Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children

Abstract

This longitudinal study compared children’s health behaviors before the COVID-19 pandemic versus during the pandemic. This analysis examined the association between individual-level characteristics and health behavior change. Four prospective cohort studies in the Environmental influences on Child Health Outcomes (ECHO) Program contributed data. Children aged 4–12 years and their caregivers were recruited in California, Colorado, North Dakota, and New Hampshire. Dietary intake, physical activity, screen time, and sleep duration were assessed with questionnaires pre-pandemic and during the pandemic. The final sample included 347 children: 47% female and 62% non-Hispanic White. Compared with pre-pandemic, weekday screen time duration was higher during the pandemic (3.0 vs. 4.5 h, p < 0.001). Unadjusted increases in screen time duration differed by race and ethnicity: 1.3 h/day for non-Hispanic White children, 2.3 h/day for Hispanic children, and 5.3 h/day for non-Hispanic Black children. Overall, no changes occurred in sugar-sweetened beverage (SSB) intake (p = 0.26), discretionary food intake (p = 0.93), and physical activity (p = 0.15). Sleep duration increased by 30 min among children who did not meet sleep recommendations pre-pandemic. Child sex and maternal education level were not associated with health behavior change. The pandemic may have exacerbated disparities in some health behaviors. Families may need support to re-establish healthy routines.

Variations in Physical Activity and Screentime According to School Format During the COVID‐19 Pandemic

“…Children generally engaged in more sedentary ST before the pandemic than is recommended 30 and our data adds existing literature showing that this increased further during early months of pandemic restrictions 7,10,34,35 . Parents in our study reported that their children spent an average of 4 to 5 hours each day engaged in recreational ST, compared to a pre‐pandemic high of 154 ± 97.1 minutes/day shown by Burkart's team 7 .…”

“…Children generally engaged in more sedentary ST before the pandemic than is recommended 30 and our data adds existing literature showing that this increased further during early months of pandemic restrictions. 7,10,34,35 Parents in our study reported that their children spent an average of 4 to 5 hours each day engaged in recreational ST, compared to a prepandemic high of 154 ± 97.1 minutes/day shown by Burkart's team. 7 Children tended to engage in a bit more ST in the winter and summer than fall and spring, but no statistically significant differences were found by school group in either the cross-sectional or longitudinal samples.…”

Dietary Changes of Youth during the COVID-19 Pandemic: A Systematic Review

“…Dates under study ranged from March 2018 (prepandemic reference) to April 2022 (during pandemic), although most studies collected data during January–December 2020. More information on characteristics of the studies can be found in Table 1 [ [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , ...…”

“…Majority of participants eating more small meals, compared with prior Parent-reported Dietary recall Bekelman et al. (2022) [ 40 ] 347 47% Female 4–12 y FFQ/questionnaire Quantity of food, SSBs, Discretionary food United States (0.92) July 2019–March 2021 No significant changes Self-reported and Parent-reported Prepandemic measurement (longitudinal) Weihrauch-Blüher et al. (2023) [ 41 ] 1004 52.3% Girls 3–17 y FFQ/questionnaire Eating more healthy Germany (0.94) March 2022–April 2022 Compared with before the pandemic, parents reported more children eating less healthy than more healthy.…”

“… Were key potential confounding variables adjusted for? Quality rating (max score of 10) Perrar et al., 2022 [ 81 ] ✓ ✓ ✓ ✓ X ✓ ✓ ✓ ✓ ✓ 9 Burkart et al., 2022 [ 43 ] ✓ ✓ ✓ ✓ X ✓ ✓ ✓ X ✓ 8 Medrano et al., 2021 [ 75 ] ✓ ✓ X ✓ ✓ ✓ ✓ ✓ X ✓ 8 Ramos-Álvarez et al., 2021 [ 85 ] ✓ ✓ ✓ ✓ X ✓ ✓ ✓ ✓ X 8 He et al., 2022 [ 54 ] ✓ ✓ ✓ ✓ X ✓ ✓ X ✓ X 7 Lee et al., 2022 [ 68 ] ✓ ✓ ✓ ✓ X ✓ ✓ ✓ N/A X 7 Bekelman et al., 2022 [ 40 ] ✓ ✓ X ✓ X ✓ ✓ ✓ X X 6 Borger et al., 2021 [ 42 ] ✓ ✓ …”