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A new two-year longitudinal study published in the BMJ looked at lifestyle risk behaviors among adolescents impacted by the COVID-19 pandemic.

“Our study focused on the ‘Big 6’ health behaviors among adolescents, being physical activity, diet, sleep, recreational screen time, alcohol use and smoking, given these are key predictors of both short- and long-term health and wellbeing,” lead author Dr. Lauren Gardner from the University of Sydney’s Matilda Centre told us. “We wanted to understand if, and how, these key health behaviors changed from before to during the pandemic, if different levels of restrictions influenced these changes, and whether there were differences among young males and females.”

Based on the evidence that emerged from research in the early stages of the pandemic, which typically focused only on participants who were in lockdown, researchers expected to see higher rates of screen time among those who were in lockdown, compared to those who weren’t in lockdown at the second time point.

“As for the other behaviors, earlier research was quite mixed, which is to be expected given the government responses and experiences of young people has varied greatly across contexts,” Dr. Gardner told us.

Although it is well established that the Big 6 health behaviors are important indicators of adolescent health and predictors of chronic diseases later in life, the pandemic has been a significant life event, and what was unknown, was how young people responded and how these behaviors had been impacted.

“Much of the existing research focused on those initial lockdown periods in 2020, but we wanted to know how the health behaviors fared over 2021, and if difference levels of restrictions played a role,” Dr. Gardner told us. “We were fortunate to have had access to data from a larger study being run by the University of Sydney’s Matilda Centre, called Health4Life, which has been running in 71 schools across NSW, WA and QLD since 2019.”

This meant researchers could assess how the key health behaviors changed from before, to during the pandemic, among a large and geographically diverse sample. At the second time point, about one-third of the sample were under the Greater Sydney stay-at-home orders, which allowed researchers to look at how being in lockdown impacted the behaviors, and they also explored if there were any differences based on gender.

“Our results demonstrated that there are ongoing impacts of the pandemic on young people, beyond those initially attributed to lockdown periods,” Dr. Gardner told us. “Although we did see some improvements in diet among young people in lockdown, including reduced sugar-sweetened beverage consumption and discretionary food intake, across the board, regardless of lockdown status, most Australian teenagers are spending too much time on screens (94%), aren’t getting enough physical activity (82%), and aren’t eating healthily (84% not enough vegetables, 41% too much discretionary food, 30% not enough fruit). Notably, among teenage girls in particular, we saw increases in poor sleep and sharper increases in alcohol use than boys.”

Given the researchers expected to see higher rates of excessive screen time among those in lockdown, compared to those not in lockdown, they were surprised that this wasn’t the case and instead a staggering 94% of the sample were spending too much time on screens, even if they weren’t in lockdown.

“This suggests that these habits have become quite entrenched among young people,” Dr. Gardner told us. “Additionally, although we would expect an increase in alcohol and tobacco use throughout the teenage years, typically we expect this to be greater among males, but we found there was a sharper increase in alcohol use among females. However, it is important to note that the rates of alcohol and tobacco use were very low at the first time point, and remained relatively low at the second time point.”

Overall, these findings highlight the need to support young people to improve their health behaviors, regardless of the course of the pandemic, and that tailored support for teenage girls may be beneficial, explained Dr. Gardner – this comes through investment from government in prevention and health promotion, and schools, parents and GPs can also play an important role.

“Although it might feel like life is starting to return to normal, as we come out of the acute phase of the pandemic, we mustn’t forget about the ongoing impacts,” Dr. Gardner told us. “We know that the physical and mental health impacts of significant events like the pandemic tend to persist over the long-term, and that health behaviors established during adolescence are likely to track into adulthood, so there is an urgent need to intervene now and support young people to improve their health trajectories.”