Adolescents' Substance Use and Physical Activity Before and During the COVID-19 Pandemic
Adolescents' Substance Use and Physical Activity Before and During the COVID-19 Pandemic
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DOI：
10.1001/jamapediatrics.2021.0541
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发表时间：
2021-05-03
期刊：
影响因子：
26.1
通讯作者：
Halpern-Felsher, Bonnie
中科院分区：
文献类型：
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作者：
Chaffee, Benjamin W.;Cheng, Jing;Halpern-Felsher, Bonnie
与COVID-19大流行相关的居家政策可能会扰乱青少年的物质使用和身体活动。目的比较居家限制前后青少年物质使用和身体活动行为。设计、环境和参与者：对2019年3月至2020年2月在北加州8所公立高中就读的九年级和十年级学生的烟草使用行为进行前瞻性队列研究，并于2019年9月至2020年9月进行随访。种族/民族从调查者提供的类别中自行分类，并根据烟草和物质使用方面的种族/民族差异收集。在加州，2020年3月19日实施了全州范围内的COVID-19居家令。在本研究中，订购前完成了521份六个月随访问卷，订购后完成了485份。在基线和随访时比较物质使用（即过去30天使用电子烟、其他烟草、大麻和酒精）和身体活动（活跃>= 5天/周）的流行程度。采用差异中的差异方法来评估如果随访发生在居家命令之后，根据基线行为和特征进行调整，从基线到6个月随访的变化是否会发生变化。所有模型均采用逆概率法对随访损失进行加权。根据基线特征和行为预测的随访反应（因变量）的逻辑回归模型得出权重。结果：1423名青少年在基线时入组，1006名完成了6个月的随访（623名[62%]为女性，492名[49%]为非西班牙裔白人）。电子烟的使用从基线下降到居家命令完成前6个月的随访(17.3%[515人中的89人]至11.3%[515人中的58人]；McNemar chi(2) = 13.54；确切P < 0.001)和居家治疗后完成6个月随访(19.9%[482例中的96例]至10.8%[482例中的52例]；McNemar chi(2) = 26.16；确切P < .001)，但在家庭主妇顺序前后作出反应的组之间，下降的程度没有统计学差异（差异中校正比值比为0.84;95% CI, 0.47-1.52; P = .58）。相比之下，如果在手术前进行随访，身体活动与基线相比没有变化（53.7%[520 / 279]至52.9% [520 / 275]）；McNemar chi(2) = 0.09；确切P = 0.82)，但如果在术后随访，则从基线急剧下降(54.0%[483例中的261例]至38.1%[483例中的184例]；确切P < .001)，表明居家秩序后与基线的变化有显著差异（差异中差校正优势比为0.49；95% CI为0.35-0.69;P < .001）。总体而言，在队列中，报告的其他烟草，大麻和酒精的使用在订单前后没有显着差异。结论和相关性在本队列中，电子烟使用的减少独立于COVID-19居家限制发生，但持续使用大麻和酒精表明继续需要青少年物质使用预防和戒烟支持。大流行期间身体活动减少是一个健康问题。
IMPORTANCE Stay-at-home policies related to the COVID-19 pandemic could disrupt adolescents' substance use and physical activity.OBJECTIVE To compare adolescents' substance use and physical activity behaviors before and after stay-at-home restrictions.DESIGN, SETTING, AND PARTICIPANTS Ongoing prospective cohort study of tobacco use behaviors among ninth- and tenth-grade students enrolled at 8 public high schools in Northern California from March 2019 to February 2020 and followed up from September 2019 to September 2020. Race/ethnicity was self-classified from investigator-provided categories and collected owing to racial/ethnic differences in tobacco and substance use.EXPOSURES In California, a COVID-19 statewide stay-at-home order was imposed March 19, 2020. In this study, 521 six-month follow-up responses were completed before the order and 485 were completed after the order.MAIN OUTCOMES AND MEASURES The prevalence of substance use (ie, past 30-day use of e-cigarettes, other tobacco, cannabis, and alcohol) and physical activity (active >= 5 days/week) was 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. All models were weighted for losses to follow-up using the inverse probability method. Weights were derived from a logistic regression model for having a follow-up response (dependent variable), as predicted by baseline characteristics and behaviors.RESULTS Of 1423 adolescents enrolled at baseline, 1006 completed 6-month follow-up (623 [62%] were female, and 492 [49%] were non-Hispanic White). e-Cigarette use declined from baseline to 6-month follow-up completed before the stay-at-home order (17.3% [89 of 515] to 11.3% [58 of 515]; McNemar chi(2) = 13.54; exact P < .001) and 6-month follow-up completed after the stay-at-home order (19.9% [96 of 482] to 10.8% [52 of 482]; McNemar chi(2) = 26.16; exact P < .001), but the extent of decline did not differ statistically between groups responding before vs after the stay-at-home order (difference-in-difference adjusted odds ratio, 0.84; 95% CI, 0.47-1.52; P = .58). In contrast, being physically active was unchanged from baseline if follow-up was before the order (53.7% [279 of 520] to 52.9% [275 of 520]; McNemar chi(2) = 0.09; exact P = .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 chi(2) = 30.72; exact P < .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 < .001). Overall in the cohort, reported use of other tobacco, cannabis, and alcohol did not differ meaningfully before and after the order.CONCLUSIONS AND RELEVANCE In this cohort, a reduction in e-cigarette use occurred independently of COVID-19 stay-at-home restrictions, but persistent cannabis and alcohol use suggest continued need for youth substance use prevention and cessation support. Declining physical activity during the pandemic is a health concern.