The COVID-19 pandemic has disrupted the economic stability, stress levels, and daily routines of many Canadian families. While governments work to open our economies, infectious disease and economic experts have indicated that our lives will not simply return to our pre-COVID-19 normality. Our way of life has fundamentally shifted. In order to identify how best to support families in this post-COVID-19 context, we need to understand how these fundamental changes have impacted families in Canada.
The government-mandated physical distancing restrictions to reduce the spread of COVID-19 likely have had a considerable impact on families’ health-related behaviors. Limited access to outdoor recreational facilities, such as parks and playgrounds, reduces the opportunity for families to be physically active. Closures of schools and child-care centers may have further reduced children’s activity levels as these settings are shown to be associated with increased physical activity [1
]. Reduced physical activity may also impact sleep quality and related routines [2
]. Furthermore, Canadian food purchasing has shifted in response to COVID-19; revenues from dry goods, shelf-stable foods, and frozen produce have drastically increased relative to the average of the previous year [3
]. This shift may influence family eating patterns and dietary intake. Lastly, as families navigate working and learning from home, time spent on screen-based devices has also reportedly increased [4
]. Collectively, these changes may have a lasting impact on health outcomes among parents and their children. While existing research has explored changes in health behaviors among adolescents and youth due to COVID-19 [5
], limited research has examined the impact of COVID-19 among families with young children. Given that the level of parental engagement in health behaviors is typically higher among families with young children versus those with older children and adolescents, the impact of COVID-19 may differ among these families as well. A clear understanding of how these changes have influenced the health behaviors, i.e., eating patterns, physical activity, sleep, and screen time, among families with young children is needed to inform family-based health promotion interventions that are relevant to the post-COVID-19 context.
In addition to the impact on health behaviors, COVID-19 also presents unique stressors that may impact families, including isolation or illness due to the virus, loss of employment with paralleled financial burdens, and coping with the abrupt shift in our everyday lives. A national survey among Canadians observed a significant decrease in mental health indices when compared to pre-COVID-19 benchmarks with 80% of respondents reporting the pandemic negatively impacting their mental health [8
]. Knowing the impact that family-level stress can have on the health behaviors and outcomes of parents [9
] and their children [11
], it is important to understand how COVID-19 has impacted stress and financial concerns among families with young children. This information will guide efforts to support families in managing stress while simultaneously promoting healthy behaviors during this unprecedented time.
The objective of this study is to examine how health behaviors (i.e., physical activity, eating patterns, sleep, screen time) and level of family stress, financial and food security among a sample of Canadian families have changed since the COVID-19 physical restrictions have been implemented. Identifying the impact that COVID-19 has had on families with young children will help inform the development of effective, family-based health promotion interventions that are relevant in this post-COVID-19 context.
Our study aimed to understand how health-related behaviors and level of stress, financial and food security have been impacted by the COVID-19 pandemic among a sample of Canadian families with young children. This is one of the first studies in Canada to identify the impact that COVID-19 has had on health-related behaviors and stress levels among families with young children. These findings will help inform how best to support families with young children during this unprecedented time.
One of the most substantive health behavior changes was screen time; 87% of children increased recreational screen use since COVID-19, which is similar to results among studies exploring changes in screen time among older children and adolescents [5
]. A systematic review by Stiglic and Viner [24
] exploring the health harms from excessive screen use in children and adolescents observed that higher levels of screen time to be strongly associated with greater adiposity, less healthful diets, depressive symptoms as well as lower quality of life. In our sample, while parents expressed concern about the amount of screen time their children were getting, many parents also identified structural changes that made it challenging to limit their children’s screen time such as using screens for children’s online learning/schooling and the need to use screens to engage their children while they completed their paid work from home. Parents in our sample requested ideas of screen-free activities that they could do with their children as ways to reduce their children’s screen time and increase their children’s physical activity. Our results suggest that guidance and resources to help parents manage their children’s screen time and physical activity during this time should acknowledge these structural challenges and should focus on balancing screen time with physically active, screen-free activities versus recommendations to meet screen time and movement guidelines.
In a recent study of 41 children and adolescents (mean age = 13 years) in Verona, Italy, Pietrobelli and colleagues [6
] observed a significant increase in potato chip, red meat, and sugary drink intakes during the COVID-19 lockdown. Although our measures of dietary intake differ from those of Pietrobelli and colleagues [6
], our study also found that many families reported eating more food and more snack foods (such as chips or cookies) since the COVID-19 pandemic. Given that many snack foods are high in added sugar, saturated fat, and sodium, this increase in snack food consumption may be of concern. Higher snack food consumption has been found to be associated with increased obesity risk among children and adolescents and increased risk for chronic disease among adults [25
]. Although many families reported increases in unhealthful behaviors, there were also notable healthful eating changes being reported since the pandemic. Roughly half of the parents and children whose eating had changed since the pandemic reported eating less fast food/take out. Many families also reported spending more time cooking, making more meals from scratch, eating with their children more often, as well as involving children more often in meal preparation. A survey of 300 adults in the US observed similar trends in cooking more from scratch and dining out less [26
]. A 5-year longitudinal study by Larson et al. [27
] demonstrated that involving adolescents in meal preparation appears to have a lasting positive influence on diet quality as well as the enjoyment of cooking in young adulthood. These healthful meal preparation habits may result in families nurturing healthy eating and meal preparation habits from a young age. As requested by parents in our sample, resources should be provided to help families with young children continue these positive behavior changes as COVID-19 physical distancing restrictions are lifted, parents return to work outside the home and children return to school. In addition, it will be important to measure how these meal preparation and routines change over time as COVID-19 restrictions are lifted in order to identify which families may need additional supports to sustain children’s engagement in meal preparation.
A pre-pandemic American survey indicated a national perceived stress average of 4.9 out of 10 [28
]. Parents surveyed during a COVID-19 poll reported an increase to 6.7 out of 10 [29
], which is similar to the mean stress level found in our sample. Children in this sample seem to be largely protected from fears of COVID-19, as indicated by nearly 50% of respondents saying their child was experiencing “very little” worry and only 7% reporting a high concern. It is possible that other stressors such as changes in routines, social isolation from friends, and adjusting to online schooling may be present, but were not captured in our survey. Some families reported that their children were misbehaving and acting out more often since the pandemic. It could be possible that some children are misbehaving in response to the stress associated with the abrupt shift in their day-to-day routines. In past public health crises, longer durations of quarantine were associated with worsening mental health [30
] and so it will be important to assess changes in family-level stress over time. Considering the physiological impact of stress on body function [31
] alongside the increased risk of chronic diseases [32
], minimizing family stress should continue to be a top priority in COVID-19 response plans and simultaneous efforts made to reduce the chances of such adversities.
Limited financial or food resources are substantial stressors that many Canadians may face during the COVID-19 pandemic. Many Canadians have experienced reduced work hours or job loss during the pandemic and parents’ ability to work is further complicated by school and child-care center closures. In our sample, approximately 20% of families reported concerns about paying their mortgage, rent, or other bills on time over the next six months. Job stability and financial concerns were also identified in the open-ended responses as key stressors among families. Our study also found that approximately 8% of families reported concerns about having enough money to purchase food for their family over the next six months. This is slightly lower than the national estimate of 12% of families experiencing food insecurity [33
]. Our sample consists of a large proportion of families with relatively high household income, which may explain these lower levels of food security concerns. Canadian food banks have experienced a 20% increase in demand, with some areas such as Toronto experiencing a 50% increased demand [34
]; a doubling of global food insecurity is predicted by the end of 2020 as a result of COVID-19 [35
]. Despite reports of panic-shopping in the early days of the pandemic [3
], Canada has a robust food supply system and government officials have assured the public that there is no anticipated food shortage as a result of COVID-19. These public messages may have helped to reassure parents in this sample, leading to a lower concern for food security observed in this study. Given that families with fewer financial and food resources are especially hard-hit in bio-emergencies [36
], a focus is needed on the long-term impact of COVID-19 among low-income families and on policies that ensure all Canadian families have adequate financial resources to weather these shocks to our economic system.
While our study provides an early understanding of the impact that COVID-19 may have on the health and wellbeing of families in Canada, some limitations should be considered when interpreting our results. First, our sample was predominantly Caucasian and roughly 56% had a household income over $100,000, which limits the generalizability of our results to lower-income and racial minority families. Second, all data were self-reported by parents and included parent perception of behavior change (vs. direct measure). The fact that 87% of parents reported an increase in their children’s screen time, which is not typically considered a desirable behavior, may however suggest that our results were not substantively influenced by social desirability bias. Finally, our study did not assess health outcomes, so it is unknown how the stressors and health behaviors assessed in this study are associated with family health status.
Among this sample of 254 families with young children, we found that the majority of families reported increased screen time and decreased physical activity since COVID-19 physical distancing restriction implementation. Over half of the families also reported changes to their eating habits and meal routines with some of those changes likely leading to improved diet quality, such as eating more meals from scratch, while others would be expected to lead to lower quality diets, such as eating more snack foods. Parents reported moderately high levels of stress; challenges related to balancing work with the added responsibility of homeschooling, concerns over contracting the COVID-19 virus, employment, and financial instability were identified as key stressors affecting families since the pandemic. Longitudinal research is needed to understand the impact of these behavior changes and stressors on health and weight-related outcomes among families. Our results suggest that COVID-19 response plans should include a focus on ensuring adequate income, minimizing family stress, and supporting healthful eating, activity, and screen-time behaviors among all Canadian families.