key: cord-0702642-v3pkzfx5 authors: Gallé, Francesca; Quaranta, Alessia; Napoli, Christian; Diella, Giusy; De Giglio, Osvalda; Caggiano, Giuseppina; Di Muzio, Marco; Stefanizzi, Pasquale; Orsi, Giovanni Battista; Liguori, Giorgio; Montagna, Maria Teresa title: How do Vaccinators Experience the Pandemic? Lifestyle Behaviors in a Sample of Italian Public Health Workers during the COVID-19 Era date: 2022-02-06 journal: Vaccines (Basel) DOI: 10.3390/vaccines10020247 sha: d1c8a50a68a8695f6d5dc6492156615f3cc83584 doc_id: 702642 cord_uid: v3pkzfx5 Public health workers (PHWs) have experienced substantial workload changes because of their role in managing measures to limit the spread of COVID-19. The study’s aim was to assess lifestyle changes in Italian PHWs during the pandemic. PHWs attending an annual meeting completed an anonymous questionnaire assessing their sociodemographic and behavioral characteristics and lifestyle changes during the pandemic. A total of 1000 questionnaires were completed. Most participants (63.5% women, mean age 40 ± 13.1 years) were of normal weight (61.5%), non-smokers (81.9%), had a total screen time of ≥5 h/day (83.1%), and slept at least 6 h/night (88.7%). Approximately one-third consumed sweet foods every day (30%) and did not engage in physical activity (34.6%). Current sweet food consumption, physical activity, and sleep were associated with changes in these behaviors in the last 2 years (Tau-b = 0.155; Tau-b = −0.175; Tau-b = −0.276, respectively, p < 0.001). An increase in remote working was associated with worse sleep (odds ratio (OR) 2.065, 95% confidence interval (CI) 1.482–2.877) and diet (OR 1.982, 95% CI 1.385–2.838), and increased tablet/PC use (OR 3.314, 95% CI 2.358–4.656). Health promotion measures are needed to support the adoption of healthy lifestyles in this population during the current pandemic. The severe acute respiratory disease caused by the novel coronavirus SARS-CoV-2 (COVID-19) is a serious public health problem worldwide and has posed an unprecedented health and socioeconomic burden [1, 2] . The virus was first reported in Italy in early 2020 and spread rapidly across the whole country in consecutive waves, causing thousands of hospitalizations and deaths [3, 4] . In response to the epidemiological situation and drawing on previous experience of infectious disease control, the Italian government adopted a series of control measures to restrict the spread of the virus, such as restriction of movements, obligatory use of facial masks, contact tracing for early warning, and specific methods of environmental control measures, that were applied beside the routine microbiological checks [5] [6] [7] [8] . Inevitably, these measures had substantial effects on citizens' lifestyle, health, and psychophysical well-being. Several studies have been conducted in Italy to assess behavioral changes during lockdowns and throughout the ongoing COVID-19 pandemic in the general population and in specific populations such as healthcare workers (HCWs) [9] [10] [11] . With few exceptions, these studies report increasing psychological distress and the adoption of unhealthy behaviors, especially related to diet and physical activity (PA). In particular for HCWs, several studies have showed how severely well-being has been affected during the pandemic in Italy. It was demonstrated that HCWs living in the most affected regions had a prevalence of psychological distress higher than their colleagues from the rest of the country; moreover, significant differences related to life changes were associated with the lockdown [12] . Another study revealed that one year after the beginning of COVID-19 emergency, Italian nurses were at the greatest risk of anxiety and depression, whereas residents were at the greatest risk of burnout, and working in intensive care units was associated with an increased risk of developing severe emotional exhaustion and a cynical attitude towards work [13] . A repeated cross-sectional study shows that one year after the baseline evaluation, Italian HCWs reported an increased workload, isolation at work and in their social life, and a lack of time for physical activity and meditation [14] . The level of these working-related unhealthy effects was higher in HCWs who directly managed the COVID-19 emergency compared to those who were not directly involved [15] . In this context, public health workers (PHWs) are health care workers dealing with preventive medicine and health promotion. With regard to the pandemic, apart from the managing role of evaluating and providing the best setting-specific procedures for disease prevention, PHWs were responsible for some crucial and direct control measures such as contact tracing and related screening by molecular testing targeted to both the general population (in drive-thru testing centers) and home quarantined contacts. Moreover, PHWs were responsible for the immunization campaigns when the first vaccines became available (vaccinating dozens of millions of Italians). Therefore, PHWs were not involved in the "clinical" management of severe cases of diseases, but they have had contact with COVID-19 patients and filled a role of high responsibility in the disease control. To our knowledge, while some studies have been published regarding the pandemic's effects on HCWs, no studies have analyzed health-related behaviors adopted by PHWs during the pandemic. The aim of this study was to explore lifestyle changes that have occurred since the beginning of the COVID-19 pandemic in Italian PHWs joining the Italian Society of Hygiene, Preventive Medicine, and Public Health (SItI) and to investigate associations between the self-reported changes and participants' sociodemographic and behavioral characteristics. A second phase of the study will be conducted in November 2022 to test long-term selfreported consequences of the pandemic. SItI represents PHWs working in both public national health system and in research institutions such as universities and public health institutions. In November 2021, the society's annual meeting was held in Lecce, southern Italy. Meeting attendees were asked to complete an anonymous questionnaire. Participation was voluntary and attendees were informed that the completion of the questionnaire implied informed consent for data collection and treatment. We considered as the target population the total number of PHWs joining the SItI (2240 PHWs). Based on the reference population and assuming a 5% margin of error and a 95% confidence level, the minimum sample size was estimated at 328 PHWs. This study was performed in accordance with the World Medical Association's Declaration of Helsinki. The study was approved by the scientific institutional review board of the Italian Inter University Research Centre "Population, environment and health" (approval number: 2810_2021). The questionnaire design was based on tools used in previous studies [16] [17] [18] and modified to fit the target population. The questionnaire was reviewed by a panel of experts comprising one epidemiologist, one public health professional, one psychologist, one expert in nutrition and movement sciences. Moreover, the intelligibility of the questions was evaluated by asking a small separate sample to assign a 7 point score from 7 (very meaningful) to 1 (not meaningful at all) to each question. To this purpose, the original questionnaire, reporting the standard questions (SQ) was revised: 10 adjunct questions (AQs), reporting both semantic and grammatical errors, were added to the standard questions. The mean score for each SQ was >6 and for each AQ was <2. Therefore, the content of the questionnaire was considered clear to readers. A preliminary pilot study involving 48 people was carried out to test the questionnaire's validity (data not published). Three sections were developed: The first section recorded sociodemographic information such as gender, age, work institution (research/healthcare service institution), and living conditions (alone/with parents/with friends or colleagues/with partner/with parents and underage children/with parents and adult children). Participants were also asked to self-report their weight and height to enable calculation of body mass index (BMI) and related weight status (underweight/normal/weight/overweight/obese) according to the World Health Organization classification [19]. The second questionnaire section comprised questions about current behaviors. Participants were asked to report if they smoked (no/yes); for how many days/weeks they ate sweet foods; if they engaged in PA (no/walking or cycling for commuting/walking or cycling for leisure/doing exercise or sport outdoors/doing exercise or sport in indoor facilities/doing exercise or sport at home); and how much they watched TV, used a smartphone, used a tablet/PC (<1/1/2/3/4/≥5 h/day), and slept (≤5/6/7/8/≥9 h/night) at the time of the investigation. Cronbach's alpha (internal consistency coefficient) was used to test the reliability of both the pilot and final study [20] . The alpha values for this section showed a good level of reliability (0.74 and 0.70, for the pilot and the final study respectively) [21] . The third section of the questionnaire assessed lifestyle changes during the pandemic. Participants were asked to report changes in work activity (no change/more remote work/more onsite work); smoking habits (stopped/decreased/no change/started/increased); dietary habits (improved/no change/worsened); sweet food consumption (decreased/no change/ started/increased); body weight (decreased/no change/increased); PA (started/increased/no change/decreased); time spent watching TV, using a smartphone, using a tablet/PC (decreased/no change/increased); and sleep time (increased/no change/decreased). In addition, for this section, the Cronbach's alpha values showed a good level of reliability (0.86 and 0.82 for the pilot and the final study respectively) [21] . In addition, participants were asked a question about their COVID-19 vaccination status ("How many doses of COVID-19 vaccine have you received so far?"). Descriptive analysis was performed on participant sociodemographic, anthropometric, and behavioral characteristics. Continuous variables were expressed as the mean value ± standard deviation. Categorical variables and responses were reported as the number and percentage of respondents. Gender comparisons were performed using the chi-square test. Kendall's correlation analysis was used to identify possible relationships between sociodemographic, anthropometric, and behavioral characteristics and vaccination status. To this aim, gender was categorized as female = 0 and male = 1; age as