Early pandemic impacts on family environments that shape childhood development and health: A Canadian study

Abstract Objectives Changes to income and employment are key social determinants of health that have impacted many families during the COVID‐19 pandemic. This research aimed to understand how changes to employment and income influenced family environments that contribute to early childhood development and health. Methods A concurrent triangulation mixed method design was used through a cross‐sectional survey on early impacts of the COVID‐19 pandemic involving families with young children in the Canadian Maritime provinces (n = 2158). Analyses included multivariate regression models to examine whether changes to employment and income predicted changes to Family access to resources and social support, parenting Abilities and self‐care at home, and home Routines and Environments (FARE Change Scale). Content analysis was used to identify themes from the open‐ended questions. Results Changes to employment and income early in the pandemic like no longer working but continued to receive salary, working fewer hours for the same salary earned before the pandemic, no longer working nor receiving salary, working fewer hours resulting in salary reduction, essential worker status and household income were significant predictors of FARE Change Scale when ethnicity/cultural background and province of residence are controlled (P < .05). Themes provided a description of family impacts, including shifting employment and income, finding time and capacity, feelings of guilt and the creation of new routines. Conclusion Our study provides insight on the implications of public health restrictions, such as the importance of increased time for parents (through reduced work hours) and access to resources and social support to support child development and health.


| INTRODUCTION
The early years of a child's life are a critical period for establishing the conditions for lifelong health. Research consistently demonstrates that early environments profoundly influence physical, emotional, social, cognitive and language development of a child (Black et al., 2017). The COVID-19 pandemic has altered these early environments for young children through the resulting changes to programmes and services (e.g. healthcare, developmental services, child care, school and recreation), limits to social support and abrupt changes to employment conditions and income for parents (Qian & Fuller, 2020). The Canadian Maritime provinces have been recognized for early implementation of stringent containment measures during the first wave of the pandemic (Rocha et al., 2020), but little is known how the resulting restrictions impacted children and their families.
The purpose of this research is to understand how rapid changes to employment and income early in the pandemic have influenced family environments that contribute to early childhood development and health.

| Background
Early childhood development is a key social determinant of health (Raphael, 2014). Ensuring access to high-quality early childhood education, family support and services, and early intervention can improve long-term health and education outcomes for children and reduce inequities in health, income and education in the population (Black et al., 2017;Marmot et al., 2008). An ecological perspective (Bronfenbrenner, 1977) considers how early childhood development and health is influenced by a system of distal and proximal environments (see Figure 1 for a depiction of the study concept within the ecological model). The chronosystem reflects major societal transitions and events occurring over time, like the COVID-19 pandemic, that influence attitudes, beliefs and ideals across time and systems. Broader societal and cultural influences at the macrosystem level and specific social structures and policies at the exosystem level related to the pandemic have shaped the environments of families, such as closures of programmes, services and workplaces and reduced access to outdoor public places like parks and playgrounds. Many young children would typically spend a significant amount of time between community-based settings (school, child care, community programmes) and their homes (both microsystem-level influences).
However, initial containment measures during the first wave of COVID-19 rapidly shifted the focus of early childhood development and health predominantly into the microsystem environment of the family home; as a result, interactions between families and community settings were reduced. Therefore, viewing the global pandemic through an ecological systems lens frames family environment at the forefront of public health efforts in the prevention of further spread of COVID-19 and as potentially the most influential microsystem shaping the development and health of young children (Gadermann et al., 2021).
Canada's unemployment reached record rates during the pandemic as some, and particularly working mothers, experienced abrupt changes to their employment conditions, reduced income and increased caregiving responsibilities with closures to school and child care (Beland et al., 2020;Del Boca et al., 2020;Qian & Fuller, 2020).
A focus on family environments emphasizes the importance of family resilience during the pandemic, which may depend on the economic resources of a family as they appraised the situation and rapidly reorganized their environments to make it more manageable (Coleman & Ganong, 2002). Family Resilience Theory turns attention to these adaptation processes of the family that is experiencing significant stress (Patterson, 2002). Understanding the experiences of families early in the pandemic will identify potential supports and stressors during the initial period of adjustment and the social systems, environmental factors and family relational processes that contribute to the family's ability to adapt to adverse events over time (Patterson, 2002).
From an ecological perspective, changes in the macrosystems and exosystems, such as those related to employment conditions and income, are likely to have influenced the microsystem of families' homes and, as a result, their ability to adjust their environments to support children's development and health. For example, access to resources and social support was drastically altered among families during the first wave of the COVID-19 pandemic with initial research suggesting more limited social supports (Roos et al., 2021). Further, healthy, safe and affordable foods as well as family participation in and support for physical activity and play are vital exosystem elements that contribute to health-promoting physical and social environments (Bassett-Gunter et al., 2017). The pandemic initially led to more time within the family home and were the main environments that shaped a child's nutrition, play and activity. However, the capacity for families to create health-promoting environments was challenged by stress

Key messages
• Families experienced abrupt change to employment, income and caregiving responsibilities early in the COVID-19 pandemic.
• In this study, changes to employment and income were used to explore changes to Family access to resources and social support, parenting Abilities and self-care at home, and home Routines and Environments (measured through a FARE Change Scale).
• The results provide implications on the impact of public health restrictions that influence child development and health, such as the negative impact of loss of income that could be addressed through government income support programmes.
• Reduced work hours and facilitating access to external resources and social support can also help to strengthen family environments during a time of uncertainty such as a global pandemic.
from job loss and balancing employment demands with fewer resources and social support (Carroll et al., 2020). These challenges may impact parenting abilities and self-care, especially for mothers (Lewis, 2020), who were the parent most likely to balance added responsibilities of child care, supporting play, creating learning opportunities and providing meals at home. High levels of family stress and mental health concerns during COVID-19 have been reported, which may influence parenting strategies and parent-to-child relationships (Prime et al., 2020;Roos et al., 2021). Changes in home routines have also occurred as a result of closures of child care and school, which has shaped their environments for play, literacy, physical activity, sleep and nutrition. For example, play is essential to enhance children's sense of belonging, confidence and resilience through the mastery of skills, to process stressful events and to share subjective experiences with others (Hertzman, 2010). However, with more isolated time at home, less interaction with peers and fewer community outdoor spaces, children's environments have been impacted by COVID-19, with early research suggesting lower physical activity levels, less outside time and more sedentary behaviour among Canadian children (Carroll et al., 2020;Moore et al., 2020).

| The current study
While studies are emerging to describe the impacts of the pandemic, few have considered the intersection of changes to employment and income across the proximal environments that shape children's development and health. Our study aims to address how the rapid changes to employment and income that occurred early in the pandemic impacted environments that contribute to early childhood development and health in the Maritime provinces. To align with the ecological model (see Figure 1), this research considers the impacts of the COVID-19 pandemic (chrono-macrosystem level) through investigating how rapid changes to employment and income (exosystem) influenced changes in environments, which was conceptualized through family access to resources and social support (exo-mesomicrosystems), parenting abilities and self-care (microsystem) and home routines and environments (microsystem). The focus on Maritime provinces is novel and important as it is the first study that explored pandemic impacts on the environments that shape Maritime children's development and health. This Maritime study provides insight on the implications of public health restrictions and offers policy recommendations acknowledging the childhood developmental and health needs across systems.

| Study design and participants
A concurrent triangulation mixed methods design allowed for a description of family adjustments during the pandemic and the change that families experienced as a result of public health restrictions and protective measures to control the spread. Participants of this study F I G U R E 1 Ecological model with study design concept depicted included 2158 families with a child aged 0-8 living in the Canadian Maritime provinces (Nova Scotia, New Brunswick and Prince Edward Island). The survey generated both qualitative and quantitative data to allow for a mixed method design where results were triangulated following independent analysis of each method. The mixed methods approach allowed for an in-depth exploration of families' environments with the qualitative findings helping to further elucidate the quantitative results. Research ethics approval was obtained from Mount Saint Vincent University.

| Data collection
The data for this study were obtained from a cross-sectional survey study as part of a broader study that was exploring families' adjustments and adaptations throughout COVID-19. Government and health authority partners contributed to the design of the survey to ensure policy relevance and pilot testing was conducted. The families were recruited through promotion of the survey using social media platforms and by sending recruitment materials through child care and family-focused organizations. The survey was available online in English early in the first wave of COVID-19 pandemic when similar lockdown restrictions, including widespread closures to schools and child care, were in place across the Maritime provinces (14 April to 4 May 2020). The survey included both closed and open-ended questions to explore demographic variables as well as family experiences during the pandemic. In particular, changes to employment and income were assessed with the following variables: changes in hours of employment and remuneration (e.g. work fewer hours resulting in salary reduction and no changes in work demands and salary); doing paid work or school work from home while also balancing parenting responsibilities; employed in a sector considered as an essential service by respective provincial government; and household income. For the purposes of this study, essential services were defined as health; food, agri-food and fisheries; transportation, including trucking, rail and transit; construction and manufacturing; information technology, telecommunications and critical infrastructure; and public services, such as police, fire and ambulances.
Consistent with our ecological approach, 20 items on the survey focused on family environments that contribute to early childhood Note: 1 = much less change; 2 = less change; 3 = about the same change; 4 = more change; 5 = much more change.
a Items are reverse scored. development, health and well-being were combined to form a scale to describe three key areas of change in families: Family access to resources and social support (exo-meso-microsystems), parenting Abilities and self-care at home (microsystem), and home Routines and Environments (microsystem) (FARE Change Scale; see Figure 1 and Table 1). The scale demonstrated satisfactory Cronbach's alpha level of .76 (n = 1769) (Taber, 2018). The scale consisted of 20 items, with each rated on a 5-point Likert scale: 1 = much less change; 2 = less change; 3 = about the same change; 4 = more change; and 5 = much more change. The item responses were summed to produce the total scores, which ranged from 1 to 100. A higher score indicated a more

| Qualitative analyses
Qualitative, open-ended responses from the survey were analysed using a content analysis (Berg & Lune, 2012)  The analysis involved five imputations to address data missingness (Graham et al., 2007). The missing values of the total item-level responses were 5.7%. The regression models were significant (P < .001) ( Table 3). The models showed that some types of changes to employment and income early in the COVID-19 pandemic were significant predictors of perceived changes to family environments that support early childhood development and health. The pooled coefficients of the full model (

| Qualitative results
The qualitative findings are presented through four interrelated themes that reflected the impacts of employment and income among

| Difficulty finding time and capacity
Participants indicated that balancing employment, parenting and other concern for their child's development and progress in school as many noted that they are not trained as teachers, for example: 'Trying to keep up with my six-year old's French homework is also challenging.
We're not a French household and I'm trying to teach him French and keep him from regressing too much. It's hard.'  was a positive change to the family environment, even if there was less overall income through a reduction to salary. Our qualitative results revealed that some families preferred to limit their work hours, leave their job or take unpaid leave to care for their children despite reduction to salary. For these families, the uncertainty during the first wave of the pandemic was concerning and disruptive; having additional time to care for their children and themselves seemed to be a positive change early in the pandemic. However, we did observe that other families affected by income loss or reduction, and essential workers experienced changes in routines that tended not to be easy to address through reorganizing routines within the home when access to resources and social support was unavailable. Further, while families reported it was difficult to manage multiple demands, the tendency was towards positive appraisal of the situation and creation of favourable home environments and routines for child development and health.

| Feelings of guilt
From the perspective of family resilience (Patterson, 2002), the experience of families with young children during the pandemic can be described through the appraisal and reorganization process that has been required due to the restructuring of external resources and social supports. Families in this study specifically spoke about the difficulty to find time and capacity to prioritize spending time supporting their child's physical and social emotional health and development while they balanced competing responsibilities, which resulted in feelings of guilt. Recent research has discussed the unprecedented demands of parenthood with increased household and family responsibilities and, at the same time, less access to supports (Evans et al., 2020). A gender imbalance suggesting a greater privileging of men's work has also been reported as families have coordinated employment and household tasks (Manzo & Minello, 2020). In Canada, labour force data have suggested a gender employment gap among parents with young children (Qian & Fuller, 2020), while a study has reported increased participation in housework and child care by fathers during the pandemic (Shafer et al., 2020). Maritime families in this study were primarily represented by mothers; many families were also employed full-time, which provided context to the types of experiences that were shared, which is important considering the recognition of gender as a social determinant of health. However, future research is needed to further elucidate differential impacts of COVID-19 through a more economically diverse and gendered balanced group of respondents.
The impact of the changes to parenting and children's environments on their development and health is not yet well understood.
Many parents in this study indicated that working from home indicated that it was difficult to balance employment demands and facilitate health-promoting activities such as outdoor play and physical activity. As a result, parents were concerned about the increased screen time and sedentary behaviours among their children, which aligns with the results of previous studies (Carroll et al., 2020;Moore et al., 2020). Another study described broader impacts of school shutdown on children's health, through food behaviours and sleep (Mantovani et al., 2021). Our study further extends existing research by considering access to resources and social support and parenting abilities. Past studies of global environmental events, such as floods and hurricanes, have discussed the importance of social support and cohesion as a protective factor in families' adaptation to their new realities (Greene et al., 2015;Reid & Reczek, 2011;Sutherland & Glendinning, 2008). In contrast, the initial containment measures of COVID-19 led to greater isolation of families with a loss of typical social support structures as a result of closures to programmes and services alongside of restrictions to gathering limits and social circles.
As the COVID-19 experience of families is indeed unique and is continuing to have ongoing impacts, continuing to explore family resilience over time will be important to identify the external supports that are required to support positive adaptations.
An ecological system perspective considers impacts arising from developments across the chronosystem, such as those that relate specifically to the COVID-19 pandemic. Ultimately, the impacts within and across system levels play a profound role in shaping a child's environment and influencing their overall development and health (Hertzman, 2010;Raphael, 2014). The impacts of changes to income and employment, at a more proximal environment, are considered for their impact on childhood development and health in this study. The initial containment measures led to families spending more time within the home environment (microsystem) without access to child care and school and, as a result, fewer interactions (mesosystem) with programmes and services that are typically available that could support a child's development and health. While research is beginning to describe the reported high levels of family stress and mental health concerns during COVID-19 (Prime et al., 2020;Roos et al., 2021) and impacts on health behaviours (Carroll et al., 2020;Moore et al., 2020), this study provided a unique contribution through its consideration of the intersection between changes to employment and income across the proximal environments that shape children's development and health.

| Strengths and limitations
This mixed methods research allowed for triangulation of quantitative and qualitative data from an online survey to describe how employment and income influenced the environments that shape early childhood development and health early in the COVID-19 pandemic. We focused on family employment situations considering the significance during COVID-19, such as the implications to families that were balancing working from home (paid work and school work) and those who were considered to be an essential worker. More studies are needed to provide a deeper understanding of other important factors that may contribute to changes in family life as a result of COVID-19.
Despite our concerted efforts to make the survey available to all Canadian Maritime families with children aged 0-8 years, most of the participants were mothers, co-parenting with their spouses or partners in the same home with household income above $80 000, had .64 = strong effect (see Table 3). This study provides only a preliminary understanding of the intersection of changes to employment and income across proximal environments that shape children's development and health in the context of the early stages of the novel COVID-19 pandemic when knowledge about the behaviour of SARS-CoV-2 was very limited and families had to adjust to sudden changes to their way of life as a result of strict public health measures in the region that drastically modified their environments.

| CONCLUSION
This study describes how changes to employment and income influenced family environments that contribute to early childhood development and health among families in the Maritime provinces in Canada. Families found it difficult to manage the abrupt changes to work demands, income and reduced access to external supports during the first wave of COVID-19, yet many were able to respond through the creation of new routines to meet the needs of their family. The results inform the development of potential supports in the mitigation of similar stressors into the future. As well as directing support to families who have lost income during the pandemic (i.e. through government income support programmes), policymakers should consider the potential support that is offered through increased time (through reduced work hours) and access to external resources and social support that can strengthen family environments during a time of upheaval and uncertainty. Our study has policy significance for public health efforts to alleviate the impacts of future sudden events that rapidly change children's immediate environments. To further understand how environments during the pandemic have shaped children's health, research should explore families' resilience throughout the pandemic. As governments and public health continue to respond to the evolving situation caused by this pandemic, implications of public health restrictions on families with young children demonstrated by this study can inform ongoing decision making related to COVID-19 and other disruptive events.