1. Introduction
Coronavirus, also known as COVID-19, has contributed to over 1 million deaths and over 96 million infected in the United States (US), with the highest mortality rates associated with those who had respiratory issues (48.6%), hypertension (18.3%,) or diabetes (15.0%) [
1]. This virus has led to hardships, as in early March 2020, business sales dropped, and food prices increased, causing a projected rise in food insecurity [
2]. For instance, for a week during 15 March 2020, it was recorded that 3.3 million people lost their jobs, with an estimated 26 million jobs lost in the first five weeks of the confinement period [
3]. The effects of confinement on the labor market were severe and impacted many adults in the US in the past two years since March 2020; nonetheless, the unemployment rate has decreased from 5.8% in 2021 to 3.6% in 2022 [
4].
Along with the financial issues caused by COVID-19, issues pertaining to the population’s access to food also developed. During the rise of the pandemic, many consumers took part in panic shopping, thus over-purchased foods that led to supply chain issues and possibly the elevation in food prices [
5]. The types of foods commonly purchased during panic shopping tended to be packaged, processed, and overall, less expensive, thus providing more fats, sugars, and sodium [
6,
7]. For example, one cross-sectional observational study demonstrated that 43.8% of participants (
n = 3313) reported an increase in consumption of sweets such as candy, cake, cookies, and pie [
8]. This is similar to other studies that showed that consuming foods considered high in saturated fats, added sugars, and sodium increased during this time [
9,
10,
11,
12,
13,
14]. On the other hand, due to safety concerns, consumers may have been cooking and eating more at home and/or participating in meal kit delivery services [
15]. These safety concerns may have been the primary reason for an increase in online grocery shopping since COVID-19, as was reported in a meta-analysis that included a total sample of 20,538 participants [
16].
Beyond challenges associated with accessing and obtaining food, mental health issues increased due to adults’ isolation and loneliness throughout COVID-19. A cross-sectional observational study (
n = 20,215) discovered that a majority (77.7%) of the participants stayed at home 50% to 95% of the time since March 2020 [
17]. The authors reported that staying at home for long periods of time, which may limit social interactions, can play a major part in growing mental health issues. Individuals that were most prone to mental health challenges due to COVID-19 included elders, academics, healthcare workers, children and teenagers, and people with a family psychiatric history [
18]. Furthermore, lifestyle habits like sleeping, exercise, and eating may have been altered during COVID-19 [
19]. Based on observational studies, most respondents decreased dining in restaurants and grocery shopping in the store; and increased levels of ordering takeout or delivery meals from restaurants and using electronic devices [
8,
20,
21,
22,
23]. The authors had conducted a prior study in early 2020; thus, as a follow-up study, the current aim was to examine food security and food attitudes and their subsequent impact on dietary habits and potential associations with demographics, health characteristics and lifestyle habits on dietary habits since March 2020.
4. Discussion
This study sought to examine food security and food attitudes and their subsequent impact on dietary habits since March 2020 and potential associations of demographics, health characteristics, and lifestyle habits with dietary habits. Results from this study showed that the association between dietary habits with food attitudes and food security continued to impact US adults in various ways. Even though a majority of participants indicated their dietary habits did not change, for those who did indicate a change, they increased their consumption of water, coffee or tea, salty and sweet foods/snacks, and decreased their consumption of white bread, red and processed meats. Furthermore, multiple lifestyle changes such as physical activity, grocery shopping in the store, meal kit services, and preparing/cooking meals at home positively impacted dietary habit scores. Factors such as medical conditions, tried a diet, and nutritional supplements intake had a significant positive relationship with dietary habit scores. In contrast, females negatively affected dietary habit scores.
Regarding dietary habits, females may have differed more than males, possibly due to preferences, and social and environmental factors [
37,
38,
39]. As demonstrated in COVID-19 specific studies related to dietary habits, Hassen and colleagues demonstrated that females (
n = 511) and males (
n = 484) had different consumption patterns dependent on the country of residence. For example, in Morocco, females consumed more food due to fear, stress, and anxiety over COVID-19 compared to males, but in Egypt, males consumed more comfort food than females [
40]. Another study that focused on 3 European countries–Denmark, Germany, and Slovenia, of a total of 2680 adults, showed that there were differences in consumption habits of males and females of foods/beverages that increased or decreased. For example, in Denmark, females increased their consumption of fresh fruits and vegetables, cakes and biscuits, and sweets and chocolate, whereas males decreased their consumption of fresh meats, fresh fish, cakes and biscuits, and increased consumption of canned foods [
41]. However, the results of this study must proceed with caution as females were overrepresented as slightly more than 77% participated. Moreover, this study found that most adults who reported a change in dietary habits decreased their consumption of red and processed meats such as bacon and hotdogs, white bread, and French-fried potatoes. Along with a decrease in these items, there was a reported increase in consumption of alcohol, low-carbonated beverages, eggs, chicken or turkey, potatoes, starchy vegetables, and salty snacks. In addition, a greater daily intake of water, coffee or tea, immune-enhancing beverages, nuts, fruits, non-starchy vegetables, oils, and sweets such as cake, cookies, and pie were observed. In contrast to the survey conducted during the confinement in 2020 within the US population, there was an increase in the consumption of immune-enhancing beverages while a decrease in white bread and French-fried potatoes [
8]. Immune-enhancing beverages may have increased due to participants’ perceptions of reducing the risk for illness. The greater intake of sweets remained significant during and post-March 2020, and alcohol consumption remained high in both surveys, possibly due to anxiety from the pandemic or returning to work [
42,
43]. Findings from this study were consistent with other studies, Kyprianidou et al. [
44] and Caso et al. [
45], regarding the increased consumption of alcohol, nuts, and oils. Moreover, Kyprianidou et al. [
44] explored changes in dietary and lifestyle habits through two observational studies during (
n = 1460) and after (
n = 1043) the COVID-19 confinement. According to their findings, post-confinement consumption of fruit/vegetables was 11% less than during confinement. This contradicts findings from this study that participants have continued increasing fruits and vegetables consumption (31.8% and 33.2%), respectively, since March 2020. Compared to the results of this study, Alvarez-Gómez et al. [
46] revealed that Spanish consumers (
n = 510) increased their intake of red meat post-COVID19 confinement due to the increased access to local markets within the country, which conflicts with the findings from this study. Overall, though, Alvarez-Gómez et al. [
46] discovered that healthy dietary and lifestyle habits, including an increase in fruit and vegetable consumption by 27% and 21%, respectively, occurred compared to pre-pandemic consumption. The higher intake of fruit and vegetables could be explained by accessibility, availability in the market, and continuing dietary habits acquired during the confinement period. Even though findings from various studies demonstrated changes in dietary habits since March 2020, very few have been conducted compared to when the confinement period occurred.
Lifestyle factors contributed positively to participants’ dietary habits. For instance, although 42.3% of participants indicated that their physical activity decreased since March 2020, physical activity was found to have a significant positive relationship with dietary habits (
p < 0.001). As many participants in this study were not at home as frequently since March 2020, it may have affected their physical activity habits due to less time available. Moreover, if someone was active since the confinement period, potentially their dietary habits may have largely remained unchanged in which they were already consuming nutritious foods. Kyprianidou et al. [
44] reported that in the Cyprus population, physical activity had decreased after the COVID-19 confinement, which aligns with this current study. Additionally, results from this study revealed that medical conditions contributed positively to dietary habits; this could be related to the healthier dietary and lifestyle habits developed during the confinement due to the participant’s awareness towards nutritious habits may lower their risk for other health problems, complications, and death. Although, no data was collected on these markers to confirm health status since March 2020. Furthermore, positive dietary habits may have been caused by more cooking at home, which causes an increase in fruit and vegetable consumption and less socializing outside the home [
47,
48].
Indeed, preparing/cooking meals in the home were significantly increased, as shown in this study (
p < 0.001). This could be due to participants decreasing socialization outside the home and enjoying cooking habits acquired since March 2020. Moreover, meal kit services were significantly associated with positive dietary habits (
p < 0.001), which could explain the increase in cooking meals at home. Meal-kit services are usually based on a subscription service, where the individual may customize meals to fit dietary preferences and receive pre-packaged fresh ingredients throughout the week. Based on a study conducted in Australia that compared 5 meal-kit delivery services with a total of 60 recipes discovered that the recipes were adequate in providing both macro and micronutrients. However, some modifications can be made to these meal-kits such as reducing sodium required in the recipes, providing more fiber-based foods and reducing the fat content, specifically saturated fat [
49]. As in this study, it is unknown the frequency or types of meals ordered from these meal-kit services, relating the increased intake of certain foods from the dietary habits to the increased ordering of these services, cannot be made. The findings from this study are consistent with those made by Alvarez-Gómez et al. [
46], who indicated that most people did not order food at home after confinement, showing that cooking at home was a practice that increased in frequency since confinement in Spain. Furthermore, Filimonau et al. [
50] revealed the same results in England households where most enjoyed cooking at home during and after national confinement and agreed to eat out less post- confinement.
This study showed low overall food security and food attitude scores, indicating that participants were food secure and had positive attitudes towards food. The average total food security score was 1.17, and the average total food attitude score was 2.50. According to the USDA’s economic research service, food consumption trends in 2021 likely reflect the improved household income resulting from the economic recovery [
51]. All food prices at stores were higher in July 2022 than in July 2021 [
51]. Even though prices went up the most for eggs (38%) and fats and oils (20%), and poultry (16%), this study revealed that adults were consuming more of these foods, which could be related to the fact that the study sample consisted primarily of full-time working, highly educated, single individuals who were less affected by food prices than other demographic categories. Lastly, food attitude and dietary habit scores were positively correlated, which may be attributed to the demographics of the study participants as opposed to the entire US population. Lower food attitude scores indicated positive dietary habits. In fact, the effects of COVID-19 and social and economic restrictions are complicated and involve many factors that can cause different groups of people to act in different ways [
52,
53].
Although life in the US is slowly reverting to pre-COVID, 71% of respondents indicated that the socialization they participated in outside the home had decreased. Most participants in this study did not shop for groceries online; thus, grocery shopping in the store was significant on total dietary habit scores (
p < 0.001), which may be due to preference, the atmosphere, and experience of shopping in physical stores [
54]. The ability to personally select food is the primary driver of the in-store benefit [
54]. Additionally, when it comes to grocery shopping, food quality has emerged as the most crucial factor to consider [
54]. These results were slightly different from a study conducted in mainland China, in which results revealed that despite an increase in online grocery shopping, purchasing food in person at local supermarkets or small shops remained the most common way to obtain food in the post-lockdown period [
55].
Some drawbacks of the present study must be acknowledged. First, due to the survey being conducted online, those who did not have access to a computer or the internet could not participate; therefore, selection bias resulted from the sample size and was not representative of a broader population [
31,
56]. This may have skewed the results with lower socioeconomic groups potentially consuming different dietary habits and participating in other lifestyle habits than those in higher socioeconomic groups. Therefore, the results from this study could not be generalized to the entire US population. Second, as a result of participants not being required to answer every survey item and may have provided inaccurate self-reporting information such as height and weight, this may have led to inaccuracies in the calculation of BMIs. Furthermore, the self-reporting bias could be from participants not remembering accurate information, wanting to look like they were in better economic standings than they were, or attempting to appear healthier based on social desirability bias [
31,
56].