The impact of COVID‐19 on adolescent wellness in Chicago

Abstract Purpose This study aimed to understand the impact of the initial COVID‐19 pandemic remote schooling period on self‐reported wellness among adolescents in Chicago. Methods Students (n = 55) completed a 22‐item wellness questionnaire before (February 2020) and shortly after the onset of the COVID‐19 outbreak (April 2020). Precomparisons/postcomparisons (overall and by survey item) were evaluated using two‐sided paired t‐tests with an alpha level of 0.05. Descriptive statistics were used to evaluate mean scores overall by demographic variables. Results Significant differences were found in the following areas: Balance (Pre: 7.3, During: 6.4, p = 0.02), Education (Pre: 8.4, During 7.7, p = 0.03) and Friends (Pre:8.0, During: 6.3, p = 0.001). Overall wellness scores varied by demographic variables, though not significantly. Conclusions Results suggest the onset of the pandemic impacted students' ability to effectively learn, as well as to maintain balance in their lives and social relationships. Comprehensive support is needed in these areas to promote adolescent wellness.


| INTRODUCTION
Adolescence is a challenging time of biological development and psychosocial maturation (Rowley et al., 2005), for which wellness plays a critical role. The World Health Organization (WHO) defines wellness as "the optimal state of health of individuals and groups" with a focus on realizing one's fullest potential and fulfilling one's role expectations (Smith et al., 2006). Understanding adolescent wellness using a holistic approach has been an emerging priority among health experts (Spurr et al., 2012), and there is increased urgency for this given the wide-ranging impacts of COVID-19 on adolescent behavioural health (United States Public Health Service, Office of the Surgeon General, 2021). While some plans exist to address this gap by creating more comprehensive assessments of the physical, psychological, spiritual, and social aspects of adolescents' lives, these approaches are not utilized in routine adolescent clinical practice (Bart et al., 2018;Hattie et al., 2004;Katja et al., 2002;Myers et al., 2000;Spurr et al., 2012;Steiner et al., 1998). The initial phase of the pandemic and the concomitant shift to remote schooling and social distancing magnify how important the holistic perspective is for understanding adolescent wellness. Social distancing measures due to the pandemic disrupted daily routines (Lee, 2020) and left many students socially isolated without Abbreviation: WHO, World Health Organization. access to school-based coping resources that provided support and helped them maintain a healthy lifestyle. Previous research has shown longitudinal evidence for the decline in adolescents' mental health during the COVID-19 pandemic. Using an online survey, adolescent life satisfaction and depressive and anxious symptoms before the pandemic restrictions and 2 months after remote learning and lockdown were studied. Findings indicated that adolescents experienced significant increases in depressive symptoms and anxiety, and a significant decrease in life satisfaction (Cohen et al., 2021). Feeling socially connected protected against poor mental health, while online learning difficulties and conflict with parents predicted increases in mental health problems across time.
To understand the short-term and potential long-term effects of the pandemic on adolescent well-being, changes in self-reported wellness factors were explored. These findings can inform paediatricians and other adolescent health practitioners about areas to consider when identifying behavioural health needs and developing tools for effective care. This study aimed to examine adolescent wellness from a holistic perspective so that a fuller understanding of their experiences during the onset of the COVID-19 pandemic could inform future clinical care.

| METHODS
Ninety-five students from 16 public high schools in Chicago participated in a programme and research study designed to help students become health leaders by creating peer-facing educational materials on community health issues. They were recruited to participate through an invitational flier sent to district principals and science teachers. Exclusion criteria included students over 18 years old or parents unable to provide consent. Institutional Review Board approval was obtained for this research.
A 22-item survey evaluating adolescent wellness was developed by physicians and researchers at the primary institution's associated medical school, and the affiliated urban children's hospital, to explore students' academic, social, physical, and creative ability, as well as factors such as balance, growth mindset, friends, and goals. Development of the survey involved a focus group of 18 adolescents and young adults to discuss the concept of wellness and create a list of terms associated with wellness. Following this meeting, a prototype survey was developed containing 31 questions. This survey was disseminated amongst the original focus group for readability, and to assess interpretation of the survey questions. After initial survey completion, members of the research team assessed the answers for concordance of interpretation with the intent of the questions, and to screen questions for redundancy.
The survey was disseminated to students prior to the COVID-19 outbreak (February 2020), and once during the pandemic (April 2020).
Students rated items on a scale of 1 (hardly ever) to 10 (all of the time) "in the past week." Descriptive statistics were used to evaluate overall mean scores by demographic variables such as grade in school, race/ ethnicity, employment status, and education. Additionally, precomparisons/postcomparisons in overall scores and individual survey items were evaluated using two-sided paired t-tests with an alpha level of 0.05. All statistical analyses were performed using Python (Rossum & Drake, 2009).

| RESULTS
Of the 95 students enrolled, 55 students completed the survey at both time points. The majority identified as female (81.8%). Many were Sophomores (40.0%) or Juniors (45.5%) in high school and identified as Hispanic (43.6%), Black (20.0%), Asian (18.2%), and White (18.2%). When evaluating scores per item, students had statistically significant differences in scores on the following items (Table 1)

Key messages
• Adolescent wellness is integral to healthy psychosocial development into young adulthood.
• There is limited data available for clinical measurement of wellness in adolescents, from a holistic perspective (e.g., when not including primary depression assessments).
• Our study aimed to assess wellness in adolescents through a comprehensive study that addressed 22 points of interest associated with overall wellness.
• Our study demonstrated that COVID-19 pandemic may be significantly affecting adolescent wellness in three specific ways: social relationships, education, and lifestyle balance.
Home confinement contributes to lifestyle changes and psychosocial stress that can generate and/or worsen child physical and mental health problems (Wang et al., 2020). Throughout child development, but particularly in adolescence, social interaction with peers plays a significant role in wellness. The necessary reduction of social interaction, secondary to physical distancing, remote learning, and sheltering in place, is likely to have contributed to the current mental health crisis among this generation of adolescents.
Adolescent medicine specialists, paediatricians, and behavioural health providers stand in a unique position to consider these effects on adolescent wellness, and to provide a range of support for parents and their teens. The early phase of the COVID-19 pandemic and the swift lifestyle and educational changes that took place appear to be T A B L E 1 Differences in wellness score by survey item associated with declines in key areas of adolescent self-reports of wellness. Additionally, chronic stressors and unexpected losses associated with an ongoing pandemic add complexity to this situation. This underscores the need for more research on adolescent wellness, to identify potentially predictive factors early for clinicians tracking. Adolescents continue to face intermittent remote learning, physical distancing, and limited social interactions, suggesting that wellness information and social support will continue to be needed. In addition to traditional behavioural health care, it is critical that new and accessible behavioural health support (i.e., telehealth and web-based platforms that provide opportunities for social connection among adolescents) is developed for adolescents.
analysed and interpreted the data, drafted and revised the manuscript, and approved the final version as submitted.

DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.