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Bertuccio P, Vigezzi GP, Amerio A, Cavalieri D'oro L, Iacoviello L, Stuckler D, Signorelli C, Zucchi A, Gallus S, Odone A. Health and social home services among community-dwelling older people during COVID-19: Results from the cross-sectional LOST in Lombardia project. Scand J Public Health 2024; 52:262-270. [PMID: 37688313 DOI: 10.1177/14034948231184516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
BACKGROUND Few studies have focused on changes in health and social services access due to the COVID-19 pandemic. We aimed to describe changes in the use of selected health and social home services due to the pandemic and to investigate potential associated factors, including socio-demographic characteristics, number of chronic diseases and mental health indicators, among older Italian individuals. METHODS We analysed data from the LOST in Lombardia cross-sectional study conducted in November 2020 on a large representative sample of 4400 individuals aged ⩾65 years. To identify potential factors associated with the increased use of three selected health and social home services, we estimated odds ratios (OR) and confidence intervals (CI) using multivariable logistic regression models. RESULTS Compared to the year before, 5.0% of older adults increased help from domestic workers (vs. 6.9% reducing) during the pandemic, 4.4% increased help from non-familiar caregivers (vs. 1.3% decreasing) and 4.7% increased medical home visits (vs. 1.0% decreasing). An increase in the use of these services was more frequent among participants with co-morbidities (p for trend <0.001), especially with diabetes (for caregivers: OR=12.2, 95% CI 6.0-24.8), and worse mental health (for caregivers and for those with a GAD-2 score ⩾3 vs. <3: OR=10.6, 95% CI 5.8-19.4). Conversely, people living in more crowded households less frequently increased health and social services use during the pandemic. CONCLUSIONS Our results should inform targeted interventions for the identified vulnerable groups to close the gap in health and social inequities.
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Affiliation(s)
- Paola Bertuccio
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Giacomo Pietro Vigezzi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
- Collegio Ca' della Paglia, Fondazione Ghislieri, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Italy
| | | | - Licia Iacoviello
- Department of Medicine and Surgery, Research Centre in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Italy
- Department of Epidemiology and Prevention, IRCCS Neuromed, Italy
| | - David Stuckler
- Department of Social and Political Sciences, Bocconi University, Italy
| | | | - Alberto Zucchi
- Epidemiology Unit, Bergamo Health Protection Agency, Italy
| | - Silvano Gallus
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Italy
| | - Anna Odone
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
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Alpers SE, Druckrey-Fiskaaen KT, Madebo T, Vold JH, Pallesen S, Skogen JC, Lunde LH, Mæland S, Fadnes LT. The association of psychological distress and economic and health worries with tobacco smoking behavior during the COVID-19 pandemic: a two-year longitudinal cohort study. BMC Public Health 2024; 24:375. [PMID: 38317145 PMCID: PMC10840189 DOI: 10.1186/s12889-024-17943-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/01/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic and other life events may trigger worries and psychological distress. These impacts may lead to unhealthy behaviors, such as tobacco smoking, but the degree of such associations is unclear. The current three-wave longitudinal study examines changes in tobacco smoking in Norway between 2020 and 2022 and their associations with psychological distress as well as health- and economy-related worries. METHODS Data were collected in April 2020 (baseline), January 2021, and January 2022 in Bergen, Norway, from an online longitudinal population-based survey. Smoking tobacco (the outcome variable) was dichotomized based on the responses to the question of whether participants smoked cigarettes or not. Tobacco smoking and its associations with psychological distress were assessed among 24,914 participants (response rate 36%) in a mixed model regression presented with coefficients and 95% confidence intervals (CI), adjusting for COVID-19-related worries, home office/study, occupational situation, age, gender, education, having children below 18 years living at home, living alone, and alcohol consumption. RESULTS A total of 10% of the study sample were current smokers at baseline. At baseline, smoking tobacco was associated with high levels of psychological distress (absolute difference 13%, 95% CI 10%; 15%), advanced age (50-59 years: 11%, CI 10%; 13%), and hazardous alcohol use (4%, CI 3%; 5%) compared to their counterparts. Higher education (-5%, CI -6%; -4%), working from home (-4%, CI -5%; -4%), and higher physical activity levels (-4%, CI -5%; -3%) were associated with non-smoking. The prevalence of smoking among individuals experiencing severe psychological distress decreased slightly over time (-2% per year, CI -3%; -1%). CONCLUSIONS Smoking was associated with severe psychological distress, advanced age, and hazardous alcohol use at baseline; non-smoking was associated with high education, working from home, and high physical activity. Nevertheless, the smoking rate among individuals experiencing severe psychological distress slightly decreased over the course of the COVID-19 pandemic.
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Affiliation(s)
- Silvia Eiken Alpers
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.
| | - Karl Trygve Druckrey-Fiskaaen
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Tesfaye Madebo
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Respiratory Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Jørn Henrik Vold
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Alcohol & Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Linn-Heidi Lunde
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Silje Mæland
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Alpers SE, Pallesen S, Vold JH, Haug E, Lunde LH, Skogen JC, Mamen A, Mæland S, Fadnes LT. The association between psychological distress and alcohol consumption and physical activity: a population-based cohort study. Front Psychiatry 2023; 14:1181046. [PMID: 37426109 PMCID: PMC10323831 DOI: 10.3389/fpsyt.2023.1181046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction The COVID-19 pandemic and infection control measures caused changes to daily life for most people. Heavy alcohol consumption and physical inactivity are two important behavioral risk factors for noncommunicable diseases worldwide. The COVID-19 pandemic, with its social distancing measures, home office policies, isolation, and quarantine requirements may have an impact on these factors. This three-wave longitudinal study aims to investigate if psychological distress and worries related to health and economy were associated with levels and changes in alcohol consumption and physical activity during the two first years of the COVID-19 pandemic in Norway. Methods We used data collected in April 2020, January 2021, and January 2022 from an online longitudinal population-based survey. Alcohol consumption and physical activity status were assessed at all three measuring points via the Alcohol Use Disorder Identification Test (AUDIT-C) and the International Physical Activity Questionnaire (IPAQ-SF). COVID-19-related worries, home office/study, occupational situation, age, gender, children below 18 years living at home, and psychological distress (measured with the Symptom Checklist (SCL-10)) were included as independent variables in the model. A mixed model regression was used and presented with coefficients with 95% confidence intervals (CI). Results Analysis of data from 25,708 participants demonstrates that participants with substantial symptoms of psychological distress more often reported higher alcohol consumption (1.86 units/week, CI 1.48-2.24) and lower levels of physical activity [-1,043 Metabolic Equivalents of Task (METs) per week, CI -1,257;-828] at baseline. Working/studying from home (0.37 units/week, CI 0.24-0.50) and being male (1.57 units/week, CI 1.45-1.69) were associated with higher alcohol consumption. Working/studying from home (-536 METs/week, CI -609;-463), and being older than 70 years (-503 METs/week, CI -650;-355) were related to lower levels of physical activity. The differences in activity levels between those with the highest and lowest levels of psychological distress reduced over time (239 METs/week, CI 67;412), and similarly the differences in alcohol intake reduced over time among those having and not having children < 18 years (0.10 units/week, CI 0.01-0.19). Conclusion These findings highlight the substantial increases in risks related to inactivity and alcohol consumption among those with high levels of psychological distress symptoms, and particularly during the COVID-19 pandemic, and increase the understanding of factors associated with worries and health behavior.
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Affiliation(s)
- Silvia Eiken Alpers
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Ståle Pallesen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Jørn Henrik Vold
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Ellen Haug
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Teacher Education, NLA University College, Bergen, Norway
| | - Linn-Heidi Lunde
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Asgeir Mamen
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Silje Mæland
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Bjørknes R, Skogen JC, Nærde A, Sandal GM, Haug E, Mæland S, Fadnes LT, Lehmann S. Parental stress during the COVID-19 pandemic: A one-year follow-up. PLoS One 2022; 17:e0276190. [PMID: 36472999 PMCID: PMC9725124 DOI: 10.1371/journal.pone.0276190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/01/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This two-wave longitudinal study aimed at increasing knowledge about levels of parental stressors and rewards among mothers and fathers of children aged 1-18 during the first year of the COVID-19 pandemic in Norway. BACKGROUND The COVID-19 pandemic and infection-control measures have caused changes to family life. Managing homeschooling or caring for younger children while working from home may have posed significant strain on parental stress, negatively impacting the quality of parent-child relationships and parents' sensitivity to their children's needs. METHOD We employed data collected in April 2020 and April 2021 from the longitudinal population-based survey in Bergen/Norway (Bergen in ChangE-study). 7424 parents participated (58.6% mothers and 41.5% fathers). RESULTS The overall levels of parental stressors and rewards did not change significantly. Over the two time points, the factors associated with decreased parental stressors were being male, aged 40-49 years, having a relatively high income, and reporting initial difficulties with closed kindergartens or schools. For parents aged 18-29 years, the level of parental stressors increased. CONCLUSION The study suggests that the overall levels of parental stress remained unchanged during the first year of the pandemic. Even so, the study also uncovered that younger parents represented a vulnerable subgroup. IMPLICATIONS To prevent detrimental consequences in the wake of the pandemic, it could be important to increase awareness and competence among professional staff in kindergartens, primary schools, and child health clinics targeting young parents and their children.
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Affiliation(s)
- Ragnhild Bjørknes
- Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Bergen, Norway
- The Norwegian Center for Child Behavioral Development, Oslo, Norway
- * E-mail:
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Alcohol & Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Ane Nærde
- The Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - Gro Mjeldheim Sandal
- Department of Psychosocial Science, Faculty of Psychology, The University of Bergen, Bergen, Norway
| | - Ellen Haug
- Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Bergen, Norway
- NLA University College, Bergen, Norway
| | - Silje Mæland
- Department of Global Public Health and Primary Care, Faculty of medicine, University of Bergen, Bergen, Norway
- Research Unit for General Practice in Bergen, The Norwegian Research Centre, NORCE, Bergen, Norway
| | - Lars T. Fadnes
- Department of Global Public Health and Primary Care, Faculty of medicine, University of Bergen, Bergen, Norway
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Stine Lehmann
- Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Bergen, Norway
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Lehmann S, Haug E, Bjørknes R, Mjeldheim Sandal G, T. Fadnes L, Skogen JC. Quality of life among young people in Norway during the COVID-19 pandemic. A longitudinal study. Eur Child Adolesc Psychiatry 2022; 32:1061-1071. [PMID: 35732752 PMCID: PMC9216295 DOI: 10.1007/s00787-022-02023-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/01/2022] [Indexed: 12/02/2022]
Abstract
In this study, we aimed to examine health-related quality of life during the COVID-19 pandemic among a general sample of young people in Norway aged 11-19 years. More specifically, we examine: (1) Change over 2 time-points in five health-related quality of life dimensions, (2) Whether sociodemographic- and COVID-19-related factors contributed to change in these five dimensions, (3) Whether parental stress and socioeconomic status at T1 interacted with change in health-related quality of life across T1 and T2. Data collection lasted from April 27th to May 11th, 2020 (T1), and from December 16th, 2020, to January 10th, 2021 (T2). Youth aged 11-19 years (N = 2997) completed the KIDSCREEN-27, COVID-19 related and sociodemographic items. Parents (N = 744) of youth aged 15 years and younger completed the parental stress scale and sociodemographic items. Physical and psychological wellbeing declined significantly from March to December 2020. Subscale scores for social support and peers increased. Controlling for a broad number of sociodemographic and COVID-19-related factors did not make an overall impact on the estimates. Those worried about infection, older aged, girls, and youth born outside Norway had a steeper decline in health-related quality of life subdimensions from T1 to T2. In the wake of the COVID-19 pandemic, we warrant special attention to the recovery of youth's physical and psychological wellbeing.
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Affiliation(s)
- Stine Lehmann
- Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Postboks 7807, 5020, Bergen, Norway.
| | - Ellen Haug
- grid.7914.b0000 0004 1936 7443Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Postboks 7807, 5020 Bergen, Norway ,grid.458561.b0000 0004 0611 5642NLA University College, Bergen, Norway
| | - Ragnhild Bjørknes
- grid.7914.b0000 0004 1936 7443Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Postboks 7807, 5020 Bergen, Norway ,grid.5510.10000 0004 1936 8921The Norwegian Center for Child Behavioral Development, Oslo, Norway
| | - Gro Mjeldheim Sandal
- grid.7914.b0000 0004 1936 7443Department of Psychosocial Science, Faculty of Psychology, The University of Bergen Norway, Bergen, Norway
| | - Lars T. Fadnes
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Bergen Addiction Research, Haukeland University Hospital, Bergen, Norway
| | - Jens Christoffer Skogen
- grid.418193.60000 0001 1541 4204Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway ,grid.412835.90000 0004 0627 2891Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway ,grid.418193.60000 0001 1541 4204Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
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Bjørknes R, Sandal GM, Mæland S, Haug E, Lehmann S. 'We are unlikely to return to the same world, and I do not want it to destroy my future.' Young people's worries through the outbreak of the COVID-19 pandemic. CHILD & FAMILY SOCIAL WORK 2022; 27:246-253. [PMID: 34899030 PMCID: PMC8653047 DOI: 10.1111/cfs.12878] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/13/2021] [Accepted: 09/20/2021] [Indexed: 06/14/2023]
Abstract
This study aims to explore what worries youth were having during the seventh to ninth week of the COVID-19 lockdown. Our findings build on the responses to an open-ended survey question from 1314 youths. The worries covered three main themes: 'That my mom dies, then I am left all alone': worries related to COVID-19 virus infection; 'To me, this is lost youth': worries about the consequences of measures for the present life and near future; and 'I will face a very difficult life in the future': worries about the consequences of measures for the outlook on life. Young people worried that the measures would have a huge impact on their present life and outlook on life. The costs of restriction measures were unevenly distributed and indicated that the measures affected their mental health. Listening to youth voices during the pandemic is important for practitioners, educators and policymakers. The results indicate that the threshold for closing schools also including the provision of distance learning should be kept high. Social and health services for youth should offer early intervention and be prepared for an escalation in mental health problems in the imminent future.
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Affiliation(s)
- Ragnhild Bjørknes
- Department of Health Promotion and Development, Faculty of PsychologyThe University of BergenBergenNorway
| | - Gro Mjeldheim Sandal
- Department of Psychosocial Science, Faculty of PsychologyThe University of BergenBergenNorway
| | - Silje Mæland
- Department of Global Public Health and Primary Care, Faculty of MedicineThe University of BergenBergenNorway
- Research Unit for General Practice in BergenThe Norwegian Research Center, NORCEBergenNorway
| | - Ellen Haug
- Department of Health Promotion and Development, Faculty of PsychologyThe University of BergenBergenNorway
- Department of EducationNLA University CollegeBergenNorway
| | - Stine Lehmann
- Department of Health Promotion and Development, Faculty of PsychologyThe University of BergenBergenNorway
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Haug E, Mæland S, Lehmann S, Bjørknes R, Fadnes LT, Sandal GM, Skogen JC. Increased Gaming During COVID-19 Predicts Physical Inactivity Among Youth in Norway—A Two-Wave Longitudinal Cohort Study. Front Public Health 2022; 10:812932. [PMID: 35237551 PMCID: PMC8884262 DOI: 10.3389/fpubh.2022.812932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/18/2022] [Indexed: 12/20/2022] Open
Abstract
Background A concern for the COVID-19 measures and the potential long-term consequences the measures may have on physical inactivity and gaming among youth. Objectives Examine the stability and change in internet and offline gaming and the association with physical inactivity among adolescents in Norway during the pandemic. Methods A total of 2940 youth (58% girls) aged 12–19 years participated in an online longitudinal two-wave survey during the first Norwegian national lockdown in April 2020 (t1) and in December 2020 (t2). Gaming behavior and physical activity status were assessed at both time points. Age, gender, and socioeconomic status were included as covariates. Results Among boys, 41% reported gaming a lot more and 35% a little more at t1 compared to before the national lockdown. The corresponding numbers for girls were 14 and 23%, respectively. In fully adjusted analysis, a pattern of increased gaming at t1 followed by an additional increase in gaming reported at t2 was associated with physical inactivity at t1 (OR = 2.10, p < 0.01) and t2 (OR = 2.45, p < 0.001). Participants gaming more at t1 followed by a reduction at t2 had higher odds of inactivity at t1 (OR = 1.88, p < 0.01). Youth reporting no gaming at t1 had lower odds for inactivity at this time point (OR = 0.67, p < 0.05). Conclusions Increased gaming among many youths and a relationship with physical inactivity was observed during the first phase of the COVID-19 pandemic. To counteract the negative long-term impacts of COVID-19 restrictions, public health initiatives should emphasize the facilitation of physical activity in youth and develop effective strategies to prevent problematic gaming.
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Affiliation(s)
- Ellen Haug
- Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Bergen, Norway
- Department of Teacher Education, NLA University College, Bergen, Norway
- *Correspondence: Ellen Haug
| | - Silje Mæland
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Stine Lehmann
- Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Bergen, Norway
| | - Ragnhild Bjørknes
- Department of Health Promotion and Development, Faculty of Psychology, The University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Bergen Addiction Research, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Gro Mjeldheim Sandal
- Department of Psychosocial Science, Faculty of Psychology, The University of Bergen, Bergen, Norway
| | - Jens Christoffer Skogen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Alcohol and Drug Research Western Norway, Stavanger University Hospital, Stavanger, Norway
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
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