Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study

Nan Dou; Rachel Deitch; Alysse J Kowalski; Ann Kuhn; Hannah Lane; Elizabeth A Parker; Yan Wang; Zafar Zafari; Maureen M Black; Erin R Hager

doi:10.1016/j.cct.2023.107408

Studying the impact of COVID-19 mitigation policies on childhood obesity, health behaviors, and disparities in an observational cohort: Protocol for the COVID-19 Family Study

Contemp Clin Trials. 2024 Jan:136:107408. doi: 10.1016/j.cct.2023.107408. Epub 2023 Dec 10.

Authors

Nan Dou¹, Rachel Deitch², Alysse J Kowalski³, Ann Kuhn⁴, Hannah Lane⁵, Elizabeth A Parker⁶, Yan Wang⁷, Zafar Zafari⁸, Maureen M Black⁹, Erin R Hager¹⁰

Affiliations

¹ Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA. Electronic address: ndou1@jhu.edu.
² Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA. Electronic address: rdeitch1@jhu.edu.
³ Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA. Electronic address: akowals7@jhu.edu.
⁴ Department of Exercise and Nutrition Sciences, University at Buffalo, The State University of New York, 401 Kimball Tower, Buffalo, NY 14214, USA. Electronic address: annkuhn@buffalo.edu.
⁵ Department of Population Health Sciences, Duke University School of Medicine, 215 Morris Street, Durham, NC 27701, USA. Electronic address: hannah.lane@duke.edu.
⁶ University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science, 100 Penn Street, Baltimore, MD 21201, USA. Electronic address: Elizabeth.parker@som.umaryland.edu.
⁷ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, NW, Washington, DC 20052, USA. Electronic address: yanwang20@gwu.edu.
⁸ Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, 20 North Pine Street, Baltimore, MD 21201, USA. Electronic address: zzafari@rx.umaryland.edu.
⁹ University of Maryland School of Medicine, Department of Pediatrics, 737 West Lombard Street, Baltimore, MD 21201, USA; RTI International, Research Triangle Park, NC 27709, USA. Electronic address: mblack@som.umaryland.edu.
¹⁰ Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 615 N Wolfe St, MD 21205, USA. Electronic address: ehager1@jhmi.edu.

PMID: 38072192
PMCID: PMC10922699 (available on 2025-01-01)
DOI: 10.1016/j.cct.2023.107408

Abstract

Background: COVID-19 pandemic control policies, including school closures, suspended extra-curricular activities, and social distancing, were introduced to prevent viral transmission, and disrupted children's daily routines, health behaviors, and wellness. This observational cohort study among 697 families with children or adolescents, based on the Family Stress Model, aims to: 1) evaluate pre- to during-pandemic changes in child health behaviors (diet, physical activity, sleep) and weight gain, 2) identify mechanisms explaining the changes, and 3) determine projected healthcare costs on weight gain and obesity. Each aim includes an examination by racial and ethnic, socioeconomic, and geographic disparities.

Methods: The study employs a mixed methods design, recruiting children and their caregivers from two obesity prevention trials halted in 2020. Enrolled participants complete annual surveys to assess child health behaviors, family resources, routines, and demographics, and home environment in 2020-2022. Height and weight are measured annually in 2021-2022. Annual semi-structured interviews are conducted within a subsample to understand mechanisms of observed changes. Multilevel mixed models and mediation analyses are used to examine changes in child health behaviors and weight gain and mechanisms underlying the changes. Qualitative data are analyzed within and across time points and integrated with quantitative findings to further explain mechanisms. Markov models are used to determine healthcare costs for unhealthy child behaviors and weight gain.

Conclusion: Findings from this study will aid in understanding pandemic-related changes in child health behaviors and weight status and will provide insights for the implementation of future programs and policies to improve child and family wellness.

Keywords: COVID-19 pandemic policies; Child health behaviors; Child, adolescents; Childhood overweight/obesity; Health disparities; Healthcare costs.

MeSH terms

Adolescent
COVID-19* / epidemiology
COVID-19* / prevention & control
Child
Health Behavior
Humans
Observational Studies as Topic
Pandemics / prevention & control
Pediatric Obesity* / epidemiology
Pediatric Obesity* / prevention & control
Weight Gain

Abstract

MeSH terms

Grants and funding