Seasonal Shifts in Children's Sedentary Behaviors, Physical Activity, and Sleep: A Systematic Review and meta-Analysis.

Children's movement behaviors (ie, sedentary behaviors, physical activity, and sleep) are related to obesity risk and may vary throughout the year. The purpose of this systematic review is to summarize existing literature on the seasonal variation in physical activity and sleep in children. This study found that children's behaviors fluctuate seasonally and thus, interventions must target behaviors during the times when children's behaviors are the least healthy, specifically during the summer (when children are not in school) and winter. Finally, the paucity of data on seasonal variation in sleep indicates a need for further research in this area.

COVID-19 mitigation strategies: A natural experiment highlighting the importance of structure in the prevention and treatment of childhood obesity.

Societal restrictions due to the Coronavirus Disease 2019 (COVID-19), such as the closure of schools, childcare centers, and community programs, were implemented to prevent the spread of the disease and to protect the health and well-being of the population. These mitigation efforts drastically interrupted the day-to-day environments of children and adolescents and influenced how they spent the majority of their waking hours. Evidence shows on days when children and adolescents are in "structured" settings, such as school or other extracurricular programs or day camps, their obesogenic behaviors (i.e., sleep, physical activity, diet, and screen/media time) are more favorable than on days with less structure (e.g., summer days, weekends). Although obesity is driven by complex interactions between environmental, behavioral, biological, and genetic factors, COVID-19 pandemic closures emphasized the importance of daily structure. This short communication used a tertiary examination of the literature to show how societal restrictions and mitigation strategies resulted in significant increases in childhood and adolescent obesity on a global scale and highlights the importance of key underlying principles of the Structured Days Hypothesis (SDH). Closure of schools and other structured programs as a result of COVID-19 exposed youth to prolonged periods of less-structured environments as youth spent considerably more time at home than normal. Societal restrictions and mitigation strategies as a result of COVID-19 inadvertently demonstrated the importance of structure in shaping children's health behaviors and weight-related outcomes. Public health practitioners and researchers should consider this framework in the development of interventions to prevent and treat obesity in youth.

Impact of Virtual vs. In-Person School on Children Meeting the 24-h Movement Guidelines during the COVID-19 Pandemic.

The pandemic mitigation strategy of closing schools, while necessary, may have unintentionally impacted children's moderate-to-vigorous physical activity (MVPA), sleep, and time spent watching screens. In some locations, schools used hybrid attendance models, with some days during the week requiring in-person and others virtual attendance. This scenario offers an opportunity to evaluate the impact of attending in-person school on meeting the 24-h movement guidelines. Children (N = 690, 50% girls, K-5th) wore wrist-placed accelerometers for 14 days during October/November 2020. Parents completed daily reports on child time spent on screens and time spent on screens for school. The schools' schedule was learning for 2 days/week in-person and 3 days/week virtually. Using only weekdays (M-F), the 24-h movement behaviors were classified, and the probability of meeting all three was compared between in-person vs. virtual learning and across grades. Data for 4956 weekdays (avg. 7 d/child) were collected. In-person school was associated with a greater proportion (OR = 1.70, 95% CI: 1.33-2.18) of days that children were meeting the 24-h movement guidelines compared to virtual school across all grades. Students were more likely to meet the screen time (OR = 9.14, 95% CI: 7.05-11.83) and MVPA (OR = 1.50, 95% CI: 1.25-1.80) guidelines and less likely to meet the sleep (OR = 0.73, 95% CI: 0.62-0.86) guidelines on the in-person compared to the virtual school days. Structured environments, such as school, have a protective effect on children's movement behaviors, especially physical activity and screen time.

Feasibility & Preliminary Efficacy of Structured Programming and a Parent Intervention to Mitigate Accelerated Summer BMI Gain: A pilot study.

BackgroundThis study assessed initial feasibility and preliminary efficacy of providing children a free summer day camp and a parent intervention to improve self-regulation and mitigate accelerated summer BMI gain.MethodsThis pilot 2x2 factorial randomized control trial used a mixed methods design to evaluate providing children a free summer day camp (SCV), a parent intervention (PI), and the combination of these two strategies (SCV + PI) to mitigate accelerated summer body mass index (BMI) gain. Feasibility (i.e., recruitment capability, retention, compliance, treatment fidelity, acceptability) was examined using means, standard deviations, and percentages for relevant variables. Changes in BMI were estimated using intent-to-treat and post-hoc dose response analyses via multilevel mixed effects regressions.ResultsA total of 89 families participated, with 24 participants randomized to the PI group, 21 randomized to the SCV group, 23 randomized to the SCV + PI group, and 21 randomized to the control. Parents and children found the summer program acceptable but attendance at the summer program and engagement in the PI were low due to COVID-19 and lack of transportation. Intent-to-treat analyses showed no statistically significant difference between groups in summer BMI gain. Post-hoc dose response analyses showed that for each day (0 to 29) of summer programming children attended they gained - 0.009 (95CI= -0.018, -0.001) less in BMI z-score.ConclusionsEngagement in both the SCV and PI was not ideal and was likely due to COVID-19 and lack of transportation. Providing children with structured summer programming to mitigate accelerated summer BMI gain may be an effective strategy. Thus, a larger trial may be warranted, but more work is needed to ensure children attend the programming.Trial registration: The trial reported herein was prospectively registered at clinicaltrials.gov. Trial #:NCT04608188.

Sensitivity of wastewater-based epidemiology for detection of SARS-CoV-2 RNA in a low prevalence setting.

To assist public health responses to COVID-19, wastewater-based epidemiology (WBE) is being utilised internationally to monitor SARS-CoV-2 infections at the community level. However, questions remain regarding the sensitivity of WBE and its use in low prevalence settings. In this study, we estimated the total number of COVID-19 cases required for detection of SARS-CoV-2 RNA in wastewater. To do this, we leveraged a unique situation where, over a 4-month period, all symptomatic and asymptomatic cases, in a population of approximately 120,000, were precisely known and mainly located in a single managed isolation and quarantine facility (MIQF) building. From 9 July to 6 November 2020, 24-hr composite wastewater samples (n = 113) were collected daily from the sewer outside the MIQF, and from the municipal wastewater treatment plant (WWTP) located 5 km downstream. New daily COVID-19 cases at the MIQF ranged from 0 to 17, and for most of the study period there were no cases outside the MIQF identified. SARS-CoV-2 RNA was detected in 54.0% (61/113) at the WWTP, compared to 95.6% (108/113) at the MIQF. We used logistic regression to estimate the shedding of SARS-CoV-2 RNA into wastewater based on four infectious shedding models. With a total of 5 and 10 COVID-19 infectious cases per 100,000 population (0.005% and 0.01% prevalence) the predicated probability of SARS-CoV-2 RNA detection at the WWTP was estimated to be 28 and 41%, respectively. When a proportional shedding model was used, this increased to 58% and 87% for 5 and 10 cases, respectively. In other words, when 10 individuals were actively shedding SARS-CoV-2 RNA in a catchment of 100,000 individuals, there was a high likelihood of detecting viral RNA in wastewater. SARS-CoV-2 RNA detections at the WWTP were associated with increasing COVID-19 cases. Our results show that WBE provides a reliable and sensitive platform for detecting infections at the community scale, even when case prevalence is low, and can be of use as an early warning system for community outbreaks.

Impact of the COVID-19 pandemic on elementary schoolers' physical activity, sleep, screen time and diet: A quasi-experimental interrupted time series study.

BACKGROUND: COVID-19 school closures pose a threat to children's wellbeing, but no COVID-19-related studies have assessed children's behaviours over multiple years . OBJECTIVE: To examine children's obesogenic behaviours during spring and summer of the COVID-19 pandemic compared to previous data collected from the same children during the same calendar period in the 2 years prior. METHODS: Physical activity and sleep data were collected via Fitbit Charge-2 in 231 children (7-12 years) over 6 weeks during spring and summer over 3 years. Parents reported their child's screen time and dietary intake via a survey on 2-3 random days/week. RESULTS: Children's behaviours worsened at a greater rate following the pandemic onset compared to pre-pandemic trends. During pandemic spring, sedentary behaviour increased (+79 min; 95% CI = 60.6, 97.1) and MVPA decreased (-10 min, 95% CI = -18.2, -1.1) compared to change in previous springs (2018-2019). Sleep timing shifted later (+124 min; 95% CI = 112.9, 135.5). Screen time (+97 min, 95% CI = 79.0, 115.4) and dietary intake increased (healthy: +0.3 foods, 95% CI = 0.2, 0.5; unhealthy: +1.2 foods, 95% CI = 1.0, 1.5). Similar patterns were observed during summer. CONCLUSIONS: Compared to pre-pandemic measures, children's PA, sedentary behaviour, sleep, screen time, and diet were adversely altered during the COVID-19 pandemic. This may ultimately exacerbate childhood obesity.

COVID-19 Leads to Accelerated Increases in Children's BMI z-Score Gain: An Interrupted Time-Series Study.

INTRODUCTION: The COVID-19 pandemic may have negatively impacted children's weight status owing to the closure of schools, increased food insecurity and reliance on ultraprocessed foods, and reduced opportunities for outdoor activity. METHODS: In this interrupted time-series study, height and weight were collected from children (n=1,770 children, mean age=8.7 years, 55.3% male, 64.6% Black) and were transformed into BMI z-score in each August/September from 2017 to 2020. Mixed-effects linear regression estimated yearly BMI z-score change before the COVID-19 pandemic year (i.e., 2017-2019) and during the COVID-19 pandemic year (i.e., 2019-2020). Subgroup analyses by sex, race (i.e., Black, White, other race), weight status (overweight or obese and normal weight), and grade (i.e., lower=kindergarten-2nd grade and upper=3rd-6th grade) were conducted. RESULTS: Before the COVID-19 pandemic, children's yearly BMI z-score change was +0.03 (95% CI= -0.10, 0.15). Change during the COVID-19 pandemic was +0.34 (95% CI=0.21, 0.47), an acceleration in BMI z-score change of +0.31 (95% CI=0.19, 0.44). For girls and boys, BMI z-score change accelerated by +0.33 (95% CI=0.16, 0.50) and +0.29 (95% CI=0.12, 0.46), respectively, during the pandemic year. Acceleration in BMI z-score change during the pandemic year was observed for children who were Black (+0.41, 95% CI=0.21, 0.61) and White (+0.22, 95% CI=0.06, 0.39). For children classified as normal weight, BMI z-score change accelerated by +0.58 (95% CI=0.40, 0.76). Yearly BMI z-score change accelerated for lower elementary/primary (+0.23, 95% CI=0.08, 0.37) and upper elementary/primary (+0.42, 95% CI=0.42, 0.63) children. CONCLUSIONS: If similar BMI z-score accelerations occurred for children across the world, public health interventions to address this rapid unhealthy BMI gain will be urgently needed.