Impact of COVID-19 pandemic on children and adolescents' lifestyle behavior larger than expected

Dry eye disease caused by viral infection: Past, present and future

Following viral infection, the innate immune system senses viral products, such as viral nucleic acids, to activate innate defence pathways, leading to inflammation and apoptosis, control of cell proliferation, and consequently, threat to the whole body. The ocular surface is exposed to the external environment and extremely vulnerable to viral infection. Several studies have revealed that viral infection can induce inflammation of the ocular surface and reduce tear secretion of the lacrimal gland (LG), consequently triggering ocular morphological and functional changes and resulting in dry eye disease (DED). Understanding the mechanisms of DED caused by viral infection and its potential therapeutic strategies are crucial for clinical interventional advances in DED. This review summarizes the roles of viral infection in the pathogenesis of DED, applicable diagnostic and therapeutic strategies, and potential regions of future studies.

Preliminary Program Evaluation of Pocket PE 3-5™, A User-Friendly Digital Application for Teacher Skills Training and Physical Education Activities for Third- to Fifth-Grade Elementary Students

BACKGROUND

In the United States, many classroom teachers also teach physical education (PE). However, there is a dearth of evidence- and standard-based PE programs designed to support classroom teachers to deliver PE effectively in schools.

METHODS

The purpose of this study was to establish proof-of-concept for the Pocket PE 3-5 digital app in school settings with 10 third- to fifth-grade classroom teachers. We assessed fidelity of program implementation, measured via observations of PE quality. Students used wrist-worn heart rate monitors during Pocket PE 3-5 lessons to measure time spent in moderate to vigorous physical activity. Program feasibility was primarily assessed through teacher-reported surveys of usability, satisfaction, and acceptability and exit interviews.

RESULTS

Mean PE observation scores were 18.6 (SD = 1.5) on a scale of 5 to 20. On average, students spent 56.7% (SD = 13.1%) of class time engaging in moderate to vigorous physical activity. Mean survey scores, reported on a 5-point scale, were 4.5 (SD = 0.6) for acceptability, 4.8 (SD = 0.4) for usability, and 4.7 (SD = 0.7) for satisfaction. Teachers liked how easy the app was to use but mentioned some technological challenges.

CONCLUSIONS

This program evaluation study established the proof-of-concept for the Pocket PE 3-5 elementary school PE program.

Daily Activities in European Children and Adolescents During COVID-19 School Closure: A Longitudinal Study Exploring Physical Activity, Use of Screens, and Sleep Patterns

This longitudinal study aimed to analyze the evolution of patterns of daily activities (physical activity time, screen usage time, and sleep hours) in European youth during school closure due to the COVID-19 health crisis. Participants were 624 caregivers of children and adolescents aged 3-18 from Italy, Spain, and Portugal. Evaluations were online, and four time-points were considered: retrospective measurement of daily activities before confinement (T1), and two (T2), five (T3), and eight (T4) weeks after starting the lockdown. Generally accepted international guidelines on physical activity time, screen usage time, and hours of sleep by age group were used to determine whether the pattern might increase the risk for ill health or not. To estimate the evolution of daily activities, generalized estimating equations (GEE) were used. The percentage of children who practiced less than 60 min of daily exercise increased significantly from before home confinement (47.8%) to T2 (86.4%); it slightly decreased at T3 (79.8%), and remained stable at T4 (76.1%). The percentage of children who made excessive use of screens (according to their age group) significantly increased from T1 to T2 and remained stable and high in the rest of the evaluations. The percentage of children who slept fewer or more hours than recommended for their age group remained stable between T1 and T4, although there was a significant increase at T3. In general, results found unhealthier behaviors as confinement was extended. Results are discussed in order to find strategies for promoting healthy daily activities for future pandemics.

Use of online food retail platforms throughout the COVID-19 pandemic and associated diet-related chronic disease risk factors: A systematic review of emerging evidence

Food accessibility was considerably impacted by restrictions during the coronavirus disease 2019 (COVID-19) pandemic, leading to growth in the online food retail sector, which offered contact-free delivery. This systematic review aimed to assess the change in use of online food retail platforms during COVID-19. The secondary aim was to identify diet-related chronic disease risk factors including dietary intake, eating behaviors, and/or weight status associated with the use of online food retail platforms during the pandemic. The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022320498) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Nine electronic databases were searched between January 2020 and October 2023. Studies that reported the frequency or change in use of online groceries, meal delivery applications, and/or meal-kit delivery services before and during the pandemic were included. A total of 53 studies were identified, including 46 cross-sectional studies, 4 qualitative studies, 2 longitudinal cohort studies, and 1 mixed-methods study. Overall, 96% (43/45) of outcomes showed an increase in the use of online groceries during COVID-19, while 55% (22/40) of outcomes showed a decrease in meal delivery applications. Eight of nine outcomes associated the use of online food retail with weight gain and emotional eating. Further research is needed to investigate the links between online food retail and obesity.

Impact of the COVID-19 pandemic on child malnutrition in Selangor, Malaysia: A pilot study

BACKGROUND

Child malnutrition risk factors are globally recognized, but the specific impact of the COVID-19 pandemic on the prevalence of child malnutrition, considering socioeconomic burdens and changes in family lifestyles, remains underexplored. This study aims to identify the significance of COVID-19-related factors in relation to the prevalence of child malnutrition in Selangor, Malaysia.

METHODS

Purposive sampling was employed in this pilot study to select the households with under-5 children and, a structured questionnaire was developed to gather data. Chi-squared tests, logistic regression modelling and World Health Organisation AnthroPlus software-based visualization were used for analyses.

RESULTS

The present study's findings indicate that demographic and social factors, including 'Citizenship,' 'Type of House,' 'Number of Earning Members,' 'Father's Highest Educational Level,' and 'Number of Children in a Family,' have a statistically significant association with Wasting. Additionally, the mother's 'Highest Educational Level' is found to be linked to underweight prevalence. Within COVID-19 factors, "COVID-19 Impact on Employment/Business" demonstrated significance for both stunting and wasting. Multivariate analysis revealed disparities in childhood malnutrition by gender, age, and factors such as "COVID-19 impact on children's physical activity" and "COVID-19 impact on children's decrease in health over the last two weeks."

CONCLUSIONS

This study identified COVID-19 factors alongside sociodemographic variables with statistically significant relationships impacting childhood malnutrition in Selangor, Malaysia. The results underscored the substantial influence of the COVID-19 pandemic on child malnutrition prevalence. Decision-makers at family and community levels can benefit by considering these factors in their actions. However, the study's limitation lay in its dataset, urging larger-scale analyses to explore further sub-categories of the examined variables.

The effect of a training program on adolescents' stress levels and healthy lifestyle behaviors during the Covid-19 pandemic: A randomized controlled study

TOPIC

Adolescence is the period when people adopt healthy lifestyle behaviors and turn them into habits. Healthy lifestyle behaviors are a significant step toward a long and healthy life.

PURPOSE

This study investigated the effect of a training program on adolescents' stress levels and healthy lifestyle behaviors during the COVID-19 pandemic.

METHODS

This randomized controlled study was conducted between May and July 2021. The sample consisted of 100 adolescents living in a city in the south of Turkey. Participants were randomized into intervention and control groups using block randomization. The intervention group participated in an online (Zoom) training program consisting of two 45 min sessions once a week for 8 weeks. Data were collected using the adolescent stress questionnaire (ASQ) and the adolescent lifestyle profile (ALP).

RESULTS

The results showed that 73% (n: 73) of the participants had developed hygiene habits since the onset of the pandemic. However, the pandemic negatively affected participants' dietary habits (45%, n: 45), physical activity (70%, n: 70), coping mechanisms (68%, n: 68), sleep patterns (54%, n: 54), Internet/social media/video game addiction (64%, n: 64), and interpersonal relationships (57%, n: 57). The intervention group had a lower mean ASQ posttest score and a higher mean ALP posttest score than the control group. The intervention group had a lower mean ASQ posttest score than their pretest score. The intervention group also had a higher mean ALP posttest score than their pretest score.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The training program helped adolescents feel less stress and adopt more healthy lifestyle behaviors. Pediatric nurses should identify risk factors and design and implement appropriate plans to help adolescents go through future pandemics with as little damage as possible. Parents and educators should support adolescents against the adverse impacts of events such as the COVID 19 pandemic.

Parent perceptions of social well-being in children with special educational needs during COVID-19: A mixed-methods analysis

BACKGROUND

Children's educational experiences worldwide have been significantly impacted as a result of global school closures during the COVID-19 pandemic of Spring 2020. A growing number of studies aim to analyse impacts of these changes on social well-being, with limited studies placing an emphasis on the experiences of students with special educational needs (SENs). This article focusses on parent perspectives regarding impacts of school closures on social well-being in Canadian children with SEN.

METHODS

This study uses a mixed-methods approach, drawing from both qualitative and quantitative survey data from Spring/Summer 2020. Participants (n = 263) were eligible for participation if they were a parent/guardian of a child or adolescent with an SEN. We first conducted a descriptive analysis of the key variables, namely, social well-being, grade level of the child, internet and device availability, and the presence of other school-aged children in the home (single child vs. multiple children). Next, we explored the relationship between these using a bivariate correlation. Finally, open-ended responses were analysed using an inductive approach to qualitative thematic analysis.

RESULTS

The majority of parents expressed concern for their child's social well-being during the Spring 2020 school closures, with increased concerns for younger children. According to parents, children experienced communication barriers to peer interaction and many experienced emotional difficulties as a result. Technology was described as critical for some in maintaining social connections. Parents raised concerns about the impact of limited peer interaction on broader social skill development, in the short and long term. A small number of participants noted feelings of relief and reduced anxiety among their children with SEN.

CONCLUSIONS

Findings highlight parent views of the negative impact of the pandemic on social well-being and the critical role in-person schooling plays in supporting peer relationships for children with SEN.

Mental health difficulties and related factors in Chinese children and adolescents during the COVID-19 pandemic: a cross-sectional study

OBJECTIVE

To examine the mental health status and related factors in children and adolescents, and to assess age groups and sexes differences in factors influencing mental health.

METHODS

This cross-sectional study was performed on Chinese children aged 6-18 years from November 2021 to January 2022. Mental health difficulties were accessed by the Strengths and Difficulties Questionnaire. Multivariate logistic regression was used to analyze factors associated with mental health status. Multiple linear regression was used to evaluate factors associated with the scores of the Strengths and Difficulties Questionnaire.

RESULTS

The prevalence of mental health difficulties was 12.98% (n =1348). Age (OR, 0.909, [95%CI, 0.830-0.996]), sex (OR, 1.424, [95%CI, 1.033-1.963]) and screen time on weekdays ("≥2" h/d vs "< 1" h/d: OR, 2.001, [95%CI, 1.300-3.080]) were related factors for mental health difficulties. For children (year ≤ 12), the strongest related factor for mental health difficulties was screen time on weekdays ("≥ 2" h/d vs "< 1" h/d: OR, 1.821 [95%CI, 1.203-2.755]). The risk of mental health difficulties in females with ≥ 2 h/d screen time on weekends was 3.420 times higher than those with < 1 h/d (OR, 3.420, [95%CI, 1.923-6.081]).

CONCLUSION

The prevalence of mental health difficulties among children and adolescents was relatively high. The lower age, female sex and excessive screen time were associated with a higher risk of mental health difficulties. The factors influencing mental health varied by different age groups and sexes. Thus, specific measures for different age groups and sexes should be adopted to mitigate the impact.

Associations Between Changes in 24-Hour Movement Behaviors in Children and Adolescents During the COVID-19 Pandemic: A Systematic Review and Mediation-Based Meta-Analysis

BACKGROUND

Although 24-hour movement behaviors are known to be interconnected, limited knowledge exists about whether change in one behavior during the COVID-19 pandemic (eg, increased screen time) was associated with change in another (eg, reduced physical activity or sleep). This review estimates mediational associations between changes in children's physical activity, screen time, and sleep during the COVID-19 pandemic.

METHODS

We included studies published between January 1, 2020 and June 27, 2022, in the PubMed/MEDLINE, Embase, PsycINFO, SPORTDiscus, and Web of Science databases. Summary data were extracted from included studies and analyzed with random-effects meta-regression.

RESULTS

This review included 26 studies representing 18,959 children across 18 mid-high-income countries (53% male; mean age, 11.5 [2.9] y). There was very good evidence of decreased total daily physical activity (factor change, 0.62; 90% CI, 0.47-0.81) and strong evidence of increased screen time (1.56; 90% CI, 1.38-1.77). There was very good evidence of decreased moderate to vigorous physical activity (0.75; 90% CI, 0.62-0.90) and weak evidence of increased sleep (1.02; 90% CI, 1.00-1.04). Mediational analysis revealed strong evidence that most of the reduction in total daily physical activity from before, to during, the pandemic was associated with increased screen time (0.53; 90% CI, 0.42-0.67). We observed no further mediational associations.

CONCLUSION

Increased reliance on and use of screen-based devices during the COVID-19 pandemic can be linked with reduced child and adolescent physical activity. This finding links COVID-related restrictions to potential displacement effects within child and adolescent 24-hour movement behavior.

COVID-19 Pandemic is Associated With Increased Prevalence of GERD and Decreased GERD-related Quality of Life: Analysis From 9800 Participants in the Indonesian GERD-Q Study

INTRODUCTION

The prevalence of gastroesophageal reflux disease (GERD) is expected to increase during the pandemic due to unexpected, sudden lifestyle changes such as decreased physical activity and worsening mental conditions. Here, we aim to explore the difference in the prevalence of GERD and GERD-related quality of life (QoL) in Indonesia during the COVID-19 pandemic compared with before the COVID-19 pandemic.

METHODS

Retrospective analysis of the Indonesian GERD Questionnaire study, a cross-sectional study utilizing an online form of the GERD Questionnaire, was done to compare the prevalence of GERD between March 2, 2018 to March 1, 2020 (prepandemic group) and March 2, 2020 to March 1, 2022 (pandemic group). The prevalence odds ratios between the 2 groups were calculated using χ 2 .

RESULTS

A total of 9800 participants were included in the analysis; 1807 and 7993 were allocated to the pandemic and prepandemic groups, respectively. The prevalence of GERD in the pandemic and prepandemic groups were 67.9% and 61.8%, respectively (prevalence odds ratio: 1.31; 95% CI: 1.17-1.46).

CONCLUSION

During the COVID-19 pandemic, the prevalence of GERD, heartburn, and those who reported impaired GERD-related quality of life increased. Regurgitation was the most common symptom reported by participants.

Predicting the onset of myopia in children by age, sex, and ethnicity: Results from the CLEERE Study

SIGNIFICANCE

Clinicians and researchers would benefit from being able to predict the onset of myopia for an individual child. This report provides a model for calculating the probability of myopia onset, year-by-year and cumulatively, based on results from the largest, most ethnically diverse study of myopia onset in the United States.

PURPOSE

This study aimed to model the probability of the onset of myopia in previously nonmyopic school-aged children.

METHODS

Children aged 6 years to less than 14 years of age at baseline participating in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study who were nonmyopic and less hyperopic than +3.00 D (spherical equivalent) were followed up for 1 to 7 years through eighth grade. Annual measurements included cycloplegic autorefraction, keratometry, ultrasound axial dimensions, and parental report of children's near work and time spent in outdoor and/or sports activities. The onset of myopia was defined as the first visit with at least -0.75 D of myopia in each principal meridian. The predictive model was built using discrete time survival analysis and evaluated with C statistics.

RESULTS

The model of the probability of the onset of myopia included cycloplegic spherical equivalent refractive error, the horizontal/vertical component of astigmatism (J0), age, sex, and race/ethnicity. Onset of myopia was more likely with lower amounts of hyperopia and less positive/more negative values of J0. Younger Asian American females had the highest eventual probability of onset, whereas older White males had the lowest. Model performance increased with older baseline age, with C statistics ranging from 0.83 at 6 years of age to 0.92 at 13 years.

CONCLUSIONS

The probability of the onset of myopia can be estimated for children in the major racial/ethnic groups within the United States on a year-by-year and cumulative basis up to age 14 years based on a simple set of refractive error and demographic variables.

Physical activity and sleep changes among children during the COVID-19 pandemic

Daily routines, including in-person school and extracurricular activities, are important for maintaining healthy physical activity and sleep habits in children. The COVID-19 pandemic significantly disrupted daily routines as in-person school and activities closed to prevent spread of SARS-CoV-2. We aimed to examine and assess differences in objectively measured physical activity levels and sleep patterns from wearable sensors in children with obesity before, during, and after a period of school and extracurricular activity closures associated with the COVID-19 pandemic. We compared average step count and sleep patterns (using the Mann-Whitney U Test) before and during the pandemic-associated school closures by using data from activity tracker wristbands (Garmin VivoFit 3). Data were collected from 94 children (aged 5-17) with obesity, who were enrolled in a randomized controlled trial testing a community-based lifestyle intervention for a duration of 12-months. During the period that in-person school and extracurricular activities were closed due to the COVID-19 pandemic, children with obesity experienced objectively-measured decreases in physical activity, and sleep duration. From March 15, 2020 to March 31, 2021, corresponding with local school closures, average daily step count decreased by 1655 steps. Sleep onset and wake time were delayed by about an hour and 45 min, respectively, while sleep duration decreased by over 12 min as compared with the pre-closure period. Step counts increased with the resumption of in-person activities. These findings provide objective evidence for parents, clinicians, and public health professionals on the importance of in-person daily activities and routines on health behaviors, particularly for children with pre-existing obesity. Trial Registration: Clinical trial registration: NCT03339440.

Neurodevelopmental Programming of Adiposity: Contributions to Obesity Risk

This review analyzes the published evidence regarding maternal factors that influence the developmental programming of long-term adiposity in humans and animals via the central nervous system (CNS). We describe the physiological outcomes of perinatal underfeeding and overfeeding and explore potential mechanisms that may mediate the impact of such exposures on the development of feeding circuits within the CNS-including the influences of metabolic hormones and epigenetic changes. The perinatal environment, reflective of maternal nutritional status, contributes to the programming of offspring adiposity. The in utero and early postnatal periods represent critically sensitive developmental windows during which the hormonal and metabolic milieu affects the maturation of the hypothalamus. Maternal hyperglycemia is associated with increased transfer of glucose to the fetus driving fetal hyperinsulinemia. Elevated fetal insulin causes increased adiposity and consequently higher fetal circulating leptin concentration. Mechanistic studies in animal models indicate important roles of leptin and insulin in central and peripheral programming of adiposity, and suggest that optimal concentrations of these hormones are critical during early life. Additionally, the environmental milieu during development may be conveyed to progeny through epigenetic marks and these can potentially be vertically transmitted to subsequent generations. Thus, nutritional and metabolic/endocrine signals during perinatal development can have lifelong (and possibly multigenerational) impacts on offspring body weight regulation.

Anxiety disorders among children and adolescents during COVID-19 lockdowns and school closures: a cross-sectional study in Kuwait

Introduction

Investigating the epidemiology of mental health disorders resulting from COVID-19 intervention measures, primary school closures, and social isolation in children and adolescents needs to be prioritized over adults at the post-pandemic stage. Most preliminary psychosocial studies conducted during the pandemic have demonstrated that younger age groups are the most vulnerable to such implications. Thus, this study aims to estimate the probable prevalence of specific anxiety disorders in children and quantify their relationships with relevant demographic risk factors.

Methods

We used a cross-sectional study comprising 430 children aged between 8- and 18 years old living in Kuwait during the period of school closures as well as full and partial lockdowns. The survey included questions about participants' characteristics, children's anxiety using the Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED) scale, and children's emotions and behaviours using the Strengths and Difficulties Questionnaire (SDQ). Univariate and multivariate logistic regression analyses were used to summarize the demographic and characteristics of the participants and their association with general, social, and generalized anxieties, as well as behavioural and emotional difficulties.

Results

We inferred that 24.83% of our participants had at least one anxiety disorder, while 20.19% were classified as abnormal on the SDQ scale. Our multivariate analysis revealed that lockdown duration and sex of the child were consistently significant predictors (p-values < 0.05) of the broad spectrum of selected mental disorders. Additionally, we inferred notable increases in the likelihood of mental disorders associated with the increased duration of lockdowns.

Conclusions

Our findings revealed preliminary insights into the vulnerability of young populations to the indirect negative impacts of strict public health measures during pandemic emergencies. Thus, authorities should consider such implications when planning and implementing similar interventions in future pandemics.

Covid lockdowns and hospitalisations for oro-facial trauma among children in Australia and the United Kingdom

BACKGROUND/AIM

This retrospective study investigated the effect of lockdowns for Covid-19 on the rates of oro-facial trauma hospitalisations in children in Australia and the United Kingdom (UK).

MATERIALS AND METHODS

Hospitalisation data for children up to 19 years old for oro-facial trauma injuries (according to ICD-10-AM principal diagnosis codes) over 5 years were collected for Australian and UK children. The age-standard rate (ASR) for each age group was calculated per 100,000 population.

RESULTS

In the younger Australian children, there was no statistically significant change in the ASR of oro-facial trauma hospitalisations during the 'Covid year', compared to the average rate over the 3 years preceding. However, there was a significant decrease in the ASR of oro-facial trauma hospitalisations during the 'Covid year' in older Australian children (aged 10-19), and for all UK children, except for infants under one-year-old.

CONCLUSIONS

Reduction of the ASR of hospitalisations due to oro-facial trauma during the 'Covid year', and the implementation of lockdown measures in the two countries provides further evidence of the impact of physical activities and travel as contributing factors to oro-facial injuries in children. In addition to its role in reducing the spread of virus infections during the pandemic, the lockdown measures also resulted in a simultaneous decrease in trauma injuries.

Physical Activity, Sleep, and Screen Time in Children and Adolescents Before and During the COVID-19 Pandemic: An Analysis of the 2019-2020 National Survey of Children's Health

PURPOSE

The purpose of this study was to examine whether engagement in health behaviors changed from pre-pandemic (2019) to during the pandemic (2020).

METHODS

The combined 2019-2020 National Survey of Children's Health (NSCH) was used to inform this study. The NSCH is an annual survey designed to provide national estimates of key indicators of childhood health and well-being. Physical activity (number of days/week with >60 min of activity), screen-time (hours/day of TV viewing and computer use), and sleep (hours/day) were assessed by parental report. Adjusted binomial and multinomial logistic regression models were used to determine the association between survey year and health behaviors.

RESULTS

Children and adolescents were 36% more likely to be physically inactive in 2020 compared to 2019. Additionally, children and adolescents were 14% more likely to meet sleep guidelines and 39% less likely to meet screen-time guidelines in 2020 compared to 2019, independent of age, sex, race/ethnicity, and poverty level. Children (6-13 year) and adolescents (14-17 years) were 10% and 15% less likely to get below the recommended amount of sleep in 2020 compared to 2019, respectively.

CONCLUSION

Prevalence of meeting sleep guidelines increased among children and adolescents in 2020 but decreased for physical activity and screen-time. Initiatives targeting activity and screen-time may be urgently needed. Whether rates of these health behaviors return to pre-pandemic levels over the next few years should be closely assessed.

Substance Abuse and Sleep Quality in University Students

Background

Substance abuse remains a challenging public health issue, especially among young people. It has been shown that poor sleep and substance abuse may have mutual intensifying effects. This study aimed to evaluate the rates of substance abuse, cigarette smoking, and alcohol consumption and their association with sleep disturbances among university students in 2021.

Methods

The participants were the students of the Faculty of Sciences, University of Guilan, Iran in 2021. Data were collected through a researcher-made demographic questionnaire, the first two questions of the translated version of the World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and the Pittsburgh Sleep Quality Index (PSQI).

Findings

A total of 222 students entered the study from March to August 2021. The rates of substance abuse in the past three months and lifetime were 35.6% and 45.5%, respectively. The most common type of substance abuse was related to the 'other substances' category. Substance abuse was significantly higher in students living in dormitories and those with a family history of substance abuse. Poor sleep was found in 34.2% of the students, and substance abuse and alcohol consumption both in the past three months and lifetime were significantly associated with lower sleep quality.

Conclusion

This study showed that substance abuse was significantly associated with sleep disturbances. The study results also illustrated an upward trend of substance abuse in recent years among students in Rasht, which may be related to economic issues in the country and/or the effects of the COVID-19 pandemic. Considering the rising prevalence of substance abuse and its impacts on society, policymakers are highly recommended to pay special attention to its risk factors.

Health-related quality of life (HRQoL) and associated factors in Bangladeshi adolescents during COVID-19

Background and Aims

The COVID-19 pandemic and its accompanying countermeasures significantly disrupt the health-related quality of life (HRQoL) of adolescents. We aimed to estimate the status and associated factors related to HRQoL of adolescents during the COVID-19 pandemic from the community population of Bangladesh.

Methods

This cross-sectional study followed two-stage sampling. From eight administrative divisions of Bangladesh, 2030 adolescents were enrolled. The KIDSCREEN-10 index was used to measure the HRQoL of adolescents. In addition to this, adolescents' data on sociodemographics, mental well-being, parenting style, insomnia, food insecurity, depression, anxiety and stress, resilient coping, screen-based activity, and anthropometry were taken for finding out the factors associated with HRQoL of adolescents. The hierarchical multilinear regression was performed to assess the association.

Results

More than 47% of adolescents were found to have moderate and high HRQoL, while 4.7% of adolescents experienced low HRQoL during data collection. Higher age (B: -0.671), having more siblings (B: -0.316), food insecurity (B: ‒2.010), depression (B: ‒0.321), anxiety (B: ‒0.362), and stress (B: ‒0.150) were found to have significantly negative associations with adolescents' HRQoL during the COVID-19 pandemic. Whereas, positive parenting (B: 0.409), inconsistent parenting discipline (B: 0.266), good mental health (B: 5.662), resilient coping (B: 0.306) were found to have significant positive relationships.

Conclusions

The findings from this study indicate that over 52% of the adolescents reported a moderate and lower level of HRQoL. In light of these results, it may be beneficial to prioritize interventions targeting psychological factors such as depression, anxiety, and stress.

Risk and protective factors for substance use and media addictive behaviors in adolescents during the COVID-19 pandemic

OBJECTIVE

This study examined the long-term effects of the COVID-19 pandemic on adolescents' substance use, digital media use, and symptoms of internet, gaming, and social media addiction.

METHOD

A nationally representative longitudinal cohort of 1665 Israeli teens and preteens, aged 9-16, completed questionnaires assessing substance use prevalence, daily screen time, symptoms of media addiction, and potential risk and protective factors. Data were collected before the pandemic (October 2019), after the second wave lockdown (November 2020), and after the fifth wave (April 2022) in Israel.

RESULTS

The analysis documented significant increases in substance use, daily screen time, and social media addiction indices over time. Gratitude, life satisfaction, positive emotions, future orientation, grit, and secure attachment emerged as significant protective factors. Sensation-seeking, negative emotions, and mental health symptoms were identified as risk factors.

CONCLUSIONS

These findings highlight the importance of educational and public mental health services in addressing the pandemic's long-term impact on the mental health and addictive behaviors of adolescents. They also emphasize the significance of enhancing protective factors and reducing risk factors to effectively mitigate substance and digital media abuse among adolescents.

Depression, anxiety, stress symptoms and their determinants among secondary students with vision impairment in rural Northwestern China during the COVID-19 pandemic

Objective

The measures implemented to control the spread of Coronavirus disease 2019 (COVID-19) could affect children's mental and vision health. Youth particularly from minority and socioeconomically disadvantaged backgrounds were more likely to be impacted by these measures. This study aimed to examine the mental health of children with vision impairment and associated factors in North-western China during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted among 2,036 secondary school children living in Ningxia Hui Autonomous Region. Participants completed a survey on sociodemographic and lifestyle information and answered the Chinese version of the 21-item Depression Anxiety Stress Scales (DASS-21) questionnaire. Presenting visual acuity was measured by a trained enumerator. Multivariate logistic regression analysis was used to identify potential risk factors for mental health problems.

Results

Responses from 1,992 (97.8%) children were included in the analysis after excluding those with incomplete mental health outcome data. The prevalence of depression, anxiety and stress symptoms within the dataset were 28.9, 46.4, and 22.3%, respectively. The distribution of children with different stress levels differed significantly between those with and without vision impairment (p = 0.03). Multivariable logistic regression analyses revealed that depression symptoms decreased with higher parental education (OR, 0.76, 95% confidence intervals (CI):0.63-0.96), longer sleep duration (OR, 0.90, 95% CI: 0.81-0.97) and longer study time (OR, 0.82, 95% CI: 0.74-0.91), whereas they increased with higher recreational screen time (OR, 1.19, 95% CI: 1.08-1.32). Anxiety symptoms decreased with higher parental education (OR, 0.80, 95% CI: 0.66-0.96) and increased with higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.27) and being a left-behind child (OR, 1.26, 95% CI: 1.04-1.54). In addition, stress symptoms decreased with longer sleep duration (OR, 0.92, 95%CI: 0.85-0.99) and increased with higher number of siblings (OR, 1.10, 95% CI: 1.01-1.19), higher recreational screen time (OR, 1.15, 95% CI: 1.04-1.28) and older age (OR,1.12, 95% CI: 1.004-1.24).

Conclusion

A considerable proportion of our sample experienced mental health problems during the pandemic. Healthcare planners in China should consider interventions such as reducing recreational screen time, ensuring sufficient sleep, and timely detection of mental health symptoms among socioeconomically disadvantaged groups.

The influence of screen time on behaviour and emotional problems among adolescents: A comparison study of the pre-, peak, and post-peak periods of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic has brought drastic changes globally in the past three years, one of which is an increase in the use of digital media or electronic devices. Previous studies have shown that long screen time may stimulate the neurobiological system, resulting in various behavioural and emotional problems; however, there is insufficient population-based evidence. This study aimed to investigate the influence of screen time on behavioural and emotional problems in Indonesian adolescents at three time points: the pre-, peak, and post-peak periods of COVID-19. Data were collected using an online community mental health survey. This survey incorporated the Youth Screen Time Survey to gauge screen time and the adolescent version of the Strengths and Difficulties Questionnaire to assess emotional, conduct, and prosocial behaviour problems. The participants were adolescents in secondary and senior high schools, with 337, 423, and 1,096 participants from the pre-, peak-, and post-pandemic periods, respectively, included in the analysis. Daily average screen time was compared, followed by the calculation of odds ratios for screen time and mental health problems during the different periods. The results demonstrated significant differences in adolescents' total daily average screen time between the different pandemic periods. Decreased screen time was associated with reduced emotional, conduct, and prosocial behaviour problems, especially during the peak period. Thus, psychoeducation on screen time in adolescents should be considered as a point of interest for mental well-being interventions.

Changes in Adolescent Health Behavior and the Exacerbation of Economic Hardship During the COVID-19 Pandemic: A Cross-sectional Study From the Korea Youth Risk Behavior Survey

OBJECTIVES

This study investigated the association between exacerbated economic hardship during the coronavirus disease 2019 (COVID-19) pandemic and changes in the health behaviors of Korean adolescents.

METHODS

We analyzed data from the 2021 Korea Youth Risk Behavior Survey and included 44 908 students (22 823 boys and 22 085 girls) as study subjects. The dependent variables included changes in health behaviors (breakfast habits, physical activity, and alcohol use) that occurred during the COVID-19 pandemic. The aggravation of economic hardship by COVID-19 and the subjective economic status of the family were used as exposure variables. Multiple logistic regression analysis was utilized to calculate the prevalence odds ratios (PORs).

RESULTS

Severe exacerbation of a family's economic hardship due to COVID-19 was negatively associated with the health behaviors of adolescents, including increased breakfast skipping (POR, 1.85; 95% confidence interval [CI], 1.55 to 2.21 for boys and POR, 1.56; 95% CI, 1.27 to 1.92 for girls) and decreased physical activity (POR, 1.37; 95% CI, 1.19 to 1.57 for boys and POR, 1.38; 95% CI, 1.19 to 1.60 for girls). These negative changes in health behaviors were further amplified when combined with a low subjective family economic status.

CONCLUSIONS

The experience of worsening household hardship can lead to negative changes in health behavior among adolescents. It is crucial to implement measures that address the economic challenges that arise from stressful events such as COVID-19 and to strive to improve the lifestyles of adolescents under such circumstances.

Social Distancing in the COVID-19 Pandemic: Associated Factors, Health Outcomes, and Implications

Social distancing has reemerged as a public health measure for containing the spread of COVID-19. This integrative review aims to analyze the historical use of social distancing, the current application during COVID-19, individual factors that affect social distancing practices, and consequential health outcomes. We analyzed relevant literature from searches conducted on Scopus, PubMed, and PsycINFO. We found that resources, culture, age, gender, and personality are associated with the degree to which people practice social distancing. Furthermore, social distancing changes our lifestyles and behavior and results in multifaceted health outcomes, including decreased physical activity and sunlight exposure, increased weight gain, and impaired sleep quality. On the positive side, social distancing has been linked to reduced crime rates and environmental damage, as well as better social and family ties. Future interventions may be utilized to increase adherence to social distancing practices and to mitigate the negative health effects of social distancing.

Lifestyle and quality of life in children and adolescents during the covid-19 social distancing period

OBJECTIVE

To evaluate the lifestyle and quality of life in Brazilian children and adolescents during the COVID-19 social distancing period in 2020.

METHODS

This cross-sectional study evaluated children and adolescents (2-18 years of age) and their parents, who voluntarily participated in an online survey. Snowball sampling was used to recruit participants during the first 6 months of the pandemic. A questionnaire was used to characterize the study population. The PedsQL 4.0 and the EUROHIS-QOL 8-item index were used to assess the quality of life (QoL) in children/adolescents and parents, respectively. Data were analyzed using SPSS 18.0 statistical program through the ANOVA with post hoc Bonferroni analysis, student's t test, and the generalized estimating equation.

RESULTS

Mean screen time increased from 2h pre-pandemic to 5h during the pandemic (p < 0.001), which was associated with a decline in PedSQL4.0 scores (from 75.7 ± 2.6 to 71.3 ± 13.7, p < 0.001). Unhealthy eating habits increased from 11% to 34% and were associated with worse QoL scores compared with improved or unchanged eating habits during the pandemic (69.7 ± 13.3 vs 72.80 ± 13.4 vs 76.4 ± 12.6; p < 0.001). Poor sleep quality increased from 9% to 31.7% and was associated with worse QoL scores compared to improved or unchanged sleep quality during the pandemic (67.3 ± 13.1 vs 74.5 ± 13.1 vs 76.8 ± 12.2; p < 0.05). Physical exercise was associated with better PedSQL4.0 scores (77.5 ± 12.3 vs 72.5 ± 14.4; p < 0.001). Children aged 2-4y old had the best QoLscores.

CONCLUSIONS

Pandemic-related social distancing promoted significant lifestyle changes in children and adolescents, increasing screen time, reducing physical activity, and worsening food and sleep quality, which resulted in worse QoL scores.

Korean Adolescents before and after COVID-19: Changes in Physical Activity, Mental Health, and Hygiene Management

Background

Adolescence is when health behaviors, namely, physical activity (PA), mental health, and hygiene management, are established. As the young represent our future societal welfare, their health requires attention, particularly in the face of a pandemic. We explored changes in Korean adolescent PA, mental health, and hygiene management before and after the COVID-19 pandemic to identify recommendations for improving adolescent health.

Methods

We collected 2019-2021 data from the Korea Youth Risk Behavior Surveys from the Korea Disease Control and Prevention Agency for 166,590 middle and high school students (2019: 57,069; 2020: 54,809; 2021: 54,712). We analyzed seven variables (regular PA, high-intensity PA, and strength exercise participation, stress recognition, sleep-time satisfaction, brushing practice, and handwashing practice) to examine changes in adolescent behavior during these years.

Results

The findings indicated statistically significant differences in all seven variables over the three years (P<0.05). Specifically, regular PA was higher in 2019 and 2021 than in 2020; high-intensity PAs were highest in 2019, followed by 2021 and 2020; strength exercises were the highest in 2020, followed by 2021 and 2019; stress recognition was higher in 2019 and 2021 than in 2020; sleep-time satisfaction was the highest in 2020, followed by 2021 and 2019; brushing practice was the highest in 2019, followed by 2020 and 2021; and handwashing practice was the highest in 2020, followed by 2021 and 2019.

Conclusion

The results recommend the need to encourage structured moderate-to-vigorous adolescent PA and systematic health education to improve Korean adolescent health behavior after COVID-19.

Associations between Parental Factors and Children's Screen Time During the COVID-19 Pandemic in South Korea

This study investigated how parental depression, parental self-care, family conflict, and parental fear of COVID-19 are associated with children's screen time during the COVID-19 pandemic. Data were collected online among South Korean families, resulting in 246 parents (59% fathers) with children between 6 and 12 years of age. Path analysis and multi-group structural equation modelling of fathers and mothers were conducted. Parent's fear of COVID-19 was positively associated with parental depression. Parent's fear of COVID-19 and parental depression were negatively related to parental self-care, which was negatively linked to family conflict. Family conflict was positively associated with children's screen time. The relationships between parental factors and children's screen time were different for mothers and fathers. Our results show that multiple family dynamics interact with children's screen time, emphasizing the need to look beyond parenting practices in understanding the effects of COVID-19 pandemic on children's screen time.

Assessing the health, social, educational and economic impact of the COVID-19 pandemic on adolescents in low- and middle-income countries: a rapid review of the literature

COVID-19 has caused profound health, social, educational and economic devastation around the world, especially among the lives of adolescents in low- and middle-income countries. This paper looks at a wide array of outcomes impacting adolescents' daily lives including health (mental, physical, sexual and reproductive health, vaccine perceptions and overlap between these topics), social relationships (family and peer), education and socio-economic disparities. Both scientific and grey literature between December 2019 and February 2022 were sought from PubMed, Google Scholar and organisations conducting research among adolescents, and coded. A total of 89 articles were included, 73% of which were peer-reviewed; 37% of the articles were from WHO's Western Pacific region; 62% of the articles were cross-sectional; 75% were quantitative. Three major topics emerged in more than half the articles: mental health (72%), education (61%) and socio-economic ramifications (55%). However, there were regional differences in topics and many of them overlapped. The results indicate that, where there has been research, almost all findings have been linked to worse mental health during the pandemic. Overall, remote education was seen as a negative experience. The ramification of school closures on future aspirations, in particular early school leaving, highlights the importance of prioritising education during future pandemics based on the situation within the country. Gender and other disparities have made marginalised adolescents vulnerable to the economic ramifications of containment measures. Given the risks identified, there is a pressing need to put adolescents at the centre of establishing priorities for their health agenda for post-pandemic recovery.

Lifestyles of 2- to 11-year-old children during the COVID-19 pandemic

INTRODUCTION

risk factors associated with obesity such as poor dietary quality, low physical activity (PA), screen time (ST), and poor sleep duration (SD) were affected during confinement resulting from the SARS-CoV-2 pandemic.

OBJECTIVE

the aim of our study was to evaluate the association between PA, ST and SD with the consumption of non-recommended food groups (N-RFG) in children during the COVID-19 pandemic, using data from ENSARS-CoV-2 Girls and Boys.

METHODS

data were gathered through a self-administered electronic survey carried out in four regions of Mexico during September and October 2020. Dietary patterns were established using k-means cluster analysis. Linear regression models were used to study the effect of food consumption patterns and PA on hours of ST per week.

RESULTS

in all, 2,405 children aged 2 to 11 were studied. Three food group consumption patterns were identified. Group 1 or "high consumption of added sugars group" and Group 2 or "high consumption of N-RFG group" children reported more hours of ST than those in Group 3 or "low consumption of N-RFG group" (p < 0.001 and p < 0.001, respectively). Group 2 reported more hours per week of ST but also more days of PA vs Group 3.

CONCLUSION

confronted by the pandemic, it is essential to redouble efforts to reverse the harmful effects of lifestyles during the COVID-19 pandemic to improve the health of Mexican children in the years to come.

The Use of Wearable Devices to Measure Sedentary Behavior during COVID-19: Systematic Review and Future Recommendations

The SARS-CoV-2 pandemic resulted in approximately 7 million deaths and impacted 767 million individuals globally, primarily through infections. Acknowledging the impactful influence of sedentary behaviors, particularly exacerbated by COVID-19 restrictions, a substantial body of research has emerged, utilizing wearable sensor technologies to assess these behaviors. This comprehensive review aims to establish a framework encompassing recent studies concerning wearable sensor applications to measure sedentary behavior parameters during the COVID-19 pandemic, spanning December 2019 to December 2022. After examining 582 articles, 7 were selected for inclusion. While most studies displayed effective reporting standards and adept use of wearable device data for their specific research aims, our inquiry revealed deficiencies in apparatus accuracy documentation and study methodology harmonization. Despite methodological variations, diverse metrics, and the absence of thorough device accuracy assessments, integrating wearables within the pandemic context offers a promising avenue for objective measurements and strategies against sedentary behaviors.

Sleep and Inflammation during COVID-19 Virtual Learning in Adolescents with Overweight or Obesity

(1) Background: Adolescents present as a high-risk group for a range of adverse physical health outcomes during the pandemic, including sleep and C-reactive protein (CRP) levels. As adolescents with overweight or obesity (OWOB) present as an even higher risk group, the present study assessed relationships between sleep and CRP levels before and during COVID-19 in adolescents with OWOB. (2) Methods: Fourteen adolescents with OWOB participated in a pre-COVID1, pre-COVID2, and during-COVID-19 lab visit, measuring sleep and CRP levels. The sample size was limited by the number of participants who provided data before COVID-19 and who were enrolled in virtual school during the recruitment phase. However, our power analyses indicated needing a minimum of 10 participants to achieve adequate power. Pre-COVID1, pre-COVID2, and during-COVID-19 normative expected CRP levels were calculated based on age, sex, race, and body mass index percentile-matched data. Analyses compared pre-COVID1 and pre-COVID2 sleep with during-COVID-19 sleep, during-COVID-19 sleep and during-COVID-19 CRP levels, during-COVID-19 CRP levels with normative expected during-COVID-19 CRP levels, change in CRP levels from pre-COVID1 and pre-COVID2 to during-COVID-19 with normative expected CRP levels during those time periods, and change in CRP levels before COVID-19 with change in CRP levels during COVID-19. (3) Results. During COVID-19, participants experienced decreased sleep efficiency (p = 0.001), later wake time (p < 0.001), longer time in bed (p = 0.021), and onset latency (p = 0.004), compared to pre-COVID1, and decreased sleep efficiency (p = 0.002), longer onset latency (p = 0.006), and later wake time (p < 0.001) and bedtime (p = 0.016) compared with pre-COVID2. During-COVID-19 CRP levels were positively correlated with during-COVID-19 wake times (p = 0.01) and times in bed (p = 0.008). During-COVID-19 CRP levels were greater than normative expected CRP levels (p < 0.001). CRP levels increased more from pre-COVID1 and pre-COVID2 to during-COVID-19 than normative expected changes in CRP levels (p < 0.003). Changes in CRP levels before and during COVID-19 were not significantly different. (4) Conclusions. These findings highlight the consequential effects of COVID-19, including impairments in sleep, on adolescents with OWOB. CRP levels increased more (~5 mg/L) during COVID-19 than normative expected change.

Korean adolescents' coping strategies on self-harm, ADHD, insomnia during COVID-19: text mining of social media big data

Introduction

Since the Coronavirus disease 2019 (COVID-19), public safety measures, including social distancing and school closures, have been implemented, precipitating psychological difficulties and heightened online activities for adolescents. However, studies examining the impact of the pandemic on adolescent mental health and their coping strategies in Asian countries are limited. Further, most studies have used survey measures to capture mental health challenges so far. Accordingly, this study aimed to examine the psychological challenges South Korean adolescents experienced and their coping strategies during the pandemic using the Natural Language Processing (NLP) and Text mining (TM) technique on adolescents' social media texts/posts.

Methods

The data were gathered from social media texts/posts such as online communities, Twitter, and personal blogs from January 1, 2019, to October 31, 2021. The 12,520,250 texts containing keywords related to adolescents' common psychological difficulties reported during the pandemic, including self-harm, Attention-Deficit/Hyperactivity Disorders (ADHD), and insomnia, were analyzed by TM, NLP using information extraction, co-occurrence and sentiment analysis. The monthly frequency of the keywords and their associated words was also analyzed to understand the time trend.

Results

Adolescents used the word "self-harm" in their social media texts more frequently during the second wave of COVID-19 (August to September 2020). "Friends" was the most associated word with "self-harm." While the frequency of texts with "Insomnia" stayed constant throughout the pandemic, the word "ADHD" was increasingly mentioned in social media. ADHD and insomnia were most frequently associated with ADHD medications and sleeping pills, respectively. Friends were generally associated with positive words, while parents were associated with negative words.

Conclusion

During COVID-19, Korean adolescents often expressed their psychological challenges on social media platforms. However, their coping strategies seemed less efficient to help with their difficulties, warranting strategies to support them in the prolonged pandemic era. For example, Korean adolescents shared psychological challenges such as self-harm with friends rather than their parents. They considered using medicine (e.g., sleeping pills and ADHD medication) as coping strategies for sleep and attention problems.

How COVID-19 Pandemic Restrictions Affected Kuwaiti College Students' Anthropometry, Lifestyle Behaviors, and Dietary Habits

The COVID-19 pandemic and the measures implemented to control it have led to widespread lifestyle changes globally. While previous studies have explored these effects across different age groups, this research focuses uniquely on college students in Kuwait. A cross-sectional study (N = 1259) was conducted among college students using a validated online questionnaire covering various aspects, including demographics, academic performance, self-reported body weight and height, sleep duration, dietary habits, and physical activity. There were equal proportions of individuals reporting decreased, increased, or no change in body weight, BMI, and dietary habits due to COVID-19, with no significant gender differences observed. A higher decrease (44.3%) than increase (29.2%) occurred due to COVID-19 in the proportion of college students engaging in physical activity. Significant differences were found in the students' responses to most of the eating behavior questions, concerning the changes attributable to the COVID-19 pandemic restrictions. Multivariable analysis showed significant interaction effects for gender by losing above 9 kg during the last 6 months in age (p = 0.037), total physical activity in METs-min/week (p = 0.048), and cake/donuts intake (p = 0.006). Logistic regression analysis, adjusted for age, revealed that a decrease in BMI was associated with an increase in daily vegetable intake (aOR = 1.531, p = 0.031), whereas increases in BMI were associated with an increased intake of sugar-sweetened drinks equal to or above 4 days/week (aOR = 1.551, p = 0.032) and increased chocolates/candy intake equal to or above 4 days/week (aOR = 1.792, p = 0.037). It was concluded that, in response to a major epidemic, such as COVID-19, college students, as a population, are susceptible to significant changes in lifestyle and eating behaviors that can impact their health and well-being. Future risks for college students' health can be reduced through appropriate lifestyle interventions.

Adolescents and young adults with oncohematological disease: use of social networks, impact of SARS-COV-2, and psychosocial well-being

Objective

Adolescents and young adults (AYA) with oncohematological diseases could have important psychosocial difficulties that could be worsened by the effects of the COVID19 pandemic. At this developmental stage, it is also important to assess the use of social networks (SNs). This study aims to investigate the type of social network use and the consequences of the COVID19 period. These patients are compared with matched healthy peers.

Methods

After the informant consent signature, the adolescents completed a series of self-report questionnaires on the use of SNs, on communication preferences, on social anxiety and on Covid19 impact through the online platform of LimeSurvey. Most of the adolescents belonged to the 18-20 age group (42.5%), were female (62%) and mainly off therapy (72%).

Results

Adolescents spent more than 2 h/day on Instagram and 1 h and half on Whatsapp, while Tik Tok use was on average 1 h/day, especially used by younger patients (r = -0.33, p = 0.023). Males used Twitch (t45 = -2.06, p = 0.05) and Youtube (t45 = -2.18, p = 0.03) for longer than females. AYA in therapy used more Tik Tok (U = 137.50; p = 0.03), Ask/Tellonym (U = 172.50; p = 0.05) and Twitch (U = 144; p = 0.017) than those off therapy. Healthy AYA showed lower levels of exposure (Z = -4.17; p = 0.00001) and impact (Z = -5.12; p = 0.00001) to Covid19, while the level of social anxiety is comparable and is in the normal range in both groups.

Discussion

Some clinical considerations and suggestions could be given based on these empirical results to health professionals in the care of AYA cancer patients.

Impact of the COVID-19 pandemic on the mental health of children and adolescents: A systematic review and meta-analysis of longitudinal studies

BACKGROUND

Children's and adolescents' mental health has been affected since the onset of the coronavirus disease (COVID-19) pandemic, receiving global attention. We conducted a systematic review and meta-analysis of longitudinal studies to assess the extent of the mental health changes of children and adolescents in the aftermath of the pandemic.

METHODS

We searched PubMed, Embase, Web of Science, and PsycINFO to explore the pandemic's impact on children and adolescents' mental health; longitudinal studies were included. We used the random effects model to estimate the standardized mean differences (SMD) with 95 % confidence intervals (CI).

RESULTS

Twenty articles were included. Results showed that there was an increase in anxiety (SMD = 0.18, 95 % CI 0.05-0.32) and depressive symptoms (SMD = 0.22, 95 % CI 0.13-0.32) in children and adolescents after the pandemic. Anxiety and depressive symptoms noticeably increased from April to May 2020, subsequently decreased, but saw a small resurgence during the second wave of the pandemic. Anxiety change varied by region; highest in Asia (SMD = 0.38, 95 % CI 0.25-0.51).

LIMITATIONS

Heterogeneity was high in this study, with high variability in psychiatric symptoms among individuals.

CONCLUSIONS

This study on changes in children's and adolescents' mental health, anxiety and depression symptoms showed varying degrees of deterioration. Changes in symptoms were influenced by time and region and showed fluctuations.

Technical efficiency and its determinants in regulating adolescents' coronavirus infection across Asian countries

The coronavirus pandemic, besides generating health distress, influences the socio-economic conditions of humankind. Every adolescent's lifestyle is affected by the virus. Healthy adolescents are not only key contributors to the forthcoming workforce but also a source of a country's human capital. The purpose of the article is to examine the efficacy of various Asian countries in regulating the spread of the coronavirus among adolescents. In addition to that, the paper also attempts to pinpoint the prime causes of the inefficiency of a country in regulating the same. The paper also examines the behavioural changes among adolescents across Asian countries in pre-and-post pandemic times. In this context, the study identifies the impact of adolescents' tobacco consumption, female political leadership, and accreditation on a country's efficacy to regulate adolescents' coronavirus infection. The study's empirical analysis covers twenty-one Asian countries. By using the Panel Stochastic Production Frontier, the study concludes that Kazakhstan is the most efficient country and Afghanistan is the least efficient country on the list. The inefficiency effects estimates conclude that adolescents' tobacco consumption decreases and good governance practices increase the efficiency of a country in regulating the spread of adolescent coronavirus infection. Additionally, the paper finds no significant behavioural changes among adolescents in pre-and-post pandemic times across Asian countries. The paper concludes with appropriate policy recommendations supported by empirical evidence. The paper also identifies its shortcomings and suggests potential future lines of inquiry.

Screen time, impulsivity, neuropsychological functions and their relationship to growth in adolescent attention-deficit/hyperactivity disorder symptoms

Previous longitudinal studies found significant associations between screen time and increase in attention-deficit/hyperactivity disorder (ADHD) symptoms, but the mechanisms mediating this association remain understudied. Thus, we used data from a 5-year population-based longitudinal cohort of nearly 4000 Canadian high school students, modeled using multivariate multilevel mediation, to investigate the association of screen time (i.e., social media, television, video games, computer use) with ADHD symptoms via different potential behavioral and neuropsychological mediators (i.e. impulsivity, response inhibition, working memory). We studied direct and indirect between-person, concurrent within-person, and lagged-within-person effects of screens on ADHD symptoms. Results showed that increases in screen time in a given year were associated with an exacerbation of ADHD symptoms within that same year (within-person association), over and above potential common vulnerability (between-person association). Impulsivity proved to be the most robust mediator in the association of screen time with ADHD symptoms at both between and within-person levels. Only social media use displayed a significant lagged-within-person association with ADHD symptoms mediated by impulsivity, indicating an enduring influence on behavior, which was further shown to be mediated by chained changes in response inhibition on a Go/No-Go task. These findings provide clinical implications of screen time and should be an important focus in the management and prevention of ADHD symptoms among adolescents.

How the COVID-19 pandemic shaped adolescents' future orientations: Insights from a global scoping review

Throughout adolescence, youth imagine what the future holds and determine plans to achieve their educational, professional, and personal goals. In this article, we review research that explores how adolescents' future orientations were shaped by the societal unpredictability, physical and mental health risks, and educational disruptions brought on by the COVID-19 pandemic. Findings show that the pandemic, which exacerbated existing societal inequities, also heightened adolescents' social awareness, provoked feelings of uncertainty, and altered adolescents' short- and long-term plans for educational and career prospects. Throughout school building closures and program cancellations, families played a greater role in fostering adolescents' plans. With prospects for more societal uncertainty on the horizon, future directions point toward supporting adolescents in developing adaptable and flexible future orientations.

The International Framework for School Health Promotion: Supporting Young People Through and After the COVID-19 Pandemic

BACKGROUND

The worldwide COVID-19 government restrictions imposed on young people to limit virus spread have precipitated a growing and long-term educational and health crisis.

CONTRIBUTIONS TO THE THEORY

This novel study used Sen's Capabilities Approach as a theoretical framework to examine the current health and educational impacts of COVID-19 on youth, referencing emerging literature. The objective was to inform the design of an internationally relevant framework for school health promotion to support young people through and after the COVID-19 pandemic. Mapping of existing health resources, internal/external conversion factors and capabilities were used to identify classroom, school and system level strategies that will enable young people to flourish. Four central enablers were identified and used in the design of the International Framework for School Health Promotion (IFSHP).

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE AND EQUITY

The IFSHP can be used by educational institutions, school leaders and teachers to innovate existing health promotion programs, policies and practices to support young people through and after the COVID-19 pandemic.

CONCLUSIONS

School systems, schools and teachers are encouraged to utilize the IFSHP to review and innovate existing school health programs to ensure they meet the increased physical and mental health needs of young people.

Association Between Depressed Mood Changes and Physical Activity Among Adolescents Post COVID-19 Pandemic

Objectives

Following the coronavirus disease 2019 (COVID-19) pandemic, adolescents have experienced decreased physical activity and a decline in mental health. This study analyzed the association between changes in depressed mood after the COVID-19 pandemic and physical activity among adolescents.

Methods

The analysis was based on the results of the 17th Youth Health Behavior Online Survey conducted in 2021, which included 54848 middle and high school students in South Korea. Information on physical activity included low-intensity physical activity lasting >60 min/day, high-intensity physical activity, and strength training exercises. A logistic regression analysis was performed to evaluate the association between physical activity and changes in depression after the COVID-19 pandemic.

Results

After adjusting for sociodemographic characteristics and previous depression, adolescents who performed strength training exercises more than once per week had a 0.95-fold lower risk (odds ratio [OR]=0.948, 95% confidence interval [CI]=0.905-0.994, p= 0.027) of increasing depression after the COVID-19 pandemic, while the risk of decreasing depression increased by 1.22-fold (OR=1.215, 95% CI=1.131-1.305, p<0.001). The results were not significant for low-intensity physical activity for >60 min/day and high-intensity physical activity.

Conclusion

Strength-training exercises are significantly associated with the prevention of depression among adolescents following the COVID-19 pandemic.

Establishment and validation of a risk assessment model for myopia among Chinese primary school students during the COVID-19 pandemic: A lasso regression approach

Purpose

To construct a risk assessment model for forecasting the likelihood of myopia in elementary school students.

Design

A cross-sectional study.

Methods

This study utilized convenient sampling and questionnaire survey to collect data from eligible elementary students and their parents during the coronavirus disease 2019 (COVID-19) pandemic period from March to December 2020. The data were divided into training and testing sets in a 7:3 ratio. Lasso regression was employed to screen variables for inclusion in the model to establish a generalized linear model, with a nomogram model as the final result.

Results

The study included 1139 elementary students, comprising 54.5 % male and 45.5 % female participants. A total of 37 variables were obtained, which were analyzed using lasso regression. Cross-validation revealed that the best lambda value was 0.04201788. Five variables affecting myopia were identified: three risk and two protective factors. The three risk factors were student age (OR = 1.32), family location (urban vs. rural, OR = 2.33), and parents' occupation (compared with farmer: worker, OR = 2.03; teacher, OR = 1.62; medical worker, OR = 5.64; self-employed, OR = 1.78; civil servant, OR = 1.65; company employee, OR = 1.45; service industries, OR = 3.38; and others, OR = 3.20). The two protective factors were eye distance score (OR = 0.83) and eye health exercise score (OR = 0.95). The model was verified and showed good accuracy with an AUC of 0.778 and Brier score of 0.122 in addition to satisfactory clinical effects.

Conclusions

The model effectively predicted the risk of myopia in elementary school students during the COVID-19 pandemic. Using this model, high-risk groups can be identified to provide a foundation for early intervention and follow-up, thereby reducing the incidence of myopia in this population.

Digital Technology Use and Adolescent Mental Health Before and During the COVID-19 Pandemic: The Roles of Internet Addiction and Digital Competence

This study examined whether Internet addiction (IA) and digital competence (DC) mediated the association between digital technology use and mental health problems in adolescents before and during the COVID-19 pandemic, when digital device use increased dramatically. Repeated cross-sectional data from a 3-year cross-cohort study adopting stratified random sampling were analyzed. In 2019, 569 adolescents (female = 312) from 14 secondary schools completed a DC assessment and an online survey on their digital technology use, IA, and mental health. In 2021, 775 adolescents (female = 397) from 11 of those 14 schools completed both instruments. Results showed that adolescents in 2021 spent more time using digital devices, were more digitally competent, and reported more mental health problems than adolescents in 2019. The prevalence of IA was 8 percent in 2019 and 12.4 percent in 2021. In both years, more frequent digital technology use predicted a higher risk of IA, which was associated with more mental health problems (indirect β = 0.08, p < 0.001 for 2019 and β = 0.05, p < 0.001 for 2021). In addition, in 2021, DC was positively associated with digital technology use and negatively with IA, which indirectly related to fewer mental health problems (indirect β = -0.01, p = 0.03). In conclusion, DC is a protective factor alleviating the positive associations of digital technology use and IA with mental health problems in adolescents when the ecological context requires high levels of digital device use.

Gaming in Pandemic Times: An International Survey Assessing the Effects of COVID-19 Lockdowns on Young Video Gamers' Health

The onset of COVID-19 coincided with the peak growth of video game usage, with 2.7 billion gamers in 2020. During the pandemic, gaming and streaming platforms offered an entertaining, social, and safe alternative to recreation during severe lockdowns and social isolations. This study aimed to examine the impact of the COVID-19 pandemic on health-related outcomes in self-proclaimed video gamers based on the type of lockdown experienced and to discuss the potential role of video games during times of preventive lockdown measures. This was a cross-sectional international survey constructed by two academic institutions, NYIT (NY, USA) and McGill University (Montreal, Canada), and Adamas Esports (BC, Canada). The survey consisted of questions including demographics, multiple choice, ratings, and Likert scales relating to the periods prior to and during the COVID-19 lockdowns. There were 897 respondents from North America (72.7%), Europe (10.9%), Asia (4.9%), and other countries (11.5%), with a mean age of 22 years. Significant increases in game time were reported in casual and competitive gamers during the first months of the pandemic. The level of gaming, type of lockdown, and physical activity level prior to the pandemic were examined as potential moderating factors. Significant increases in sedentary behaviors (video game time and sitting time) were observed, while physical activity levels remained unchanged in most participants, regardless of the type of lockdown. Sleep time, but not sleep quality, increased, while mental health exhibited opposing effects, influenced by the type of lockdown and gaming competition levels. Video games, when played moderately, could offer a cost-effective, safe strategy to promote socialization and mental health and improve the overall well-being of the non-gaming and gaming population during pandemic times when strict lockdowns are in place.

Physical activity and sleep changes among children with obesity during a period of school closures related to the COVID-19 pandemic

Daily routines, including in-person school and extracurricular activities, are important for maintaining healthy physical activity and sleep habits in children. The COVID-19 pandemic significantly disrupted daily routines as in-person school and activities closed to prevent spread of SARS-CoV-2. We aimed to examine and assess differences in objectively measured physical activity levels and sleep patterns from wearable sensors in children with obesity before, during, and after a period of school and extracurricular activity closures associated with the COVID-19 pandemic. We compared average step count and sleep patterns (using the Mann Whitney U Test) before and during the pandemic-associated school closures by using data from activity tracker wristbands (Garmin VivoFit 3). Data was collected from 94 children (aged 5-17) with obesity, who were enrolled in a randomized controlled trial testing a community-based lifestyle intervention for a duration of 12-months. During the period that in-person school and extracurricular activities were closed due to the COVID-19 pandemic, children with obesity experienced objectively-measured decreases in physical activity, and sleep duration. From March 15, 2020 to March 31, 2021, corresponding with local school closures, average daily step count decreased by 1,655 steps. Sleep onset and wake time were delayed by about an hour and 45 minutes, respectively, while sleep duration decreased by over 12 minutes as compared with the pre-closure period. Step counts increased with the resumption of in-person activities. These findings provide objective evidence for parents, clinicians, and public health professionals on the importance of in-person daily activities and routines on health behaviors, particularly for children with pre-existing obesity. We demonstrate the utility of wearable sensors in objectively measuring longitudinal physical activity and sleep behavior patterns in children with obesity and in quantifying changes in their health behaviors due to disruption of structured, daily routines following in-person school closures during the COVID-19 pandemic.

Trial Registration

Clinical trial registration: NCT03339440.

Multilevel Factors Associated With Obesity Among South Korean Adolescents Before and During the COVID-19 Pandemic

Background: Coronavirus disease 2019 (COVID-19)-necessitated lockdowns and school closures have limited social interactions among adolescents, which result in unhealthy behaviors. This study compared the multilevel factors associated with obesity among adolescents in South Korea before and during the pandemic. Method: We applied the social-ecological model and analyzed the 2019 and 2020 Korea Youth Risk Behavior Web-based Survey (KYRBS), including middle and high school students. We considered factors at the individual, family, and community levels in the logistic regression. Age and gender-adjusted obesity (body mass index ≥ the 95th percentile) was the dependent variable. Result: The prevalence of obesity slightly increased from 11.31% before the pandemic to 12.48% during it; the odds of obesity were 1.12 times (95% confidence interval [CI] = 1.08-1.16) as high during the pandemic compared to before it. Several individual factors (e.g., age, gender, fast-food consumption) and perceived family economic status were commonly associated with obesity before and during the COVID-19 pandemic. Physical activity and city type were related to obesity only before the pandemic. Downgraded economic status owing to COVID-19 was adversely related to obesity during the pandemic. Conclusion: Inclusive multilevel support is needed to combat obesity in adolescence during the pandemic and those economically impacted require additional support.

Implications of the COVID-19 pandemic on athletes, sports events, and mass gathering events: Review and recommendations

Since the coronavirus disease 19 (COVID-19), which caused several respiratory diseases, was formally declared a global pandemic by the World Health Organization (WHO) on March 11, 2020, it affected the lifestyle and health of athletes, both directly through cardiorespiratory and other health related effects, and indirectly as the pandemic has forced the suspension, postponement, or cancellation of most professional sporting events around the world. In this review, we explore the journey of athletes throughout the pandemic and during their return to their competitive routine. We also highlight potential pitfalls during the process and summarize the recommendations for the optimal return to sport participation. We further discuss the impact of the pandemic on the psychology of athletes, the variance between the team and individual athletes, and their ability to cope with the changes. Moreover, we specifically reviewed the pandemic impact on younger professional athletes in terms of mental and fitness health. Finally, we shaded light on the various impacts of mass gathering events and recommendations for managing upcoming events.

Construct Validity of a Questionnaire on Eating and Physical Activity Habits for Adolescents in Mexico City

The assessment of eating and physical activity habits is an important step in promoting healthy behaviors among the adolescent population and is key in the prevention and management of chronic non-communicable diseases, such as obesity, diabetes, and cardiovascular disease. For this purpose, reliable and valid measuring instruments are essential. In this context, the aim of this article is to present the validation of a self-report questionnaire on eating and physical activity habits among adolescents in Mexico City. In order to validate the questionnaire, a cross-sectional study was conducted with a sample of 2710 adolescents between 11 and 12 years of age, the piloting of the questionnaire was carried out in September 2022 with a focus group, and the programming of the anthropometric measurements was established with the Federal Educational Authority of CDMX, as well as the application of the questionnaire to 33 schools, with these activities being scheduled from 7 November 2022 to 3 February 2023 and having an application duration of 15-25 min for each of the groups to which it was applied; the questionnaire that was applied consists of 31 questions that refer to the frequencies, quantity, or performance of behaviors related to the frequency and type of food, type of physical activity and behaviors related to the act of eating referring to the place where it is carried out (home or away from home) and with whom it is carried out (alone or in company), and about the individual's lifestyle. Subsequently, the reliability of the instrument was evaluated using Cronbach's alpha coefficient, and an exploratory factor analysis was conducted to determine the structure of the questionnaire. The results obtained showed that the questionnaire was adequately reliable (α = 0.778) with an eight-factor structure: four questions on mealtime frequencies, four questions on physical activity and lifestyles, six questions on the consumption of high-calorie foods, four questions on company and food consumption, four questions on the consumption of vegetables and fruits, four questions on the place of food consumption, two questions on the consumption of alcoholic beverages, and three questions on the consumption of sugary drinks, plain water, and milk. In conclusion, the self-report questionnaire on eating and physical activity habits among adolescents in Mexico City is reliable, has adequate internal consistency, and can therefore be used as a useful tool for the evaluation of eating and physical activity habits in this population.

Effects of the COVID-19 pandemic on the physical activity and screen time habits of children aged 11-13 years in Sweden

Introduction

Physical activity (PA), exercise, sedentary behavior and screen time are lifestyle factors that have been shown to significantly impact child health in different ways. These lifestyle factors were affected to different degrees by global restrictions during the COVID-19 pandemic. We investigated PA and screen time in a cohort of Swedish children in both 2019 and 2021, before and during the pandemic.

Method

Adolescents born in 2008 in Halland, Sweden, and included in a previous longitudinal birth cohort study were invited to take part in follow-up questionnaires about PA, screen time and COVID-19. A total of 1041 children aged 11 (in 2019) and 13 years (in 2021) replied and 777 of them answered on both occasions.

Results

Most children (42.1%) reported that their leisure time PA was unchanged from 2019 to 2021. Compared to unchanged PA 33.9% exercised more often (p = 0.011) and 23.9% exercised less (p < 0.001), both differences statistically significant. Roughly, 43.2% of boys and 34.9% of girls in 2021 exercised so that they became breathless or broke a sweat at least 4 times a week not counting physical education in school, corresponding figures for 2019 were 38.2% for boys and 35.2% for girls. The majority of children were able to continue attending leisure time sports clubs during the pandemic, but participation decreased from 88.3% to 76.3% from 11 to 13 years of age. Most reported that sports club routines changed during the pandemic, but only 40.9% reported fewer practice opportunities. Attending a sports club gave greater protection against loss of PA during the pandemic than not belonging to one (41.0% vs. 23.2%, p < 0.001). The majority (71.1%) of children spent more time on screens in 2021 than 2019, with a mean increase of 9.4 h (95% CI 8.6 to 10.2 h) from 20.7 to 30.1 hours per week (p < 0.001) during the study.

Conclusions

Swedish children largely maintained their levels of PA during the pandemic at 13 years of age and these were possibly safeguarded by the comparably mild pandemic restrictions in Sweden in 2021. However, they did increase their screen time between 11 and 13 years of age.

Effect of COVID-19 pandemic on eating habits and lifestyle of college students in Tabriz, Iran: a cross-sectional study

Background

The pandemic of coronavirus disease (COVID-19) has influenced lifestyle behaviors and the health of populations worldwide. The purpose of this study was to determine the effects of the COVID-19 pandemic on the eating habits and lifestyle behaviors of Tabriz University of Medical Sciences students in Tabriz, Iran.

Methods

This cross-sectional study was conducted on 220 college students selected using a convenience sampling method in May-June 2022. Data were collected by the questionnaire, which included information on eating habits, physical activity, smoking, watching television, social media use, sleep, anxiety and stress, and smoking before and during the pandemic. The Chi-square test was used to analyze the association of COVID-19 with lifestyle behaviors.

Results

The median age of participants was 22.00 (IQR: 3.00) years old. The median BMI was 21.69 (IQR: 3.82) kg/m2, and 74.5% of participants had a BMI of 18.5 to 25 kg/m2. Around 34.5% of participants reported a weight gain during the pandemic. During the pandemic, students' eating habits improved by maintaining a regular meal pattern, eating a balanced diet, consuming 2-3 servings of milk or its products, consuming one or more servings of pulses, eggs, or meat per day, decreasing consumption of fast food, fried, and junk foods, adding less sugar to meals and beverages, and consuming fewer sugar-sweetened beverages and foods with high sugar (all p = 0.000). They also reported less physical activity and more sitting and screen time. Sleep time and poorer quality of sleep increased during the pandemic (p = 0.000). Feeling stress or anxiety in a day increased, and 2.2% of our participants decided to smoke. The biggest reasons for eating habits changes were less eating out, fear of coronavirus spreading through food, preferring home-cooked food, and improved knowledge about nutrition.

Conclusion

The results indicated that the eating habits of university students improved; however, participants stated increased weight gain, screen, sitting, and sleep time, declined physical activity, worse sleep quality, and feeling stress or anxiety during the COVID-19 pandemic. The findings can help to develop nutritional and behavioral recommendations for maintaining adults' health during and after the pandemic.

Physical activity maintenance and increase in Chinese children and adolescents: the role of intrinsic motivation and parental support

Objective

This longitudinal study aimed to examine the association of intrinsic motivation, parental physical activity, and parental support with physical activity maintenance and increase among children and adolescents.

Methods

A sample of 2,424 children and adolescents in Shanghai, China participated in the two-wave survey before and during the COVID-19 pandemic. The questionnaire measured children and adolescents' physical activity and intrinsic motivation, as well as their parental physical activity and support (concern for their child and co-activity with their child). Multivariable logistic regressions were performed by groups to examine the associations between these factors and physical activity change.

Results

Most children and adolescents exhibited a decline in physical activity participation during the pandemic, as indicated by a mere 15.0 and 8.0% of individuals maintaining and increasing their pre-pandemic levels, respectively. Among the initially active participants, perceived self-choice [OR = 1.341 (95%CI: 1.173-1.533)] and parental concern [OR = 1.922 (95%CI: 1.204-3.068)] predicted maintained physical activity. Increased physical activity was predicted by perceived enjoyment [OR = 1.193 (95%CI: 1.046-1.362)] and parental co-activity (OR = 1.995 [95%CI: 1.095-3.633]).

Conclusion

This study provides longitudinal evidence that intrinsic motivation and parental support can have a positive impact when physical activity levels change significantly. Effective interventions targeting multilevel factors are needed to maintain or increase children and adolescents' physical activity.

Physical activity and mental health in children and youth during COVID-19: a systematic review and meta-analysis

BACKGROUND

The coronavirus disease (COVID-19) and universal mitigation strategies have fundamentally affected peoples' lives worldwide, particularly during the first two years of the pandemic. Reductions in physical activity (PA) and increased mental health (MH) problems among children and youth have been observed. This systematic review and meta-analysis investigated the relationship between physical activity (PA) and mental health (MH) among children and youth during the COVID-19 pandemic.

METHODS

Four electronic databases (EMBASE, PsycINFO, PubMed, and Web of Science) were systematically searched to identify studies that (1) examined the relationship between PA and MH among children and youth (aged 2-24 years old) and (2) were published in peer-reviewed journals in English between January 2020 and December 2021. Relationships between PA and two MH aspects (i.e., negative and positive psychological responses) among children and youth at different age ranges and those with disabilities or chronic conditions (DCC) were synthesized. Meta-analyses were also performed for eligible studies to determine the pooled effect size.

RESULTS

A total of 58 studies were eventually included for variable categorization, with 32 eligible for meta-analyses. Our synthesis results showed that greater PA participation was strongly related to lower negative psychological responses (i.e., anxiety, depression, stress, insomnia, fatigue, and mental health problems) and higher positive psychological responses (i.e., general well-being and vigor) in children and youth during COVID-19. The pattern and strength of relations between PA and MH outcomes varied across age ranges and health conditions, with preschoolers and those with DCC receiving less attention in the existing research. Meta-analysis results showed that the magnitude of associations of PA with negative (Fisher's z = - 0.198, p < 0.001) and positive (Fisher's z = 0.170, p < 0.001) psychological responses among children and youth was weak. These results were linked to age of participants, study quality, and reporting of PA-related information.

CONCLUSIONS

PA participation and MH among children and youth deteriorated during the COVID-19 pandemic and were closely associated with each other. For the post-COVID-19 era, additional research on age- and health condition-specific relationships between PA and MH outcomes from a comprehensive perspective is warranted. (Word count: 344 words).