COVID-19 effects on diet, sleep, and physical activity among mid- to late-adolescents residing in the deep south in the United States.

The study was observational and compared periods before and after COVID-19 restrictions, so it cannot show that the restrictions caused the changes. Sleep, diet, and physical activity were self-reported, and objective measures such as actigraphy were not used. The sample was modest at 190 adolescents and came from Birmingham, Alabama, with 73% Black/African American participants, so results may not apply to other regions or groups. Diet and physical activity were measured at scheduled months 1, 12, and 18, so the timing relative to restriction onset varied. Some interaction models could not be estimated for fruit or sweets, and fast food could not be estimated in either model because of data separation. Generalizability may be limited to jurisdictions with similar COVID-19 mitigation efforts and restrictions. The study did not consider adolescent transmission rates or other pandemic-era factors that could have changed behavior.

The parent REACT study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors declared no conflicts of interest, and the sponsor had no role in study design, data collection, analysis, interpretation, writing, or the decision to submit. No honorarium, grant, or other payment was given to produce the manuscript.

Do not conclude that COVID-19 restrictions caused poorer adolescent health. This was an observational pre-post study using self-reported measures, and some diet changes, such as more daily fruit and vegetable consumption, were not uniformly negative.