Article Appetite 166 (2021) 105430 Available online 3 June 2021 0195-6663/© 2021 Elsevier Ltd. All rights reserved. An unintended consequence of Covid-1

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Appetite 166 (2021) 105430

Available online 3 June 2021
0195-6663/© 2021 Elsevier Ltd. All rights reserved.

An unintended consequence of Covid-19: Healthy nutrition

Nilsah Cavdar Aksoy a, *, Ebru Tumer Kabadayi a, Alev Kocak Alan b

a Faculty of Business Administration, Gebze Technical University, Kocaeli, Turkey
b Albeka Consulting, Istanbul, Turkey

A R T I C L E I N F O

Keywords:
Healthy nutrition
Attitude
Health consciousness
Fear
Social influence

A B S T R A C T

The Covid-19 pandemic involving mass quarantines and stay at home orders in many nations has affected
consumer behaviour including food intake. Despite the seriousness of the situation, spending more time at home
may have had some unintended consequences for consumers. The aim of this study was to investigate the
consequences of the current adverse circumstances on nutrition, within the framework of changes in attitude
toward healthy eating, health consciousness, fear, and social influence of family, peers, and social media in-
teractions. For this purpose, 732 participants, the majority of whom were female, aged between 26 and 55 years
with university degrees, were surveyed online. Data were analyzed using a structural equation modeling
approach. Based on results, family influence and social media influence were found to have positive effects on
fear of Covid-19 and greater health consciousness. The effect of peer influence was only observed for health
consciousness, not fear of Covid-19. Health consciousness and Covid-19 fears positively affected attitude and
health consciousness, and attitude was positively related to healthy nutrition, indicating these individuals’ be-
liefs about the healthiness of their current daily diets. Future research and practices may consider the effect of
Covid-19 on humans’ nutritional attitudes and behaviours based on our study so that health-related issues in the
pandemic can be further examined and explained through nutritional consequences by researchers and practi-
tioners in the future.

1. Introduction

Covid-19 is a strain of coronavirus, which is transmitted between
people, has caused massive changes that have affected daily life (Haleem
and Javaid, 2020). For instance, compulsory or voluntary quarantines
have been experienced. As a result, daily habits and consumption pat-
terns significantly changed. During this time, consumers started to buy
certain products more often and stock up on essentials (i.e.,
non-perishable groceries, household & cleaning supplies, frozen food)
(PWC, 2020). They also turned to certain experiences more often, such
as their kinds of entertainment, watching/reading the news, hobbies,
cooking, social media, household chores, shopping more online, and
physical fitness (PWC, 2020). Consumers have also begun to focus more
on online options to deal with the pandemic (McKinsey, 2020).

Covid-19 is still with us and has been considered a real-time exper-
iment (Cohen, 2020) that can have new and different effects on various
disciplines. The pandemic desires more attention on behavioural
research, especially consumer behaviour. For example, more focus is
needed for consumer behavioural research to determine the unintended

consequences of this process, including the rising importance of health
concern for consumption (Cranfield, 2020; Zwanka & Buff, 2020). Much
of current research has focused on the significant impairment to daily
life for individuals across nations (e.g., Ahorsu et al., 2020; Lee, 2020);
however, some unintended consequences can be revealed during or after
these events (Buheji and Ahmed, 2020). As an example, such collectively
experienced events resulted in new situations, such as the development
of health systems or the set of stage for the modern welfare state, in the
past (Zwanka & Buff, 2020). On the other hand, some studies have
emphasized that certain behaviours of consumers do start to change and
pandemics do create fundamental changes in consumption and nutrition
(Cranfield, 2020; Zwanka & Buff, 2020).

Thus, the aim of this study is to investigate the consequences of the
current adverse circumstances on nutrition, within the framework of
changes in attitude toward healthy eating, health consciousness, fear,
and social influence of family, peers, and social media interactions. In
this study, we defined healthy nutrition as individuals’ beliefs about the
healthiness of their current daily diets during the Covid-19 and desired
to analyze this unintended consequence of the pandemic by explaining

* Corresponding author.
E-mail addresses: n.cavdar@gtu.edu.tr (N.C. Aksoy), tumer@gtu.edu.tr (E.T. Kabadayi), alev.alan@albekaconsulting.com (A.K. Alan).

Contents lists available at ScienceDirect

Appetite

journal homepage: www.elsevier.com/locate/appet

https://doi.org/10.1016/j.appet.2021.105430
Received 20 July 2020; Received in revised form 10 May 2021; Accepted 20 May 2021

Appetite 166 (2021) 105430

2

these beliefs of individuals for two key reasons.
First, positive effects concerning personal health are one of the

important effects of the Covid-19 pandemic on consumer behaviour that
despite the number of deaths and severe long-term illnesses suffered by
those who have tested positive from the coronavirus, those who have
remained well have had the opportunity to reflect on health behaviours
including diet (Murphy, 2020; Oaklander, 2020). Healthiness becomes
an important concern of individuals during Covid-19 (Cranfield, 2020;
Zwanka & Buff, 2020) due to the desire of being sure about the in-
gredients of the foods and having a strong immune system in this time
(Butler and Barrientos, 2020; Muscogiuri et al., 2020).

Second, we focused on exploring healthy nutrition that during the
current pandemic, as there is a need for consumers to understand the
role of healthy nutrition, in line with calls from the work of Zwanka and
Buff (2020). Zwanka and Buff (2020) called for research and an
empirical analysis of the implications of their framework, including the
shift to cooking at home, controlling ingredients to see what we actually eat,
and the shift to healthiness as an implication of the concerns about
Covid-19.

2. Theoretical background

Fig. 1 shows the conceptual model of the study deriving from the
desire to explore healthy nutrition, which was conceptualized based on
the muddling-through theory (Lindblom, 1959) in this study. We
focused on the issue of healthy food consumption that is in perfect
harmony with the framework suggested by the muddling-through the-
ory. In explaining these kinds of issues (i.e., healthy food consumption),
some decision-making theories are weak, so this theory helps in un-
derstanding the complex decision-making processes of consumers
caused by their behaviours (Hausman, 2012). On the other hand,
Covid-19 is a complicated issue in and of itself and consumer behaviour
that is already difficult to understand thus becomes even more complex.
In this regard, the relevant theoretical approach helps us to understand
healthiness-oriented positive consumer behaviour during an unusual
and complex process.

This study examines social influence, Covid-19 fear, health con-
sciousness and attitudes and how these turn into influence on nutrition.
In this way, the psychological (i.e., fear) and the social conditions (i.e.,
social influence) revealed by the pandemic are kept within the frame-
work of health consciousness and the positive attitudes toward giving up
unhealthy foods to understand the healthiness that stands out both due
to and during this pandemic.

3. Hypothesis development

3.1. The effects of social influence

Social influence refers to a concept that has been known and defined
based on its effects on human behaviours for many years, and it is used
as an essential factor in various theories to explain these behaviours (i.e.,
Ajzen, 1985, 1991; Ajzen & Fishbein, 1980; Fishbein & Ajzen, 1975).
The influence is defined as the substantial impact of other people on the
decision-making processes of individuals and the claim is that in-
dividuals may decide on something by undertaking various evaluations
as a result of their interactions with their social environments, thereby
representing the social influence on the decision-making process (Wood
& Hayes, 2012). The concept is subject to studies in different contexts in
several different disciplines, such as consumer behaviour (Batinic and
Appel, 2013; Goodwin, 2013). The scope of social influence (family,
peer, friends, etc.) on consumption has expanded as a result of de-
velopments in information technologies, and the effect of interactions on
social media has also been included into these influences (Zhou, 2011,
pp. 1–25). In our context, social influence includes the impacts of family,
peers, and social media interactions on purchasing and consumption
decisions of individuals, thereby revealing through interpersonal
communication with family members, peers, and social media in-
teractions about new consumption ideas during Covid-19. Here, family
influence refers to the impacts arising from interpersonal communica-
tion between family members about purchasing and consumption de-
cisions related to this process. Peer influence is the impact of the
communication between friends on these decisions. Social media

Fig. 1. Research model.
Note: Parameter estimates *p < .05, **p < .01, ***p < .001.

N.C. Aksoy et al.

Appetite 166 (2021) 105430

3

influence is the impact of the interactions between individuals on social
media for such decisions during Covid-19.

We believed that family influence, peer influence, and social media
influence are positively related to fear of Covid-19 and greater health
consciousness during this adverse pandemic. In general, social influence
is frequently used to explain different behaviours by associating it with
both health-related issues (Butterfield & Lewis, 2002; Cruwys et al.,
2015; Poirier & Cobb, 2012; Russell & Champion, 1996) and emotions
(Jones, 2001; Scherer, 1993; Van Kleef et al., 2011). In addition, social
influence has also been discussed in different studies to explore its ef-
fects on cataclysmic events, such as disasters (Riad et al., 1999; Rice
et al., 2010). This knowledge gives us the basis to use to explain the
effects of the same concept in the context of Covid-19. Moreover, in line
with our focus, the approaches offered by social influences on health and
health-related issues are vital to know to understand the pandemic and
its unintended consequences. In the interaction between individuals,
health issues are commonly handled and explained by showing the ex-
istence of social influence in health-related topics (Cline, 2003; Meng,
2016; Wang et al., 2008). Thus, individuals are afraid of an unusual
event and become more conscious about their health so as to cope with
the illness by trying to stay healthy. Because of this,

H1. Family influence (a), peer influence (b), and social media influ-
ence (c) positively relate to Covid-19 fear.

H2. Family influence (a), peer influence (b), and social media influ-
ence (c) positively relate to health consciousness.

3.2. The effects of Covid-19 fear

Covid-19 has different features than past cataclysmic events that
individuals have experienced around the world (Cranfield, 2020). Since
this virus is highly contagious, it has significantly changed the routines
of individuals. They have changed their lives and ways of doing works;
they have had to take on greater personal responsibility because of the
risk of infecting someone else with the virus. Thus, individuals began to
have negative toward this unusual and unknown virus and fear it and its
consequences (Ahorsu et al., 2020). This fear is called Covid-19 fear in
psychology and refers to a fear that includes being afraid of catching this
illness, being anxious even while following the news about it, thinking
about the situation they live in, and fear of losing loved ones because of
the illness. This Covid-19 fear is one of the most important impacts of
this pandemic in terms of the mental health of individuals, and there
may be other situations and behaviours as well that this fear during the
pandemic and/or afterwards can also impact.

In some cases, negative emotions may not produce completely
negative results (Match, 2008). For example, individuals who are
struggling with certain diseases can deal better with their illness in line
with their negative feelings, and in that case, their negative feelings can
act as a motivator in their lives and their decisions (Lee et al., 2008). In
our context, it is predicted that individuals will focus more on positive
behaviours and that will produce more positive results for dealing with
this kind of fear and the effects of the pandemic. On the one hand, since
this virus appeared as a food-centric event, it can also be associated with
nutrition, and individuals may reassess their views or change their
sensitivities and beliefs on food health issues in situations that arise from
food safety crises (Xie et al., 2020). In that environment, people who are
afraid of this event and its current or possible consequences may start to
exhibit more positive attitudes and behaviours to increase their
healthiness. When fear, a natural response to a pandemic, is ignored, no
progress can be made, but that crisis will be easier to handle once its
existence is actually accepted (Finset et al., 2020). In this case, human
psychology and the possible positive consequences of negative emotions
are not ignored, since the pandemic affects mental health as well as
physical health (Ahorsu et al., 2020). In our context, the fear of Covid-19
affects a nutrition-related positive attitude, the attitude toward giving
up unhealthy foods, and a nutrition-related belief of individuals. Thus,

H3. Covid-19 fear positively relates to the attitude toward giving up
unhealthy foods (a) and healthy nutrition (b).

3.3. The effects of health consciousness

Health consciousness refers to an individual’s readiness to take
health actions (Becker et al., 1977). Conscious individuals reviewing
their health monitor their own health and well-being and thus, they try
to keep their health in good condition and not become ill (Michaelidou
and Hassan, 2007). Further still, health-conscious people will consume
based on their evaluations of food and apply a high consciousness. In our
context, health consciousness is the readiness of people to take actions to
stay healthy during the Covid-19 pandemic through more
nutrition-related evaluations and their consequences. This action refers
to an intrinsic driver of thinking about health-related issues deeply and
then making the right decisions by choosing healthy foods, and behaving
as a health-conscious individual.

During the Covid-19 pandemic, individuals have had more
confrontation with health issues. We believe that individuals who have
the opportunity to think about strengthening their immune systems and
taking care of their health have a positive attitude about giving up un-
healthy foods and adopting healthy nutrition as a health action. In
general, health consciousness shapes the attitudes of individuals (Kumar
& Smith, 2018; Michaelidou and Hassan, 2007; Rojas-Méndez et al.,
2015) and prepares them for their actions towards increasing their
health (Iversen & Kraft, 2006; Jayanti & Burns, 1998; Mai & Hoffmann,
2012). This concept was further examined in the context of disasters
(Handler, 2016). It also provides a basis for studying these effects during
an up-to-date cataclysmic event. The effects of health consciousness are
not yet known fully for Covid-19 although health consciousness is seen
as a reflection of the impacts of Covid-19 among people (e.g., Nicomedes
& Avila, 2020). For instance, Zwanka and Buff (2020) argue that
increased health consciousness in the Covid-19 pandemic will lead to
increased demands on food safety and balanced nutrition; yet an
empirical finding for this argument is not yet available in the extant
literature. Therefore,

H4. Health consciousness is positively related to attitude toward giv-
ing up unhealthy foods (a) and healthy nutrition (b).

3.4. The effect of attitude

Attitude is a psychological tendency that is a predictor of behaviour
and revealed as the result of one’s positive or negative evaluations to-
ward a particular product, service, or idea. (Ajzen, 1991; Davis, 1989;
Holbrook et al., 2005; Venkatesh et al., 2003). It is possible to predict an
individual’s behavioural beliefs, intentions, and behaviours that have
not yet turned into action and the behaviours that will be revealed as a
result of attitudes. During the consumption process, we also see a strong
effect, linking attitude to behaviour. In our context, the existence of a
positive relationship between the attitude toward giving up unhealthy
foods (energy-dense foods included high fat, saturates, sugar, salt)
(Lobstein and Davies, 2008; Talukdar & Lindsey, 2013; Vandevijvere
et al., 2018) and healthy nutrition is predicted. Another reason for this
argument in addition to the evidence found in consumer behaviour
research is that attitude towards healthy eating or food consumption
also strongly and positively affects actions (Graham & Laska, 2012;
Nardi et al., 2020; Pieniak et al., 2009; Sun, 2008; Vermeir & Verbeke,
2006). Individuals who develop positive attitudes towards certain
products, services and behaviours are then prepared to take a health
action. In our study, it is believed that individuals, who act from the
effect of this approach, turn to healthy nutrition at a time (i.e.,
pandemic) when it is important to give up unhealthy foods and focus on
attitude from a novel and new perspective. Such an attitude then posi-
tively affects the behaviour of healthy food consumption (Hausman,
2012). Here we examine a broader healthy consumption behaviour,

N.C. Aksoy et al.

Appetite 166 (2021) 105430

4

healthy nutrition, through individuals’ self-assessments about it.
Further, due to the lifestyle-changing nature of the pandemic (Van et al.,
2010), we expect to reveal specific attitudes and consequent actions
related to healthy nutrition beliefs. For this purpose,

H5. Attitude toward giving up unhealthy foods positively relates to
healthy nutrition.

We also include multi-group analysis in our research to see the dif-
ferential effects of using traditional versus online channels as an infor-
mation source when gathering and sharing information about Covid-19.
These two sources of information may have different features in some
cases. There are certain fundamental differences, especially in terms of
seeking health information and the use of traditional and online chan-
nels, and these differences can cause varying results (Cotten & Gupta,
2004; Rains, 2007). Following this perspective, we compare online
channel users and traditional channel users based on their healthy
nutrition using the effects of their attitudes toward giving up unhealthy
foods, their Covid-19 fear, and their basic health consciousness.

4. Research method

4.1. Measurement

The questionnaire used for this study to examine the proposed hy-
potheses was developed using the multi-item scales in the prior litera-
ture. We assessed family influence, peer influence, and social media
influence using eleven items adapted from Zhang et al. (2017). The fear
of Covid-19 was measured using a novel scale consisting of seven items
(Ahorsu et al., 2020). Four items were used to measure attitude toward
giving up unhealthy foods (Hausman, 2012). We defined unhealthy
foods as energy-dense foods (i.e., having high amount of energy (calorie)
per gram) which include high fat, saturates, sugar, salt, and minimal
amounts of vitamins and minerals. We asked our respondents to eval-
uate their approaches toward such foods in their daily nutrition (i.e.,
meals, snacks) during the Covid-19 pandemic through the idea of giving
up them. The health consciousness scale proposed by Shin and Mattila
(2019) who handled that construct by linking it to food choices and food
consumption was also used in our study. For healthy nutrition, we
adapted the health behaviour scale of Thomsen and Hansen (2015)
including its three items. Healthy nutrition was defined in our ques-
tionnaire as following a healthy daily diet (i.e., following a balanced
daily diet, implementing nutritional recommendations) and wanted our
respondents to think about their daily diet through their intakes of foods
and drinks and evaluate them based on their perception of healthiness of
their daily nutrition. We modified the scale items based on our research
context, consumption during the Covid-19 pandemic, as demonstrated
here in Table 2. To measure the constructs, we used the itemized rating
scale from ‘Never’ (1) to ‘Always’ (5). Table 1 shows demographics and
pandemic-related general questions. Ratio or categorical scales were
used or open-ended questions were posed to the respondents here.

The questionnaire was first created in the original language of the
scales, in English. Then, two bilingual researchers translated the survey
items into Turkish. A third researcher who is also proficient both in
English and Turkish translated this Turkish version back into English.
Afterwards, three researchers who studied the translation process and
we examined the original items and the translated them to check any
linguistic differences, expressions, wordings, and clarity. Following this
evaluation process, we created a draft questionnaire to improve the
content and face validity. During this process, three researchers in the
consumer behaviour and marketing fields and 15 PhD students who had
taken Marketing courses evaluated the entire draft questionnaire. We
refined the questionnaire items further based on their feedback on
content, clarity, meaningfulness of the items, and the questionnaire
overall to produce its final version.

4.2. Sample and data collection

Empirical data were collected using the online survey method noted
in this study. The questionnaire was designed in an online survey
creating platform (surveey.com). A non-probability convenience sam-
pling technique was used to reach respondents by sharing the survey link
on social media and different communication platforms to gain repre-
sentative results about the population (Krathwohl, 1977). First, we
conducted a pilot test with 50 respondents most of which were female
(59.4%), aged between 26 and 39 (56.7%) and then modified some of
the questions and items based on those results. Then, we shared the
survey link with our personal contacts through these platforms and they
further contributed to the data collection process by personally sharing
the link. The data collection took place between 15 April 2020 and 15
May 2020.

Turkey is one of the highest representative countries to investigate
the effects of this pandemic due to the large number of infected people in
that country. Turkey has been listed in the top ten countries with the
highest numbers of total cases from March until December (Data Studio,
2020). As stated by Cohen (2020), observing the effects of Covid-19
pandemic on people’s feelings, attitudes, and behaviours is possible in
an environment where individuals must continue their lives under the
intense influence of a pandemic.

We received 732 questionnaires using this process with a response

Table 1
Descriptive statistics of survey respondents (n = 688).

Demographics Category N %

Gender Female 468 68.1
Male 220 31.9

Age 18–25 125 18.1
26–39 325 47.2
40–54 193 28.1
>54 45 6.6

Educational level ~College 139 20.2
University 434 63.1
Graduate school 115 16.7

Household size 1 28 4.1
2 142 20.6
3 209 30.4
4 212 30.8
5 63 9.2
>5 34 4.9

Household income per montha <$250 29 4.2
$250-$600 177 25.7
$601-$1000 149 21.7
>$1000 333 48.4

Information gathering and sharing
channel during Covid-19

Twitter 167 24.3

Instagram 88 12.8
Facebook 10 1.5
WhatsApp 35 5.1
YouTube 3 0.4
News portals 153 22.2
TV news 232 33.7

Shopping frequency during Covid-
19

Everyday 25 3.6

3-4 in a week 69 10.1
1-2 in a week 382 55.5
Once every 10 days 136 19.8
Twice a month 62 9
Once a month 14 2

Most frequently used shopping
channel during Covid-19

Physical store 455 66.1

Corporate website of the
firm

60 8.7

Mobile application of the
firm

78 11.4

Intermediary firms’ websites
or applications

95 13.8

a This has been converted to dollars from Turkish Lira.

N.C. Aksoy et al.

Appetite 166 (2021) 105430

5

rate of approximately 78%. After eliminating inconsistent results
(including too many missing values and/or careless responses that were
completed in too little time), 688 questionnaires remained and these
represented an adequate sample size (Hair et al., 2006; Westland 2010).
Descriptive statistics of respondents are presented in Table 1. As shown
in Table 1, most of the respondents were female (68.1%), ages between
26 and 39 (47.2%), with a University degree (63.1), living with 3
(30.4%) or 4 (30.8%) people in their homes, and with more than $1000
household income per month (48.4%). Of all the respondents, 33.7% use
TV news, 24.3% use Twitter, and 22.2% use News portals on the web to
gather and share information on the Covid-19 pandemic. Approximately
half of the respondents (55.5%) have done their shopping 1–2 times in a
week during the pandemic. Most of them (66.1%) prefer physical stores
for shopping. The respondents were also asked specific questions about
their shopping items. Based on these gathered results, most were buying
foodstuffs, cleaning products, books, and hobby items. The edible items
that these respondents consumed during Covid-19 more than usual were
bread, coffee, fruit, flour, vitamin, and yogurt and inedible items were
sanitizers and cologne. The edible items that the respondents consumed
during Covid-19 less than usual were fast food, snacks, desserts, ciga-
rettes, packaged foods, and delicatessen food and inedible items were
gas and wearing apparels.

4.3. Measure validity and reliability

Confirmatory factor analysis (CFA) was used to assess the reliability
and validity of the variables (Fornell & Larcker, 1981). We performed

Table 2
Factor loadings, reliability, and validity.

Variables Standardized
loadings

AVE Cronbach’s
alpha

CR

Family influence (adapted from
Zhang et al., 2017)

.66 .88 .89

During the Covid-19 pandemic, I
often ask my family for
opinion to help me decide in
the shopping and consumption
process.

.87***

During the Covid-19 pandemic, I
highly value my family’s
opinion in the shopping and
consumption process.

.87***

During the Covid-19 pandemic,
my family influence me a lot in
the decision-making process.

.82***

During the Covid-19 pandemic, I
am more likely to buy or
consume what my family think
is right.

.68***

Peer influence (adapted from
Zhang et al., 2017)

.79 .94 .94

During the Covid-19 pandemic, I
often ask my friends/peers for
their opinion to assist with
shopping and consumption
decisions.

.88***

During the Covid-19 pandemic, I
highly value my friends/peers’
opinion in the shopping and
consumption process.

.91***

During the Covid-19 pandemic,
my friends/peers influence me
a lot in decision-making
process.

.90***

During the Covid-19 pandemic, I
am likely to choose to buy or
consume what my friends/
peers agree with.

.86***

Social media influence (adapted
from Zhang et al., 2017)

.72 .88 .88

During the Covid-19 pandemic, I
visit social networking sites
(such as Facebook, Twitter,
Linkedin, Youtube) about my
shopping and consumption
process very often.

.84***

During the Covid-19 pandemic, I
frequently use social
networking sites about my
shopping and consumption
process.

.92***

During the Covid-19 pandemic, I
am fond of interacting and
communicating with others
via social networking sites to
assist with shopping and
consumption decisions.

.77***

Covid-19 fear (adapted from
Ahorsu et al., 2020)

.50 .88 .87

I am most afraid of Covid-19. .69***
It makes me uncomfortable to

think about Covid-19.
.72***

My hands become clammy when
I think about Covid-19.

.58***

My heart races or palpitates
when I think about getting
Covid-19.

.76***

I am afraid of losing my life
because of Covid-19.

.76***

I cannot sleep because I’m
worrying about getting Covid-
19.

.61***

When watching news and stories
about Covid-19 on social

.79***

Table 2 (continued )

Variables Standardized
loadings

AVE Cronbach’s
alpha

CR

media, I become nervous or
anxious.

Attitude toward giving up
unhealthy foods (adapted from
Hausman, 2012)

.65 .88 .88

In the process of Covid-19
pandemic, giving up unhealthy
foods is good.

.88***

In the process of Covid-19
pandemic, giving up unhealthy
foods is pleasant.

.71***

In the

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