The Change in Health and Wellness Priorities Among U.S., Middle-Class Residents Prior to and During the COVID-19 Event of 2020

The Change in Health and Wellness Priorities Among U.S., Middle-Class Residents Prior to and During the COVID-19 Event of 2020

Dr. Edward De La Torre

Lecturer of Management

College of Business and Economics

California State University, Fullerton

800 N. State College Blvd.

Fullerton, CA 92834

[email protected]

Dr. Massiel Perez-Calhoon

Lecturer of Education

School of Education

University of Massachusetts, Global

16355 Laguna Canyon Rd #1

Irvine, CA 92618

[email protected]

Abstract

This research study consisted of an exploratory, mixed methods approach to investigate the change in health and wellness priorities among adults in the United States (U.S) during the 2020 COVID-19 pandemic environment.? Over 120 participants completed an online survey and interview questions regarding their shift in fitness, dietary, and overall wellness priorities and behaviors from before the pandemic to during the lockdown environment (2020 COVID-19 pandemic).? This sample targeted adult women in the Southern California region of the U.S.? Unlike other sub-populations of women in regions like Western Europe, China, and Australia, the women in the Southern California region reported a general increase in fitness goals and behaviors, a shift to a healthier diet, and an active approach to managing their emotional and psychological wellbeing during the national COVID stay-at-home order.

Introduction

According to the United States Center for Disease Control (CDC), in December 2019 the COVID-19 (coronavirus disease 2019) was discovered in Wuhan, China (CDC, 2021).? COVID-19 quickly spread around the world and The World Health Organization (WHO) declared COVID-19 a global pandemic on March 11, 2020 (Cucinotta, D., & Vanelli, M., 2020). As of March 2020, the WHO reported that COVID-19 had infected over 4 million individuals and resulted in over 280,000 deaths worldwide.? At that time, approximately 1,350,000 individuals in the U.S. were infected with COVID-19 and over 80,000 died from complications due to the virus (Centers for Disease Control and Prevention [CDC], 2020).?

In the U.S., California publicly announced a state stay-at-home order on March 19, 2020 in an attempt to slow the transmission of COVID-19. This stay-at-home order required individuals to predominantly remain in their homes unless necessitated to leave to perform essential life activities, such as work, grocery shopping, and physical exercise (CDC, 2021).

Due in part to this stay-at-home order, the COVID-19 pandemic shook up and disrupted the lives and well-being of many Americans across the U.S. In addition to the threat of infection or death, secondary stressors associated with the pandemic included: social isolation, weight gain, weight loss, stress, poor dietary habits, lack of physical activity, anxiety, depression, isolation, and other mental illnesses (Heinberg & Steffen, 2021). One particular population affected by this sudden lifestyle change were women from the Southern California area. This sudden shift to work from home, in isolation largely with only themselves or immediate family members, took a toll on the overall health and wellness of labor forces across industries. With such an unexpected lifestyle shift, many were left to cope with the strict stay-at-home order, the possibility of severe illness by contracting the Covid-19 virus, or even of death. Flnagan et al., (2021) found that the fear of contracting COVID-19 coupled with government mandates not only declined mental health bu, also made a significant impact on lifestyle behaviors.?

Since COVID-19 began in 2019, we have seen an overall decline in the mental health of working professionals. The decrease of physical activity, alongside closed gyms, and social distancing restrictions limited individuals to participate in various forms of exercise, and created a sedentary and isolated workforce? (Totosy de Zepetnek et al., 2021). The limitations to work from home also caused many additional stressors that created barriers between individuals and a healthy lifestyle. Previous research shows that this immediate shift in priorities towards (or away) health and fitness, diet and nutrition, and total wellness, along with the balance (or imbalance) of work and life, played a role in workers' sedentary behavior and overall lifestyle. This may be due to changes in the workplace to work remotely (Totosy de Zepetnek et al., 2021). This disruption in lifestyle begets the question, did working professionals who maintained a health and wellness lifestyle through the COVID-19 environment exhibit what is known as a grit mindset to persevere through such life-shift??

As? Totosy de Zepetnek et al., (2021) stated, “Although there is limited literature examining the association between grit and dietary habits/behaviors, this previous work suggests that grit is involved in exercise behaviors and further supports the notion that grit may assist individuals in maintaining healthy lifestyle behaviors during a global pandemic” (p. 2).? Additionally, Perez-Calhoon (2017) found that participants lacked the the ability to creatively “modify the exercise activity and prioritize exercise when faced with a challenge” (p. 91). It is safe to say that individuals were ill-prepared to cope with challenges and barriers to abrupt lifestyle shifts such as a pandemic, or stay-at-home orders. Further questions arising out of this unexpected event include, why were individuals not prepared to make drastic life shifts and do life challenges or crises increase grit??

There is evidence that those working professionals who maintained a commitment to priorities when faced with a barrier such as the stay-a-home order, possess what is called a “grit mindset.” According to Duckworth (2016), a grit mindset is a life philosophy focused on the interplay of passion and persistence in the pursuit of core personal goals, and the grittier you are, the more likely you will live a better life and balanced well-being. Duckworth (2016) continued by adding that grit comes with age. Therefore, grit can grow with time and life experience. Or simply put, the older you are, the grittier you will have become.?

Given the recent and sudden emergence of COVID-19, research in this area is understandably limited. As we continue to see COVID variants surface, it is important to know what individuals can do to protect their health and wellness through exercise, a balanced diet, sufficient sleep, meditation, and a grit mindset. We cannot allow a future life disruptor like another lockdown event to hinder the lives of more Americans and negatively impact their lifestyles the way the response to the COVID-19 outbreak had on the global population. We need to be able to move and grow with changing times and life stressors, especially in respect to the ongoing pandemic environment and future responses to future variants.

This study aims to explore the relationship between health and wellness priorities as they relate to coping mechanisms, personal grit and mindset during the COVID-19 pandemic in a sample of adults from the United States.?

Theoretical Background

The Covid-19 environment, consisting of the enforced stay-at-home order among most nations beginning in Spring 2020 following an announcement by the World Health Organization (Cucinota et al., 2020), presented many challenges to everyday people worldwide.? In the U.S., adults were forced to remain anchored to their homes with their families for several months, only being sanctioned to leave for subsistence activities such as picking up groceries and food orders, exercising, commuting to work, and performing other necessary activities outdoors.? Having their normal schedules and activities disrupted to help control the potential contraction and spread of the Covid-19 virus in the name of caution and safety, U.S. adults were faced with the challenge of reprioritizing most aspects of everyday life (Totosy de Zepetnek et al., 2021).

One of the facets of life that was reprioritized to varying degrees was the maintenance of an active and healthy lifestyle, including an appropriate diet, exercise regimen, and adherence to total wellness objectives (Ammar et al., 2020). Some adults in the U.S. were able to maintain their standards for healthy living, while others faltered to maintain their pre-Covid habits.? Researchers? investigating the differences between people that maintained healthy living versus those that did not concluded that personal grit–the persistence and passion for achieving a resonant goal (Duckworth, 2016)–was a salient factor in these decisions in times of stress (Totosy de Zepetnek et al., 2021).? That is, those with higher levels of grit maintained a standard of healthy living more effectively that those with lower levels of grit during negative events (Reed et al., 2014; Sharkey et al., 2017). Therefore, the following research question is raised regarding the health and fitness behaviors of U.S. adults in 2020:

RQ1 - What were the changes in health and fitness priorities among U.S. middle-class adults during the 2020 pandemic environment?

Throughout the course of the pandemic environment, people in the U.S. engaged in varying coping mechanisms to deal with the stress lockdown facilitated by Covid-19. The mounting stress of uncertainty from the viral transmission, contraction, and possible death, impacted people to seek solace through different coping mechanisms. One notable mechanism was engaging in an increased consumption of comfort food (Di Renzo et al., 2020; Litwin et al., 2017), which tend to be higher in fats and carbohydrates. Researchers noted that due to this overconsumption, weight gain and obesity increased during the pandemic environment for many people in the U.S. (Flanagan et al., 2021). Interestingly enough, when investigating the individual differences among the U.S. population in the past, it seemed that older adults were more adept at making healthier consumption choices than younger adults (Lee-Win et al., 2016). However, little difference among genders was found in consuming sweeter foods during similarly depressive times (Kontinnen et al., 2010; Meyer et al., 2020). Therefore, the following research question is also raised regarding the dietary and nutritional priorities of U.S. adults in 2020:

RQ2 - What were the changes in diet and nutrition priorities among U.S. middle-class adults during the 2020 pandemic environment?

Apart from an exercise regimen and healthy diet, total wellness involves a balanced lifestyle in which there is a commitment to healthy choices and active living to fortify and protect physical, psychological, and emotional well-being.? As mentioned, the lockdown following the public onset of the Covid-19 environment created an incredible challenge for the U.S. population to maintain this kind of balanced lifestyle. Given the heightened stress from the unknown, multiplied by added responsibilities by having to juggle work and domestic responsibilities limited to in the home, became a life changer with no end. That is, many people reported feelings of burnout from the siloed living conditions, and suffered from the psychological and sociological isolation (Flanagan et al., 2021). According to Zeigler (2021), “Boredom, stress, anxiety, and depression may lead to emotional eating, contributing to weight gain" (p. 429). This situation thereby compounded the stress that people felt in their lives, leading to changes in maintaining balanced living, such as by resorting to unhealthier eating and sedentary activity, as previously mentioned (Yildirium et al. 2020).? This reality therefore raises the following research question regarding total wellness priorities of U.S. adults in 2020:

RQ3 - What were the changes in the total wellness priorities among U.S. middle-class adults during the 2020 pandemic environment?

Past research has shown that periods of excessive stress, poor diet, and inactivity often lead to decreases in the biological fortification of the human immunity system (Lavie et al., 2019; Nieman et al., 2019).? Moreover, mandates during the pandemic lockdown environment– such as instituting social distancing and outdoor servicing standards–deteriorated some of the U.S. population’s social group structures that would have otherwise helped in maintaining a balanced lifestyle (Smith et al., 2020).? Thus, this vicious cycle can shorten people’s longevity and increase their mortality rate (Ussery et al., 2015), and can make people more susceptible to contracting the Covid-19 virus, among other ailments. Research shows that the simple act of engaging in routine physical activity often correlates with better emotional health and immunological responses (Qin et al., 2020; Rebar et al., 2015; Sallis et al., 2020).? Therefore, understanding what precipitated the changes in the U.S. population’s reprioritization choices towards total wellness is important for the future reinforcement of balanced living as Covid-19 continues with different and new variants (Galea et al. 2010). In so doing, the following research questions regarding the changes in health and fitness behaviors among U.S. adults in 2020 are necessitated to ensure that any significant differences can be addressed by medical and health experts in the future:

RQ 4 - Were changes in physical fitness priorities related to emotional health during the 2020 pandemic environment among U.S. middle-class adults?

RQ 5 - Were changes in dietary and nutritional priorities related to emotional health during the 2020 pandemic environment among U.S. middle-class adults?

RQ 6 - Were there any differences in health and fitness priorities between U.S. middle-class women and men during the 2020 pandemic environment?

Not only is learning about the individual differences that pertain to people lacking the proper outlook and encouragement to fortify their immune system imperative to safeguard one's health (Galea et al. 2010), but understanding the psychological differences of U.S. adults that pursued new and continuing wellness priorities is pertinent for instilling health-minded resoluteness in the population.? Furthermore, since the duty of public health officials will be to amplify understanding of building a strong immunity system among the U.S. population, these officials may be reliant on those that pursue health goals and priorities with more adherence than others to replicate these behaviors in others.? Thus, it is imperative to determine what individual characteristics and behaviors should be possessed among U.S. adults to combat future health crises by remaining committed to fitness and wellness priorities.

Therefore, the following research question is raised to investigate the qualities of U.S. adults that persevered through the challenges of the pandemic environment in 2020:

RQ7 - How does one persevere through life challenges, such as with the 2020 global pandemic, with respect to overall health management??

According to Bansal et al., (2020), “While we face the defining moment of our time, resilience, compassion, and serenity may be great assets” (p. 1787).?

Methodology

Procedure

Research consisted of a mixed-methods phenomenological study with a cross-sectional quantitative survey emerging from a qualitative survey on the change in health and fitness priorities prior to and during the Covid-19 lockdown environment.? Participants in the study were self-selected to complete an online questionnaire hosted through SurveyMonkey in Spring 2021. The link to the survey was posted to the researchers’ LinkedIn accounts and forwarded to colleagues and acquaintances through work affiliates and personal contact channels (e.g. email and text messages). Participants agreed to a consent form, acknowledging voluntary and confidentiality in participation in the study.

Sample

The sample for this study consisted of 230 participants in the online questionnaire that ranged in age from 21 to 68 years old across the United States, predominantly representative of the Southern California region.? About 25% of the participants identified as either Traditional or Cis-Gendered Male, and 75% identified as either Traditional or Cis-Gendered Female. In terms of ethnic diversity: 44% reported as White, 32% as Latinx, 6% as Black, 3% as Asian, and 14% as Other/Mixed. For marital status: 56% identified as Married, 30% as Single, 10% as Divorced, and 3% as Domestic Partners.? Education levels were reported as: 2% for attaining a High School diploma, 7% for Some College, 34% for College Grad, 55% for Post Grad, and 2% for a Vocational degree. Annual household income ranged from $0 to $4,000,000, and in terms of careers, 30% worked in Education, 8% in Health/Medical, 6% in Construction, and 26% in Other industries.

Measures

Mixed methods survey.? A mixed methods questionnaire was created by the researchers that was unique to this study.? The questionnaire was created through the SurveyMonkey online platform, and disseminated to participants through social media outlets such as LinkedIn in late-Spring and Summer 2021.? There was a qualitative component that asked participants to provide open-ended responses across three health priorities: physical fitness, diet and nutrition, and total wellness prior to and during the Covid-19 lockdown environment.? In conjunction, the quantitative component sought clarification from participants on the magnitude of changes in the three health priorities prior to and during the Covid-19 lockdown environment.? Responses were provided on a 5-point Likert scale (1 = substantially declined to 3 = no change to 5 = substantially increased).

Demographic variables.? The questionnaire also posed demographic questions to the participants to collect data on the following: sex identity, age, ethnicity, marital status, education level, annual household income, and work industry.? Lastly, the questionnaire asked participants to register their interest in participating in a follow-up study by voluntarily providing their email address.

Data Analysis

Qualitative analysis. The qualitative responses were evaluated interdependently by the researchers. The researchers conducted open coding separately to generate the themes of the participants’ responses that pertained to each of the health priorities, and then conducted axial coding by comparing these evaluations to synthesize the overlapping themes. Further refinement was conducted by merging the themes together until six to eight overarching themes were determined.

Quantitative analysis. Basic statistical application software was used for the analysis of the quantitative responses. Descriptive statistics, such as the central tendencies and standard deviations, were determined for the responses to changes in the health priorities prior to and during the Covid-19 lockdown environment. The statistical methods were used for determining the demography of the participants, as mentioned above.?

Results

Table 1 presents the relative frequencies of the qualitative results related to each of the research questions presented in the study.

The responses by the participants (n = 160) were reviewed and categorized through open coding according to major themes independently recognized by each researcher. The themes were filtered further through axial coding by the researchers to develop six to eight overarching themes related to each of eight research questions. The results were compared to the quantitative results provisioned through the descriptive statistics for the questions accompanying the qualitative items associated with each research question.

RQ1 examined the changes in health and fitness priorities among U.S. middle-class adults during the 2020 pandemic environment.? The participants explained that prior to Covid, the predominant concerns for health and fitness related to physical activity (48%), nutrition (19%), overall health (11%), self-care (7%), and specific health problems (6%).? A small minority reported that they held no such concerns regarding their health and fitness priorities (9%).? During the pandemic environment, the participants revealed that their health and fitness habits were altered to include more exercise (20%), a better diet and focus on nutrition (10%), and improved self-care (6%), while others recognized that their habits changed but offered no further explanation (30%).? Moreover, a minority of participants explained that their health and fitness habits had changed for the worse with a degraded regard for diet and nutrition (9%) and negligent behavior towards their health (5%).? These responses reflect the quantitative results of the item that examined if participants felt that their priorities for health and fitness increased (39%) rather than decreased (27%).

RQ2 examined the changes in diet and nutrition among U.S. middle-class adults during the 2020 pandemic environment. The participants reported that prior to Covid, the primary concerns were adhering to a specific diet program (56%), focusing on losing weight or weight management (15%), maintaining balance (7%), and responding to health conditions (7%). Only a small minority explained that they had no concern or inconsistent concerns for diet and nutrition (15%). During the pandemic environment, the participants reported that they improved their priorities for diet and nutrition by engaging in healthier eating (23%), enhancing mindfulness of dietary choices (9%), incorporating the diet into a healthier lifestyle (9%), or through another health priority (14%). Others explained that their diet and nutrition choices declined due to indulgent behavior or a lack of care (19%), while some said that their diet and nutrition largely remained unchanged (26%). These responses reflect the quantitative results of the item that examined if participants felt that their priorities for diet and nutrition increased (38%) rather than decreased (21%).

RQ3 examined the changes in total wellness among U.S. middle-class adults during the 2020 pandemic environment. The participants stated that prior to Covid, their focus was on: maintaining a healthy life balance (44%), engaging in a consistent fitness routine (24%), eating healthy and maintaining their weight (15%), and addressing aspects of an illness or specific health condition (3%). A small minority explained that they had no attention or largely inconsistent attention to total wellness concerns (13%). During the pandemic environment, the participants revealed that their priorities for total wellness were elevated to incorporate more self-care activities (28%), reoriented efforts for their mental health (11%), increased their exercise (10%), and practiced better nutrition (4%). Some participants admitted to a decline in their total wellness due to inconsistent healthy choices (9%), and heightened anxiety with feelings of isolation (4%).? A minority of participants stated that no changes were made regarding their priorities for total wellness (28%). These responses reflect the quantitative results of the item that examined if participants felt that their priorities for total wellness increased (45%) rather than decreased (19%).

Discussion

The purpose of this study was to examine the changes in health and fitness priorities among U.S. middle-class adults during the 2020 pandemic environment. This study yielded a number of findings.? First, not only were a majority of surveyed participants actively engaged in a regimen for physical activity, diet and nutrition, and overall health prior to the pandemic environment, but they maintained or even increased their health and fitness priorities following the national lockdown. The study therefore supported the findings of recent research that reported international citizens reprioritizing their health and fitness activities by maintaining or promoting an appropriate diet, exercise regimen, and adherence to total wellness goals in the midst of the Covid-19 pandemic? (Ammar et al., 2020; Totosy de Zepetnek et al., 2021). U.S. citizens therefore, were no different from the international community in focusing on improving their overall health standards in light of the need to fortify their biological and immunological systems against the threat of the viral outbreak.

Second, there was ample reporting that their focus on diet and nutrition before the pandemic was strong, and following the pandemic lockdown, these programs were maintained if not enhanced by a majority of the participants. This study therefore was in conflict with recent findings among the international community that consumption of comfort foods–those of high fats and sugary content–increased following the pandemic lockdown (Di Renzo et al., 2020; Litwin et al., 2017), and that unhealthy weight gain also resulted from this circumstance (Flanagan et al., 2021). Moreover, this study did not shadow past findings in that females rather than males increased their consumption of unhealthy foods during perceived depressive times (Flanagan et al., 2021). This is a salient finding given that the majority of participants in the study were women and a maintenance or improvement of a healthy diet and nutrition standards were practiced following the lockdown.

Third, the study also discovered that participants predominantly reported that they had maintained or improved upon a lifestyle focused on total wellness through balanced living, a fitness regimen, and focus on a proper diet prior to and after the pandemic environment. These findings are again, in conflict with research showing that international adults were experiencing crippling feelings of psychological and social isolation (Flanagan et al. 2021), resulting in sedentary and inactive living (Yildirium et al. 2020). In fact, this study supports past speculation that physical activity is strongly associated with emotional health (Qin et al., 2020; Rebar et al., 2015; Sallis et al., 2020), given that the participants were strong in practicing lifestyles focused on total wellness and reported little to no decrease in emotional well-being.

Theoretical Implications

One contribution that our study makes is the focus on a socioeconomic status in reporting the health and fitness priorities of a population. Recent research has holistically reported the responses of entire national populations to the pandemic environment, while circumventing the emphasis of a sub-population in the economic strata of society. Given the unintended focus of our study on U.S. middle-class adults, the study was able to elucidate that not all sub-populations reacted similarly to the national lockdown, specifically in veering towards unhealthier practices in diet, nutrition, and total wellness. Had this study incorporated other sub-populations, namely the working and low-income classes, findings that were more consistent with past research might have surfaced.

A second contribution to the gap of research on this topic is that our study gives the indication that past behavior is a greater predictor of subsequent behavior following a catastrophic event such as the pandemic lockdown.? Specifically, the study highlighted that U.S. adults that practiced health and fitness priorities such as an exercise regimen, appropriate diet, and emphasis on total wellness were just as likely to maintain these activities throughout the lockdown.? Thus, the existence of a gritty mindset–the interplay of passion and persistence in individual pursuits–is likely to result in the maintenance or expansion of priorities deemed imperative for the survivability of a crisis (Duckworth, 2016).? Indeed, this study demonstrates this principle in action through the self-reporting of the participants.

Practical Implications

The findings of the study also have implications for the practice of health management and leadership. This study indicated that individuals who actively incorporate healthy standards of living, will continue to maintain these practices in their daily routines even in the face of barriers.? Therefore, ensuring that citizens within a nation are educated and encouraged on health management practices such as physical fitness, appropriate dieting, and total wellness activities will likely lead to the continuance of these practices, which is of vitally important for fortifying the immunological processes of individuals during a pandemic event (Qin et al., 2020; Rebar et al., 2015; Sallis et al., 2020).

This study also indicated that those that exhibit qualities of grit in their behavior, such as the passion and perseverance for completing goals and objectives, will likely continue with activities that enforce the realization of such goals.? Specifically speaking, the participants in the study demonstrated that those with regimens for health and fitness continued with their daily wellness routines in spite of lockdown orders during the pandemic event. Thus, as Galea et al. (2010) recommended,? individuals should be publicly spurred and supported through their passion and commitment to wellness and longevity with habits that safeguard their health.

Limitations and Directions for Future Research

The study had several limitations that suggest decisions for future research. First, the methodology relied on the self-reporting of participants regarding their practices of health and fitness before and during the lockdown event. The researchers were therefore reliant on the participants to truthfully gauge and express the changes in their habits. Future studies should be conducted with data collection that relies on more objective means of verifying activities, such as with a longitudinal approach.

The study also did not register if the participants (predominantly U.S. middle-class citizens), reported a commitment to health and fitness activities in many instances, actually demonstrated a lower rate of pandemic afflictions than other sub-populations.? Incorporating data that correlated the number of instances the participants had contracted the COVID-19 virus and the severity of symptoms would have helped substantiate the importance of grit and the public support of healthy habits as previously mentioned. Future studies that include this data would be beneficial for the establishment of public education in fitness, diet, and wellness practices to fortify the immunological potential of a nation’s population should we encounter another pandemic such as Covid-19.?

Conclusion

The world was severely impacted and challenged by the COVID-1 9 virus and continues to be as emerging viruses continue to pervade communities. As a result of this traumatic event, individuals quickly had to adapt to preventing transmission and slowing the rate of infection by adhering to the state's stay-at-home order and social distancing measures (Cucinotta & Vanelli, 2020).?

This study aimed to provide information of changes in daily habits and the inclusion of coping mechanisms among U.S. residents during the COVID-19 pandemic, and specifically looked at perseverance over challenges in adherence to healthy lifestyle choices during such an event. This study found that U.S. middle-class residents, specifically working professionals and educators who were predominantly women, maintained and improved health and wellness priorities during the COVID-19 environment. Thus, the participants exhibited commitment to their health and wellness lifestyles even when faced with unforeseen challenges and barriers, such as with the stay-at-home order. This study found that a common component across participants was the ability to maintain perseverance, and exhibit grit and growth philosophy even under extreme challenges, barriers, and lifestyle shifts.??

This research is aligned with the findings of Duckworth (2016) when she stated, “When you keep searching for ways to change your situation for the better, you stand a chance of finding them” (p. 178). That is, those who persevered through barriers and challenges during the global pandemic, are those who remained gritty during this time and kept their overall health and wellness as a priority.?

As it becomes more evident that another global health crisis may be imminent, further exploration into these ideas are warranted for future studies as the global pandemic environment continues to shift, and evolve with new variants.?

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