Maximova Katerina, Wu Xiuyun, Khan Mohammed K A, Dabravolskaj Julia, Sim Shannon, Mandour Boshra, Pabayo Roman, Veugelers Paul J
MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St, Toronto, Ontario, M5B 1T8, Canada.
Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, Ontario, M5T 3M7, Canada.
SSM Popul Health. 2023 Jun 12;23:101454. doi: 10.1016/j.ssmph.2023.101454. eCollection 2023 Sep.
The COVID-19 pandemic has negatively affected children's lifestyle behaviours and mental health and wellbeing, and concerns have been raised that COVID-19 has also increased health inequalities. No study to date has quantified the impact of COVID-19 on health inequalities among children. We compared pre-pandemic vs. post-lockdown inequalities in lifestyle behaviours and mental health and wellbeing among children living in rural and remote northern communities.
We surveyed 473 grade 4-6 students (9-12 years of age) from 11 schools in rural and remote communities in northern Canada in 2018 (pre-pandemic), and 443 grade 4-6 students from the same schools in 2020 (post-lockdown). The surveys included questions on sedentary behaviours, physical activity, dietary intake, and mental health and wellbeing. We measured inequality in these behaviors using the Gini coefficient, a unitless measure ranging from 0 to 1 with a higher value indicating greater inequality. We used temporal changes (2020 vs. 2018) in Gini coefficients to assess the impact of COVID-19 on inequalities in lifestyle behaviours and mental health and wellbeing separately among girls and boys.
Inequalities in all examined lifestyle behaviours increased between 2018 and 2020. Inequalities in watching TV, playing video games, and using a cell phone increased among girls, while inequalities in playing video games, using computers and tablets, and consumption of sugar, salt, saturated fat and total fat increased among boys. Changes in inequalities in mental health and wellbeing were small and not statistically significant.
The findings suggest that the COVID-19 pandemic has exacerbated inequalities in lifestyle behaviours among children living in rural and remote northern communities. If not addressed, these differences may translate into exacerbated inequalities in future health. The findings further suggest that school health programs can help mitigate the negative impact of the pandemic on lifestyle behaviours and mental health and wellbeing.
新冠疫情对儿童的生活方式行为以及心理健康和幸福产生了负面影响，人们担心新冠疫情还加剧了健康不平等。迄今为止，尚无研究对新冠疫情对儿童健康不平等的影响进行量化。我们比较了加拿大北部农村和偏远社区儿童在疫情前与封锁后生活方式行为、心理健康和幸福方面的不平等情况。
我们在2018年（疫情前）对加拿大北部农村和偏远社区11所学校的473名四至六年级学生（9至12岁）进行了调查，并于2020年（封锁后）对同一学校的443名四至六年级学生进行了调查。调查问题包括久坐行为、体育活动、饮食摄入以及心理健康和幸福方面的问题。我们使用基尼系数来衡量这些行为的不平等程度，基尼系数是一个无量纲的指标，范围从0到1，数值越高表明不平等程度越大。我们利用基尼系数的时间变化（2020年与2018年相比）分别评估新冠疫情对女孩和男孩生活方式行为、心理健康和幸福不平等的影响。
在2018年至2020年期间，所有被调查的生活方式行为的不平等程度都有所增加。女孩中看电视、玩电子游戏和使用手机的不平等程度增加，而男孩中玩电子游戏、使用电脑和平板电脑以及糖、盐、饱和脂肪和总脂肪摄入量的不平等程度增加。心理健康和幸福方面不平等程度的变化很小，且无统计学意义。
研究结果表明，新冠疫情加剧了加拿大北部农村和偏远社区儿童生活方式行为的不平等。如果不加以解决，这些差异可能会导致未来健康方面的不平等加剧。研究结果还表明，学校健康计划有助于减轻疫情对生活方式行为以及心理健康和幸福的负面影响。
