Compliance with preventative measures during the COVID-19 pandemic in the USA and Canada: Results from an online survey

How to distinguish climate sceptics, antivaxxers, and persistent sceptics: Evidence from a multi-country survey of public attitudes

Distrust in science has been linked to scepticism over vaccines and climate change. Using data from nationally representative surveys administered in eight key countries for global efforts to mitigate climate change and COVID-19 (Australia, Brazil, China, India, Japan, South Africa, the UK and US), we find that distrust in scientists was an important predictor variable for most sceptics, who were sceptical of one issue but not both, in February 2021, when most countries had experienced their first wave of the pandemic. However, the association was significantly weaker among the segment of hardcore sceptics who were both climate sceptics and antivaxxers. We demonstrate that these individuals tended to possess many of the typical sceptic characteristics such as high distrust in social institutions and rightward political orientation, which are (collectively) suggestive of an underlying sceptic mindset rather than a specific distrust of scientists. Our results suggest that different types of sceptics necessitate different strategies to dispel scepticism.

How sustainable is resilience? A mixed-methods study on the COVID-19-pandemic as a challenge to resilience resources of older adults who previously recovered from depression

OBJECTIVES

Despite expanding knowledge about the internal and external resources that contribute to resilience among individuals who have experienced depression, the long-term accessibility and protectiveness of these resources across different stressors is unknown. We investigated whether and how the resilience resources of individuals who previously recovered from late-life depression remained protective during the COVID-19 pandemic.

METHODS

We used a sequential explanatory mixed methods design. Quantitative data were derived from two psychiatric case-control cohorts and included twelve repeated measures during the COVID-19 pandemic (n = 465, aged ≥ 60). Qualitative data included two sequential interviews held in 2020 (n = 25) and 2021 (n = 19). We used thematic analysis to determine the protective resources after depression and during the COVID-19 pandemic and linear mixed models to examine the effect of these resources on change in depressive symptoms during the COVID-19 pandemic.

RESULTS

While resources of 'Taking agency', 'Need for rest', 'Managing thought processes' and 'Learning from depression' remained accessible and protective during the pandemic, 'Social support' and 'Engaging in activities' did not. 'Negotiating with lockdown measures', 'changing social contact' and 'changing activities' were compensating strategies. Quantitative data confirmed the protectiveness of social contact, social cohesion, sense of mastery, physical activity, staying active and entertained and not following the media.

CONCLUSION

Many of the resources that previously helped to recover from depression also helped to maintain good mental health during the COVID-19 pandemic. Where accessibility and protectiveness declined, compensatory strategies or new resources were used. Hence, the sustainability of resilience is enabled through adaptation and compensation processes.

Exploring the impact of pandemic fear on visitation to park attractions in urban city: A case study in Seoul, South Korea

This research explores changes in perceptions and utilization of parks during the COVID-19 pandemic in Seoul, South Korea. It investigates the relationship between fear of the pandemic and individuals' opinions about open spaces and their visiting decisions. The study surveyed 600 adults from February 22-23, 2022, and used structural equation modeling to analyze the data. The findings revealed that increased fear of the pandemic led to more positive park sentiments, resulting in higher park visits and fewer visits to other public spaces. The research highlights the significance of parks during the COVID-19 pandemic and how people's perceptions were influenced by their pandemic-related fear.

The Politicization of the COVID-19 Pandemic

Political actors and institutions are largely responsible for effectively implementing the latest scientific and medical information in the form of public health measures. However, when politicians' judgments and decision-making are not founded on scientific facts or when scientific findings are misrepresented to further political goals, global crises such as pandemics may be even more galvanized. Like other scientific topics that entered public debate before 2020 (e.g., the debate on climate change), the COVID-19 pandemic has been heavily politicized worldwide. Consequently, COVID-19-related outcomes were strongly affected by politicization-a process of making a non-political issue political, i.e., debating it in the public sphere as an issue of public contestation. The present chapter presents a condensed overview and synthesis of the literature on the politicization of the COVID-19 pandemic in high- and low-income countries. In addition, we discuss several mechanisms explaining why, to some extent universally, conservatives (the right-wing oriented public) were less likely to follow public health recommendations, were more COVID-19 vaccine-hesitant, and had increased infection rates, poor health outcomes, and increased mortality compared to left-wing oriented public. The mechanisms explaining the links include the media, trust, cognitions, and values. We conclude the chapter with lessons learned during the COVID-19 pandemic and future research directions on the pandemics' politicization.

The role of general vs pandemic-specific paranoid ideation in the use of recommended health behaviors and vaccine willingness during a worldwide pandemic: An international study in the general public

BACKGROUND

The public's adherence to recommended COVID-19 preventative behaviors, including vaccinations and social distancing, has been low in certain groups and has contributed to many preventable deaths worldwide. An examination of general and pandemic-specific aspects of nonclinical paranoid ideation may aid in the understanding of the public's response to the pandemic, given that it is a global threat event.

METHODS

A representative international sample of general adults (N = 2,510) from five international sites were recruited with stratified quota sampling. Structural equation modeling (SEM) was used to examine the relationships among general paranoid ideation, pandemic paranoid ideation (interpersonal mistrust, conspiratorial thinking, and persecutory threat), general distress (depression, anxiety), vaccine willingness, and other preventative behaviors (masking, social distancing, hygiene).

RESULTS

Although general distress and paranoid ideation were associated with vaccination willingness and preventative behaviors, their effects were inconsistent or weak. Pandemic paranoid ideation showed robust direct and indirect effects that differentially predicted COVID-19 preventative behaviors, with higher interpersonal mistrust associated with higher adherence to all behaviors, higher conspiratorial thinking related to lower adherence to all behaviors, and higher persecutory threat related to higher vaccine willingness, but lower adherence to other preventative behaviors.

CONCLUSIONS

Examination of pandemic-specific paranoid ideation leads to more precise prediction of the public's adherence to recommended health behaviors during the COVID-19 outbreak. This information could be used to inform intervention strategies for micro-targeting different subgroups with nonclinical paranoid thinking, as well as for improving responses to future pandemics and vaccination efforts for other common illnesses.

Socioeconomic and risk-related drivers of compliance with measures to prevent SARS-CoV-2 infection: evidence from the Munich-based KoCo19 study

OBJECTIVES

Although a growing share of the population in many countries has been vaccinated against the SARS-CoV-2 virus to different degrees, social distancing and hygienic non-pharmaceutical interventions still play a substantial role in containing the pandemic. The goal of this study was to investigate which factors are correlated with a higher compliance with these regulations in the context of a cohort study in the city of Munich, southern Germany, during the summer of 2020, i.e. after the first lockdown phase.

METHODS

Using self-reported compliance with six regulations and personal hygiene rules (washing hands, avoiding touching face, wearing a mask, keeping distance, avoiding social gatherings, avoiding public spaces) we extracted two compliance factor scores, namely compliance with personal hygiene measures and compliance with social distancing regulations. Using linear and logistic regressions, we estimated the correlation of several socio-demographic and risk perception variables with both compliance scores.

RESULTS

Risk aversion proved to be a consistent and significant driver of compliance across all compliance behaviors. Furthermore, being female, being retired and having a migration background were positively associated with compliance with personal hygiene regulations, whereas older age was related with a higher compliance with social distancing regulations. Generally, socioeconomic characteristics were not related with compliance, except for education, which was negatively related with compliance with personal hygiene measures.

CONCLUSIONS

Our results suggest that for a targeted approach to improve compliance with measures to prevent SARS-CoV-2 infection, special attention should be given to younger, male and risk-prone individuals.

COVID-19 risk, attitudes and behaviour study (CRAB study): A knowledge, attitudes, and practise qualitative study of COVID-19 in the Royal Navy

Introduction

Outbreaks of SARS-CoV-2 onboard maritime platforms spread rapidly and have high attack rates. The aim of the COVID-19 Risk, Attitudes and Behaviour (CRAB) study was to investigate the knowledge, attitudes, and practises in the Royal Navy in relation to COVID-19 prevention.

Methods

The CRAB study was a cross-sectional survey, using a census sampling method, conducted in May and June 2021. An online questionnaire was distributed to all serving Royal Navy regular personnel using either the MyNavy application or via a QR code through email for a continuous 14 day period. The questionnaire was based on an existing validated questionnaire used for avian influenza epidemics. Questions investigated individual perceptions of COVID-19 seriousness, compliance with prevention methods, explored vaccination intention and vaccine hesitancy (unvaccinated individuals who declined or were unsure about receiving a COVID-19 vaccine). The chi-squared test of best fit was used to compare the demographic responses against the whole organisation, with p-value < 0.05 deemed significant. Odds ratios were used to investigate associations between demographic groups and responses to questions, with an odds ratio crossing 1.0 deemed non-significant.

Results

The response rate was 6% (2,080/33,200), with 315 responses collated in the pilot phase and 1,765 in the main study phase. Male participants were less likely to rate COVID-19 as serious (OR 0.34; 95% CI: 0.23-0.49). BAME ethnicity (OR 2.41; 95% CI: 1.12-5.17) rated it as more serious. At the time of the study 62% of respondents had received one dose of a COVID-19 vaccine. In the 797 unvaccinated personnel, vaccine hesitancy accounted for 24.2% (193/797), of whom 136 were white males. Those who had a higher COVID-19 serious rating, the most significant factor for non-adherence to COVID-19 prevention measures in both vaccinated (OR 1.61 [95%CI: 1.20-2.17]) and vaccine-hesitant (OR 3.24 [95%CI: 1.63-6.41]) individuals was colleagues' non-adherence. The most trusted source of information on vaccines was provided by the Defence Medical Services (77.2% [1,606/2,080]).

Conclusion

This study has identified reasons for COVID-19 protective measure adherence, sources of information trusted by respondents and vaccine hesitancy, in the Royal Navy. The questionnaire can be used to investigate attitudes and behaviours in future emerging infectious diseases.

The impact of loneliness on compliance with COVID-19 prevention guidelines

Many individuals have been reluctant to follow the COVID-19 prevention guidelines (e.g., wearing a mask, physical distancing, and vigilant handwashing) set forth by the U.S. Center for Disease Control to reduce the spread of COVID-19. In this research, we use reciprocal altruism theory to investigate the role of loneliness and its impact on compliance with these guidelines. Our findings indicate that lonely individuals are less willing to comply with COVID-19 prevention guidelines than non-lonely individuals. Process evidence suggests that this occurs as loneliness can inhibit an individual's sense of obligation to reciprocate to others. However, we demonstrate that framing information about COVID-19 through agentic (vs. communal) advertising messaging strategies can offset the negative impact of loneliness on compliance with COVID-19 prevention guidelines. Thus, marketers and policymakers may want to consider the important role of loneliness when tailoring messaging appeals that encourage compliance with COVID-19 prevention guidelines.

COVID-19 Incidence and Death Rates in the Southern Region of the United States: A Racial and Ethnic Association

The SARS-CoV-2 virus responsible for the COVID-19 pandemic continues to spread worldwide, with over half a billion cases linked to over 6 million deaths globally. COVID-19 has impacted populations unequally based on income, age, race, sex, and geographical location. This study aimed to characterize COVID-19 incidence and death rate trends in six states of the southern region of the USA and to understand the demographic and racial differences in its incidence and death rates. Data for the study were collected from the COVID-19 Data tracker of the Centers for Disease Control and Prevention for the following southern states: Alabama (AL), Florida (FL), Georgia (GA), Louisiana (LA), Mississippi (MS), and Tennessee (TN). The results showed a significant geographical variation in the COVID-19 cases and related deaths. Significant variations in COVID-19 cases and death rates were observed among different races and ethnic groups. The highest number of COVID-19 cases were observed among the Hispanic and Black populations, and the highest death rates were found among non-Hispanic Blacks and Whites. The southern states included in this paper showed a high number of COVID-19 cases and high death rates during the study period. These increased rates may result from the low socioeconomic status and large minority populations.

Translation, Adaptation and Validation of the Pandemic Fatigue Scale (PFS) in the Greek Language

The growing fatigue of citizens due to the COVID-19 pandemic has already been addressed and its results are visible and threatens citizen compliance. The aim of this study was to translate and validate the Pandemic Fatigue Scale (PFS) in the Greek language. A cross-sectional study was conducted between October 2021 to March 2022. The translation and cultural adaptation process was developed according to the research protocols among the university student population in Cyprus and tested the psychometric properties of PFS. Three hundred thirty-four subjects participated in the study through a web survey, which included general information and the study process. The internal consistency for the total PFS showed good reliability (six items, a = 0.88). A weak statistically significant positive correlation was found between the PFS and the Greek versions of Generalised Anxiety Disorder Assessment—GAD-7 (r = 0.1.96; p < 0.001) and the PFS and Patient Health Questionnaire—PHQ-9 (r = 0.173; p = 0.002) demonstrating good concurrent validity. Recovering from the pandemic, it is necessary to build systems to detect and respond to future healthcare crises. The results suggest that the psychometric properties of the Greek PFS are satisfactory. The measure of pandemic fatigue allows for identifying fatigue groups for targeted interventions and testing how pandemic fatigue might be reduced in such situations.

Misrepresentation and Nonadherence Regarding COVID-19 Public Health Measures

Importance

The effectiveness of public health measures implemented to mitigate the spread and impact of SARS-CoV-2 relies heavily on honesty and adherence from the general public.

Objective

To examine the frequency of, reasons for, and factors associated with misrepresentation and nonadherence regarding COVID-19 public health measures.

Design, Setting, and Participants

This survey study recruited a national, nonprobability sample of US adults to participate in an online survey using Qualtrics online panels (participation rate, 1811 of 2260 [80.1%]) from December 8 to 23, 2021. The survey contained screening questions to allow for a targeted sample of one-third who had had COVID-19, one-third who had not had COVID-19 and were vaccinated, and one-third who had not had COVID-19 and were unvaccinated.

Main Outcomes and Measures

The survey assessed 9 different types of misrepresentation and nonadherence related to COVID-19 public health measures and the reasons underlying such behaviors. Additional questions measured COVID-19-related beliefs and behaviors and demographic characteristics.

Results

The final sample included 1733 participants. The mean (SD) participant age was 41 (15) years and the sample predominantly identified as female (1143 of 1732 [66.0%]) and non-Hispanic White (1151 of 1733 [66.4%]). Seven hundred twenty-one participants (41.6%) reported misrepresentation and/or nonadherence in at least 1 of the 9 items; telling someone they were with or about to be with in person that they were taking more COVID-19 preventive measures than they actually were (420 of 1726 [24.3%]) and breaking quarantine rules (190 of 845 [22.5%]) were the most common manifestations. The most commonly endorsed reasons included wanting life to feel normal and wanting to exercise personal freedom. All age groups younger than 60 years (eg, odds ratio for those aged 18-29 years, 4.87 [95% CI, 3.27-7.34]) and those who had greater distrust in science (odds ratio, 1.14 [95% CI, 1.05-1.23]) had significantly higher odds of misrepresentation and/or nonadherence for at least 1 of the 9 items.

Conclusions and Relevance

In this survey study of US adults, nearly half of participants reported misrepresentation and/or nonadherence regarding public health measures against COVID-19. Future work is needed to examine strategies for communicating the consequences of misrepresentation and nonadherence and to address contributing factors.

Religion, Islam, and Compliance with COVID-19 Best Practices

While many have implemented best practices intended to help stem the spread of COVID-19, there are also a substantial number of citizens, both domestically and abroad, who have resisted these practices. We argue that public health authorities, as well as scientific researchers and funders, should help address this resistance by putting greater effort into ascertaining how existing religious practices and beliefs align with COVID-19 guidelines. In particular, we contend that Euro-American scholars-who have often tended to implicitly favor secular and Christian worldviews-should put added focus on how Islamic commitments may (or may not) support COVID-19 best practices, including practices that extend beyond the domain of support for mental health.

Risk, Obligation, and Public Noncompliance with Mobility Directives in China during the COVID-19 Pandemic

Human mobility greatly increases the risk of epidemic transmission. This study examines the psychological mechanism of individuals' noncompliance with public health directives and their choice to travel amidst threats through two rounds of surveys (N = 1473 in total) in China at different stages of the COVID-19 pandemic. This research revealed the relative strength of the motivating and impeding factors that determined behavioral intention. In subtle internal conflicts, maladaptive responses (e.g., wishful thinking, denial, fatalism) were identified as a significant factor in negotiating risk-related constraints and encouraging risky travel behavior. Interestingly, both those who traveled amidst threats and those who did not travel agreed that they had social obligations for epidemic prevention. The results demonstrated that obligation could have an indirect negative impact on behavioral intention only via attitude. By unveiling the psychological mechanism of individuals' noncompliance with health directives and travel during the pandemic, this study can aid in the development of appropriate operational strategies to manage population mobility during crises.

Factors Associated with the COVID-19 Vaccination Status of Higher Education Students: Results of an Online Cross-Sectional Survey at Six Universities in Southwestern Germany

This cross-sectional study explored factors associated with the corona virus disease 2019 (COVID-19) vaccination acceptance among higher education students in southwestern Germany. We conducted a cross-sectional online survey at six state-approved higher education institutions (HEIs) between July and November 2021. In addition to descriptive analyses, univariate as well as multivariate binary logistic regression analyses were conducted. A total of 6556 higher education students aged 18 years and older participated in our survey; 91.4% of participating students had been vaccinated against COVID-19 at least once. The factors that significantly contributed to the explanation of higher education students’ vaccination status in the multivariate analysis (area under curve—AUC = 0.94) were variables on the perception of the virus SARS-CoV-2 (affective risk perception: Adjusted odds ratio—aOR = 1.2; perception of the outbreak as a media-hype: aOR = 0.8), attitudes towards personal (aOR = 0.7) and study-related (aOR = 0.8) health and safety measures to prevent transmission of SARS-CoV-2, and attitudes towards COVID-19 vaccination (preservation of own health: aOR = 1.3; confidence in vaccine safety: aOR = 1.7; supporting higher education through vaccination: aOR = 1.2; own contribution to the containment of the pandemic: aOR = 1.7). The findings target assisting HEIs in returning to face-to-face teaching after previous semesters of online teaching.

The Roles of Health and e-Health Literacy, Conspiracy Beliefs and Political Sympathy in the Adherence to Preventive Measures Recommended during the Pandemic

Adherence to preventive measures is of the utmost importance for limiting the spreading of the coronavirus. Many predictors of adopting preventive behaviors have been analyzed in different countries during the COVID-19 pandemic. Objectives: The study’s main aim was to assess the roles of health (HL) and e-health literacy (eHL), conspiracy beliefs, political sympathy, and religious practices in the adherence to COVID-19 preventive measures after adjusting for sociodemographic factors. The analysis was based on the data obtained from a survey conducted among 2410 adult Internet users in Poland in October 2020. The survey was performed with a computer-assisted web-based interviewing technique. Survey data were analyzed through uni- and multivariable linear regression models. The multivariable regression model revealed that after adjusting for sociodemographic variables, the preventive measures score (PMS) was significantly associated with HL (B = 0.04, p < 0.001), eHL (B = 0.03, p < 0.001) and the COVID-19-related conspiracy beliefs score (C19CBS) (B = −0.24, p < 0.001). There was also a significant statistical relationship between PMS and political sympathies and religious practices. HL and eHL are key factors eligible for modification through appropriate interventions and showing positive effects in compliance with preventive measures. Conspiracy beliefs, political sympathy and religious beliefs are independently associated with the adherence.

Web-Based Perspectives of Deemed Consent Organ Donation Legislation in Nova Scotia: Thematic Analysis of Commentary in Facebook Groups

Background

The Canadian province of Nova Scotia recently became the first jurisdiction in North America to implement deemed consent organ donation legislation. Changing the consent models constituted one aspect of a larger provincial program to increase organ and tissue donation and transplantation rates. Deemed consent legislation can be controversial among the public, and public participation is integral to the successful implementation of the program.

Objective

Social media constitutes key spaces where people express opinions and discuss topics, and social media discourse can influence public perceptions. This project aimed to examine how the public in Nova Scotia responded to legislative changes in Facebook groups.

Methods

Using Facebook's search engine, we searched for posts in public Facebook groups using the terms "deemed consent," "presumed consent," "opt out," or "organ donation" and "Nova Scotia," appearing from January 1, 2020, to May 1, 2021. The finalized data set included 2337 comments on 26 relevant posts in 12 different public Nova Scotia-based Facebook groups. We conducted thematic and content analyses of the comments to determine how the public responded to the legislative changes and how the participants interacted with one another in the discussions.

Results

Our thematic analysis revealed principal themes that supported and critiqued the legislation, raised specific issues, and reflected on the topic from a neutral perspective. Subthemes showed individuals presenting perspectives through a variety of themes, including compassion, anger, frustration, mistrust, and a range of argumentative tactics. The comments included personal narratives, beliefs about the government, altruism, autonomy, misinformation, and reflections on religion and death. Content analysis revealed that Facebook users reacted to popular comments with "likes" more than other reactions. Comments with the most reactions included both negative and positive perspectives about the legislation. Personal donation and transplantation success stories, as well as attempts to correct misinformation, were some of the most "liked" positive comments.

Conclusions

The findings provide key insights into perspectives of individuals from Nova Scotia on deemed consent legislation, as well as organ donation and transplantation broadly. The insights derived from this analysis can contribute to public understanding, policy creation, and public outreach efforts that might occur in other jurisdictions considering the enactment of similar legislation.

Individual differences and compliance intentions with COVID-19 restrictions: insights from a lockdown in Melbourne (Australia)

The coronavirus (COVID-19) pandemic has caused an international public health and economic crisis. Despite the COVID-19 vaccine rollout in many countries from late 2020, non-pharmaceutical interventions are still required to minimize the spread of the virus. However, notable variation in voluntary compliance with these interventions has been reported. This study investigated various individual differences associated with intentions to comply with COVID-19 restrictions during a sustained (112 day) lockdown in Melbourne (Australia) in late 2020. Participants (N = 363) completed an online survey where they responded to various socio-demographic, health and psychological questions. Participants also responded to a series of vignettes that assessed their intended behaviour in specific situations and their knowledge of the current COVID-19 restrictions. Overall, it was found that greater levels of organization predicted greater intentions to comply with the COVID-19 restrictions, while higher socio-economic status, sociability and anxiety predicted lower compliance intentions. Further, individuals previously diagnosed with COVID-19 reported lower intentions to comply with the COVID-19 restrictions. The strongest predictor of compliance intentions, however, was a greater knowledge of the current restrictions. These findings highlight that public health orders around COVID-19 restrictions should be presented in a clear and uncomplicated manner and should target specific groups to increase compliance.

Integrated Analysis of Behavioural and Health COVID-19 Data Combining Bayesian Networks and Structural Equation Models

The response to the COVID-19 pandemic has been highly variable. Governments have applied different mitigation policies with varying effect on social and economic measures, over time. This article presents a methodology for examining the effect of mobility restriction measures and the association between health and population activity data. As case studies, we refer to the pre-vaccination experience in Italy and Israel. Facing the pandemic, Israel and Italy implemented different policy measures and experienced different population behavioral patterns. Data from these countries are used to demonstrate the proposed methodology. The analysis we introduce in this paper is a staged approach using Bayesian Networks and Structural Equations Models. The goal is to assess the impact of pandemic management and mitigation policies on pandemic spread and population activity. The proposed methodology models data from health registries and Google mobility data and then shows how decision makers can conduct scenario analyses to help design adequate pandemic management policies.

The perceived threat of COVID-19 and its impact on hygienic precautionary behaviors: A multi-countries study

OBJECTIVE(S)

To explore the perceived threats of COVID-19 and how it changed the personal hygienic precautionary behaviors across multiple countries in the Middle East and North Africa (MENA) region.

DESIGN

A cross-sectional descriptive design was used to survey the four targeted MENA countries: Jordan, Palestinian territories, Saudi Arabia, and Egypt.

SAMPLE

A nonprobability convenience sampling design was utilized. The link to the survey questionnaire was distributed through social media groups within Facebook^® and Twitter^® . The groups are known and accessible by known across the general population at the targeted countries.

MEASUREMENT

Data was collected using The Brief Illness Perception Questionnaire and an adapted instrument that examine the hygienic precautionary behaviors during COVID-19 pandemic.

RESULTS

Answers of participants (n = 2604) were valid and included in the study. The results show that a minimal perception of threat among the participants on most of the BIP-Q5 items (M = 12.9, SD = 7.2). Moreover, the highest compliance rates to recommended hygienic precautionary behaviors were found among populations above the age of 50 years (F = 2.89, p = .04), females (t = 5.18, p = .003), being married (F = 3.09, p = .029), and being a health care professional (t = -2.20, p = .028).

CONCLUSION

The perceived threat of COVID-19 and compliance rates with the recommended hygienic precautionary behaviors among Arab societies were found to below and need critically urgent attention.

COmpliance with pandemic COmmands Scale (COCOS): The relationship between compliance with COVID-19 measures and sociodemographic and attitudinal variables

Several studies in different countries have reported that part of the population does not fully comply with the measures recommended to prevent COVID-19, and therefore poses a risk to public health. For this reason, several measures have been developed to assess the level of compliance, although many of them have methodological limitations or do not include a comprehensive set of items. The main goal of the current study was to develop a new instrument with suitable psychometric properties, which includes a more complete set of items and controls the impact of acquiescence bias. The participants were 1410 individuals (59.2% women) from Spain, who answered the new questionnaire and several items on sociodemographic and attitudinal issues. Exploratory and confirmatory factor analyses were carried out, and the results suggested that only one content factor was underlying the data. This solution was replicated in a different subsample, which shows the stability of the solution. Furthermore, the relationships between the scores of the new questionnaire and the sociodemographic and attitudinal variables are similar to those obtained in previous studies, which can be regarded as evidence of the validity of the new questionnaire.

Fear of COVID-19, compliance with recommendations against virus transmission, and attitudes towards vaccination in Sweden

Following the immense impact of the COVID-19 pandemic on health and everyday lives world-wide, people's fear of COVID-19 has been studied in a number of settings using the Fear of COVID scale. In Sweden, virus-preventing strategies have differed from comparable countries, with low use of formal lock-down procedures. It is crucial to study correlates of non-compliance with COVID-19 recommendations, and unwillingness to become vaccinated. This study aims to study whether fear of COVID is associated with mental distress and attitudes towards the pandemic, and to study correlates of non-compliance with key anti-COVID recommendations and with reluctancy to vaccination. This anonymous online survey study in web panel participants (N = 1,501) aimed to study a range of behavioral changes during COVID-19. Recommendations and vaccinations reluctancy were analyzed in logistic regressions against socio-demographic data, COVID-19 status, and mental health history. Internal consistency of the Fear of COVID scale was calculated. The Fear of COVID scale had a satisfactory internal consistency (Cronbach-alpha 0.84), and was significantly associated with compliance with all COVID-19 recommendations and with mental health. Non-compliance with recommendations was associated with low fear of disease and younger age, among other variables. Being against vaccination was associated, among other variables, with low fear of disease and with low education. In conclusion, the Fear of COVID scale appears to be associated with key attitudes towards the COVID-19 disease. Anti-virus strategies may need to promote compliance with recommendations in subgroups who feel low fear of disease or who believe not to be in a risk group for severe disease.

Factors related to compliance with the COVID-19 health regulations among young people

The coronavirus pandemic has affected all facets of our lives and all ages and social strata worldwide. Measures have been taken to protect against the spread of the virus, such as more rigorous hand hygiene, the use of face masks and social distancing. However, the focus has often been on young people, who have been seen as a group lacking sufficient respect for government-imposed measures. This review outlines the preventive measures that have been taken in different countries and discusses their specific impact on young people and adolescents, taking into account the developmental stage and concrete needs of this age group. It summarizes those studies that have provided information on compliance with preventive measures by young people and adolescents, concluding that although compliance levels among this age group are lower than among older adults, the general view of youths as non-compliant is not consistent with real, objective data. The review also summarizes different views regarding the possible reasons for this lower level of compliance, taking into account both social (gender and age) and personal factors (personality, empathy, prosociality, self-control, cognitive styles and motivations), and discusses the practical implications of these findings for the future.

Associations between postpartum depression and assistance with household tasks and childcare during the COVID-19 pandemic: evidence from American mothers

BACKGROUND

The early postpartum period is recognized cross-culturally as being important for recovery, with new parents receiving increased levels of community support. However, COVID-19-related lockdown measures may have disrupted these support systems, with possible implications for mental health. Here, we use a cross-sectional analysis among individuals who gave birth at different stages of the pandemic to test (i) if instrumental support access in the form of help with household tasks, newborn care, and care for older children has varied temporally across the pandemic, and (ii) whether access to these forms of instrumental support is associated with lower postpartum depression scores.

METHODS

This study used data from the COVID-19 And Reproductive Effects (CARE) study, an online survey of pregnant persons in the United States. Participants completed postnatal surveys between April 30 - November 18, 2020 (n = 971). Logistic regression analysis tested whether birth timing during the pandemic was associated with odds of reported sustained instrumental support. Linear regression analyses assessed whether instrumental support was associated with lower depression scores as measured via the Edinburgh Postnatal Depression survey.

RESULTS

Participants who gave birth later in the pandemic were more likely to report that the pandemic had not affected the help they received with household work and newborn care (p < 0.001), while access to childcare for older children appeared to vary non-linearly throughout the pandemic. Additionally, respondents who reported that the pandemic had not impacted their childcare access or help received around the house displayed significantly lower depression scores compared to participants who reported pandemic-related disruptions to these support types (p < 0.05).

CONCLUSIONS

The maintenance of postpartum instrumental support during the pandemic appears to be associated with better maternal mental health. Healthcare providers should therefore consider disrupted support systems as a risk factor for postpartum depression and ask patients how the pandemic has affected support access. Policymakers seeking to improve parental wellbeing should design strategies that reduce disease transmission, while facilitating safe interactions within immediate social networks (e.g., through investment in COVID-19 testing and contact tracing). Cumulatively, postpartum instrumental support represents a potential tool to protect against depression, both during and after the COVID-19 pandemic.

The effects of quality of evidence communication on perception of public health information about COVID-19: Two randomised controlled trials

BACKGROUND

The quality of evidence about the effectiveness of non-pharmaceutical health interventions is often low, but little is known about the effects of communicating indications of evidence quality to the public.

METHODS

In two blinded, randomised, controlled, online experiments, US participants (total n = 2140) were shown one of several versions of an infographic illustrating the effectiveness of eye protection in reducing COVID-19 transmission. Their trust in the information, understanding, feelings of effectiveness of eye protection, and the likelihood of them adopting it were measured.

FINDINGS

Compared to those given no quality cues, participants who were told the quality of the evidence on eye protection was 'low', rated the evidence less trustworthy (p = .001, d = 0.25), and rated it as subjectively less effective (p = .018, d = 0.19). The same effects emerged compared to those who were told the quality of the evidence was 'high', and in one of the two studies, those shown 'low' quality of evidence said they were less likely to use eye protection (p = .005, d = 0.18). Participants who were told the quality of the evidence was 'high' showed no statistically significant differences on these measures compared to those given no information about evidence quality.

CONCLUSIONS

Without quality of evidence cues, participants responded to the evidence about the public health intervention as if it was high quality and this affected their subjective perceptions of its efficacy and trust in the provided information. This raises the ethical dilemma of weighing the importance of transparently stating when the evidence base is actually low quality against evidence that providing such information can decrease trust, perception of intervention efficacy, and likelihood of adopting it.

University students' adherence and vaccination attitudes during the COVID-19 pandemic: Focusing on costs and benefits

Numerous measures were implemented to contain the COVID‐19 pandemic. Adhering to these measures as well as getting vaccinated is associated with subjective costs and benefits. Since young people like university students largely feel less vulnerable to the virus, other costs and benefits than health might be more decisive for them. This article combines the results of a qualitative and a quantitative longitudinal study conducted with university students mainly living in Tyrol, Austria. The studies focused on the second wave of infections of the COVID‐19 pandemic. Health concerns, altruistic concerns, worrying about the economic consequences of the measures and reactance played an important role for students in deciding what measures to follow and their vaccination attitudes. The effects were partially mediated by understanding the measures' necessity. Qualitative results enabled further insights into thought processes during these decisions and revealed additional aspects, such as concerns about mental health consequences. This research suggests that students make their decisions about adherence and vaccinations based on a variety of aspects that they weigh against each other. Understanding the individual assessments of costs and benefits is crucial to promote both adherence to the measures against the COVID‐19 pandemic and vaccination readiness.

Detection of Spatiotemporal Clusters of COVID-19-Associated Symptoms and Prevention Using a Participatory Surveillance App: Protocol for the @choum Study

BACKGROUND

The early detection of clusters of infectious diseases such as the SARS-CoV-2-related COVID-19 disease can promote timely testing recommendation compliance and help to prevent disease outbreaks. Prior research revealed the potential of COVID-19 participatory syndromic surveillance systems to complement traditional surveillance systems. However, most existing systems did not integrate geographic information at a local scale, which could improve the management of the SARS-CoV-2 pandemic.

OBJECTIVE

The aim of this study is to detect active and emerging spatiotemporal clusters of COVID-19-associated symptoms, and to examine (a posteriori) the association between the clusters' characteristics and sociodemographic and environmental determinants.

METHODS

This report presents the methodology and development of the @choum (English: "achoo") study, evaluating an epidemiological digital surveillance tool to detect and prevent clusters of individuals (target sample size, N=5000), aged 18 years or above, with COVID-19-associated symptoms living and/or working in the canton of Geneva, Switzerland. The tool is a 5-minute survey integrated into a free and secure mobile app (CoronApp-HUG). Participants are enrolled through a comprehensive communication campaign conducted throughout the 12-month data collection phase. Participants register to the tool by providing electronic informed consent and nonsensitive information (gender, age, geographically masked addresses). Symptomatic participants can then report COVID-19-associated symptoms at their onset (eg, symptoms type, test date) by tapping on the @choum button. Those who have not yet been tested are offered the possibility to be informed on their cluster status (information returned by daily automated clustering analysis). At each participation step, participants are redirected to the official COVID-19 recommendations websites. Geospatial clustering analyses are performed using the modified space-time density-based spatial clustering of applications with noise (MST-DBSCAN) algorithm.

RESULTS

The study began on September 1, 2020, and will be completed on February 28, 2022. Multiple tests performed at various time points throughout the 5-month preparation phase have helped to improve the tool's user experience and the accuracy of the clustering analyses. A 1-month pilot study performed among 38 pharmacists working in 7 Geneva-based pharmacies confirmed the proper functioning of the tool. Since the tool's launch to the entire population of Geneva on February 11, 2021, data are being collected and clusters are being carefully monitored. The primary study outcomes are expected to be published in mid-2022.

CONCLUSIONS

The @choum study evaluates an innovative participatory epidemiological digital surveillance tool to detect and prevent clusters of COVID-19-associated symptoms. @choum collects precise geographic information while protecting the user's privacy by using geomasking methods. By providing an evidence base to inform citizens and local authorities on areas potentially facing a high COVID-19 burden, the tool supports the targeted allocation of public health resources and promotes testing.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/30444.

Identifying consumer segments based on COVID-19 pandemic perceptions and responses

Consumer responses to the COVID-19 pandemic have varied widely. Thus, marketers need to understand consumer segments based on pandemic-related responses and behaviors. Through two studies conducted 9 months apart, we find that consumers shift from three segments in Study 1-the Apprehensive, the Prepared, and the Dismissive, to two segments in Study 2-the Dedicated and the Dismissive. The Apprehensive feel particularly threatened of the virus. The Prepared and the Dedicated perceive a lower susceptibility but still take the health threat seriously. The Dismissive downplay the threat and exhibit more negative reactions to mitigation measures. We also demonstrate between-segment downstream response differences. While the Apprehensive and the Prepared/Dedicated exhibit positive attitude toward companies enforcing guidelines, the Apprehensive engage in the most panic buying, hoarding, and stockpiling. The Dedicated also express greater stress and less life satisfaction than the Dismissive. The findings offer theoretical and practical implications for pandemic-related consumer responses.

Crafting Compliance Regime under COVID-19: Using Taiwan's Quarantine Policy as a Case Study

One year after the World Health Organization declared COVID-19 a global pandemic, governments around the world adopt similar practices in containing the COVID-19 spread. Nevertheless, variation exists in the level of policy compliance, which directly contribute to policy success/failure across countries. As the pandemic continues, pandemic fatigue also decreases the public's willingness to comply. Increasing policy compliance during the remainder of pandemic has become a transnational concern. Using Taiwan's quarantine policy as an example, this article illustrates three aspects to craft an effective compliance regime to fight public health crises like COVID-19: (1) a comprehensive policy mix to reduce heterogeneous compliance barriers that impact different social groups; (2) constant and various policy communication with heterogeneous target audiences; and (3) leveraging and integrating street-level bureaucrats in the policy implementation stages. Taiwan's case provides several policy lessons for other countries: compliance regime is not driven by top-down enforcement but through the integration of policy design and implementation that remove all barriers for compliance. Taiwan's street level bureaucrats are the glue of the compliance regime. This article bears policy implications for policy makers around the world when aiming for increasing policy compliance.

Depression Symptoms Mediate Mismatch Between Perceived Severity of the COVID-19 Pandemic and Preventive Motives

The present study monitored changes in beliefs about the coronavirus disease 2019 (COVID-19) pandemic, depressive symptoms, and preventive motives between the first and second waves in South Korea using an online survey administered to 1,144 individuals nationally representative for age, gender, and areas of residence. While participants correctly updated their beliefs about the worsening pandemic situations, the perceived importance of social distancing did not change, and their motives to follow prevention measures shifted toward compulsory rather than voluntary motives. This inconsistency appeared to be mediated by depressive symptoms, such that negative belief changes followed by increased depressive symptoms were associated with the decreased perceived importance of social distancing and decreased voluntary motives. Our data highlights the importance of psychological responses to the dynamically evolving pandemic situations in promoting preventive behaviors.

Predictors of COVID-19 Preventive Behavior Adoption Intention in Malaysia

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

SARS-CoV-2 Surveillance System in Canada: Longitudinal Trend Analysis

BACKGROUND

The COVID-19 global pandemic has disrupted structures and communities across the globe. Numerous regions of the world have had varying responses in their attempts to contain the spread of the virus. Factors such as public health policies, governance, and sociopolitical climate have led to differential levels of success at controlling the spread of SARS-CoV-2. Ultimately, a more advanced surveillance metric for COVID-19 transmission is necessary to help government systems and national leaders understand which responses have been effective and gauge where outbreaks occur.

OBJECTIVE

The goal of this study is to provide advanced COVID-19 surveillance metrics for Canada at the country, province, and territory level that account for shifts in the pandemic including speed, acceleration, jerk, and persistence. Enhanced surveillance identifies risks for explosive growth and regions that have controlled outbreaks successfully.

METHODS

Using a longitudinal trend analysis study design, we extracted 62 days of COVID-19 data from Canadian public health registries for 13 provinces and territories. We used an empirical difference equation to measure the daily number of cases in Canada as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R.

RESULTS

We compare the week of February 7-13, 2021, with the week of February 14-20, 2021. Canada, as a whole, had a decrease in speed from 8.4 daily new cases per 100,000 population to 7.5 daily new cases per 100,000 population. The persistence of new cases during the week of February 14-20 reported 7.5 cases that are a result of COVID-19 transmissions 7 days earlier. The two most populous provinces of Ontario and Quebec both experienced decreases in speed from 7.9 and 11.5 daily new cases per 100,000 population for the week of February 7-13 to speeds of 6.9 and 9.3 for the week of February 14-20, respectively. Nunavut experienced a significant increase in speed during this time, from 3.3 daily new cases per 100,000 population to 10.9 daily new cases per 100,000 population.

CONCLUSIONS

Canada excelled at COVID-19 control early on in the pandemic, especially during the first COVID-19 shutdown. The second wave at the end of 2020 resulted in a resurgence of the outbreak, which has since been controlled. Enhanced surveillance identifies outbreaks and where there is the potential for explosive growth, which informs proactive health policy.

Exploring Factors Associated with Alcohol and/or Substance Use During the COVID-19 Pandemic

This study explored the relationship between alcohol and substance use in the general population during the early stages of COVID-19 as related to individual, family, and community stressors. A convenience sample of adults who resided in the USA and Canada was utilized. An online survey was conducted. Over one-third of the sample reported utilizing alcohol and substances as a means to cope during the pandemic. A linear regression revealed that use of social media as a source of information, being personally affected by COVID-19, experiencing child care challenges, and not being associated with a religious community were related to increased likeliness for alcohol and/or substance use. Future research should explore these concepts further within the general population.