COVID-19 Policies: Impact Over Time on Child Health, Obesity, and Disparities

Project Summary In the Spring of 2020, Maryland introduced policies to reduce the spread of COVID-19, including closures of schools, child care, and work sites, and social distancing requirements. Based on the Family Stress Model (FSM), the economic losses and social disruptions associated with COVID-19 policies can undermine family routines, resulting in negative impacts on children's health behaviors and risk for obesity/excess weight gain. Guided by the FSM, we implemented a rapid-response research project in Spring 2020 to examine disparities (race/ethnicity, socio-economic status, and locale) resulting from COVID-19 policies by merging two ongoing federally funded obesity prevention trials (school and child care). Enrolled families have children age 3-15 years and live in 10 rural, urban, and suburban Maryland counties. Families repeated pre-pandemic evaluations, including diet screeners, objectively measured activity/sleep (accelerometry), surveys on family routines, food insecurity, well-being, etc., in addition to supplemental COVID-19-related surveys and interviews. Data collection recently ended, with 563 families evaluated. This proposed study extends the rapid-response project to include: (1) the long-term impact of COVID-19 policies on disparities related to children's health over two years following the pandemic start, (2) measures of obesity and an analysis of projected impact on health care costs, (3) an explanatory mixed methods approach to understand the mechanisms linking COVID-19 policies and health behaviors. This study is time-sensitive in that follow-up data must be collected during Spring 2021 (the first year anniversary of the pandemic), to understand the impact of COVID-19 policies on childhood obesity and health behaviors over time. Specifically, this study aims to (1) examine changes over time [4 data points: before the pandemic, onset (spring 2020), 2 years following (2021-2023)] in child health behaviors (diet, physical activity, and sleep) and obesity/excess weight gain, (2) examine the mechanisms explaining observed changes in child health behaviors and obesity/excess weight gain (mixed methods, focusing on family routines and child emotional health), and (3) determine projected health care costs related to changes in child health behaviors and obesity/excess weight gain due to COVID-19 pandemic control policies overall and for specific populations, by race/ethnicity, SES, and geographic locale. Specific hypotheses seek to examine the impact on health disparities, the link between health behaviors and excess weight gain during the pandemic, and linkages within the components of the FSM. This proposed study has significant relevance to public health along at least three areas. First, findings will quantify the impact of the COVID-19 policies on children's health behaviors and obesity/excess weight gain, thus facilitating planning on strategies to promote children's health during recovery and to consider in planning for future pandemics and disasters. Second, findings related to health and social disparities provides information on the vulnerabilities of groups and issues to consider in planning for future disasters to reduce disparities. Finally, findings related to projected health care costs related to child health during the pandemic will inform the future public health agenda with respect to necessary investments in obesity treatment and prevention.