Parental Nonadherence to COVID Guidelines Threatens Pediatric Health

On March 6, 2023, Andrea Levy, PhD, MBE, and her colleagues published a research letter in JAMA Network Open on parental nonadherence to COVID guidelines. The study’s results alarmed researchers as misrepresentation and nonadherence could threaten pediatric health and further COVID-19 transmission.

While acknowledging that parents were stretched thin throughout the COVID-19 pandemic, the researchers set out to determine the extent of misrepresentation and nonadherence to COVID-19 public health measures (PHMs).

According to the research letter, participants were recruited via a survey sent out to a sample of adults in the United States between December 8 and December 23, 2021. The survey received responses from 580 parents with children under 18 living at home during the pandemic.

Most survey respondents identified as women, at 70.2%, while smaller proportions identified as men, another gender identity, or did not specify.

In addition to gender demographics, the researchers also collected data on racial and ethnic backgrounds. Most participants were non-Hispanic White individuals, accounting for 67.1% of the patient population. Roughly 0.2% of participants identified as White but did not include ethnicity data. Other ethnic and racial backgrounds, including Hispanic, non-Hispanic American Indian or Alaskan Native, non-Hispanic Asian, non-Hispanic Black, and mixed-race individuals, made up 13.8%, 0.9%, 2.4%, 14.8%, and 0.9% of the participant population, respectively.

The researchers looked at five types of misrepresentation and two types of non-adherence. The nonadherence practices that were measured included avoiding COVID-19 testing for a child when it was suspected and allowing children to break quarantine rules. The following misrepresentation responses were also assessed:

• not mentioning confirmed or suspected COVID-19 to someone the child would interact with in person
• misrepresenting their child’s age so they could get vaccinated sooner
• lying about vaccination status by saying a child was vaccinated against COVID-19
• lying about vaccination status by saying a child was not vaccinated against COVID-19
• saying that a child did not have to quarantine when they were supposed to

A large portion of the participant population, 25.9%, engaged in one or more of the seven misrepresentation or nonadherence behaviors mentioned. The most common behavior was not saying that a child had or might have COVID-19, with 24% of people admitting to it. The least common behavior was misrepresenting their child’s age so they could get vaccinated sooner, with only 9.7% of respondents saying they did so.

Beyond looking at what kind of misrepresentation and nonadherence was reported, the researchers also aimed to understand why parents engaged in these behaviors. According to the publication, the most common reason for these actions was the parents’ desire to exercise parental freedom. Additional explanations included wanting to give children a sense of normalcy and the inability to miss other obligations such as work.

Regardless of the reason for misrepresentation or nonadherence, the researchers state, “These results suggest that some PHMs implemented to limit the spread of COVID-19 may have been compromised due to misrepresentation and nonadherence by parents on behalf of their children, contributing to COVID-19-related morbidity and mortality.”