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

Impacts of the COVID-19 Pandemic on Preexisting Racial and Ethnic Disparities, and Results of an Integrated Safety Net Response in Arlington County, Virginia

This paper presents research conducted by the Arlington County Department of Human Services to understand the use of safety net services during the pandemic, identify disparities, and reduce or eliminate them. Arlington County's levels of health and economic wellbeing are generally high; however, residents of color experience significant disparities compared with White residents, with lower median incomes, lower rates of college completion, lower life expectancies, and higher rates of chronic illness. During the COVID-19 pandemic, these disparities were amplified as Black and Latinx residents experienced disproportionately high rates of COVID-19 infection, hospitalization, and death, as well as disproportionately high rates of job loss. During the COVID-19 pandemic, Arlington County mounted an interdisciplinary response to stabilize community needs, including food security, eviction prevention, isolation housing, behavioral health stabilization, and digital equity. This integrated approach was especially important during the pandemic, as the direct and indirect effects of the pandemic disproportionately impacted health and economic wellbeing among Arlington's Black and Latinx residents, low-income residents, and vulnerable communities.

Motivations, barriers, and communication recommendations for promoting face coverings during the COVID-19 pandemic: Survey findings from a diverse sample

State and local health departments have been tasked with promoting the use of face coverings to decrease the spread of COVID-19 in their respective communities. However, little is known about motivations and barriers to wearing face coverings in the context of COVID-19 prevention, particularly among communities of color who are at an increased risk of serious illness from the disease. The purpose of this study was to identify common motivations and barriers to face covering use, as well as explore perceptions of messages encouraging the use of face coverings among a racially and ethnically diverse sample. A survey was distributed electronically to North Carolina (NC) residents through NC Department of Health and Human Services listservs in July 2020. Participants self-categorized as Latino/a (33.5%), Black (39.1%), or white or another race (27.5%). The most commonly endorsed motivations for wearing face coverings were to avoid spreading COVID-19 (77%), as well as to protect people who are vulnerable (76%) and one's community (72%). Being uncomfortable (40%) was the most commonly endorsed barrier. Messages that included a clear request (ex. please wear a face covering) and a direct benefit (ex. keep community safe) were more commonly endorsed than those that did not. Commonly endorsed motivations, behaviors, and messages differed by race and ethnicity. Increased attention to message content, message structure, and access to information and resources may aid local officials in increasing consistent use of face coverings.

Associations Between Health Literacy, eHealth Literacy, and COVID-19-Related Health Behaviors Among Chinese College Students: Cross-sectional Online Study

Background

During the COVID-19 pandemic, the internet has significantly spread information, providing people with knowledge and advice about health protection regarding COVID-19. While a previous study demonstrated that health and eHealth literacy are related to COVID-19 prevention behaviors, few studies have focused on the relationship between health literacy, eHealth literacy, and COVID-19–related health behaviors. The latter includes not only preventative behaviors but also conventional health behaviors.

Objective

The objective of this study was to develop and verify a COVID-19–related health behavior questionnaire, explore its status and structure, and examine the associations between these behaviors and participants’ health literacy and eHealth literacy.

Methods

A snowball sampling method was adopted to recruit participants to complete anonymous cross-sectional questionnaire surveys online that assessed sociodemographic information, self-reported coronavirus knowledge, health literacy, eHealth literacy, and COVID-19–related health behaviors.

Results

Of 1873 college students who were recruited, 781 (41.7%) had adequate health literacy; the mean eHealth literacy score was 30.16 (SD 6.31). The COVID-19–related health behavior questionnaire presented a two-factor structure—COVID-19–specific precautionary behaviors and conventional health behaviors—with satisfactory fit indices and internal consistency (Cronbach α=.79). The mean score of COVID-19–related health behaviors was 53.77 (SD 8.03), and scores differed significantly (P<.05) with respect to residence, college year, academic major, family economic level, self-reported health status, having a family member or friend infected with coronavirus, and health literacy level. Linear regression analysis showed that health literacy and eHealth literacy were positively associated with COVID-19–specific precautionary behaviors (β_{health literacy}=.149, β_{eHealth literacy}=.368; P<.001) and conventional health behaviors (β_{health literacy}=.219, β_{eHealth literacy}=.277; P<.001).

Conclusions

The COVID-19–related health behavior questionnaire was a valid and reliable measure for assessing health behaviors during the pandemic. College students with higher health literacy and eHealth literacy can more actively adopt COVID-19–related health behaviors. Additionally, compared to health literacy, eHealth literacy is more closely related to COVID-19–related health behaviors. Public intervention measures based on health and eHealth literacy are required to promote COVID-19–related health behaviors during the pandemic, which may be helpful to reduce the risk of COVID-19 infection among college students.

The Escalating Magnitude of COVID-19 Infections among the Northeastern Ethiopia Region: A Community-Based Cross-Sectional Study

Background

The novel coronavirus disease (COVID-19) is lethal and extremely contagious, with a rapidly rising global prevalence. The World Health Organization has declared the outbreak a global pandemic; it is reported to have spread to nearly every country in the world. However, the prevalence varies across developed and developing countries, as well as within different regions of the same country. It is not hidden that estimating the magnitude of COVID-19 infection from the community surveys is critical for public health policymakers to make decisions to deal with the outbreak, optimize measures, and design mitigation plans.

Methods

A community-based cross-sectional study was conducted from 01 July to 31 August 2020 in the northeastern Ethiopia region. A simple random sampling technique was used to select study participants from the community survey, contact traces from confirmed cases, and infection suspects. After extraction of viral nucleic acid from oropharyngeal specimen, the real-time fluorescent polymerase chain reaction (RT-PCR) kit was used for detecting novel coronavirus.

Results

A total of 8752 study participants were included in this study. About 63.6% were males and 36.4% were females. Out of the total 8752 study participants, 291 (3.3%) were found to be infected with the virus. The first laboratory-confirmed cases of COVID-19 were detected in the fourth week of the study period, that is, from July 24 to July 31, 2020, and the peak prevalence was observed in the last two weeks. The COVID-19 infection was more prevalent among males and in the age group of 36–52 years. Participants tested via contact trace had 1.65 times (AOR = 1.65, 95% CI = 1.09–2.51, P=0.018) the likelihood of COVID-19 infection in comparison to the other forms of community surveys.

Conclusion

The trend in the prevalence of COVID-19 infection in the northeastern region has shown increment, and increasing testing capacity has a greater benefit in identifying early infection for the prevention, treatment, and control of the international pandemic.

Covid-19 Community Mitigation Status at Selected Districts of Southwest Ethiopia: A Mixed Design Survey

BACKGROUND

The spread of covid-19 was alarmingly continued in Ethiopia. This survey assessed the status of community mitigations to fight the pandemic. The ongoing forward effort by local task forces can be assessed to note the achievements.

METHODS

A mixed design using quantitative and qualitative triangulations used. Data was collected through interviewer administration using a structured W.H.O tool. The univariate and bivariate analysis employed to analyze descriptive statistics. The logistic regression model was applied to control confounders and determine potent predictors.

OBJECTIVE

This study assessed community mitigation status on covid-19 pandemic at four selected districts of southwest Ethiopia: a mixed design survey.

RESULTS

From the total of 624 participants interviewed, nearly half reported good mitigations toward fighting the covid-19 epidemic. This study suggested that nearly half (54.2%) of the participants had good knowledge about the newly emerged epidemic symptoms. Three out of five participants had good Knowledge of preventive practices (63.1%). Nearly four out of five (72.6%) participants were knowledgeable about 14 days incubation period. The odds of having good mitigation to prevent covid-19 among the participants who had single marital status were 55% lower than those married union (AOR=0.45, 95% CI: 0.24, 0.86). The odds of having good mitigation to prevent covid-19 among the participants (good knowledge symptoms) were 3.4 times higher than those with poor knowledge (AOR= 3.39, 95% CI: 2.19, 5.23).

CONCLUSIONS AND RECOMMENDATIONS

Participants' mitigation status to fight covid-19 was promising. Handwashing with soap and water, disinfecting surfaces, and covering mouth or nose while coughing were mitigated practices by the vast majority. Home staying was the least mitigated practice. Participants' demographic status, knowledge of the epidemic symptoms, and knowledge of preventive measures were potent predictors of mitigations to fight covid-19. HID services should be extended to the rural population through HCWs and task forces.

Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study

Background

During a global pandemic, it is critical that the public is able to rapidly acquire new and accurate health information. The internet is a major source of health information. eHealth literacy is the ability of individuals to find, assess, and use health information available on the internet.

Objective

The goals of this study were to assess coronavirus-related eHealth literacy and examine the relationship between eHealth literacy and COVID-19−related knowledge, attitudes, and practices (KAPs).

Methods

We conducted a web-based survey of a representative sample of 1074 US adults. We adapted the 8-item eHealth Literacy Scale to develop the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) to measure COVID-19−related knowledge, conspiracy beliefs, and adherence to protective behaviors (eg, wearing facial masks and social distancing). Our analyses identified sociodemographic associations with the participants’ CoV-eHEALS scores and an association between the CoV-eHEALS measure and COVID-19 KAPs.

Results

The internal consistency of the adapted CoV-eHEALS measure was high (Cronbach α=.92). The mean score for the CoV-eHEALS was 29.0 (SD 6.1). A total of 29% (306/1074) of the survey participants were classified as having low coronavirus-related eHealth literacy (CoV-eHEALS score <26). Independent associations were found between CoV-eHEALS scores and ethnicity (standardized β=–.083, P=.016 for Black participants) and education level (standardized β=–.151, P=.001 for participants with high-school education or lower). Controlling for demographic characteristics, CoV-eHEALS scores demonstrated positive independent associations with knowledge (standardized β=.168, P<.001) and adherence to protective behaviors (standardized β=.241, P<.001) and a negative association with conspiracy beliefs (standardized β=–.082, P=.009).

Conclusions

This study provides an estimate of coronavirus-related eHealth literacy among US adults. Our findings suggest that a substantial proportion of US adults have low coronavirus-related eHealth literacy and are thus at a greater risk of lower and less-protective COVID-19 KAPs. These findings highlight the need to assess and address eHealth literacy as part of COVID-19 control efforts. Potential strategies include improving the quality of health information about COVID-19 available on the internet, assisting or simplifying web-based search for information about COVID-19, and training to improve general or coronavirus-specific search skills.

The impact of lockdown policy on depressive symptoms among pregnant women in China: mediating effects of internet use and family support

BACKGROUND

Although more and more attention has been paid to the psychological consequences of the lockdown policy amongst pregnant women, the underlying mechanism linking the lockdown policy to maternal depression has not been studied in the context of China. This study aimed to explore the association between the lockdown policy and maternal depressive symptoms, and whether such association was mediated by internet use and/or family support.

METHODS

This cross-sectional study used multi-stage sampling techniques in central and western China. Data were collected from 1266 pregnant women using a structtured questionnaire that measured internet use, family support, and depressive symptoms. The Patient Health Questionnaire-9 (PHQ-9) was used to measure depressive symptoms. Internet use was measured by length of usage and varierity of purpose for internet use. Family support was measureed by spousal support and parental support. The structural equation modelling was employed to conduct mediation analysis to test the specificity of the hypothetical paths.

RESULTS

Overall, 527 respondents (41.63%) presented depressive symptoms. The lockdown policy was negatively associated with depressive symptoms in pregnant women (β = - 0.925, 95% CI = -1.510, - 0.360). The impact of the lockdown policy on depressive symptoms was partially mediated by internet use (β = 1.589, 95% CI = 0.730, 2.807) and family support (β = - 0.162, 95% CI = - 0.341, - 0.017), accounting for 42.67% of the total effect.

CONCLUSIONS

The lockdown policy was generally associated with fewer depressive symptoms in pregnant women. The lockdown policy increased maternal depressive symptoms through increased internet use, but decreased maternal depressive symptoms through enhanced family support. The findings suggest that the psychological consequence of the lockdown policy may vary across different populations, and warrant the need to take into consideration the features of subgroups.

Risk Perception in a Real-World Situation (COVID-19): How It Changes From 18 to 87 Years Old

Studies on age-related differences in risk perception in a real-world situation, such as the recent COVID-19 outbreak, showed that the risk perception of getting COVID-19 tends to decrease as age increases. This finding raised the question on what factors could explain risk perception in older adults. The present study examined age-related differences in risk perception in the early stages of COVID-19 lockdown, analyzing variables that can explain the differences in perception of risk at different ages. A total of 1,765 adults aged between 18 and 87 years old completed an online survey assessing perceived risk severity and risk vulnerability of getting COVID-19, sociodemographic status, emotional state, experience relating to COVID-19, and physical health status. Results showed that the older the participants, the lower the perceived vulnerability to getting COVID-19, but the higher the perceived severity. Different predictors explain the perception of risk severity and vulnerability at different ages. Overall, self-reported anxiety over the pandemic is a crucial predictor in explaining risk perceptions in all age groups. Theoretical and practical implications of the empirical findings are discussed.

Self-efficacy for taking Preventive Measures against COVID-19 among Undergraduate University Students in Saudi Arabia

The COVID-19 pandemic has imposed various stresses on individuals and communities. Coping with sudden, tense, demanding situations during an infectious disease outbreak requires self-efficacy. Increasing the public’s self-efficacy for preventive and control measures is important in the management of the COVID-19 pandemic. This research was aimed at evaluating the self-efficacy and associated factors of students at a public university in the southwest region of Saudi Arabia during the COVID-19 pandemic. This was a cross-sectional study, and a snowball sampling method was used to recruit participants. Data were collected from the beginning of April to the end of June 2020 using an online questionnaire. A total of 761 students were included in the study. The participants’ demographic data were collected, and self-efficacy was analyzed using the General Self-efficacy Scale. The results showed that self-efficacy for dealing with the COVID-19 pandemic was moderate in almost half of the students but was low in approximately 25% of the participants. There were statistically significant associations between self-efficacy regarding the COVID-19 pandemic and gender, college type, marital status, and family income (p < 0.05). However, the participants’ self-efficacy was not associated with age, residence, or history of chronic illness. In dealing with the COVID-19 pandemic, most students had either moderate or low self-efficacy. Certain demographic variables were positively associated with self-efficacy as perceived by the students. These findings provide data central to the development of self-efficacy initiatives. They may also be useful for the effective implementation of public health preventive behavior programs during the COVID-19 pandemic.

Knowledge, attitude, practice towards COVID-19 pandemic and its prevalence among hospital visitors at Ataye district hospital, Northeast Ethiopia

BACKGROUND

Coronavirus disease 19 (COVID-19) is currently a global health threat and public health emergency of international concern. Africa is the last continent to be hit by this pandemic and the population is still prone to misconceptions and may not take it seriously. In developing countries including Ethiopia, where trained human resources and equipment for the treatment of COVID-19 are scarce, working on prevention of the viral spread should be a priority as a feasible intervention strategy. The aim of this study was to determine the level of knowledge, attitude, practice (KAP) towards COVID-19 and its prevalence among hospital visitors.

METHODS

Health institution based cross sectional study was conducted among 513 hospital visitors who are recruited by using simple random sampling technique at Ataye district hospital, Northeast Ethiopia from June 3, 2020 to August 10, 2020. A pre-tested structured questionnaire was used to obtain information related to socio-demographic characteristics, knowledge (11 questions), attitude (9 questions) and practice (9 questions). Oro-pharyngeal specimen was collected by trained healthcare provider and processed in a molecular laboratory. After extraction of viral nucleic acid, the Real-time fluorescent polymerase chain reaction (RT-PCR) kit was used for detecting novel coronavirus (2019-nCoV). Data was analyzed using bi-variable and multivariable logistic regression model with 95% CI (confidence interval). From the bi-variable analysis, variables having a P-value <0.25 were retained into multivariable analysis. From the multivariable analysis, variables with a P-value <0.05 was declared as associated factors.

RESULTS

Majority (72.9%) of the study participants were male; and most were urban dwellers. From the total study participants, 17 (3.3%) were found to be infected with the virus. The magnitude of low-level of knowledge was 4.9%; and of the analyzed risk factors, female gender, age (category less than 16 years and category between 16 and 65 years), and usual alcohol drinking habit had statistically significant association with low level knowledge. The proportion of study participants who had low level of practice was 75/513 (14.62%). Family size, age category between 16 and 65 years, and low-level knowledge were associated with low-level practice.

CONCLUSION

Limited number of study participants had high-level knowledge and practice towards COVID-19; while majority of the study candidates demonstrated moderate level of knowledge and practice. Good knowledge, positive attitude and good practice can be a guarantee for the prevention and control of COVID-19. Hence, various measurements to combat the pandemic should be taken by different stakeholders including the community members, religious leader, health professionals and others.

The Moderating Effects of Perceived Severity on the Generational Gap in Preventive Behaviors during the COVID-19 Pandemic in the U.S

During the COVID-19 pandemic, older adults appear to be more susceptible to the coronavirus disease. Although the health stakes are higher for older adults, individuals of all ages should adopt preventive measures to contain the human-to-human transmission of the virus. This study conducted a national online survey of 1843 adults at the early stage of the COVID-19 pandemic in the U.S. to examine age disparities in preventive behaviors against the virus. The results show that older generations, motivated by a higher perceived severity of the disease, were more likely to take the precautionary actions recommended by the U.S. Centers for Disease Control and Prevention (CDC) than younger generations. This thus suggests that persuasive health messages addressing the severity of COVID-19 might reduce the generational gap and promote preventive behaviors among young people, to protect themselves and the elderly.

Precautionary Behavior and Depression in Older Adults during the COVID-19 Pandemic: An Online Cross-Sectional Study in Hubei, China

The large-scale COVID-19 pandemic has not only resulted in the risk of death but also augmented the levels of depression in community-dwelling older adults. The present study aimed to investigate the characteristics of depression in Chinese older adults during the COVID-19 pandemic, to examine the association of individual precautionary behavior with older adults’ depression levels, and to identify the moderating role of socioeconomic indicators in the aforementioned association. Five hundred and sixteen older adults were recruited from five cities of Hubei province in China. They were asked to complete an online questionnaire survey. Results showed that 30.8% of participants indicated a significant depressive symptom during the pandemic. Older adults’ depression levels differed significantly in marital status, living situation, education level, household income, subjective health status, and infected cases of acquaintances. Precautionary behavior change showed significant inverse associations with older adults’ depression levels, where household income moderated this relationship. This is the first study to investigate the characteristics, behavioral correlates, and moderators of depression among Chinese older adults during the COVID-19 pandemic. Research findings may provide new insights into interventions and policy-making on individual precautionary behavior and mental health among older adults for future pandemics.

The Relation of Threat Level and Age With Protective Behavior Intentions During Covid-19 in Germany

To contain the spread of Covid-19, engagement in protective behaviors across the population is of great importance. The present study investigated protective behavior intentions during the early phases of Covid-19 in Germany (February 2–April 3, 2020) as a function of threat level and age using data from 4,940 participants in the EUCLID project. Results indicated that the intention to engage in social distancing increased sharply with threat level. Intentions for personal hygiene also increased, although to a lesser extent. While age only had a small overall effect on behavioral intentions, differential patterns emerged. After the lockdown was introduced, the impact of age decreased for social distancing and hygiene behavior intentions but increased for seeing a doctor. Since containing the Covid-19 pandemic depends on high adoption rates of protective behaviors, future research should track sustained phases of the pandemic, including the easing of restrictions and possible new waves of infections.

Controlling COVID-19 Pandemic: A Mass Screening Experience in Saudi Arabia

A highly accelerating number of people around the world have been infected with novel Coronavirus disease 2019 (COVID-19). Mass screening programs were suggested by the World Health Organization (WHO) as an effective precautionary measure to contain the spread of the virus. On 16 April 2020, a COVID-19 mass screening program was initiated in Saudi Arabia in multiple phases. This study aims to analyze the number of detected COVID-19 cases, their demographic data, and regions most affected in the initial two phases of these mass screening programs. A retrospective cross-sectional study was conducted among the high-risk population as part of the COVID-19 mass screening program across all regions in Saudi Arabia during April and May 2020. A Chi-square-test was used to determine the associations between positive cases and various demographic variables. Out of 71,854 screened individuals, 13.50% (n = 9701) were COVID-19 positive, of which 83.27% (n = 59,835) were males. Among positive cases, in the 30-39 years age group, 6.36% were in the active phase, and 2.19% were in the community phase. Based on our experience, launching mass screening programs is crucial for early case detection, isolation, and pattern recognition for immediate public interventions.

Information Sources, Risk Perception, and Efficacy Appraisal's Prediction of Engagement in Protective Behaviors Against COVID-19 in China: Repeated Cross-sectional Survey

Background

As the COVID-19 pandemic has become a major public health threat worldwide, it is critical to understand what factors affect individual engagement in protective actions. Because of its authoritarian political system and state-owned media system, how Chinese individuals engaged in protective actions against COVID-19 might be different compared to other countries.

Objective

The purpose of this study is to examine how the source of information about COVID-19, Chinese individuals’ risk perception of COVID-19 (ie, perceived severity and perceived susceptibility), and their efficacy appraisal in controlling COVID-19 (ie, response efficacy and self-efficacy) affected their engagement in protective actions. Additionally, this study aims to investigate whether there is any difference in these relationships throughout the duration of this pandemic.

Methods

A six-wave repeated cross-sectional survey (N=1942) was conducted in six major cities in China between February 7 and April 23, 2020. Participants’ reliance on expert versus inexpert sources for information about COVID-19, their perceived severity of and susceptibility to COVID-19, their response efficacy and self-efficacy, and their engagement in protective actions (staying at home, wearing a face mask, and washing hands) were measured. Demographic variables (sex, age, income, education, and city of residence), knowledge of COVID-19, and self-rated health condition were controlled.

Results

Reliance on expert sources did not become the major factor that motivated these actions until wave 3, and the negative effect of inexpert sources on these actions was limited to wave 2. Perceived severity encouraged some protective behaviors but its effect varied depending on the specific behavior. In addition, perceived severity exhibited a stronger effect on these behaviors compared to perceived susceptibility. The positive effect of response efficacy was only significant at waves 1 and 2, and limited to certain behaviors.

Conclusions

Chinese individuals’ engagement in protective behaviors might not entirely be their autonomous decision but a result of compliance with executive orders. After the early outbreak, expert sources started to facilitate protective behaviors, suggesting that it might take time to develop trust in these sources. The facilitating effect of perceived severity lasted throughout the duration of the pandemic, but that of response efficacy was limited to the early stage.

The Association Between Chronic Disease and Serious COVID-19 Outcomes and Its Influence on Risk Perception: Survey Study and Database Analysis

BACKGROUND

COVID-19, a viral respiratory disease first reported in December 2019, quickly became a threat to global public health. Further understanding of the epidemiology of the SARS-CoV-2 virus and the risk perception of the community may better inform targeted interventions to reduce the impact and spread of COVID-19.

OBJECTIVE

In this study, we aimed to examine the association between chronic diseases and serious outcomes following COVID-19 infection, and to explore its influence on people's self-perception of risk for worse COVID-19 outcomes.

METHODS

This study draws data from two databases: (1) the nationwide database of all confirmed COVID-19 cases in Portugal, extracted on April 28, 2020 (n=20,293); and (2) the community-based COVID-19 Barometer survey, which contains data on health status, perceptions, and behaviors during the first wave of COVID-19 (n=171,087). We assessed the association between relevant chronic diseases (ie, respiratory, cardiovascular, and renal diseases; diabetes; and cancer) and death and intensive care unit (ICU) admission following COVID-19 infection. We identified determinants of self-perception of risk for severe COVID-19 outcomes using logistic regression models.

RESULTS

Respiratory, cardiovascular, and renal diseases were associated with mortality and ICU admission among patients hospitalized due to COVID-19 infection (odds ratio [OR] 1.48, 95% CI 1.11-1.98; OR 3.39, 95% CI 1.80-6.40; and OR 2.25, 95% CI 1.66-3.06, respectively). Diabetes and cancer were associated with serious outcomes only when considering the full sample of COVID-19-infected cases in the country (OR 1.30, 95% CI 1.03-1.64; and OR 1.40, 95% CI 1.03-1.89, respectively). Older age and male sex were both associated with mortality and ICU admission. The perception of risk for severe COVID-19 disease in the study population was 23.9% (n=40,890). This was markedly higher for older adults (n=5235, 46.4%), those with at least one chronic disease (n=17,647, 51.6%), or those in both of these categories (n=3212, 67.7%). All included diseases were associated with self-perceptions of high risk in this population.

CONCLUSIONS

Our results demonstrate the association between some prevalent chronic diseases and increased risk of worse COVID-19 outcomes. It also brings forth a greater understanding of the community's risk perceptions of serious COVID-19 disease. Hence, this study may aid health authorities to better adapt measures to the real needs of the population and to identify vulnerable individuals requiring further education and awareness of preventive measures.

Risk Perception in a Real-World Situation (COVID-19): How It Changes From 18 to 87 Years Old

Studies on age-related differences in risk perception in a real-world situation, such as the recent COVID-19 outbreak, showed that the risk perception of getting COVID-19 tends to decrease as age increases. This finding raised the question on what factors could explain risk perception in older adults. The present study examined age-related differences in risk perception in the early stages of COVID-19 lockdown, analyzing variables that can explain the differences in perception of risk at different ages. A total of 1,765 adults aged between 18 and 87 years old completed an online survey assessing perceived risk severity and risk vulnerability of getting COVID-19, sociodemographic status, emotional state, experience relating to COVID-19, and physical health status. Results showed that the older the participants, the lower the perceived vulnerability to getting COVID-19, but the higher the perceived severity. Different predictors explain the perception of risk severity and vulnerability at different ages. Overall, self-reported anxiety over the pandemic is a crucial predictor in explaining risk perceptions in all age groups. Theoretical and practical implications of the empirical findings are discussed.

An Observational Study in Manipur State, India on Preventive Behavior Influenced by Social Media During the COVID-19 Pandemic Mediated by Cyberchondria and Information Overload

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency posing unprecedented challenges for health authorities. Social media may serve as an effective platform to disseminate health-related information. This study aimed to assess the extent of social media use, its impact on preventive behavior, and negative health effects such as cyberchondria and information overload.

METHODS

A cross-sectional observational study was conducted between June 10, 2020 and August 9, 2020 among people visiting the outpatient department of the authors' institution, and participants were also recruited during field visits for an awareness drive. Questions were developed on preventive behavior, and the Short Cyberchondria Scale and instruments dealing with information overload and perceived vulnerability were used.

RESULTS

The study recruited 767 participants with a mean age of about 45 years. Most of the participants (>90%) engaged in preventive behaviors, which were influenced by the extent of information received through social media platforms (β=3.297; p<0.001) and awareness of infection when a family member tested positive (β=29.082; p<0.001) or a neighbor tested positive (β=27.964; p<0.001). The majority (63.0%) of individuals often searched for COVID-19 related news on social media platforms. The mean±standard deviation scores for cyberchondria and information overload were 9.09±4.05 and 8.69±2.56, respectively. Significant and moderately strong correlations were found between cyberchondria, information overload, and perceived vulnerability to COVID-19.

CONCLUSIONS

This study provides evidence that the use of social media as an information- seeking platform altered preventive behavior. However, excessive and misleading information resulted in cyberchondria and information overload.

Towards Covid-19 Literacy: Investigating the Literacy Levels of University Students in Colombia

Covid-19 literacy, induced by the coronavirus disease (2019), is characterized as the understanding of Covid-19 as well as informed decisions based upon this understanding. This type of literacy is closely related to health literacy, scientific literacy, and scientific media literacy. It may be obvious to say that Covid-19 literacy is a key factor for governments to effectively manage the Covid-19 transition. However, lack of literature exists about Covid-19 literacy among university students. Therefore, the current study aimed to determine the Covid-19 literacy level among 4168 students from a Colombian university. The data were derived from students' responses to a 25-item anonymous online self-reporting questionnaire. We found that 21-25-year age group, graduate students, students enrolled prior to 2015, and medical students had a significantly higher mean score. Moreover, the Internet (86.8%) was the most popular source of information from which participants gained most information regarding Covid-19. Furthermore, 58.5% of the participants considered health workers as a source that can provide accurate information. Most importantly, the findings reveal the students' knowledge about (1) the role of an eventual process of vaccination, (2) the test currently used as diagnostic for Covid-19, and (3) the fatality rate, three aspects of Covid-19 literacy that deserve more attention. The findings provide a useful basis for the formulation of policies and concrete actions in improving Covid-19 literacy.

Safe Use and Storage of Cleaners, Disinfectants, and Hand Sanitizers: Knowledge, Attitudes, and Practices among U.S. Adults during the COVID-19 Pandemic, May 2020

Cleaning and disinfection of frequently touched surfaces and frequent hand hygiene are recommended measures to prevent transmission of SARS-CoV-2, the virus that causes COVID-19. Since the onset of the COVID-19 pandemic, poison center calls regarding exposures to cleaners, disinfectants, and hand sanitizers have increased as compared with prior years, indicating a need to evaluate household safety precautions. An opt-in Internet panel survey of 502 U.S. adults was conducted in May 2020. Survey items evaluated knowledge regarding use and storage of cleaners, disinfectants, and hand sanitizers; attitudes about household cleaning and disinfection; and safety precautions practiced during the prior month. We assigned a knowledge score to each respondent to quantify knowledge of safety precautions and calculated median scores by demographic characteristics and attitudes. We identified gaps in knowledge regarding safe use and storage of cleaners, disinfectants, and hand sanitizers; the overall median knowledge score was 5.17 (95% CI: 4.85-5.50; maximum 9.00). Knowledge scores were lower among younger than older age-groups and among black non-Hispanic and Hispanic respondents compared with white non-Hispanic respondents. A greater proportion of respondents expressed knowledge of safety precautions than the proportion who engaged in these precautions. Tailored communication strategies should be used to reach populations with lower knowledge of cleaning and disinfection safety. In addition, as knowledge alone did not shape individual engagement in safety precautions, health promotion campaigns may specifically emphasize the health risks of unsafe use and storage of cleaners, disinfectants, and hand sanitizers to address risk perception.

Community Risk Perception and Compliance with Preventive Measures for COVID-19 Pandemic in Ethiopia

PURPOSE

This study assessed the community's level of risk perception of COVID-19, their compliance with recommended precautionary measures, and factors that influence compliance behavior.

METHODS

This study is a cross-sectional online survey administered using google forms. Data were collected from 521 respondents using various social media channels, including e-mail, Facebook, messenger, telegram, and IMO.

RESULTS

About 9 in 10 respondents (90.4%) perceived that they are susceptible to COVID-19. Nearly 9 in 10 participants (87.5%) perceived that COVID-19 is a serious disease. The majority of respondents (81%) got information about COVID-19 from television and social networking sites. The regression analyses revealed that compliance with preventive behaviors is differed by respondents' socio-demographic characteristics. Being female (β: 0.094, P<0.05), higher perceived effectiveness of recommended preventive measures (β: 0.367, P<0.001), and higher perceived reliability of media (β: 0.189, P<0.001) facilitated compliance with preventive measures. On the other hand, increasing age (β: -0.096, P<0.05), being single (β: -0.127, P<0.01), lower education level (β: -0.168, P<0.01), and living at a lower administrative level were barriers to be compliant with preventive measures.

CONCLUSION

The majority of the respondents exercised one or more of the recommended preventive measures to avoid COVID-19 infection. Most of the respondents got information about COVID-19 from television and social networking sites. Given that about 80% of the Ethiopian population is living in rural areas without television and higher illiteracy rate to use social networking sites, concerned bodies should introduce tailored interventions to impart knowledge about COVID-19 infection and mitigating measures.

LIMITATIONS

Although the sampling procedure was random through the online system, it might not be representative to study the perception and compliance of people towards COVID-19 prevention practices at a country level due to its small size. Thus, the interpretation of the study findings needs to consider this limitation.

Who Is Willing to Engage in Social Gatherings During the Coronavirus Disease 2019 Lockdown? A Curvilinear Relationship Between Age and Heuristic Processing

BACKGROUND

The Chinese government implemented a lockdown to contain the coronavirus disease 2019 (COVID-19) pandemic during the Chinese Lunar New Year when people have the tradition to visit families and friends. Previous research suggested that heuristic processing increased risky behavioral willingness (e.g., desire to have social gatherings despite the pandemic) and that people's tendency to use heuristic processing varied across different adulthood stages. This study thus investigated the relationships among age, heuristic processing of COVID-19-related information, and the willingness to have social gatherings during the lockdown.

METHODS

A sample of 1,651 participants was recruited from an online crowdsourcing platform between January 31 and February 04 in 2020, with a mean age of 30.69, 47.9% being women. Participants completed an online questionnaire about heuristic processing of COVID-19-related information, willingness to engage in social gatherings during the lockdown, age, and other demographic information.

RESULTS

Age was found to have a U-shaped curvilinear relationship with heuristic processing, and heuristic processing was positively correlated with the willingness to have social gatherings. Further analyses showed that heuristic processing curvilinearly mediated the relationship between age and the willingness to have social gatherings.

CONCLUSION

Compared with young adults, emerging and older adults are more likely to engage in heuristic processing, which in turn, increases the willingness to have social gatherings. Heuristic processing serves as an underlying mechanism to explain the relationship between age and risky behavioral willingness.

Health Literacy, eHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19 Symptoms Among Health Care Workers During Lockdown: Online Survey

Background

The COVID-19 pandemic has imposed a heavy burden on health care systems and governments. Health literacy (HL) and eHealth literacy (as measured by the eHealth Literacy Scale [eHEALS]) are recognized as strategic public health elements but they have been underestimated during the pandemic. HL, eHEALS score, practices, lifestyles, and the health status of health care workers (HCWs) play crucial roles in containing the COVID-19 pandemic.

Objective

The aim of this study is to evaluate the psychometric properties of the eHEALS and examine associations of HL and eHEALS scores with adherence to infection prevention and control (IPC) procedures, lifestyle changes, and suspected COVID-19 symptoms among HCWs during lockdown.

Methods

We conducted an online survey of 5209 HCWs from 15 hospitals and health centers across Vietnam from April 6 to April 19, 2020. Participants answered questions related to sociodemographics, HL, eHEALS, adherence to IPC procedures, behavior changes in eating, smoking, drinking, and physical activity, and suspected COVID-19 symptoms. Principal component analysis, correlation analysis, and bivariate and multivariate linear and logistic regression models were used to validate the eHEALS and examine associations.

Results

The eHEALS had a satisfactory construct validity with 8 items highly loaded on one component, with factor loadings ranked from 0.78 to 0.92 explaining 76.34% of variance; satisfactory criterion validity as correlated with HL (ρ=0.42); satisfactory convergent validity with high item-scale correlations (ρ=0.80-0.84); and high internal consistency (Cronbach α=.95). HL and eHEALS scores were significantly higher in men (unstandardized coefficient [B]=1.01, 95% CI 0.57-1.45, P<.001; B=0.72, 95% CI 0.43-1.00, P<.001), those with a better ability to pay for medication (B=1.65, 95% CI 1.25-2.05, P<.001; B=0.60, 95% CI 0.34-0.86, P<.001), doctors (B=1.29, 95% CI 0.73-1.84, P<.001; B 0.56, 95% CI 0.20-0.93, P=.003), and those with epidemic containment experience (B=1.96, 95% CI 1.56-2.37, P<.001; B=0.64, 95% CI 0.38-0.91, P<.001), as compared to their counterparts, respectively. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures (B=0.13, 95% CI 0.10-0.15, P<.001; B=0.22, 95% CI 0.19-0.26, P<.001), had a higher likelihood of healthy eating (odds ratio [OR] 1.04, 95% CI 1.01-1.06, P=.001; OR 1.04, 95% CI 1.02-1.07, P=.002), were more physically active (OR 1.03, 95% CI 1.02-1.03, P<.001; OR 1.04, 95% CI 1.03-1.05, P<.001), and had a lower likelihood of suspected COVID-19 symptoms (OR 0.97, 95% CI 0.96-0.98, P<.001; OR 0.96, 95% CI 0.95-0.98, P<.001), respectively.

Conclusions

The eHEALS is a valid and reliable survey tool. Gender, ability to pay for medication, profession, and epidemic containment experience were independent predictors of HL and eHEALS scores. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures, healthier lifestyles, and a lower likelihood of suspected COVID-19 symptoms. Efforts to improve HCWs’ HL and eHEALS scores can help to contain the COVID-19 pandemic and minimize its consequences.

Concerns About Information Regarding COVID-19 on the Internet: Cross-Sectional Study

Background

Since the outbreak of COVID-19, the Chinese government and the Chinese Center for Disease Control and Prevention have released COVID-19–related information to the public through various channels to raise their concern level of the pandemic, increase their knowledge of disease prevention, and ensure the uptake of proper preventive practices.

Objective

Our objectives were to determine Chinese netizens’ concerns related to COVID-19 and the relationship between their concerns and information on the internet. We also aimed to elucidate the association between individuals’ levels of concern, knowledge, and behaviors related to COVID-19.

Methods

The questionnaire, which consisted of 15 closed-ended questions, was designed to investigate Chinese netizens’ knowledge about COVID-19. The self-selection online survey method of nonprobability sampling was used to recruit participants through Dingxiangyisheng WeChat (a public, medical, and health service platform in China) accounts. Standard descriptive statistics and multivariate logistic regression analyses were conducted to analyze the data.

Results

In total, 10,304 respondents were surveyed on the internet (response rate=1.75%; 10,304/590,000). Nearly all (n=9803, 95.30%) participants were concerned about “confirmed cases” of COVID-19, and 87.70% (n=9036) received information about the outbreak through social media websites. There were significant differences in participants’ concerns by sex (P=.02), age (P<.001), educational attainment (P=.001), and occupation (P<.001). All knowledge questions and preventive practices were associated with concerns about COVID-19. The results of the multivariate logistic regression indicated that participants’ sex, educational attainment, occupation and employment status, knowledge acquisition, and concern level were significantly associated with the practice of proper preventive behaviors.

Conclusions

This study elucidated Chinese netizens’ concerns, information sources, and preventive behaviors related to the COVID-19 pandemic. Sex, educational attainment, occupation and employment status, knowledge acquisition, and level of concern were key factors associated with proper preventive behaviors. This offers a theoretical basis for the government to provide targeted disease prevention and control information to the public.

Exploring the Role of Media Sources on COVID-19-Related Discrimination Experiences and Concerns Among Asian People in the United States: Cross-Sectional Survey Study

Background

Media coverage and scholarly research have reported that Asian people who reside in the United States have been the targets of racially motivated incidents during the COVID-19 pandemic.

Objective

This study aimed to examine the types of discrimination and worries experienced by Asians and Asian Americans living in the United States during the pandemic, as well as factors that were associated with everyday discrimination experience and concerns about future discrimination that the Asian community may face.

Methods

A cross-sectional online survey was conducted. A total of 235 people who identified themselves as Asian or Asian American and resided in the United States completed the questionnaire.

Results

Our study suggested that up to a third of Asians surveyed had experienced some type of discrimination. Pooling the responses “very often,” “often,” and “sometimes,” the percentages for each experienced discrimination type ranged between 14%-34%. In total, 49%-58% of respondents expressed concerns about discrimination in the future. The most frequently experienced discrimination types, as indicated by responses “very often” and “often,” were “people act as if they think you are dangerous” (25/235, 11%) and “being treated with less courtesy or respect” (24/235, 10%). About 14% (32/235) of individuals reported very often, often, or sometimes being threatened or harassed. In addition, social media use was significantly associated with a higher likelihood of experiencing discrimination (β=.18, P=.01) and having concerns about future episodes of discrimination the community may face (β=.20, P=.005). Use of print media was also positively associated with experiencing discrimination (β=.31, P<.001).

Conclusions

Our study provided important empirical evidence regarding the various types of discrimination Asians residing in the United States experienced or worried about during the COVID-19 pandemic. The relationship between media sources and the perception of racial biases in this group was also identified. We noted the role of social media in reinforcing the perception of discrimination experience and concerns about future discrimination among Asians during this outbreak. Our results indicate several practical implications for public health agencies. To reduce discrimination against Asians during the pandemic, official sources and public health professionals should be cognizant of the possible impacts of stigmatizing cues in media reports on activating racial biases. Furthermore, Asians or Asian Americans could also be informed that using social media to obtain COVID-19 information is associated with an increase in concerns about future discrimination, and thus they may consider approaching this media source with caution.

COVID-19 pandemic preventive behaviors and causal beliefs among Italian community dwelling adults

In an online sample of 1054 Italian community-dwelling adults, we assessed the relationships between the frequency of implementation of practices intended to prevent COVID-19 infection, degree of agreement with theories about the origin of the infections, and the frequency of use of different sources of information concerning the COVID-19 pandemic. The results showed that participants' COVID-19-related preventive behaviors and causal beliefs were significantly associated with selected demographic variables and frequency of use of specific sources of information (e.g. scientific journals vs social media).

Men and COVID-19: the aftermath

The global pandemic as a result of the SARS-CoV2 virus has seen over 16 m people infected and over 650,000 deaths, with men at double the risk of both developing the severe form of the disease and mortality. There are both biological (sex) and socio-cultural (gender) factors, compounded by socio-economic factors and ethnicity, that impact on the aftermath of what has occurred over the short time that this novel coronavirus has been circulating the world. The potential life-long morbidity as a result of the infection and as a consequence of highly invasive critical care treatment needs to be factored into the rehabilitation of survivors. There are also many men whose lives will have been severely affected both physically and emotionally by the pandemic without ever contracting the disease, with the widespread disruption to normal existence and its impact on their social world and the economy. The implications of the closure of many healthcare services over the initial lockdown will also have both a shorter- and longer-term impact on other diseases due to missed early diagnosis and disrupted treatment regimes. Getting effective public health messages out to the population is critical and this current pandemic is demonstrating that there needs to be a more focused view on men's health behavior. Without effective public support for preventative action, the more likely the disease will continue its path unabated. This review explores the wider ramifications of the disease both for those men who have survived the disease and those that have been affected by the wider social effects of the pandemic. The pandemic should be a wake-up call for all involved in the planning and delivery of health and social care for the greater attention to the central role of sex and gender.

The Recommended and Excessive Preventive Behaviors during the COVID-19 Pandemic: A Community-Based Online Survey in China

COVID-19 presents unprecedented challenges to the global public health response. Preventive behaviors and keeping social distance are regarded as compelling ways to prevent COVID-19. This study focused on the sociological and psychological factors associated with proper and excessive preventive behaviors of the COVID-19 outbreak in China. For the sample, we collected the data of 4788 participants who were surveyed between 4 April and 15 April 2020 from eight provinces in China. This study designed a self-filled questionnaire that included demographic information, six components of the Health Belief Model, and target preventive behaviors. Descriptive analysis, Chi-square test, logistic regression analysis, Mantel-Haenszel hierarchical analysis, and propensity score matching were employed in this study. The results showed that 54.7% of the participants had adequate basic prevention, 63.6% of the participants had adequate advanced prevention, and 5.8% of the participants practiced excessive prevention. The elder participants were less likely to engage in proper preventive behaviors. Perceived susceptibility, perceived benefits, perceived barriers, cues to action, and knowledge levels were associated with preventive behaviors. Excessive preventive behaviors in high-risk groups with suspected symptoms were associated with their extreme psychological condition, while the support from the community and family plays an important role in avoiding these behaviors.

Chinese Public's Engagement in Preventive and Intervening Health Behaviors During the Early Breakout of COVID-19: Cross-Sectional Study

BACKGROUND

Since January 2020, the coronavirus disease (COVID-19) swept over China and then the world, causing a global public health crisis. People's adoption of preventive and intervening behaviors is critical in curbing the spread of the virus.

OBJECTIVE

The aim of this study is to evaluate Chinese people's adoption of health behaviors in responding to COVID-19 and to identify key determinants for their engagement.

METHODS

An anonymous online questionnaire was distributed in early February 2020 among Mainland Chinese (18 years or older) to examine their engagement in preventive behaviors (eg, frequent handwashing, wearing masks, staying at home) and intervening behaviors (eg, advising family to wash hands frequently), and to explore potential determinants for their adoption of these health behaviors.

RESULTS

Out of 2949 participants, 55.3% (n=1629) reported frequent engagement in preventive health behaviors, and over 84% (n=2493) performed at least one intervening health behavior. Greater engagement in preventive behaviors was found among participants who received higher education, were married, reported fewer barriers and greater benefits of engagement, reported greater self-efficacy and emotional support, had greater patient-centered communication before, had a greater media literacy level, and had greater new media and traditional media use for COVID-19 news. Greater engagement in intervening behaviors was observed among participants who were married, had lower income, reported greater benefits of health behaviors, had greater patient-centered communication before, had a lower media literacy level, and had a greater new media and traditional media use for COVID-19 news.

CONCLUSIONS

Participants' engagement in coronavirus-related preventive and intervening behaviors was overall high, and the associations varied across demographic and psychosocial variables. Hence, customized health interventions that address the determinants for health behaviors are needed to improve people's adherence to coronavirus-related behavior guidelines.