Children and Adolescents' Behavioral Patterns in Response to Escalating COVID-19 Restriction Reveal Sex and Age Differences

Abstract

Purpose: The COVID-19 pandemic affects students in a myriad of different ways. Our prospective, longitudinal study in a cohort of students in Hannover, Germany explores behavioral patterns during escalating COVID-19 restrictions.

Methods: In total, 777 students between the age of 9 and 20 were assessed for their activity engagement, travel patterns, and self-assessed compliance with protective recommendations at six time points between June 2020 and June 2021 (3,564 observations) and were monitored for severe acute respiratory syndrome coronavirus 2 infection by nasal swab polymerase chain reaction and serum antibody titers.

Results: Activity engagement decreased, but self-assessed compliance with measures such as mask wearing and social distancing was stable during escalating restrictions. Although we found no sex difference during the summer break, when incidence was lowest, females engaged in a higher variety of activities than males for all other time points. Older students engaged in more activities and self-assigned themselves lower compliance values than younger ones. Greater involvement in different activities was seen in households which traveled more frequently. Infection rate in our cohort was low (0.03% acute infections, 1.94% positive seroprevalence).

Discussion: Our study supports the view that, overall, students show high compliance with COVID-19 recommendations and restrictions. The identification of subsets, such as female and older students, with higher risk behavioral patterns should be considered when implementing public information campaigns. In light of the low infection rate in our cohort, we conclude that in-person learning can occur safely if extensive protective measures are in place and the incidence in the general population remains moderate.

Keywords: Adolescents; Behavior; COVID-19; Infections; School.

Graphical abstract

Figure 1

Study design. Testing time points (TP0–TP4) in relation to regional infection rate shown as number of confirmed cases (orange bars) and rolling 7-day average per 100,000 inhabitants [15] (orange line). Serum collection (SC) and pharyngeal swap (PS) sampling are indicated. School-opening levels (A–C) (Figure A1), school breaks, and national restrictions are displayed (A). Percentage of students participating in this study per grade including subject that consented to serum collection (B). Proportion of chronic disease reported by participants. Chronic diseases were summarized in organ related groups (C).

Figure 2

Activity engagement over time during COVID-19 restrictions. The number of different activities students engaged in shown by time point (TP) (A), sex (B), and age group (C). ∗p < .05, ∗∗p < .01, ∗∗∗p < .001, ns p > .05. Activity engagement by type of activity over time (D). ns, not significant.

Figure 3

Travel patterns. Travel frequencies during school breaks or while school was in session (A). Total number of trips by travel destination for summer and autumn break (B). Number of activities for different travel frequencies (C) and for students either traveled or stayed home in autumn break (D). ∗p < .05, ∗∗p < .01, ∗∗∗p < .001, p > .05. ns, not significant.

Figure 4

Self-assessment of compliance with COVID-19 measures. Assessment of compliance with protective measures of students by time point (TP) (A) and age groups (B). Correlation of number of activities with different self-assessment in groups (C). ∗∗p < .01, ∗∗∗p < .001, ns p > .05. ns, not significant.