The COVID-19 pandemic and measures taken to limit its spread significantly disrupted the life of children and adolescents worldwide. Evidence showed that stay-at-home orders, school closures, and restrictions on social and recreational activities negatively affected youth lifestyle and well-being. However, the medium-term effects of the pandemic, as well as their socio-economic distribution remain poorly studied, particularly in countries with relatively light measures like Switzerland. This thesis investigates the impact of the COVID-19 pandemic and related restrictions on the well-being and health behaviors of children and adolescents (referred to as children hereafter), according to their socio-economic circumstances, in the canton of Geneva, Switzerland.
The thesis relies on epidemiological population-based studies conducted between fall 2020 and summer 2024, including randomly selected children living in the canton of Geneva and their siblings. Parents completed health and lifestyle questionnaires about their participating children, as well as socio-demographic information about themselves and their household. Adolescents additionally filled age-appropriate self-reported questionnaires. Data was analyzed with regression-based approaches taking the household clustering into account, such as generalized estimating equations or mixed effects models.
A poor health-related quality of life (HRQoL) was reported in 11% of adolescents in fall 2020 and 11.5% of children aged 2-17 years in spring 2022, while 5.1% of children had mental health difficulties. In 2022, 78.2% met sleep duration recommendations, while 68.2% and 68.0% met physical activity and screen time guidelines. Health behaviors remained largely unchanged following the pandemic, except for screen time, which increased for 51.9% of children.
Between 8% and 13% of children experienced a severe negative impact of the pandemic on their daily life, social interactions, family dynamics, or emotional functioning. This was associated with poorer HRQoL and mental health two years into the pandemic. By 2024, the mental health of negatively impacted children had improved, reaching levels comparable to their unaffected peers. Disadvantaged financial and family circumstances were linked to poorer health and greater exposure to a negative pandemic impact. However, mental health consequences of a negative impact were more pronounced in socioeconomically privileged children than in their disadvantaged counterparts. Moreover, children from lower-income households were more likely to experience both positive and negative changes in health behaviors because of the pandemic.
Overall, there was no evidence of lasting population-level consequences of the pandemic on the health and health behaviors of children and adolescents in Geneva, except potentially for increased screen use. However, although they eventually recovered, severely impacted children experienced meaningful medium-term well-being impacts, highlighting the need to minimize restrictive measures in such crises. Furthermore, these findings reveal the complex social distribution of pandemic effects and reinforce the importance of addressing persistent socio-economic health inequalities through equity-focused interventions. Finally, they underscore the urgent need for long-term cohort studies to monitor youth health and inform evidence-based policies.
