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Is a Higher-risk Health Lifestyle Connected to Preventive Behaviour during the COVID-19 Pandemic?

Researchers explore the connection of risky health behaviour and compliance with preventive health measures among Europeans and Israelis 50+

  • Around 80% of the respondents reported engaging in at least one behavioural risk factor, while low physical activity (around 50%), overweight/obesity (around 25%), unhealthy eating habits (around 25%) and smoking (around 15%) were the most reported risk factors.
  • The study shows a significant association between behavioural risk factors and prevention related to hygiene measures, as people engaging in at least one behavioural risk factor were less likely to wash their hands, amongst others.
  • In contrast to what might have been expected, elderly people with behavioural risk factors did not report higher adherences to preventive measures like mask-wearing or physical distancing than people without behavioural risk factors.
  • In total, over 65% of respondents across Europe and Israel engaged in preventative measures and country differences could be observed.

(August 2021) While COVID-19 infections are a potential health threat to the entire population, particularly elderly people and those with pre-existing medical conditions have a higher risk for severe infection outcomes. Age in combination with the engagement in behavioural risk factors such as smoking, risky alcohol consumption, unhealthy eating habits, physical inactivity and obesity elevates the risk for fatal infection outcomes, which highlights the importance of protection for these population groups.

A previous SHARE study found that higher risk individuals, identified by the presence of chronic medical conditions, reported greater adherence to prevention measures and more effort to avoid infection. However, it remains unclear whether behavioural risk factors lead to lesser or greater adherence to preventive behaviour. The present study uses data from the Survey of Health, Ageing and Retirement in Europe (SHARE) Corona Survey to investigate whether behavioural risk factors play a role in the adherence to preventive COVID-19 measures such as hand-washing and keeping distance. By focusing on elderly people aged 50+, researchers Mendoza-Jiménez, Hannemann and Atzendorf from the Munich Center for the Economics of Aging (MEA) provide insights into preventive behaviour of one of the most vulnerable groups.

Assessing preventive behaviour of SHARE respondents across Europe

To investigate whether individuals with behavioural risk factors are more or less likely to participate in recommended preventive measures, data from the preliminary beta release 0 of SHARE Wave 8 and from the SHARE Corona Survey were analysed. The authors focus on the preventive measure variables social isolation, hygiene measures and regulated measures (e.g. mask-wearing), where respondents were asked whether and how often they engaged in these behaviours. Additionally, data from the Oxford COVID-19 Government Response Tracker (OxGRT) were used to gain information on restrictions and confirmed cases. In the end, data from over 17,500 people over 50 from 23 European countries plus Israel were included in the analysis.

Around 80% of respondents were engaging in at least one behavioural risk factor

In total, around 80% of the respondents reported engaging in at least one behavioural risk factor, while low physical activity (around 50%), overweight/obesity (around 25%), unhealthy eating habits (around 25%) and smoking (around 15%) were the most reported risk factors. Due to the added stress on overall health, behavioural risk factors are pre-existing medical conditions and potential health threats, even if their health impairments and negative effects are not yet manifested.

People with behavioural risk factors were less likely to engage in hygiene preventive measures

The researchers found a significant association between behavioural risk factors and prevention related to hygiene measures. The engagement in one risk factor is associated with less adherence to hygiene prevention measures such as hand-washing compared to people without behavioural risk factors. The engagement in multiple risk factors even increases the likelihood of non-compliance with preventive hygiene measures. In other words: the more behavioural risk factors people have, the less likely they are to engage in hygiene measures during the pandemic. Other preventive behaviours such as keeping distance, mask-wearing and reducing contacts were not related to the engagement in behavioural risk factors. But despite their enhanced risk, individuals with behavioural risk factors were not more likely to adhere to regulated measures or social isolation recommendations than respondents without behavioural risk factors.

Lack of awareness and knowledge of the increased risk for severe COVID-19 infections

Controversially to what might have been expected, elderly people with behavioural risk factors did not report higher adherences to preventive measures and are even less likely to engage in preventive hygiene measures – despite their high vulnerability. According to the authors, one reason could be that there is less awareness of the increased risk of morbidity and mortality of a COVID-19 infection due to behavioural risk factors. Furthermore, engaging in hygiene measures is a voluntary protective measure. In contrast, regulated or social isolation measures include law and socially-driven enforcement (e.g. fines) which might also have an impact on people´s behaviour.

In total, over 65% of respondents engaged in preventative measures

In total, people across Europe and Israel show an overall high adherence (more than 65%) to preventive measures, particularly regarding the variables physical distance (∼95%), hand-washing (∼90%), hand-sanitising (∼85%) and visiting other people less often (∼83%). Country differences could be particularly observed regarding mask-wearing and social isolation. The lowest adherence to mask-wearing was for example found in Northern Countries like Sweden (∼2%) and Denmark (∼3%).

Importance of assessing preventive behaviour of vulnerable groups during a global pandemic

The study shows a significant association between behavioural risk factors and prevention related to hygiene measures, as people engaging in at least one behavioural risk factor were less likely to wash their hands, amongst others. Other behaviours such as mask-wearing and reducing contacts were not related to engagement in risk factors. According to the authors, improving adherence to protective measures among the most vulnerable groups is important to reduce negative infection outcomes. As awareness and knowledge of the vulnerability and increased risk seem to be lacking, the authors highlight the importance of promoting preventive behaviour through effective risk communication.


Study by María-José Mendoza-Jiménez, Tessa-Virginia Hannemann and Josefine Atzendorf (2021). Behavioral Risk Factors and Adherence to Preventive Measures: Evidence from the Early Stages of the COVID-19 Pandemic. Frontiers in Public Health 9. DOI: 10.3389/fpubh.2021.674597

URL: https://www.frontiersin.org/articles/10.3389/fpubh.2021.674597/full

Photo: Adobe Stock / Saravoot