How did COVID-19 pandemic–related experiences vary by caregiver education level, child life stage, and urban vs. rural residence?

By Neha MathurAug 30 2023Reviewed by Lily Ramsey, LLM

In a recent article published in JAMA Network Open, researchers performed a cross-sectional analysis of the Environmental influences on Child Health Outcomes (ECHO) data collected between April 2020 and March 2022.

The study aimed to examine the varying experiences of children and caregivers in the United States (US) during the coronavirus disease 2019 (COVID-19) pandemic.

Study: Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States. Image Credit: FamVeld/Shutterstock.com

Background

The ongoing National Institutes of Health (NIH)–funded ECHO survey began capturing COVID-19 pandemic experiences in families across the US in April 2020.

This multi-cohort currently encompasses 64 individual cohorts, with 24,757 children and 31,700 caregiver participants from 50 US states and Puerto Rico.

The COVID-19 pandemic disproportionately disrupted the US children's and their families' day-to-day lives.

It led schools to shut down, caused disruptions in access to healthcare, and many child caregivers even experienced financial and health-related concerns due to the loss of jobs.

Most studies examining COVID-19 pandemic-related experiences among families in the US used publicly available administrative data (e.g., the Centers for Disease Control and Prevention data), which restricted their ability to capture the instantaneous experiences of children and their families during the pandemic.

These studies identified notable social inequities among adults; however, data gathered on the experiences of children and their caregivers was inadequate.

Understanding social inequities using population-based datasets of children could inform recovery efforts and support families during similar large-scale disruptions in the future.

About the study

In the present study, researchers used data from over 13,000 children and caregivers from the ECHO study, representing a socio-demographically, racially, ethnically, and geographically diverse population to examine independent associations between caregiver's educational status, child life stage, residence type, and varying COVID-19 pandemic-related experiences.

The authors used two distinct samples to describe varying COVID-19 pandemic-related experiences. They included data from caregivers (mostly mothers) who finished the ECHO COVID-19 surveys between April 2020 and March 2022.

Next, they derived the child analytical sample from the parent survey, considering only the earliest survey data if parents completed more than one survey per child.

Among sociodemographic measures, the team first classified caregivers into five groups based on their highest level of education. Secondly, they considered four child life stages for their assessments: infancy, early childhood, middle childhood, and young adulthood, with children aged zero to one year, one to five years, six to 11 years, and 12 to 21 years, respectively. Thirdly, they ascertained whether a child lived in an urban or rural area.

Further, the team collected self-reported race and ethnicity data from all the participants.

The team used logistic regression models to examine independent associations of each sociodemographic measure with COVID-19 pandemic-related experiences stratified by child life stage, caregivers' education level, and residence type (rural or urban).

Furthermore, the researchers examined each child's analytical sample for COVID-19 testing, healthcare, school, or daycare access. Among caregivers, they focused on whether they had difficulty arranging childcare and transitioning to remote work to care for children.

Other COVID-19-related stressors evaluated for caregivers were accessibility to food, health or financial concerns, social distancing or quarantining effects, and the overall impact of the pandemic on their child, family, and work.

Results

The child dataset had 14,646 participants from 57 cohorts with a mean age of 7.1 years, of which 49% were female. They self-reported their race as American Indian (3%), Asian (3%), Black (14%), Hispanic (24%), and White (65%).

The remaining 1,443 children belonged to more than one race. Compared to the ECHO cohort, the study cohort had a large proportion of rural participants (16% vs. 13%). 

Likewise, the caregiver dataset had 13,653 adult participants, with a mean age of 37.6 years, of which 98% were females.

Compared to the ECHO cohort, it had fewer Hispanic and more rural participants. In addition, this dataset overrepresented and underrepresented Black and Asian caregivers, respectively.

Caregivers with lower educational status were more likely to postpone/cancel their children's healthcare appointments due to COVID-19-related concerns and had more food access-related and financial concerns. Moreover, they were less likely to consider working remotely. 

Conversely, caregivers with higher educational status faced challenges arranging childcare and endorsed social distancing and impacts on work or their child as top stressors.

Furthermore, the authors noted that rural caregivers were less likely to consider social distancing a pandemic-related stressor than urban caregivers.

In addition, children aged 1-5 (young) were least likely to receive support from schools during pandemic-induced closures.

Conclusions

Overall, the study findings highlighted the inequitable COVID-19 pandemic-related burden on US families with lower socioeconomic status and young children. Policymakers should prioritize these vulnerable groups in recovery efforts and offer more support to them during future public health crises. 

Future studies should evaluate the long-term impacts of the COVID-19 pandemic among children as ECHO data grows. Additionally, they could consider refining the nuanced associations observed in this study.