What factors underlie attitudes regarding protective mask use during the COVID-19 pandemic?

Patient autonomy in the era of the sustainability crisis

In the realm of medical ethics, the foundational principle of respecting patient autonomy holds significant importance, often emerging as a central concern in numerous ethically complex cases, as authorizing medical assistance in dying or healthy limb amputation on patient request. Even though advocates for either alternative regularly utilize prima facie principles to resolve ethical dilemmas, the interplay between these principles is often the core of the theoretical frameworks. As the ramifications of the sustainability crisis become increasingly evident, there is a growing need to integrate awareness for sustainability into medical decision-making, thus reintroducing potential conflict with patient autonomy. The contention of this study is that the ethical standards established in the 20th century may not adequately address the challenges that have arisen in the 21st century. The author suggests an advanced perception of patient autonomy that prioritizes fostering patients' knowledge, self-awareness, and sense of responsibility, going beyond a sole focus on their intrinsic values. Empowering patients could serve as a tool to align patient autonomy, beneficence, and the aim to reduce resource consumption.

Did COVID-19 influence fruit and vegetable consumption? Explaining and comparing pandemic peak and post-peak periods

The COVID-19 pandemic, one of the worst global health crises in the last century, impacted nearly every aspect of people's lives, including their dietary choices and food consumption patterns. It arrived during a long shift in American diets featuring increasingly large portions of processed foods as well as fruit and vegetable consumption that is well below recommended levels. Improving the latter has been a key part of policymakers' efforts to improve consumers' diets. This study surveyed individuals in the US South to determine the factors influencing their consumption of fruit and vegetables during the pandemic peak and how these have changed post-peak. During the peak, food venue, demographics, and concerns about diet and the seriousness of the virus heavily affected consumption. Greater amounts of fresh fruit and vegetables were consumed post-peak pandemic. Changes post-peak were predicted by food venue. Cooking meals at home was the main positive predictor for consumption. US policymakers should try and leverage the changes since the peak to promote greater consumption of fruit and vegetables.

Attitudes, Beliefs, and Perceptions Associated with Mask Wearing within Four Racial and Ethnic Groups Early in the COVID-19 Pandemic

BACKGROUND

While previous studies have identified a range of factors associated with mask wearing in the US, little is known about drivers of mask-wearing among racial and ethnic minority groups. This analysis assessed whether factors positively associated with wearing a mask early in the pandemic differed between participants grouped by race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic White).

METHOD

Data were obtained from a US internet panel survey of 3217 respondents during May-November 2020 (weighted by race/ethnicity, age, gender, and education to the US national population). Within each of the four available racial/ethnic groups, crude and adjusted odds ratios (COR and AOR) were calculated using logistic regression to assess factors positively associated with wearing a mask. Adjusted models were controlled for age, gender, education, county COVID-19 case count, presence of a state-issued mask mandate, and interview month.

RESULTS

The following variables were most strongly positively associated with mask wearing (p<0.05) in each racial/ethnic group: Hispanic-seeing others wearing masks (AOR: 6.7), importance of wearing a mask combined with social distancing (AOR: 3.0); non-Hispanic Black-belief that wearing a mask would protect others from coronavirus (AOR: 5.1), reporting hearing that one should wear a mask (AOR: 3.6); non-Hispanic Asian-belief that people important to them believe they should wear a mask (COR: 5.1, not statistically significant); and non-Hispanic White-seeing others wearing masks (AOR: 3.1), importance of wearing a mask (AOR: 2.3).

CONCLUSION

Public health efforts to encourage mask wearing should consider the diversity of behavioral influences within different population groups.

COVID-19: did the masks work?

During the early stages of the COVID-19 pandemic, we called for mandatory public masking to 'flatten the curve'. We helped formulate a national standard (SWiFT 19) for barrier facemasks, and, using a novel laser-based approach, we determined that mask efficacy is dependent on both fabric and fit; with both variables being inversely related. Herein, we take a retrospective view of the role of masks during the pandemic and surmise that, on the balance of evidence to date, masks were effective at stemming the spread of SARS-CoV-2 and may well be an effective early control strategy for potential future respiratory pandemics.

Using narratives to correct politically charged health misinformation and address affective belief echoes

BACKGROUND

In May 2020, news outlets reported misinformation about the Centers for Disease Control (CDC) related to COVID-19. Correcting misinformation about outbreaks and politics is particularly challenging. Affective belief echoes continue to influence audiences even after successful correction. Narrative and emotional flow scholarship suggest that a narrative corrective with a positive ending could reduce belief echoes. Therefore, this study investigated the efficacy of a narrative corrective with a relief ending for correcting misinformation about the CDC.

METHODS

Between 29 May and 4 June 2020, we tested the effectiveness of a narrative to correct this misinformation. Participants in the United States (N = 469) were enrolled via Qualtrics panels in an online message experiment and randomized to receive a narrative corrective, a didactic corrective or no corrective.

RESULTS

The narrative corrective resulted in lower endorsement of the misinformation compared with the control and the didactic corrective. The narrative corrective had a positive indirect effect on perceived CDC competence and mask wearing intentions for politically moderate and conservative participants via relief.

CONCLUSIONS

Public health institutions, such as the CDC, should consider utilizing narrative messaging with positive emotion endings to correct misinformation. Narratives better address affective belief echoes, particularly for counter-attitudinal audiences.

Veiled to Express: Uncovering the Effect of Mask-Wearing on Voice Behavior in the Workplace

Since the outbreak of COVID-19, mask-wearing has become a widespread phenomenon. Even after the pandemic, people continue to maintain the habit of wearing masks in their daily lives. While existing research has explored how mask-wearing can influence wearers' behavior in everyday life, its effects in the workplace have received less attention. Drawing on self-perception theory, this study examined the positive effect of mask-wearing in the workplace on wearers' voice behavior via psychological safety. An online experiment (N = 291) using a within-subject manipulation of wearing masks supported our hypotheses. This study uncovered the positive psychological and behavioral consequences of mask-wearing beyond its benefits in people's health conditions and everyday life.

Meaningful Media Experiences and Vaccination Message Communication: An Experimental Study with Vaccine-Hesitant Individuals

Guided by the eudaimonic media and the health persuasion literature, the current study explores how meaningful emotions elicited from entertainment media exposure decreases anti-vaccination attitudes among vaccine-hesitant individuals. Results of a between-subjects experiment (N = 409) showed that participants who viewed meaningful music videos (vs. neutral videos) and vaccination messages embedded in the user-generated comments reported more empathy, less reactance, and less anti-vaccination attitudes. Multigroup analysis revealed that this association was held for participants who were hesitant about whether they would get fully vaccinated, but not for participants who were determined to not get vaccinated. Theoretical and practical implications were discussed.

In masks we trust: explicit and implicit reactions to masked faces vary by political orientation

Previous studies in the context of the COVID-19 pandemic indicated that wearing a medical-style mask affects whether a stranger's face is judged as more trustworthy, socially desirable, or likely to be ill. However, given political controversies around mask use, these effects might vary by political orientation. In a pre-registered online experiment, we measured evaluations of trustworthiness, social desirability and perceived illness in masked and unmasked faces by 1241 British and US participants. We included questions on political orientation, along with the implicit online-VAAST approach/avoid task to test reaction times to masked/unmasked faces. There was a medium-sized effect of masks on trustworthiness and a significant interaction with political orientation, in that conservatives found masked faces less trustworthy than did liberals. Participants were quicker to approach masked than unmasked faces, but conservatives were relatively slower than liberals. The effects on trustworthiness suggest that differential moralization of novel social norms can affect how their adherents are evaluated in terms of their suitability for social interactions. Furthermore, the congruence between implicit and explicit methods implies that such differences can have deep-seated effects on reactions.

More Than Meets the Eyes: Bringing Attention to the Eyes Increases First Impressions of Warmth and Competence

The present research examined how face masks alter first impressions of warmth and competence for different racial groups. Participants were randomly assigned to view photographs of White, Black, and Asian targets with or without masks. Across four separate studies (total N = 1,012), masked targets were rated significantly higher in warmth and competence compared with unmasked targets, regardless of their race. However, Asian targets benefited the least from being seen masked compared with Black or White targets. Studies 3 and 4 demonstrate how the positive effect of masks is likely due to these clothing garments re-directing attention toward the eyes of the wearer. Participants viewing faces cropped to the eyes (Study 3), or instructed to gaze into the eyes of faces (Study 4), rated these targets similarly to masked targets, and higher than unmasked targets. Neither political affiliation, belief in mask effectiveness, nor explicit racial prejudice moderated any hypothesized effects.

Trust in science moderates the effects of high/low threat communication on psychological reactance to COVID-19-related public health messages

BACKGROUND

As illustrated by the COVID-19 pandemic, communicating evidence-based health recommendations represents a tremendous challenge; among some recipients, public health messages can cause anger and negative cognitions, also known as psychological reactance, and consequently lead to negative attitudes and low intentions to perform the promoted behavior. The present study investigated the role of message characteristics (i.e. high vs. low freedom-threat messages), individuals' trust in science (i.e. high vs. low trust in science), and their interaction in determining responses to public health messages.

METHODS

We conducted an experimental study, in which participants (N = 228) with high or low trust in science were exposed to high or low freedom-threat messages promoting mask-wearing to reduce the spread of COVID-19 and regular physical activity.

RESULTS

We found support for the notion that messages imposing high threat to freedom lead to higher state psychological reactance, and more negative attitudes and behavioral intentions. Moreover, our results showed that trust in science has a main and interaction effect (together with message characteristics) on state reactance, behavioral intentions, and - to a lesser degree - attitudes, in the case of COVID-19, but not physical activity messages. The findings remained the same regardless of controlling for other relevant variables.

CONCLUSIONS

While our study has some limitations, such as a rather homogeneous sample, a limited number of experimental stimuli, and a relatively artificial experimental environment, it offers some insight into the important role of health communication recipients' trust in science and provides advice on how to communicate health recommendations to skeptics.

The Usability of Face Coverings Used to Prevent the Spread of COVID-19

OBJECTIVE

To describe the perceived usability and usability problems associated with face coverings used to prevent the spread of COVID-19.

BACKGROUND

Since public health experts have now identified the appropriate use of facemasks as one of the critical elements in an effective COVID mitigation strategy, understanding how people use and care for them has become important.

METHOD

Data were collected via a survey that was shared on social media to which 2148 people responded. Participants were asked to identify the category class of the face covering they most often wear, rate its usability, answer demographic information, and questions about their mask use and hygiene, and identify issues they may suffer in relation to face cover use.

RESULTS

Overall, users appear to perceive their face coverings favorably from a usability and satisfaction standpoint, even though almost two-thirds of users indicated that they experienced discomfort and problems with glasses fogging with the most popular mask types. When considering demographic information, users' political party affiliation appears related to how they perceive the usability of their face covering.

CONCLUSION

Designers should work to improve the fit and comfort properties of protective masks; evidence suggests the System Usability Scale may be a useful tool in those efforts.

APPLICATION

Understanding mask design and behavioral issues related to their use can help in the development of masks and will maximize their acceptance and effectiveness in the field.

Do Italian people still wear masks? Analysis of personality and dispositional correlates of facemask use in post Covid-19 scenario

Face mask wearing is a low-cost preventative measure for the Covid-19 pandemic. In Italy, face masks are no longer mandatory indoors from the 1st of May 2022. Some research focused on factors that influence the choice of using masks, but less is known about mask-wearing when non-mandatory. The present study aims to compare those who were still wearing masks indoors when non-mandatory and those who were not, in personality traits, anxiety, depression, and trust in healthcare professions, in Italy, in 2022. Furthermore, we analyze if resilience, reactance, political orientation, and Covid-19 vaccinations moderate between negative affectivity and the choice of wearing masks. 1151 adults, aged 18-64, were recruited. Using the Qualtrics platform, participants filled in a socio-demographic interview, and self-report questionnaires. Results showed that people who were still wearing a mask indoors had higher levels of psychoticism and negative affectivity, worse mental health, greater trust in healthcare professions, and worries about the pandemic. Moreover, resilience partially moderates the relationship between negative affectivity and the choice of wearing a mask. These findings provide a better understanding of individuals' responses to post-pandemic changes, identifying the personal and contextual aspects that can make people struggle with the process of returning to normality.

Intellectual Humility and Responsiveness to Public Health Recommendations

We examined the association between intellectual humility (IH)-a willingness to consider credible new information and alternative views and revise one's own views if warranted-and adherence to experts' health behavior recommendations in the U.S. during the COVID-19 pandemic. Study 1 (N = 541) results showed that people higher in IH are more likely to engage in recommended health behaviors (e.g., mask-wearing, social distancing)-even when controlling for political affiliation. Additional analyses focused specifically on mask-wearing produced initial evidence consistent with mediation of the IH-mask-wearing relationship by the beliefs that mask-wearing 1) is an effective way to slow the spread of COVID-19 and 2) protects others. Based on the pathway from IH to mask-wearing through a concern for others found in Study 1, Study 2 further examined the relationship between IH and prosocial tendencies. The results from Study 2 (Ns for correlation coefficients ranged from 265 to 702) showed an association between IH and several values and traits that reflect a concern for others (e.g., agreeableness, benevolence). These findings suggest that IH may influence behavior through both intra- and interpersonal mechanisms. Implications of these findings for the health-behavior domain are discussed.

Psychological and psychosocial determinants of COVID Health Related Behaviours (COHeRe): An evidence and gap map

Background

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. Common recommended measures to limit risk of infection include frequent handwashing, reducing the frequency of social interactions and the use of face coverings. It is important to identify those factors that can predict the uptake and maintenance of these protective behaviours.

Objectives

We aimed to identify and map the existing evidence (published and unpublished) on psychological and psychosocial factors that determine uptake and adherence to behaviours aimed at reducing the risk of infection or transmission of COVID-19.

Search Methods

Our extensive search included electronic databases (n = 12), web searches, conference proceedings, government reports, other repositories including both published peer reviewed, pre-prints and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID-19), (2) behaviours of interest and (3) terms related to psychological and psychosocial determinants of COVID Health-Related Behaviours and adherence or compliance with recommended behaviours, to capture both malleable and non-malleable determinants (i.e. determinants that could be changed and those that could not).

Selection Criteria

This Evidence and Gap Map (EGM) includes all types of studies examining determinants of common recommended behaviours aimed at mitigating human-to-human spread of COVID-19. All potential malleable and non-malleable determinants of one or more behaviours are included in the map. As part of the mapping process, categories are used to group determinants. The mapping categories were based on a previous rapid review by Hanratty 2021. These include: 'behaviour', 'cognition', 'demographics', 'disease', 'emotions', 'health status', 'information', 'intervention', and 'knowledge'. Those not suitable for categorisation in any of these groups are included in the map as 'other' determinants.

Data Collection and Analysis

Results were imported to a bibliographic reference manager where duplications of identical studies gathered from multiple sources were removed. Data extraction procedures were managed in EPPI-Reviewer software. Information on study type, population, behaviours measured and determinants measured were extracted. We appraised the methodological quality of systematic reviews with AMSTAR-2. We did not appraise the quality of primary studies in this map.

Main Results

As of 1 June 2022 the EGM includes 1034 records reporting on 860 cross-sectional, 68 longitudinal, 78 qualitative, 25 reviews, 62 interventional, and 39 other studies (e.g., mixed-methods approaches). The map includes studies that measured social distancing (n = 487), masks and face coverings (n = 382), handwashing (n = 308), physical distancing (n = 177), isolation/quarantine (n = 157), respiratory hygiene/etiquette (n = 75), cleaning surfaces (n = 59), and avoiding touching the T-zone (n = 48). There were 333 studies that assessed composite measures of two or more behaviours. The largest cluster of determinants was 'demographics' (n = 730 studies), followed by 'cognition' (n = 496 studies) and determinants categorised as 'other' (n = 447). These included factors such as 'beliefs', 'culture' and 'access to resources'. Less evidence is available for some determinants such as 'interventions' (n = 99 studies), 'information' (n = 101 studies), and 'behaviour' (149 studies).

Authors' Conclusions

This EGM provides a valuable resource for researchers, policy-makers and the public to access the available evidence on the determinants of various COVID-19 health-related behaviours. The map can also be used to help guide research commissioning, by evidence synthesis teams and evidence intermediaries to inform policy during the ongoing pandemic and potential future outbreaks of COVID-19 or other respiratory infections. Evidence included in the map will be explored further through a series of systematic reviews examining the strength of the associations between malleable determinants and the uptake and maintenance of individual protective behaviours.

TRACE-Omicron: Policy Counterfactuals to Inform Mitigation of COVID-19 Spread in the United States

The Omicron wave was the largest wave of COVID-19 pandemic to date, more than doubling any other in terms of cases and hospitalizations in the United States. In this paper, we present a large-scale agent-based model of policy interventions that could have been implemented to mitigate the Omicron wave. Our model takes into account the behaviors of individuals and their interactions with one another within a nationally representative population, as well as the efficacy of various interventions such as social distancing, mask wearing, testing, tracing, and vaccination. We use the model to simulate the impact of different policy scenarios and evaluate their potential effectiveness in controlling the spread of the virus. Our results suggest the Omicron wave could have been substantially curtailed via a combination of interventions comparable in effectiveness to extreme and unpopular singular measures such as widespread closure of schools and workplaces, and highlight the importance of early and decisive action.

How Ethical Ideology Influences Mask-Wearing Intention in a Pandemic: The Mediating Role of Moral Norms and Threat to Freedom

The present study examined how two types of ethical ideologies (idealism, and relativism) influenced behavioral intention to wear a mask during the COVID-19 pandemic through two appraisals (moral norms, and threat to freedom) of a mask-wearing issue. A total of 823 responses were collected through a cross-sectional survey, and 776 responses were used for testing hypotheses. The study found that idealism has a significant indirect effect on behavioral intention through increased moral norms and decreased threat to freedom. Also, the study revealed that relativism has a significant indirect effect on behavioral intention through increased threat to freedom.

Review of Immunologic Manifestations of COVID-19 Infection and Vaccination

We herein summarize currently available and clinically relevant information regarding the human immune responses to SARS-CoV-2 infection and vaccination, in relation to COVID-19 outcomes with a focus on acute respiratory distress syndrome (ARDS) and myocarditis.

Evolution of Public Attitudes and Opinions Regarding COVID-19 Vaccination During the Vaccine Campaign in China: Year-Long Infodemiology Study of Weibo Posts

BACKGROUND

Monitoring people's perspectives on the COVID-19 vaccine is crucial for understanding public vaccination hesitancy and developing effective, targeted vaccine promotion strategies. Although this is widely recognized, studies on the evolution of public opinion over the course of an actual vaccination campaign are rare.

OBJECTIVE

We aimed to track the evolution of public opinion and sentiment toward COVID-19 vaccines in online discussions over an entire vaccination campaign. Moreover, we aimed to reveal the pattern of gender differences in attitudes and perceptions toward vaccination.

METHODS

We collected COVID-19 vaccine-related posts by the general public that appeared on Sina Weibo from January 1, 2021, to December 31, 2021; this period covered the entire vaccination process in China. We identified popular discussion topics using latent Dirichlet allocation. We further examined changes in public sentiment and topics during the 3 stages of the vaccination timeline. Gender differences in perceptions toward vaccination were also investigated.

RESULTS

Of 495,229 crawled posts, 96,145 original posts from individual accounts were included. Most posts presented positive sentiments (positive: 65,981/96,145, 68.63%; negative: 23,184/96,145, 24.11%; neutral: 6980/96,145, 7.26%). The average sentiment scores were 0.75 (SD 0.35) for men and 0.67 (SD 0.37) for women. The overall trends in sentiment scores showed a mixed response to the number of new cases and significant events related to vaccine development and important holidays. The sentiment scores showed a weak correlation with new case numbers (R=0.296; P=.03). Significant sentiment score differences were observed between men and women (P<.001). Common and distinguishing characteristics were found among frequently discussed topics during the different stages, with significant differences in topic distribution between men and women (January 1, 2021, to March 31, 2021: χ²₃=3030.9; April 1, 2021, to September 30, 2021: χ²₄=8893.8; October 1, 2021, to December 31, 2021: χ²₅=3019.5; P<.001). Women were more concerned with side effects and vaccine effectiveness. In contrast, men reported broader concerns around the global pandemic, the progress of vaccine development, and economics affected by the pandemic.

CONCLUSIONS

Understanding public concerns regarding vaccination is essential for reaching vaccine-induced herd immunity. This study tracked the year-long evolution of attitudes and opinions on COVID-19 vaccines according to the different stages of vaccination in China. These findings provide timely information that will enable the government to understand the reasons for low vaccine uptake and promote COVID-19 vaccination nationwide.

Time to Lift up COVID-19 Restrictions? Public Support towards Living with the Virus Policy and Associated Factors among Hong Kong General Public

The fifth wave of the COVID-19 pandemic has caused an unprecedented toll on Hong Kong. As more countries are starting to lift COVID-19 restrictions, it would be important to understand the public attitudes towards lifting COVID-19 restrictions and to identify its associated factors. The present study examined the level of support towards the living with the virus (LWV) policy for COVID-19 among the public in Hong Kong and to identify the associations between resilient coping, self-efficacy and emotional distress with support towards the LWV policy. A random population-based telephone survey was conducted among 500 Hong Kong Chinese adults from 7 March to 19 April 2022, i.e., during the fifth wave of COVID-19 outbreak. Of the respondents, 39.6% showed a supportive attitude towards the LWV policy. Results from the structural equational modeling showed a positive correlation between resilient coping and self-efficacy. Resilient coping was associated with support towards the LWV policy directly and indirectly through a lower level of emotional distress. Self-efficacy had a direct association with support towards the LWV policy but its indirect association through emotional distress was not significant. Interventions that foster resilient coping and self-efficacy would be effective in reducing public emotional distress and promoting their positive view towards the LWV policy.

What Factors Will Influence Chinese International Traveling for Leisure in the Post-COVID-19 Era: Role of Health Priorities and Health-Related Information Literacy

China used to be the world's leading nation in terms of international (outward) tourism till the COVID-19 outbreak. However, due to the COVID-19 crisis, several new macro and micro-level factors might affect their international (outward) traveling behavior. The purpose of the current research was to examine the avoidance of international traveling for leisure in the Chinese population. The goal of the study was to highlight the importance of information self-efficacy and digital literacy as the key factors influencing tourists' traveling readiness. To achieve the goal, the study adapted the quantitative instruments from existing sources to map media exhaustion, information overload, and perceived health concerns, i.e., perceived effectiveness of health-protective measures, fear of new possible outbreaks, and pandemic crisis at source and destination. Chinese citizens' opinions were collected during the third quarter of the year 2022. Specifically, the quantitative survey from China collected a total number of 1308 respondents. This study used the statistical analysis software SPSS to analyze collected data. The findings conclude that the role of media is pivotal to shaping and predicting future trends in tourism preferences, perception of protective measures against COVID-19, and perceived seriousness of the pandemic crisis in the Chinese population. In addition, technology readiness (as hard self-efficacy) and health-related information literacy (soft self-efficacy) are critical to cope with the dark aspects of information exhaustion, overload, and pandemic seriousness in the post-truth era. The study is unique, as it examines the role of the seriousness of the pandemic at its source and destination and fear of new outbreaks simultaneously, underlining the potential future of immersive tourism (i.e., virtual reality, augmented reality, or mixed reality-based tourism). This study has drawn interesting theoretical and practical implications for researchers, policymakers, and academicians.

A conceptual model on caregivers' hesitancy of topical fluoride for their children

BACKGROUND

Topical fluoride hesitancy is a well-documented and growing public health problem. Despite extensive evidence that topical fluoride is safe and prevents tooth decay, an increasing number of caregivers are hesitant about their children receiving topical fluoride, leading to challenges in clinical settings where caregivers refuse preventive care.

PURPOSE

To explore the determinants of topical fluoride hesitancy for caregivers with dependent children.

METHODS

In this qualitative study, we interviewed 56 fluoride-hesitant caregivers to develop an inductive conceptual model of reasons why caregivers are hesitant.

RESULTS

The core construct of the conceptual model of topical fluoride hesitancy centered on caregivers "wanting to protect and not mess up their child". Six domains comprised this core construct: thinking topical fluoride is unnecessary, wanting to keep chemicals out of my child's body, thinking fluoride is harmful, thinking there is too much uncertainty about fluoride, feeling pressured to get topical fluoride, and feeling fluoride should be a choice.

CONCLUSIONS

Topical fluoride hesitancy is complex and multifactorial. Study findings provide insight for future efforts to understand and optimize caregivers' preventive care decision making.

Development and initial validation of the attitudes toward face mask use scale (ATFMUS)

Despite availability of instruments for measuring attitudes towards mask use, the psychometric properties of many available instruments are not adequately established which limits their research usefulness across contexts. In three studies, we developed the Attitudes Towards Face Mask Use Scale (ATFMUS) in three phases: item generation, scale development, and scale evaluation. Phase one and two were addressed in study 1 while phase three was addressed in studies 2 and 3. In Study 1, a combined online and pen-and-paper sample of 174 (78% university students) completed a questionnaire with 19 items regarding attitudes towards face mask use derived from theory, previous research, and experience. Responses were subjected to item reduction analysis, exploratory factor analysis and reliability analysis. In Study 2, a student sample of 674 (70.5% high school) completed the new scale together with measures of COVID-19 related anxiety and obsession, personality, affect, social media use, and social desirability. Data from the ATFMUS were analyzed using confirmatory factor analysis and pertinent revisions done. The ATFMUS was then validated using correlation analyses, measurement invariance analyses, and known-group comparisons. In study 3, two samples of university students from Ghana (n = 242) and Kenya (n = 199) were involved in testing the cross-country invariance of the ATFMUS. The results reveal that the 5-item ATFMUS is a reliable and valid scale for assessing attitudes towards face mask use. Invariance analysis revealed that the ATFMUS is fair to use across participants of different age, level of education, and countries. The scale is also sensitive to participants' actual use of face masks as well as their beliefs about COVID-19 and efficacy of the facemasks. This study offers a foundation for further psychometric evaluation of the ATFMUS.

"Any idea how fast 'It's just a mask!' can turn into 'It's just a vaccine!'": From mask mandates to vaccine mandates during the COVID-19 pandemic

Protests starting in the summer of 2020, notedly in the US and UK, have brought together two constituencies: pre-existing anti-vaccine groups and newly formed oppositional COVID-19 groups. The oppositional COVID-19 groups vary in composition and nature, but the central focus is a disagreement about the seriousness and threat of COVID-19 and with the public health measures to control COVID-19. What unites many disparate interests is an aversion to mandates. The compulsion to undertake particular public health activities such as mask-wearing and vaccination is a complex topic of public attitudes and beliefs alongside public health goals and messaging. We aim to analyse social media discussions about facemask wearing and the adoption of potential vaccines for COVID-19. Using media monitoring software Meltwater^TM, we analyse English-language tweets for one year from 1st June 2020 until 1st June 2021. We pay particular attention to connections in conversations between key topics of concern regarding masks and vaccines across social media networks. We track where ideas and activist behaviours towards both health interventions have originated, have similarities, and how they have changed over time. Our aim is to provide an overview of the key trends and themes of discussion concerning attitudes to and adoption of health measures in the control of COVID-19 and how publics react when confronted with mandatory policies. We draw on an already extensive literature about mandatory vaccination policies to inform our assessment, from psychology and behavioural science to ethics, political theory, sociology, and public policy.

State mask mandates and psychological reactance theory: The role of political partisanship and COVID-19 risk in mask adoption and resistance

RATIONALE

Psychological reactance theory was applied to examine the implications of state-level mask mandates in the United States during the COVID-19 pandemic. We evaluated the role of political partisanship and COVID-19 risk on changes in self-reported mask wearing before and after the imposition and removal of state mask mandates.

METHOD

Secondary data from several sources were aggregated about self-reported mask wearing behavior, state mandates, COVID-19 infection rates, and state-level political partisanship. Difference-in-differences tests were performed using logistic regression to evaluate whether change in mask wearing behavior following the imposition or removal of a mandate was greater in states based on state-level political partisanship and COVID-19 infection rates.

RESULTS

Although mask adoption generally increased following mandates, the amount of increase was smaller in more Republican states compared to more Democratic states. Mask wearing generally decreased following the removal of mandates, with greater decreases when COVID-19 infection rates were lower.

CONCLUSION

The results collectively offer insights about the nuanced role of contextual factors in the adoption and resistance to masks following state mask mandates. Partisanship was important in responses to the imposition of state mask mandates and COVID-19 risk played a critical role in responses to mandate removal.

Psychological factors responsible for low adherence to mask-wearing measures during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has led to >6 million deaths. Anti-mask movements may decrease the effects of preventive measures. Psychological factors that may be related to anti-mask behaviour are not well researched.

AIMS

This study aims to determine the psychological correlates of anti-mask attitudes and behaviour in an online general population sample, focusing on the possible role of claustrophobia.

METHOD

Data on attitudes and behaviour toward mask-wearing were collected from an online sample of 3709 people. Predictors of both anti-mask attitudes and behaviour were assessed with linear and logistic regression analyses.

RESULTS

Few people (3.3%) were overtly opposed to mask-wearing; mask opposition was more common in men than women. Predictors of negative attitude toward mask-wearing and low adherence to mask-related measures were similar and included male gender, lower education, lower income, being employed, having had COVID-19 and lower COVID-19-related anxiety. Psychopathology measures did not show a prediction, whereas claustrophobia had a significant prediction that was over and above those of other predictors. Avoidance behaviour had similar predictors, except for higher COVID-19-related anxiety.

CONCLUSIONS

Although low adherence to mask-wearing during the pandemic was not related to having a mental disorder, it may partly be caused by psychological factors. Those who had a negative attitude also reported lower adherence behaviour, and were characterised by being male, having lower education, being employed and having lower COVID-19-related anxiety; claustrophobia was a strong predictor of attitude. Understanding psychological factors responsible for low adherence may help to decrease morbidity and mortality in future pandemics.

Factors associated with COVID-19 masking behavior: an application of the Health Belief Model

Wearing a face mask is effective in minimizing the spread of coronavirus disease 2019 (COVID-19) among unvaccinated individuals and preventing severe illness among the vaccinated. Country, state and local guidelines promote, and at times mandate, mask-wearing despite it being publicly perceived as an individual's choice. Guided by the Health Belief Model (HBM), structural equation modeling was used to analyze longitudinal data in a sample of US adults aged 18-49 years to identify constructs that contribute to face mask-wearing. Results indicated that perceived COVID-19 severity, perceived masking benefits and self-efficacy were positively associated with masking behavior, and masking barriers were negatively associated with masking behavior. Perceived susceptibility to COVID-19 and cues to action were nonsignificant correlates of masking behavior. These results' theoretical and practical implications contribute to the literature on the HBM and the COVID-19 pandemic. Future directions and limitations are discussed.

Mask-Wearing Behaviors after Two Years of Wearing Masks Due to COVID-19 in Korea: A Cross-Sectional Study

In Korea, wearing masks in public places has become the norm during the prolonged coronavirus disease 2019 (COVID-19) pandemic. This cross-sectional study investigated the mask-wearing behavior of Koreans (n = 433) via online mode living in Seoul and Gwangju after wearing a mask in public spaces for two years due to COVID-19. The respondents selected their face masks based on season, gender, age, occupation, mask-wearing hours, mask filter performance, mask shape, and mask color. The general discomfort caused by wearing a mask was divided into physical and speech discomfort, and it was not correlated with anxiety when not wearing a face mask. Speech discomfort caused by wearing a mask was correlated with general discomfort, clear speech, vocal pain, anxiety, and only-indoor mask-off plans. Anxiety when not wearing a mask appeared to affect both indoor and outdoor mask-off plans. The more uncomfortable and less anxious respondents were when not wearing a mask, the sooner they wanted to discontinue wearing masks indoors and outdoors. It is expected that the use of masks will continue in the future and that there may be differences in the place and time of use of masks in Korea and around the world due to new infectious diseases and fine dust. Facial masks can be worn more comfortably and conveniently if the discomfort and anxiety of wearing a mask are improved by considering various behaviors when wearing a mask in the future.

Face mask use as a categorical dimension in social perception

Prevention measures aimed at combating COVID-19 pandemic strongly impact several aspects of social life. In particular, interpersonal perception is affected as a function of whether the persons perceived wear or not face masks. In two experimental studies, we here explored whether people rely on the presence vs. absence of face masks when encoding information in memory about other individuals. In a memory confusion paradigm, participants were initially presented with individuals either wearing a face mask or not, each conveying a series of sentences. Next, participants were probed about the identity of the speaker of each sentence. Results showed that it was more likely to erroneously attribute a sentence to a speaker who also was wearing a face mask (or not) as the original speaker, demonstrating that the cue about wearing or not a face mask was spontaneously used to encode information. Study 2 ruled out an alternative explanation based on perceptual processes, suggesting that face masks represent meaningful social objects. Overall, it emerged that participants spontaneously categorize others as a function of whether they wear a mask or not. Findings also confirmed previous research evidence about the more positive evaluation of mask wearers as compared to non-wearers, and the overall detrimental impact that face masks may have on the correct identification of social targets.

Masks as a moral symbol: Masks reduce wearers' deviant behavior in China during COVID-19

Since the outbreak of COVID-19, mask wearing has become a global phenomenon. How do masks influence wearers' behavior in everyday life? We examine the effect of masks on wearers' deviant behavior in China, where mask wearing is mostly a public-health issue rather than a political issue. Drawing on behavioral ethics research, we test two competing hypotheses: (a) masks disinhibit wearers' deviant behavior by increasing their sense of anonymity and (b) masks are a moral symbol that reduces wearers' deviant behavior by heightening their moral awareness. The latter hypothesis was consistently supported by 10 studies (including direct replications) using mixed methods (e.g., traffic camera recording analysis, observational field studies, experiments, and natural field experiment) and different measures of deviant behavior (e.g., running a red light, bike parking in no-parking zones, cheating for money, and deviant behavior in the library). Our research (n = 68,243) is among the first to uncover the psychological and behavioral consequences of mask wearing beyond its health benefits.

Support for mask use as a COVID-19 public health measure among a large sample of Canadian secondary school students

BACKGROUND

Youth voice has been largely absent from deliberations regarding public health measures intended to prevent SARS-CoV-2 transmission, despite being one of the populations most impacted by school-based policies. To inform public health strategies and messages, we examined the level of student support of mask use in public spaces and school mask requirements, as well as factors associated with students' perspectives.

METHODS

We used cross-sectional survey data from 42,767 adolescents attending 133 Canadian secondary schools that participated in the COMPASS study during the 2020/2021 school year. Multinomial regression models assessed support for i) wearing a mask in indoor public spaces and ii) schools requiring students to wear masks, in association with COVID-19 knowledge, concerns, and perceived risk.

RESULTS

Wearing masks in indoor public spaces was supported by 81.9% of students; 8.7% were unsupportive and 9.4% were neutral/undecided. School mask requirements were supported by 67.8%, with 23.1% neutral and 9.1% unsupportive. More females supported mask wearing in public spaces (83.9% vs. 79.1%) and school mask requirements (70.8% vs. 63.5%) than males. Students had increased odds of supporting mask use in public spaces and school mask requirements if they reported concerns about their own or their family's health, had discussions regarding ways to prevent infection, perceived COVID-19 to be a risk to young people, and knew that signs are not always present in COVID-19 cases and that masks prevent SARS-CoV-2 transmission if someone coughs.

CONCLUSIONS

During the year following the beginning of the pandemic, most students supported the required use of masks in schools and wearing masks in indoor public spaces. Improving knowledge around the effectiveness of masks appears likely to have the largest impact on mask support in adolescent populations among the factors studied.

COVID-19 health practices and attitudes in the United States: the role of trust in healthcare

Aim

Individual-level COVID-19 vaccination and related preventive health behaviors is politically polarized in the United States. We examined whether the current polarization in COVID-19 health behavior may be explained by differences in trust in healthcare, locus of control, or insurance status.

Subject and methods

Our sample includes 553 US adults recruited on Amazon MTurk. We assessed odds ratios of currently vaccinated, or willing to be vaccinated if unvaccinated using logistic regression. We assessed count of routine changes and positive attitudes toward facemasks using negative binomial regression.

Results

Trust in healthcare was found to be an important determinant of all COVID-19 related health behavior measured in our study. Further, the effects on COVID-related attitudes/behavior from trust in healthcare are large in magnitude. For instance, our results suggest that individuals at or above the upper quartile of trust in healthcare are around 20 percentage points more likely to be vaccinated than those at or below the lower quartile. Further, we find that the effect of trust in healthcare on adherence or endorsement of COVID-19 mitigation strategies is distinct from political affiliation, i.e., the effect on COVID-19 related health behavior is independent of the polarization across political party lines. Locus of control was not associated with adherence/attitude toward COVID-19 mitigation strategies. Insurance status was only found to be positively associated with odds of being vaccinated.

Conclusion

Our study highlights the importance of increasing trust in healthcare as a means to protect public health in the wake of major public health crises.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01737-9.

Risky business: A mixed methods study of decision-making regarding COVID-19 risk at a public university in the United States

Introduction

Until vaccines became available in late 2020, our ability to prevent the spread of COVID-19 within countries depended largely on voluntary adherence to mitigation measures. However, individual decision-making regarding acceptable COVID-19 risk is complex. To better understand decision-making regarding COVID-19 risk, we conducted a qualitative substudy within a larger Berkeley COVID-19 Safe Campus Initiative (BCSCI) during the summer of 2020, and completed a mixed-methods analysis of factors influencing decision-making.

Materials and methods

We interviewed 20 participants who tested positive for SARS-CoV-2 and 10 who remained negative, and analyzed quantitative survey data from 3,324 BCSCI participants. The BCSCI study enrolled university-affiliated people living in the local area during summer of 2020, collected data on behaviors and attitudes toward COVID-19, and conducted SARS-CoV-2 testing at baseline and endline.

Results

At baseline, 1362 students (57.5%) and 285 non-students (35.1%) said it had been somewhat or very difficult to comply with COVID-19-related mandates. Most-cited reasons were the need to go out for food/essentials, difficulty of being away from family/friends, and loneliness. Eight interviewees explicitly noted they made decisions partially because of others who may be at high risk. We did not find significant differences between the behaviors of students and non-students.

Discussion

Despite prevailing attitudes about irresponsibility of college students during the COVID-19 pandemic, students in our study demonstrated a commitment to making rational choices about risk behavior, not unlike non-students around them. Decision-making was driven by perceived susceptibility to severe disease, need for social interaction, and concern about risk to others. A harm reduction public health approach may be beneficial.

Capturing Time Dynamics from Speech using Neural Networks for Surgical Masks Detection

The importance of detecting whether a per- son wears a face mask while speaking has tremendously increased since the outbreak of SARS-CoV-2 (COVID-19), as wearing a mask can help to reduce the spread of the virus and mitigate the public health crisis. Besides affecting human speech characteristics related to frequency, face masks cause temporal interferences in speech, altering the pace, rhythm, and pronunciation speed. In this regard, this paper presents two effective neural network models to detect surgical masks from audio. The proposed architectures are both based on Convolutional Neural Net- works (CNNs), chosen as an optimal approach for the spatial processing of the audio signals. One architecture applies a Long Short-Term Memory (LSTM) network to model the time-dependencies. Through an additional attention mechanism, the LSTM-based architecture enables the extraction of more salient temporal information. The other architecture (named ConvTx) retrieves the relative position of a sequence through the positional encoder of a transformer module. In order to assess to which extent both architectures can complement each other when modelling temporal dynamics, we also explore the combination of LSTM and Transformers in three hybrid models. Finally, we also investigate whether data augmentation techniques, such as, using transitions between audio frames and considering gender-dependent frameworks might impact the performance of the proposed architectures. Our experimental results show that one of the hybrid models achieves the best performance, surpassing existing state-of-the-art results for the task at hand.

Role of Time Scales in the Coupled Epidemic-Opinion Dynamics on Multiplex Networks

Modelling the epidemic’s spread on multiplex networks, considering complex human behaviours, has recently gained the attention of many scientists. In this work, we study the interplay between epidemic spreading and opinion dynamics on multiplex networks. An agent in the epidemic layer could remain in one of five distinct states, resulting in the SIRQD model. The agent’s attitude towards respecting the restrictions of the pandemic plays a crucial role in its prevalence. In our model, the agent’s point of view could be altered by either conformism mechanism, social pressure, or independent actions. As the underlying opinion model, we leverage the q-voter model. The entire system constitutes a coupled opinion–dynamic model where two distinct processes occur. The question arises of how to properly align these dynamics, i.e., whether they should possess equal or disparate timescales. This paper highlights the impact of different timescales of opinion dynamics on epidemic spreading, focusing on the time and the infection’s peak.

Self-reported mask-related worrying reduces relative avoidance bias toward unmasked faces in individuals with low Covid19 anxiety syndrome

Facial masks have become and may remain ubiquitous. Though important for preventing infection, they may also serve as a reminder of the risks of disease. Thus, they may either act as cues for threat, priming avoidance-related behavior, or as cues for a safe interaction, priming social approach. To distinguish between these possibilities, we assessed implicit and explicit evaluations of masked individuals as well as avoidance bias toward relatively unsafe interactions with unmasked individuals in an approach-avoidance task in an online study. We further assessed Covid19 anxiety and specific attitudes toward mask-wearing, including mask effectiveness and desirability, hindrance of communication from masks, aesthetic appeal of masks, and mask-related worrying. Across one sample of younger (18-35 years, N = 147) and one of older adults (60+ years, N = 150), we found neither an average approach nor avoidance bias toward mask-wearing compared to unmasked individuals in the indirect behavior measurement task. However, across the combined sample, self-reported mask-related worrying correlated with reduced avoidance tendencies toward unmasked individuals when Covid19 anxiety was low, but not when it was high. This relationship was specific to avoidance tendencies and was not observed in respect to explicit or implicit preference for mask-wearing individuals. We conclude that unsafe interaction styles may be reduced by targeting mask-related worrying with public interventions, in particular for populations that otherwise have low generalized Covid19 anxiety.