The Impact of COVID-19 on Health Behavior, Stress, Financial and Food Security among Middle to High Income Canadian Families with Young Children

This was not an intervention study. The researchers tested the *association* between the COVID-19 pandemic and self-reported changes in:

**Eating and meal routines** (e.g., snacking frequency, cooking time, family meal frequency)

**Screen time** (hours per day for mothers, fathers, and children)

**Physical activity** (frequency and duration)

**Stress levels** (sources and severity)

**Financial and food security** (job loss, income reduction, worry about food access)

There was no comparator group (e.g., pre-pandemic data from the same families or a non-pandemic control group). Instead, participants retrospectively reported how their behaviors had changed "since COVID-19" compared to before. Outcome measures were self-reported via an online survey with both closed-ended (Likert-scale, multiple-choice) and open-ended questions.

**Sample size:** 126 respondents (from 254 families enrolled in an ongoing longitudinal study; 49.6% response rate)

**Population:** Middle-to-high-income Canadian families with at least one child aged 2–8 years

**Setting:** Urban and suburban areas in Ontario, Canada (primarily Guelph, Waterloo, and surrounding regions)

**Demographics:**

- 100% of respondents were mothers (the survey was directed to the primary caregiver, who was overwhelmingly female)

- Mean household income: $100,000–$150,000 CAD (above national median)

- 89% had a university degree or higher

- 92% were married or living with a partner

- Mean number of children: 2.1

- Children's mean age: 5.2 years

**Exclusion criteria:** Families not already enrolled in the ongoing study; families without internet access (since the survey was online)

The researchers used a custom online survey (no validated psychometric scales were reported) administered via Qualtrics between April 14 and May 8, 2020 (approximately 4–8 weeks after Canada declared a national emergency on March 13, 2020). The survey included:

**Closed-ended questions** (Likert scales, multiple choice, yes/no):

- "Since COVID-19, has your screen time increased, decreased, or stayed the same?" (for each family member)

- "Since COVID-19, has your physical activity increased, decreased, or stayed the same?" (for each family member)

- "How often do you eat snack foods?" (5-point scale: much less to much more)

- "How often do you cook meals from scratch?" (5-point scale)

- "How often does your family eat meals together?" (5-point scale)

- Financial stress: "Has your household income decreased due to COVID-19?" (yes/no)

- Food security: "Are you worried about having enough food for your family?" (4-point scale: not at all to very worried)

- Stress sources: open-ended question: "What are the main sources of stress for your family right now?"

**Open-ended questions** (thematic analysis):

- "Please describe any other changes in your family's eating or physical activity habits since COVID-19."

- "What has been the biggest challenge for your family during this time?"

**Why this measurement approach matters:** The survey was designed quickly in response to an emerging crisis, so it prioritized speed over rigor. No validated instruments (e.g., International Physical Activity Questionnaire, Food Frequency Questionnaire) were used. The reliance on retrospective self-report ("since COVID-19") is vulnerable to recall bias—people may misremember or exaggerate changes. The open-ended questions provided rich qualitative data but cannot be quantified precisely.

**Study design:** Cross-sectional survey nested within an ongoing longitudinal cohort study (the "Family Food and Health Study," which began in 2018). This is an observational, descriptive study—not an experiment, not a randomized controlled trial, not a meta-analysis.

**Key design features:**

**No randomisation:** Not applicable—this is not an intervention study. The "exposure" (COVID-19 pandemic) was universal and not assigned.

**No blinding:** Not applicable. Participants knew they were reporting on pandemic-related changes.

**No control group:** There was no comparison group of families not affected by COVID-19 (impossible in a pandemic). The study relies on within-person retrospective comparison ("before vs. during COVID-19").

**Duration:** The survey captured a single snapshot in time (April–May 2020), approximately 4–8 weeks into the pandemic. No follow-up data are reported.

**Statistical approach:** Descriptive statistics only (frequencies, percentages, means). No inferential statistics (no p-values, no confidence intervals, no effect sizes, no regression models). Qualitative data were analyzed using thematic analysis (Braun & Clarke's six-phase approach) with two coders and consensus discussion.

**What this design can prove:**

It can describe what a specific group of families *reported* about their behavioral changes during the early pandemic.

It can identify common themes in stress sources and coping strategies.

It can generate hypotheses for future research (e.g., "screen time increased in children—does this persist?").

**What this design cannot prove:**

It cannot prove that COVID-19 *caused* these changes (no control group, no pre-pandemic baseline data from the same families—though the ongoing study may eventually provide that).

It cannot quantify the magnitude of change precisely (no validated instruments, no objective measures like accelerometry for physical activity).

It cannot determine whether these changes are temporary or long-lasting (single time point).

It cannot generalize to lower-income families, single-parent households, rural populations, or families without internet access (the sample is highly educated, high-income, and predominantly two-parent).

It cannot detect differences between subgroups (no inferential statistics, small sample size for subgroup analyses).

**Major methodological weaknesses:**

1. **No pre-pandemic baseline:** The ongoing study had data from 2018–2019, but the authors did not report comparing current responses to those earlier data. Instead, they relied on retrospective recall.

2. **Low response rate (49.6%):** Half of eligible families did not respond, introducing potential non-response bias (e.g., families under more stress may have been less likely to complete the survey).

3. **Single informant:** Only mothers responded. Fathers' and children's behaviors were reported *by the mother*, not directly measured.

4. **No validated scales:** The survey was ad hoc and not psychometrically tested.

5. **Social desirability bias:** Participants may have underreported unhealthful behaviors or overreported healthful ones (e.g., cooking from scratch).

6. **No objective measures:** Screen time, physical activity, and dietary changes were all self-reported, not measured with devices or diaries.

All results are based on self-reported retrospective change ("since COVID-19") among 126 mothers. No p-values, confidence intervals, or effect sizes were reported—only percentages and qualitative themes.

**Primary outcomes (behavioral changes):**

**Eating and meal routines:**

- 54% reported that their eating and meal routines had changed "since COVID-19"

- Of those reporting changes:

- 44% reported eating more snack foods

- 38% reported spending more time cooking

- 29% reported eating more meals together as a family

- 19% reported eating more takeout or delivery food

- 12% reported eating more fruits and vegetables

- 8% reported eating more baked goods or desserts

**Screen time (reported by mothers for each family member):**

- Increased among 74% of mothers

- Increased among 61% of fathers

- Increased among 87% of children

- No quantitative data on *how much* screen time increased (e.g., hours per day)

**Physical activity:**

- Decreased among 59% of mothers

- Decreased among 52% of fathers

- Decreased among 52% of children

- No quantitative data on *how much* activity decreased (e.g., minutes per week)

**Secondary outcomes (stress, financial, and food security):**

**Financial stress:**

- 34% reported that their household income had decreased due to COVID-19

- 22% reported that their spouse/partner had lost their job or been laid off

- 12% reported that they themselves had lost their job or been laid off

**Food security:**

- 11% reported being "somewhat worried" or "very worried" about having enough food for their family

- 89% reported being "not at all worried" about food access

**Sources of stress (qualitative themes, ranked by frequency):**

1. Balancing work/telework with childcare and homeschooling (mentioned by ~60% of respondents)

2. Financial instability and job loss (mentioned by ~35%)

3. Concerns about family health and COVID-19 infection (mentioned by ~30%)

4. Lack of personal time and self-care (mentioned by ~25%)

5. Children's screen time and behavior changes (mentioned by ~20%)

6. Social isolation and missing extended family (mentioned by ~15%)

**Qualitative themes (positive changes reported):**

More family meals and shared cooking activities

More outdoor play and walks (among those who reported increased physical activity)

Trying new recipes and cooking from scratch

Slower pace of life and more family connection

Because the study reported only percentages (not means, standard deviations, or effect sizes), the magnitude of change cannot be precisely quantified. However, the *direction* and *prevalence* of changes are striking:

**Screen time:** If 87% of children increased screen time, and assuming a typical pre-pandemic baseline of ~2 hours/day for young children (based on Canadian guidelines), even a modest increase of 1 hour/day would mean most children in this sample were getting 3+ hours/day of screen time—exceeding the recommended <1 hour/day for children aged 2–5 and <2 hours/day for children aged 5–8.

**Physical activity:** If 52–59% of family members decreased activity, and assuming pre-pandemic levels were already below recommendations (only 9% of Canadian children meet physical activity guidelines), the pandemic likely pushed many families further into sedentary patterns.

**Snacking:** 44% of those reporting changes said they ate more snack foods. If this translates to even one extra snack per day (~200–300 kcal), over 8 weeks that could mean ~1–2 kg of weight gain for some individuals.

**Cooking:** 38% reported spending more time cooking. This is a healthful shift, but it may compete with time for physical activity and self-care.

**In plain English:** Think of it this way—if you normally let your child watch one movie per day (90 minutes), during the pandemic you might have let them watch two movies (3 hours). If you normally took a 30-minute walk after dinner, you might have stopped entirely. If you normally had one snack in the evening, you might have added a second. These are small daily changes that, over weeks, add up to meaningful shifts in health behaviors.

**Acknowledged by authors:**

Small sample size (n=126) from a single geographic region (Ontario, Canada)

Homogeneous sample: predominantly white, highly educated, high-income, two-parent families

Cross-sectional design with no pre-pandemic baseline comparison

Reliance on retrospective self-report (recall bias)

Single informant (mothers only)

Survey was not validated and was developed rapidly

Response rate of 49.6% may introduce non-response bias

Cannot determine causality or long-term effects

**Additional critical limitations:**

**No inferential statistics:** Without p-values or confidence intervals, we cannot know if the observed percentages are statistically reliable or could be due to chance.

**No effect sizes:** We cannot compare the magnitude of change across behaviors (e.g., did screen time increase more than physical activity decreased?).

**No objective measures:** Screen time and physical activity are notoriously over- or under-estimated in self-report. A child who "increased screen time" might have gone from 30 minutes to 1 hour (a 100% increase) or from 2 hours to 4 hours (also a 100% increase)—the study cannot distinguish.

**Timing matters:** The survey was conducted in April–May 2020, when many Canadian schools and workplaces were closed. By June 2020, some restrictions had eased. The findings may not apply to later phases of the pandemic.

**No data on children's age differences:** Children aged 2–8 have very different screen time and activity needs. The study did not break down results by child age.

**No data on fathers' or children's direct reports:** Mothers' perceptions of fathers' and children's behavior may be inaccurate.

**Industry funding:** The study was funded by the Canadian Institutes of Health Research (CIHR) and the Ontario Ministry of Agriculture, Food and Rural Affairs—no obvious conflict of interest, but government funding does not guarantee methodological rigor.

For someone running their own n=1 experiment (e.g., testing how an external stressor like a lockdown affects your own health behaviors):

### What to test

**Specific intervention:** Simulate a "mini-lockdown" for 1–2 weeks where you work from home, have children home from school, and have limited access to gyms, restaurants, and social activities. Alternatively, test a specific stressor (e.g., a major work deadline, a family illness) and track how it changes your eating, screen time, and activity.

**Dose:** The "dose" in this study was the COVID-19 pandemic—an extreme, prolonged stressor. For a self-experiment, you could test a milder version: a 7-day period of increased home responsibilities (e.g., caring for a sick family member, working overtime).

### Minimum meaningful duration

**At least 7–14 days** to capture behavioral shifts that emerge after the initial adjustment period. The pandemic study captured changes after 4–8 weeks, but even 1 week of disruption can reveal patterns.

**Longer is better:** 4 weeks would allow you to see if changes stabilize, worsen, or reverse.

### What to measure (specific metrics)

**Screen time:** Use a screen-time tracker on your phone (iOS Screen Time or Android Digital Wellbeing) to log daily hours for yourself and, if applicable, your children. Record separately: work screen time vs. leisure screen time.

**Physical activity:** Use a pedometer or fitness tracker (e.g., Fitbit, Apple Watch, or a simple step counter). Record daily steps and minutes of moderate-to-vigorous activity. Alternatively, log exercise sessions (type, duration, intensity).

**Eating habits:** Keep a daily food diary (paper or app like MyFitnessPal). Track: number of snacks per day, frequency of takeout meals, time spent cooking, and number of family meals eaten together.

**Stress:** Use a validated scale like the Perceived Stress Scale (PSS-10, 0–40, higher = more stress) daily or weekly. Also rate your stress on a 1–10 scale each evening.

**Financial/food security:** Not typically relevant for a self-experiment, but you could track worry about money or food access on a 1–10 scale if applicable.

### Key confounds to control for

**Seasonal effects:** If you run your