Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey

Effects of Screen Time on Problematic Behavior in Children During the COVID-19 Pandemic in South Korea

Objectives

The coronavirus disease 2019 (COVID-19) pandemic has led to a decrease in face-to-face classes worldwide, affecting the mental health of children and their parents. The global pandemic has increased children's overall use of electronic media. This study analyzed the effect of children's screen time on problematic behaviors during the COVID-19 pandemic.

Methods

A total of 186 parents from Suwon, South Korea, were recruited to participate in an online survey. The mean age of the children was 10.14 years old, and 44.1% were females. The questionnaire included questions on children's screen time, problematic behaviors, and parental stress. Children's behavioral problems were evaluated using the Behavior Problem Index, whereas the Parental Stress Scale was used to estimate parental stress.

Results

The mean smartphone usage frequency of the children was 5.35 days per week, and the mean smartphone screen time was 3.52 hours per day. Smartphone screen time (Z=4.49, p <0.001) and usage frequency (Z=2.75, p=0.006) were significantly correlated with children's behavioral problem scores. The indirect effect of parental stress on this relationship was also statistically significant (p=0.049, p=0.045, respectively).

Conclusion

This study suggests that children's smartphone screen time has affected problematic behaviors during the COVID-19 pandemic. Furthermore, parental stress is related to the relationship between children's screen time and problematic behaviors.

Impact of Age and School Instruction Mode on Children's Occupations Early in the COVID-19 Pandemic: A Longitudinal Survey Study

IMPORTANCE

The coronavirus disease 2019 (COVID-19) pandemic disrupted participation in routines and daily activities. It is unclear how children reengaged in activities during the pandemic, particularly as a new school year began. Differences in school instruction mode (in person, hybrid, or remote) during the pandemic could further affect activity participation.

OBJECTIVE

To examine changes in sedentary and nonsedentary activity participation in children and to determine whether school instruction mode was associated with participation.

SETTING

Home-based survey of U.S. residents.

PARTICIPANTS

Parents of 208 children (46.2% female) between ages 5 and 18 yr were surveyed at two waves: March through April 2020 and October 2020.

OUTCOMES AND MEASURES

Frequency of sedentary (indoor play, electronic device usage) and nonsedentary (outdoor play, leisure and extracurriculars) activity participation was observed. Descriptive and inferential statistics of the changes from Wave 1 to Wave 2 and linear regression were used to determine statistically significant variables associated with activity participation.

RESULTS

Nonsedentary activity participation increased and sedentary activity decreased from Wave 1 to Wave 2. Instruction mode was statistically associated with nonsedentary, but not sedentary, participation. Negative mood, local COVID-19 severity, and household income were also associated with nonsedentary and sedentary participation.

CONCLUSIONS AND RELEVANCE

Children's participation in sedentary and nonsedentary activities normalized during the new school year; however, many factors likely contributed to these changes. What This Article Adds: Despite differences in school instruction mode and the influence of mental health early in the pandemic, children's nonsedentary activity participation increased. Occupational therapy practitioners can reinforce the importance of reengaging in activities and regular routines to promote health and well-being during challenging situations.

Variability in the psychological impact of four waves of COVID-19: a time-series study of 60 000 text-based counseling sessions

BACKGROUND

Continuous exposure to stressors can lead to vulnerability and, in some cases, resilience. This study examined the variation in its psychological impact across the first four waves of COVID-19 in Hong Kong.

METHODS

Transcripts from Open Up, an online text-based counseling service, between January 2019 and January 2021 were analyzed (N = 60 775). We identified COVID-19 mentioned sessions using keywords and further categorized them into those that also mentioned symptoms of common mental disorders (CMDs) and those that did not. Autoregressive integrated moving average models were used to analyze the associations between the severity of the outbreak and the mention of COVID-19 and CMDs.

RESULTS

Results revealed that the pandemic led to increased psychological distress. Compared to prior to its advent, more people sought help in the initial months of the outbreak. Furthermore, associations were found between the severity of the outbreak and the number of help-seeker mentioning the pandemic, as well as between the outbreak severity and the number of help-seekers disclosing psychological distress. However, these relationships were not uniform across the four waves of outbreaks; a dissociation between outbreak severity and help-seekers' concern was found in the fourth wave.

CONCLUSION

As the pandemic waxes and wanes, people may become habituated to its psychological toll. This may be interpreted as a form of resilience. Instead of worsening with time, the psychological impact of COVID-19 may reduce with repeated exposure.

Physical Activity Trajectories in Early Childhood: Investigating Personal, Environmental, and Participation Factors

INTRODUCTION/PURPOSE

To determine personal, environmental, and participation factors that predict children's physical activity (PA) trajectories from preschool through to school years.

METHODS

Two hundred seventy-nine children (4.5 ± 0.9 yr, 52% boys) were included in this study. Physical activity was collected via accelerometry at six different timepoints over 6.3 ± 0.6 yr. Time-stable variables were collected at baseline and included child's sex and ethnicity. Time-dependent variables were collected at six timepoints (age, years) and included household income (CAD), parental total PA, parental influence on PA, and parent-reported child's quality of life, child's sleep, and child's amount of weekend outdoor PA. Group-based trajectory modeling was applied to identify trajectories of moderate-to-vigorous PA (MVPA) and total PA (TPA). Multivariable regression analysis identified personal, environmental, and participation factors associated with trajectory membership.

RESULTS

Three trajectories were identified for each of MVPA and TPA. Group 3 in MVPA and TPA expressed the most PA over time, with increased activity from timepoints 1 to 3, and then declining from timepoints 4 to 6. For the group 3 MVPA trajectory, male sex (β estimate, 3.437; P = 0.001) and quality of life (β estimate, 0.513; P < 0.001) were the only significant correlates for group membership. For the group 3 TPA trajectory, male sex (β estimate, 1.970; P = 0.035), greater household income (β estimate, 94.615; P < 0.001), and greater parental total PA (β estimate, 0.574; P = 0.023) increased the probability of belonging to this trajectory group.

CONCLUSIONS

These findings suggest a need for interventions and public health campaigns to increase opportunities for PA engagement in girls starting in the early years. Policies and programs to address financial inequities, positive parental modeling, and improving quality of life are also warranted.

Pre-pandemic support for shared reading buffers adverse parenting impacts: an RCT in Brazil

BACKGROUND

To examine whether (1) a parent-child reading program (Universidade do Bebê [UBB]), conducted in Brazil pre-pandemic can support parenting and parent-child reading 6 months into the pandemic, (2) cognitive stimulation at pandemic onset mediates effects of UBB on these outcomes, and (3) UBB pre-pandemic buffers associations between COVID-19-related distress and parenting/parent-child reading 6 months into the pandemic.

METHODS

400 women, either pregnant or with children 0-24 months, were randomized to UBB (n = 200) or control groups. UBB consisted of monthly parent workshops focusing on parent-child reading and a book-lending library. Assessments pre-pandemic (June-2019) and at pandemic onset (April-2020) included cognitive stimulation. Assessments 6 months into the pandemic (October-2020) included COVID-19 exposure/impact/distress, as well as parenting and parent-child reading.

RESULTS

133 families (n = 69 UBB) contributed data 6 months into the pandemic. Participation in UBB pre-pandemic was associated with parent-child reading but not parenting 6 months into the pandemic. Indirect effects of UBB through cognitive stimulation at pandemic onset were observed for both outcomes. Increased COVID-19-related distress was significantly associated with reduced parenting/parent-child reading 6 months into the pandemic in the control group only.

CONCLUSION

Promotion of cognitive stimulation pre-pandemic may have reduced risk for effects of the pandemic on parenting/parent-child reading.

CLINICAL TRIAL REGISTRATION

The trial has been registered with the Brazilian Clinical Trials Registry RBR-29RZDH on 05/28/2018.

IMPACT

This is the first study showing sustained impacts of a reading aloud intervention beginning in pregnancy and early infancy implemented pre-pandemic. Findings suggest that participation in a reading-aloud intervention buffered associations between COVID-19 distress and parenting/parent-child reading 6 months into the pandemic. Novel empirical evidence suggests that promotion of cognitive stimulation prior to the pandemic may buffer its impacts on parenting and parent-child book reading following onset in low- and middle-income countries. Findings provide important new support for implementation of parent-child reading aloud programs and likely have implications for early childhood development beyond the COVID-19 pandemic for disasters generally.

Children's activities, parental concerns, and child care service utilization in the early stages of the COVID-19 pandemic

Introduction

In the early stages of the COVID-19 pandemic, most Canadian provinces and territories enacted public health measures to reduce virus spread, leading most child care centers across the country to limit or halt in-person service delivery. While it is broadly known that the range of activities available to children and youth reduced drastically as a result, research has yet to explore if and how children's activities shifted in relation to changes in child care arrangements.

Method

Children's activities during the early months of the pandemic were assessed based on parent-report data (n = 19,959). Activity patterns were extracted via latent profile analysis. Thereafter, differences in child-care related outcomes across profiles were compared via logistic regression models.

Results

Latent profile analysis yielded three distinct activity patterns: Screenies (91.5%) were children who engaged in high amounts of screen use relative to all other activities; Analog children (3.1%) exhibited mostly off-screen activities (e.g., reading, physical exercise); and children in the Balanced group (5.4%) appeared to pursue a wide variety of activities. Children were more likely to fall into the Screenies or Balanced profiles when caregivers reported changes in child care arrangements. Moreover, parents of children with Balanced activity profiles were more likely to be planning to use child care when services reopened post-pandemic, compared to parents of children in the Analog group.

Discussion

The present findings call attention to heterogeneity in children's activities during COVID-19, which should be considered in the context of pandemic-related child care closures. Implications for children, families, and child care services during and beyond COVID-19 are discussed.

Mental health in Canadian children and adolescents during COVID-19 pandemic: the role of personality and, coping and stress responses

In December 2019, the Coronavirus Disease (COVID-19) pandemic first emerged in China and quickly spread to other countries. Previous studies have shown that the COVID-19 pandemic and the consequences have negatively impacted the mental health of adults. Individual differences such as personality could contribute to mental health. Furthermore, coping and responses to stress may affect an individual's response to the pandemic. In the past, studies have only investigated this relationship in adults. In the current study, we examine how personality traits (using the Five-Factor Model as our framework) and Coping and Response to COVID-19 stress are related to the mental health of Canadian children and adolescents during the pandemic. Using parent reports of 100 preschoolers and 607 6-18-year-old children, we performed multiple regression analysis to explore how personality traits predict the effects of COVID-19 on mental health. The results showed that personality traits are associated with the mental health of Canadian youth during the COVID-19 pandemic. In preschoolers, Neuroticism and Agreeableness predicted the most mental health problems, and in 6-18-year-old children, Extraversion negatively predicted the most mental health problems. Also, Openness to Experience was the weakest predictor of mental health status in Canadian youth. These findings could be useful in understanding children's responses to the COVID-19 pandemic and could assist public health services delivering mental health services specifically tailored to children's personalities during and after this pandemic.

The Longitudinal Features of Depressive Symptoms During the COVID-19 Pandemic Among Chinese College Students: A Network Perspective

There is substantial evidence that the Corona Virus Disease 2019 (COVID-19) pandemic increased the risk of depressive symptoms among college students, but the long-term features of depressive symptoms on a symptom level have been poorly described. The current study investigated interaction patterns between depressive symptoms via network analysis. In this longitudinal study, participants included 860 Chinese college students (65.8% female; M_age = 20.6, SD_age = 1.8, range: 17-27) who completed a questionnaire at three-time points three months apart. Results demonstrated that fatigue was the most influential symptom, and the occurrence of fatigue could give rise to other depressive symptoms. In addition to predicting other symptoms, fatigue could be predicted by other symptoms in the measurement. The network structures were similar across time, suggesting that the overall interaction pattern of depressive symptoms was stable over the longitudinal course. These findings suggest that depressive symptoms during the COVID-19 period are associated with the presence of fatigue.

Physical, psychological, and behavioral problems among children and adolescents in countries with different economic statuses during the COVID-19 pandemic: a systematic review and meta-analysis

Introduction

The COVID-19 pandemic has impacted children and adolescents' physical activity (PA), sleeping patterns, and psychological and behavioral health. Yet, little is known about the differences between those in countries with various economic statuses.

Methods

Articles published from database inception through 16 March 2022 were retrieved using CINAHL Complete, Cochrane Library, EMBASE, Medline, PubMed, and PsycINFO. High-quality studies that reported the number of participants with parameters associated with PA, sleeping patterns, and psychological and behavioral problems in young people aged under 18 years during the pandemic were included. We referenced the Canadian 24-Hour Movement Guidelines for PA and sleep duration to provide the event rate for young people who were not compliant with the guidelines. The event rate of young people who had decreased sleep quality and experienced psychological and behavioral problems were also investigated. A subgroup analysis was conducted to identify the differences in those in countries with diverse economic statuses. Funnel plot analysis and Egger's test were also conducted to identify any risk of publication bias.

Result

A total of 66 studies with 1,371,168 participants aged between 0 and 18 years, involving 27 countries, were included. During the pandemic, we identified that 41% (95% CI: 39%, 43%; I2 = 96.62) and 43% (95% CI: 34%, 52%; I2 = 99.42) of young people did not meet the PA and sleep duration recommendation guidelines. In addition, 31% (95% CI: 28%, 35%; I2 = 99.66) of young people had decreased their sleep quality. Yet, no significant difference was found across countries with different economic statuses. However, the event rates of participants with psychological and behavioral problems were 32% (95% CI: 28%, 36%; I2 = 99.85) and 19% (95% CI: 14%, 25%; I2 = 99.72), respectively. In addition, the rate of psychological problems was more severe in those who live in lower middle-income countries (p < 0.001), while the rate of behavioral problems was more severe in those who live in high-income countries (p = 0.001).

Discussion

During the pandemic, the discouragement of PA, poor sleep quality, and high risk of psychological and behavioral problems are concerning. A large number of young people did not comply with the recommendation guidelines. Timely implementation of recovery plans is critical to address the adverse effects on young people.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=309209, identifier CRD42022309209.

Mental Health and Health-Related Quality of Life of Children and Youth during the First Year of the COVID-19 Pandemic: Results from a Cross-Sectional Survey in Saskatchewan, Canada

For children and youth, the COVID-19 pandemic surfaced at a critical time in their development. Children have experienced extended disruptions to routines including in-person schooling, physical activities, and social interactions-things that bring meaning and structure to their daily lives. We estimated the prevalence of anxiety and depression symptoms of children and youth and their experiences of health-related quality of life (HRQoL), during the first year of the pandemic, and identified factors related to these outcomes. Further, we examined these effects among ethnocultural minority families. We conducted an online survey (March-July 2021) with 510 children and youth aged 8-18 years and their parents/caregivers. The sample was representative of the targeted population. We modelled the relationship between anxiety, depression (measured using the Revised Child Anxiety and Depression Scale), HRQoL (measured using KIDSCREEN-10), and sociodemographic, behavioural, and COVID-19-contributing factors using binary logistic regression. A priori-selected moderating effects of sociodemographic characteristics and self-identified ethnocultural minority groups on the outcomes were tested. The point-in-time prevalence of medium-to-high anxiety symptoms and depression symptoms was 10.19% and 9.26%, respectively. Almost half (49.15%) reported low-to-moderate HRQoL. Children reporting medium-to-high anxiety symptoms, depression symptoms, and low-to-moderate HRQoL were more likely to be aged 8-11 years, 16-18 years, ethnocultural minority participants, living in rural/urban areas, having good/fair MH before COVID-19, experiencing household conflicts, having less physical activity, and having ≥3 h of recreational screen time. Those who had more people living at home and ≥8 h of sleep reported low anxiety and depression symptoms. Ethnocultural minority 16-18-year-olds were more likely to report low-to-moderate HRQoL, compared to 12-15-year-olds. Additionally, 8-11-year-olds, 16-18-year-olds with immigrant parents, and 16-18-year-olds with Canadian-born parents were more likely to report low-moderate HRQoL, compared to 12-15-year-olds. Children and youth MH and HRQoL were impacted during the pandemic. Adverse MH outcomes were evident among ethnocultural minority families. Our results reveal the need to prioritize children's MH and to build equity-driven, targeted interventions.

Parents' Perceptions of Changes in Sleep Duration, Physical Activity, and Sedentary Behavior in Arab Israeli Children during the COVID-19 Outbreak

The COVID-19 pandemic led many countries to apply lockdown measures that could prevent children from achieving the physical activity, sedentary behavior, and sleep levels suggested for their psychophysical health. The current study tested changes in physical activity, sedentary behavior, and sleep length of children and the incidence of achieving the 24 h movement standards through the limitations of COVID-19. A total of 490 Arab Israeli parents were surveyed. An electronic cross-sectional survey was performed, including questions addressing engagement in physical activities, use of screens, and sleep duration. Throughout the COVID-19 outbreak, time spent participating in physical activity was reduced, sedentary behavior and sleep duration were increased, and the percentage of the sample who met the physical activity and sedentary behavior suggestions lessened. The percentage of participants who attained the overall 24 h movement recommendations was very low during the pandemic; school children met the guideline recommendations for physical activity and sleep duration more than preschool children, and girls spent more time in physical activity. These findings highlight the need for strategies to enhance physical activity and decrease sedentary behavior in children to prevent long-term effects of limitations imposed by COVID-19. Efforts to perceive and encourage healthy routines in Arab Israeli children in the case of pandemic limitations are expected to serve as a precedence.

A Sociodemographic Analysis of the Impact of COVID-19-Related Schools' Closure on the Diet and Physical Activity of Children and Adolescents in Qatar

OBJECTIVES

To assess the impact of the COVID-19-related closure of government schools in Qatar on children and adolescents' dietary habits and physical activities and associated sociodemographic factors.

METHODS

An analytical cross-sectional study was conducted between June and August 2022 utilizing the national electronic health records system in Qatar to extract a sampling frame of students enrolled in governmental schools, specifically targeting students in 3rd to 9th grades, stratified by sex and developmental stage. A stratified sampling technique was employed to randomly select a proportionate number of students from each stratum, and data were collected through telephone interviews with the parents of selected students.

RESULTS

A total of 1546 interviews were completed by the end of the study. Of the included sample, 845 (54.7%) were between 8 and 11 years of age (middle childhood), while the rest were 12-15 years old (young teens and teenagers). Male to female ratio was almost 1:1. We found a significant decrease in the intake of vegetables, increases in the intake of soft drinks, fried food, fast food, and sweets, and a reduction in physical activity during schools' closure compared to before. Higher parental educational levels, maternal employment, and having a positive family history of obesity and/or overweight in first-degree relatives were significantly associated with adverse lifestyle changes during schools' closure.

CONCLUSION

The trends of lifestyle changes reported in this study during the periods of COVID-19-related schools' closure were found to be going in a health-compromising direction. These results underscore the importance of implementing targeted interventions to promote healthy lifestyles during such disruptions and emphasize the need to address lifestyle changes beyond emergencies and outbreaks to mitigate potential long-term health consequences, including the increased risk of non-communicable diseases.

The 2022 ParticipACTION Report Card on Physical Activity for Children and Youth: Focus on the COVID-19 pandemic impact and equity-deserving groups

Introduction

The ParticipACTION Report Card on Physical Activity for Children and Youth is the most comprehensive national assessment of physical activity and related behaviors, characteristics, and opportunities for children and youth. The 2022 Report Card assigned grades based on data gathered during the COVID-19 pandemic to reflect this extraordinary time-period in Canada. Further, while not graded, efforts were made to summarize key findings for early years children and those identifying as: having a disability, Indigenous, 2SLGBTQ+, newcomers to Canada, racialized, or girls. The purpose of this paper is to summarize the 2022 ParticipACTION Report Card on Physical Activity for Children and Youth.

Methods

The best available physical activity data captured during the whole COVID-19 pandemic was synthesized across 14 different indicators in four categories. The 2022 Report Card Research Committee assigned letter grades (i.e., A-F) based on expert consensus of the evidence.

Synthesis

Grades were assigned for: Daily Behaviors (Overall Physical Activity: D; Active Play: D-; Active Transportation: C-; Organized Sport: C+; Physical Education: Incomplete [INC]; Sedentary Behaviors: F; Sleep: B; 24-Hour Movement Behaviors: F), Individual Characteristics (Physical Literacy: INC; Physical Fitness: INC), Spaces and Places (Household: C, School: B-, Community and Environment: B), and Strategies and Investments (Government: B-). Compared to the 2020 Report Card, the COVID-19 specific grades increased for Active Play and Active Transportation; and decreased for Overall Physical Activity, Sedentary Behaviors, Organized Sport, and Community and Environment. There were many data gaps for equity-deserving groups.

Conclusion

During the COVID-19 pandemic, the grade for Overall Physical Activity decreased from a D+ (2020) to a D, coinciding with decreases in grades reflecting fewer opportunities for sport and community/facility-based activities as well as higher levels of sedentary behaviors. Fortunately, improvements in Active Transportation and Active Play during COVID-19 prevented a worse shift in children's health behaviors. Efforts are needed to improve physical activity for children and youth during and post-pandemic, with a greater emphasis on equity-deserving groups.

Sport and academic engagement of 1,387 Slovenian dual-career athletes before and during COVID-19 lockdown-what did we learn?

Introduction

Since the coronavirus disease outbreak in 2019, there have been several preventive measures and restrictions applied to minimize the transmission of the virus. While lockdown has affected our everyday lives, it has negatively impacted sport and athletes as well.

Methods

1,387 Slovenian dual-career (DC) athletes (47.4% females, 52.6% males) participated in the 22-item questionnaire to gather information on their sports and academic engagement before and during COVID-19 lockdown period. Half of the athletes were enrolled in education at the secondary level (n = 819, aged 15-18  years), while the others were enrolled in primary (n = 301, 8-14 years) and tertiary (n = 267, 19-36  years) education. All participants in the current study have a valid athlete categorization by the Slovenian Olympic Committee and are competing at either junior (31.7%), national (26.9%), prospective (29.5%), international (8.5%), world (2.3%) or Olympic (1.2%) level.

Results

DC athletes spent less time on training (-4.7 h; p < 0.001), learning (-1.0 h; p < 0.001), exams (-0.9 h; p < 0.001), laboratory work (-0.6 h; p < 0.001), and other educational activities (-0.3 h; p < 0.001) during COVID-19 lockdown compared to period before the lockdown. Their training environment was changed so they trained either at home or outdoors. Results showed that indoor (-3.7 h; p < 0.001) and team sport athletes (-1.3 h; p < 0.001) trained less than outdoor and individual sports. Male athletes spent more time on training both before (1.3 h; p < 0.001) and during lockdown (1.3 h; p < 0.001) and other sport-related activities (1.3 h; p < 0.001). On the other hand, female athletes spent more time on studying both before (1.5 h; p < 0.001) and during lockdown (2.6 h; p < 0.001). Both sport and educational activities were influenced by athletes' age (p ≤ 0.017).

Conclusion

Indoor and team sport athletes were more affected by the governmental measures than outdoor and individual sport athletes. Male athletes experienced a greater decline in learning time compared to female athletes. DC is shown to be beneficial for athletes even in times of COVID-19 lockdown, as DC athletes report smaller decline in motivation, shifting attention from sport to study and having fewer mental problems due to uncertain sports future. The feedback of the preventive measures could serve to assist policy makers and athlete's support staff to form and apply preventive measures that are more effective for DC athletes' training and education.

Longitudinal Association of Changes in Parental Correlates With Screen Time in Chinese Preschoolers

BACKGROUND

This study aimed to explore the relationship between the changes in parent-related factors and preschoolers exceeding screen time (ST) recommendations.

METHODS

A longitudinal analysis using 2-year follow-up data from 4 kindergartens (n = 409) was conducted in Zhejiang, China, from 2019 to 2021. Multivariate logistic regression models were used to determine the potential parental modifiable predictors.

RESULTS

The significant associations of baseline ST, change in screen accessibility, and the interaction of preschooler ST with maternal ST change with preschooler follow-up ST were observed. For preschool-aged children with baseline ST ≤ 1 hour per day, the follow-up of preschoolers with ST > 1 hour per day increased significantly when parental clarity of their ST rules decreased or remained low. For preschool children with baseline ST > 1 hour per day, follow-up ST increased significantly when their father kept ST >2 hours per day, when the screen accessibility became or remained easy, or when parental awareness of the ST decreased.

CONCLUSIONS

Changes in parental correlates played an important role in preschooler ST based on 2-year longitudinal data. Early interventions should focus on improving the clarity of parental rules and perceptions, as well as on reducing parental ST and accessibility of home screens.

Effects of digital game addiction on cardiovascular health behavior on secondary school students during the COVID-19 pandemic

PURPOSE

This study aimed to investigate factors affecting digital game addiction in secondary school students during the COVID-19 pandemic and the effects of digital game addiction on cardiovascular health behavior.

DESIGN AND METHODS

This descriptive, correlational, and cross-sectional study was conducted with 619 secondary school students aged 10-14 years. Study data were analyzed using World Health Organization AnthroPlus and SPSS programs. Simple linear regression and multiple linear regression methods were used in the analysis process.

RESULTS

Findings showed that 43.6% of the students played digital games for more than two hours a day. Descriptive characteristics (gender, age, basal metabolic rate, educational status of parent, income status, etc.) and digital gaming habits of the students accounted for 37.0% of the variance in digital game addiction. Digital game addiction adversely affected cardiovascular health behavior and all its sub-dimensions.

CONCLUSION

The first factor that predicted digital game addiction, in order of significance, was daily digital game playing time. Digital game addiction negatively affected the sedentary lifestyle sub-dimension of cardiovascular health behavior most. Digital game addiction may trigger an increase in the incidence of diseases such as diabetes, cancer, and especially cardiovascular diseases, at later ages.

PRACTICE IMPLICATIONS

Nurses, schools, and parents have critical responsibilities in preventing digital game addiction. Results of this research will make a remarkable contribution to the development of preventive services by revealing risk factors for digital game addiction and the effects of digital game addiction on cardiovascular health behavior.

Leadership and contagion by COVID-19 among residence hall students: A social network analysis approach

University students have changed their behaviour due to the COVID-19 pandemic. In this paper, we describe the characteristics of PCR+ and PCR- nodes, analyse the structure, and relate the structure of student leaders to pandemic contagion as determined by PCR+ in 93 residential university students. Leadership comes from the male students of social science degrees who have PCR +, with an eigenvector centrality structure, β-centrality, and who are part of the bow-tie structure. There was a significant difference in β-centrality between leaders and non-leaders and in β-centrality between PCR+ and non-leaders. Leading nodes were part of the bow-tie structure. MR-QAP results show how residence and scientific branch were the most important factors in network formation. Therefore, university leaders should consider influential leaders, as they are vectors for disseminating both positive and negative outcomes.

The impact of the covid-19 pandemic on lifestyle behaviors in U.S. college students

OBJECTIVE

To investigate COVID-19's impact on college student health behaviors.

PARTICIPANTS

189 college students.

METHODS

Participants completed an online survey on behaviors relating to sleep, sedentary activities, and physical activity before and during the COVID-19 pandemic. Comparisons utilized Students' dependent t-test or Wilcoxon signed-rank tests.

RESULTS

There was an increase in time to fall asleep (before: 23.4 ± 18.0 vs. during: 42.8 ± 44.3 min·day^-1, p < 0.001), time spent in bed (before: 7.8 ± 1.5 vs. during: 8.5 ± 1.5 hr·day^-1, p < 0.001), as well as shifts in later bed and awake time (p < 0.001). Total sedentary time increased during the pandemic (before: 9.0 ± 3.8 vs. during: 9.9 ± 4.1 hr·day^-1, p = 0.016); and time spent using a TV, computer, or phone (before: 3.1 ± 1.9 vs. during: 4.2 ± 2.3 hr·day^-1, p < 0.001). There was a significant decrease in moderate-vigorous activity (before: 123.8 ± 96.0 vs. during: 108.9 ± 75.5 min·week^-1, p = 0.028) and resistance training days (before: 2.4 ± 2.1 vs. during: 1.7 ± 2.1 days·week^-1, p < 0.001).

CONCLUSIONS

COVID-19 negatively influenced health behaviors in college students.

Screen exposure and sleep: How the COVID-19 pandemic influenced children and adolescents - A questionnaire-based study

BACKGROUND

COVID-19 pandemic has drastically increased the exposure to electronic devices in children, influencing their lifestyle and their sleep. This study was conducted to explore the relationship between the augmented screen exposure and sleep habits in children during and after the pandemic.

METHODS

Using the "Google Forms" tool, we created an online questionnaire addressed to parents of children and adolescents aged 2-18 years. We explored the use of screens before and during/after the lockdown and assessed the presence of sleep disturbances through the Sleep Disturbance Scale for Children (SDSC), referring to the period before and during/after COVID-19 pandemic.

RESULTS

We collected 1084 valid questionnaires (median age 8.5 ± 4.1 years). We observed a significant increase in screens exposure for school (72%) and for leisure (49.7%) during the pandemic. We reported an increased sleep disturbances prevalence from 22.1% before the pandemic to 33.9% during the outbreak (p < 0.001). Even before the pandemic, the highest risks for sleep disorders were related to daily screen time for school reasons (OR 1.65, p < 0.001) and total screen time after 6 p.m. (OR 1.59, p < 0.001). The augmented exposure to screens for any reasons during the pandemic was significantly related to an increase of sleep disorders, especially regarding the increased exposure after 6 p.m. (OR 1.67, p < 0.001).

CONCLUSIONS

The augmented use of electronic devices was recognized to be a significant predisposing factor in increasing the rate of sleep disorders during and after the pandemic, thus sleep hygiene recommendations should be highlighted to improve sleep habits.

The Relative Contributions of Center Demographic, Director, Parental, Social, Environmental, and Policy Factors to Changes in Outdoor Play in Childcare Centers During the COVID-19 Pandemic

BACKGROUND

The primary objective of this study was to investigate the relative contributions of factors from multiple social-ecological levels in explaining outdoor play changes in childcare centers during the COVID-19 pandemic.

METHODS

In Alberta, Canada, licensed childcare center directors (n = 160) completed an online questionnaire. For outcomes, changes in the frequency and duration of outdoor play in childcare centers during COVID-19 compared to before COVID-19 were measured. For exposures, center demographic, director, parental, social, environmental, and policy-level factors were measured. Hierarchical regression analyses were conducted separately for winter (December-March) and nonwinter months (April-November).

RESULTS

In most instances, factors at each social-ecological level explained a statistically significant amount of unique variance in changes in outdoor play in childcare centers during COVID-19. Full models accounted for more than 26% of the variance in the outcomes. Changes in parental interest in outdoor play was the most consistent correlate of changes in the frequency and duration of outdoor play in both winter and nonwinter months during COVID-19. In terms of changes in the duration of outdoor play, social support from the provincial government, health authority, and licensing, and changes in the number of play areas in licensed outdoor play spaces were also consistent correlates in both winter and nonwinter months during COVID-19.

CONCLUSIONS

Factors from multiple social-ecological levels uniquely contributed to changes in outdoor play in childcare centers during the COVID-19 pandemic. Findings can help inform interventions and public health initiatives related to outdoor play in childcare centers during and after the ongoing pandemic.

Piloting the Virtual PLAYshop Program: A Parent-Focused Physical Literacy Intervention for Early Childhood

The PLAYshop program is a parent-focused physical literacy intervention for early childhood. This single-group mixed-methods pilot study aimed to explore the feasibility of virtually delivering and assessing the PLAYshop program. The virtual PLAYshop program included a virtual workshop, resources/basic equipment, and two booster emails (3-week and 6-week follow-up). Data on 34 preschool-aged children (3-5 years) and their parents from Edmonton and Victoria, Canada, were collected via an online questionnaire, virtual assessment session, and interview at single or multiple time points (baseline, post-workshop, 2-month follow-up). Intraclass correlation coefficients (ICCs), paired t-tests, repeated measures ANOVAs, and thematic analyses were conducted. Regarding feasibility, most parents (≥94%) were satisfied/extremely satisfied with the virtual workshop and planned to continue physical literacy activities post-workshop. The virtual assessment protocol for children's fundamental movement skills (FMS; overhand throw, underhand throw, horizontal jump, hop, one-leg balance) was feasible, with high completion rates (>90%) and reliable scoring (ICC = 0.79-0.99). For positive changes in potential outcomes, a medium effect size was observed for children's hopping skills (d = 0.54), and large effect sizes were observed for several parental outcomes (partial η² = 0.20-0.54). The findings support the feasibility and potential positive outcomes of the virtual PLAYshop program. A larger randomized controlled efficacy trial is recommended.

Effects of behaviors and surrounding environment on myopia before and during the COVID-19 pandemic: a longitudinal analysis of children and adolescents in China

Aim

To investigate the relationship between related factors and visual acuity of Chinese school students before and during the COVID-19 pandemic.

Subject and methods

Chinese students from primary and secondary schools were included from the Chinese National Surveys on Students' Constitution and Health CNSSCH (2019). A total of 1496 participants completed follow-ups in June and December 2020, respectively. Generalized estimating equations were used to test the differences in visual environment. Logistic regression models were utilized to examine the roles of behaviors and surrounding environment changes associated with myopia before and during the pandemic.

Results

The prevalence of myopia was 47.7%, 55.6%, and 57.2% in baseline and two follow-ups, respectively. Significant differences existed for gender, learning level, and region (all P < 0.05). The proportion of new myopia and myopia torsion was the highest in the primary schools. Multivariate logistic regression analysis found that screen time ≥ 4h/d (OR = 2.717), poor eye habits (OR = 1.477), insufficient lighting for studying at night (OR = 1.779), desk or roof lamps only (OR = 1.388), and poor sleep quality (OR = 4.512) were the risk factors for myopia (all P < 0.05), and eye exercises (OR = 0.417), milk intake (OR = 0.758), and eggs intake (OR = 0.735) were the protective factors for myopia (all P < 0.05).

Conclusion

Prevalence of myopia increased among Chinese students before and during the COVID-19. It is necessary to pay more attention to the pupils' visual acuity, especially in primary school students, in the future.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01900-w.

Children's Physical Activity During the COVID-19 Lockdown: A Cross Cultural Comparison Between Portugal, Brazil and Italy

The COVID-19 pandemic forced governments to implement measures that disrupted the daily routines of many families worldwide. We studied how the COVID-19 lockdown affected children's routines in Portugal (PT), Brazil (BR), and Italy (IT) to determine if children's age and country impacted their physical activity (PA) and sedentary time. We launched an anonymous online survey to assess how 3-12 years old children adjusted their daily routines to this situation. Parents reported the times each child was engaged in different activities throughout the day, and we used these data to calculate separately overall sedentary and physical activity time. We conducted separate analyses of variance for age and country on the percentage of time spent in the different activities. Results, based on the data from 3045 children in these three countries (PT n = 2044; BR n = 836; IT n = 165), showed that, during lockdown, most children spent most of their awake daily hours in sedentary activities. There was a clear age effect on the way their routines were organized. Percentages of time spent in intellectual activity, playful screen activity, and overall sedentary time were greater in the older age groups, whereas percentages of time spent in play (with and without PA) and in overall PA were greater in the younger groups. We found a main effect of country for all variables except play without PA. The country effect was mainly due to the difference between the routines in BR when compared to PT and IT. Values of playful screen time and overall sedentary activity were higher in BR than in the two European countries. Conversely, values for play with PA, PA, and overall PA (except in the older group) were lower in BR. Patterns of time spent in these activities were similar in IT and PT, but PA and overall PA times were higher in the two younger age groups in IT. In summary, percentage of PA time of confined children was low and decreased with age across all three countries and was particularly low for children in BR relative to those in PT and IT.

Rural parent and elementary school student resilience to COVID-19: Disability status and parental predictors of change

Little is known about how the COVID-19 pandemic relates to child and parent functioning in a rural population. The present study investigated how disability status and parent factors related to resilience in a rural population before and after the shift to remote instruction. Parents of elementary-aged children in a rural area of the U.S. completed an online questionnaire, rating their own functioning and their child's academic, cognitive, and socioemotional functioning (1) retrospectively thinking back to a month before the pandemic, and (2) at the time of the survey, approximately four months after the onset of pandemic changes. Parents of children with disabilities perceived stronger child resilience through the pandemic transition than parents of children without disabilities. Additionally, parents who better maintained their work-life balance and support through the pandemic transition reported stronger resilience in their children. These results highlight the importance of supporting all children and parents during difficult transitions (e.g., providing additional resources so that parents can maintain similar levels of balance and support through the transition), including those students who have experienced less adversity pre-transition.

Changes in Pediatric Movement Behaviors During the COVID-19 Pandemic by Stages of Lockdown in Ontario, Canada: A Longitudinal Cohort Study

BACKGROUND

Children's movement behaviors have been affected by the COVID-19 pandemic; however, little is known regarding movement behavior patterns over time by government-issued lockdowns. Our primary objective was to evaluate how children's movement behaviors changed by stages of lockdown/reopening in Ontario, Canada, from 2020 to 2021.

METHODS

A longitudinal cohort study with repeated measures of exposure and outcomes was conducted. The exposure variables were dates from before and during COVID-19 when child movement behavior questionnaires were completed. Lockdown/reopening dates were included as knot locations in the spline model. The outcomes were daily screen, physical activity, outdoor, and sleep time.

RESULTS

A total of 589 children with 4805 observations were included (53.1% boys, 5.9 [2.6] y). On average, screen time increased during the first and second lockdowns and decreased during the second reopening. Physical activity and outdoor time increased during the first lockdown, decreased during the first reopening, and increased during the second reopening. Younger children (<5 y) had greater increases in screen time and lower increases in physical activity and outdoor time than older children (≥5 y).

CONCLUSIONS

Policy makers should consider the impact of lockdowns on child movement behaviors, especially in younger children.

Sleep Deprivation and Insomnia in Adolescence: Implications for Mental Health

Sleep changes significantly throughout the human lifespan. Physiological modifications in sleep regulation, in common with many mammals (especially in the circadian rhythms), predispose adolescents to sleep loss until early adulthood. Adolescents are one-sixth of all human beings and are at high risk for mental diseases (particularly mood disorders) and self-injury. This has been attributed to the incredible number of changes occurring in a limited time window that encompasses rapid biological and psychosocial modifications, which predispose teens to at-risk behaviors. Adolescents’ sleep patterns have been investigated as a biunivocal cause for potential damaging conditions, in which insufficient sleep may be both a cause and a consequence of mental health problems. The recent COVID-19 pandemic in particular has made a detrimental contribution to many adolescents’ mental health and sleep quality. In this review, we aim to summarize the knowledge in the field and to explore implications for adolescents’ (and future adults’) mental and physical health, as well as to outline potential strategies of prevention.

Association between decreased grip strength in preschool children and the COVID-19 pandemic: an observational study from 2015 to 2021

Background

Coronavirus disease 2019 (COVID-19) has reduced people’s physical activity. It is essential to accumulate knowledge regarding the influence of COVID-19 on the stimulation of physical fitness and physical functions. Several studies have reported the effects of COVID-19 on physical fitness; however, there are very few reports regarding preschoolers. This study aimed to compare the physical fitness of preschoolers before and during the COVID-19 pandemic to clarify the effects of curtailment of outings implemented to control the pandemic on physical fitness among preschoolers.

Methods

The subjects were 593 Japanese preschool children enrolled at a kindergarten during 2015–2019 and in 2021 who received a physical fitness test. Children enrolled in 2020 who did not receive a physical fitness test because of the COVID-19 pandemic were excluded. The physical fitness test included grip strength, standing long jump, and a 25-m run. The relationship between physical fitness level and survey year was analyzed using a general linear model, with grip strength and standing long jump as dependent variables, year of study as the independent variable, and sex and age in months as adjusted variables. Kruskal–Wallis test was used to analyze data for the 25-m run. Multiple comparisons were used to compare fitness levels between 2021 (during the COVID-19 pandemic) with levels in previous years.

Results

Significant relationships were found between survey year and each of grip strength (p < 0.001), standing long jump (p < 0.05), and 25-m run (p < 0.001) among the overall subjects. Grip strength was significantly lower in 2021 compared with the 2016–2019 period. Similarly, sub-stratification analysis by sex showed that grip strength was lower in 2021 than in previous survey years, in both sexes. However, there was no difference in standing long jump or 25-m run times between before and during the pandemic among the overall subjects or according to sex.

Conclusions

These findings indicate that the COVID-19 pandemic has had a negative effect on the development of muscle strength in preschoolers, and suggest the need to develop strategies that could promote the development of muscle strength of preschool children when limitations are placed on activity during prolonged infectious disease pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40101-023-00321-8.

Impact of the COVID-19 pandemic on the well-being of preschoolers: A parental guide

Unexpected changes brought about by the coronavirus disease 2019 (COVID-19) have affected humans worldwide. This review attempts to address major parental concerns about the development of preschool-aged children during the pandemic from the perspectives of neuropsychology, consultation, and motor development for preschoolers aged 2–5 years.

Methods

A total of 273 articles including original data, review articles, national and regional perspectives, government websites, and commentaries were considered in this review, of which 117 manuscripts were excluded because they were unrelated to children, adolescents, or COVID -19 pandemic/upper respiratory infections. A total of 156 manuscripts were included after reading the abstract and entire article.

Results

Telehealth could be an effective tool for addressing cognitive and emotional challenges that arise during the pandemic. Online consultations are highlighted for nutritional guidelines and to overcome problems that parents face when caring for children in difficult times. Outdoor activities using sanitisers, proper cleanliness, and following standard operating procedures are recommended. Parental preoccupation with media should be avoided. Interpretation: Many preschoolers show delays in reaching their developmental milestones, and the pandemic has increased parents' concerns, as access to practitioners is limited. Therefore, parents should be encouraged to undergo neuropsychological consultations whenever necessary. This study emphasises important strategies to ensure that children's development is minimally affected while staying in the confined environment of their homes. This study serves as a new guide for parents, as they raise young children in the new normal. Parents should undergo basic yearly physical, neuropsychological, nutritional, and speech checkups.

Stress induced proinflammatory adaptations: Plausible mechanisms for the link between stress and cardiovascular disease

Initiating from Hans Selye’s conceptualization of stress physiology, to our present understanding of allostatic load as the cumulative burden of chronic psychological stress and life events, investigators have sought to identify the physiological mechanisms that link stress to health and disease. Of particular interest has been the link between psychological stress and cardiovascular disease (CVD), the number one cause of death in the United States. In this regard, attention has been directed toward alterations in the immune system in response to stress that lead to increased levels of systemic inflammation as a potential pathway by which stress contributes to the development of CVD. More specifically, psychological stress is an independent risk factor for CVD, and as such, mechanisms that explain the connection of stress hormones to systemic inflammation have been examined to gain a greater understanding of the etiology of CVD. Research on proinflammatory cellular mechanisms that are activated in response to psychological stress demonstrates that the ensuing low-grade inflammation mediates pathways that contribute to the development of CVD. Interestingly, physical activity, along with its direct benefits to cardiovascular health, has been shown to buffer against the harmful consequences of psychological stress by “toughening” the SAM system, HPA axis, and immune system as “cross-stressor adaptations” that maintain allostasis and prevent allostatic load. Thus, physical activity training reduces psychological stress induced proinflammation and attenuates the activation of mechanisms associated with the development of cardiovascular disease. Finally, COVID-19 associated psychological stress and its associated health risks has provided another model for examining the stress-health relationship.

Changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease

OBJECTIVE

To describe the changes in lifestyle behaviors during the COVID-19 pandemic in children and adolescents with congenital heart disease and to investigate the association of congenital heart disease complexity with lifestyle behavior changes.

METHODS

Cross-sectional study with 127 children and adolescents with congenital heart disease, who underwent cardiac procedure (mean postoperative time: 10.11±3.13 years), conducted between December 2020 and January 2021. Lifestyle behaviors, such as dietary intake, physical activity, sedentary behavior, and sleep, were assessed through telephone interview based on validated questionnaires. Dietary patterns were identified using principal component analysis. Frequency of general and specific combinations of healthy and unhealthy lifestyle behavior changes was evaluated. Multinomial logistic regressions were used to test the association between congenital heart disease complexity and changes in lifestyle behavior.

RESULTS

The main lifestyle behaviors acquired during pandemic were: 83.5% decreased physical activity; 37.0% increased sedentary behavior; 26.0% slept more than usual; and 23.6% adopted a less-healthy dietary pattern. Almost half of the participants (41.8%) had at least one unhealthy change in lifestyle behavior. Complex congenital heart diseases were associated with increased sedentary behavior (OR 3.49, 95%CI 1.23-9.90).

CONCLUSIONS

Children and adolescents with congenital heart disease had unhealthy lifestyle behavior during the pandemic, mainly in the form of reduced physical activity and increased sedentary behavior.

Loneliness, affective disorders, suicidal ideation, and the use of psychoactive substances in a sample of adolescents during the COVID-19 pandemic: A cross-sectional study

PROBLEM

The global coronavirus (COVID-19) pandemic has been challenging for adolescents. Indeed, with the closure of schools and social centers and reduction of extracurricular activities, increased social isolation has compounded difficulties in and with school performance, loneliness, and social networking. Increased risk of mental health problems, substance abuse, affective disorders, suicidal ideation, and suicide has been reported in adolescents.

METHODS

This cross-sectional study assesses the association between loneliness, depression, anxiety, suicidal ideation, the use of social networks, and school achievement in a sample of Italian adolescents during the COVID-19 pandemic. This study also explores emotional dysregulation through the association between affective disorders (depression and anxiety), substance use, and social networks. The sample comprises adolescents in the first and second grades of high school during the pandemic; participants received an email explaining the purpose of the e-research. Data were collected using the Strengths and Difficulties Questionnaire, the Achenbach System of Empirically Based Assessment, and the Loneliness Scale.

FINDINGS

A total of 505 adolescents completed the web survey. Data revealed that students experienced difficulties with loneliness, problems with school achievement, and extracurricular activities. The mean scores for depression and anxiety were close to the borderline range. A total of 14.3% of adolescents intentionally harmed themselves or attempted suicide.

CONCLUSIONS

This study raises concerns about the impacts of the pandemic on adolescents that require the attention of adult reference figures who deal with adolescents, such as parents, teachers, and healthcare professionals. Results indicate the necessity of providing early interventions aimed at the prevention of psychopathologies and the promotion of adolescent mental health due to the pandemic.

Physical activity and sedentary behaviour of male adolescents in Indonesia during the COVID-19 pandemic: a mixed-method case study using accelerometers, automated wearable cameras, diaries, and interviews

Background

Previous physical activity and sedentary behaviour studies during the pandemic have largely utilized online surveys, with known limitations including recall bias. Employing both device-based and self-reported measurements may provide a more comprehensive picture of both behaviours. Physical activity and sedentary behaviour research in adolescents is still limited in low- and middle-income countries (LMICs), including Indonesia. Male adolescents had been identified as more active than females but have had a greater decrease in physical activity during the pandemic. The present study aimed to investigate the quantity, temporal patterns, contexts, and biopsychosocial factors of physical activity and sedentary behaviour during the COVID-19 pandemic in a small group of male Indonesian adolescents.

Methods

Male adolescents (n = 5; 14-15 years old) from Yogyakarta wore accelerometers and automated wearable cameras for four days, and completed diaries and interviews in November 2020.

Results

Participants' activity was dominated by light intensity (67% of all physical activity). Sedentary behaviour was high; accelerometer, school days: 456 ± 145 min (78 ± 10% of wear time), non-school days: 344 ± 160 min (79 ± 17% of wear time); camera, school days: 176 ± 101 min (81 ± 46% of wear time), non-school days: 210 ± 165 min (86 ± 67% of wear time). Sedentary behaviour was mainly done during school hours on school days and from late afternoon to evening on non-school days. Screen time was largely for leisure purposes and action games were most favoured. Smartphones were the most used device, mainly used in a solitary context in the bedroom. Non-screen-based sedentary behaviour was consistently low. Interviews suggested that during the pandemic, supporting factors for physical activity are: self-determination, enjoyment, parental support, and physical education; meanwhile, factors influencing screen time are: educational demands, device and internet availability, screen time opportunities, parental control, social facilitators, phone notifications, and emotional state.

Conclusions

Most participants were not able to stay active during the pandemic. Using digital platforms may be beneficial to shift some screen-based sedentary behaviour to 'screen-based' or 'screen-prompted' physical activity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-022-00014-0.

Parental Perceptions of the Impact of the COVID-19 Pandemic on the Sleep of Children With Neurodevelopmental Disorders

INTRODUCTION

Little is known about the impact of the COVID-19 pandemic on sleep in schoolaged children with neurodevelopmental disorders. This study aimed to (1) determine and describe the impact of the COVID-19 pandemic, and (2) identify and describe contributing factors.

METHOD

Parents of children with neurodevelopmental disorders and insomnia symptoms (n = 100) were surveyed to determine if their child's sleep had changed because of the COVID-19 pandemic. Parents who reported changes were asked to describe how the pandemic influenced their child's sleep.

RESULTS

Most parents (66%) reported the pandemic did not worsen their child's sleep, 30% stated their child's sleep had worsened, and 4% reported an improvement. Stress and anxiety about the pandemic, disrupted routines, and increased screen time were common parent-identified contributing factors.

DISCUSSION

Health care providers should explore strategies to mitigate contributing factors, such as anxiety about the pandemic, disrupted routines, and increased screen time.

Children's digital play as collective family resilience in the face of the pandemic

In this article we explore how digital play as conducted through various social media and online meeting platforms facilitated resiliency and confidence building in children during the COVID-19 pandemic. Using day-in-the-life methodology and narrative inquiry, we disseminate and examine observations collected on children aged 2-10 during lockdown in a Newfoundland neighbourhood. Children utilized platforms such as TikTok, YouTube, and Zoom to embrace their agentic digital play in ways that repurposed the platforms to fulfil life milestones and social needs otherwise impacted and disrupted by pandemic restrictions. Through a series of vignettes and interviews, our research not only examines how such digital play benefits children and their healthy development, but how parents reacted to and assisted with their children's agentic digital platform manipulation and how this provided positive benefits and enriching experiences to the entire family. We additionally explore the conflicts and tensions both children and parents encountered in securely implementing free play via digital platforms, including fears of excess screen-time, digital dependency, and online threats, all of which risk limiting children's ability to independently explore their creativity and identities through digital play if not handled sensitively. Despite the hurdles to implementing digital play, this study exposes why it is essential for families to navigate this online terrain; this study ultimately poses that digital play and online platforms not only were beneficial to maintaining and building family resilience during the pandemic but will be vital assets in sustaining resiliency and positive mindsets moving forward with pandemic recovery.

Using an influenza surveillance system to estimate the number of SARS-CoV-2 infections in Beijing, China, weeks 2 to 6 2023

With COVID-19 public health control measures downgraded in China in January 2023, reported COVID-19 case numbers may underestimate the true numbers after the SARS-CoV-2 Omicron wave. Using a multiplier model based on our influenza surveillance system, we estimated that the overall incidence of SARS-CoV-2 infections was 392/100,000 population in Beijing during the 5 weeks following policy adjustment. No notable change occurred after the Spring Festival in early February. The multiplier model provides an opportunity for assessing the actual COVID-19 situation.

Outdoor Play as a Mitigating Factor in the Association Between Screen Time for Young Children and Neurodevelopmental Outcomes

Importance

Whether the association between higher screen time in infancy and later suboptimal neurodevelopment can be mitigated by frequency of outdoor play is unknown.

Objective

To investigate whether higher screen time at age 2 years is associated with neurodevelopmental outcomes at age 4 years and whether this association is mediated by frequency of outdoor play at age 2 years 8 months.

Design, Setting, and Participants

Participants were a subsample of the Hamamatsu Birth Cohort Study for Mothers and Children (HBC Study, N = 1258). Children were born between December 2007 and March 2012 and followed up from 1 year 6 months to 4 years. The analysis was conducted from April 2021 to June 2022.

Exposures

Screen time longer than 1 hour a day at age 2 years was coded as higher screen time.

Main Outcomes and Measures

Standardized scores for communication, daily living skills, and socialization domains of the Vineland Adaptive Behavior Scale, second edition, at age 4 years were used (mean [SD], 100 [15]). The mediating factor was frequency of outdoor play at age 2 years 8 months, with 6 or 7 days per week coded as frequent outdoor play.

Results

Of 885 participants, 445 children (50%) were female; mean (SD) screen time per day was 2.6 (2.0) hours. Causal mediation analyses revealed that higher screen time at age 2 years was associated with lower scores in communication at age 4 years (nonstandardized coefficient b = -2.32; 95% CI, -4.03 to -0.60), but the association was not mediated by frequency of outdoor play. Higher screen time was also associated with lower scores in daily living skills (b = -1.76; 95% CI, -3.21 to -0.31); 18% of this association was mediated by frequency of outdoor play. Frequency of outdoor play was associated with socialization (b = 2.73; 95% CI, 1.06 to 4.39), whereas higher screen time was not (b = -1.34; 95% CI, -3.05 to 0.36).

Conclusions and Relevance

Higher screen time at age 2 years was directly associated with poorer communication at age 4 years. It was also associated with daily living skills, but frequency of outdoor play at age 2 years 8 months alleviated it, suggesting outdoor play mitigated the association between higher screen time and suboptimal neurodevelopment. Future research should specify the nature of the associations and intervention measures, enabling targeted interventions that reduce the potential risk in screen time.

Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review

BACKGROUND

In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status.

AIMS

This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures.

METHODS

Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains.

RESULTS

The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices.

CONCLUSIONS

Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.

The effect of the COVID-19 disruption on the gender gap in students' performance: a cross-country analysis

BACKGROUND

This paper investigates how the COVID-19 school closure has affected the gender gap in grade-8 students' performance and what are the drivers behind this. By analysing four different countries (i.e., the Russian Federation, Slovenia, Uzbekistan and the United Arab Emirates), the paper represents the first study addressing the issue from a comparative perspective.

METHODS

The study uses data from the Responses to Educational Disruption Survey (REDS) survey, which comprises international comparable data on how students approached remote learning during the COVID-19 disruption. The extent of the gender gap is estimated by employing an ordered logit model, while the Karlson-Holm-Breen (KHB) decomposition method is used to analyse the different potential channels that could account for the gender gap during COVID-19.

RESULTS

The empirical results reveal that, during the COVID-19 school closure, girls tended to perceive changes in their learnings less favourably than boys, both in terms of improvement in self-perceived learning and self-reported improvement in grades-with odds of a more affirmative response between 20 and 25% lower for girls relative to boys. The main drivers explaining this gender gap are physical activity and psychological distress of students during the COVID-19 disruption, as well as the perceived family climate.

CONCLUSIONS

The paper shows systematic gender differences in how students perceived their educational outcomes changed due to the COVID-19 disruption, providing evidence on the factors driving these differences. The findings could be employed to design policy actions aimed at increasing gender equality in education.

Regional Difference in the Impact of COVID-19 Pandemic on Domain-Specific Physical Activity, Sedentary Behavior, Sleeping Time, and Step Count: Web-Based Cross-sectional Nationwide Survey and Accelerometer-Based Observational Study

BACKGROUND

Physical activity (PA) and sedentary behavior (SB) have been affected by the COVID-19 pandemic and its restrictive environments, such as social distancing and lockdown measures. However, regional differences in the changes in domain-specific PA and SB in response to the COVID-19 pandemic are not clearly understood.

OBJECTIVE

This study aimed to examine regional differences in domain-specific PA and SB, as well as sleeping time in response to the COVID-19 pandemic in Japan.

METHODS

A web-based cross-sectional nationwide survey and an accelerometer-based longitudinal observation were conducted. In the web-based survey, we recruited 150 Japanese men and 150 Japanese women for each of the following age groups: 20s, 30s, 40s, 50s, 60s, and 70s (n=1800). A total of 1627 adults provided valid responses to web-based surveillance from June to July 2020. Participants were recruited from urban (Greater Tokyo Area, n=1028), urban-rural (regional core cities, n=459), or rural (regional small and medium cities, n=140) areas. They answered sociodemographic and health-related questions and retrospectively registered the PA data of their average day before and during the COVID-19 pandemic in a web-based PA record system. In the accelerometer-based observation, PA and step count data were obtained using a triaxial accelerometer on people living in urban (n=370) and rural (n=308) areas.

RESULTS

Before the COVID-19 pandemic, there were no significant differences between these 3 regions in the time spent sleeping, staying at home, working or studying, and exercising (P>.05). By contrast, people living in urban areas had a longer duration of SB and transportation and a shorter duration of moderate-to-vigorous PA and lying or napping time compared with people living in rural areas (P>.05). During the COVID-19 pandemic, a significant decrease was observed in transportation time in urban (-7.2 min/day, P<.001) and urban-rural (-2.0 min/day, P=.009) areas but not in rural (-0.4 min/day, P=.52) areas. The moderate-to-vigorous PA was decreased in urban (-31.3 min/day, P<.001) and urban-rural (-30.0 min/day, P<.001) areas but not in rural areas (-17.3 min/day, P=.08). A significant increase was observed in time spent sleeping in urban (+22.4 min/day, P<.001) and urban-rural (+24.2 min/day, P<.001) but not in rural areas (+3.9 min/day, P=.74). Lying or napping was increased in urban (+14.9 min/day, P<.001) but not in rural areas (-6.9 min/day, P=.68). PA and step count obtained using an accelerometer significantly decreased in urban (P<.05) but not in rural areas (P>.05).

CONCLUSIONS

The effect of the COVID-19 pandemic on PA and SB was significantly dependent on living area, even in a single country. The effects of PA and SB were greater in the Greater Tokyo Area and regional core cities but were not observed in regional small and medium cities in Japan.

Associations between screen use, outdoor time/daylight exposure and sleep changes during the first COVID-19 lockdown in French children from the ELFE and EPIPAGE2 birth cohorts

AIMS

To investigate associations between outdoor and screen time and changes in sleep patterns in children from two nationwide birth-cohorts in the SAPRIS project.

METHODS

During the first French COVID-19 pandemic lockdown, volunteer parents of children enrolled in the ELFE and EPIPAGE2 birth-cohorts completed online questions about their child's outdoor time, screen time, and changes in sleep duration and quality compared with the pre-lockdown situation. In 5700 children (aged 8-9 years, 52% boys) with available data, we assessed associations between outdoor time, screen time, and sleep changes using multinomial logistic regression models adjusted for confounders.

RESULTS

Children spent on average 3 h08 outdoors and 4 h34 using screens/day (3 h27 for leisure, 1 h07 for class-work). Sleep duration increased in 36% of children and decreased in 13.4%; sleep difficulties appeared/increased in 22.5% and decreased/disappeared/remained stable in 18.3%. After adjustment, increased screen time, especially for leisure, was associated with increased and decreased sleep duration (OR(95%CI) = 1.03(1.00-1.06) and OR = 1.06(1.02-1.10), respectively). No association was observed between outdoor time and sleep changes after adjustment.

CONCLUSIONS

Our study adds evidence for the association between high leisure-time screen time and shorter sleep time. It supports current screen guidelines for children, especially during leisure time and for those whose sleep duration is short.

Changes in Body Mass, Physical Activity, and Dietary Intake during the COVID-19 Pandemic Lockdowns in Canadian University Students

This study examined changes in body mass and body mass index (BMI), physical activity, and dietary intake in Canadian university students during the first year of the COVID-19 pandemic. Two self-reported recall surveys were conducted: after the first lockdown in September 2020 (T1) and following the second lockdown in March 2021 (T2). Eligible participants were full-time undergraduate students attending a Canadian university and residing in Canada during the first year of the pandemic. At T1, 510 students (99 male, 411 female) completed the survey, and of those, 135 (32 males, 103 females) completed the survey at T2 (73% attrition). At both T1 and T2, most participants were 18-24 years of age (93% and 90%, respectively), Caucasian (73% and 78%, respectively), and resided in the province of Ontario (79% and 80%, respectively). Body mass increased from T1 to T2 (+0.91 ± 3.89 kg t(132) = -2.7, p = 0.008). BMI also increased from T1 to T2 (+0.30 ± 1.33 kg/m² [t(130) = -2.5, p = 0.012), with a greater number of participants within the overweight range (19.8% versus 24.4%, respectively). At T1, 38% of the participants reported a decrease in physical activity, while the number of students reporting a decrease in activity increased to 56% at T2. Dietary energy intake decreased from 1678 ± 958 kcal/day at T1 to 1565 ± 842 kcal/day at T2 [c²(1) = 7.2, p = 0.007]. Diet quality also decreased, with participants not meeting the recommended daily allowance for essential macro and micronutrients. A decrease was observed in daily servings of fruits (-27%, p < 0.001), vegetables (-72%, p < 0.001), and grains (-68%, p < 0.001). In conclusion, despite a small decrease in dietary energy intake, a modest weight gain occurred during the first year of the COVID-19 pandemic in this cohort of Canadian university students, which was potentially related to decreased physical activity and diet quality.

Caregiver Perceptions of Children's and Adolescents' Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study

BACKGROUND

The COVID-19 pandemic represents a global health crisis. The Shanghai municipal government in China implemented strict and comprehensive pandemic control strategies in the first half of 2022 to eliminate a wave of COVID-19 infection. The pandemic and the resulting government responses have led to abrupt changes to families' daily lives, including the mental health of children and adolescents.

OBJECTIVE

The aim of this paper is to examine the impact of COVID-19 exposure and the stringent lockdown measures on the daily life and mental health of children and adolescents and to provide suggestions on maintaining their mental health when similar public health emergencies occur in the future.

METHODS

In this cross-sectional study, an anonymous survey was distributed online in May 1-15, 2022, in Shanghai. Individuals were eligible to participate if they were currently the caregiver of a child or adolescent (aged 4-17 years). Outcomes were psychosocial functioning of children and adolescents, as reported by parents, using the Pediatric Symptom Checklist-17. COVID-19 exposure and life changes were also reported. Multivariate logistic regression was used to analyze risk factors for poor psychosocial functioning.

RESULTS

In total, 2493 valid questionnaires were analyzed. The rate of positive scores on the global Pediatric Symptom Checklist-17 scale was 16.5% (n=411). Internalizing, attention, and externalizing problem subscale positivity rates were 17.3% (n=431), 10.9% (n=272), and 8.9% (n=221), respectively. Caregivers reported that 64.2% (n=1601) and 20.7% (n=516) of the children's interactions with friends or peers and parents deteriorated, respectively. Compared with male caregivers, female caregivers were less likely to report psychosocial problems in children and adolescents (adjusted odds ratio [aOR] 0.68; 95% CI 0.53-0.88). Older children and those with lower COVID-19 Exposure and Family Impact Scales scores were less likely to have psychological problems (aOR 1.15; 95% CI 1.10-1.21). Compared with children with screen times <1 hour per day for recreation, those using screens for >3 hours had higher odds of psychological distress (aOR 2.09; 95% CI 1.47-1.97). Children who spent 1-2 hours exercising and had better interactions with friends or peers and parents showed a trend toward lower odds of psychological problems. Children and adolescents with worse sleep compared with preclosure were more likely to have psychological problems.

CONCLUSIONS

The prevalence of psychosocial problems among children and adolescents is relatively high. Being young, having more COVID-19 exposure, and having more screen times (>3 h/day), less exercise time (<30 min), worse sleep, and deteriorated interactions with friends or peers and parents were risk factors for poor psychosocial functioning. It is necessary for governments, communities, schools, and families to take appropriate countermeasures to reduce the negative impact of the stringent control measures on caregivers' parenting and psychosocial functioning of children and adolescents.

[Assessment of the effect of the COVID-19 health crisis on the aerobic capacities of healthy patients. Analysis of the effort tests of the patients of the sports medicine services of the Angers UHC and the Cholet HC between May 2018 and May 2021]

Objectives

To measure the impact of the health crisis related to SARS-CoV-2 on the aerobic capacities of healthy patients based on the measurement of VO_2max and VO₂ at the first ventilatory threshold (AT). To measure the impact of the introduction of the antibacterial filter on the ventilatory parameter measuring device.

Materials and methods

Based on a multicentre (Angers and Cholet), observational and retrospective study, we want to analyze the effect of containment measures and the cessation of sports competitions on the measurement of VO_2max in healthy patients. For each patient, will be collected: the gross value of the max VO₂ and indexed to the weight of the patient, as well as its percentage with respect to the expected theoretical value, the value of the VO2 at the aerobic threshold indexed to the wieght of the patient and the usual cardiorespiratory parameters (HR max, RR max, VE max, RER max). Two samples will be analyzed: patients with only one EFX ("unpaired" sample) and patients with multiple successive EFX over three years ("matched" sample). The impact of the antibacterial filter, used in one of the Sports Medicine departments, will be studied as a secondary issue. Statistical analyses were performed with the IBM SPSS 26 software. For all statistical tests, a p value of 0.05 was used in bilateral testing as the significance criterion.

Results

There is a significant difference in the value of VO_2max and AT in both the "unpaired" (VO_2max: 36.72 vs. 35.08 mL/kg/min, P = 0.014-AT: 21.03 vs. 19.25 mL/kg/min, P < 0.001) and "matched" groups (VO_2max: 2.76 vs. 2.64 L/min, P = 0.037-AT: 1.55 vs. 1.38 L/min, P = 0.001), more pronounced in patients over 60 years of age. The impact of the antibacterial filter does not show any particular impact within the "independent" sample. Within the "matched" sample, the significant age difference is not conclusive, but the exclusion of patients over the age of 60 makes the results meaningless.

Impact of the COVID-19 pandemic on children's sleep habits: an ECHO study

BACKGROUND

Sleep in childhood is affected by behavioral, environmental, and parental factors. We propose that these factors were altered during the COVID-19 pandemic. This study investigates sleep habit changes during the pandemic in 528 children 4-12 years old in the US, leveraging data from the Environmental Influences on Child Health Outcomes (ECHO) Program.

METHODS

Data collection occurred in July 2019-March 2020 (pre-pandemic) and two pandemic periods: December 2020-April 2021 and May-August 2021. Qualitative interviews were performed in 38 participants.

RESULTS

We found no changes in sleep duration, but a shift to later sleep midpoint during the pandemic periods. There was an increase in latency at the first pandemic collection period but no increase in the frequency of bedtime resistance, and a reduced frequency of naps during the pandemic. Qualitative interviews revealed that parents prioritized routines to maintain sleep duration but were more flexible regarding timing. Children from racial/ethnic minoritized communities slept less at night, had later sleep midpoint, and napped more frequently across all collection periods, warranting in-depth investigation to examine and address root causes.

CONCLUSIONS

The COVID-19 pandemic significantly impacted children sleep, but parental knowledge of the importance of sleep might have played a significant protective role.

IMPACT

During the COVID-19 pandemic, US children changed their sleep habits, going to bed and waking up later, but their sleep duration did not change. Sleep latency was longer. Parental knowledge of sleep importance might have played a protective role. Regardless of data collection periods, children from racial/ethnic minoritized communities slept less and went to bed later. This is one of the first study on this topic in the US, including prospective pre-pandemic qualitative and quantitative data on sleep habits. Our findings highlight the pandemic long-term impact on childhood sleep. Results warrants further investigations on implications for overall childhood health.

National trends in physical activity among adolescents in South Korea before and during the COVID-19 pandemic, 2009-2021

With the ongoing COVID-19 pandemic, several previous studies from different countries showed that physical activity (PA) decreased during the COVID-19 outbreak. However, few studies have examined the recent tendency of PA in the adolescent population. Thus, we aimed to investigate the long-term trend of PA in Korean youth and the prevalence changes between before and during the COVID-19 pandemic. Data from Korea Youth Risk Behavior Web-Based Survey (KYRBS) was collected for consecutive years between 2009 and 2021. The period was separated into prepandemic (2009-2019), early-pandemic (2020), and mid-pandemic (2021). Self-reported amount of PA was categorized into four groups (insufficient, aerobic, muscle strengthening, and both physical activities) according to World Health Organization (WHO) PA guidelines. A total of 840 488 adolescents aged 12-18 who fully responded to the survey were selected (response rate: 95.2%). The 13-year trends in the proportion of adolescents who reported aerobic and muscle-strengthening activities met or exceeded 2020 WHO exercise guidelines for adolescents plateaued (11.9% from 2009 to 2011, 14.2% from 2018 to 2019, 14.4% from 2020, and 14.0% from 2021); however, the slope decreased during the pandemic (β_diff , -0.076; 95% confidence interval [CI], -0.123 to -0.029). Proportion of sufficient aerobic exercise among adolescents sharply decreased midst the pandemic (28.0% from 2009 to 2011, 29.4% from 2018 to 2019, and 23.8% from 2020; β_diff , -0.266; 95% CI, -0.306 to -0.226) but increased again in 2021 (26.0% from mid-COVID 19; 95% CI, 25.4-26.7). Similar patterns were observed in Metabolic Equivalent Task (MET) score (MET-min/week; 804.1 from 2018 to 2019, 720.9 from 2020, and 779.6 from 2021). The mean difference in MET score between pre-COVID and post-COVID was -55.4 MET-min/week (95% CI, -70.5 to -40.3). Through a nationwide representative study, there was no significant difference with regard to the number of Korean adolescents who achieved the PA guidelines (pre and postpandemic); however, the prevalence of recommended levels of PA needs to increase more based on the trend before the COVID-19 outbreak. The findings of this study suggest reinforcement of the importance of public health policies for Korean youths to be more physically active, especially during and after the pandemic.

Children's excessive digital media use, mental health problems and the protective role of parenting during COVID-19

COVID-19's outbreak in March 2020 and the social distancing measures that followed it changed the lives of children worldwide. Studies assessing the pandemic's implications for children have reported an alarming increase in the use of digital media (DM) and warned of its adverse impacts on children's functioning and development. The current study aimed to assess the relationship between excessive and problematic DM use and emotional, behavioral, and academic functioning among Israeli adolescents during COVID-19 and to identify adolescents at elevated risk of developing problematic DM use. Three hundred forty-seven Israeli parent-child dyads (M age = 11.81, SD = 1.41) separately completed measures assessing children's DM use (time and addiction), functioning (academic, social, emotional, and behavioral), behavioral dysregulation, and the parents' parenting practices. The results showed that DM addiction, but not DM use, was related to children's emotional, behavioral, and academic difficulties. Moreover, the results indicated that negative parenting and behavioral dysregulation increased the risk of DM addiction, which in turn increased emotional, behavioral, and academic difficulties. The results underscored parents' role in preventing problematic DM use and highlighted the need to treat DM use and problematic DM use as distinct constructs.

Temporal patterns of sleep and eating among children during school closure in Japan due to COVID-19 pandemic: associations with lifestyle behaviours and dietary intake

OBJECTIVE

To identify temporal patterns of sleep and eating among school-age children during school closure due to the COVID-19 pandemic and to examine their associations with lifestyle behaviours and dietary intake.

DESIGN

In this cross-sectional study, questionnaires were used to assess sleep and eating times, lifestyle behaviours and dietary intake during school closure. Latent class analysis was performed to identify temporal patterns of sleep and eating based on self-reported clock times for wake-up, going to bed and eating meals. Lifestyle behaviours and dietary intake were compared between latent classes.

SETTING

Forty-eight primary and secondary schools in Japan.

PARTICIPANTS

Totally, 6220 children (aged 8-15 years).

RESULTS

Four patterns, labelled 'Very early (20 % of children)', 'Early (24 %)', 'Late (30 %)' and 'Very late (26 %),' were identified and ordered according to the circadian timing. Latter patterns were characterised by later timings of sleep and eating, especially in clock times for wake-up, breakfast and lunch compared with earlier patterns. Children with latter patterns had a less physically active lifestyle, longer screen time (≥4 h/d), shorter study time (<2 h/d) and more frequent skipping of breakfast and lunch than those with earlier patterns. In addition, children with latter patterns had lower intakes of several vitamins, vegetables, fruits, fish and shellfish and dairy products and higher intakes of sugar and confectionaries and sweetened beverages.

CONCLUSION

More than half of the participants had later wake-up, breakfast and lunch during school closure, which was associated with more unfavourable lifestyles and dietary intakes.

Parent-Reported Changes in Ontario Children's Physical Activity Levels during the COVID-19 Pandemic

The COVID-19 pandemic resulted in closures of physical-activity-supporting environments, including playgrounds, outdoor recreation facilities (e.g., basketball courts), and community centers, which impacted children's movement opportunities. This study evaluated changes in Ontario children's physical activity levels during the COVID-19 pandemic and explored the impact of family sociodemographic markers on children's activity. Parents (n = 243; M_age = 38.8 years) of children aged 12 and under (n = 408; M_age = 6.7 years) living in Ontario, Canada, completed two online surveys between August and December 2020 (survey 1) and August and December 2021 (survey 2). Generalized linear mixed-effects models were used to estimate changes in the proportion of children who accumulated 60 min of physical activity per day pre-lockdown, during lockdown, and post-lockdown in Ontario. Results revealed a significant non-linear trajectory whereby the proportion of children achieving 60 min of physical activity per day pre-lockdown (63%) declined during lockdown (21%) and then increased post-lockdown (54%). Changes in the proportion of children engaging in 60 min of daily physical activity were moderated by several demographic variables. Efforts are needed to provide parents of young children with a wider variety of resources to ensure children are obtaining sufficient levels of physical activity regardless of the presence of community lockdowns.

Time to Play in Javanese Preschool Children-An Examination of Screen Time and Playtime before and during the COVID-19 Pandemic

This comparative-descriptive multi-national research examined the screen time and playtime of preschool children aged 1-6 years before and during the COVID-19 pandemic. Parents reported on the play and screen habits of preschool-aged children on the weekday and weekends using a questionnaire on the lifestyle habits of their children. Results indicated a significant difference in screen time and playtime on the weekday and weekend before the pandemic (screen time: 1.91 ± 2.40 vs. 2.16 ± 2.60 h; playtime: 3.55 ± 2.49 vs. 4.11 ± 2.58 h, both p < 0.05), but during the COVID-19 pandemic, only the weekday-weekend difference in screen time was significantly different (screen time: 2.87 ± 3.15 vs. 3.26 ± 3.18 h, p < 0.05; playtime: 3.25 ± 3.41 vs. 3.48 ± 2.41, p > 0.05). Before- and during-COVID-19 comparisons showed that the average daily screen time increased by 150% from 2.04 h to 3.06 h (p < 0.05), while the average play time decreased by 12.3% (3.83 to 3.36 h, p < 0.05). Based upon international guidelines for movement behaviours of young children, special attention and actions are needed to manage the excessive daily screen time and preserve the average daily playtime of Javanese preschool children. These results present useful benchmarking data for parents, teachers, and health authorities to initiate ameliorative interventions to better balance children's screen time and playtime as Indonesia emerges from the COVID-19 pandemic to a COVID-19 endemic.