Parental decision-making on summer program enrollment: A mixed methods Covid-19 impact study.

BACKGROUND: The closure of childcare organizations (e.g. schools, childcare centers, afterschool programs, summer camps) during the Covid-19 pandemic impacted the health and wellbeing of families. Despite their reopening, parents may be reluctant to enroll their children in summer programming. Knowledge of the beliefs that underlie parental concerns will inform best practices for organizations that serve children. METHODS: Parents (n = 17) participated in qualitative interviews (October 2020) to discuss Covid-19 risk perceptions and summer program enrollment intentions. Based on interview responses to perceived Covid-19 risk, two groups emerged for analysis- "Elevated Risk (ER)" and "Conditional Risk (CR)". Themes were identified utilizing independent coding and constant-comparison analysis. Follow-up interviews (n = 12) in the Spring of 2021 evaluated the impact of vaccine availability on parent risk perceptions. Additionally, parents (n = 17) completed the Covid-19 Impact survey to assess perceived exposure (Range: 0-25) and household impact (Range: 2-60) of the pandemic. Scores were summed and averaged for the sample and by risk classification group. RESULTS: Parents overwhelmingly supported the operation of summer programming during the pandemic due to perceived child benefits. Parent willingness to enroll their children in summer programming evolved with time and was contingent upon the successful implementation of safety precautions (e.g. outdoor activities, increased handwashing/sanitizing of surfaces). Interestingly, parents indicated low exposure (ER: Avg. 6.3 ± 3.1 Range [2-12], CR: Avg. 7.5 ± 3.6 Range [1-14]) and moderate family impact (ER: Avg. 27.1 ± 6.9 Range [20-36], CR: Avg. 33.7 ± 11.4 Range [9-48]) on the impact survey. CONCLUSION: Childcare organizations should mandate and evaluate the implementation of desired Covid-19 safety precautions for their patrons.

Patterns of Food Security and Dietary Intake Among Children Across the U.S. Child Tax Credit Expansion

Objectives Families with lower economic resources are at higher risk for experiencing food insecurity and suboptimal diet quality. During COVID-19, the novel expansion to the U.S. Child Tax Credit (CTC) provided families from lower income backgrounds with unconditional cash assistance ($250–300 per child, each month) from July to December 2021. This additional income has potential to improve food security and diet quality, if spent towards food resources. This study aimed to examine patterns of food insecurity and children's dietary intake before and during monthly CTC payments. Methods Parents (N = 621) with a child ages 2–10 years who qualified for the full CTC benefit were enrolled. Three online surveys were completed baseline (T0: June 2021) and at two timepoints during (T1: September 2021;T2: December 2021) the CTC expansion. The validated 18-item USDA Food Security Module, NCI Dietary Screening Questionnaire, and Beverage Intake Questionnaire were administered at each timepoint. Repeated measures analysis of variance models will examine changes in dietary intake before and during the CTC expansion. Results To date, data from T0 and T1 have been analyzed. Late-breaking data that include T2 results will be presented at Nutrition 2022. At T1, after receiving 3 monthly payments, 45.9% of parents reported spending CTC funds on foods/beverages. This was the most commonly reported use of CTC funds, particularly for families with very low food security (63.0%). From T0 to T1, families with very low food security decreased (T0: 12.7% vs. T1: 5.6%), while food security increased (T0: 57.4% vs. T1: 66.4%). Children's consumption of added sugar, sugar-sweetened beverages, and sweetened fruit juice decreased over time (qs < .05). No changes were observed in other dietary components (qs > .05). Conclusions Initial patterns indicate promise that CTC monthly payments are associated with reduced household food insecurity and lower sugar-sweetened beverage intake among children. This line of research can inform legislative decisions regarding the maintenance of this policy mandate, by enhancing understanding of the CTC expansion's impact on children's food security and nutritional intake. Funding Sources Child Health Research Institute at Virginia Commonwealth University and NIH (2T32CA093423) for ELA effort.

Patterns Of Food Security And Dietary Intake During The First Half Of The Child Tax Credit Expansion.

Temporary expansion of the Child Tax Credit (CTC) during the COVID-19 pandemic provided additional monthly income for US families, with no restrictions on use, from July through December 2021. This study examined food security and children's dietary intake after three months of expanded CTC payments. Parents completed online surveys before and after three months of CTC payments. Among parents participating in the expansion, food and beverage purchases were the most common use of expanded CTC funds (45.9 percent), particularly in households with very low food security (63.0 percent). From before to midway through the CTC expansion, very low food security decreased from 12.7 percent to 5.6 percent, and simultaneously, food security increased from 57.4 percent to 66.4 percent. The CTC expansion was also associated with decreases in children's consumption of added sugar, sugar-sweetened beverages, and sweetened fruit beverages. No changes were observed in children's intake of other dietary components. Our findings suggest that the expanded CTC payments may have helped lessen food insecurity and supported reductions in children's intake of added sugar in participating households.

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.