There is no published national research reporting child care professionals’ physical health, depression, or stress during the COVID-19 pandemic. Given their central role in supporting children’s development, child care professionals’ overall physical and mental health is important. In this large-scale national survey, data were collected through an online survey from May 22, 2020 to June 8, 2020. We analyzed the association of sociodemographic characteristics with four physical health conditions (asthma, heart disease, diabetes, and obesity), depression, and stress weighted to national representativeness. Sociodemographic characteristics included race, ethnicity, age, gender, medical insurance status, and child care type. Our findings highlight that child care professionals’ depression rates during the pandemic were much higher than before the pandemic, and depression, stress and asthma rates were higher than U.S. adult depression rates during the pandemic. Given the essential work child care professionals provide during the pandemic, policy makers and public health officials should consider what can be done to support the physical and mental health of child care professionals.
The COVID-19 pandemic led to a worldwide lockdown and school closures, which have placed a substantial mental health burden on children and college students. Through a systematic search of the literature on PubMed and Collabovid of studies published January 2020–July 2021, our findings of five studies on children and 16 studies on college students found that both groups reported feeling more anxious, depressed, fatigued, and distressed than prior to the pandemic. Several risk factors such as living in rural areas, low family socioeconomic status, and being a family member or friend to a healthcare worker were strongly associated with worse mental health outcomes. As schools and researchers discuss future strategies on how to combine on-site teaching with online courses, our results indicate the importance of considering social contacts in students’ mental health to support students at higher risk of social isolation during the COVID-19 pandemic.
The relationship between the use of nonpharmaceutical interventions and COVID-19 vaccination among U.S. child care providers remains unknown. If unvaccinated child care providers are also less likely to employ nonpharmaceutical interventions, then a vaccine mandate across child care programs may have larger health and safety benefits. To assess and quantify the relationship between the use of nonpharmaceutical interventions and COVID-19 vaccination among U.S. child care providers, we conducted a prospective cohort study of child care providers (N = 20,013) from all 50 states, the District of Columbia, and Puerto Rico. Child care providers were asked to complete a self-administered email survey in May-June 2020 assessing the use of nonpharmaceutical interventions (predictors) and a follow-up survey in May-June 2021 assessing COVID-19 vaccination (outcome). Nonpharmaceutical interventions were dichotomized as personal mitigation measures (e.g., masking, social distancing, handwashing) and classroom mitigation measures (e.g., temperature checks of staff/children, symptom screening for staff/children, cohorting).
For each unendorsed personal mitigation measure during 2020, the likelihood of vaccination in 2021 decreased by 7% (Risk Ratio = 0.93 [95% 0.93 – 0.95]). No significant association was found between classroom mitigation measures and child care provider vaccination (Risk Ratio = 1.01 [95% CI 1.00-1.01]).
Child care providers who used less personal mitigation measures were also less likely to get vaccinated for COVID-19 as an alternative form of protection. The combined nonadherence to multiple types of preventative health behaviors, that is, both nonpharmaceutical interventions and vaccination, among some child care providers may support a role for mandatory vaccination to achieve pandemic control.
Widespread vaccination remains the best option for controlling the spread of COVID-19 and ending the pandemic. Despite the considerable disruption the virus has caused to people’s lives, many people are still hesitant to receive a vaccine. Without high rates of uptake, however, the pandemic is likely to be prolonged. Here we use two survey experiments to study how persuasive messaging affects COVID-19 vaccine uptake intentions. In the first experiment, we test a large number of treatment messages. One subgroup of messages draws on the idea that mass vaccination is a collective action problem and highlighting the prosocial benefit of vaccination or the reputational costs that one might incur if one chooses not to vaccinate. Another subgroup of messages built on contemporary concerns about the pandemic, like issues of restricting personal freedom or economic security. We find that persuasive messaging that invokes prosocial vaccination and social image concerns is effective at increasing intended uptake and also the willingness to persuade others and judgments of non-vaccinators. We replicate this result on a nationally representative sample of Americans and observe that prosocial messaging is robust across subgroups, including those who are most hesitant about vaccines generally. The experiments demonstrate how persuasive messaging can induce individuals to be more likely to vaccinate and also create spillover effects to persuade others to do so as well.
To determine which states had issued legislative and/or regulatory directives requiring vaccination of childcare and/or school personnel (as of November 1, 2021), we reviewed official archives of executive orders for all 50 states and the District of Columbia (DC) and COVID-19 state databases maintained by the National Conference of State Legislatures and the National Academy for State Health Policy. For each state with legislative or regulatory directives, we collected information on issue date and compliance deadline, type (e.g., executive order, public health order), issuer (e.g., governor, public health officer), availability of vaccine exemptions and testing alternatives, and acceptable proofs of vaccination.
While ten states (including DC) have issued directives requiring either COVID-19 vaccination or routine testing among school teachers, only half include childcare providers. This emerging trend suggests an unwarranted disparity between childcare and school settings in states’ efforts to promote vaccination, as the argument in favor of vaccinating the former is at least as strong as that of the latter for several reasons. First, both staff and children in childcare programs may be at higher risk for contracting COVID-19 than those in schools, given the congregation of infants and young children who are both ineligible for vaccination and possibly less effectively adherent to nonpharmaceutical interventions (e.g., masking, social distancing, handwashing). Second, childcare providers have a lower COVID-19 vaccine uptake compared to school teachers (78% versus 90% as of late Spring 2021). Finally, childcare providers skew more heavily minority, and therefore may be at greater risk for COVID-19-related morbidity and mortality (17.3 and 19.3 percent of childcare personnel are Black and Hispanic versus 12.1 and 13.0 percent of school personnel, respectively). To ensure equitable consideration for the health and safety of childcare providers and school teachers alike, states should consider expanding directives to include childcare providers—as has been done by both New Jersey and Illinois—to bridge the COVID-19 vaccination gap between childcare providers and school teachers.
To characterize vaccine uptake among US child care providers, we conducted a multistate cross-sectional survey of the child care workforce. Providers were identified through various national databases and state registries. A link to the survey was sent via e-mail between May 26 and June 23, 2021. A 37.8% response yielded 21 663 respondents, with 20 013 satisfying inclusion criteria. Overall COVID-19 vaccine uptake among US child care providers (78.2%, 90% confidence interval: 77.5% to 78.9%) was higher than the US general adult population (65%). Vaccination rates varied between states from 53.5% to 89.4%. Vaccine uptake among respondents differed significantly (P < .01) based on respondent age (70.0% for ages 25–34, 91.6% for ages 75–84), race (70.0% for Black or African Americans, 92.5% for Asian Americans), annual household income (70.8% for <$35 000, 85.1% for >$75 000), and child care setting (73.0% for home-based, 79.7% for center-based).
In the absence of widespread vaccination for COVID-19, governments and public health officials have advocated for the public to wear masks during the pandemic. The decision to wear a mask in public is likely affected by both beliefs about its efficacy and the prevalence of the behavior. Greater mask use in the community may encourage others to follow this norm, but it also creates an incentive for individuals to free ride on the protection afforded to them by others. We report the results of two vignette-based experiments conducted in the United States (n = 3,100) and Italy (n = 2,659) to examine the causal relationship between beliefs, social norms, and reported intentions to engage in mask promoting behavior. In both countries, survey respondents were quota sampled to be representative of the country’s population on key demographics. We find that providing information about how masks protect others increases the likelihood that someone would wear a mask or encourage others to do so in the United States, but not in Italy. There is no effect of providing information about how masks protect the wearer in either country. Additionally, greater mask use increases intentions to wear a mask and encourage someone else to wear theirs properly in both the United States and Italy. Thus, community mask use may be self-reinforcing.
Staying home and avoiding unnecessary contact is an important part of the effort to contain COVID-19 and limit deaths. Every state in the United States enacted policies to encourage distancing and some mandated staying home. Understanding how these policies interact with individuals' voluntary responses to the COVID-19 epidemic is a critical initial step in understanding the role of these nonpharmaceutical interventions in transmission dynamics and assessing policy impacts. We use variation in policy responses along with smart device data that measures the amount of time Americans stayed home to disentangle the extent that observed shifts in staying home behavior are induced by policy. We find evidence that stay-at-home orders and voluntary response to locally reported COVID-19 cases and deaths led to behavioral change. For the median county, which implemented a stay-at-home order with about two cases, we find that the response to stay-at-home orders increased time at home as if the county had experienced 29 additional local cases. However, the relative effect of stay-at-home orders was much greater in select counties. On the one hand, the mandate can be viewed as displacing a voluntary response to this rise in cases. On the other hand, policy accelerated the response, which likely helped reduce spread in the early phase of the pandemic. It is important to be able to attribute the relative role of self-interested behavior or policy mandates to understand the limits and opportunities for relying on voluntary behavior as opposed to imposing stay-at-home orders.
The COVID-19 pandemic and resulting childcare closures have left many parents and guardians struggling to find care for their children while continuing to work, leading to adverse mental health and financial outcomes for families. Thus, keeping childcare programs open safely is of paramount importance. Although exposure to childcare early in the pandemic demonstrated no increased risk of contracting COVID-19, the highly contagious B.1.617.2 (Delta) variant has increased community prevalence, and COVID-19 outbreaks in childcare and among younger children are now well described. Furthermore, the attack rate for the B.1.1.7 (Alpha) variant, another highly contagious strain, is similar for both children and adults during childcare outbreaks.
Face masks reduce SARS-CoV-2 respiratory droplet transmission in the community and high-risk environments. In kindergarten through 12th grade schools, masks are part of successful risk mitigation bundles that facilitate a safe return to in-person education. Studies suggest that with strict masking policies social distancing can be safely reduced from 6 to 3 feet. However, child masking has not been studied in childcare, where children are typically younger than 5 years, social distancing is challenging, and adherence to masking is less than in older children. This gap in science is particularly problematic given current public debate regarding the benefits and risks of masking younger children not yet eligible for vaccination. We hypothesized that child masking, regardless of social distancing practices, is associated with reduced risk of a childcare program closing because of COVID-19 cases in either staff or children.
Data were obtained from US child care providers (N = 57 335) reporting whether they had ever tested positive or been hospitalized for COVID-19 (n = 427 cases) along with their degree of exposure to child care. Background transmission rates were controlled statistically, and other demographic, programmatic, and community variables were explored as potential confounders. Logistic regression analysis was used in both unmatched and propensity score–matched case-control analyses. No association was found between exposure to child care and COVID-19 in both unmatched (odds ratio [OR], 1.06; 95% confidence interval [CI], 0.82–1.38) and matched (OR, 0.94; 95% CI, 0.73–1.21) analyses. In matched analysis, being a home-based provider (as opposed to a center-based provider) was associated with COVID-19 (OR, 1.59; 95% CI, 1.14–2.23) but revealed no interaction with exposure.