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Table 1.  

Student experience

Question

Analytic coding

Economic insecurity
Parent job loss* During the COVID-19 pandemic, did a parent or other adult in your home lose their job even for a short amount of time? Yes versus no
Student job loss* During the COVID-19 pandemic, did you lose your paying job even for a short amount of time? Yes versus no
Food and nutrition insecurity
Hunger During the COVID-19 pandemic, how often did you go hungry because there was not enough food in your home? Yes (rarely, sometimes, most of the time, or always) versus no (never)
Housing insecurity
Homelessness During the past 30 days, where did you usually sleep? Yes (in the home of a friend, family member, or other person because I had to leave my home; my parent or guardian cannot afford housing; in a shelter or emergency housing; in a motel or hotel; in a car, park, campground, or other public place; or I do not have a usual place to sleep) versus no (in my parent's or guardian's home)
Abuse by a parent
Emotional abuse During the COVID-19 pandemic, how often did a parent or other adult in your home swear at you, insult you, or put you down? Yes (rarely, sometimes, most of the time, or always) versus no (never)
Physical abuse During the COVID-19 pandemic, how often did a parent or other adult in your home hit, beat, kick, or physically hurt you in any way? Yes (rarely, sometimes, most of the time, or always) versus no (never)
Received telemedicine
Care from a doctor or nurse During the COVID-19 pandemic, did you get medical care from a doctor or nurse using a computer, phone, or other device (also called telemedicine)? Yes versus no
Mental health or drug and alcohol counseling During the COVID-19 pandemic, did you get mental health care, including treatment or counseling for your use of alcohol or drugs using a computer, phone, or other device (also called telemedicine)? Yes versus no
Schooling
Schoolwork difficulty Do you agree or disagree that doing your schoolwork was more difficult during the COVID-19 pandemic than before the pandemic started? Yes (strongly agree, or agree) versus no (not sure, disagree, or strongly disagree)

Table 1. Measures of disruptions and adverse experiences, receipt of telemedicine, and schoolwork difficulty during the COVID-19 pandemic among high school students — Adolescent Behaviors and Experiences Survey, United States, January–June 2021

*The denominator includes only those who had jobs prior to the beginning of the pandemic.

Table 2.  

Characteristic

Economic insecurity

Food and nutrition insecurity

Housing insecurity

Abuse by a parent

Received telemedicine

Schooling

Parent job loss

Student job loss

Hunger

Homelessness

Emotional abuse

Physical abuse

Care from a doctor or nurse

Mental health or drug and alcohol counseling

Schoolwork difficulty

%* (95% CI)

%* (95% CI)

%* (95% CI)

%* (95% CI)

%* (95% CI)

%* (95% CI)

%* (95% CI)

%* (95% CI)

%* (95% CI)

Sex
  Female 31.3 (28.9–33.9) 25.5 (22.3–29.0) 24.9 (22.1–28.0) 1.1 (0.8–1.4) 62.8 (59.5–66.1) 11.6 (10.1–13.2) 29.8 (27.1–32.7) 10.1 (8.5–11.9) 69.1 (66.0–72.0)
  Male 25.6 (23.0–28.4) 19.0 (15.7–22.8) 22.7 (20.3–25.2) 3.0 (2.1–4.2) 46.8 (44.2–49.4) 10.9 (9.7–12.2) 21.7 (19.7–23.9) 6.5 (5.5–7.7) 64.1 (62.0–66.1)
Race and ethnicity
  AI/AN, non-Hispanic 15.7 (9.1–25.5) § 31.2 (19.2–46.4) 1.9 (0.8–4.7) 54.9 (47.7–62.0) 12.5 (8.3–18.5) 24.1 (15.8–34.7) 7.0 (2.5–18.1) 72.4 (64.2–79.3)
  Asian, non-Hispanic 37.1 (29.3–45.7) 18.7 (12.5–27) 28.3 (22.5–34.9) 2.2 (0.7–7.4) 59.2 (54.5–63.7) 12.9 (8.9–18.5) 24.7 (15.2–37.6) 3.9 (2.3–6.7) 61.7 (51.5–70.9)
  Black, non-Hispanic 24.9 (21.4–28.7)¶,** 23.6 (18.6–29.5) 32.0 (28.4–35.7) 2.5 (1.6–3.8) 49.6 (44.0–55.2)** 15.0 (11.6–19.1) 21.1 (17.8–24.9) 6.3 (4.5–8.7) 67.7 (63.3–71.7)
  Hispanic or Latino 38.0 (33.9–42.2)¶,†† 21.8 (17.0–27.5) 28.2 (24.1–32.7) 1.7 (1.1–2.5) 52.5 (48.0–56.9) 11.2 (9.4–13.3) 22.3 (19.1–25.8) 5.4 (4.2–7.0) 69.4 (65.4–73.1)
  Multiracial, non-Hispanic 25.4 (18.8–33.4)¶, **,§§ 25.1 (17.4–34.7) 29.5 (23.4–36.5) 1.1 (0.5–2.5) †† 65.5 (59.7–70.8) ¶,††,§§ 13.4 (10.6–16.9) 29.7 (24.2–35.8)††,§§ 15.0 (10.8–20.5)¶,**,††,§§ 67.3 (60.5–73.5)
  White, non-Hispanic 24.4 (22.0–27.1)¶,**,§§ 22.2 (19.0–25.8) 18.5 (16.5–20.6)**,††,§§,¶¶ 2.1 (1.5–2.9 ) 56.4 (52.3–60.3)††,¶¶ 9.8 (8.6–11.1)†† 28.8 (26.2–31.6)††,§§ 10.2 (8.7–11.9)**,††,§§ 65.5 (63.1–67.8)
Grade
  9 29.1 (24.7–33.8) 12.6 (9.5–16.6) 24.9 (21.3–28.8) 1.9 (1.3–2.7) 58.0 (54.1–61.8) 14.3 (12.1–16.7) 23.9 (21.4–26.5) 8.0 (6.4–9.9) 66.8 (63.5–69.9)
  10 29.0 (26.3–31.8) 17.2 (13.9–21.0) 23.9 (20.4–27.9) 2.3 (1.4–3.6) 54.4 (51.5–57.3) 11.9 (10.0–14.0) 25.7 (22.8–28.8) 8.9 (7.4–10.8) 67.1 (63.9–70.2)
  11 27.4 (24.1–31.0) 18.6 (14.8–23.0)*** 23.1 (20.3–26.2) 1.6 (0.9–2.8) 53.9 (49.4–58.4) 10.6 (8.4–13.3)*** 25.8 (23.1–28.7) 8.1 (6.4–10.3) 65.6 (61.9–69.2)
  12 28.3 (25.0–31.8) 33.6 (29.6–37.9)***,†††,§§§ 23.3 (20.2–26.7) 2.3 (1.4–3.6) 53.8 (49.9–57.6)*** 7.7 (6.4–9.3)***,††† 28.3 (24.4–32.5)*** 9.0 (7.0–11.4) 66.9 (62.6–70.9)
  Total 28.5 (26.2–30.9) 22.3 (19.8–24.9) 23.8 (21.6–26.3) 2.0 (1.5–2.6) 55.1 (52.3–57.8) 11.3 (10.2–12.4) 25.8 (23.8–28.0) 8.5 (7.4–9.6) 66.6 (64.5–68.6)

Table 2. Percentage of economic, food and nutrition, and housing insecurity, abuse by a parent, receipt of telemedicine, and schoolwork difficulty among high school students during COVID-19 pandemic, by sex, race and ethnicity, and grade — Adolescent Behaviors and Experiences Survey, United States, January–June 2021

Abbreviation: AI/AN = American Indian or Alaska Native.

* Weighted estimate.

Pairwise t-test significantly different from female students (p<0.05).

§ Dash indicates that results are suppressed because n<30.

Pairwise t-test significantly different from non-Hispanic AI/AN students (p<0.05).

** Pairwise t-test significantly different from non-Hispanic Asian students (p<0.05).

†† Pairwise t-test significantly different from non-Hispanic Black students (p<0.05).

§§ Pairwise t-test significantly different from Hispanic or Latino students (p<0.05).

¶¶ Pairwise t-test significantly different from non-Hispanic multiracial students (p<0.05).

*** Pairwise t-test significantly different from 9th-grade students (p<0.05).

††† Pairwise t-test significantly different from 10th-grade students (p<0.05).

§§§ Pairwise t-test significantly different from 11th-grade students (p<0.05).

Table 3.  

Experience

Experienced schoolwork difficulty

Yes

No

%* (95% CI)

%* (95% CI)

Economic insecurity
  Parent job loss 30.9 (28.4–33.4) 23.9 (20.9–27.2)
  Student job loss 23.0 (20.5–25.8) 20.7 (17.2–24.7)
Food and nutrition insecurity
  Hunger 25.5 (22.9–28.2) 20.6 (18.1–23.4)
Housing insecurity
  Homelessness 1.9 (1.4–2.6) 2.2 (1.5–3.1)
Abuse by a parent
  Emotional abuse 58.3 (55.5–61.2) 48.7 (44.9–52.5)
  Physical abuse 11.3 (10.1–12.6) 11.1 (9.1–13.5)
Received telemedicine
  Care from a doctor or nurse 26.3 (24.1–28.7) 24.7 (22.0–27.6)
  Mental health or drug and alcohol counseling 8.1 (6.9–9.5) 9.2 (7.6–11.2)

Table 3. Percentage of economic, food and nutrition, and housing insecurity, abuse by a parent, and receipt of telemedicine among high school students during COVID-19 pandemic, by schoolwork difficulty — Adolescent Behaviors and Experiences Survey, United States, January–June 2021

* Weighted estimate.

Pairwise t-test significantly different from students who responded "yes" (p<0.05).

CME / ABIM MOC / CE

Disruptions to School and Home Life Among High School Students During the COVID-19 Pandemic — Adolescent Behaviors and Experiences Survey, United States, January–June 2021

  • Authors: Kathleen H. Krause, PhD; Jorge V. Verlenden, PhD; Leigh E. Szucs, PhD; Elizabeth A. Swedo, MD; Caitlin L. Merlo, MPH; Phyllis Holditch Niolon, PhD; Zanie C. Leroy, MD; Valerie M. Sims, MA; Xiaoyi Deng, MS; Sarah Lee, PhD; Catherine N. Rasberry, PhD; J. Michael Underwood, PhD
  • CME / ABIM MOC / CE Released: 8/16/2022
  • Valid for credit through: 8/16/2023
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Target Audience and Goal Statement

This activity is intended for public health officials, pediatricians, psychiatrists, family practitioners, nurses, pharmacists, and other clinicians caring for youths with disruptions to school and home life during the COVID-19 pandemic.

The goal of this activity is for the learner to be better able to describe estimated prevalence of disruptions and adverse experiences during the pandemic among youths overall and by sex, race and ethnicity, grade, and sexual identity, according to the Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of US public and private school students in grades 9 through 12 (N = 7705), conducted by the Centers for Disease Control and Prevention during January through June 2021.

Upon completion of this activity, participants will:

  • Describe estimated prevalence of disruptions and adverse experiences during the pandemic among high school students overall, according to the Adolescent Behaviors and Experiences Survey (ABES) survey conducted by the Centers for Disease Control and Prevention (CDC) during January through June 2021
  • Determine estimated prevalence of disruptions and adverse experiences during the pandemic among high school students by sex, race and ethnicity, grade, and sexual identity, according to the ABES survey conducted by the CDC during January through June 2021
  • Identify public health implications of estimated prevalence of disruptions and adverse experiences during the pandemic among high school students overall and by sex, race and ethnicity, grade, and sexual identity, according to the ABES survey conducted by CDC during January through June 2021


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Faculty

  • Kathleen H. Krause, PhD

    Division of Adolescent and School Health
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Kathleen H. Krause, PhD, has no relevant financial relationships.

  • Jorge V. Verlenden, PhD

    Division of Adolescent and School Health
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Jorge V. Verlenden, PhD, has no relevant financial relationships.

  • Leigh E. Szucs, PhD

    Division of Adolescent and School Health
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Leigh E. Szucs, PhD, has no relevant financial relationships.

  • Elizabeth A. Swedo, MD

    Division of Violence Prevention
    National Center for Injury Prevention and Control
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Elizabeth A. Swedo, MD, has no relevant financial relationships.

  • Caitlin L. Merlo, MPH

    Division of Population Health
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Caitlin L. Merlo, MPH, has no relevant financial relationships.

  • Phyllis Holditch Niolon, PhD

    Division of Violence Prevention
    National Center for Injury Prevention and Control
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Phyllis Holditch Niolon, PhD, has no relevant financial relationships.

  • Zanie C. Leroy, MD

    Division of Population Health
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Zanie C. Leroy, MD, has no relevant financial relationships.

  • Valerie M. Sims, MA

    Division of Adolescent and School Health
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)

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    Valerie M. Sims, MA, has no relevant financial relationships.

  • Xiaoyi Deng, MS

    ICF International Inc.
    Rockville, Maryland

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    Xiaoyi Deng, MS, has no relevant financial relationships.

  • Sarah Lee, PhD

    Division of Population Health
    National Center for Chronic Disease Prevention and Health Promotion
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Sarah Lee, PhD, has no relevant financial relationships.

  • Catherine N. Rasberry, PhD

    Division of Adolescent and School Health
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)

    Disclosures

    Catherine N. Rasberry, PhD, has no relevant financial relationships.

  • J. Michael Underwood, PhD

    Division of Adolescent and School Health
    National Center for HIV, Viral Hepatitis, STD, and TB Prevention
    Centers for Disease Control and Prevention (CDC)

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    J. Michael Underwood, PhD, has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

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    Laurie Barclay, MD, has the following relevant financial relationships:
    Formerly owned stocks in: AbbVie

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  • Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP

    Associate Director, Accreditation and Compliance
    Medscape, LLC

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    Leigh A. Schmidt, MSN, RN, CMSRN, CNE, CHCP, has no relevant financial relationships.


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CME / ABIM MOC / CE

Disruptions to School and Home Life Among High School Students During the COVID-19 Pandemic — Adolescent Behaviors and Experiences Survey, United States, January–June 2021

Authors: Kathleen H. Krause, PhD; Jorge V. Verlenden, PhD; Leigh E. Szucs, PhD; Elizabeth A. Swedo, MD; Caitlin L. Merlo, MPH; Phyllis Holditch Niolon, PhD; Zanie C. Leroy, MD; Valerie M. Sims, MA; Xiaoyi Deng, MS; Sarah Lee, PhD; Catherine N. Rasberry, PhD; J. Michael Underwood, PhDFaculty and Disclosures

CME / ABIM MOC / CE Released: 8/16/2022

Valid for credit through: 8/16/2023

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Abstract and Introduction

Abstract

Youths have experienced disruptions to school and home life since the COVID-19 pandemic began in March 2020. During January–June 2021, CDC conducted the Adolescent Behaviors and Experiences Survey (ABES), an online survey of a probability-based, nationally representative sample of U.S. public- and private-school students in grades 9–12 (N = 7,705). ABES data were used to estimate the prevalence of disruptions and adverse experiences during the pandemic, including parental and personal job loss, homelessness, hunger, emotional or physical abuse by a parent or other adult at home, receipt of telemedicine, and difficulty completing schoolwork. Prevalence estimates are presented for all students and by sex, race and ethnicity, grade, sexual identity, and difficulty completing schoolwork. Since the beginning of the pandemic, more than half of students found it more difficult to complete their schoolwork (66%) and experienced emotional abuse by a parent or other adult in their home (55%). Prevalence of emotional and physical abuse by a parent or other adult in the home was highest among students who identified as gay, lesbian, or bisexual (74% emotional abuse and 20% physical abuse) and those who identified as other or questioning (76% and 13%) compared with students who identified as heterosexual (50% and 10%). Overall, students experienced insecurity via parental job loss (29%), personal job loss (22%), and hunger (24%). Disparities by sex and by race and ethnicity also were noted. Understanding health disparities and student disruptions and adverse experiences as interconnected problems can inform school and community initiatives that promote adolescent health and well-being. With community support to provide coordinated, cross-sector programming, schools can facilitate linkages to services that help students address the adverse experiences that they faced during the ongoing COVID-19 pandemic. Public health and health care professionals, communities, schools, families, and adolescents can use these findings to better understand how students’ lives have been affected during the pandemic and what challenges need to be addressed to promote adolescent health and well-being during and after the pandemic.

Introduction

Youths have experienced disruptions to school and home life since the COVID-19 pandemic began in March 2020 [1]. The COVID-19 pandemic has disrupted the lives of adolescents by creating or exacerbating economic, food and nutrition, and housing insecurity as well as experiences of abuse, all of which negatively affect health and well-being [2,3]. Racial and ethnic discrimination is a social determinant of health [4], and existing health disparities persisted or worsened during the pandemic. For example, American Indian or Alaska Native, Black, and Hispanic or Latino populations typically experienced higher rates of morbidity and mortality and economic vulnerability compared with the White population before the pandemic and also were more likely than the White population to experience morbidity and mortality from COVID-19 and economic vulnerability during the pandemic [5]. Adolescents experienced disruptions to education and accessing health care, although schools and health care providers shifted rapidly to virtual platforms and telemedicine to continue providing services [6].

To date, no study has assessed national prevalence of disruptions and adverse experiences experienced by high school students during the COVID-19 pandemic. This study addresses this knowledge gap by estimating the prevalence of disruptions and adverse experiences during the pandemic, overall and by sex, race and ethnicity, grade, and sexual identity. Public health and health care professionals, communities, schools, families, and adolescents can use these findings to better understand how students’ lives have been affected during the pandemic and what challenges need to be addressed to promote adolescent health and well-being during and after the pandemic.