The Impact of Scholastic Factors on Physical Activity Levels during the COVID-19 Lockdown: A Prospective Study on Adolescents from Bosnia and Herzegovina

How the COVID-19 pandemic and related school closures reduce physical activity among children and adolescents in the WHO European Region: a systematic review and meta-analysis

BACKGROUND

Emerging research suggests that physical activity among children and adolescents decreased during the COVID-19 pandemic. However, a differentiated overview of European youth is lacking. In particular, no systematic analysis has been conducted to date on the impact of heterogeneous pandemic restrictions and school closures within European countries, and with regard to potentially vulnerable groups.

METHODS

We searched seven databases and included studies for children and adolescents (≤ 19 years) of the WHO European Region that compared physical activity during the COVID-19 pandemic with a pre-pandemic baseline using validated measurement instruments. We used the Oxford Stringency Index and School Closure Index as indicators of restriction stringency. Screening for eligibility, data extraction, assessment of the study risk of bias (using the 'Risk of Bias in Non-randomized Studies - of Exposure' [ROBINS-E]) and certainty grading of evidence (using the GRADE approach), were all done in duplicate. Unpublished data was requested from study authors. Data were pooled in random effects models. An a priori protocol was published, reporting is carried out in accordance with the 'Preferred Reporting Items for Systematic Review and Meta-Analyses' (PRISMA) statement.

RESULTS

Of 14,897 non-duplicate records, 26 publications (n = 15,038 pre-pandemic, n = 13,041 during pandemic) met full inclusion criteria. Comparison before and during the COVID-19 pandemic revealed a significant reduction in total physical activity (standardized mean difference [SMD], -0.57 [95%CI, -0.95; -0.20]) and moderate-to-vigorous physical activity (SMD, -0.43 [95% CI, -0.75; -0.10]), corresponding to a decrease of 12 min per day (a 20% reduction of the WHO recommendation). A decrease in sporting activity was also recorded. Subgroup analyses suggested that middle childhood (aged 8-12) and adolescents were particularly affected by the decline. School closures were associated with a reduction in physical activity. The certainty of evidence for all outcomes was low.

CONCLUSIONS

A sharp decline in all forms of physical activity was recorded among European children and adolescents during the COVID-19 pandemic. This decline was higher during periods of school closure and mainly affected younger schoolchildren and adolescents. Immediate action by policy-makers and practitioners, as well as evidence-based public health strategies, are imperative in reversing this trend.

TRIAL REGISTRATION

PROSPERO: CRD42023395871.

To Create a Safe and Healthy Place for Children: The Associations of Green Open Space Characteristics With Children's Use

Green open space (GOS) is an important outdoor resource for the well-being of children by providing places for physical activity (PA), especially in the highly urbanized environment. The COVID-19 lockdowns have made children have more sedentary time than before due to less access to public places. This article aims to examine the associations of GOS characteristics (environmental and surrounding) and children's use (visitation and PA pattern) to provide evidence for promoting their PA during the pandemic. This study employed the method of GPS positioner, accelerometer, and survey to measure the children's actual use in GOS. A total of 179 children participated in the study and 10 GOSs were selected. The children were provided with the accelerometers and GPS positioners to track their walking steps, duration, and locations. The environmental characteristics and 1 km buffer of the selected GOSs were explored as extended study area. Results showed that 49.16% of children reported more visitations than before the pandemic, and 48.60% of them preferred to go on weekdays during the pandemic. Both environmental and surrounding characteristics could affect the visitation pattern. The size (p < 0.000), residential ratio (p < 0.000), and intersection density (p < 0.000) were found as the factors significantly associated with visitation pattern. The children's PA pattern was mainly associated with the environmental characteristics of size (p < 0.000), sports, and playground proportion (p < 0.000). The locations of children's PA were mainly around square, playground, sheltered place, and waterside areas. COVID-19 has transformed the children's use of GOS, as well as their relationship with GOS. The large GOS was more likely to promote PA and its use by the children. The environmental and surrounding characteristics of GOS could affect their use pattern, whereas their PA pattern was mainly associated with the environmental characteristics. The findings suggest that GOS characteristics could be an effective solution to respond the challenge from the pandemic, and promote their visitation and PA.

Orthodontic Adolescent Patients’ Attitudes toward Protective Face Mask Wearing during the COVID-19 Pandemic

Background and Objectives: The COVID-19 pandemic led to restrictive measures, which aimed to limit the spread of the SARS-CoV-2 virus. These restrictions impacted all areas of life, including the activity of dental offices. For patients with orthodontic appliances, closing the dental offices was a major issue, as most orthodontic treatments last for more than a year and require regular checkups. The aim of this research was to assess the impact that the restrictive measures that were imposed during the COVID-19 pandemic, and, especially, wearing a face mask had on a sample of Romanian teenagers undergoing fixed orthodontic treatment. Material and Methods: The study group consisted of 277 orthodontic patients, with ages between 12 and 17.9 years, from North-Western Romania. They completed a 9-item questionnaire. The control group consisted of 231 participants, with ages between 12 and 17.9 years. They completed an 8-item questionnaire. Results: Most patients from the study group were not worried that wearing a protective face mask would hide their braces (never—49.5%; rarely—26.7%), and their desire to undergo an orthodontic treatment was not affected by the compulsoriness of face mask wearing (never—51.6%; rarely—26%). In contrast to that, in the control group, more than 50% of the participants were worried to some degree that wearing a protective face mask would hide their smile (occasionally—29.9%; frequently—18.2%; very frequently—2.2%). The majority of the participants from the study group did not consider interrupting the orthodontic treatment due to the COVID-19 pandemic (62.5%), and the majority of the participants from the control group did not consider not going to the dentist due to the COVID-19 pandemic (70.6%). Most of the participants from the study group were not happy that they had to wear a face mask, which covered their orthodontic appliances, during the orthodontic treatment (68.6%). The attitude was similar to that of the participants from the control group, who were not happy that they had to wear a face mask, that covered their smile (51.1%). In the study group, most patients did not want face mask wearing to continue to be compulsory, given the fact that their orthodontic appliances were no longer visible (52%). In the control group, the attitude was similar, with 48.1% of the participants not wanting face mask compulsoriness to be maintained. Conclusions: In conclusion, although, most patients would not like to continue wearing a face mask as a mandatory regulation, they were not concerned or negatively affected by wearing a protective face mask, even though face masks hid their braces.

Socio-Economic Determinants of Health Literacy in High School Students: A Cross-Sectional Study

Today, a person’s health literacy (HL) is perceived as a critical determinant for their health. It is well known that limited health literacy is associated with harmful health behaviours, the lower use of preventive services, problems in making use of healthcare resources and poor skills for the self-management of chronic disorders. This study analysed the level and factors associated with HL in high school students in southern Poland. The study is based on the data from a paper-and-pencil survey of high schools students in the Malopolska Voivodshop. The students were selected using a two-stage cluster random sampling procedure. The level of HL was assessed with the European Health Literacy Survey Questionnaire, consisting of 47 items. Univariate logistic and linear regression models were applied to analyse the association between general HL score and the main domain-specific indices. The respondents whose parents had attended University and came from more affluent families were less likely to demonstrate limited HL. There was a significant positive relationship between the self-assessment of the economic situation, size of accommodation, the level of expenditure on a mobile phone and receiving external support, the size of the book collection at home, and domain-specific HL sub-indices. In conclusion, among socio-demographic factors, the parents’ education is the only consistent predictor of the level of HL in high school students. Furthermore, most variables reflecting the economic status of the respondent’s family are significantly associated with the general HL score and its sub-indices.