Internet Use, Risk Awareness, and Demographic Characteristics Associated With Engagement in Preventive Behaviors and Testing: Cross-Sectional Survey on COVID-19 in the United States

Infection preventive behaviors and its association with perceived threat and perceived social factors during the COVID-19 pandemic in South Korea: 2020 community health survey

BACKGROUND

This study examined why some individuals have not properly performed health prevention behavior during the coronavirus disease 2019 (COVID-19) pandemic. We used data from a community health survey conducted by public health centers in South Korea to identify factors affecting COVID-19 prevention behavior in urban and rural areas. Also, we examined whether individual-level demographic, socio-psychological, and structural variables affected COVID-19 prevention behavior by referring to a model explaining individuals' health prevention behavior. In particular, the study is significant as not many other measures were suggested besides compliance with personal quarantine rules during the early phase of the pandemic in 2020. We hope that the results of this study will be considered in further analysis of infection preventive behavior and in future health crises.

METHODS

Probability proportional and systematic sampling were used to collect data in 2020 from 229,269 individuals. After exclusion, the valid data from 141,902 adults (86,163 urban and 44,739 rural) were analyzed. We performed t-tests and analyses of variance to ascertain the differences in COVID-19 preventive behaviors according to demographic characteristics, and a post-hoc analysis was conducted using Scheffé's test. Factors that affected participants' COVID-19 preventive behaviors were analyzed using multiple regression analyses.

RESULTS

The variables significantly influencing COVID-19 preventive behaviors in urban areas were age, gender, living with two or more people, educational level, monthly household income, working status, influenza vaccination, daily life stress, and perceived threat. In rural areas, age, gender, living with two or more people, education level, influenza vaccination, daily life stress, perceived threat, and perceived social factors were significantly associated with increased COVID-19 preventive behaviors.

CONCLUSIONS

Several demographic characteristics were associated with urban and rural residents' COVID-19-related preventive behaviors. A different approach is needed for the two regions in future policy. Future studies should aim to improve the power of the model and include other factors that may be related to COVID-19 preventive behavior.

An Integrated Approach to COVID-19 Preventive Behaviour Intentions: Protection Motivation Theory, Information Acquisition, and Trust

COVID-19 has been a global threat since November 2019 due to its high transmission rates and the issue of unwillingness to vaccinate. Effective risk management requires accurate health communication and public compliance with reccomended preventive behaviors. Therefore, we investigated predictors of COVID-19 preventive behavior intention based on Protection Motivation Theory (PMT) in addition to frequency of public's use of and trust in a group of COVID-19 related information sources. This cross-sectional study was conducted on 458 adults in Turkey with online survey. Results showed that all PMT components (except perceived susceptibility) accounted for 49% of the variance in protection motivation and there was relationship between information sources and protection motivation. Overall, our study findings suggested that being more informed and having confidence in the feasibility (self-efficacy) and effectiveness (response efficacy) of preventive behaviors may particularly help slow the disease spread.

Promoting Social Distancing and COVID-19 Vaccine Intentions to Mothers: Randomized Comparison of Information Sources in Social Media Messages

Background

Social media disseminated information and spread misinformation during the COVID-19 pandemic that affected prevention measures, including social distancing and vaccine acceptance.

Objective

In this study, we aimed to test the effect of a series of social media posts promoting COVID-19 nonpharmaceutical interventions (NPIs) and vaccine intentions and compare effects among 3 common types of information sources: government agency, near-peer parents, and news media.

Methods

A sample of mothers of teen daughters (N=303) recruited from a prior trial were enrolled in a 3 (information source) × 4 (assessment period) randomized factorial trial from January to March 2021 to evaluate the effects of information sources in a social media campaign addressing NPIs (ie, social distancing), COVID-19 vaccinations, media literacy, and mother-daughter communication about COVID-19. Mothers received 1 social media post per day in 3 randomly assigned Facebook private groups, Monday-Friday, covering all 4 topics each week, plus 1 additional post on a positive nonpandemic topic to promote engagement. Posts in the 3 groups had the same messages but differed by links to information from government agencies, near-peer parents, or news media in the post. Mothers reported on social distancing behavior and COVID-19 vaccine intentions for self and daughter, theoretic mediators, and covariates in baseline and 3-, 6-, and 9-week postrandomization assessments. Views, reactions, and comments related to each post were counted to measure engagement with the messages.

Results

Nearly all mothers (n=298, 98.3%) remained in the Facebook private groups throughout the 9-week trial period, and follow-up rates were high (n=276, 91.1%, completed the 3-week posttest; n=273, 90.1%, completed the 6-week posttest; n=275, 90.8%, completed the 9-week posttest; and n=244, 80.5%, completed all assessments). In intent-to-treat analyses, social distancing behavior by mothers (b=-0.10, 95% CI -0.12 to -0.08, P<.001) and daughters (b=-0.10, 95% CI -0.18 to -0.03, P<.001) decreased over time but vaccine intentions increased (mothers: b=0.34, 95% CI 0.19-0.49, P<.001; daughters: b=0.17, 95% CI 0.04-0.29, P=.01). Decrease in social distancing by daughters was greater in the near-peer source group (b=-0.04, 95% CI -0.07 to 0.00, P=.03) and lesser in the government agency group (b=0.05, 95% CI 0.02-0.09, P=.003). The higher perceived credibility of the assigned information source increased social distancing (mothers: b=0.29, 95% CI 0.09-0.49, P<.01; daughters: b=0.31, 95% CI 0.11-0.51, P<.01) and vaccine intentions (mothers: b=4.18, 95% CI 1.83-6.53, P<.001; daughters: b=3.36, 95% CI 1.67-5.04, P<.001). Mothers' intentions to vaccinate self may have increased when they considered the near-peer source to be not credible (b=-0.50, 95% CI -0.99 to -0.01, P=.05).

Conclusions

Decreasing case counts, relaxation of government restrictions, and vaccine distribution during the study may explain the decreased social distancing and increased vaccine intentions. When promoting COVID-19 prevention, campaign planners may be more effective when selecting information sources that audiences consider credible, as no source was more credible in general.

Trial Registration

ClinicalTrials.gov NCT02835807; https://clinicaltrials.gov/ct2/show/NCT02835807.

Voluntary testing for COVID-19: perceptions and utilization among the inhabitants of Saudi Arabia

Objectives

Voluntary testing (VT) plays a crucial role in the prevention and control of infectious diseases. The present study investigated the perceptions and utilization of VT services for coronavirus disease 2019 (COVID-19) among the inhabitants of Saudi Arabia.

Methods

In total, 3,510 adult participants from all provinces of Saudi Arabia were recruited via a national online survey.

Results

Of the 3,510 participants, 88.9% were aware of the testing services available to them and of those, more than half (59.5%) had used the VT services and 96.1% were satisfied with the services. Contact with a positive COVID-19 case was the top reason for accessing VT, while a lack of awareness about the availability of VT services was the top perceived limiting factor. A history of chronic health conditions, anxiety and/or depression, and previous symptoms suggestive of COVID-19 were found to be predictors of the utilization of VT services (OR 1.55, 95% CI 1.22−1.96; OR 1.48, 95% CI 1.16−1.88; OR 3.31, 95% CI 2.77−3.95; and OR 1.62, 95% CI 1.34−1.96; respectively), respectively.

Conclusion

The awareness of voluntary COVID-19 testing services was satisfactory among the Saudi Arabian population, but can be improved. Sociodemographic and health history predictors of the utilization of VT services were identified.

Smart design of energy-saving and water-saving facilities: a perspective of emotional factors

Purpose

This paper aims to answer these questions: “Is the public adopting energy-saving and water-saving facilities because they want to save energy and water in their psychological perception?”, “Is it convenient to use energy-saving and water-saving facilities?”, “If the inductive design of energy-saving and water-saving facilities attracts the public’s interest, the public is it more willing to install energy-saving and water-saving facilities in a widespread manner?” and “Can inductive energy-saving and water-saving facilities be introduced into the smart manufacturing system of manufacturing industries that require a lot of water to effectively save water and save costs for the company?”.

Design/methodology/approach

This paper aims to investigate the attitudes of employees toward using energy-saving and water-saving facilities by constructing a questionnaire based on the ABC (Affect, Behavior, Cognition) model to survey the attitudes of employees from the Southern and Eastern of Taiwan and establishing a structural equation modeling (SEM) to examine the relationship between affect, behavior and cognition while using energy-saving and water-saving facilities.

Findings

There are some findings in this paper that the affective design have a strongly significant positive impact for using energy-saving and water-saving facility in the proposed model. People are willing to use energy-saving and water-saving facilities but are more willing to adopt those energy-saving and water-saving products of smart designs, as those take into account the emotional factors. The critical factor for the public to adopt energy-saving and water-saving facilities is smart design, which incorporates emotional elements.

Research limitations/implications

There are still some limitations of this study that the ABC model can only be used as a psychological discussion, and the development and design of related facilities still needs to be jointly developed with professionals in related technical fields. The introduction of induction water supply facilities needs to be considered while the company introduces the design of the smart manufacturing system. Therefore, professionals related to induction water supply should participate in the planning at the initial stage of the company's concept of introducing the smart manufacturing system.

Practical implications

On the practical side, based on preliminary research conclusions, this study proposes to introduce inductive water supply into smart manufacturing systems for manufacturing companies that require a lot of water in their manufacturing processes. In practice, the company can actually save a lot of water, thereby saving costs and reducing waste water discharge.

Social implications

The results of this study show that the public has a cognition of energy-saving and water-saving. However, there is a Chinese proverb that “easy to know and hard to do”, when actually using facilities, convenience is an important consideration for public. Smart facilities of energy-saving and water-saving, in addition to the benefits of energy-saving and water-saving, it is easy to use, and interacts with users through inductive water supply, which can more emotionally attract people's willingness to use.

Originality/value

This study found that smart facilities, which can more emotionally attract people's willingness to use. On the academic side, this study proves that using the ABC theory to explore the public’s psychological affective, behavior and cognition response to the use of facilities is a very suitable method. On the practical side, based on preliminary research conclusions, this study proposes to introduce inductive water supply into smart manufacturing systems for manufacturing companies that require a lot of water in their manufacturing processes. In practice, the company can actually save a lot of water, thereby saving costs and reducing waste water discharge.

Wear or Not to Wear a Mask? Recommendation Inconsistency, Government Trust and the Adoption of Protection Behaviors in Cross-Lagged TPB Models

This study examined how exposure to government health advisories on face mask-wearing and trust in government influenced people's compliance with the advisory overtime. We conducted a three-wave panel survey (N = 1,024; T1 in February, T2 in March, T3 in April 2020) in Singapore, where the government initially enforced wearing a face mask conditional on feeling sick, and then later revised its advisory to make mask-wearing mandatory regardless of sickness. Exposure to the initial advisory at T1 had cross-lagged effects on forming positive expectancy, normative, and self-efficacy beliefs on conditional face mask-wearing at T2. Government trust at T1 also had a cross-lagged effect on increasing supportive perceived norm for conditional mask-wearing, while reducing positive expectancy of nonconditional mask-wearing at T2. Exposure to the revised advisory and government trust at T3 were positively associated with outcome expectancy, perceived norm, and self-efficacy regardless of behavior type. Regarding nonconditional mask-wearing, the autoregressive links from T2 to T3 were insignificant for perceived norm and self-efficacy and even negatively significant for intention and behavior. This study offers theoretical and practical insights by documenting the complex and dynamic processes involved in health decision-making during a novel disease pandemic.

Cross-sectional study of COVID-19 knowledge, beliefs and prevention behaviours among adults in Senegal

OBJECTIVES

The aim of the study was to explore COVID-19 beliefs and prevention behaviours in a francophone West African nation, Senegal.

DESIGN

This was a cross-sectional analysis of survey data collected via a multimodal observational study.

PARTICIPANTS

Senegalese adults aged 18 years or older (n=1452).

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures were COVID-19 prevention behaviours. Secondary outcome measures included COVID-19 knowledge and beliefs. Univariate, bivariate and multivariate statistics were generated to describe the sample and explore potential correlations.

SETTING

Participants from Senegal were recruited online and telephonically between June and August 2020.

RESULTS

Mask wearing, hand washing and use of hand sanitiser were most frequently reported. Social distancing and staying at home were also reported although to a lower degree. Knowledge and perceived risk of COVID-19 were very high in general, but risk was a stronger and more influential predictor of COVID-19 prevention behaviours. Men, compared with women, had lower odds (adjusted OR (aOR)=0.59, 95% CI 0.46 to 0.75, p<0.001) of reporting prevention behaviours. Rural residents (vs urban; aOR=1.49, 95% CI 1.12 to 1.98, p=0.001) and participants with at least a high school education (vs less than high school education; aOR=1.33, 95% CI 1.01 to 1.76, p=0.006) were more likely to report COVID-19 prevention behaviours.

CONCLUSIONS

In Senegal, we observed high compliance with recommended COVID-19 prevention behaviours among our sample of respondents, in particular for masking and personal hygiene practice. We also identified a range of psychosocial and demographic predictors for COVID-19 prevention behaviours such as knowledge and perceived risk. Stakeholders and decision makers in Senegal and across Africa can use place-based evidence like ours to address COVID-19 risk factors and intervene effectively with policies and programming. Use of both phone and online surveys enhances representation and study generalisability and should be considered in future research with hard-to-reach populations.

Understanding the Association between Online Social Support Obtainment and Coping during a Public Crisis

This study aims to examine how the process of online support obtainment may affect cognitive and behavioral coping during a public crisis. A cross-sectional online survey (N = 555) was conducted during the early stage of the COVID-19 pandemic in the U.S. Our findings revealed that informational support, obtained primarily through passive and private online involvement, led to increased risk perceptions of COVID-19; emotional support, obtained mainly via private online involvement, appeared to elicit higher perceived efficacy to cope with the crisis. People's engagement in preventive behaviors was found to be affected by efficacy perceptions, but not by risk perceptions. The results suggested that online social support functioned as a double-edged sword to affect people's coping with a public crisis.

Adoption of Preventive Behaviour Strategies and Public Perceptions About COVID-19 in Singapore

BACKGROUND

The unprecedented severity of coronavirus disease 2019 (COVID-19) constitutes a serious public health concern. However, adoption of COVID-19-related preventive behaviours remain relatively unknown. This study investigated predictors of preventive behaviours.

METHODS

An analytical sample of 897 Singaporean adults who were quota sampled based on age, gender, and ethnicity were recruited through a web-enabled survey. Outcomes were adoption of, or increased frequency of preventive behaviours (avoiding social events; avoiding public transport; reducing time spent shopping and eating out; wearing a mask in public; avoiding hospitals/clinics; keeping children out of school, washing hands/using sanitisers; keeping surroundings clean; avoiding touching public surfaces; working from/studying at home). Public perceptions regarding COVID-19 (chances of getting COVID-19; perceived likelihood of COVID-19-related intensive care unit (ICU) admission; government trust; self-efficacy; perceived appropriateness of COVID-19 behaviours; response efficacy), anxiety, and demographic characteristics (age; ethnicity; marital status; education; chronic conditions; current living arrangements) were investigated as predictors of preventive behaviours adopted during COVID-19 in binomial and ordered logistic regressions.

RESULTS

Though adoption of preventive behaviours among Singaporeans varied, it was, overall, high, and consistent with government recommendations. Nearly a quarter reported moderate to severe anxiety (General Anxiety Disorder 7-item - GAD-7 scores). Respondents who perceived higher COVID-19 risks, had higher government trust, higher self-efficacy, and perceived that others acted appropriately reported increased adoption/frequency of preventive measures. The strongest indicator of behavioural change was response efficacy. Respondents who were older, highly educated, anxious and married reported higher adoption/frequency of preventive measures.

CONCLUSION

To successfully influence appropriate preventive behaviours, public health messages should highlight response efficacy, increase self-efficacy, and promote trust in governmental response. Focus should be on demographic segments with low adoptions, such as younger individuals and those with low education.

Barriers to and strategies to address COVID-19 testing hesitancy: a rapid scoping review

BACKGROUND

Testing is a foundational component of any COVID-19 management strategy; however, emerging evidence suggests that barriers and hesitancy to COVID-19 testing may affect uptake or participation and often these are multiple and intersecting factors that may vary across population groups. To this end, Health Canada's COVID-19 Testing and Screening Expert Advisory Panel commissioned this rapid review in January 2021 to explore the available evidence in this area. The aim of this rapid review was to identify barriers to COVID-19 testing and strategies used to mitigate these barriers.

METHODS

Searches (completed January 8, 2021) were conducted in MEDLINE, Scopus, medRxiv/bioRxiv, Cochrane and online grey literature sources to identify publications that described barriers and strategies related to COVID-19 testing.

RESULTS

From 1294 academic and 97 grey literature search results, 31 academic and 31 grey literature sources were included. Data were extracted from the relevant papers. The most cited barriers were cost of testing; low health literacy; low trust in the healthcare system; availability and accessibility of testing sites; and stigma and consequences of testing positive. Strategies to mitigate barriers to COVID-19 testing included: free testing; promoting awareness of importance to testing; presenting various testing options and types of testing centres (i.e., drive-thru, walk-up, home testing); providing transportation to testing centres; and offering support for self-isolation (e.g., salary support or housing).

CONCLUSION

Various barriers to COVID-19 testing and strategies for mitigating these barriers were identified. Further research to test the efficacy of these strategies is needed to better support testing for COVID-19 by addressing testing hesitancy as part of the broader COVID-19 public health response.

Optimistic Youth: Young Adults Predicted a Faster Decrease in Risk during COVID-19 Emergency State in Portugal

Perception of risk is known to change throughout the lifespan. Previous studies showed that younger adults are more prone to risk behaviours than older adults. Do these age-related differences influence risk perception during a pandemic crisis? Here, we investigated how age influenced predicted risk during the COVID-19 emergency state in Portugal. We show that time-projected estimations (e.g., appraisals based on 'now' vs. 'in two weeks' time', or 'in four weeks' time') of both risk behaviour and importance of transmission prevention decrease over time. Importantly, projected risk decreased more steeply for younger than older adults. Our findings suggest that younger adults have a different perception of epidemic-related risk than older adults. This seems to support the view that public health policy making during epidemics should differentially target younger adults.

Double standards in the COVID-19 pandemic: The moderation of perceived threat

This research explored whether people hold double standards in a public crisis. We proposed that during the COVID-19 pandemic, people required others to strictly follow self-quarantine rules and other preventive behaviours, whereas they themselves would not, demonstrating double standards. Moreover, this effect would be moderated by the perceived threat from the pandemic. Using data collected in the United States and China, three studies (N = 2180) tested the hypotheses by measuring (Study 1) and manipulating the perceived threat (Studies 2 and 3). We found that people generally applied higher standards to others than to themselves when it came to following the self-quarantine rules. This effect was strong when a relatively low threat was perceived, but the self-other difference disappeared when the perceived threat was relatively high, as the demands they placed on themselves would increase as the perceived threat intensified, but their requirements of others would be constantly strict.

Effectiveness of educational interventions in knowledge, attitude, and practice for preventing respiratory infections: a systematic review and meta-analysis

OBJECTIVES

to demonstrate the effectiveness of educational interventions in knowledge, attitude and practice for preventing respiratory infections in adults and older adults.

METHODS

this is a systematic review carried out in 11 databases. Primary studies, without language and time restrictions, of the randomized, non-randomized and before-and-after clinical trial type, were selected. The risk of bias was assessed by two independent researchers, and the methodological quality was generated by the Grading of Recommendations, Assessment, Development and Evaluation.

RESULTS

the intervention effectiveness was evidenced in seven studies. The results of the random effects meta-analysis show that there is a statistically significant difference between knowledge about preventing respiratory diseases, with an OR of 2.82 (95%CI 1.70 to 4.69) for the occurrence of events represented by improved knowledge.

CONCLUSIONS

most studies show the effectiveness of educational interventions, which was determined through the Knowledge, Attitude and Practice survey.

Willingness and uptake of the COVID-19 testing and vaccination in urban China during the low-risk period: a cross-sectional study

BACKGROUND

Regular testing and vaccination are effective measures to mitigate the ongoing COVID-19 pandemic. Evidence on the willingness and uptake of the COVID-19 testing is scarce, and the willingness and uptake of vaccination may change as the pandemic evolves. This study aims to examine willingness and uptake of COVID-19 testing and vaccination during a low-risk period of the COVID-19 pandemic in urban China.

METHODS

A cross-sectional online survey was conducted among 2244 adults in urban China. Descriptive analyses were performed to compare the respondents' willingness and uptake of COVID-19 testing and vaccination. Multivariate logistic regressions were fitted to investigate factors associated with the willingness and uptake of the two measures.

RESULTS

In early 2021, about half (52.45%) of the respondents had received or scheduled a COVID-19 test at least once, and a majority (95.63%) of the respondents were willing to receive testing. About two-thirds (63.28%) of the respondents had received/scheduled or were willing to receive a COVID-19 vaccine. Willingness and uptake of COVID-19 testing were not associated with socio-demographic characteristics, except for occupation. Being of older age, migrants, having higher educational attainment and secure employment were associated with a higher uptake of COVID-19 vaccination among the surveyed respondents, while willingness to vaccinate was consistent across socio-demographic characteristics among those who had not been vaccinated.

CONCLUSIONS

By early 2021, Chinese adults expressed almost universal willingness of COVID-19 testing and over half of adults have been tested, while the willingness and uptake of COVID-19 vaccination were relatively low at the low-risk period of the COVID-19 pandemic. Maintaining willingness of COVID-19 vaccination is critical and necessary, especially when the pandemic evolved into a low-risk period.

Information Usage and Compliance with Preventive Behaviors for COVID-19: A Longitudinal Study with Data from the JACSIS 2020/JASTIS 2021

The influence of different types of information sources on individual preventive behaviors remains unclear. We aimed to investigate the associations between individual information usage to obtain information about COVID-19 and compliance with preventive behaviors. This longitudinal study was based on an Internet survey conducted in August−September 2020 and February 2021. We used compliance with four preventive behaviors for COVID-19, “wearing a mask”, “ventilation”, “social distancing”, and “avoiding crowds” as outcome variables, and 20 types of information sources based on people or institutions (Medical worker, Government, etc.) and media (TV news, Twitter, etc.) as predictors. Absolute differences and 95% confidence intervals were estimated using generalized estimating equations adjusted for possible confounders. Among the 18,151 participants aged 20−79, the mean age was 51.7 (SD = 15.9) in 2020, and 51.3% were male. In total, compliance with “wearing a mask”, “ventilation”, “social distancing”, and “avoiding crowds” was seen in 86.2%, 46.9%, 45.4%, and 62.6% of individuals in 2020, and 89.3%, 38.2%, 47.2%, and 61.6% of individuals in 2021, respectively. In the multivariate analysis, “medical workers”, “professionals”, “the government”, “Twitter”, “news websites”, and “TV news” were positively associated with compliance with two or more preventive behaviors (p < 0.05). The type of information source may play an important role in providing information for COVID-19 prevention.

Predictors of COVID-19 preventive behaviours in a sample of the Turkish population

AIM

This research aimed to determine predictors of COVID-19 preventive behaviours in a sample of the Turkish population.

METHODS

The study was conducted with 575 individuals. COVID-19 preventive behaviours were evaluated with a 19-item scale scored from 19 to 95. Knowledge on COVID-19 was evaluated with a 22-item scale scored from 0 to 22. General health literacy was evaluated with the Turkey Health Literacy Scale (THLS), which was scored from 0 to 50.

RESULTS

The average COVID-19 preventive behaviours score was moderately high in this sample of the Turkish population. Being female, having a higher level of education, better economic status, being a non-smoker, having a higher level of COVID-19 knowledge and better general health literacy score were significant predictors of COVID-19 preventive behaviours (P < 0.05).

CONCLUSION

Sociodemographic characteristics, knowledge of COVID-19 and general health literacy are crucial in preventing COVID-19 infections in a sample of the Turkish population.

Barriers to and Facilitators of COVID-19 Prevention Behaviors Among North Carolina Residents

COVID-19 was the third leading cause of death in the United States in 2020. Prior to the wide dissemination of SARS-CoV-2 vaccines, individual prevention behaviors, such as wearing face masks, have been the primary non-pharmaceutical interventions to reduce infections. We surveyed 404 North Carolina residents recruited through Amazon MTurk in July 2020 to assess adherence to key prevention behaviors (6-foot distancing, mask wearing, and gathering limits) and barriers to and facilitators of adherence. Participants reported past 7-day prevention behaviors and behavioral barriers and facilitators informed by the Integrated Behavior Model and the Health Belief Model (perceived risk, perceived severity, behavioral attitudes, injunctive and descriptive norms, and personal agency). Reported adherence to each behavior in the past 7 days was generally high, with lower adherence to 6-foot distancing and mask wearing in the work context. The most commonly endorsed barriers to 6-foot distancing included physical impediments, forgetting, and unfavorable descriptive norms. For mask wearing, ability to keep a distance, discomfort/inconvenience, and forgetting were most commonly endorsed. In logistic regression models, injunctive social norms followed by perceived personal agency were the strongest independent correlates of 6-foot distancing. Behavioral attitudes and injunctive social norms were independently associated with mask wearing. For gathering size limit adherence, perceived personal agency was the strongest independent predictor followed by perceived severity of COVID-19. Messaging campaigns targeting these barriers and facilitators should be tested. Interventions improving the convenience and salience of physical distancing and mask wearing in high-density public places and places of work may also promote prevention behaviors.

Increase in people's behavioural risks for contracting COVID-19 during the 2021 New Year holiday season: longitudinal survey of the general population in Japan

OBJECTIVES

There has been no study in Japan on the predictors of risk for acquiring SARS-CoV-2 infection based on people's behaviour during the COVID-19 pandemic. The aim of this study was to document changes in risk behaviour during the New Year's holiday season in 2021 and to identify factors associated with high-risk behaviour for infection using a quantitative assessment tool.

DESIGN

A longitudinal survey.

SETTING

Multiphasic health check-ups for the general population in Iwate Prefecture.

PARTICIPANTS

Serial cross-sectional data were obtained using rapid online surveys of residents in Iwate Prefecture from 4 to 7 December 2020 (baseline survey) and from 5 to 7 February 2021 (follow-up survey). The data in those two surveys were available for a total of 9741 participants.

MAIN OUTCOME MEASURES

We estimated each individual's risk of acquiring SARS-CoV-2 infection based on the microCOVID calculator. We defined four trajectories of individual risk behaviours based on the probabilities of remaining at low risk, increasing to high risk, improving to low risk and persistence of high risk.

RESULTS

Among people in the low-risk group in the first survey, 3.6% increased to high risk, while high risk persisted in 80.0% of people who were in the high-risk group at baseline. While healthcare workers were significantly more likely to be represented in both the increasing risk and persistently high-risk group, workers in the education setting were also associated with persistence of high risk (OR 2.58, 95% CI 1.52 to 4.39; p<0.001).

CONCLUSIONS

In determining countermeasures against COVID-19 (as well as future outbreaks), health officials should take into account population changes in behaviour during large-scale public events.

Social Media Use, eHealth Literacy, Knowledge, Attitudes, and Practices Toward COVID-19 Vaccination Among Chinese College Students in the Phase of Regular Epidemic Prevention and Control: A Cross-Sectional Survey

Background

College students are at a high risk of being infected with COVID-19, and they are one of the key population clusters that should be vaccinated. The present study aimed to investigate the knowledge, attitudes, and practices (KAP) toward COVID-19 vaccination among Chinese college students, and to determine the relationships among social media use, eHealth literacy, and KAP toward COVID-19 vaccination among Chinese college students.

Methods

A cross-sectional survey was conducted by administering questionnaires to evaluate KAP toward COVID-19 vaccination, social media use, and eHealth literacy in one of the groups of Chinese college students. Multiple linear regression analysis was performed to determine the association among social media use, eHealth literacy, and KAP regarding COVID-19 vaccination.

Results

Among the 3,785 validated questionnaires collected from Chinese college students, male students accounted for 59.74%, and the mean age of the college students was (20.90 ± 3.14) years. More than four-fifths (83.43%) of the college students spent <2 h a week on social media, and the official and public social media were most common social media types. Additionally, the scores for KAP toward COVID-19 vaccination ranging from 0 to 48 among college students were high (39.73 ± 5.58), lowest for knowledge domain (3.07 ± 0.76), and the highest for practice domain (3.47 ± 0.63). Female college students who were in good health status and who spent more time browsing social media, frequently used official and public social media, rarely used aggregated social media, and had a relatively strong self-perception of eHealth literacy and information acquisition of eHealth literacy were more likely to have high levels of KAP regarding COVID-19 vaccination.

Conclusions

Overall, Chinese college students have excellent KAP toward COVID-19 vaccination. Based on the findings of this study, we recommend that health counseling regarding COVID-19 vaccination should target male students and those with inferior health status. Dissemination of health education regarding COVID-19 vaccination should be purposely conducted, and cooperation with official and public social media platforms should be promoted. Finally, eHealth literacy, which is one of the predictors of the level of KAP regarding COVID-19 vaccination, should be emphasized.

The mechanism of governments' and individuals' influence on protective behaviours during the second wave of COVID-19: a multiple mediation model

Background: The SARS-CoV-2 virus continues to spread and resurge globally with signs of a second wave, despite actions by governments to curb the COVID-19 pandemic. However, evidence-based strategies to combat COVID-19 recurrence are poorly documented. Objective: To reveal how governments and individuals should act to effectively cope with future waves, this study proposed a preventive model of COVID-19 resurgence. Method: A questionnaire survey was conducted among 1,137 residents of Beijing, where the epidemic reoccurred. Structural equation model was used to explore the mechanism among government intervention, perceived efficacy, positive emotions, posttraumatic growth (PTG) and protective behaviours. Results: Data analysis revealed that during COVID-19 resurgence, government intervention could directly and indirectly influence protective behaviours through individual factors (i.e. perceived efficacy, positive emotions), and PTG could mediate the indirect pathway to protective behaviours. Conclusions: These findings implied that government intervention needs to be integrated with individual factors to effectively control repeated COVID-19 outbreaks.

Association Between Awareness, Perceived Severity, and Behavioral Control of COVID -19 With Self-Care and Anxiety in Pregnancy: A Cross-Sectional Study

COVID-19 pandemic has caused a tidal wave of anxiety and stress among Iranians, especially pregnant women. This study aimed to assess the association between knowledge, perceived severity, and controllability of COVID-19 with self-care and health anxiety specially in pregnancy. This cross-sectional study was performed on 440 pregnant women. Data were collected using demographic-obstetrics characteristics, as well as the questionnaires of knowledge, perceived severity, and perceived controllability of the COVID-19, health anxiety, and self-care. Self-care was positively correlated with knowledge, perceived severity, and perceived controllability of the COVID-19. Nonetheless, health anxiety had a significant and inverse association with knowledge and perceived controllability, while there was a positive and significant correlation between perceived severity and health anxiety. Based on linear regression, three variables of knowledge, perceived severity, and perceived controllability of the COVID-19 could explain 46.3 and 17.5% of variations in self-care and health anxiety, respectively. It is suggested that due to the critical importance of prenatal care, managers, and health-care providers promote the use of such methods as telehealth and home-based caregivers, especially in areas with inadequate access to health care. So, the pregnant women can be followed up and receive medical care devoid of any stress and anxiety.

Risk mitigation behaviors to prevent infection in the mitochondrial disease community during the COVID19 pandemic

Background

A challenge during the COVID-19 pandemic has been widespread adherence to risk-reducing behaviors. Individuals with mitochondrial disease (MtD) are special population with an increased risk of morbidity associated with infection.

Purpose

To measure risk mitigation behaviors (RMBs) in families affected by MtD and identify factors that may influence these behaviors.

Methods

An online questionnaire was distributed in April and June 2020. Individuals with MtD or their caregivers completed the survey.

Results

We received 529 eligible responses with n = 312 completing all questions for our multivariate regression model. The most common RMBs were increased hand washing (96%), social distancing (94%), and avoiding public gatherings (93%). Higher numbers of recent healthcare visits (b = 0.62, p < 0.05) and expressed fear of the MtD patient contracting COVID-19 (b = 0.92, p < 0.05) were associated with more RMBs. Living in a rural community (b = −0.99,p < 0.05) and a history of COVID-19 testing (b = −2.14,p < 0.01) were associated with fewer RMBs.

Conclusions

Our results suggest that during the COVID-19 pandemic, families affected by MtD have near universal adherence to basic RMBs. This may be motivated by fear of the severe morbidity associated with infection in MtD. Patients with frequent healthcare visits may be sicker and therefore take more precautions. Living in a rural community may also impact these behaviors. People who practice fewer RMBs may be more likely to seek testing. Our findings may generalize to other chronic diseases.

Sentiment Analysis of Comments of American Birders during Two Waves of the COVID-19 Pandemic Reveal More Negative Sentiments in the Context of Birding

Human-nature relationships are an important aspect of leisure research. Previous studies also reported that nature-related activities have a health benefit. In this study, we surveyed US-American birdwatchers at two time points during the COVID pandemic (independent samples). During the beginning of the COVID pandemic in spring 2020, we analyzed their comments with an AI sentiment analysis. Approximately one year later (winter 2020/21), during the second wave, the study was repeated, and a second data set was analyzed. Here we show that during the ongoing pandemic, the sentiments became more negative. This is an important result because it shows that despite the positive impact of nature on mental health, the sentiments become more negative in the enduring pandemic.

Behavioral and Mental Responses towards the COVID-19 Pandemic among Chinese Older Adults: A Cross-Sectional Study

The novel COVID-19 pandemic spread quickly and continuously influenced global societies. As a vulnerable population that accounted for the highest percentage of deaths from the pandemic, older adults have experienced huge life-altering challenges and increased risks of mental problems during the pandemic. Empirical evidence is needed to develop effective strategies to promote preventive measures and mitigate the adverse psychological impacts of the COVID-19 pandemic. This study aimed to investigate the behavioral responses (i.e., preventive behaviors, physical activity, fruit and vegetable consumption) and mental responses (i.e., depression and loneliness) towards the COVID-19 pandemic among Chinese older adults. A further aim was to identify the associations among demographics, behavioral responses, and mental responses. Using a convenience sampling approach, 516 older adults were randomly recruited from five cities of Hubei province in China. Results of the cross-sectional survey showed that 11.7% of participants did not adhere to the WHO recommended preventive measures, while 37.6% and 8.3% of participants decreased physical activity and fruit–vegetable consumption respectively. For mental responses, 30.8% and 69.2% of participants indicated significantly depressive symptoms and severe loneliness, respectively. Participants’ behavioral and mental responses differed significantly in several demographics, such as age group, living situation, marital status, education levels, household income, medical conditions, and perceived health status. Demographic correlates and behavioral responses could significantly predicate the mental response with small-to-moderate effect sizes. This is the first study to investigate the characteristics of behavioral and mental responses of Chinese older adults during the COVID-19 pandemic. Research findings may give new insights into future developments of effective interventions and policies to promote health among older adults in the fight against the pandemic.

Immunosuppression and COVID-19 infection in British Columbia: Protocol for a linkage study of population-based administrative and self-reported survey data

Introduction

Cases of the novel coronavirus disease (COVID-19) continue to spread around the world even one year after the declaration of a global pandemic. Those with weakened immune systems, due to immunosuppressive medications or disease, may be at higher risk of COVID-19. This includes individuals with autoimmune diseases, cancer, transplants, and dialysis patients. Assessing the risk and outcomes of COVID-19 in this population has been challenging. While administrative databases provide data with minimal selection and recall bias, clinical and behavioral data is lacking. To address this, we are collecting self-reported survey data from a randomly selected subsample with and without COVID-19, which will be linked to administrative health data, to better quantify the risk of COVID-19 infection associated with immunosuppression.

Methods and analysis

Using administrative and laboratory data from British Columbia (BC), Canada, we established a population-based case-control study of all individuals who tested positive for SARS-CoV-2. Each case was matched to 40 randomly selected individuals from two control groups: individuals who tested negative for SARS-CoV-2 (i.e., negative controls) and untested individuals from the general population (i.e., untested controls). We will contact 1000 individuals from each group to complete a survey co-designed with patient partners. A conditional logistic regression model will adjust for potential confounders and effect modifiers. We will examine the odds of COVID-19 infection according to immunosuppressive medication or disease type. To adjust for relevant confounders and effect modifiers not available in administrative data, the survey will include questions on behavioural variables that influence probability of being tested, acquiring COVID-19, and experiencing severe outcomes.

Ethics and dissemination

This study has received approval from the University of British Columbia Clinical Research Ethics Board [H20-01914]. Findings will be disseminated through scientific conferences, open access peer-reviewed journals, COVID-19 research repositories and dissemination channels used by our patient partners.

Compliance with the main preventive measures of COVID-19 in Spain: The role of knowledge, attitudes, practices, and risk perception

In epidemics such as COVID‐19, major changes need to be made to the population's behavior to prevent infection and stop disease transmission. The three most recommended preventive measures are wearing a mask, washing hands with soap or hydroalcoholic gel, and watching an interpersonal distance of at least two meters (3W) from other people. This study aimed to assess adherence to these COVID‐19‐related three preventive measures and its association with knowledge, attitudes, risk perception, and practices in Spain. The COSMO‐Spain survey, based on the WHO Behavioral Insights questionnaire on COVID‐19, was conducted in the general Spanish population using an online questionnaire (n = 1,033). Sociodemographic, knowledge, attitudes, practices, and risk perception variables were included. A multivariable logistic regression model was carried out to evaluate the factors associated with compliance with the three preventive measures. Half of the respondents (49.8%) were women with a median age of 45 (Inter‐quartile Range, IR = 21) years. In the logistic regression, the factors associated with 3W compliance were being over 45 years; knowing about how COVID‐19 spreads and wearing masks properly; appropriate attitudes towards COVID‐19 (greater agreement with mandatory mask use); high risk perception (feeling that the coronavirus is spreading rapidly, being concerned about non‐mask wearers), and adherence to other preventive measures against COVID‐19, such as staying at home. Adequate knowledge, attitudes and risk perception are determinants of 3W compliance. Developing effective health education programs and frequent communication strategies are necessary, particularly for those who adhere less to preventive measures.

Understanding Drivers of Coronavirus Disease 2019 (COVID-19) Racial Disparities: A Population-Level Analysis of COVID-19 Testing Among Black and White Populations

Background

Disparities in coronavirus disease 2019 (COVID-19) testing—the pandemic’s most critical but limited resource—may be an important but modifiable driver of COVID-19 inequities.

Methods

We analyzed data from the Missouri State Department of Health and Senior Services on all COVID-19 tests conducted in the St Louis and Kansas City regions. We adapted a well-established tool for measuring inequity—the Lorenz curve—to compare COVID-19 testing rates per diagnosed case among Black and White populations.

Results

Between 14/3/2020 and 15/9/2020, 606 725 and 328 204 COVID-19 tests were conducted in the St Louis and Kansas City regions, respectively. Over time, Black individuals consistently had approximately half the rate of testing per case than White individuals. In the early period (14/3/2020 to 15/6/2020), zip codes in the lowest quartile of testing rates accounted for only 12.1% and 8.8% of all tests in the St Louis and Kansas City regions, respectively, even though they accounted for 25% of all cases in each region. These zip codes had higher proportions of residents who were Black, without insurance, and with lower median incomes. These disparities were reduced but still persisted during later phases of the pandemic (16/6/2020 to 15/9/2020). Last, even within the same zip code, Black residents had lower rates of tests per case than White residents.

Conclusions

Black populations had consistently lower COVID-19 testing rates per diagnosed case than White populations in 2 Missouri regions. Public health strategies should proactively focus on addressing equity gaps in COVID-19 testing to improve equity of the overall response.

Descriptive Norms and Prototypes Predict COVID-19 Prevention Cognitions and Behaviors in the United States: Applying the Prototype Willingness Model to Pandemic Mitigation

BACKGROUND

Early in the COVID-19 pandemic, prevention behavior adoption occurred in a rapidly changing context. In contrast to expectancy-value theories, the Prototype Willingness Model (PWM) is well-suited for investigating novel and socially informed behaviors.

PURPOSE

We explored whether PWM social cognitions predicted coronavirus prevention behaviors.

METHOD

A representative sample of United States adults (N = 738; Mage = 46.8; 51.8% women; 78% white; April 2020) who had not had COVID-19 reported PWM predictor variables (perceived vulnerability, prevention descriptive norms, prototypes engaging in prevention behavior, and prevention behavioral intentions). Two weeks later, participants reported their prevention behaviors (handwashing, mask-wearing, social distancing, etc.) and future public health behavioral willingness (contact tracing, temperature checks, etc.).

RESULTS

Controlling for putative demographic, past behavior, and coronavirus-contextual (e.g., local infection rates) covariates, mediation models indicated that higher norms and favorable prototypes were associated with greater prevention behavioral intentions, which in turn predicted increased prevention behavior, F(18, 705) = 92.20, p < .001, R2 = .70. Higher norms and favorable prototypes associated both directly and indirectly (through greater prevention behavioral intention) with greater willingness to engage in emerging public health behaviors, F(15, 715) = 21.49, p < .001, R2 = .31.

CONCLUSIONS

Greater descriptive norms and favorable prototypes for prevention behavior predicted: (a) future prevention behaviors through increases in behavioral intentions and (b) willingness to participate in emerging public health behaviors. These results held across demographic groups, political affiliation, and severity of regional outbreaks. Public health efforts to curb pandemics should highlight normative prevention participation and enhance positive prototypes.

The Association of Cardiometabolic Disease with Psychological Factors in Colombian People during the COVID-19 Pandemic: A Cross-Sectional Study

During the COVID-19 pandemic, psychological disorders have been documented in the population, and their exacerbation in vulnerable populations such as those with Cardiometabolic Diseases (CD) might challenge health systems. This study determined psychological factors associated with CD in Colombian adults during the COVID-19 pandemic. For this purpose, 284 persons were evaluated, 142 without CD and 142 with CD. Sociodemographic data were collected, and the International Physical Activity Questionnaire (IPAQ), the SF-12v2, the Pittsburgh Sleep Quality Index (PSQI) and the Zung Self-Rating Depression Scale (ZSDS), which were integrated into an online form, were used. Through a simple and multiple logistic regression model, it was shown that CD was associated with low sleeping quality (LSQ) (OR = 3.51) and with depressive symptoms (DS) (OR = 1.98). In addition, in the group with CD, the presence of DS was related to BMI (OR = 2.45), and LSQ was related to living with persons at risk for COVID-19 (OR = 3.64) and BMI (OR = 5.88). In conclusion, this study showed that people with CD have a higher chance of presenting DS and LSQ. Furthermore, living with people at risk for COVID-19 was related to the presence of LSQ.

Age Differences in COVID-19 Preventive Behavior

Abstract. Age is a critical risk factor for severe COVID-19. This is mirrored by older people showing preventive health behaviors more frequently. However, collective action across all age groups is necessary to reduce transmission. Therefore, this study assessed whether age differences are moderated by policy changes and whether policies further moderate the relationship between psychological determinants of behavior (risk perceptions and trust), age, and preventive behaviors. Risk perceptions, trust in institutions, self-reported frequency of preventive behaviors (mask-wearing, avoiding social gatherings), and demographics (e.g., age) were collected within the COVID-19 Snapshot Monitoring (COSMO), a German serial cross-sectional survey. A total of 19,069 participants across 20 measurement points were included (online sample, quota-representative for Age × Gender and federal state in Germany; mid-April to the end of November 2020). Regression analyses showed that age differences in avoiding social gatherings and mask-wearing remained stable under different health policies but were further moderated by psychological variables. The introduction of stricter policies alone was not related to higher adoption rates of preventive behaviors, but it mitigated the effects of age and risk perceptions. Moreover, under mandatory policies, the correlation between trust in institutions and behaviors was amplified. The present research made a strong case for quality, targeted health, and risk communication. Without mandatory policies, the importance of preventive behaviors must be well understood to achieve high adherence – especially in young people who are threatened by the disease less directly.

Role of repeating quarantine instructions and healthy practices on COVID-19 patients and contacted persons to raise their awareness and adherence to quarantine instructions

OBJECTIVE

This study aimed to develop a model evaluating the role of repeating quarantine instructions and healthy practices among COVID-19 patients and contact persons at-home quarantine and to evaluate the instructions' adequacy in decreasing the rate of disease spread with better clinical outcomes.

METHODS

A structured questionnaire was distributed to COVID-19 patients (mild and moderate cases isolated at home) and contacting persons during May and June 2020. Data were collected using a structured online survey collected every five days for three times from each participant. The questionnaire was divided into three sections, consisting of 35 questions for a total possible score of 0 to 35.

RESULTS

A total of 150 valid participant's responses out of 304 participants were obtained. Among the150 total participants, 88 were infected with COVID-19, and 62 were contacting with COVID-19 patients. The improvement in the score of awareness and adherence to instructions for the infected patients and their contacts was significantly high in the third questionnaire than in the second and the first questionnaire. The people who live in cities followed the instructions provided at the home quarantine better than those who live in the country. The city patients improved in symptoms better than the country patients. Also, patients followed the instructions better than their contacts. City females adhered to the instructions better than city males. Young people had high awareness score than older people. City people are committed to taking both immune boosters supplements as prophylaxis or prescribed medications on time for treatment more than country people.

CONCLUSION

This study offers useful insights into factors associated with the role of repeating quarantine instructions and healthy practices to overcome the COVID-19 pandemic. So, repeating the instructions is important to increase adherence to the instructions, decrease the rate of disease progression and decrease the spread of the infection.

Effect of a Brief Web-Based Educational Intervention on Willingness to Consider Human Papillomavirus Vaccination for Children in Japan: Randomized Controlled Trial

Background

The human papillomavirus (HPV) vaccination rate in Japan has fallen to nearly zero since the suspension of governmental proactive recommendations in 2013, owing to the development of purported adverse events.

Objective

This study aimed to evaluate the effects of a brief web-based educational intervention using the theory of behavioral insights on the willingness of adults to consider the HPV vaccine for their daughters and sons.

Methods

We recruited 1660 participants aged 20 years or older in March 2018 via a webpage and provided them with a 10-item questionnaire related to the following aspects: awareness regarding HPV infection and vaccination, willingness for immunization, and actions for prevention. We randomly stratified participants based on sex and age with or without a brief educational intervention involving scientific information presented in an easy-to-read format.

Results

Only 484 (29.2%) of the respondents were aware of the benefits of HPV vaccination. Although only 352 (21.2%) of the respondents displayed a willingness for immunization of their daughters, there were 40 (4.8%) more respondents in the intervention group with this willingness (adjusted odds ratio [aOR] 1.32, 95% CI 1.04-1.69). In a subanalysis, the willingness toward vaccination for daughters in men was significantly higher in the intervention group (aOR 1.46, 95% CI 1.05-2.02). However, such a difference was not observed among women (aOR 1.20, 95% CI 0.83-1.73).

Conclusions

This study suggests that a brief web-based educational intervention increases the willingness of adults to consider the HPV vaccine for their children, especially among men. Thus, providing adequate information to men may be a useful strategy to improve the currently low rates of HPV vaccination.

Trial Registration

UMIN Clinical Trials Registry UMIN000049745 (UMIN-CTR); https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049745

Factors influencing protective behavior in the post-COVID-19 period in China: a cross-sectional study

BACKGROUND

The study aimed to explore the factors influencing protective behavior and its association with factors during the post-COVID-19 period in China based on the risk perception emotion model and the protective action decision model (PADM).

METHODS

A total of 2830 valid questionnaires were collected as data for empirical analysis via network sampling in China. Structural equation modeling (SEM) was performed to explore the relationships between the latent variables.

RESULTS

SEM indicated that social emotion significantly positively affected protective behavior and intention. Protective behavioral intention had significant direct effects on protective behavior, and the direct effects were also the largest. Government trust did not have a significant effect on protective behavior but did have a significant indirect effect. Moreover, it was found that government trust had the greatest direct effect on social emotion. In addition, we found that excessive risk perception level may directly reduce people's intention and frequency of engaging in protective behavior, which was not conducive to positive, protective behavior.

CONCLUSION

In the post-COVID-19 period, theoretical framework constructed in this study can be used to evaluate people's protective behavior. The government should strengthen its information-sharing and interaction with the public, enhance people's trust in the government, create a positive social mood, appropriately regulate people's risk perception, and, finally, maintain a positive attitude and intent of protection.

The Association Between Financial Hardship and Mental Health Difficulties Among Adult Wage Earners During the COVID-19 Pandemic in Bangladesh: Findings From a Cross-Sectional Analysis

Background: The ongoing COVID-19 pandemic has created several challenges including financial burdens that may result in mental health conditions. This study was undertaken to gauge mental health difficulties during the COVID-19 pandemic and gain an insight into wage earners' mental health. Method: This cross-sectional study was conducted through an online survey. A t total of 707 individual Bangladeshi wage earners were enrolled between 20 and 30 May 2020. The questionnaire had sections on sociodemographic information, COVID-19 related questions, PHQ-9 and GAD-7 scales. STATA version 14.1 program was used to carry out all the analyses. Results: The study revealed that 58.6 and 55.9% of the respondents had moderate to severe anxiety and depressive symptoms, respectively. The total monthly income was <30,000 BDT (353.73USD) and displayed increased odds of suffering from depressive symptoms (OR = 4.12; 95% CI: 2.68-6.34) and anxiety (OR = 3.31; 95% CI: 2.17-5.03). Participants who did not receive salary income, had no income source during the pandemic, had financial problems, and inadequate food supply and were more likely to suffer from anxiety and depressive symptoms (p ≤ 0.01). Perceiving the upcoming financial crisis as a stressor was a potential risk factor for anxiety (OR = 1.91; 95% CI:1.32-2.77) and depressive symptoms (OR = 1.50; 95% CI:1.04-2.16). Limitations: The online survey method used in this study limits the generalizability of the findings and self-reported answers might include selection and social desirability bias as a community-based survey was not possible during the pandemic. Conclusion: Wage earners in a low resource setting like Bangladesh require mental health attention and financial consideration to deal with mental health difficulties.

Knowledge, Attitudes, and Behavior Related to COVID-19 Testing: A Rapid Scoping Review

Testing programs for COVID-19 depend on the voluntary actions of members of the public for their success. Understanding people's knowledge, attitudes, and behavior related to COVID-19 testing is, therefore, key to the design of effective testing programs worldwide. This paper reports on the findings of a rapid scoping review to map the extent, characteristics, and scope of social science research on COVID-19 testing and identifies key themes from the literature. Main findings include the discoveries that people are largely accepting of testing technologies and guidelines and that a sense of social solidarity is a key motivator of testing uptake. The main barriers to accessing and undertaking testing include uncertainty about eligibility and how to access tests, difficulty interpreting symptoms, logistical issues including transport to and from test sites and the discomfort of sample extraction, and concerns about the consequences of a positive result. The review found that existing research was limited in depth and scope. More research employing longitudinal and qualitative methods based in under-resourced settings and examining intersections between testing and experiences of social, political, and economic vulnerability is needed. Last, the findings of this review suggest that testing should be understood as a social process that is inseparable from processes of contact tracing and isolation and is embedded in people's everyday routines, livelihoods and relationships.

Opportunities to Reduce Young Adult College Students' COVID-19-Related Risk Behaviors: Insights From a National, Longitudinal Cohort

PURPOSE

To study how young adult college students are managing their health behaviors and risks related to spreading COVID-19.

METHODS

We created a national cohort of full-time college students in late April 2020 (n = 707), and conducted a follow-up survey with participants in July 2020 (n = 543). Participants reported COVID-19-related health risk behaviors and COVID-19 symptoms, and also responded to an open-ended prompt about how the COVID-19 pandemic has affected their lives. Quantitative data were analyzed in Stata and we conducted content analysis to identify themes in the qualitative data.

RESULTS

For most health protective behaviors (e.g., frequent handwashing, social distancing), participants were less compliant in summer 2020 than spring 2020, with the exception of face mask use, which increased. In each month of the first half of 2020, only approximately half of participants with any symptoms that could indicate COVID-19 stayed home exclusively while symptomatic (there was no meaningful change from pre-pandemic or over the course of the pandemic). In qualitative data, the participants who had gone to bars or clubs at least twice within a 4-week period this summer reported being bored and/or isolated, stressed, and/or taking pandemic safety measures seriously.

CONCLUSIONS

These findings suggest multiple areas for intervention, including harm reduction and risk management education approaches for the students who are going to bars and clubs, and creating policies and programs to better incentivize young people with symptoms to stay home exclusively while symptomatic.

The COVID-19 Pandemic Led to a Small Increase in Changed Mentality Regarding Infection Risk without Any Change in Willingness to Be Vaccinated in Chronic Diseases Patients

The objective of this study was to assess the impact of the COVID-19 pandemic on patients’ perceptions regarding infection risk and vaccination in subjects suffering from chronic diseases. A prospective observational multicentric study conducted from December 2020 to April 2021 in three French University Hospitals. Patients with chronic diseases were proposed to complete a questionnaire regarding the impact of the COVID-19 pandemic on infectious risk knowledge and vaccination. A total of 1151 patients were included and analyzed (62% of which were people with diabetes). The COVID-19 pandemic increased awareness of infectious risks by 19.3%, significantly more in people with diabetes (23.2%, from 54.4% to 67.0%, p < 0.01) when compared to the other high-risk patients (12.5%, from 50.5% to 56.8%, p = 0.06). Respectively, 30.6% and 16.5% of patients not up-to-date for pneumococcal and flu vaccines reported wanting to update their vaccination due to the COVID-19 pandemic. By contrast, the proportion of patients against vaccines increased during the COVID-19 pandemic (6.0% vs. 9.5%, p < 0.01). The COVID-19 pandemic has led to a small increase in awareness regarding the risks of infection in patients with chronic diseases, including people with diabetes, but without any change in willingness to be vaccinated. This underlines the urgent need to sensibilize people with diabetes to infection risk and the importance of vaccination.

A scoping review of research on the determinants of adherence to social distancing measures during the COVID-19 pandemic

This scoping review focused on answering key questions about the focus, quality and generalisability of the quantitative evidence on the determinants of adherence to social distancing measures in research during the first wave of COVID-19. The review included 84 studies. The majority of included studies were conducted in Western Europe and the USA. Many lacked theoretical input, were at risk for bias, and few were experimental in design. The most commonly coded domains of the TDF in the included studies were 'Environmental Context and Resources' (388 codes across 76 studies), 'Beliefs about Consequences' (34 codes across 21 studies), 'Emotion' (28 codes across 12 studies), and 'Social Influences' (26 codes across 16 studies). The least frequently coded TDF domains included 'Optimism' (not coded), 'Intentions' (coded once), 'Goals' (2 codes across 2 studies), 'Reinforcement' (3 codes across 2 studies), and 'Behavioural Regulation' (3 codes across 3 studies). Examining the focus of the included studies identified a lack of studies on potentially important determinants of adherence such as reinforcement, goal setting and self-monitoring. The quality of the included studies was variable and their generalisablity was threatened by their reliance on convenience samples.

Lessons for Workforce Disaster Planning from the First Nosocomial Outbreak of COVID-19 in Rural Tasmania, Australia: A Case Study

The identification and announcement of the COVID-19 pandemic has been a global issue. Disaster preparedness for internal and external threats is inherent within health care environments and requires agile thinking and swift remediation. Nosocomial infection is a risk for recipients of care, especially in hospital settings, which has implications for workforce planning. The aim of this case study was to examine the community response to the internal disaster of the first nosocomial COVID-19 outbreak within an Australian rural health care environment. A critical discourse analysis method was adopted to generate and analyse data collected from three different media platforms during a six-week period. Four main themes were distilled: actions and intent, loss, well-being and recognising choice, and community action. Phase two of the study interrogated these themes to expose the power positioning of speakers and their relationships to the audiences. Strengthening communication with local communities within health care environments must be a priority in any future rural workforce disaster preparedness planning. Maintenance of trust with health service provision and delivery in rural communities is imperative. The inclusion of a robust communication plan within any risk management strategy that meets the needs of the local users of health services is mandatory.

The impact of the COVID-19 pandemic on stress, mental health and coping behavior in German University students - a longitudinal study before and after the onset of the pandemic

BACKGROUND

The COVID-19 pandemic has led to massive restrictions in public and private lives, including a shut-down of face-to-face teaching at universities in Germany. We aimed to examine the impact of these changes on perceived stress, mental health and (study-)related health behavior of students in a longitudinal study.

METHODS

For two timepoints - the year before the COVID-19 pandemic (2019, n = 1377) and the year during the COVID-19 pandemic (2020, n = 1867) - we surveyed students of all faculties at one German university for perceptions and preventive behavior regarding the COVID-19 pandemic using standard instruments for stress, anxiety, depression, and behavior and experience patterns.

RESULTS

About 90% of students (n = 1633) in 2020 did not have a known contact infected with SARS-CoV-2, while 180 (9.8%) did have one. Only 10 respondents (0.5%) reported an infection with SARS-CoV-2. Wearing masks and washing hands more often were practiced by ≥80% of students. Taking more care about cleanliness (51.8%) and using disinfectants (39.2%) were practiced much less. A higher percentage of female compared with male students and medical/health science students compared with science, technology, engineering, and mathematics students engaged more frequently in specific or nonspecific preventive measures. More than three quarters (77.1%) of all students rated their general health as (very) good. There were no significant differences in general health, stress, and depression between 2019 and 2020 in the students who responded at both timepoints. The distribution of behavior and experience patterns for this group showed a slight but significant difference from 2019 to 2020, namely decreasing proportions of students with a healthy pattern and a risk pattern for overexertion. Students with different behavior and experience patterns showed marked differences in perceptions and reaction to the COVID-19 pandemic as well as psychosocial stress and symptoms, with higher scores for mental health symptoms and lower scores in preventive behavior regarding risk patterns.

CONCLUSION

Despite massive alterations to students' lives in 2020, there were only moderate consequences for mental health compared with 2019 in the total student group of this German university. However, identifying students at risk would offer opportunities to foster mental health in relevant subgroups.

Associations with COVID-19 Symptoms, Prevention Interest, and Testing Among Sexual and Gender Minority Adults in a Diverse National Sample

Purpose: Sexual and gender minority (SGM) and racial/ethnic minority populations may differ in coronavirus disease 2019 (COVID-19) prevention, testing, and vaccine interest, although little research has explored these disparities. It is critical to understand the differential experiences within minoritized communities to ensure effective intervention and vaccine rollout. Methods: In a national online survey of U.S. adult SGM individuals, conducted between April and August 2020, 932 participants responded about COVID-19 testing, symptoms, interest in vaccination, and interest in at-home testing. Bivariate associations between these outcomes and demographic factors, including sexual orientation, gender identity, endorsing intersex traits, gender modality, race/ethnicity, and HIV status were calculated. Results: Despite 24% of the sample reporting COVID-19 symptoms, testing was relatively low at 13.3%. Transgender and bisexual/pansexual individuals were more likely to be interested in a COVID-19 vaccine and an at-home test compared with cisgender and gay/lesbian respondents, respectively. Compared with cisgender individuals, transgender individuals were nearly twice as likely to report COVID-19 symptoms. Latinx individuals were less likely to be interested in a future COVID-19 vaccination and Black individuals were less likely to be interested in an at-home COVID-19 test compared with White participants. Both respondents who endorsed intersex traits and people with HIV were less likely to be interested in an at-home test compared with those who did not endorse having intersex traits and people without HIV, respectively. Conclusions: These results show critical disparities in COVID-19 symptomology and prevention interest within SGM populations that must be taken into account when designing or tailoring effective COVID-19 interventions.

Lessons from countries implementing find, test, trace, isolation and support policies in the rapid response of the COVID-19 pandemic: a systematic review

OBJECTIVE

To systematically learn lessons from the experiences of countries implementing find, test, trace, isolate, support (FTTIS) in the first wave of the COVID-19 pandemic.

DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA

We searched MEDLINE (PubMed), Cochrane Library, SCOPUS and JSTOR, initially between 31 May 2019 and 21 January 2021. Research articles and reviews on the use of contact tracing, testing, self-isolation and quarantine for COVID-19 management were included in the review.

DATA EXTRACTION AND SYNTHESIS

We extracted information including study objective, design, methods, main findings and implications. These were tabulated and a narrative synthesis was undertaken given the diverse research designs, methods and implications.

RESULTS

We identified and included 118 eligible studies. We identified the core elements of an effective find, test, trace, isolate, support (FTTIS) system needed to interrupt the spread of a novel infectious disease, where treatment or vaccination was not yet available, as pertained in the initial stages of the COVID-19 pandemic. We report methods used to shorten case finding time, improve accuracy and efficiency of tests, coordinate stakeholders and actors involved in an FTTIS system, support individuals isolating and make appropriate use of digital tools.

CONCLUSIONS

We identified in our systematic review the key components of an FTTIS system. These include border controls, restricted entry, inbound traveller quarantine and comprehensive case finding; repeated testing to minimise false diagnoses and pooled testing in resource-limited circumstances; extended quarantine period and the use of digital tools for contact tracing and self-isolation. Support for mental or physical health and livelihoods is needed for individuals undergoing self-isolation/quarantine. An integrated system with rolling-wave planning can best use effective FTTIS tools to respond to the fast-changing COVID-19 pandemic. Results of the review may inform countries considering implementing these measures.

Engagement With COVID-19 Public Health Measures in the United States: A Cross-sectional Social Media Analysis from June to November 2020

Background

COVID-19 has continued to spread in the United States and globally. Closely monitoring public engagement and perceptions of COVID-19 and preventive measures using social media data could provide important information for understanding the progress of current interventions and planning future programs.

Objective

The aim of this study is to measure the public’s behaviors and perceptions regarding COVID-19 and its effects on daily life during 5 months of the pandemic.

Methods

Natural language processing (NLP) algorithms were used to identify COVID-19–related and unrelated topics in over 300 million online data sources from June 15 to November 15, 2020. Posts in the sample were geotagged by NetBase, a third-party data provider, and sensitivity and positive predictive value were both calculated to validate the classification of posts. Each post may have included discussion of multiple topics. The prevalence of discussion regarding these topics was measured over this time period and compared to daily case rates in the United States.

Results

The final sample size included 9,065,733 posts, 70% of which were sourced from the United States. In October and November, discussion including mentions of COVID-19 and related health behaviors did not increase as it had from June to September, despite an increase in COVID-19 daily cases in the United States beginning in October. Additionally, discussion was more focused on daily life topics (n=6,210,255, 69%), compared with COVID-19 in general (n=3,390,139, 37%) and COVID-19 public health measures (n=1,836,200, 20%).

Conclusions

There was a decline in COVID-19–related social media discussion sourced mainly from the United States, even as COVID-19 cases in the United States increased to the highest rate since the beginning of the pandemic. Targeted public health messaging may be needed to ensure engagement in public health prevention measures as global vaccination efforts continue.

The role of sexual dimorphism in susceptibility to SARS-CoV-2 infection, disease severity, and mortality: facts, controversies and future perspectives

Former studies have revealed intersex variability in immune response to infectious diseases, including Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological surveillance of the ongoing pandemic has demonstrated a male vulnerability to morbidity and mortality, despite similar infection rates between the two sexes. Divergence in the frequency of comorbidities between males and females, differences in hormonal profile, chromosomal composition and gender behavior have all been proposed as potential causative factors. Data deriving from the immunization process indirectly support the existence of a sex-specific response to SARS-CoV-2, since females apparently produce higher numbers of antibodies while simultaneously exhibiting higher rates of side effects, indicating a stronger immune reactivity to the vaccine's elements. Interpreting intersex differences in immune response to SARS-CoV-2 could lead to a deeper understanding of the COVID-19 pathophysiology and enable healthcare professionals to conduct a more accurate patient risk assessment and better predict the clinical outcome of the disease. This narrative review aims to discuss the pathophysiological and behavioral basis of the disproportionate male morbidity and mortality observed in COVID-19, in the context of most research findings in the field.

Predictors of COVID-19 Preventive Behavior Adoption Intention in Malaysia

Preventive behavior adoption is the key to reduce the possibility of getting COVID-19 infection. This paper aims to examine the determinants of intention to adopt preventive behavior by incorporating perception of e-government information and services and perception of social media into the theory of reasoned action. A cross-sectional online survey was carried out among Malaysian residents. Four hundred four valid responses were obtained and used for data analysis. A partial least-square-based path analysis revealed direct effects of attitude and subjective norm in predicting intention to adopt preventive behavior. In addition, perception of e-government information and services and perception of social media were found to be significant predictors of attitude toward preventive behavior. The findings highlight the importance of digital platforms in improving people’s attitudes toward preventive behavior and in turn contain the spread of the infectious disease.

Development of a coronavirus social distance attitudes scale

OBJECTIVE

Our goal was to develop a scale to assess social distance attitudes related to COVID-19.

METHODS

We performed an online national survey of US adults (n = 1,074) to assess social distance attitudes, COVID-19 related beliefs and behaviors, and demographics. We assessed scale structure using confirmatory factor analysis and evaluated internal consistency and validity. We assessed association of scale factors with respondent characteristics.

RESULTS

Confirmatory factor analysis supported a hypothesized two-factor solution. Internal consistency was high for both positive (Alpha = 0.92) and negative (Alpha = 0.91) attitude factors. Analyses supported construct and predictive validity with expected associations between scale factors and perceived norms and behavior (e.g. trips out of the home). We found an interaction suggesting that holding highly negative attitudes reduced the effect of holding positive beliefs. Both attitude factors were related to age, gender, race/ethnicity, and political affiliation. Perceived COVID-19 risk (to others but not for self) and perceived severity were consistently associated with higher positive and lower negative attitudes.

CONCLUSION

This COVID-19 Social Distance Attitude Scale contains positive and negative factors with high internal consistency and construct and predictive validity.

PRACTICE IMPLICATION

A greater understanding and ongoing assessment of COVID-19 social distance attitudes could inform policymakers, researchers, and clinicians who seek to promote protective social distance behaviors.

How Social Media Comments Inform the Promotion of Mask-Wearing and Other COVID-19 Prevention Strategies

Current COVID-19 messaging efforts by public health departments are primarily informational in nature and assume that audiences will make rational choices in compliance, contradicting extensive research indicating that individuals make lifestyle choices based on emotional, social, and impulsive factors. To complement the current model, audience barriers to prevention need to be better understood. A content analysis of news source comments in response to daily COVID-19 reports was conducted in Montana, one of the states expressing resistance to routine prevention efforts. A total of 615 Facebook comments drawn from Montana news sources were analyzed using the Persuasive Health Message Framework to identify perceived barriers and benefits of mask-wearing. A majority (63%) of comments expressed barriers, the most common of which were categorized as either misinformation about the virus or conspiracy theories. Benefits (46%) of mask-wearing were articulated as benefits to loved ones or people in one's community or saving hospital space. This paper analyzes the implications of low perceived threat accompanied by low perceived efficacy of mask-wearing to make recommendations for future prevention efforts.