The impact of school closures on adolescent health-related outcomes during the COVID-19 pandemic: A natural experiment in South Korea

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Abstract

A large number of countries implemented school closure as a response to the COVID-19 pandemic in 2020. As existing studies mostly rely on retrospective or pre/post comparisons that are prone to unmeasured confounding, the effect of school closure on adolescent health is poorly understood. The South Korean government implemented school closure to prevent the spread of COVID-19. A difference-in-differences comparing changes in health-related outcomes between provinces with differing degrees of school closure was performed. The main analysis group consists of middle school students of age 14 to 16 who were hit hardest where up to 73% of total schooling was taken online in Seoul (the physical attendance was reduced from 170 days to 45 days). For sensitivity analysis, a placebo group of high school students of age 19 who attended all school-days physically was included to detect any violation of our identification strategy. In the main analysis group of boys that experienced reduced physical school-days, both total and vigorous physical activity were reduced (−0.35 [-0.54 -0.17] days/week for vigorous physical activity and -0.38 [-0.61 -0.16] days/week for total physical activity) while such effect was absent in the placebo group of boys that actually did not experience school closure (−0.08 [-0.49 0.32] days/week for vigorous PA and -0.16 [-0.67 0.34] days/week for total PA). In girls, vigorous physical activity decreased (−0.22 [-0.40 -0.04] days/week) but the total physical activity was nearly constant (0.03 [-0.18 0.25] days/week). Other outcomes were largely unchanged.

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  1. SciScore for 10.1101/2021.08.12.21261943: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationEach year, under the administration of the Ministry of Health and the Ministry of Education, schools are randomly selected from 17 provinces.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.


    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).


    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Despite these achievements, our study also entails several limitations. First, our study is based on self-reported questionnaire that might entail a substantial measurement error. However, a study by maintainers of the data found that the responses of KYRBS are generally consistent with objective measurements(10). Second, causal inference methods, including the ones that we used, rely on number of empirically unverifiable assumptions. Although we carefully examined the possible violations by examining the pre-trends and the placebo groups, some violation might remain that can bias the estimates. Third, our study was limited only to few numbers of health-related outcome due to the insufficiency of the data. Further studies with more extensive set of variables are required to understand the full extent of the effect of school closure on adolescent health. Fourth, the Wald-IV approach only estimates the causal effect of physical activity among compliers of the intervention (local average treatment effect, LATE). The effect of physical activity on BMI may differ in always-takers and never-takers in our sample. Finally, the exposure instruments in mendelian randomization were measured in adults whereby the effect of SNPs might differ in adults and adolescents. Nevertheless, we provide one of the first evidence up to our knowledge on the causal impact of school closure based on a nation-wide sample of adolescents. Further studies from different countries under different cultural an...

    Results from TrialIdentifier: No clinical trial numbers were referenced.


    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.


    Results from JetFighter: We did not find any issues relating to colormaps.


    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.


    About SciScore

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