An Analysis of Covid-19 Public Health Measure Adherence among Parents and Children and the Corresponding Effects of Lockdowns and School Closures

ABSTRACT

BACKGROUND: Public health preventive measures have been a necessary intervention in preventing COVID-19 transmission. OBJECTIVE(S) The objectives of this study were 1) To investigate how the adherence to COVID-19 public health measures among parents and children in Ontario changed over time;2) To determine if provincial lockdowns were associated with higher adherence to public health measures among parents;3) To determine if school closures were associated with higher adherence to public health measures among children. DESIGN/METHODS: A longitudinal study was conducted in children aged 0-10 years and their parents through the TARGet Kids! COVID-19 Study of Children and Families in the Greater Toronto Area, Canada (April 2020 -May 2021). Parents completed weekly questionnaires on sociodemographics and public health practices. The primary exposure was calendar date. Secondary exposures were provincial lockdowns and school closures. The primary outcome was adherence to public health preventive measures (staying home, limiting visitors in the home, avoiding contact with others, socially distancing, and handwashing, measured as number of days practicing per week) measured separately for parents and children. Linear mixed effects regression and piecewise linear splines mixed effects models were conducted. RESULT(S) 819 children and their parents contributed 13,220 observations to the study over 13 months. Mean age was 5.6 years (SD=2.7) and 373 were female (45.5%). 273 children (35.1%) had a parent who worked as an essential worker and 254 (35.4%) of families lived in a COVID-19 'hotspot'. The number of days per week that parents adhered to all 5 public health measures decreased by 0.029 days (p<0.001), and by 0.146 days for children (p<0.001) over the study duration. For parents, adherence to the five public health measures decreased over time during the first lockdown (beta=- 0.06, p<0.001) and first reopening (beta=-0.01, p<0.001), but increased again during the second lockdown (beta=0.01, p<0.001). For children, adherence to the five public health measures decreased over time during the first school closure, increased during the second closure, and decreased during second reopening (beta=-0.04, p<0.01). See Figure 1. CONCLUSION(S) Parents and children both decreased in their adherence to social distancing, staying at home, and avoiding contact with others over time. Lockdown after a period of reopening increased parent adherence to public health measures and school closures increased adherence in children. Supports may be necessary to help children and parents maintain adherence to public measures over prolonged periods of lockdown and school closure. .