Heterogeneity in preventive behaviors during COVID-19: Health risk, economic insecurity, and slanted information

Effect of face-covering use on adherence to other COVID-19 protective behaviours: A systematic review

During the COVID-19 pandemic, concerns were raised that face covering use may elicit risk compensation; a false sense of security resulting in reduced adherence to other protective behaviours such as physical distancing. This systematic review aimed to investigate the effect of face covering use on adherence to other COVID-19 related protective behaviours. Medline, Embase, PsychInfo, EmCare, medRxiv preprints, Research Square and WHO COVID-19 Research Database were searched for all primary research studies published from 1st January 2020 to 17th May 2022 that investigated the effect of face covering use on adherence to other protective behaviours in public settings during the COVID-19 pandemic. Papers were selected and screened in accordance with the PRISMA framework. Backwards and forwards citation searches of included papers were also conducted on 16th September 2022, with eligible papers published between 1st January 2020 and that date being included. A quality appraisal including risk of bias was assessed using the Academy of Nutrition and Dietetics' Quality Criteria Checklist. This review is registered on PROSPERO, number CRD42022331961. 47 papers were included, with quality ranging from low to high. These papers investigated the effects of face covering use and face covering policies on adherence to six categories of behaviour: physical distancing; mobility; face-touching; hand hygiene; close contacts; and generalised protective behaviour. Results reveal no consistent evidence for or against risk compensation, with findings varying according to behaviour and across study types, and therefore confident conclusions cannot be made. Any policy decisions related to face coverings must consider the inconsistencies and caveats in this evidence base.

Heterogeneous risk tolerance, in-groups, and epidemic waves

There is a growing interest in the joint modeling of the dynamics of disease and health-related beliefs and attitudes, but coupling mechanisms are yet to be understood. We introduce a model where risk information, which can be delayed, comes in two flavors, including historical risk derived from perceived incidence data and predicted risk information. Our model also includes an interpretation domain where the behavioral response to risk information is subject to in-group pressure. We then simulate how the strength of behavioral reaction impacts epidemic severity as measured by epidemic peak size, number of waves, and final size. Simulated behavioral response is not effective when the level of protection that prophylactic behavior provides is as small as 50% or lower. At a higher level of 75% or more, we see the emergence of multiple epidemic waves. In addition, simulations show that different behavioral response profiles can lead to various epidemic outcomes that are non-monotonic with the strength of reaction to risk information. We also modeled heterogeneity in the response profile of a population and find they can lead to less severe epidemic outcome in terms of peak size.

Health disparity in the spread of COVID-19: Evidence from social distancing, risk of interactions, and access to testing

OBJECTIVE

- To identify and assess whether three major risk factors that due to differential access to flexible resources might help explain disparities in the spread of COVID-19 across communities with different socioeconomic status, including socioeconomic inequalities in social distancing, the potential risk of interpersonal interactions, and access to testing.

METHODS

Analysis uses ZIP code level weekly COVID-19 new cases, weekly population movement flows, weekly close-contact index, and weekly COVID-19 testing sites in Southern California from March 2020 to April 2021, merged with the U.S. census data to measure ZIP code level socioeconomic status and cofounders. This study first develops the measures for social distancing, the potential risk of interactions, and access to testing. Then we employ a spatial lag regression model to quantify the contributions of those factors to weekly COVID-19 case growth.

RESULTS

Results identify that, during the first COVID-19 wave, new case growth of the low-income group is two times higher than that of the high-income group. The COVID-19 case disparity widens to four times in the second COVID-19 wave. We also observed significant disparities in social distancing, the potential risk of interactions, and access to testing among communities with different socioeconomic status. In addition, all of them contribute to the disparities of COVID-19 incidences. Among them, the potential risk of interactions is the most important contributor, whereas testing accessibility contributes least. We also found that close-contact is a more effective measure of social distancing than population movements in examining the spread of COVID-19.

CONCLUSION

- This study answers critically unaddressed questions about health disparities in the spread of COVID-19 by assessing factors that might explain why the spread is different in different groups.

Facilitators and barriers of preventive behaviors against COVID-19 during Ramadan: A phenomenology of Indonesian adults

Introduction

Intercity mobility restriction, physical distancing, and mask-wearing are preventive behaviors to reduce the transmission of COVID-19. However, strong cultural and religious traditions become particular challenges in Indonesia. This study uses the Behavior Change Wheel to explore barriers and facilitators for intercity mobility restriction, physical distancing, and mask-wearing during Ramadan.

Methods

Semi-structured in-depth interviews with 50 Indonesian adults were conducted between 10 April and 4 June 2020. Having mapped codes into the Capacity, Opportunity, Motivation - Behavior (COM-B), and Theoretical Domain Framework (TDF) model, we conducted summative content analysis to analyze the most identified factors to preventive behaviors and proposed interventions to address those factors.

Results

Belief about the consequence of preventive behaviors was the most mentioned facilitator to all preventive behaviors among compliers. However, optimism as a TDF factor was commonly mentioned as a barrier to preventive behaviors among non-compliers, while environmental context and resources were the most commonly mentioned factors for intercity mobility restriction.

Conclusions

Public health intervention should be implemented considering the persuasion and involvement of religious and local leaders. Concerning job and economic context, policy related to the intercity mobility restriction should be reconsidered to prevent a counterproductive effect.

An International Systematic Review Concerning the Effect of Social Media Exposure on Public Compliance with Infection Prevention and Control Measures During the COVID-19 Pandemic

Background

Effective health communication is crucial for achieving positive population health outcomes. This is important for infection prevention and control (IPC), which relies on widespread public compliance to be effective. Whilst social media (SM) platforms disseminate health information, there is conflicting evidence to suggest their influence on compliance with public health guidelines.

Objective

To appraise the available evidence and determine the extent to which social media exposure contributes to public compliance with IPC measures.

Methods

A systematic protocol based on the MOOSE and PRISMA guidelines was followed. Observational studies were identified through systematic searches of four electronic databases and a hand search. Following data extraction, eligible studies were quality assessed, and the findings were integrated using narrative synthesis.

Findings

15 studies were included. The studies located presented heterogeneous designs and findings. A weak positive association was identified, with 60% of the studies observing a positive association between social media and compliance with IPC measures. 26.7% identified a negative correlation, and 13.3% identified no correlation. Several factors were identified to mediate the relationship, including knowledge and conspiracy beliefs.

Discussion

This systematic review identified a weak positive correlation between exposure to social media and public compliance with recommended IPC measures, suggesting that social media should be utilised in future IPC related communication strategies. Social media provides a cost-effective, publicly accessible platform to disseminate accurate information, and neutralise misinformation. Recommendations are made for further research to reduce the uncertainty created by the identification of heterogenous studies.

A systematic review of worldwide causal and correlational evidence on digital media and democracy

One of today's most controversial and consequential issues is whether the global uptake of digital media is causally related to a decline in democracy. We conducted a systematic review of causal and correlational evidence (N = 496 articles) on the link between digital media use and different political variables. Some associations, such as increasing political participation and information consumption, are likely to be beneficial for democracy and were often observed in autocracies and emerging democracies. Other associations, such as declining political trust, increasing populism and growing polarization, are likely to be detrimental to democracy and were more pronounced in established democracies. While the impact of digital media on political systems depends on the specific variable and system in question, several variables show clear directions of associations. The evidence calls for research efforts and vigilance by governments and civil societies to better understand, design and regulate the interplay of digital media and democracy.

Social Norms and Preventive Behaviors in Japan and Germany During the COVID-19 Pandemic

Background

According to a recent paper by Gelfand et al., COVID-19 infection and case mortality rates are closely connected to the strength of social norms: “Tighter” cultures that abide by strict social norms are more successful in combating the pandemic than “looser” cultures that are more permissive. However, countries with similar levels of cultural tightness exhibit big differences in mortality rates. We are investigating potential explanations for this fact. Using data from Germany and Japan—two “tight” countries with very different infection and mortality rates—we examined how differences in socio-demographic and other determinants explain differences in individual preventive attitudes and behaviors.

Methods

We compared preventive attitudes and behaviors in 2020 based on real-time representative survey data and used logit regression models to study how individual attitudes and behaviors are shaped by four sets of covariates: individual socio-demographics, health, personality, and regional-level controls. Employing Blinder-Oaxaca regression techniques, we quantified the extent to which differences in averages of the covariates between Japan and Germany explain the differences in the observed preventive attitudes and behaviors.

Results

In Germany and Japan, similar proportions of the population supported mandatory vaccination, avoided travel, and avoided people with symptoms of a cold. In Germany, however, a significantly higher proportion washed their hands frequently and avoided crowds, physical contact, public transport, peak-hour shopping, and contact with the elderly. In Japan, a significantly higher proportion were willing to be vaccinated. We also show that attitudes and behaviors varied significantly more with covariates in Germany than in Japan. Differences in averages of the covariates contribute little to explaining the observed differences in preventive attitudes and behaviors between the two countries.

Conclusion

Consistent with tightness-looseness theory, the populations of Japan and Germany responded similarly to the pandemic. The observed differences in infection and fatality rates therefore cannot be explained by differences in behavior. The major difference in attitudes is the willingness to be vaccinated, which was much higher in Japan. Furthermore, the Japanese population behaved more uniformly across social groups than the German population. This difference in the degree of homogeneity has important implications for the effectiveness of policy measures during the pandemic.

Emerging Zoonotic Infections, Social Processes and Their Measurement and Enhanced Surveillance to Improve Zoonotic Epidemic Responses: A "Big Events" Perspective

Zoonotic epidemics and pandemics have become frequent. From HIV/AIDS through COVID-19, they demonstrate that pandemics are social processes as well as health occurrences. The roots of these pandemics lie in changes in the socioeconomic interface between humanity and non-human host species that facilitate interspecies transmission. The degree to which zoonoses spread has been increased by the greater speed and extent of modern transportation and trade. Pre-existing sociopolitical and economic structures and conflicts in societies also affect pathogen propagation. As an epidemic develops, it can itself become a social and political factor, and change and interact with pre-existing sociobehavioral norms and institutional structures. This paper uses a "Big Events" approach to frame these processes. Based on this framework, we discuss how social readiness surveys implemented both before and during an outbreak might help public health predict how overall systems might react to an epidemic and/or to disease control measures, and thus might inform interventions to mitigate potential adverse outcomes or possibly preventing outbreaks from developing into epidemics. We conclude by considering what "pathways measures", in addition to those we and others have already developed, might usefully be developed and validated to assist outbreak and epidemic disease responses.

Examining insurance companies' use of technology for innovation

The insurance industry is innovating. Business models, services and processes are rapidly evolving, largely backed by technological developments. The particular historical context of COVID-19 provides a suitable case to understand the relevance of exploiting technology to react quickly to traditional and emerging risks. Focusing on the initiatives put in place by the most influential insurance companies at the global level, we have framed the innovation mechanisms in the industry, highlighting four rationales underpinning these initiatives (Adaption, Expansion, Reaction and Aggression), which differ according to the relevance of the technology in use and innovation to the portfolio of risks covered. Overall, it emerges that insurance companies have the room and capability to innovate, in many cases using technological applications to cover new and existing risks. While the initiatives studied concern the entire value chain, basic primary activities, such as product development, sales and claims management, show that innovation based on new or existing technology determines the success and competitiveness of the business.