Covid-19 lockdown: Ethnic differences in childrens self-reported physical activity and the importance of leaving the home environment. A longitudinal and cross-sectional (preprint)

BackgroundIn England, the onset of COVID-19 and a rapidly increasing infection rate resulted in a lockdown (March-June 2020) which placed strict restrictions on movement of the public, including children. Using data collected from children living in a multi-ethnic city with high levels of deprivation, this study aimed to: (1) report childrens self-reported physical activity (PA) during the first COVID-19 UK lockdown and identify associated factors; (2) examine changes of childrens self-reported PA prior to and during the first UK lockdown. MethodsThis study is part of the Born in Bradford (BiB) COVID-19 Research Study. PA (amended Youth Activity Profile), sleep, sedentary behaviours, daily frequency/time/destination/activity when leaving the home, were self-reported by 949 children (9-13 years). A sub-sample (n=634) also self-reported PA (Physical Activity Questionnaire for Children) pre-pandemic (2017-February 2020). Univariate analysis assessed differences in PA between sex and ethnicity groups; multivariable logistic regression identified factors associated with childrens PA. Differences in childrens levels of being sufficiently active were examined using the McNemar test examined change in PA prior to and during the lockdown, and multivariable logistic regression to identify factors explaining change. ResultsDuring the pandemic, White British (WB) children were more sufficiently active (34.1%) compared to Pakistani Heritage children (PH) (22.8%) or Other ethnicity children (O) (22.8%). WB children reported leaving the home more frequently and for longer periods than PH and O children. Modifiable variables related to being sufficiently active were frequency, duration, type of activity, and destination away from the home environment. There was a large reduction in children being sufficiently active during the first COVID-19 lockdown (28.9%) compared to pre-pandemic (69.4%). ConclusionsPromoting safe extended periods of PA everyday outdoors is important for all children, in particular for children from ethnic minority groups. Childrens PA during the first COVID-19 UK lockdown has drastically reduced from before. Policy and decision makers, and practitioners should consider the findings in order to begin to understand the impact and consequences that COVID-19 has had upon childrens PA which is a key and vital behaviour for health and development.

Investigating the impact of London’s Ultra Low Emission Zone on children’s health: Children’s Health in London and Luton (CHILL): Protocol for a prospective parallel cohort study (preprint)

Introduction Air pollution harms health across the life course. Children are at particular risk of adverse effects during development, which may impact on health in later life. Interventions that improve air quality are therefore urgently needed not only to improve public health now, but to prevent longer-term increased vulnerability to chronic disease. Low Emission Zones are a public health policy intervention aimed at reducing traffic-derived contributions to urban air pollution, but evidence that they deliver clear health benefits is lacking. We established a natural experiment design study (CHILL: Children’s Health in London and Luton) to evaluate the impacts of the introduction of London’s Ultra Low Emission Zone (ULEZ) on children’s health. Methods and analysis CHILL is a prospective two-arm parallel longitudinal cohort study of children aged 6-9 years, attending primary schools in Central London (the focus of the first phase of the ULEZ) and Luton (a comparator site). The primary goal of the study is to examine the impact of changes in annual air pollutant exposures as oxides of nitrogen, nitrogen dioxide, particulate matter less than 2.5microns and 10microns (NOx, NO 2 , PM 2.5 , PM 10 respectively) across the two sites on lung growth, measured as forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC), over four consecutive years. Secondary outcomes being investigated include a range of respiratory health indicators as well as inequality and health economic measures. Ethics and dissemination Ethics approval has been given by Queen Mary University of London Research Ethics Committee (ref 2018/08). Dissemination will target audiences through a variety of channels, including research papers, conference and media presentations, web summaries and social media. CHILL is funded by National Institute for Health Research (NIHR) Public Health Research (Ref 16/139/09) with additional funding by Natural Environment Research Council, NIHR CLAHRC North Thames, NIHR ARC North Thames, and the Mayor of London. ClinicalTrials.gov: NCT04695093 Strengths and limitations of this study Strengths CHILL uses a prospective parallel cohort design, allowing robust conclusions to be drawn on the impact of the ULEZ - a major city-wide air quality mitigation strategy - on air quality and children’s respiratory health. CHILL study cohorts include children from large and ethnically diverse populations living in urban areas characterised by poor air quality. Limitations Attrition of study cohort population over time, although this has been accounted for in the original design of the study. Potential diminution of the ULEZ air pollution signal due to pre-compliance with ULEZ restrictions in the run up to the introduction of the scheme in Central London on the 8 th April 2019, and minor impacts of other pollution mitigation measures. Added complexity of accounting for effects of COVID-19 and related lockdowns on traffic flows, air quality and children’s health.

Vulnerabilities in child wellbeing among primary school children: a cross-sectional study in Bradford, UK (preprint)

ABSTRACT Objective To describe the prevalence of factors related to wellbeing among primary school children in a deprived multi-ethnic community. Design and participants Cross-sectional survey of 15,641 children aged 7-10 years in Born in Bradford’s Primary School Years study: whole-classroom samples in 89 Bradford primary schools between 2016 and 2019. Main outcome measures Prevalence estimates by ethnicity (%, 95% CI) of single and multiple vulnerabilities in child wellbeing within and across four domains (home, family, relationships; material resources; friends and school; subjective wellbeing). Results Only 10% of children have no vulnerabilities in any domain of wellbeing; 10% have one or more vulnerabilities in all four domains. The highest prevalence estimates were for being bullied some or all of the time (52.7%, 51.9 to 53.4%), keeping worries to oneself (31.2%, 30.5 to 31.9%), having no park near home (30.8%, 30.1 to 31.5%) and worrying all the time about how much money their family has (26.3%, 25.6 to 27%). Boys were consistently significantly more likely than girls to report all of the vulnerabilities in the Home, Family and Family Relationships domain, and the majority of indicators in the other domains, and in all domains except Friends and School, boys were significantly more likely to have at least one vulnerability. Girls were significantly more likely to report not having many friends (16.7%, 95% CI: 15.9 to 17.6% vs. 12.5%, 95% CI: 11.8 to 13.2%), being bullied some or all of the time (55.8%, 95% CI: 54.7 to 56.9% vs. 49.7%, 95% CI: 48.6 to 50.8%) and feeling left out all the time (12.1%, 95% CI: 11.4 to 12.8%) vs. 10.3%, 95% CI: 9.7 to 11.0%). Variations in vulnerabilities by ethnicity were complex, with children in Black, Asian and Minority Ethnic groups sometimes reporting more vulnerabilities and sometimes fewer than White British children. For example, compared to children of Pakistani heritage, White British children were more likely to say that their family never gets along well (6.3%,5.6 to 7.1% vs. 4.1%,3.6 to 4.6%) and to have no access to the internet at home (22.3%,21 to 23.6% vs. 18%,17 to 18.9%). Children with Pakistani heritage were more likely than White British children to say they had no park near their home where they can play with friends (32.7%,31.6 to 33.9% vs. 29.9%,28.6 to 31.3%), to report not having three meals a day (17.9%,16.9 to 18.8% vs. 11.9%,10.9 to 12.9%) and to worry all the time about how much money their families have (29.3%,28.2 to 30.3%) vs. 21.6%,20.4 to 22.9%). Gypsy/Irish Traveller children were less likely than White British children to say they were bullied some or all of the time (42.2%,35.4 to 49.4% vs. 53.8%,52.3 to 55.3%), but more likely to say they were mean to others all the time (9.9%,6.3 to 15.2% vs. 4%,3.5 to 4.7%) and can never work out what to do when things are hard (15.2%,10.6 to 21.2% vs. 9%, 8.2 to 9.9%). We considered six vulnerabilities to be of particular concern during the current Covid-19 pandemic and associated national and local lockdowns: family never gets along well together; no garden where child can play; no nearby park where they can play; not having 3 meals a day; no internet at home; worried about money all the time. Pre-pandemic, 37.4% (36.6 to 38.3%) of Bradford children had one of these vulnerabilities and a further 29.6% (28.9 to 30.4%) had more than one. Conclusions Although most primary school children aged 7-10 in our study have good levels of wellbeing on most indicators across multiple domains, fewer than 10% have no vulnerabilities at all, a worrying 10% have at least one vulnerability in all the four domains we studied and two thirds have vulnerabilities of concern during the Covid-19 lockdowns.