**1. Introduction**

Originating in Wuhan (Hubei, China) in December 2019 as a cluster of unexplained cases of pneumonia, the World Health Organization classified the SARS-Cov-2 outbreak as a pandemic in March 2020, affecting multiple countries, with more than 110 million confirmed cases and more than 2.5 million deaths [1]. On 26 February 2020, the first case of COVID-19 was detected in Spain. Due to the large increase in the number of cases, on 14 March, the Spanish government declared a state of alarm throughout the country. Beyond impacting millions of lives around the world, the pandemic has dealt a blow to the economy on a global level. The COVID-19 health crisis has posed a complex scenario for economy not only because of the shock it has produced, but also because its repercussions will be significant [2]. The world economy is facing its greatest challenge since the Great Recession. The state of alarm in Spain has resulted in the confinement of millions of people and, for this reason, the Spanish economy was forced to establish urgent measures

**Citation:** Rodriguez-Besteiro, S.; Tornero-Aguilera, J.F.; Fernández-Lucas, J.; Clemente-Suárez, V.J. Gender Differences in the COVID-19 Pandemic Risk Perception, Psychology, and Behaviors of Spanish University Students. *Int. J. Environ. Res. Public Health* **2021**, *18*, 3908. https://doi.org/10.3390/ ijerph18083908

Academic Editors: Paolo Roma, Merylin Monaro, Cristina Mazza and Paul B. Tchounwou

Received: 2 March 2021 Accepted: 2 April 2021 Published: 8 April 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

to avoid the paralysis of both public and private administrative activity. In this way, many companies were forced to implement teleworking quickly so that their employees could continue to carry out their duties from home. Similarly, universities also moved 75% of their students [3] to online learning so that they could continue their studies [4]. However, not all companies have been able to adapt to this new modality, so they have been forced to permanently or temporarily suspend all or part of their activity, exercising Temporary Employment Regulation Files or on many occasions to dismiss their employees.

Because of the interactions between biological factors and social determinants, including gender stereotypes, differences and roles, social stigma, and social autonomy [5], inequities are expected to appear in the context of COVID-19. Indeed, COVID-19 has affected males and females differently, presenting higher fatality rates, a worse prognosis, and a higher risk of death in males [6]. Yet, despite fatality rates, females have a higher prevalence and severity of anxiety, depression, and acute stress symptoms [7]. However, females have experienced a greater number of psychological alterations that can be associated with isolated symptoms and complex disorders, which are related to a deterioration in functionality and the development of anxiety, insomnia, depression, or post-traumatic stress disorder (PTSD). In addition, gender moderates the relationship between emotional disturbances (e.g., psychological distress) and personal strengths such as resilience and social support in students. Thus, differences in psychometric and emotional profiles are key elements to understand the striking differences between males and females regarding COVID-19 beliefs and behaviors.

In this line, the authors hypothesize that females are more likely to take the pandemic seriously. In March, 59% of female respondents considered COVID-19 to be a very serious health problem compared to 49% of males. In mid-April, both numbers decreased, but the gender difference remained: 40% of females still saw the virus as a very serious risk compared to 33% of males. This difference is present among studied countries [8]. Indeed, the authors postulate that gender differences regarding perception risk are echoed in behavioral differences between male and female leaders. Countries which are led by females have responded with greater effectiveness to the pandemic than countries led by males [9]. For example, Germany, Iceland, New Zealand, and Denmark, which have female leaders, have used a more democratic and inclusive style of leadership, with decisive and clear communication strategies. Meanwhile, countries with male leaders such as the US, Brazil, and the UK have experienced the worst COVID-19 outcomes [9].

Yet, one of the most affected by the COVID-19 pandemic groups are students, since their welfare and mental health is threatened. Previous research on COVID-19's psychological effect on university students indicates that the economic situation, as well as delays in academic activities, are risk factors for developing anxiety, with depressive symptoms, stress, and anxiety being the most commonly identified psychological effects [10]. When compared to other collectives, such as professors, students seem to present higher scores of stress and anxiety [11], with females presenting higher ratios and a growing and greater prevalence of depression among male students [12]. However, the psychological and emotional profiles and the behavioral responses depend greatly on both contextual and multifactorial factors such as nutritional status, oral health, and the amount of physical exercise [13]. All of these factors are influenced by gender [14], and previous authors have remarked that these factors may be influenced by the pandemic situation (-) and lockdown (-).

In this line, researchers have established an association between the way people eat and their mood. Thus, eating patterns can affect the way people feel [15]. During the period of confinement, nutritional habits changed dramatically in parallel with the increase in anxiety and stress values among the population [16]. Previous authors have found that the most frequent changes related to an increased consumption of fruit (27%), eggs (25.4%), legumes (22.5%), vegetables (21%), and fish (20%), and a reduced consumption of processed meats (35.5%) and sugary drinks (32.8%), with clear differences according to age and gender. Physical activity can be a contextual factor for the psychological profile. Students who are physically active tend to have a healthier and more balanced diet than those

who are not physically active. University students practice an average 40 min of physical activity per day, being significantly higher in males than in females [17]. Along these lines, male university students tend to opt for sporting activities in their leisure time, while females give greater importance to other social activities and personal hobbies in detriment of physical activity [18]. Few studies have focused on gender differences regarding the impact of the COVID-19 outbreak countries like Spain, where mortality remains one of the highest worldwide, especially when considering a wide range of multifactorial variables. Thus, we conducted the present research with the aim of studying gender differences in university student regarding the perceived risk of the COVID-19 pandemic and in psychological, nutritional, oral health, and physical activity habits. The initial hypotheses were: (i) There are gender differences in the perceived risk of the COVID-19 pandemic, and (ii) there are gender differences in the psychological, nutritional, oral health, and physical activity habits of students.
