The LoCo (Lockdown Cohort)-effect: Socioeconomic differences in fertility during the pandemic

Abstract Background The economic and social disruptions caused by the COVID-19 pandemic and its mitigation measures may have affected fertility unequally across social strata. If a compositional change in maternal socioeconomic characteristics is confirmed, counterintuitive changes in future population health - the LoCo-effect - are likely. Methods We analysed data from maternal inpatient discharge records containing births between January 2018 and November 2021 by Scottish Index of Multiple Deprivation (SIMD) quintile. We used monthly number of births before November 2020 to estimate expected monthly births after November 2020 and compared against observed births in each SIMD quintile. Further, we estimated associations between monthly average stringency of national mitigation measures (Stringency Index (0-100)) and births 9 to 13 months later using distributed lag models. Results Between November 2020 and November 2021, there were 1301 (10.3%) fewer births than expected for the most deprived quintile (Q1; 953 (8.7%) and 375 (4.1%) less in Q2 and Q3). In the two least deprived quintiles, however, fertility remained mostly unchanged. A 10-point increase in monthly average Stringency Index in Q1 was associated with an average cumulative decrease of 8.5 births (95%CI: -14.1; -2.8, p = 0.006) 9 to 13 months later. Conversely, this estimate was a 4.4 increase (95%CI: 1.3; 7.5, p = 0.008) in Q5 and a 5.9 increase (95%CI: 1.4; 10.4, p = 0.013) in Q4. Conclusions Apart from their exposure to pandemic and lockdowns, it is likely that, due to compositional changes in births, the observed LoCo started life, on average, more socially advantaged than previous birth cohorts in Scotland. We show a substantial decrease in fertility in the most deprived areas, while fertility remained little changed in the least deprived areas. Increases in the stringency of lockdown measures were associated with a decrease in births in the most deprived but an increase in the least deprived areas 9 to 13 months later. Key messages • Between November 2020 and November 2021, there were substantial decreases in births among deprived areas in Scotland while fertility in the least deprived areas remained mostly unchanged. • For these births, the observed compositional shift in maternal socioeconomic characteristics may lead to changes in current and future health and health needs – the LoCo (Lockdown Cohort)-effect.


Background:
The ''infodemic'' related to Covid-19 emphasized the importance of the public's ability to access, understand, appraise and use information to make decisions about health. This study aimed to: 1. Assess the components of Covid-19 related health literacy (Co-HL) 2. Examine the associations of socio-demographic variables and health status with Co-HL Methods: This study was conducted as part of the European Health Literacy Population Survey 2019-2021 (HLS19). A crosssectional survey of a representative sample of adults in Israel was conducted in December 2020 using phone interviews and an online survey (n = 1,315). Five items measuring Co-HL were added. Multivariable regression models were used to assess the associations between socio-demographic variables and health status with Co-HL.

Results:
Of participants, 63% reported concern about Covid-19. The mean general HL was lower among those who reported concern about Covid-19 compared to those who worried less (p = 0.002). The most difficult component of Co-HL was ''judging the reliability of information regarding Covid-19'' (36% expressed difficulty). Older participants, those with low self-reported social status, and low self-assessed health, were significantly (p < 0.05) more likely to express difficulty in judging the reliability of Covid-19 information. Interestingly, education level was not significantly associated with Co-HL.

Conclusions:
Our results suggest that, to best promote the use of information on Covid-19 prevention, older people, those with low social status and those with poor general health should be prioritized for improving critical health literacy.

Key messages:
Co-HL is unequally distributed in the population, warranting tailored health promotion efforts. It is vital to improve the ability of the population to identify reliable information about covid-19.

Background:
The economic and social disruptions caused by the COVID-19 pandemic and its mitigation measures may have affected fertility unequally across social strata. If a compositional change in maternal socioeconomic characteristics is confirmed, counterintuitive changes in future population health -the LoCo-effect -are likely.

Methods:
We analysed data from maternal inpatient discharge records containing births between January 2018 and November 2021 by Scottish Index of Multiple Deprivation (SIMD) quintile. We used monthly number of births before November 2020 to estimate expected monthly births after November 2020 and compared against observed births in each SIMD quintile. Further, we estimated associations between monthly average stringency of national mitigation measures (Stringency Index (0-100)) and births 9 to 13 months later using distributed lag models.
iii450 European Journal of Public Health, Volume 32 Supplement 3, 2022 Conclusions: Apart from their exposure to pandemic and lockdowns, it is likely that, due to compositional changes in births, the observed LoCo started life, on average, more socially advantaged than previous birth cohorts in Scotland. We show a substantial decrease in fertility in the most deprived areas, while fertility remained little changed in the least deprived areas. Increases in the stringency of lockdown measures were associated with a decrease in births in the most deprived but an increase in the least deprived areas 9 to 13 months later. Key messages: Between November 2020 and November 2021, there were substantial decreases in births among deprived areas in Scotland while fertility in the least deprived areas remained mostly unchanged. For these births, the observed compositional shift in maternal socioeconomic characteristics may lead to changes in current and future health and health needs -the LoCo (Lockdown Cohort)-effect.

Background:
Local contact tracing teams needed to be reinforced in preparation for a peak in Covid-19 cases. The Portuguese Armed Forces showed availability and their members initiated a formal training facilitated by the Public Health Unit (PHU) of Amadora. Health systems must be prepared to respond to all threats, as the COVID-19 pandemic showed us the need for quick task shifting and the training of non-experts' workers.

Objectives:
The aim of the project was to develop contact tracing skills by non-health professionals, in the context of the COVID-19 pandemic. The training program was held online, with a total duration of 48 hours, distributed by the topics described: introduction to health and epidemiology concepts, the national guidelines, and the information systems (13h). We privileged demonstrative and participatory training methods, followed by continuous supervision of each contact tracing survey and constant feedback (35h). Learning support materials were sent out to assist the trainees, including written and video support.

Results:
More than 200 personnel -sailors, soldiers and airmen -were trained. Each Lisbon and Tagus Valley area PHU was reinforced with a team of military professionals in order to support the contact tracing process, with an increase in the number of surveys completed. We highlight as positive aspects: increased number of contact tracing surveys carried out; growth of inter-institutional partnerships; freeing up of specialized PHU resources to other important tasks. As for negative aspects we focus on the complexity in health communication, the limited time for training, and the lack of specific health knowledge of the trainees.

Conclusions:
This pandemic revealed the Portuguese need for a transdisciplinary approach in the provision of care, specially at a Public Health level. Training programs like these highlight the vital role of reshaping and reorganizing the healthcare workforce answering Public Health necessities. Key messages: Training programs for non-health workers must be prepared to reinforce health systems when necessary. The reinforcement of contact tracing teams by the Portuguese Armed Forces was a great example. A transdisciplinary approach in the provision of care was essential during the COVID-19 pandemic. Specific training of non-health workers can be planned in time to respond to health threats. could not yet have sufficient vaccination protection appears particularly worrying here. Other parents' coping strategies included working early in the morning or at night (23 %; n = 850), or leaving children unsupervised (25 %, n = 929).

Conclusions:
School closures shift families to new strategies, including unhealthy models of alternating work/childcare, 'illegal' involvement of third parties outside the nuclear family, and neglect of age-appropriate childcare. Our findings highlight that when childcare facilities are repeatedly closed, working families need additional support strategies to reduce contact and minimize secondary harms. Key messages: When schools close, parents have to find new strategies for where to take their children, many have contacts outside the home. Grandparents (also as a risk group) play a major role in childcare even during a lockdown.