An online survey was conducted on main caregivers of 1- to 5-year-old children in Chile, Mexico, and the USA. The study was promoted through different online channels, including social media (Facebook, Twitter, Instagram), text messages (i.e., WhatsApp and SMS), and emails. Potential participants accessed a personalized link for each study site to obtain details about the study and gave their online informed consent to participate.
The inclusion criteria were: 1) living in Chile, Mexico, or the USA, 2) being the main caregiver of a 1- to 5-year-old child, 3) living with the child most of the time before and during the COVID-19 pandemic, and 4) only in the USA, identifying as Latino/Hispanic (defined as being of Latin American origin or descend). The study was approved by the Scientific Ethics Committee for each study site independently (Universidad de La Frontera, Chile [ORD.: 009-2020], the National Institute of Public Health of Mexico [CI: 1661], and Washington University in St. Louis [IRB ID:202005074]), in accordance with of the Declaration of Helsinki.
The study data were collected and managed using REDCap (Research Electronic Data Capture)2 in the three places.
Data collection occurred during the early stages of the pandemic, soon after the closure of educational centers (Chile: March 30th to April 27th, 2020; Mexico: April 30th to July 27th, 2020; USA: May 14th to August 30th, 2020). Schools were still closed in the three sites when data collection stopped.
Sociodemographic variables that may be potentially associated with movement behaviors were measured. Child characteristics included sex, age, enrolment in ECEC (yes/no), whether the child usually played with someone or alone, access to electronic devices (none, 1 to 2, 3 or more), electronic devices in the room where the child usually sleeps (yes/no), and parental restrictions in the use of electronic devices (yes/no). When the adult was the caregiver of more than one child aged 1-5 years, the participant was asked to answer for only one child. Caregiver characteristics included age, sex, and educational level. Household characteristics included housing type (house, condominium or apartment, or other), number of adults and number of children ≤18 years at home, available space to play (yes/no), available backyard (yes/no), squared meters per person at home, and income level. In Chile, households were classified into low (<530 USD), medium (≥530-<1830 USD), and high (≥1830 USD) income. In the USA, households with an income <200% of the 2019 federal poverty levels were classified as low, those between 200-399% were classified as medium, and those >400% were classified as high. In Mexico, households were categorized as with high (A/B), medium (C+, C y C), or low (D+, D y E) income using a validated questionnaire.8 The area of residence (urban/rural) was also asked. Finally, caregivers reported whether they were in home confinement and the number of days they allowed their child to use electronic devices as an education means or to entertain or calm them before and during COVID-19.
Caregivers were asked to report on their child’s time (in hours and minutes per day) spent in PA (total PA and moderate to vigorous PA or energetic play), sedentary behaviors (sitting time and screen time [ST]), and sleep in a typical week before and during COVID-19. The questions were based on the recommendations for each behavior4 and then extensively tested and refined as part of the SUNRISE pilot studies in 22 countries, ensuring feasibility and acceptability among participating populations.9–11 We calculated the time (min/d) spent in each of these behaviors before and during COVID-19 and the difference between these two periods. We also estimated the proportion of children meeting WHO movement behavior guidelines for children under 5 in both periods.4
During both periods, sleep quality was assessed with the question “How would you rate your child’s sleep quality?”, with Likert scale response options (1 to 7, a higher score indicates better quality). Children with a sleep quality ≥4 were considered as with good sleep quality. We calculated the proportion of children with good sleep quality in both periods and the difference in sleep quality between them.
On each study site, means and standard deviations, and frequencies and percentages were used to describe the samples. For each country, total time in movement behaviors and movement behavior guidelines compliance before and during COVID-19 were compared using t-tests and proportion tests, respectively. Multiple linear regressions were used to assess the association between factors and changes in movement behaviors for each country, adjusting by all the factors. Logistic regressions were used to explore the association between factors and changes in movement behavior compliance (supplementary file). All data preparation and analysis were conducted with Stata 15.0 (College Station, TX: StataCorp LLC). The level of significance was p<0.05, two-tailed.