Disruptions to School and Home Life Among High School Students…

Discussion

During January–June 2021, approximately half of high school students in the United States reported emotional abuse by a parent or reported difficulty completing their schoolwork since the COVID-19 pandemic began in March 2020. In addition, nearly one in four students reported experiencing hunger or economic insecurity and one in 10 students reported physical abuse by a parent. These findings indicate that adolescents have encountered disruptions and adverse experiences during the pandemic that might impact their immediate and long-term health and well-being.

The finding that more than half of adolescents reported emotional abuse and one in 10 reported physical abuse by a parent or other adult in the home during the pandemic is a public health concern; comparatively, a nationally representative sample from the National Survey of Children’s Exposure to Violence (NSCEV)reported a lower proportion of children aged 14–17 years (13.9% for past-year emotional abuse and 5.5% for past-year physical abuse by a caregiver) (8). Although these differences might be attributable in part to variations in sampling frame, methodology (e.g., NSCEV is not school based and is administered by telephone) and question wording, the high prevalence of self-reported emotional and physical abuse during the pandemic highlights that increased stress contributes to violence. The situation is further complicated by the fact that school closings because of COVID-19 have resulted in students’ decreased contact with mandated reporters (9); therefore, the self-reported data in this report are critically important to elucidate the occurrence of child abuse during the pandemic and underscores the need for enhanced violence surveillance and prevention strategies during public health emergencies.

Disparities in experiences of disruption and adversity were observed by sexual identity, race and ethnicity, and sex. Students identifying as gay, lesbian, or bisexual, other or questioning; students of color;,and female students more commonly had disruptions and adverse experiences compared with heterosexual, White, and male students, respectively. Among any demographic grouping, youths who identified as gay, lesbian, or bisexual and other or questioning experienced the highest levels of emotional and physical abuse by a parent. Per analyzed chat transcripts from national online LGBTQ+ support groups for youth, adolescents identifying as lesbian, gay, bisexual, or questioning have been struggling with isolation during the COVID-19 pandemic and coping with family dynamics described as “unsupportive” and “homophobic” (10). Disparities based on race and ethnicity and sex have been documented throughout the pandemic. Previous research shows that during the pandemic, Black and Hispanic or Latino students were more likely to be in households experiencing food and nutrition insecurity, difficulty paying rent, and difficulty affording household expenses compared with White students (11), and that approximately two thirds of female adolescents reported an increase in household chores during the pandemic compared with less than half (43%) of the boys, and more girls (20%) compared with boys (10%) reported having too many chores to do to be able to learn (12).

Many student disruptions and adverse experiences in this report are interconnected with the social determinants of health. Previous research shows that disparities based on race and ethnicity and sex existed among persons who experienced economic, food and nutrition, or housing insecurity before the pandemic, and these persons had a greater likelihood of experiencing these insecurities during the pandemic (13). In addition, financial and social stressors of the COVID-19 pandemic have been documented as risk factors for increased child abuse (9). Finally, the bivariate analysis provides evidence that these experiences are interconnected; students who had difficulty completing their schoolwork experienced higher levels of parental job loss, food and nutrition insecurity, and emotional abuse.

One in four students reported using telemedicine to access care from a doctor or nurse and less than one in 10 reported using telemedicine to access mental health or drug and alcohol counseling, with differences by sex and race and ethnicity; White and multiracial students and female students using telemedicine more than other groups. Given the paucity of data on adolescent use of telemedicine, the context for the telemedicine findings of this report remains unclear. Telemedicine might serve as an alternative access point for adolescents seeking essential health services that might address disruptions and adverse experiences, but data describing adolescents’ prepandemic telemedicine use are lacking. A study using data from four major U.S. telehealth providers found that use of telemedicine decreased slightly among youths aged 5–17 years at the start of the pandemic in early 2020 (8.6%) compared with early 2019 (10.0%) (6), which reflects a lower use than what was found in this report. Future studies could help researchers better understand the range of telemedicine services received and quality of care.

Two thirds of adolescents had difficulty completing their schoolwork since the beginning of the pandemic. These findings are consistent with previous research, which indicates that throughout the COVID-19 pandemic, adolescents have had difficulty transitioning to virtual learning, reporting inconsistencies in school coursework expectations, and confusion about complex and complicated assignments (14). Students who had difficulty completing their schoolwork experienced higher levels of emotional abuse by a parent, parental job loss, and hunger. These disruptions and adverse experiences threaten adolescents’ health and safety in addition to acting as barriers to learning. Learning is fostered in environments where students’ basic needs are met and where students feel safe, supported, challenged, and engaged (15). Before the pandemic, schools offered essential health services and social supports, such as school meals, chronic disease management, and mental health counseling; however, the pandemic has challenged the ability of schools to meet students’ evolving academic and health needs (16).

Schools offer an important pathway to help address the needs of students, but they rely on coordinated efforts across sectors to meet these needs. Prioritization of school health programs and services within schools, in collaboration with families and communities, will be critical to address disruptions to student life and other related effects of the pandemic (17). For example, during the pandemic, the U.S. Department of Agriculture issued multiple waivers that permitted schools flexibility in distributing free meals to school-aged youths, regardless of family income level, through June 2022 (18). In addition to traditional meal service in schools, meals are also being distributed in alternative locations, including along school bus routes and in school parking lots and churches (18). Coordinated, cross-sector programs and services like these are important for providing continued support for students in their lives both inside and outside of school.