdown in February on subjectively-

measured physical activity recommendations and active recreation participation among

Australian children, adolescents, and adults. The results of this study suggest that Australian

COVID-19 lockdown restrictions in April/May 2020 may have negatively impacted the

proportion of children, and positively impacted the proportion of adults meeting MVPA

recommendations, with no change among adolescents. There were varying reported effects

on active recreation across age groups and by sex. Potential physical activity promotion

strategies as COVID-19 lockdown restrictions progress and ease include supporting at home

physical activity options, active neighbourhoods and (re)engagement in informal sport

practice and play and recreational activity. These findings can inform government policy and

investment in public health, sport and recreation strategies to maintain adults' physical

activity and (re)engage children and adolescents' physical activity post-COVID-19 (Arundell

et al., 2022).

Public health recommendations and governmental measures have enforced lockdowns

and restrictions. While these restrictions help to abate the rate of infection, such limitations

result in negative effects by limiting participation in normal daily activities, physical activity

(PA), travel and access to many forms of exercise (e.g., closed gyms, no group gatherings,

increased social distancing). Several countries are enforcing curfews, which limit the time to

participate in outdoor activities, or are excluding outdoor activities entirely. Such restrictions
impose a burden on population health by potentially compromising physical fitness, which is

positively associated with the ability to cope with infections and the immunologic and

cardiopulmonary complications of more severe outcomes. Globally, physical inactivity and

poor mental health are among the most important risk factors for major disease morbidity.

This holds true not only for the general population, but specifically for older adults and

chronically ill patient populations, who are at heightened risk of COVID-19-induced

mortality. For children and youth, physical activity is closely coupled to school-related

activities, active transport and sport participation. As schools have been closed during the

COVID-19 pandemic, this also compromises physical activity participation, therefore

increasing the risk of longer-term sedentary behaviours. The results of this survey concur

with recent studies demonstrating that the current COVID-19 home confinement could

dramatically impact lifestyle activities globally, including participation in sports and PA

engagement. The restrictions have reduced overall PA (number of days and number of hours)

and access to exercise. In spite of an increased offering of PA guidance and classes available

on social media, present results indicate that it has not been possible for individuals to

adequately maintain their normal PA patterns with home activities. The decline in PA was

accompanied by increased sedentary (sitting) behaviour. However, the extent to which PA

participation is impacted by the current COVID-19 pandemic will be linked to the stringency

of individual government confinement policies. It is already shown in China that different

regional policies and socio-economic factors were associated with differences in PA. These

factors need to be considered when designing and promoting PA interventions for the

COVID-19 pandemic. It was recently demonstrated that individuals demonstrate a greater use

(15%) of Information and Communications Technology (ICT) during the confinement period.

Therefore, future PA intervention to foster an Active and Healthy Confinement Lifestyle

(AHCL) during pandemic can be based on ICT solutions, such as home-based exergames and

fitness apps (Ammar et al., 2020).

Social distancing and home deliveries decreased the opportunities for physical

activity, especially in individuals living in small apartments in urban areas, increasing

sedentariness, and affecting health and wellbeing. However, it is important to emphasize that

numerous interindividual differences account for different behaviors that may depend on

personal characteristics and that have led some to cook more and devote more time to meals

within the family and others instead to use the food in a disorderly way for boredom, as a

consolation or to quell anxiety. Although most people show good resilience, still a large part

of the community is at risk and predisposed to acquire lifestyle behaviors that are potentially

harmful to their health, regardless of the initial body weight. Indeed, we observed that while

some took advantage of the home confinement to increase physical activity, many people

stopped or reduced sports and recreational activities also facilitated by the closure of gyms

and swimming pools. These findings suggest the need to raise awareness of subjects

regarding lifestyle according to national guidelines, and to tailor strategies for health policies

(Maffoni et al., 2021).

Mental Health

The COVID-19 pandemic may have brought many changes to how you live your life,

and with it, at times, uncertainty, altered daily routines, financial pressures and social

isolation. You may worry about getting sick, how long the pandemic will last, whether your

job will be affected and what the future will bring. Information overload, rumors and

misinformation can make your life feel out of control and make it unclear what to do. During

the COVID-19 pandemic, you may experience stress, anxiety, fear, sadness and loneliness.

And mental health disorders, including anxiety and depression, can worsen. Surveys show a
major increase in the number of U.S. adults who report symptoms of stress, anxiety,

depression and insomnia during the pandemic, compared with surveys before the pandemic.

Some people have increased their use of alcohol or drugs, thinking that can help them cope

with their fears about the pandemic. In reality, using these substances can worsen anxiety and

depression (Phruthi et al., 2022).

Research indicates that mental health worsened during the Coronavirus crisis, in

particular among women and university students. However, few longitudinal studies have so

far investigated the changes in mental health outcomes across three subsequent waves of the

COVID-19 pandemic. The results of the study are consistent if comparing mental health

variables considered as categorical and continuous. Significant changes across gender and

three waves of the COVID-19 pandemic were found in anxiety, perceived stress, self-

reported physical health, and life satisfaction. It means that future systematic reviews and

meta-analyses could be more sensitive at the period of data collecting in particular studies.

Wave of pandemic, as well as gender, should be consider in the future studies as factors

affecting mental health condition. The development and implementation of adequate

prevention and intervention programs at universities should be a priority in the fight against

the COVID-19 pandemic (Rogowska et al., 2021).

The uncertainties and fears associated with the virus outbreak, along with mass

lockdowns and economic recession are predicted to lead to increases in suicide as well as

mental disorders associated with suicide. For example, McIntyre and Lee (2020b) have

reported a projected increase in suicide from 418 to 2114 in Canadian suicide cases

associated with joblessness. The foregoing result (i.e., rising trajectory of suicide) was also

reported in the USA, Pakistan, India, France, Germany, and Italy (Mamun and Ullah, 2020;

Thakur and Jain, 2020). Separate lines of research have also reported an increase in

psychological distress in the general population, persons with pre-existing mental disorders,
as well as in healthcare workers (Hao et al., 2020; Tan et al., 2020; Wang et al., 2020b).

Taken together, there is an urgent call for more attention given to public mental health and

policies to assist people through this challenging time. Several studies identified frequent

exposure to social media/news relating to COVID-19 as a cause of anxiety and stress

symptoms (Gao et al., 2020; Moghanibashi-Mansourieh, 2020). Frequent social media use

exposes oneself to potential fake news/reports/disinformation and the possibility for

amplified anxiety. With the unpredictable situation and a lot of unknowns about the novel

coronavirus, misinformation and fake news are being easily spread via social media platforms

(Erku et al., 2020), creating unnecessary fears and anxiety. Sadness and anxious feelings

could also arise when constantly seeing members of the community suffering from the

pandemic via social media platforms or news reports (Li et al., 2020). Reports also suggested

that poor economic status, lower education level, and unemployment are significant risk

factors for developing symptoms of mental disorders, especially depressive symptoms during

the pandemic period (Gao et al., 2020; Lei et al., 2020; Mazza et al., 2020; Olagoke et al.,

2020;). The coronavirus outbreak has led to strictly imposed stay-home-order and a decrease

in demands for services and goods (Nicola et al., 2020), which has adversely influenced local

businesses and industries worldwide. Surges in unemployment rates were noted in many

countries (Statistics Canada, 2020; Statista, 2020). A decrease in quality of life and

uncertainty as a result of financial hardship can put individuals into greater risks for

developing adverse psychological symptoms (Ng et al., 2013).

Conceptual Framework

Independent variable Dependent variable

Profile of the Respondents: Lifestyle changes in terms of:

 Age  Dietary changes

 Sex  Sleeping pattern

 Year Level  Leisure activities

 Body Mass Index (BMI)  Overall mental health

 Self-report of overall health

Figure 1. Conceptual Model

Figure 1 shows a modified schema that visualizes the relationship of the following variables.

The diagrammatic paradigm above depicts a more accurate way this framework is trying to convey.

The independent variable which is the profile of the respondents are the: (a) age, (b) sex, (c) year

level, (d) body mass index, and (e) Self-report of overall health of the respondents. The dependent

variable are the lifestyle changes due to COVID-19 in terms of: (a) dietary changes, (b) sleeping

pattern, (c) lifestyle changes and the (d) overall mental health of the respondents. The diagram shows

a relationship/connection to the demographic profile of the respondents (independent variable) to the

lifestyle changes due to COVID-19 (dependent variable).

Hypothesis of the study

There is no significant relationship between the demographic profile of the respondents (age,

sex, year level, body mass index, and self-report of overall health) to the lifestyle changes due to

COVID-19 (dietary changes, sleeping pattern, leisure activity, and overall mental health).