Exposome changes in primary school children following the wide population non-pharmacological interventions implemented due to COVID-19 in Cyprus: a national survey

Abstract

Background: School closures were part of a series of non-pharmacological intervention (NPI) measures addressing the COVID-19 pandemic in Cyprus. We aimed to study changes in the environment, diet, behavior, personal hygiene, contacts, lifestyle choices and the degree of compliance to NPI measures by primary school children in Cyprus at school and at home for two periods, i.e., before lockdown and during the school re-opening using the methodological context of the human exposome. Methods: During June 2020, an online survey questionnaire was forwarded to parents of primary school children through schools administrations, with questions about the children lifestyle/behaviours for two periods; school re-opening, following the population-wide lockdown (May 21-June 26, 2020), and the school period before lockdown (before March 2020). Descriptive statistics and exposome wide association analysis were implemented to agnostically assess associations of demographic, lifestyle and behavioral parameters with the degree of compliance to NPI measures. Findings: A total of 1509 children from more than 180 primary schools (out of 330 schools) in Cyprus were included. Median number of contacts per day at home, school and other places during weekdays was lower (p<0.001) in the post-lockdown period compared to the pre-lockdown period (5 vs 12, 10 vs 29 and 6 vs 14, respectively). Vulnerable contacts with children also decreased from 2[1, 3] in the pre-lockdown to 1[0, 2] in the post-lockdown period (p<0.001). Differences in sugary and ready-made food consumption, physical activity, screen time, digital communication and hand hygiene were noted between the two periods. More than 72% of children complied with the NPI measures, with the exception of the decrease in number of vulnerable contact(s) indicator (48%). Eating meat more frequently post-lockdown and doing less physical activity during school break post-lockdown were positively associated with increased time spent at home post-lockdown. Furthermore, the odds of compliance, as indicated by the time spent at home post-lockdown were lower with days elapsing from school re-opening, living in smaller town and using antiseptic more frequently pre-lockdown. Interpretation: In this national survey, children showed a high degree of compliance to most NPI measures for the community and primary school settings in Cyprus. The initial NPI measures may have affected children exposome profile in the following months, by altering their diet, physical activity, sedentary lifestyle and hand hygiene habits.

Impacts of school closures on physical and mental health of children and young people: a systematic review

“…All COVID-19 data included here are short-term and relate to the first pandemic wave. There is concerning evidence that harmful changes in PA, screentime and diet can continue once schools are reopened, 104 emphasising the potential for persisting harms. Longer-term harms are likely to be magnified by further school closures in subsequent waves.…”

Physical Activity, Eating Behaviour and Well-Being During a COVID-19 Period Among Greek Adolescents

“…This is an unsurprising finding because sedentary time has been repeatedly associated with deteriorated well-being components (e.g., depression) in large-scale epidemiological studies across adolescents [7,8] and adult populations [3]. Moreover, adolescents living in COVID-19 lockdowns have demonstrated increased sedentariness and low well-being [14][15][16][17][18][19]; sitting time in particular has dramatically increased [34] and clearly related with deteriorated well-being components including sleeping patters and depressive and anxiety symptoms [37]. Tackling sedentary time in Greek adolescents during the COVID-19 pandemic and involved lockdowns should thus be prioritized to decrease sitting time modalities such as the widespread screen time.…”

“…However, physical activity and well-being are decreasing worldwide after the COVID-19 pandemic declaration by the WHO in March 2020. Particularly, lockdown measures via social distance restrictions including closures of schools, leisure facilities and sport clubs have been repeatedly introduced to contain the spread of the SARS-CoV-2 virus but led adolescents to lower physical activity and well-being [14][15][16][17][18][19]. In this rather grief reality, some encouraging findings were provided by a study conducted in China [16], which reported that even limited weekly physical activity (>60min of weekly) was linked to lower risk of deteriorated well-being in young people during the COVID-19 pandemic In line, the WHO [13] recommends >60min/day of moderate-vigorous physical activity for better mental health in adolescents.…”