Study suggests that the overall physical health of adolescents was negatively impacted by COVID-19 mitigation efforts

In a recent study published in the Journal of Pediatric Nursing, researchers examined the impact of coronavirus disease 2019 (COVID-19) on the sleep, diet, and physical activity of mid to late adolescents.

Background

The COVID-19 pandemic required many people to stay at home, leading to irregular schedules, which may have resulted in disrupted sleep patterns. COVID-19 may have caused sleep issues in teenagers due to heightened stress levels, changes in sleep schedules, and the need to study from home for online classes, leading to increased wakefulness.

The relationship between diet, sleep, and physical activity is interconnected. Inadequate dietary habits can have an adverse impact on both the amount and quality of sleep. Insufficient physical activity is linked to higher chances of experiencing sleep problems and a greater risk of developing mental health issues.

This study examined how COVID-19 restrictions affected physical health outcomes, specifically diet, sleep, and physical activity.

About the study

Participants were recruited in a parent study, REACT, which focused on adolescent driving, but also involved detailed estimates of adolescents' physical health. To enroll in REACT, participants were required to meet certain criteria: they had to be either 16 or 18 years old, have received a driver's license within two weeks of study recruitment, and be proficient in spoken and written English.

REACT participants were enrolled for a period of 18 months. The participants attended seven in-person meetings and responded to surveys assessing their physical health outcomes. Participants completed sociodemographic and health surveys before each in-person visit. Participants reported their age, sex, and race during enrollment.

The Pittsburgh Sleep Quality Index (PSQI) measured subjective sleep quality at all seven time points. Seven scales were calculated using the 19 items of the PSQI: subjective sleep quality, sleep onset, number of hours of actual sleep, sleep efficiency, sleep disturbances, use of medication as sleep aids, and daytime functioning difficulties. Participants documented their average nightly awakenings and the likelihood of dozing off through daily activities at all seven time points.

Depressive symptoms were measured using the 10-item Center for Epidemiological Studies Depression Scale (CES-D-10) at all seven time points. Participants reported the frequency of their diet in the previous seven days at months one, 12, and 18 using a survey developed by the team, including non-diet soda, caffeinated beverages, fruit, vegetables, fast food, and sweet foods.

Participants were also asked to report their physical activity levels at months one, 12, and 18 via a survey enquiring how many days per week they engaged in physical activity for 20, 30, or 60 minutes. Participants also rated their activity level in these three categories on a scale of zero to seven, indicating the number of active days in each category.

The study assessed the socioeconomic status (SES) of participants using a modified version of the Family Affluence Scale, which included five items, including asking participants how many times they had traveled abroad for vacation in the past year.

Results

A cohort of 190 teenagers participated in the study, providing a total of 1,330 reports over 194 weeks. The team noted a decrease in the self-reported probability of dozing, as well as physical activity of a minimum of 20 and 30 minutes post-COVID-19. The PSQI scores showed a significant increase following the COVID-19 outbreak, suggesting a decline in sleep quality.

During the COVID-19 pandemic, there was a significant increase in the frequency of participants reporting being awakened by electronic notifications on an average night. Also, age and COVID-19 had a noteworthy interaction. Individuals aged 18 experienced less frequent disruptions from electronic notifications during the pandemic than those aged 16.

Furthermore, during the COVID-19 pandemic, individuals aged 16 years experienced a notable rise in the frequency of being disturbed by electronic notifications on an average night, as compared to the pre-COVID-19 period. Post-COVID-19, the probability of falling asleep during routine tasks decreased compared to pre-COVID-19.

COVID-19 was linked to higher chances of daily soda, caffeine, fruit, and vegetable intake daily. The study found that sociodemographic factors impacted the relationship between COVID-19 and daily soda consumption. Specifically, the likelihood of daily soda intake increased, but this effect was less pronounced in individuals who were 18 years old at the time of enrollment. In particular, males showed a significant increase in the likelihood of consuming caffeine daily.

The study found that COVID-19 was linked to a reduction in the number of days individuals exercised to the point where they were sweating or breathing heavily for at least 30 minutes, especially in participants aged 18.

Furthermore, 18-year-olds exercised less frequently than 16-year-olds, irrespective of time. Males exercised more frequently than females both before and after the COVID-19 pandemic, with a significant difference in the number of days per week they exercised for at least 20 and 60 minutes. Black participants reported fewer days with at least 30 minutes of physical activity in comparison to white participants, irrespective of time. Notably, the frequency of exercising or engaging in physical activity for 60 minutes per day was not impacted by COVID-19.

Conclusion

The study found that COVID-19 mitigation efforts had a negative impact on physical health, regardless of factors such as race, sex, or SES. Understanding the impact of COVID-19 on adolescents' functioning and long-term trajectories is crucial from a holistic perspective. The study found that physical health outcomes declined after COVID-19, irrespective of covariables.

The present findings have relevance for both clinicians and researchers. The study provides new information on how COVID-19 and its mitigation efforts affect the physical health of adolescents.

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.