Keywords
School Health Services
COVID-19
Communicable Disease Control
Public Health Surveillance
How to Cite
Abstract
Introduction: The COVID-19 pandemic led to the implementation of prevention, containment, and infection control measures in all settings, including educational ones. Although evidence exists on the influence of social determinants on infection transmission in educational centers, there is limited literature on the degree of compliance with these measures. Objective: To analyze the relationship between social determinants and the level of compliance with anti-COVID-19 measures among students, identifying differential patterns according to sociodemographic and educational context characteristics. Methods: This was a descriptive, cross-sectional observational study conducted through a questionnaire addressed to teachers in educational centers in Bilbao, between November 2021 and January 2022. The sample consisted of 997 teachers. A descriptive and bivariate analysis was performed between sociodemographic variables and those related to COVID-19. Results: High compliance with anti-COVID-19 measures was observed among schoolchildren, with the greatest adherence seen in mask use (p < 0.0001) and hand hygiene (p < 0.0001). Statistically significant differences were found across educational stages (p < 0.0001), type of educational center (p = 0.001), and districts (p = 0.006). Districts with lower purchasing power, public schools, and preschool and secondary education stages showed lower adherence to anti-COVID-19 measures. Conclusions: In line with other research, it is evident that higher purchasing power is associated with greater compliance with anti-COVID-19 measures. Social determinants of health are shown to influence adherence to anti-COVID-19 measures in educational settings.
1. World Health Organization. Coronavirus disease 2019 (COVID-19): Situation report-51 [internet]. Washington; 2020 mar 11. Disponible en: https://www.who.int/publications/m/item/situation-report---51
2. World Health Organization. WHO director-general´s opening remarks at the media briefing on COVID-19 [internet]. Ginebra; 2020 mar 11. Disponible en: https://www.who.int/news-room/speeches/item/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
3. Ministerio de Sanidad de España. Plan de respuesta temprana en un escenario de control de la pandemia por COVID-19 [internet]. Madrid; 2020. Disponible en: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Plan_de_respuesta_temprana_escenario_control.pdf
4. Boletín Oficial del Estado. Real Decreto 463/2020, de 14 de marzo, por el que se declara el estado de alarma para la gestión de la situación de crisis sanitaria ocasionada por el COVID-19. BOE núm. 67 de 14 de marzo de 2020 [internet]. Disponible en: https://www.boe.es/eli/es/rd/2020/03/14/463
5. Ministerio de Sanidad y Ministerio de Educación y Formación Profesional. Medidas de prevención e higiene frente a la COVID-19 para la reapertura parcial de centros educativos en el curso 2019-2020 [internet]. Madrid; 2020. Disponible en: https://www.educacionyfp.gob.es/dam/jcr:52e023fd-339f-48af-96f1-ddd6ad77c4fd/20200514-medidas-sanitarias-para-reapertura-centros-fase-2-final.pdf
6. Ministerio de Sanidad y Ministerio de Educación y Formación Profesional. Medidas de prevención, higiene y promoción de la salud frente a COVID-19 para centros educativos en el curso 2020-2021 [internet]. Madrid; 2020. Disponible en: https://www.sanidad.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/Medidas_centros_educativos_Curso_2020_2021_17.09.20.pdf
7. Mazzalai E, Giannini D, Tosti ME, D’Angelo F, Declich S, Jaljaa A, et al. Risk of covid-19 severe outcomes and mortality in migrants and ethnic minorities compared to the general population in the European WHO region: a systematic review. J Int Migr Integr. 2023;24(3):1305-35. https://doi.org/10.1007/s12134-023-01007-x
8. Agyemang C, Richters A, Jolani S, Hendriks S, Zalpuri S, Yu E, et al. Ethnic minority status as social determinant for COVID-19 infection, hospitalisation, severity, ICU admission and deaths in the early phase of the pandemic: a meta-analysis. BMJ Glob Heal. 2021;6(11):e007433. https://doi.org/10.1136/bmjgh-2021-007433
9. Acosta AM, Garg S, Pham H, Whitaker M, Anglin O, O’Halloran A, et al. Racial and ethnic disparities in rates of COVID-19-associated hospitalization, intensive care unit admission, and in-hospital death in the United States from March 2020 to February 2021. JAMA Netw Open. 2021;4(10):e2130479. https://doi.org/10.1001/jamanetworkopen.2021.30479
10. Abrams EM, Greenhawt M, Shaker M, Pinto AD, Sinha I, Singer A. The COVID-19 pandemic: adverse effects on the social determinants of health in children and families. Ann Allergy Asthma Immunol. 2022;128(1):19-25. https://doi.org/10.1016/j.anai.2021.10.022
11. Yancy CW. COVID-19 and African Americans. JAMA. 2020;323(19):1891-2. https://doi.org/10.1001/jama.2020.6548
12. Burström B, Tao W. Social determinants of health and inequalities in COVID-19. Eur J Public Health. 2020;30(4):617-8. https://doi.org/10.1093/eurpub/ckaa095
13. Tsai J, Wilson M. COVID-19: a potential public health problem for homeless populations. Lancet Public Health. 2020;5(4):e186-7. https://doi.org/10.1016/s2468-2667(20)30053-0
14. Davies P, Evans C, Kanthimathinathan HK, Lillie J, Brierley J, Waters G, et al. Intensive care admissions of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in the UK: a multicentre observational study. Lancet Child Adolesc Health. 2020;4(9):669-77. https://doi.org/10.1016/s2352-4642(20)30215-7
15. Ministerio de Sanidad de España. Equidad en salud y COVID-19: análisis y propuestas para abordar la vulnerabilidad epidemiológica vinculada a las desigualdades sociales [internet]. Madrid; 2020. Disponible en: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Equidad_en_salud_y_covid19.pdf
16. World Health Organization Western Pacific Region. Actions for consideration in the care and protection of vulnerable population for COVID-19 [internet]. 2021. Disponible en: https://iris.who.int/bitstream/handle/10665/333043/WPR-DSE-2020-021-eng.pdf?sequence=5
17. Callies M, Kabouche I, Desombere I, Merckx J, Roelants M, Vermeulen M, et al. SARS-CoV-2 infection prevention and control measures in Belgian schools between December 2020 and June 2021 and their association with seroprevalence: a cross-sectional analysis of a prospective cohort study. BMC Public Health. 2023;23(1).1-11. https://doi.org/10.1186/s12889-023-15806-5
18. Instituto Vasco de Estadística (Eustat). Datos estadísticos de Bilbao [internet]. Disponible en: https://www.eustat.eus/municipal/datos_estadisticos/bilbao_c.html
19. Reglamento (UE) 2016/679 del Parlamento Europeo y del Consejo, de 27 de abril de 2016, relativo a la protección de las personas físicas en lo que respecta al tratamiento de datos personales y a la libre circulación de estos datos y por el que se deroga la Directiva 95/46/CE (Reglamento general de protección de datos). Diario Oficial de la Unión Europea núm. 119 [internet], de 4 de mayo de 2016. Disponible en: http://data.europa.eu/eli/reg/2016/679/oj
20. Ley Orgánica 3/2018, de 5 de diciembre, de protección de datos personales y garantía de los derechos digitales [internet]. Boletín Oficial del Estado núm. 294, de 6 de diciembre de 2018. Disponible en: https://www.boe.es/eli/es/lo/2018/12/05/3/con
21. Paulsen M, Zychlinsky Scharff A, de Cassan K, Sugianto RI, Blume C, et al. Children and adolescents' behavioral patterns in response to escalating COVID-19 restriction reveal sex and age differences. J Adolesc Health. 2022;70(3):378-86. https://doi.org/10.1016/j.jadohealth.2021.11.021
22. Nivette A, Ribeaud D, Murray A, Steinhoff A, Bechtiger L, Hepp U, et al. Non-compliance with COVID-19-related public health measures among young adults in Switzerland: Insights from a longitudinal cohort study. Soc Sci Med. 2021;268:113370. https://doi.org/10.1016/j.socscimed.2020.113370
23. Von Soest T, Pedersen W, Bakken A, Sletten MA. Compliance with infection control rules among adolescents in Oslo during the COVID-19 pandemic. Tidsskr Nor Laegeforen. 2020;140(10). https://doi.org/10.4045/tidsskr.20.0449
24. Gamboa-Moreno E, Garitano-Gutiérrez I, Portuondo-Jiménez J, Cabrera-Rodríguez A, Aldeguer-Corbi J, Tapia-Alonso N, Arrospide A, Picón-Santamaría A. Baja transmisión del SARS-CoV-2 en el ámbito escolar: estudio poblacional en Euskadi. Rev Esp Salud Publica [internet]. 2021;95:e202112196. Disponible en: https://pubmed.ncbi.nlm.nih.gov/34927605/
25. Cárdenas-Soriano MP, Medrano-Sánchez JC, Gómez-Martínez JA. Transmisión del SARS-CoV-2 en escolares durante el primer trimestre del curso 2021/2022 en la provincia de Albacete: incidencia e impacto de las nuevas variantes. Aten Primaria. 2023;55(1):102516. https://doi.org/10.1016/j.aprim.2022.102516
26. Jordan I, Fernandez de Sevilla M, Fumado V, Bassat Q, Bonet-Carne E, Fortuny C, et al. transmission of severe acute respiratory syndrome coronavirus 2 infection among children in summer schools applying stringent control measures in Barcelona, Spain. Clin Infect Dis. 2022;74(1):66-73. https://doi.org/10.1093/cid/ciab227
27. Lee GB, Jung SJ, Yiyi Y, Yang JW, Thang HM, Kim HC. Socioeconomic inequality in compliance with precautions and health behavior changes during the COVID-19 outbreak: an analysis of the Korean Community Health Survey 2020. Epidemiol Health. 2022;44:e2022013. https://doi.org/10.4178/epih.e2022013
28. Arvelo W, Fahrenbruch M, Hast M, Puddy R. COVID-19 stats: percentage of middle and high school students aged 13-21 years attending in-person classes who reported observing fellow students wearing a mask all the time,* by School Setting and Activity - United States, October 2020. MMWR Morb Mortal Wkly Rep. 2021;70(6):223. https://doi.org/10.15585/mmwr.mm7006a5
29. Lorenc A, Kesten JM, Kidger J, Langford R, Horwood J. Reducing COVID-19 risk in schools: a qualitative examination of secondary school staff and family views and concerns in the South West of England. BMJ Paediatr Open. 2021;5(1):e000987. https://doi.org/10.1136/bmjpo-2020-000987
30. Instituto Vasco de Estadística (Eustat). Renta familiar media de la C.A. de Euskadi por barrio de residencia de las capitales, según tipo de renta (euros) [internet]. 2021. Disponible en: https://www.eustat.eus/elementos/ele0006200/renta-familiar-media-de-la-ca-de-euskadi-por-barrio-de-residencia-de-las-capitales-segun-tipo-de-renta-euros/tbl0006266_c.html
31. Otxarkoaga-Txurdinaga no remonta. El Correo [internet]. 2023 may 17. Disponible en: https://www.elcorreo.com/elecciones/forales-municipales/otxarkoagatxurdinaga-remonta-20230514164835-nt.html
32. Jones NR, Qureshi ZU, Temple RJ, Larwood JPJ, Greenhalgh T, Bourouiba L. Two metres or one: what is the evidence for physical distancing in covid-19? BMJ. 2020;370:m3223. https://doi.org/10.1136/bmj.m3223
33. Banholzer N, Zürcher K, Jent P, Bittel P, Furrer L, Egger M, et al. SARS-CoV-2 transmission with and without mask wearing or air cleaners in schools in Switzerland: a modeling study of epidemiological, environmental, and molecular data. PLoS Med. 2023;20(5). https://doi.org/10.1371/journal.pmed.1004226
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Copyright (c) 2026 Airam Cabrera-Rodríguez, Ane Bóveda-San José, Jon Alarcia-Mercado, Félix Menéndez-Pérez, María Soledad Barrueta-Beraza, Miren Elizabete Recalde-Polo, Jesús Alberto Martín-González, María Isabel Mármol-López