Attitudes towards vaccination are associated with vaccination behaviour among university students

Introduction

Vaccination behaviour is influenced by various determinants. Evidence indicates a higher COVID-19 vaccine hesitancy among university students due to their age and a lower risk of complications compared to the general population in Germany. However, little is known about other COVID-19-related determinants for the population of German university students. This study aimed to investigate determinants of vaccination behaviour among German university students.

Methods

The cross-sectional COVID-19 German Student Well-being Study was conducted at five German universities at the end of 2021 via an online survey (n = 7.267). Multiple logistic regressions were calculated to examine associations of vaccination behaviour (not vaccinated vs. fully vaccinated) and attitudes towards vaccination (5Cs: confidence in the safety of the vaccine, complacency - not perceiving diseases as high risk, constraints - structural and psychological barriers, calculation - engagement in information seeking, collective responsibility - willingness to protect others), health literacy in a pandemic (CHL-P), and additional determinants.

Results

All 5Cs were associated with the vaccination status ‘fully vaccinated’, except for complacency. Regarding CHL-P, we found that students who felt that the current scientific knowledge about COVID-19 in terms of the policy decisions on pandemic measures was very complex had a higher odds for being vaccinated (OR = 3.02; 95% CI: 2.26-4.04). Regarding additional determinants, the analysis revealed that students who had been previously infected had in all regressions a lower odds for being vaccinated compared to students with no previous infection.

Conclusions

Due to the strong association of the attitudes towards vaccination and vaccination behaviour among university students, we recommend that the different components of the 5Cs should be considered in future COVID-19 vaccination campaigns in the university context.

Key messages

Change in the financial situation of students during COVID-19 and its impact on depressive symptoms

Background

Students faced unique challenges during the COVID-19 pandemic that may have affected their financial situation as well as their mental health. This study sought to examine whether changes in financial situation before and during the COVID-19 pandemic were associated with depressive symptoms among German university students.

Methods

The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS; N = 7,267) was implemented at five German universities between 27.10. and 14.11.2021. Students were asked if they had had sufficient financial resources to cover monthly expenses before the pandemic, as well as during the first and third waves of the pandemic. Depressive symptoms were assessed using the CES-D 8 (score ranges 0-24) and the PHQ-2 (0-6); higher scores indicating more severe depressive symptoms. Linear regression models were used to examine associations between variables.

Results

A worsened financial situation between the first and the third wave of the pandemic was associated with a one point (0.95) increase on the CES-D 8 scale (95% CI: 0.61, 1.29) and an improved financial situation with a decrease by 0.81 points (95% CI: -1.20, -0.42). A worsened financial situation was associated with a 0.26-point increase in PHQ-2 (95% CI: 0.14, 0.37) and an improved financial situation with a -0.12-point decrease (95% CI: -0.25, 0.01). Similarly, worsened financial situation in the third wave compared to prior to the pandemic, was also associated with an increase in CES-D 8 score and PHQ-2 and an improved financial situation with a decrease in CES-D 8 and PHQ-2.

Conclusions

Our findings suggest associations between students’ financial situation during the COVID-19 pandemic and their mental health. Due to their instable financial situation, students are a vulnerable group in need of mental and financial support during pandemic crises.

Key messages

Anxiety among students during the pandemic - Results from the C-19 German Student Well-being Study

Background

Anxiety is widespread among university students. The COVID-19 pandemic af-fected students’ mental health negatively. Given the long duration of the pandemic monitoring mental health remains important. This study aims to determine to which extent anxiety is preva-lent among students (1), what factors are associated with it (2) and which student groups are mostly affected (3).

Methods

The cross-sectional COVID-19 German Student Well-being Study (C19 GSWS) sur-veyed mental health and well-being of students at five universities in Germany from 27.10.-14.11.21. Anxiety was assessed using the GAD-2. Associations between anxiety and sociodem-ographic, socioeconomic/social support factors as well as health- and COVID-19-related factors were determined using multiple binary logistic regression models.

Results

The mean age of students was 24.1 years (SD = 4.9), 67% were women and 31% men. The prevalence of anxiety was 32% and diverse gender (OR = 3.98, 95% CI: 1.71-9.23), a com-plicated relationship status (OR = 1.66, 95% CI: 1.06-2.60), the lack of a confidant (OR = 2.50, 95% CI: 1.80-3.46), and financial difficulties (e.g., being able to cover monthly expenses; OR = 1.76, 95% CI: 1.36-2.29) were associated with anxiety. Participants who were worried about (re)infection with COVID-19 had a 1.28-times higher chance (OR, 95% CI: 1.03-1.59) for anxie-ty. Students who were (rather) not worried that a relative would become severely ill with COVID-19 had a lower chance to experience anxiety (OR = 0.72, 95% CI: 0.53-0.98) as well as those who were confident receiving medical care in case of an infection with COVID-19 (OR = 0.80, 95% CI: 0.65-0.98).

Conclusions

Concepts for prevention and counselling in terms of mental health problems in students should be developed considering specific stressors due to the pandemic.

Key messages

• This study shows that anxiety is widespread among university students and associated with a variety of stressors.

• The findings can help to develop specific concepts for prevention and counselling.

Modified Glasgow prognostic score (mGPS) is correlated with sarcopenia and dominates the prognostic role of baseline body composition parameters in advanced gastric and esophagogastric junction cancer patients undergoing first-line treatment from the phase III EXPAND trial

PURPOSE

Sarcopenia represents an established adverse prognostic factor in cancer patients. Consequently, different means to counteract sarcopenia have been proposed to improve cancer treatment. Computed tomography (CT) based measurements, also labor intensive, are well validated for the analysis of sarcopenia. As inflammation plays a key role in the development of sarcopenia, we here studied the role of the modified Glasgow prognostic score (mGPS), consisting of inflammation parameters plasma C-reactive protein and albumin, to predicting sarcopenia and adipose tissue related body composition (BC) parameters at baseline and their changes during treatment and to analyze its prognostic role in conjunction with BC parameters.

PATIENTS AND METHODS

CT measurements of body composition parameters were performed at baseline and week 12 in patients with advanced gastric or esophago-gastric junction (EGJ) cancer from the phase III EXPAND trial, undergoing first-line platinum-fluoropyrimidine chemotherapy. mGPS was calculated from baseline CRP and albumin plasma levels. Pearson correlation and Cox regression analyses were performed.

RESULTS

mGPS is strongly prognostic for overall survival (OS). Baseline mGPS is significantly correlated with baseline mean muscle attenuation (MA), P<0.0001. Baseline mGPS did not predict a decline in muscle or adipose tissue parameters during 12 weeks of treatment and a decline in muscle or adipose tissue parameters was not prognostic for OS. MA lost its prognostic role for OS when mGPS or CRP was entered into the COX models. ECOG performance status together with CRP or mGPS remained as sole baseline prognostic factors for OS.

CONCLUSIONS

Our findings support a model where tumor-mediated inflammatory response represents a strong prognostic factor, which is causally related to sarcopenia, but with no direct causal path from sarcopenia to survival. Therefore, therapeutic targeting of systemic inflammation should be further explored as a promising strategy to improve both sarcopenia and the efficacy and tolerability of cancer treatment.

Depressive symptoms in higher education students during the first wave of the COVID-19 pandemic. An examination of the association with various social risk factors across multiple high- and middle-income countries

Higher-education students face substantial risks for developing depressive symptoms during the COVID-19 pandemic or experiencing exacerbated pre-existing depressive symptoms. This study uses data from the COVID-19 International Student Well-Being Study, which collected data through a non-representative convenience sample in 125 higher-education institutions (HEI) across 26 high- and middle-income countries (N: 20,103) during the first wave of the COVID-19 pandemic. It describes the prevalence of depressive symptoms in higher-education students. We find substantial cross-national variation in depressive symptoms, with lowest mean levels established in the Nordic countries and France, while highest mean levels of depressive symptoms were found in Turkey, South Africa, Spain and the USA. Elevated risk for depressive symptoms was found in female students, students with fewer social support resources and in a more disadvantaged socioeconomic position, and students with a migrant background. COVID-19 related stressors, such as reduced social contact, increased financial insecurity, and academic stress explained a relatively larger proportion of the variance in depressive symptoms compared to non-COVID-19 related stressors. This finding shows that not the pandemic itself, but rather the secondary effects of the pandemic relate to students' mental health. Our results enable HEIs to be better equipped to target groups that are particularly at risk during a pandemic.

Mental wellbeing and engagement in health risk behaviours in German university students during the COVID-19 pandemic: Findings of a cross-sectional study

Background

Daily life of higher education students across the world changed profoundly in 2020 with the implementation of governmental and institutional measures to control the COVID-19 pandemic. We investigated mental wellbeing and engagement in health risk behaviours (HRB) in German university students at the start of the COVID-19 pandemic.

Methods

Data stem from the COVID-19 International Student Wellbeing Study (C19 ISWS). The web-based survey was conducted in May 2020 at four German universities. HRBs included tobacco and cannabis use, alcohol consumption, and engagement in physical activity. All HRBs were assessed retrospectively and at the time of data collection. Mental wellbeing was assessed using the 8-item Center for Epidemiologic Studies-Depression Scale (CES-D 8). We conducted multinomial regression analyses to investigate factors associated with changes in HRBs and latent transition analysis to identify substance use profiles.

Results

5021 students completed the survey (69% female; mean age 24.4 years, SD = 5.1). The mean score for depressive symptoms was 9.25 (SD = 0.67, range 0-24). Sixty-one percent of students reported consuming alcohol, 46% binge drinking, 44% inactivity, 19% smoking and 11% cannabis use. While smoking and cannabis use remained unchanged during the COVID-19 pandemic, 24% reported a decrease in binge drinking. Changes to physical activity were frequently reported, with 31% reporting an increase and 19% reporting a decrease in vigorous physical activity. Higher depressive symptoms were found to be associated with changes in HRBs. Five substance use behaviour profiles were identified, which remained fairly unchanged.

Conclusions

Engagement in HRBs remains at high level during the COVID-19 pandemic among German students. Depressive symptoms were found to be associated with changes in HRBs. Efforts to promote student health and wellbeing are needed in times of the COVID-19 pandemic and thereafter to prevent longer-term consequences.

Prevalence and associated harm of engagement in self-asphyxial behaviours ('choking game') in young people: a systematic review

OBJECTIVE

To assess the prevalence of engagement in self-asphyxial (risk-taking) behaviour (SAB) ('choking game') and associated morbidity and mortality in children and young people up to age 20.

DESIGN

Systematic literature review.

SEARCH STRATEGY

Electronic database search of MEDLINE, Embase, PsycINFO, CINAHL, PubMed, Web of Science Core Collection, BIOSIS citation index and the Cochrane register with no language or date limits applied. References of key papers were reviewed, and experts were contacted to identify additional relevant papers.

ELIGIBILITY CRITERIA

Systematic reviews, cross-sectional, cohort and case-control studies, and case reports examining SAB with regard to individuals aged 0-20 years, without explicitly stated autoerotic, suicidal or self-harm intentions were included.

RESULTS

Thirty-six relevant studies were identified, and SAB was reported in 10 countries. In North America, France and Colombia, awareness of SAB ranged from 36% to 91% across studies/settings, and the median lifetime prevalence of engagement in SAB was 7.4%. Six studies identified the potential for SAB to be associated with engagement in other risk behaviours. Ninety-nine fatal cases were reported. Of the 24 cases described in detail, most occurred when individuals engaged in SAB alone and used a ligature.

CONCLUSIONS

The current evidence on SAB among young people is limited, and stems predominantly from North America and France. Awareness of SAB among young people is high, and engagement varies by setting. Further research is needed to understand the level of risk and harm associated with SAB, and to determine the appropriate public health response.

HCV treatment rates and sustained viral response among people who inject drugs in seven UK sites: real world results and modelling of treatment impact

Hepatitis C virus (HCV) antiviral treatment for people who inject drugs (PWID) could prevent onwards transmission and reduce chronic prevalence. We assessed current PWID treatment rates in seven UK settings and projected the potential impact of current and scaled-up treatment on HCV chronic prevalence. Data on number of PWID treated and sustained viral response rates (SVR) were collected from seven UK settings: Bristol (37-48% HCV chronic prevalence among PWID), East London (37-48%), Manchester (48-56%), Nottingham (37-44%), Plymouth (30-37%), Dundee (20-27%) and North Wales (27-33%). A model of HCV transmission among PWID projected the 10-year impact of (i) current treatment rates and SVR (ii) scale-up with interferon-free direct acting antivirals (IFN-free DAAs) with 90% SVR. Treatment rates varied from <5 to over 25 per 1000 PWID. Pooled intention-to-treat SVR for PWID were 45% genotypes 1/4 [95%CI 33-57%] and 61% genotypes 2/3 [95%CI 47-76%]. Projections of chronic HCV prevalence among PWID after 10 years of current levels of treatment overlapped substantially with current HCV prevalence estimates. Scaling-up treatment to 26/1000 PWID annually (achieved already in two sites) with IFN-free DAAs could achieve an observable absolute reduction in HCV chronic prevalence of at least 15% among PWID in all sites and greater than a halving in chronic HCV in Plymouth, Dundee and North Wales within a decade. Current treatment rates among PWID are unlikely to achieve observable reductions in HCV chronic prevalence over the next 10 years. Achievable scale-up, however, could lead to substantial reductions in HCV chronic prevalence.