The Covid-19 pandemic led to dramatic changes in people’s health behaviors, including an uptick in substance use among U.S. adults—but, Benjamin W. Chaffee, DDS, MPH, PhD, of the University of California San Francisco, and colleagues say the pandemic’s effect on adolescents and teens is not a mirror image of the impact observed among their elders.
For example, a pair of recent cross-sectional studies—one from Canada and another from the U.S.—found that teens reported lower rates of e-cigarette and cannabis use, as well as lower rates of binge drinking, but those pandemic benefits are combined with a sharp decline in physical activity, according to results from a prospective analysis of data collected from high school students in Northern California.
Chaffee and colleagues looked at findings from a cohort of 1,423 public high school students recruited from Northern California from March 2019-February 2020, with follow-up as of September 2020. Coincidentally, California governor Gavin Newsom issued a statewide stay-at-home order on March 19, 2020 due to the growing Covid-19 pandemic. Roughly half of the study cohort completed the baseline survey from March-May 2019, with six-month follow-up prior to the stay-at-home order, while the rest completed the baseline survey from August-February 2020 and completed follow-up after the order, allowing Chaffee and colleagues to evaluate “behavioral changes over time as a function of whether follow-up responses were made before or after the statewide stay-at-home order.”
The results of their analysis were published in JAMA Pediatrics.
Chaffee and colleagues found that the overall reported use of tobacco, cannabis, and alcohol use was not altered substantially following school closures and other social distancing measures implemented due to the Covid-19 pandemic. Meanwhile, “achieving at least five days of vigorous physical activity a week was notably less common following the California stay-at-home order,” they reported. “These findings suggest a need for parents and schools to continue substance use prevention efforts and to dedicate additional attention to physical activity promotion.”
In an editorial accompanying the study, Sherry L. Pagoto, PhD, of the University of Connecticut in Storrs, Connecticut, and David E. Conroy, PhD, of the Pennsylvania State University in University Park, Pennsylvania, suggested that the decline in physical activity can be attributed to cancellation of youth sports, a decline in active commuting due to online learning, and restrictions to face-to-face socializing that cut off teens’ ability to participate in group activities. And, without the proper interventions, this downward trend may have dangerous consequences for future health.
“What will happen to adolescents’ physical activity, substance use, and other health behaviors when school, sports, and social activities resume?”, they asked. “Interventions may be needed to ensure that physical activity levels rebound to prepandemic levels to prevent this cohort of adolescents from experiencing a premature decline in physical activity, which could track into adulthood and increase the risk for chronic disease later in life. Given that healthy and unhealthy behaviors that are established in adolescence often extend into adulthood, a deep exploration into the association between adolescent health behaviors during the pandemic and health outcomes is needed in the post-Covid-19 era.”
This prospective cohort study included students attending eight public high schools in Northern California—study staff visited each school to explain the study objectives and distribute parental consent and student assent forms. The study staff then returned one to two weeks later and assigned individual identifiers and administer electronic baseline surveys. Six-month follow-up surveys were administered remotely using personalized survey links sent via either text or email, and students received a $10 gift card to an online retailer for each survey wave completed. Of the 1,423 study participants, 1,006 completed six-month follow-up (623 [62%] female, 492 [49%] non-Hispanic White).
The main study outcomes were substance use (i.e., past 30-day use of e-cigarettes, other tobacco, cannabis, and alcohol) and physical activity (active ≥5 days/week), compared at baseline and follow-up. “A difference-in-difference approach was used to assess whether changes from baseline to 6-month follow-up varied if follow-up occurred after the stay-at-home order, adjusting for baseline behaviors and characteristics,” the study authors wrote.
Chaffee and colleagues found that “being physically active [for ≥5 days/week] was unchanged from baseline if follow-up was before the [stay-at-home] order (53.7% [279 of 520] to 52.9% [275 of 520]; McNemar χ2=0.09; exact P=0.82) but declined sharply from baseline if follow-up was after the order (54.0% [261 of 483] to 38.1% [184 of 483]; McNemar χ2=30.72; exact P<0.001), indicating a pronounced difference in change from baseline after the stay-at-home order (difference-in-difference adjusted odds ratio, 0.49; 95% CI, 0.35-0.69; P<0.001),” they wrote. “Overall in the cohort, reported use of other tobacco, cannabis, and alcohol did not differ meaningfully before and after the order.”
The study authors wrote that enhancing physical activity in teens during the pandemic will require novel and creative strategies, “especially given suspended interscholastic sports seasons, potentially restricted access to exercise venues, such as gyms, recreation centers, parks and trails, and restrictions on nonessential travel to exercise spaces.”
In their editorial, Pagoto and Conroy argued that fostering a resilient, physically active lifestyle among adolescents can potentially offset this issue, and that doing so will require “teaching youths to anticipate and plan for disruptions to their physical activity” and instilling “intrinsic motivation,” or a desire to participate in exercise for its own sake.
“Youths who enjoy exercise and consider it to be part of their core values are more likely to continue being active,” they wrote. Facilitating these drivers inside and outside the context of sports could improve resilience among youths. Exercise enjoyment can be derived from both the social and motivational context of exercise and the activity’s impact on mood, making it important to help children select activity types, durations, and intensities that make them feel good. Exercise has been found to have an acute impact on mood and has been used successfully as treatment for depression. Avoiding physical activities that create unfavorable experiences is also important as this likely would counteract the benefits of exercise in improving mood.”
They added that digital health technologies “that leverage social connection to enhance the physical activity experience” could potentially help overcome the impact of loss of face-to-face socializing on teen physical activity.
Interestingly, the study authors noted that e-cigarette use declined from baseline to six-month follow-up completed after the stay-at-home order (19.9% [96 of 482] to 10.8% [52 of 482]; McNemar χ2= 26.16; exact P<0.001)—however, it also declined among those with six-month follow-up before the order (17.3% [89 of 515] to 11.3% [58 of 515]; McNemar χ2=13.54; exact P<0.001), and the difference in the extent of the decline was not statistically significant between the two groups (difference-in-difference adjusted odds ratio, 0.84; 95% CI, 0.47-1.52; P=0.58).
They argued that one possible explanation for reduced e-cigarette use prior to the pandemic is fear following the outbreak of e-cigarette or vaping product use associated lung injury, or EVALI, a health care emergency that received a lot of media attention before being eclipsed by the more pressing Covid-19 pandemic. “A pending question,” they added, “is whether declines in e-cigarette use will persist after media attention to EVALI fades.”
Study limitations include a possible lack of generalizability and the inability to account for factors beyond the Covid-19 pandemic that may have impacted teen substance use and physical activity.
- Covid-19 stay-at-home orders did not have any notable impact on rates of adolescent substance use, but they did have a substantial impact on physical activity levels.
- These findings suggest that parents and schools should continue substance use prevention efforts and dedicate additional attention to physical activity promotion.
John McKenna, Associate Editor, BreakingMED™
Chaffee reported personal fees from Westat for consulting related to design and data analysis of studies of tobacco and oral health. Coauthor Halpern-Felsher reports personal fees from e-cigarette litigation outside the submitted work and is an unpaid scientific advisor and expert witness regarding some tobacco-related policies.
Pagoto reported receiving grants from the National Institutes of Health and the National Science Foundation and personal fees from Fitbit outside the submitted work. Conroy reported receiving grants from the National Institutes of Health, National Science Foundation, and American Institute for Cancer Research and personal fees from Gelesis and Rutgers University/Rutgers Cancer Institute of New Jersey outside the submitted work.
Cat ID: 138
Topic ID: 85,138,730,138,192,144,925
