Risky Health Behaviors
and COVID-19
Obesity and COVID-19
• Individuals with obesity are 46% more likely to test
positive for COVID than healthy-weight individuals
• Among COVID patients, those with obesity are, relative
to healthy-weight patients:
– 113% more likely to be hospitalized
– 74% more likely to be admitted to ICU
– 48% more likely to die
• Why?
– Fat in abdomen constricts diaphragm/lungs; obstructive sleep
apnea
– Fat is an endocrine organ that secretes hormones that:
• Compromise immune system
• Increases tendency towards blood clots, COVID also increases blood
clots
Sources: Science (2020), Popkin et al. (2020)
Exercise, Weight, and COVID-19
• Shutdown of many gyms/fitness centers
• Shift to home exercise:
– Large increases (130% +) in sales of home fitness equipment (Reuters,
2020)
– Peloton stock price up 95% since March 2020
• Unclear what net change is in time spent exercising or # calories
burned through exercise
– American Time Use Survey (ATUS), which documents time spent
exercising, stopped collecting data
• Unclear what net change is in weight; small (N=173) online survey
(Zeigler et al., 2020) found:
–
–
–
–
Gained 5-10 lbs: 22%
Weight stable: 59%
Lost 5-10 lbs: 15%
Lost >10 lbs: 4%
Smoking and COVID-19
• During COVID, cigarette sales have reduced their long-term downward slide
– Decline of 2-3.5% rather than projected 4-6% decline (WSJ, 2020)
– Altria execs attribute higher-than-expected sales to more time at home (lack of ban), stimulus
money, increased e-cig regulation
• E-cig sales down 14%, but this is attributed to other factors, such as FDA banning
flavors, raising minimum purchase age
• Significant association between smoking and severity of COVID-19 outcomes, such
as admission to ICU, ventilator use, and death (WHO, 2020)
Legal Cannabis and COVID-19
• Cannabis dispensaries generally designated essential services, allowed to
remain open during COVID shutdown
– Customers urged to order online or over phone
– Most sales involve curbside pickup or delivery
• Both legal and illegal sources have reported large increases in sales (e.g.
NYT, 2020)
– In CO, marijuana tax revenue at record high, over $240 million Jan-Aug 2020
(CBS, 2020)
– In OR, sales 30% higher than previously forecast (Oregon Office of Economic
Analysis, 2020)
STIs and COVID-19
• COVID-19 shutdown led to closure of many STI testing sites
– Interferes with accurate surveillance
– # of new positive cases down, but due at least in part to fewer tests
• Also led to closure of condom distribution centers, reassignment of STI health
workforce
• Has shutdown reduced risky sex?
• Concern cases are spreading undetected
Alcohol and COVID-19
• Change in alcohol sales/consumption during COVID:
– Alcohol consumption in bars (traditionally, 45% of all alcohol
spending) is down 90% due to bar closures (Forbes, 2020)
– People are transferring a subset of those alcohol purchases to other
locations:
• Sales of alcohol at brick-and-mortar retail stores are up 41% (Winsight Grocery
Business, 2020)
– Sales of large sizes are particularly high: boxed wine sales up 44%, 30-packs of beer up
20.9%, over 2019. Sales of 6-packs down 2.0%. (Nielsen, 2020)
– Sales favor big business: craft beers down 11%, imports down 8%, from 2019 (Nielsen,
2020)
• Sales of alcohol online are up 339% (Winsight Grocery Business, 2020)
– Alcohol is the fastest growing e-commerce item among consumer packaged goods
(Nielsen, 2020)
– Overall, Americans probably spending less on alcohol, but are
switching from expensive purchases (bars) to cheaper ones (retail);
ambiguous effect on consumption
• NIH has released data for select states, by month and alcohol type (beer, wine,
spirits)
% Change in Per Capita Sales of Alcohol in March 2020 Compared to Prior
3-Year March Average
Source: NIAAA, NIH (2020). Combination of on-premises and off-premises sales of
alcohol. Expressed as gallons of ethanol. Blue: spirits. Red: wine. Green: beer
% Change in Per Capita Sales of Alcohol in April 2020 Compared to Prior
3-Year April Average
Source: NIAAA, NIH (2020). Combination of on-premises and off-premises sales of
alcohol. Expressed as gallons of ethanol. Blue: spirits. Red: wine. Green: beer
% Change in Per Capita Sales of Alcohol in May 2020 Compared to Prior
3-Year May Average
Source: NIAAA, NIH (2020). Combination of on-premises and off-premises sales of
alcohol. Expressed as gallons of ethanol. Blue: spirits. Red: wine. Green: beer
% Change in Per Capita Sales of Alcohol in June 2020 Compared to Prior
3-Year June Average
Source: NIAAA, NIH (2020). Combination of on-premises and off-premises sales of
alcohol. Expressed as gallons of ethanol. Blue: spirits. Red: wine. Green: beer
Alcohol and COVID-19
• Relevance for COVID-19:
– Alcohol abuse weakens your immune system (WHO, 2020; NIH, 2020)
– Alcohol consumption reduces inhibitions, can reduce physical distancing
Alcohol, Universities, and COVID
• SUNY-Oneonta: shut down after 500 students tested positive 2 weeks after opening;
parties as vector
• Notre Dame: shut down after 147 students tested positive one week after opening;
parties as vector
• UNC-Chapel Hill: shut down after 177 students tested positive one week after
opening; parties as vector
• Univ suspending numerous students for attending parties without masks/physical
distancing: Ohio State (>200), SUNY Plattsburgh (43), Syracuse University (23),
Marist College (15)
• Cornell: staked out unusual position early on, allowing all students back, some inperson classes (WSJ editorials). So far, so good
– Instagram influencer shared photos from party without masks, social distancing
COVID-Related Policies
• In light of COVID, what are optimal policies?
– Alcohol:
• Liquor stores essential businesses?
• Restaurants/bars – open? Socially distanced?
• Allow take-out and delivery of alcohol?
– Universities:
•
•
•
•
Online-online, hybrid, or in-person?
Party policy? On-campus vs off-campus?
Regarding housing, testing, quarantine?
Implications for educational quality, costs, tuition?
– Legal marijuana markets:
• Dispensaries essential businesses?
• Allow take-out and delivery of marijuana?
– Promote exercise, healthy weight?
– Monitor, reduce STIs?