Lifestyle behaviours of children and adolescents during the first two waves of the COVID-19 pandemic in Switzerland and their relation to well-being: a population-based study
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Abstract
Background
Previous studies assessing the impact of the COVID-19 pandemic on children’s and adolescent’s lifestyle focused mainly on the first wave in early 2020. We aimed to describe changes in adherence to recommendations for physical activity (PA), screen time (ST), and sleep duration over the first two waves of the pandemic (March-May 2020 and October 2020-January 2021) in Switzerland, and to assess the associations of these lifestyle behaviours with life satisfaction and overall health, as indicators of well-being.
Methods
We included 3168 participants aged 5 to 18 years from four Swiss cantons. Participants or their parents completed repeated questionnaires and reported on their (child’s) PA, ST, sleep, life satisfaction, and overall health. We analysed lifestyle behaviours in terms of adherence to international recommendations. We used linear and logistic regression models to assess the associations of number of recommendations met and adherence patterns with well-being indicators.
Findings
Compared to the pre-pandemic period, the percentage of participants meeting the recommendations for PA and ST decreased strikingly during March-May 2020, while there was a slight increase in those meeting recommendations for sleep. During October 2020-January 2021, the percentage of compliant children for PA and ST increased but remained lower than before the pandemic. Participants meeting all three recommendations were more likely to report excellent health (OR: 1·87 [1·15-3·08]) and a higher life satisfaction score (β: 0·59 [0·30-0·88]) than participants not meeting any recommendation. Adherence to recommendations for PA and sleep, PA and ST, and sleep and ST was similarly associated with both well-being indicators.
Interpretation
We show a substantial impact of the COVID-19 pandemic on children’s and adolescents’ lifestyle behaviours with a partial recovery over time, and an association between lifestyle and well-being. Public health policies to promote children’s and adolescents’ well-being should target PA, ST, and sleep simultaneously.
Funding
Corona Immunitas.
RESEARCH IN CONTEXT
Evidence before the study
We searched PubMed for studies assessing the effects of the COVID-19 pandemic on children’s and adolescents’ lifestyle behaviours, published up to September 6, 2021, with no language restrictions. Of the studies found, nearly all compared lifestyle behaviours before and during the strict confinement in the first wave of the pandemic, and very few studies extended their assessment beyond June 2020. The only longitudinal study assessing lifestyle changes up to 2021 included a sample of nineteen boys. Some studies assessed the association between lifestyle behaviours and well-being after the outbreak of the pandemic, but all used a single-behaviour approach (i.e., evaluated only one lifestyle behaviour) and no study considered the combined contribution of physical activity (PA), screen time (ST), and sleep. In addition, most studies were cross-sectional and did not consider pre-pandemic lifestyle behaviours.
Added value of this study
This is the first study assessing changes in adherence to international recommendations regarding PA, ST, and sleep duration in children and adolescents during the first two waves of the COVID-19 pandemic and the joint associations of these lifestyle behaviours with well-being. We used data from 3168 children and adolescents from four different Swiss cantons. We included measurements of PA, ST, and sleep before the pandemic, during the first wave between March and May 2020, and during the second wave between October 2020 and January 2021. We also assessed life satisfaction and overall health as indicators of well-being, between January and April 2021. We showed that, compared to the pre-pandemic period, the proportion of children and adolescents following the recommendations for PA and ST decreased during the first wave (lockdown period), while there was a slight increase in those meeting recommendations for sleep. During the second wave, the prevalence of compliant children and adolescents for PA and ST recovered but remained below pre-pandemic levels. Furthermore, we found an association between the number of recommendations met for lifestyle behaviours during the second wave and well-being assessed between January and April 2021. In contrast, there was no such association for the periods before the pandemic or during the lockdown. Participants following the recommendations for all three lifestyle behaviours or for combinations of two of them in the second wave were more likely to report excellent health and had a higher life satisfaction score, than those not meeting any recommendation.
Implications of all the available evidence
Our findings demonstrate that the COVID-19 pandemic has had a strong negative effect on children’s and adolescents’ lifestyle behaviours, but some recovery has taken place within the first year since the outbreak. Policymakers should imperatively consider the balance of disease prevention and promotion of a healthy lifestyle when (re-)activating restrictive measures. Given the already high prevalence of children and adolescents not meeting lifestyle recommendations in the pre-pandemic period, our findings highlight the urgent need for public health policies aiming to avoid permanent negative changes on children’s and adolescents’ lifestyle and to mitigate the health risks associated with adverse changes during the pandemic. In addition, our study indicates that lifestyle is an important predictor of children’s and adolescents’ well-being, and it further suggests that future public health strategies aiming to promote well-being should target sufficient time for PA and sleep as well as reduce ST.
Article activity feed
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SciScore for 10.1101/2021.11.29.21267019: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was approved by the Ethics Committee of all regions (TI: 2020-01514; SG/GR: 2020-01247; ZH: 2020-01336).
Consent: All participants and/or their parents provided informed consent.Sex as a biological variable not detected. Randomization Primary schools were randomly selected from the list of all schools in the canton of ZH and matched with the geographically closest secondary school. Blinding not detected. Power Analysis not 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 …SciScore for 10.1101/2021.11.29.21267019: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was approved by the Ethics Committee of all regions (TI: 2020-01514; SG/GR: 2020-01247; ZH: 2020-01336).
Consent: All participants and/or their parents provided informed consent.Sex as a biological variable not detected. Randomization Primary schools were randomly selected from the list of all schools in the canton of ZH and matched with the geographically closest secondary school. Blinding not detected. Power Analysis not 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:We need to acknowledge some limitations. Lifestyle behaviours were self-reported or based on parental-report, with potential bias in the estimation of PA, ST, and sleep. In ZH, questions for PA referred to hours per day (instead of hours per week), which could have led to an overestimation of PA for this subgroup. Well-being indicators were also reported by parents for younger children and therefore some bias is possible for these measures. In addition, the fact that participants included in the study were more often from families with Swiss nationality and a high education level than those excluded due to missing data may not allow the generalizability of our results to populations with more ethnic variability and lower socio-economic status. Finally, although we accounted for a wide range of potential confounders when assessing the associations between lifestyle and well-being, residual confounding may still be a concern as we did not consider other factors such as existing psychological problems, parental mental health or family cohesion. In conclusion, the COVID-19 pandemic has had a negative effect on children’s and adolescents’ lifestyle behaviours up to 2021, but some recovery has taken place. Policymakers should imperatively consider the balance of disease prevention and promotion of a healthy lifestyle when (re-)activating restrictive measures. In addition, future public health strategies aiming to promote children’s and adolescents’ well-being should target sufficie...
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.
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