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A caregiver’s education level and their child’s age played large roles in determining their primary sources of stress during the COVID-19 pandemic, researchers found in a recent study by NIH’s Environmental influences on Child Health Outcomes (ECHO) Program. Caregivers who had less than a high school education were less likely to work remotely and were more worried about finances, childcare, and access to necessities like food. Caregivers with a master’s degree or higher reported greater concern about social distancing and impacts on their work.

The social factors that influenced infection rates, disease severity, and financial burden among adults during the pandemic have been broadly documented. However, ECHO researchers wanted to understand the experiences of children and their caregivers.

“Understanding these experiences can help uncover social differences that could worsen conditions for some populations during future public health crises,” said Kaja Z. LeWinn, ScD of the University of California, San Francisco.

Conducting population-based studies during the pandemic was challenging, but by using existing ECHO Program research sites across the United States and COVID-19 questionnaires, researchers were able to see how social and economic factors were affecting families and children throughout the height of the pandemic. The study analyzed data from 14,646 ECHO children and 13,644 ECHO caregivers between April 2020 and March 2022.

Caregivers completed ECHO’s COVID-19 surveys about their child’s and their own experiences during the pandemic. Researchers measured how the pandemic affected caregivers based on three demographic characteristics—caregiver education, their child’s age, and whether they lived in urban or rural settings. Researchers documented different pandemic-related outcomes for children and caregivers and compared these outcomes across demographic groups. For children, researchers documented COVID-19 infection, availability of COVID-19 testing, healthcare changes, and disruptions to school and daycare. For caregivers, researchers asked questions about remote work, childcare challenges, and their personal ranking of pandemic-related stressors.

Education affected caregiver experiences

Researchers found that caregivers with less than a high school education were more likely to report difficulties getting COVID-19 tests for their children. Caregivers also cited financial concerns and access to necessities such as food as primary sources of stress. In contrast, caregivers with a master’s degree or higher were more likely to name social distancing as the top source of their pandemic-related stress.

The study's findings also indicate that caregivers with higher education were significantly more likely to have the option to work remotely. Caregivers with a high school or less education were less likely to be able to work remotely or change work schedules to care for their children compared to those with a master’s degree or greater. Even though those with a bachelor’s degree were less likely than those with a master’s degree to work remotely, they were still more likely than those with lower education to change their work schedule to care for children.

Interestingly, the opposite relationship existed for arranging childcare. Those with a master’s degree or higher reported more challenges finding childcare than those with less than a high school education. There is evidence suggesting greater rates of childcare center closures in areas where people had higher levels of education. Informal childcare arrangements among families with lower education levels may have been less affected by center closures.

Caregivers of young children faced more challenges

Caregivers with children between the ages of 1 and 5 years reported the least support from school systems, the most difficulty finding childcare, and fewer remote learning options. They were also more likely to have healthcare appointments canceled due to COVID‑19 concerns and were most concerned about how the pandemic would affect their ability to work.

“Our findings suggest that families with young children may need more support related to childcare and work flexibility, especially when school disruptions are involved,” Dr. LeWinn said.

Researchers observed few differences in the experiences of urban and rural residents.

Future research may investigate the long-term effects these pandemic challenges may have on children in the ECHO Program over time.

Dr. LeWinn and Lisa Jacobson, ScD of Johns Hopkins University led this collaborative research published in JAMA Network Open.

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About ECHO: Launched in 2016, the Environmental influences on Child Health Outcomes (ECHO) Program is a research program in the Office of the Director at the NIH with the mission to enhance the health of children for generations to come. ECHO investigators study the effects of a broad range of early environmental influences on child health and development. For more information, visit echochildren.org.

About the NIH: NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information, visit www.nih.gov.