The COVID-19 pandemic did not affect all US families the same way, a new cohort study in JAMA Network Open claims, with families helmed by caregivers with lower levels of education more strained during the first 2 years of the pandemic.
The findings come from the Environmental Influences on Child Health Outcomes (ECHO) multi-cohort consortium, an ongoing study of 64 individual cohorts with participants (24,757 children and 31,700 caregivers in this study) who live in all 50 states and Puerto Rico.
Participants in the study completed the ECHO COVID-19 survey between April 2020 and March 2022.
The authors of the study were interested in the effects of caregiver education level, child life stage (infant, preschool, middle childhood, and adolescent), and urban or rural residence on how US families faced the challenges brought on by the pandemic, including school closures and remote work.
Among the caregivers surveyed, the average age was 37.6 years, and 98% were women. The average age of children in the study was 7.1 years. Caregivers were 63% White, 19% Hispanic, and 16% Black.
Caregivers with low education levels had hard time accessing tests
Caregivers who had less than a high school education (compared to a master’s degree or higher) had more challenges accessing COVID-19 tests, lower odds of working remotely (adjusted odds ratio [aOR], 0.04; 95% confidence interval [CI], 0.03 to 0.07), and more food-access concerns (aOR, 4.14; 95% CI, 3.20 to 5.36).
During the study period, 5.9% of children had COVID-19 infections, but caregiver education level affected how quickly they could get tested. Among the 4,030 caregivers who wanted to get their child tested for COVID-19, those with less than a high school education (aOR, 1.88; 95% CI, 1.06 to 1.58) or a high school education (aOR, 1.97; 95% CI, 1.32 to 2.96) were more likely to be unable to get the test than those with a master’s level or higher education.
Almost all (97%) of children ages 5 and older included in the survey were offered online learning amid school closures, but only 56% of children 5 and younger were also offered some kind of online learning support.
"We observed no differences in school, preschool, or daycare closure by caregiver education or urban vs rural residence; however, children of caregivers with lower levels of education were more likely to have free meal service continue during the pandemic and also more likely to receive free home internet or a computer to support for remote learning," the authors wrote.
Remote work was biggest difference
The most dramatic difference seen among caregivers in terms of education level was the ability to work remotely during the initial months of the pandemic. Only 4% of those with less than a high school degree were able to work from home, and only 9% of those with high school degrees were able to.
Caregivers with lower levels of education were more likely to endorse finances and accessing food and supplies as top stressors.
Caregivers with higher levels of education, however, had a harder time securing childcare.
Overall, the pandemic’s impact on children made up 62% of caregivers' biggest stressors during the pandemic. More specifically, caregivers with low levels of education were also more likely to say access to food was a top stressor during the pandemic.
"Caregivers with lower levels of education were more likely to endorse finances and accessing food and supplies as top stressors, which is consistent with evidence suggesting that pandemic-related financial insecurity was the most salient issue facing many families with lower socioeconomic status," the authors concluded. "In contrast, caregivers with higher levels of education were more likely to endorse social distancing and quarantine or impacts on work or their child as top stressors."
