Disruption and recovery in physical and mental health, body mass index and smoking during the COVID-19 pandemic: a trend analysis of US BRFSS data from 2016 to 2022.

Introduction: The COVID-19 pandemic caused widespread disruptions to population health, affecting key risk factors such as physical and mental health, smoking status and body weight. While short-term impacts have been studied extensively, long-term trends and recovery patterns remain unclear. Methods: This study used data from the Behavioural Risk Factor Surveillance System covering 2016-2022. Weighted proportions for health outcomes were calculated, and trends were analysed using locally weighted scatterplot smoothing and Kendall's tau correlation. Bootstrapping was used to estimate CIs. Results: During the pandemic, individuals reporting 14+not good physical health days increased significantly (τ=0.7238, p<0.0001). Mental health also deteriorated, with 14+not good mental health days increasing (τ=0.7263, p<0.0001). Smoking prevalence declined (τ=-0.5536, p<0.0001) while those who 'never smoked' increased (τ=0.6024, p<0.0001). Obesity prevalence rose significantly postpandemic (τ=0.6632, p<0.0001). Conclusions: The findings highlight the pandemic's profound and differential impact on physical health and persistent worsening of not good mental health days and body mass index indicating obesity. The decline in smoking prevalence suggests a positive behavioural shift during the early years of the pandemic. Targeted public health interventions are needed to address these challenges and promote recovery.