Association between health behaviours and the COVID-19 vaccination: risk compensation among healthcare workers in Taizhou, China

Investigating the causal effects of COVID-19 vaccination on the adoption of protective behaviors in Japan: Insights from a fuzzy regression discontinuity design

BACKGROUND

During the COVID-19 pandemic, concerns emerged that vaccinated individuals might engage less in infection-preventive behaviors, potentially contributing to virus transmission. This study evaluates the causal effects of COVID-19 vaccination on such behaviors within Japan, highlighting the significance of understanding behavioral dynamics in public health strategies.

METHODS

Utilizing Japan's age-based vaccination priority for those born before April 1, 1957, this research employs a regression discontinuity design (RDD) to assess the vaccination's impact. Data from the fourth round of a longitudinal online survey, conducted from July 20 to 27, 2021, served as the basis for analyzing 14 infection-protective behaviors, including mask usage, handwashing, and avoiding crowds.

RESULTS

A total of 12067 participants completed the survey. The analyzed sample size varied by outcome variable, ranging from 1499 to 5233. The analysis revealed no significant differences in the 14 behaviors examined among fully vaccinated, partially vaccinated, and unvaccinated individuals. This consistency across groups suggests that vaccination status did not significantly alter engagement in protective behaviors during the observation period.

CONCLUSIONS

Empirical findings highlight the complexity of behavioral responses following vaccination, indicating that such responses may be influenced by various factors, rather than by vaccination status alone. Additionally, this result underscores the importance of crafting public health policies that account for the intricate interplay between vaccination and behavior. This study contributes to the broader discourse on managing responses to the pandemic and tailoring interventions to sustain or enhance protective health behaviors amid vaccination rollouts.

Two-Year-Span Breast Cancer Screening Uptake in Japan after the COVID-19 Pandemic and Its Association with the COVID-19 Vaccination

There is limited information on whether the COVID-19 pandemic was associated with decreased breast cancer screening uptake and if COVID-19 vaccination was associated with an increase in screening uptake. Our study explored the uptake of breast cancer screening in Japan after the COVID-19 pandemic and assessed its association with the COVID-19 vaccination. We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), a web-based prospective cohort survey, and we included 6110 women without cancer history who were aged 40 to 74 years that participated in the 2012 and 2022 surveys. We examined the regular breast cancer screening uptake before and after the pandemic and employed a multivariable Poisson regression model to seek any association between COVID-19 vaccination and screening uptake. Of 6110, 38.2% regularly participated in screening before the pandemic and 46.9% did so after the pandemic. Individuals unvaccinated due to health reasons (incidence rate ratio (IRR) = 0.47, 95% CI: 0.29-0.77, p = 0.003) and for other reasons (IRR = 0.73, 95% CI: 0.62-0.86, p < 0.001) were less likely to undergo screening compared to fully vaccinated individuals. There was no long-term decrease in breast cancer screening uptake after the pandemic in Japan. Vaccination was linked to increased uptake, but there was no dose relationship.

Perception of interpersonal distance and social distancing before and during COVID-19 pandemic

Since COVID-19 is easily transmitted among people in close physical proximity, the focus of epidemiological policy during the COVID-19 crisis included major restrictions on interpersonal distance. However, the way in which distance restrictions affected spatial perception is unclear. In the current study, we examined interpersonal distance preferences and perceptions at three time points: pre-pandemic, early post-pandemic, and late post-pandemic. The results indicate that following the pandemic outbreak, people perceived others as farther away than they actually were, suggesting that the distance restrictions were associated with an enlargement of perceived interpersonal distance. Interestingly, however, people maintained the same distance from one another as before the outbreak, indicating no change in actual distance behavior due to the risk of infection. These findings suggest that COVID-19 was associated with a change in the way distance is perceived, while in practice, people maintain the same distance as before. In contrast, COVID-related anxiety predicted both a preference for maintaining a greater distance and a bias toward underestimating perceived distance from others. Thus, individuals who were highly fearful of COVID-19 perceived other people to be closer than they actually were and preferred to maintain a larger distance from them. The results suggest that subjective risk can lead to an increased perception of danger and a subsequent change in behavior. Taken together, even when behaviors should logically change, the decision-making process can be based on distorted perceptions. This insight may be used to predict public compliance.

COVID-19 Vaccine Confidence Mediates the Relationship between Health Literacy and Vaccination in a Diverse Sample of Urban Adults

We sought to analyze the relationship between health literacy, confidence in COVID-19 vaccines, and self-reported vaccination. We hypothesized that the relationship between health literacy and vaccination would be mediated by vaccine confidence. We recruited (N = 271) English- and Spanish-speaking adults in Boston and Chicago from September 2018 to September 2021. We performed a probit mediation analysis to determine if confidence in COVID-19 vaccines and health literacy predicted self-reported vaccination. We hypothesized that the relationship between health literacy and vaccination would be mediated by vaccine confidence. Participants were on average 50 years old, 65% female, 40% non-Hispanic Black, 25% Hispanic, and 30% non-Hispanic White; 231 (85%) reported at least one COVID-19 vaccination. A higher mean vaccine confidence score (t = -7.9, p < 0.001) and higher health literacy (t = -2.2, p = 0.03) were associated with vaccination, but only vaccine confidence predicted vaccination in a multivariate model. Vaccine confidence mediated the relationship between health literacy and COVID-19 vaccination (mediated effects: 0.04; 95% CI [0.02, 0.08]). We found that using a simple tool to measure vaccine confidence identified people who declined or delayed COVID-19 vaccination in a diverse sample of adults with varying levels of health literacy. Simple short survey tools can be useful to identify people who may benefit from vaccine promotion efforts and evidence-based communication strategies.

Examining outpatients' hand hygiene behaviour and its relation to COVID-19 infection prevention measures

BACKGROUND

The increasing demand for outpatient care is associated with a higher risk of infection transmission in these settings. However, there is limited research on infection prevention and control practices in ambulatory clinics, and none focuses on patients.

AIM

To examine outpatients' hand hygiene behaviours, their determinants, and their associations with other infection prevention measures during the COVID-19 pandemic.

METHODS

We observed the hand hygiene behaviour of one cohort of patients in one outpatient clinic and surveyed a separate sample in five clinics about their hand hygiene practice in outpatient facilities. A questionnaire based on the Theoretical Domains Framework (TDF) was used to examine predictors of the behaviour. Moreover, patients indicated their compliance with COVID-19 infection prevention measures, vaccination status, disease risk perception, and vaccine hesitancy.

FINDINGS

Observed hand hygiene rates among 618 patients were low (12.8%), while 67.3% of the 300 surveyed patients indicated sanitizing their hands upon entering the clinic. The TDF domains 'memory, attention, and decision processes' and 'emotions' significantly predicted both current (today's) and general hand hygiene behaviour in outpatient clinics. Hand hygiene behaviour and compliance with COVID-19 infection prevention showed a positive association; however, no significant connection was found with patients' vaccination status, suggesting different behavioural motivators.

CONCLUSION

Hand hygiene among outpatients should be improved through interventions focusing on helping patients remember to clean their hands. More research on infection prevention in outpatient facilities is needed to ensure patient safety.

The Potential Risk Compensation after Receiving HPV Vaccination among Men Who Have Sex with Men in Southwest China: A HAPA-Based Analysis

Background: men who have sex with men (MSM) are a high-risk group for human papillomavirus (HPV) infection, and the HPV vaccine is effective in preventing it. However, according to risk compensation theory, people may increase sexual risk behaviors after receiving HPV vaccination. Based on the Health Action Process Approach (HAPA), this study investigated the influencing factors to predict intention to reduce condom use (risk compensation intention) among MSM after taking HPV vaccination in southwest China. Methods: we conducted a cross-sectional study among 948 MSM in southwest China using a non-probability sampling method and an electronic questionnaire including sociodemographic characteristics, sexual risk behavior characteristics, HPV-related prevention behavior, and the HAPA scale. Confirmatory factor analysis was performed using a structural equation model. Results: among 948 MSM, the incidence rate of reducing the frequency of condom use was 14.1%. The structural equation model showed that self-efficacy (β = -0.378, p = 0.020) and positive outcome expectancy (β = 0.366, p < 0.05) had greater effects on behavioral intention, followed by negative outcome expectancy (β = -0.296, p < 0.05) and risk perception (β = -0.232, p < 0.05). Conclusions: risk compensation may not be a major barrier to receiving HPV vaccination among MSM. Nevertheless, the recognition of possible risk compensation is necessary to implement appropriate interventions to reduce the occurrence of risk compensation.

Applicability of risk compensation to the relationship between health behaviors and COVID-19 vaccination among inpatients in Taizhou, China

Aim

Based on the risk compensation theory, this study was designed to investigate the relationship between health behaviors of inpatients and COVID-19 vaccination during the epidemic with regard to the Omicron variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Taizhou, China.

Subject and methods

We conducted an online self-administered survey with a group of inpatients in a grade III, class A hospital in Taizhou, China, from February 27, 2022, to March 8, 2022. A total of 562 complete questionnaires were collected, and 18 questionnaires completed in under 180 seconds were rejected, leaving a total of 544 (96.8%) valid questionnaires collected. The participants who had received a COVID-19 vaccine were asked to describe the differences in their health behaviors before and after the vaccination, and the data were analyzed using SPSS Statistics version 22.0 software.

Results

There were significant differences in the percentage of individuals wearing masks (97.2% and 78.9%, P < 0.001) and the percentage of hand washing after taking off the mask (89.1% and 63.2%, P < 0.001) between the inoculated group and the uninoculated group; however, there were no significant differences in other health behaviors. The participants showed better health behaviors (handwashing and wearing a mask) after the vaccination than prior to it.

Conclusions

Our findings suggest that the Peltzman effect did not increase risk behaviors during the Omicron epidemic. There was no reduction in health behaviors among inpatients after the COVID-19 vaccine, which may have even improved their health behaviors.

An examination and extension of the Peltzman effect during the Covid-19 pandemic

Since the first COVID-19 case was confirmed in Germany, the German government has introduced various measures to counteract the pandemic. The implementation of safety measures can have counterproductive effects: people engage in risk compensatory behavior (fewer safety behaviors) after regulations are introduced and obligated by the government, which is known as the Peltzman effect (Peltzman, 1975). Based on the Peltzman effect, the researchers of this study hypothesized that people complied less with safety behaviors and took more health risks (e.g. keep less distance) after the implementation of more stringent COVID-19-related regulations (quarantine obligation and face mask duty) between the two measurement periods of this study. They also extended the Peltzman model by hypothesizing moderating roles of age, gender, and perceived COVID-19 threat. Results of the longitudinal survey study (N = 989, T1: 26 March - 31 March 2020 and T2: 27 April - 4 May 2020) confirm that people indeed complied less with safety recommendations over time associated with strengthened COVID-19-related regulations. Perceived COVID-19 threat to those in a person's surroundings (e.g. family, neighbors) had a positive impact on compliance, but age and gender had no effect. This extends the literature on the Peltzman effect by adding perceived COVID-19 threat as a new relevant construct, enabling the development of more effective safety preventions in the future.

Health Behaviours among Travellers Regarding Risk Compensation Following COVID-19 Vaccination in Taizhou, China

Background

During the COVID-19 pandemic, public transport was restricted in many countries because of the transmission risk. According to the risk compensation theory, travellers post-COVID-19 vaccination may encounter higher risks; however, no real-world studies provide such evidence. Therefore, we conducted a survey to assess whether risk compensation would occur among travellers' health-related behaviours after COVID-19 vaccination, potentially aggravating the transmission of the virus.

Materials and Methods

A self-administered online survey was designed and distributed over WeChat to identify the difference in health behaviours before and after COVID-19 vaccination among travellers at a train station in Taizhou, China, from 13 February to 26 April 2022.

Results

A total of 602 individuals completed the questionnaire. The results revealed no statistical difference between the health behaviours reported by the vaccinated and unvaccinated groups. Participants who received the first dose of the vaccine earlier showed no statistical difference in harmful health behaviours (hand washing frequency decreased by 4.1% (P=0.145) and the duration of public transport travel increased by 3.4% (P=0.437)), but showed better protective health behaviours (mask-wearing duration increased by 24.7% (P=0.014)). Compared to those vaccinated less than three times, participants vaccinated against COVID-19 three times showed no statistical differences in harmful health behaviours mask-wearing duration decreased by 7.0% (P=0.927), their hand washing frequency decreased by 4.8% (P=0.905), and the duration of public transport travel increased by 2.5% (P=0.287). After vaccination, when compared to themselves before vaccination, participants exhibited better health behaviours (increased hand washing frequency and mask-wearing duration, and decreased duration of public transport travel) to some extent.

Conclusion

In conclusion, this study found no evidence of risk compensation among travellers. After being vaccinated, health behaviours partly improved among travellers.

Challenges and opportunities in current vaccine technology and administration: A comprehensive survey examining oral vaccine potential in the United States

This study provides a snapshot of the current vaccine business ecosystem, including practices, challenges, beliefs, and expectations of vaccine providers. Our team focused on providers' firsthand experience with administering vaccines to determine if an oral vaccine (e.g. pill or oral-drop) would be well-received. We interviewed 135 healthcare providers and vaccine specialists across the US, focusing questions on routine vaccinations, not COVID-19 vaccines. Improving workflow efficiency is a top concern among vaccine providers due to shrinking reimbursement rates-determined by pharmacy benefit managers (PBMs)-and the time-intensiveness of injectable vaccines. Administering injectable vaccines takes 23 minutes/patient on average, while dispensing pills takes only 5 minutes/patient. An average of 24% of patients express needle-fear, which further lengthens the processing time. Misaligned incentives between providers and PBMs could reduce the quality and availability of vaccine-related care. The unavailability of single-dose orders prevents some rural providers from offering certain vaccines. Most interviewees (74%) believe an oral vaccine would improve patient-provider experience, patient-compliance, and workflow efficiency, while detractors (26%) worry about the taste, vaccine absorption, and efficacy. Additional research could investigate whether currently non-vaccinating pharmacies would be willing to offer oral vaccines, and the impact of oral vaccines on vaccine acceptance.