Health behaviour changes around transitions into and out of unpaid caregiving in the UK: A longitudinal study.

Background: While unpaid caregiving has become an increasing public health concern, less is known about its association with modifiable health behaviours across the lifecourse. This study examined how transitions into and out of unpaid caregiving influence physical activity, diet, smoking, and alcohol consumption among UK adults aged 16 years and older. Methods: We used longitudinal data from up to 35,779 participants from the UK Household Longitudinal Study (UKHLS) spanning 2013 to 2023. Fixed effects models were used to estimate changes in health behaviour when people transition in or out of caregiving. As a robustness check, we applied piecewise growth curve models on a propensity score matched sample to model the trajectory of behaviours before, during and after the transition. Results: Transitioning into caregiving was associated with decreased physical inactivity while caregiving exit was linked to a rise in physical inactivity, although this may reflect caregiving-related physical tasks rather than health-enhancing leisure activity. Entry into caregiving was also associated with an increased probability of smoking particularly among adults aged 16-49, while changes in diet were not statistically significant. Findings for problematic alcohol use were inconsistent between the fixed effect models and piecewise regression. Conclusions: Caregiving transitions are associated with both beneficial and adverse changes in health behaviours. Caution is warranted in interpreting potential positive health behaviour changes which may reflect a burden of caregiving rather than healthy lifestyle choices. The findings underscore the need for targeted public health interventions that support unpaid caregivers.