Sociodemographic Differences in COVID-19 Pandemic Experiences Among Families in the United States

• Type of Material: Article
• Authors: Daniel J. Jackson, University of Wisconsin; Robert A. Wood, Johns Hopkins University; Tina V. Hartert, Vanderbilt University; Young Shim Kim, University of California San Francisco; Cristiane S. Duarte, Columbia University; Julie B. Schweitzer, University of California Davis; Barry M. Lester, Brown Alpert Medical School; Cynthia T. McEvoy, Oregon Health and Science University; Thomas G. O'Connor, University of Rochester; Emily Oken, Harvard University; Nicole Bornkamp, Harvard University; Eric D. Brown, Jr., University of North Carolina Chapel Hill; Christina A. Porucznik, University of Utah; Assiamira Ferrara, Kaiser Permanente Northern California; Carlos A. Camargo, Jr., Harvard University; Qi Zhao, University of Tennessee; Jody M. Ganiban, George Washington University; Lisa P. Jacobson, Johns Hopkins University; Kaja Z. LeWinn, University of California San Francisco; Leonardo Trasende, New York University; Andrew Law, Johns Hopkins University; Courtney K. Blackwell, Northwestern University; Traci A. Bekelman, University of Colorado; Jessica A. Arizaga, University of California San Francisco; Alexis A. Sullivan, University of California San Francisco; Theresa M. Bastain, University of Southern California; Carrie V. Breton, University of Southern California; Margaret R. Karagas, Dartmouth University; Amy J. Elliott, Avera Health Institute; Catherine J. Karr, University of Washington; Kecia N. Carroll, Icahn School of Medicine at Mount Sinai; Anne Lang Dunlop, Emory University; Lisa A. Croen, Kaiser Permanente Northern California; Amy E. Margolis, Columbia University; Akram N. Alshawabkeh, Northeastern University; Jose F. Cordero, University of Georgia; Anne Marie Singh, University of Wisconsin; Christine M. Seroogy, University of Wisconsin
• Language: English
• Date: 2023-08
• Publisher: JAMA
• Publication Version: Final Published Version
• Copyright Statement: 2023 LeWinn KZ et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1001%2Fjamanetworkopen.2023.30495
• Title of Journal or Parent Work: JAMA Network Open
• Volume: 6
• Issue: 8
• Start Page: e2330495
• Grant/Funding Information: Research reported in this publication was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of the Director, National Institutes of Health, under Award Numbers U2COD023375 (Coordinating Center), U24OD023382 (Data Analysis Center), U24OD023319 with cofunding from the Office of Behavioral and Social Science Research (PRO Core), UH3OD023251 (Alshawabkeh), UH3OD023320 (Aschner), UH3OD023332 (Trasande), UH3OD023253 (Camargo), UH3OD023248 (Dabelea), UH3OD023313 (Koinis Mitchell), UH3OD023328 (Duarte), UH3OD023318 (Dunlop), UH3OD023279 (Elliott), UH3OD023289 (Ferrara), UH3OD023282 (Gern), UH3OD023287 (Breton), UH3OD023365 (Hertz-Picciotto), UH3OD023244 (Hipwell), UH3OD023275 (Karagas), UH3OD023271 (Karr), UH3OD023347 (Lester), UH3OD023389 (Leve), UH3OD023268 (Weiss), UH3OD023288 (McEvoy), UH3OD023342 (Lyall), UH3OD023349 (O’Connor), UH3OD023286 (Oken), UH3OD023348 (O’Shea), UH3OD023285 (Kerver), UH3OD023290 (Herbstman), UH3OD023272 (Schantz), UH3OD023249 (Stanford), UH3OD023305 (Trasande), UH3OD023337 (Wright).
• Keywords: caregivers; children; sociodemographically diverse sample; Environmental influences on Child Health Outcomes (ECHO); COVID-19
• Research Categories: Health Sciences, Public Health; Sociology, Public and Social Welfare

Abstract

Importance Few population-based studies in the US collected individual-level data from families during the COVID-19 pandemic. Objective To examine differences in COVID-19 pandemic–related experiences in a large sociodemographically diverse sample of children and caregivers. Design, Setting, and Participants The Environmental influences on Child Health Outcomes (ECHO) multi-cohort consortium is an ongoing study that brings together 64 individual cohorts with participants (24 757 children and 31 700 caregivers in this study) in all 50 US states and Puerto Rico. Participants who completed the ECHO COVID-19 survey between April 2020 and March 2022 were included in this cross-sectional analysis. Data were analyzed from July 2021 to September 2022. Main Outcomes and Measures Exposures of interest were caregiver education level, child life stage (infant, preschool, middle childhood, and adolescent), and urban or rural (population <50 000) residence. Dependent variables included COVID-19 infection status and testing; disruptions to school, child care, and health care; financial hardships; and remote work. Outcomes were examined separately in logistic regression models mutually adjusted for exposures of interest and race, ethnicity, US Census division, sex, and survey administration date. Results Analyses included 14 646 children (mean [SD] age, 7.1 [4.4] years; 7120 [49%] female) and 13 644 caregivers (mean [SD] age, 37.6 [7.2] years; 13 381 [98%] female). Caregivers were racially (3% Asian; 16% Black; 12% multiple race; 63% White) and ethnically (19% Hispanic) diverse and comparable with the US population. Less than high school education (vs master’s degree or more) was associated with more challenges accessing COVID-19 tests (adjusted odds ratio [aOR], 1.88; 95% CI, 1.06-1.58), lower odds of working remotely (aOR, 0.04; 95% CI, 0.03-0.07), and more food access concerns (aOR, 4.14; 95% CI, 3.20-5.36). Compared with other age groups, young children (age 1 to 5 years) were least likely to receive support from schools during school closures, and their caregivers were most likely to have challenges arranging childcare and concerns about work impacts. Rural caregivers were less likely to rank health concerns (aOR, 0.77; 95% CI, 0.69-0.86) and social distancing (aOR, 0.82; 95% CI, 0.73-0.91) as top stressors compared with urban caregivers. Conclusions Findings in this cohort study of US families highlighted pandemic-related burdens faced by families with lower socioeconomic status and young children. Populations more vulnerable to public health crises should be prioritized in recovery efforts and future planning.