This study aimed to compare self-reported changes on lifestyle behaviors during two phases of the
COVID-19 pandemic in Spain, and to evaluate clinical and sociodemographic factors associated with lifestyles.
Methods: Two cross-sectional web surveys were conducted during lockdown (April 15-May 15, 2020) and seven
months later (November 16-December 16, 2020). Lifestyle behaviors were self-reported by a multidimensional
scale (SMILE-C). Two separate samples of respondents were analyzed. A multivariate regression model was
performed to evaluate the association of SMILE-C scores with demographic and clinical variables.
Results: The sample comprised, 3412 participants from the first survey (S1) and in the S1 and 3635 from the
second (S2). SMILE-C score decreased across surveys (p < 0.001). The rates of positive screenings for depression
and anxiety were similar between the surveys, whereas those for alcohol abuse decreased (p < 0.001). Most
participants in S2 reported that their lifestyle had not changed compared to those before the pandemic. Variables
independently associated with an unhealthier lifestyle were working as an essential worker, lower educational
level, previous mental disease, worse self-rated health, totally/moderate changes on diet, sleep or social support,
as well as positive screenings for alcohol abuse, anxiety and depression.
Limitations: The cross-sectional design and recruitment by non-probabilistic methods limit inferring causality and
the external validity of the results.Instituto Carlos III, PI16/01770Ministerio de Ciencia e Innovación, PI15/00283, PI18/0080