Internet Use, Risk Awareness, and Demographic Characteristics Associated With Engagement in Preventive Behaviors and Testing: Cross-Sectional Survey on COVID-19 in the United States

A Cross-Sectional Study of COVID-19 Knowledge, Attitudes, and Practices Among Black Communities in the Greater Toronto Area

INTRODUCTION AND BACKGROUND

COVID-19 preventative practices such as hand washing, social distancing, and mask wearing have been identified as ways to prevent the spread of COVID-19. However, social determinants can play a role in the ability of individuals and groups to adhere to recommended COVID-19 preventative practices. A cross-sectional study was undertaken to explore the COVID-19 knowledge, attitude, and practices (KAPs), and information sources used in the adult Black population within the Greater Toronto Area (GTA).

METHODS

An online questionnaire was completed by Black adults living in the GTA. Associations between KAPs, health literacy, and sociodemographic variables were assessed using descriptive tests. A multivariate logistic regression model was used to examine predictors of high preventative practices.

RESULTS AND ANALYSIS

Of the 169 respondents, most had high knowledge scores (80.5%), low attitudes (85.2%), and high COVID-19 preventative practices (82.2%). Hotspot status, working from home, and high health literacy were found to be independent predictors of high preventative practices.

CONCLUSION AND IMPLICATIONS

This study provides new knowledge that advances understanding of the COVID-19 KAPs of Black communities in a Canadian context. Our findings point to the inadequacy of current prevention strategies that focus narrowly on individual actions while overlooking the importance of systemic influences on health.

Association between trust in the incumbent president and COVID-19 preventive behaviors during the pandemic in four Latin American countries

The COVID-19 pandemic revealed disparities in policy responses in Latin America. We examined the association between trust in the president and COVID-19 preventive behaviors in Brazil, Chile, Colombia, and Mexico. We used data from the Collaborative COVID-19 Response Survey by the McDonnell Academy at Washington University in St. Louis (United States), from September 2020 to March 2021. Nonprobabilistic sampling included adult citizens from the four countries. Multivariate negative binomial regression models were applied. The study included 8,125 participants, with Brazil showing the lowest adherence to preventive behaviors (65.5%). Increased adoption of preventive behaviors was linked with ages 18-26 (aIRR = 1.05; 95%CI: 1.01-1.09), 60 or more (aIRR = 1.10; 95%CI: 1.05-1.15), and high socioeconomic status (aIRR = 1.09; 95%CI: 1.05-1.13). Decreased engagement was linked to participants from Brazil (aIRR = 0.74; 95%CI: 0.71-0.78), Mexico (aIRR = 0.95; 95%CI: 0.92-0.99), basic education (aIRR = 0.75; 95%CI: 0.68-0.84), intermediate education (aIRR = 0.88; 95%CI: 0.85-0.91), low socioeconomic status (aIRR = 0.91; 95%CI: 0.87-0.94), lack of concern about contracting COVID-19 (aIRR = 0.93; 95%CI: 0.88-0.98), and poor knowledge about COVID-19 (aIRR = 0.92; 95%CI: 0.88-0.96). No significant association was found between trust in the president and preventive behaviors. Targeted communication, public education, and improved access to reliable information are crucial for fostering preventive behaviors. Public health practitioners should not overly concern themselves with political rhetoric, as our study suggests that trust in political authorities may not systematically affect compliance with directives.

"Searching for equity: White normativity in online skin cancer images"

In this paper, we examine the range of skin tones represented in publicly available online image search results through which non-medical audiences might seek information about skin cancer signs, symptoms, and risks. We use the Fitzpatrick scale, a numerical classification system grouping six human skin tones (or "phototypes") in dermatology, as a guide for analyzing the skin tones appearing in (n = 1600) Google image search results for search terms related to skin cancer. We find that light skin tones (1,2, and 3 on the Fitzpatrick scale) comprise the significant majority (roughly 96%) of those depicted in Google image searches of information about skin cancer signs and prevention; dark skin tones (4, 5, and 6 on the Fitzpatrick scale) appear with significantly less frequency (roughly 4%) in the same search results. Disparate representation of diverse skin tones-and, more specifically, omission of dark skin images-suggests that racial biases inflect the search results generated by seemingly race-neutral skin-cancer related search terms. This embedded racial bias privileges white normativity to the disadvantage of dark-skinned patients, who are most likely to be racially classified as Black.

Association between e-health literacy and perceived importance of future pandemic preparedness in sub-saharan Africa

INTRODUCTION

Emerging and re-emerging infectious diseases continue to pose a severe threat to public health in Sub-Saharan Africa (SSA) and globally. Community-related interventions, such as community e-Health literacy, can contribute to the preparedness to respond effectively to emerging and re-emerging infectious diseases. This study investigated the relationship between e-Health literacy and SSA countries' perceptions of the importance of readiness for potential pandemics.

METHOD

This cross-sectional study was conducted in sub-Saharan African countries (Nigeria, Rwanda, Burundi, and South Africa) among adults aged 18 years and above between July 2020 and August 2021, respondents were recruited through a non-probability sampling technique. Participants were asked to self-report the perceived importance of 13 items on future pandemic preparedness scored on a 5 Likert-point scale. The four key dimensions of pandemic preparedness were online medical consultation, online courses, messaging for healthcare, and shopping. E-Health literacy was the key exposure. The questionnaire was adapted from a previously validated e-Health literacy scale. Data was collected through a self-administered questionnaire online. Data analysis was done using Stata and descriptive statistics including frequency, proportions, means, and standard deviation were used to summarize variables. Inferential statistics including chi-square and logistic regressions were used to test the significance of association between e-health literacy and pandemic preparedness setting the level of significance at 5%.

RESULTS

A total of 1295 people participated in this study. Roughly half of all participants, 685 (52.90%), were aged between 18 and 29 and 685 (52.90%) were females. The standardised average (SE) e-Health literacy score was 29.55 (0.19). Shopping was perceived as the most important dimension of pandemic preparedness across participating countries (mean (SE) of 3.32 (0.06) and above across all countries for online shopping), while online medical consultation was the least perceived as important (mean (SE) of 2.88 (0.08) or less in two countries for instant health advice from chatbot). In the fully adjusted model, e-Health literacy was associated with 8 out of 13 items of the perceived importance of the pandemic preparedness questionnaire. Those include online consultation with doctors (OR = 1.11, 95% CI 1.02-1.21), telephone health advice (OR = 1.07, 95%CI 1.00-1.15), medicine delivery (OR = 1.04, 95% CI 1.03-1.06), getting medicine prescribed in a hospital visit/follow-up in a community pharmacy (OR = 1.07, 95% CI 1.05-1.10), receiving health information via email (OR = 1.08, 95% CI 1.01-1.17) and via social media (OR = 1.08, 95% CI 1.03-1.14), online shopping (OR = 1.07, 95% CI 1.03-1.11) and instant streaming courses (OR = 1.09, 95% CI 1.02-1.16).

CONCLUSIONS

The higher e-Health literacy scores were associated with a higher perception of most elements as important in future pandemic readiness. Strengthening e-Health literacy can be a key element of the preparation for pandemics in SSA countries.

Predictors of older adults' health behaviours to prevent COVID-19 transmission: a multilevel analysis

OBJECTIVES

While older adults showed higher mortality during COVID-19 pandemic, protective behaviours (knowledge regarding coping with COVID-19 symptoms and preventive behaviours) were highlighted to be important to prevent the spread of infection. This study aimed to identify individual and community-level variables influencing deficient knowledge regarding coping with COVID-19 and not-practicing COVID-19 of older adults during the pandemic.

DESIGN

This is a secondary analysis of a cross-sectional study using the 2020 Korea Community Health Survey (KCHS).

SETTING

255 community public health centres nationwide, South Korea.

METHODS AND ANALYSIS

Using 2020 KCHS data, multilevel logistic regression analysis was conducted on 55 005 adults aged 65 years or older.

RESULTS

Older adults who reside alone, as opposed to with their spouse and who lack the support of another individual exhibited insufficient COVID-19 coping-related knowledge (OR: 1.142, p<0.001) and poor preventive behaviours (OR: 1.177, p<0.001). Furthermore, lower municipal social welfare budget levels were associated with worse health behaviours (OR: 0.062, p<0.001). Specifically, older adults living in rural areas were less likely to engage in COVID-19 preventive behaviours compared with those in urban areas (OR: 1.247, p<0.001). Additionally, the effectiveness of mass media as a motivating factor for adopting preventive measures was only significant in rural populations (OR: 0.944, p<0.05).

CONCLUSIONS

Both individual-level and community-level approaches are necessary as an initial response during the pandemic. Since elderly people living alone with low socioeconomic status are vulnerable groups with poor health behaviours, it is helpful to provide social support on how to respond to infectious diseases and manage symptoms. In addition, it is important to expand the municipal social welfare budget to promote health equity between regions through appropriate health behaviour education and the strengthening of public medical services.

Preventive health behaviour differences across racial groups during the early stages of COVID-19

Background

Throughout the COVID-19 pandemic, the practice of preventative health behaviours had been used disparately across different racial groups. This study seeks to identify any differences in preventative health behaviours across racial groups, controlling for other socio-demographic factors.

Methods

A US national survey study was electronically conducted from July through November 2020, to measure racial/ethnic differences in health preventive behaviours about COVID-19. We performed 2-part regression models to assess whether preventive health behaviours differed by race and ethnicity. Specifically, we employed generalized logistic regressions for investigating the predictors of the use of complementary or alternative medicine (CAM), or stay-at-home strategy, then performed ordinal logistic regression to examine the predictors of social distancing, face mask wearing, and hand hygiene strategy practice.

Results

The results show that non-White respondents were more likely to practice social distancing, mask wearing, and hand hygiene strategy to prevent COVID-19, compared to their White counterparts. Additionally, the findings indicate that individuals who experienced COVID-19-related racial abuse or depression had a higher likelihood of practicing preventive health behaviours.

Discussion

We found ethnicity can be a predictor of health preventive behaviours, in accordance with previous research. The causes of these disparities will require further investigation in order to be addressed.

Association between Health Literacy and Self-care Behaviors with Traditional Thai Medicine during the COVID-19 Pandemic

Background

Health literacy is a multidimensional concept that can lead to changing self-care behaviors.

Objective

This study aimed to assess health literacy, self-care behaviors, and factors related to self-care behaviors in traditional Thai medicine during the COVID-19 pandemic.

Methods

This cross-sectional study included 422 participants. The questionnaire consisted of sociodemographic characteristics, health literacy of traditional Thai medicine with COVID-19, and self-care behavior with traditional Thai medicine in relation to COVID-19. The data were analyzed using descriptive statistics, independent-sample test, one-way ANOVA, and Pearson's correlation coefficient.

Results

The mean score for communication to promote health was high (34.6±8.4). The mean score of overall health literacy was moderate (156.8±20.7), followed by self-care behavior (45.6±6.0), access to health information and services (30.5±5.2), and health knowledge and understanding (26.7±2.6). Pearson correlation coefficient analysis showed that there were significantly positive self-care behaviors, namely, access to health information and services (P-value < 0.001), communication to promote health (P-value < 0.001), media and information literacy (P-value < 0.043), and overall health literacy (P-value < 0.003), while informed decision-making was significantly negatively associated with self-care behaviors (P-value < 0.004).

Conclusion

Increasing overall health literacy and each dimension was associated with self-care behaviors. The findings suggest that interventional programs to develop health literacy are required to improve self-care behaviors.

Preventive behaviors and psychological effects of COVID-19 and their associated factors among Iranian older adults: A cross-sectional study

BACKGROUND

The spread of the coronavirus disease 2019 (COVID-19) pandemic caused a variety of psychological complications. One way to control the spread of this pandemic is compliance with health protocols and standards. Considering the limited research into the psychological effects of COVID-19 and the preventive behaviors among older adults, this study aimed to determine these variables and their relationship with associated factors.

MATERIALS AND METHODS

This cross-sectional study was conducted on 153 older adults who were referred to the clinic of Pirouz Hospital in the east of Guilan, in the north of Iran, in 2022. The research instruments included the Impact of Event Scale-Revised (IES-R) and the preventive behavior questionnaires. Descriptive (mean, standard deviation, frequency, and percentage) and inferential (Kruskal-Wallis and Mann-Whitney tests) statistics were used to analyze the data using Statistical Package for the Social Sciences (SPSS) software version 20 with a significant level of 0.05.

RESULTS

The findings showed that the overall mean score for preventive behaviors was 107 ± 10.38. The highest mean score of preventive behaviors was related to personal behavior (43.00 ± 5.58) and instructions to enter the house (30.15 ± 4.84), respectively. The highest mean scores of psychological effects were related to the intrusion dimension (11 ± 5.33) and avoidance dimension (7 ± 4.74), respectively. There was a significant relationship between drug use (F = 27.136, P = 0.028) and the psychological effects of COVID-19.

CONCLUSION

Based on the results, the general condition of the preventive behaviors of older adults was average, and the majority of them were at a normal level of psychological effects. However, administrators and health policymakers should consider planning to develop interventions to encourage and improve preventive behaviors against COVID-19, especially among older adults during the COVID-19 pandemic.

The relationship between young college students' recognition of national COVID-19 crisis governance capabilities and the improvement of national identity: the mediating role of online participation in public health critical events

Background

Improving the young college students' national identity is crucial for ensuring social stability and fostering development during public health critical events such as COVID-19. Young college students' recognition of national COVID-19 crisis governance capabilities can influence their national identity, and online participation in public health criticalevents may serve as a crucial role in shaping this intricate relationship. To investigate this possibility, the present study established an intermediary model to examine the impact of online participation in public health critical events on young college students' recognition of national COVID-19 crisis governance capabilities and improvement of national identity.

Methods

This cross-sectional survey study employed a convenience sampling method to investigate a total of 3041 young college students in China. The correlations between study variables were analyzed using Spearman's rank correlation. The mediation model was established using PROCESS Model 4 with 5000 bootstrap samples in SPSS. The bias-corrected bootstrap method provided statistical efficacy and identification interval estimation.

Results

Young college students' recognition of national COVID-19 crisis governance capabilities (r=0.729, P<0.001) and online participation in public health critical events (r=0.609, P<0.001) were positively correlated with improvement of their national identity. The relationship between these two factors was partially mediated by online participation in public health critical events (Indirect effect estimate=0.196, P<0.001).

Conclusion

Online participation in public health critical events played a mediating role in the association between college students' recognition of national COVID-19 crisis governance capabilities and the improvement of national identity. Our findings provide a novel intervention strategy for improving college students' national identity, which is to encourage their online participation in public health critical events.

Protective behaviors against COVID-19 and their association with psychological factors in China and South Korea during the Omicron wave: a comparative study

OBJECTIVES

We aimed to explore the level of protective behaviors against COVID-19 and its association with psychological factors in China and South Korea during the Omicron wave.

STUDY DESIGN

Cross-sectional study.

METHODS

We conducted a population-based cross-sectional survey from March 15 to 30, 2023 in China and South Korea. Demographic characteristics, health status, protective behaviors, and psychological factors (including perceived risks, efficacy belief, attribution of disease, fear of COVID-19, trust and evaluation, fatalism, resilience, and pandemic fatigue) were investigated. After adjusting for sociodemographic and health-related factors, multivariable regression models were constructed to explore the psychological influencing factors of protective behavior.

RESULTS

A total of 3000 participants from China and 1000 participants from Korea were included in the final analysis. The mean performance score for protective behaviors among all respondents was 2.885 in China and 3.139 in Korea, with scores ranging from 1 to 4. In China, performance scores were higher in those who were female, aged 30-39, employed, married, living in urban areas, having the highest income level, having the best subjective health status, and having a history of chronic disease (P-value <0.05). In Korea, performance scores were higher for individuals who were female, over 50 years old, educated to high school or below, unemployed, married, had a history of chronic disease, and had never been infected with SARS-CoV-2 (P-value <0.05). In the multivariable regression model, perceived severity (β = 0.067), attribution of disease (β = 0.121), fear of COVID-19 (β = 0.128), trust and evaluation (β = 0.097), psychological resilience (β = 0.068), and efficacy belief (β = 0.216) were positively associated with the performance scores, pandemic fatigue (β = -0.089) was negatively associated with performance scores in China (P-value <0.05). However, in Korea, perceived susceptibility (β = 0.075), fear of COVID-19 (β = 0.107), and efficacy belief (β = 0.357) were positively associated with protective behaviors (P-value <0.05), trust and evaluation (β = -0.078) and pandemic fatigue (β = -0.063) were negatively associated with performance scores (P-value <0.05).

CONCLUSIONS

Populations in both China and Korea demonstrated great compliance with protective behaviors during the Omicron wave. Because of the sociocultural, economic, and political differences, there were differences in the association between psychological factors and protective behaviors in the two countries. This study, from the perspective of psychological factors in different cultural contexts, would provide references for increasing adherence to protective guidelines in future outbreaks of emerging infectious diseases.

Association of COVID-19 preventive behavior and job-related stress with the sleep quality of healthcare workers one year into the COVID-19 outbreak: a Japanese cross-sectional survey

BACKGROUND

This study aimed to evaluate the association of COVID-19 preventive behavior and job-related stress with sleep quality among healthcare workers (HCWs). We conducted a cross-sectional survey using a questionnaire at the National Center of Neurology and Psychiatry, Tokyo, Japan.

METHODS

A total of 586 participants who completed the questionnaire were eligible for the study. The Pittsburgh Sleep Quality Index was used to evaluate sleep quality. We examined the level of engagement between poor sleep and COVID-19-related infection preventive behaviors, such as avoiding closed spaces, crowded places, and close contact (three Cs), a distance of at least one meter from others, wearing a face mask regularly, washing hands regularly, and working remotely, as well as job-related stress in the work environment, exposure to patients, potential risk of infection, fear of infecting others, need for social confinement, and financial instability. We conducted a hierarchical logistic regression analysis to examine the relationship between poor sleep and COVID-19 preventive behavior, job-related stress, and other covariates, including age, sex, and the Kessler Psychological Distress Scale (K6), which was used to measure non-specific psychological distress.

RESULTS

Poor sleep was observed in 223 (38.1%) participants. Adherence to COVID-19 preventive measures was relatively high: 84.1% of participants answered "always" for wearing a face mask regularly and 83.4% for washing hands regularly. In the multivariate logistic regression analysis, stress in the work environment (odds ratio [OR] = 2.09, 95% confidence interval [CI], 1.37-3.20; p < 0.001), financial instability (OR = 1.73, 95% CI, 1.12-2.67; p < 0.05), and low adherence to working remotely (OR = 1.65, 95% CI, 1.06-2.57; p < 0.05) were independently and significantly associated with poor sleep after controlling for the covariates.

CONCLUSIONS

One year into the COVID-19 pandemic, the poor sleep rates of HCWs remained high. These results emphasize the need to protect HCWs from work environment stress and financial concerns.

County-Level Mandates Were Generally Effective At Slowing COVID-19 Transmission

Throughout the COVID-19 pandemic in the US, counties adopted numerous nonpharmaceutical interventions, such as mask mandates and stay-at-home orders, to slow COVID-19 transmission and prevent hospitals from reaching full capacity. Early evidence has been mixed about whether these interventions are effective. However, most studies only covered the early waves of COVID-19 and did not account for county-level variation in the adoption and repeal of such policies. Using daily county-level data from the Centers for Disease Control and Prevention, we evaluated the joint impact of bans on large gatherings, stay-at-home orders, mask mandates, and bar and restaurant closures on slowing COVID-19 transmission during waves 1-4 of the pandemic in the US (March 1, 2020-June 30, 2021). Our survival analysis showed that these interventions were generally effective at slowing COVID-19 transmission during this period. The mitigating effect was particularly strong during waves 2 and 3 and less substantial during waves 1 and 4. We also found strong evidence of the overall protective effect of mask mandates and, to a lesser degree, anticongregation policies. These study findings provide crucial evidence for public health officials to reference for support when using nonpharmaceutical interventions to flatten the curve of future waves of COVID-19 or other infectious disease outbreaks.

Explaining differences in self-focused and other-involved public health preventive behaviors between the US and China: the role of self- construal and health locus of control

Background

This study examined national similarities and differences in people's engagement in health preventive behaviors during a public health crisis, as well as investigated the underlying individual-level psychological mechanisms. A conceptual distinction was made between self-focused and other-involved preventive behaviors in response to public health crises.

Method

Two cross-sectional surveys were conducted in the United States (N = 888) and China (N = 844) during the early stage of the COVID-19 pandemic. Hayes' PROCESS was utilized to assess national differences in seven preventive behaviors, along with the mediating effects of self-construal and health locus of control.

Results

The results showed that American participants reported greater engagement in self-focused preventive behaviors than Chinese, whereas Chinese participants reported greater engagement in other-involved preventive behaviors than Americans. Chinese participants also engaged more in other-involved than self-focused preventive behaviors. Self-construal and health locus of control partially explained the observed differences in engagement in preventive behaviors.

Discussion

This study introduces a culture-sensitive approach to provide insights for crafting communication interventions that can enhance the effectiveness of health campaigns in the context of a public health crisis.

Factors Associated with Korean American Women's Health-Related Internet Use: Findings from Andersen's Behavioral Model

Literature suggests that access to health information improves health outcomes in various medical domains. This study investigated health-related Internet use levels and examined which factors influence health-related Internet use in Korean American women, grounded by Andersen's Behavioral Model. Participants included 243 Korean American women aged 19-85 years old residing in a Southeastern metropolitan area. Health-related Internet use was assessed by 11 items taken from HINTS 4 Cycle 2. Multiple regression analysis was conducted to reveal factors significantly associated with health-related Internet use of Korean American women. Predisposing factors of being aged 60 or older (β = - 0.329, SE = 0.694, p = 0.004) and employment status (β = 0.179, SE = 0.404, p = 0.037), as well as an enabling factor of having a primary care physician (β = 0.217, SE = 0.423, p = 0.013), were significantly associated with health-related Internet use. The differences in health-related Internet use may exacerbate disparities in access to healthcare services. The primary care physician's role is important in enhancing health-related Internet use. Research, policy, and programmatic attention are necessary to enhance physicians' encouragement and education for patients to use existing digital technology to improve their health and wellness.

COVID-19 related messaging, beliefs, information sources, and mitigation behaviors in Virginia: a cross-sectional survey in the summer of 2020

Background

Conflicting messages and misleading information related to the coronavirus (COVID-19) pandemic (SARS-CoV-2) have hindered mitigation efforts. It is important that trust in evidence-based public health information be maintained to effectively continue pandemic mitigation strategies. Officials, researchers, and the public can benefit from exploring how people receive information they believe and trust, and how their beliefs influence their behaviors.

Methods

To gain insight and inform effective evidence-based public health messaging, we distributed an anonymous online cross-sectional survey from May to July, 2020 to Virginia residents, 18 years of age or older. Participants were surveyed about their perceptions of COVID-19, risk mitigation behaviors, messages and events they felt influenced their beliefs and behaviors, and where they obtained information that they trust. The survey also collected socio-demographic information, including gender, age, race, ethnicity, level of education, income, employment status, occupation, changes in employment due to the pandemic, political affiliation, sexual orientation, and zip code. Analyses included specific focus on the most effective behavioral measures: wearing a face mask and distancing in public.

Results

Among 3,488 respondents, systematic differences were observed in information sources that people trust, events that impacted beliefs and behaviors, and how behaviors changed by socio-demographics, political identity, and geography within Virginia. Characteristics significantly associated (p < 0.025) with not wearing a mask in public included identifying as non-Hispanic white, male, Republican political identity, younger age, lower income, not trusting national science and health organizations, believing one or more non-evidence-based messages, and residing in Southwest Virginia in logistic regression. Similar, lesser in magnitude correlations, were observed for distancing in public.

Conclusions

This study describes how information sources considered trustworthy vary across different populations and identities, and how these differentially correspond to beliefs and behaviors. This study can assist decision makers and the public to improve and effectively target public health messaging related to the ongoing COVID-19 pandemic and future public health challenges in Virginia and similar jurisdictions.

Endorsement of COVID-19 misinformation among criminal legal involved individuals in the United States: Prevalence and relationship with information sources

Criminal legal system involvement (CLI) is a critical social determinant of health that lies at the intersection of multiple sources of health disparities. The COVID-19 pandemic exacerbates many of these disparities, and specific vulnerabilities faced by the CLI population. This study investigated the prevalence of COVID-19-related misinformation, as well as its relationship with COVID-19 information sources used among Americans experiencing CLI. A nationally representative sample of American adults aged 18+ (N = 1,161), including a subsample of CLI individuals (n = 168), were surveyed in February-March 2021. On a 10-item test, CLI participants endorsed a greater number of misinformation statements (M = 1.88 vs. 1.27) than non-CLI participants, p < .001. CLI participants reported less use of government and scientific sources (p = .017) and less use of personal sources (p = .003) for COVID-19 information than non-CLI participants. Poisson models showed that use of government and scientific sources was negatively associated with misinformation endorsement for non-CLI participants (IRR = .841, p < .001), but not for CLI participants (IRR = .957, p = .619). These findings suggest that building and leveraging trust in important information sources are critical to the containment and mitigation of COVID-19-related misinformation in the CLI population.

Knowledge and behaviors of prevention of COVID-19 and the related factors in the rural population referred to the health centers: a cross-sectional study

BACKGROUND AND OBJECTIVE

Observance of preventive behaviors is one of the main ways to break the coronavirus disease 2019 (COVID-19) chain of transmission. Therefore, the present study was conducted to determine the knowledge and behaviors of prevention of COVID-19 and the related factors in the rural population of Rasht city.

METHODS

In this cross-sectional study, 344 people of the population referred to health centers in Rasht city were included through multi-stage cluster random sampling. The data were collected using a three-part researcher-made questionnaire including individual-social factors, knowledge about the prevention of COVID-19, and the preventive behaviors against COVID-19. Data analysis was performed using the Kolmogorov-Smirnov and Shapiro-Wilk tests, Spearman's correlation coefficient, and multiple logistic regression analysis, by SPSS software version 16 at a significance level < 0.05.

RESULTS

The mean total score of knowledge about COVID-19 was at a moderate level, and the preventive behaviors of COVID-19 were at a good level. There was no significant relationship between the scores of awareness and preventive behaviors of COVID-19 (rs=0.001, P = 0.998). Awareness of COVID-19 was higher in university-educated individuals and women. Also, women, individuals who had access to the Internet, those trained by health centers, and those who were visited by health workers at home had more preventive behaviors.

CONCLUSION

Despite the lack of connection between knowledge and preventive behaviors, the villagers living in the suburbs of Rasht had a moderate level of knowledge and a good level of preventive behaviors of COVID-19. Appropriate educational interventions should be carried out to increase the awareness and performance of the rural residents.

Association of COVID-19 information media, providers, and content with vaccine uptake among Tokyo residents

To elucidate appropriate ways to induce behavior that prevents the spread of infection, we examined the association between COVID-19 vaccination and COVID-19-related information after more than 85% of the population had been vaccinated. Nonprobability quota sampling was used to recruit 2000 Tokyo residents as participants. The association between previous vaccine uptake and how much people thought they were affected by each of nine media, seven providers, and four content types of information was assessed using an online survey form. Subjective influence was assessed, and order logistic regression analyses were performed. We further calculated standardized partial regression coefficients for the independent variables. The results showed that while people did not think they were strongly affected by any COVID-19 information, significant positive associations between 9 of 20 variables, and significant negative associations between 7 of 20 variables were observed with vaccine uptake. The regression analysis involving the interaction terms between independent variables and sex showed a significant association between vaccine uptake and only daily conversation. Simple slope analysis showed a stronger positive association for females than for males. Regression analysis with interaction terms between each independent variable and age showed a significant association between vaccine uptake and print newspapers, social networking services, prefectural governors, family/relatives, accessibility, side effects, and supply visibility. Simple slope analysis also showed that the positive association between the subjective influence of newspapers and vaccine uptake was observed only for older people (≥69 years), and that of prefectural governors was more significant for older than younger people (≤32 years). In contrast, the trustworthy information provided by family/relatives was positively associated with vaccine uptake only for younger people. These results suggest that careful consideration must be given to the differences in age and sex to provide appropriate information that motivates Tokyo residents to receive vaccination during COVID-19 pandemic.

Understanding social risk factors of county-level disparities in COVID-19 tests per confirmed case in South Carolina using statewide electronic health records data

BACKGROUND

COVID-19 testing is essential for pandemic control, and insufficient testing in areas with high disease burdens could magnify the risk of poor health outcomes. However, few area-based studies on COVID-19 testing disparities have considered the disease burden (e.g., confirmed cases). The current study aims to investigate socioeconomic drivers of geospatial disparities in COVID-19 testing relative to disease burden across 46 counties in South Carolina (SC) in the early (from April 1, 2020, to June 30, 2020) and later (from July 1, 2020, to September 30, 2021) phases of the pandemic.

METHODS

Using SC statewide COVID-19 testing data, the COVID-19 testing coverage was measured by monthly COVID-19 tests per confirmed case (hereafter CTPC) in each county. We used modified Lorenz curves to describe the unequal geographic distribution of CTPC and generalized linear mixed-effects regression models to assess the association of county-level social risk factors with CTPC in two phases of the pandemic in SC.

RESULTS

As of September 30, 2021, a total of 641,201 out of 2,941,227 tests were positive in SC. The Lorenz curve showed that county-level disparities in CTPC were less apparent in the later phase of the pandemic. Counties with a larger percentage of Black had lower CTPC during the early phase (β = -0.94, 95%CI: -1.80, -0.08), while such associations reversed in the later phase (β = 0.28, 95%CI: 0.01, 0.55). The association of some other social risk factors diminished as the pandemic evolved, such as food insecurity (β: -1.19 and -0.42; p-value is < 0.05 for both).

CONCLUSIONS

County-level disparities in CTPC and their predictors are dynamic across the pandemic. These results highlight the systematic inequalities in COVID-19 testing resources and accessibility, especially in the early stage of the pandemic. Counties with greater social vulnerability and those with fewer health care resources should be paid extra attention in the early and later phases, respectively. The current study provided empirical evidence for public health agencies to conduct more targeted community-based testing campaigns to enhance access to testing in future public health crises.

Correlates of COVID-19 Preventative Behaviors before and after Vaccination Availability

As the COVID-19 pandemic progressed, various preventative behaviors and eventually vaccinations became available to decrease the spread of the virus. The current study examined a variety of variables (i.e., age, COVID-19-related economic hardship, interpersonal concern, personality, fear of COVID-19, normative beliefs, political beliefs, and vaccine hesitancy) to better understand predictors of preventative behaviors and vaccination status at different points throughout the pandemic. Online questionnaires, administered through Qualtrics, were used to collect data using two convenience samples. One was a small sample (N = 44) of non-student participants before the vaccine was readily available. The other sample (N = 274) included college student participants and occurred after the vaccine had been available to all participants. Results suggest that several variables (i.e., fear of COVID-19, normative beliefs, interpersonal concern, and openness) were consistent predictors of public health behaviors at both points in time and across differently aged samples. Other variables (i.e., agreeableness, extraversion, conscientiousness, and economic hardship) were less consistent with their relationships with public health behaviors. Implications related to both research and public health are discussed.

The impact of informal and formal care disruption on older adults' psychological distress during the COVID-19 pandemic in UK

This paper investigates how formal and informal caregiving disruptions-due to the U.K. government's non-pharmaceutical interventions (NPIs) aimed at reducing transmission of the SARS-CoV-2 virus-may have affected the likelihood of psychological distress among older individuals. We model the association between disruption of formal and informal care and mental health of the elderly during the first wave of the COVID-19 pandemic using a recursive simultaneous - equation model for binary variables. Our findings reveal that public interventions, which are most essential for reducing the pandemic spread, influenced the provision of formal and informal care. The lack of adequate long-term care following the COVID-19 outbreak has also had negative repercussions on the psychological well-being of these adults.

Factors associated with non-pharmaceutical interventions compliance during COVID-19 pandemic: a Portuguese cross-sectional survey

BACKGROUND

The use of non-pharmaceutical interventions (NPI) is one of the main tools used in the coronavirus disease 2019 (COVID-19) pandemic response, including physical distancing, frequent hand washing, face mask use, respiratory hygiene and use of contact tracing apps. Literature on compliance with NPI during the COVID-19 pandemic is limited.

METHODS

We studied this compliance and associated factors in Portugal, between 28th October 2020 and 11th January 2021 (Portuguese second and third waves of the pandemic), using logistic regressions. Data were collected through a web-based survey and included questions regarding NPI compliance, COVID-19-related concerns, perception of institutions' performance, agreement with the measures implemented and socio-demographic characteristics.

RESULTS

From the 1263 eligible responses, we found high levels of compliance among all COVID-19 related NPI, except for the contact tracing app. Females and older participants showed the highest compliance levels, whereas the opposite was observed for previously infected participants. There was heterogeneity of COVID-19 NPI compliance across Portuguese regions and a clear gradient between concern, government performance's perception or agreement and compliance.

CONCLUSIONS

Results suggested areas for further study with important implications for pandemic management and communication, for future preparedness, highlighting other factors to be accounted for when recommending policy measures during public health threats.

Differences in attitude toward COVID-19 based on internet and social media usage among community-dwelling older adults during the first state of emergency

AIM

In order to understand the digital divide among older adults during the coronavirus disease 2019 (COVID-19) pandemic, we investigated the association between internet use and compliance with COVID-19 preventive behaviors during the first state of emergency in Japan.

METHODS

A total of 8952 community-dwelling citizens aged 75 years and above were asked about their preventive behaviors during the first state of emergency using a paper-based questionnaire. Among them, 51% responded and were divided into internet users and non-users. We used multivariable logistic regression models to estimate the adjusted odds ratios and 95% confidence intervals of internet use for compliance with preventive behaviors.

RESULTS

Approximately 40% of the respondents used the internet, and 9.29% used social media to collect COVID-19-related information. Internet usage was independently associated with compliance with using hand sanitizers, avoiding going out, avoiding eating out, avoiding traveling, getting vaccinated, and getting tested for COVID-19; the adjusted odds ratios (95% confidence intervals) were 1.21 (1.05-1.38), 1.19 (1.04-1.37), 1.20 (1.05-1.38), 1.32 (1.15-1.52), 1.30 (1.11-1.53), and 1.23 (1.07-1.41), respectively. Exploratory subgroup analyses demonstrated that social media users might have shown early adaptation to newly recommended preventive behaviors during the first state of emergency.

CONCLUSIONS

Results suggest that a digital divide exists, as evidenced by the varied compliance with preventive behaviors depending on internet use. Additionally, social media use may be associated with early adaptation to newly recommended preventive behaviors. Therefore, future studies regarding the digital divide among older adults should investigate differences depending on the types and content of internet resources. Geriatr Gerontol Int 2023; ••: ••-••.

Understanding COVID-19 Risk Perceptions and Precautionary Behaviors in Black Chicagoans: A Grounded Theory Approach

OBJECTIVES

To determine whether actual community-level risk for COVID-19 in the Black community influenced individual perceptions of community-level and personal risk and how self-assessment of personal risk was reflected in the adoption of COVID-19 precautionary behaviors.

METHODS

Semistructured interviews were conducted with 20 Black Chicago adults from February to July 2021. A grounded theory approach was used for the qualitative analysis and initial, focused, and theoretical coding were performed.

RESULTS

We developed a grounded model consisting of four major themes: (a) Pre-Existing Health Conditions; (b) Presence of COVID-19 Infection in Participant Social Network; (c) COVID-19-Related Information, Participant Trust, and Perceived Personal Risk; and (d) Perceived Higher Burden of COVID-19 in the Black Community.

CONCLUSIONS

Higher perceptions of personal risk were shaped by pre-existing health conditions and experiences with COVID-19 in one's social network but were not influenced by perceived higher burden of COVID-19 in the Black community.

POLICY IMPLICATIONS

Black adults' perceptions of their individual risk and precautionary behaviors were not congruent with public health data and recommendations. Therefore, COVID-19 messaging and mitigation should be informed by local community engagement and transparent communication.

The roles of risk perception, negative emotions and perceived efficacy in the association between COVID-19 infection cues and preventive behaviors: a moderated mediation model

Preventive behaviors during the COVID-19 pandemic are especially critical to the protection of individuals whose family members or acquaintances have been infected. However, limited research has explored the influence of infection cues on preventive behaviors. This study proposed an interaction model of environment-cognitive/affective-behavior to elucidate the mechanism by which infection cues influence preventive behaviors and the roles of risk perception, negative emotions, and perceived efficacy in that influence. To explore the relationships among these factors, we conducted a cross-sectional online survey in 34 provinces in China during the first wave of the COVID-19 pandemic. A total of 26,511 participants responded to the survey, and 20,205 valid responses (76.2%) were obtained for further analysis. The moderated mediation results show that infection cues positively predicted preventive behaviors in a manner mediated by risk perception and negative emotions. Moreover, perceived efficacy moderated the influence of infection cues not only on preventive behaviors but also on risk perception and negative emotions. The higher the perceived efficacy, the stronger these influences were. These findings validated our model, which elucidates the mechanisms underlying the promoting effect of infection cues on preventive behaviors during the initial stage of the COVID-19 pandemic. The implications of these results for the COVID-19 pandemic and beyond are discussed.

Factors Influencing COVID-19 Prevention Behaviors

COVID-19 remains a public health emergency with prevention guidelines and mitigation strategies being constantly updated to curb the rapid spread of the disease. Despite proven successes of recommended preventive behaviors, there is low uptake of wearing a mask, washing of hands, and social distancing in the United States (US). The purpose of this study was to examine factors that influence COVID-19 preventive behaviors. We used data from the nationally representative COVID-19 Household Impact Survey (n = 19,815) conducted in the US from April to June 2020. Chi-square (χ2) test and bivariate analyses were performed to compare study participants who used all COVID-19 related preventive behaviors and those who did not, and multivariate logistic regressions to determine associations across demographic and social characteristics. Of the 19,815 participants, 79.2% of participants reported practicing the aforementioned COVID-19 preventive behaviors. Further, non-Hispanic white, Spanish speaking, living in urban areas, of older age (60+), being female, having an education above an undergraduate, those with income levels $100K or more, living in the urban northeast region that trust and communicate frequently with family and neighbors were more likely to use all three preventive behaviors. Findings suggest a need for continued provision of information on prevention and vaccination importance, but expand efforts to target adopters of these behaviors and encourage them to share their uptake and adherence efforts. This type of horizontal communication where information is shared within trusted social networks can shape social norms that influence the uptake of COVID-19 preventive behaviors and slowly curb communal spread.

Assessing Differences in Attitudes toward Occupational Safety and Health Measures for Infection Control between Office and Assembly Line Employees during the COVID-19 Pandemic in Germany: A Cross-Sectional Analysis of Baseline Data from a Repeated Employee Survey

In our study, we investigated possible differences across occupational groups regarding employees’ perceived work-related risk of infection with SARS-CoV-2, attitudes toward technical, organisational, and personal occupational safety and health (OSH) measures for infection control, and factors associated with this attitude. We analysed baseline data (10 August to 25 October 2020) from a repeated standardised online survey distributed at a worldwide leading global supplier of technology and services in Germany. 2144 employees (32.4% women; age (mean ± SD): 44 ± 11 years) who worked predominantly remotely (n = 358), at an on-site office (n = 1451), and assembly line/manufacturing (n = 335) were included. The work-related SARS-CoV-2 risk of infection differed between office employees working remotely and on-site (mean ± SD = 2.9 ± 1.5 vs. 3.2 ± 1.5; Mann-Whitney-U-Test: W = 283,346; p < 0.002; ε2 = 0.01) and between on-site office and assembly line/manufacturing employees (3.8 ± 1.7; W = 289,174; p < 0.001; ε2 = 0.02). Attitude scores toward technical OSH-measures differed between remote and on-site office (4.3 ± 0.5 vs. 4.1 ± 0.6; W = 216,787; p < 0.001; ε2 = 0.01), and between on-site office and assembly line/manufacturing employees (3.6 ± 0.9; W = 149,881; p < 0.001; ε2 = 0.07). Findings were similar for organisational and personal measures. Affective risk perception, COVID-19-specific resilience, and information about COVID-19-related risks were associated with the employees’ attitudes. To promote positive attitudes, it seems to be important to consider occupational-group-specific context factors when implementing OSH-measures for infection control.

Behavioral responses for facemask use messages to prevent COVID-19 among residents of Bahir Dar City, Ethiopia: an application of extended parallel process model

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic causes major morbidity and mortality in the world. Timely behavioral response assessment of the community is important to shape the next effective interventions and risk communication strategies to adopt preventive behavior. Hence, this study aimed to assess behavioral responses for facemask-use messages to prevent COVID-19 and its predictors among residents of Bahir Dar City, Ethiopia, 2021 by using the Extended Parallel Process Model.  METHODS: A community-based cross-sectional study was conducted with the guide of the Extended Parallel Process Model in Bahir Dar city from March 9 to April 9, 2021. A multistage sampling technique was used, and data was collected through a face-to-face interviewer-administered questionnaire using Epicollect5. Descriptive statistics and Binary logistic regression were computed using SPSS V.25. Variable with P < 0.25 in the bivariable analysis was a candidate for multivariable analysis to control confounding effect. In multivariable analysis, variables with P < 0.05 were considered statistically significant and the result was presented using an adjusted odd ratio (AOR) with a 95% confidence interval (CI).

RESULTS

A total of 616 participants with a response rate of 97.1% were included. Of the total participants, 229(37.2%) were in the danger control response. The behavioral response was affected by Occupational status [AOR (95%CI) 3.53(1.67-7.46)], the number of people living together [AOR (95%CI) 2.62(1.28-5.39)], self-control [AOR (95%CI) 1.14(1.05-1.25)], a friend for the preferred source of information [AOR (95%CI) 5.18(3.22-8.33)] and printed materials for the preferred channel [AOR (95%CI) 2.14(1.35-3.43)].

CONCLUSION

Above one-third of the participants were in the danger control response. Occupational status, number of people living together, self-control, a friend for the preferred source of information, and printed materials for the preferred channel were independent predictors of resident behavioral response to the use of facemasks. Policymakers should consider students and people who live alone. Message developers should use a friendly person to transmit messages and should prepare printed materials. Activities and strategies should also focus on self-control and perceived efficacy without ignoring the perceived threat.

Using core values and social influence to increase mask-wearing in non-compliant college students

Determining the best way to increase public health behaviors like mask-wearing in non-compliant individuals remains an important problem. In this two-part study, we examined the correlates of mask non-compliance in undergraduates at a selective East Coast university, and then developed an intervention designed to appeal to individuals with those traits. We found that being politically conservative and favoring the core values of respect for authority and in-group loyalty were associated with mask non-compliance. We then developed two novel public service announcement (PSA) videos. One featured peer campus leaders (e.g. the president of the College Republicans) to appeal to both social influence and the core values of authority and loyalty. The other featured national and local health care authorities. We found that (a) conservative students rated the two videos as equally authoritative, while liberal students rated the health authority PSA to be significantly more authoritative; (b) conservative participants significantly increased their self-reported mask-wearing rates compared to baseline, narrowing the gap in compliance substantially; and (c) the two PSAs were equally effective for conservative students at increasing mask-wearing. This study shows that public health interventions that target the values and beliefs associated with non-compliance may best influence behavior.

Socioeconomic correlates of face mask use among pedestrians during the COVID-19 pandemic: An ecological study

Background

Many countries have recommended using face masks for the general population in public places to reduce the risk of COVID-19 transmission. This study aimed to assess the effects of socioeconomic status on face mask use among pedestrians during the COVID-19 pandemic.

Methods

This cross-sectional study was conducted in Ahvaz, southwest Iran in August 2020. A total of 10,440 pedestrians have been studied from 92 neighborhoods of the city. Three socioeconomic indicators including Land price, Literacy rate, and the Employment rate for each neighborhood were used in this study. Analysis of Covariance and partial correlation coefficients were applied to assess the relationship between prevalence rates of mask usage and SES indicators.

Results

The mean ± SD age of the pedestrians was 32.2 ± 15.1 years. Of 10,440 observed participants, 67.9% were male. The overall prevalence of face mask usage was 45.6%. The prevalence of mask usage in older people and women was significantly higher than the others. The three assessed socioeconomic indicators were directly correlated to the prevalence of mask usage at individual and neighborhood levels.

Conclusion

We found that literacy had the strongest correlation with the prevalence of mask usage compared to the land price and employment rate among the three assessed SES indicators. Hence, it can be concluded that the social component of socioeconomic status has a greater effect on mask usage by people than the economic component of socioeconomic status.

Factors affecting face mask-wearing behaviors to prevent COVID-19 among Thai people: A binary logistic regression model

OBJECTIVES

Face mask wearing is a standard preventive measure, in addition to handwashing and physical distancing. Individuals may find that wearing a face mask protects their physical health and prevents viral transmission. However, none of the studies in Thailand identified factors associated with face mask-wearing behaviors among Thai people. Therefore, this study aims to determine factors affecting face mask-wearing behaviors to prevent COVID-19.

METHODS

This research is analytical survey research. The data used in this study were under the project title "The assessment of psychosocial and behavioral response and compliance to restriction measures to prevent and control COVID-19: A series of the rapid survey." A total of 6,521 people participated in an online survey by multi-stage sampling. Bivariate logistic regression analysis was used to examine the factors associated with face mask-wearing behaviors.

RESULTS

After adjusting for independent variables (i.e., gender, age, education, career, smoking, and comorbidity disease), the bivariate logistic regression analysis revealed that gender, age, and career were statistically significant to the face mask-wearing behaviors (p < 0.05). Level of education, smoking, and comorbidity disease were not statistically significant with face mask-wearing behaviors among Thai people.

CONCLUSION

Further study should explore broader on individual face mask perceptions and wearing in the continuing of COVID-19 across gender, age, and careers to better understand their health behaviors and to inform further policy. In addition, the development of an intervention to promote face mask wearing should target men who age below 30 yrs. and did not work in government services careers as this group of the population was likely not to wear a face mask outside the home.

Preventive Behaviors and Information Sources during COVID-19 Pandemic: A Cross-Sectional Study in Japan

BACKGROUND

individual preventive behaviors are one of the key measures needed to prevent the spread of COVID-19. This study sought to identify the factors associated with the adoption of COVID-19 preventive measures, focusing specifically on information sources.

METHODS

we conducted a nationally representative cross-sectional survey of 30,053 Japanese adults in February 2021. The survey asked about socioeconomic, health-related, and psychological characteristics, attitudes toward immunization, and the use of information sources regarding COVID-19. We have constructed multivariable logistic regression to estimate the factors associated with the adoption of three preventive measures: 3Cs avoidance, hand hygiene and respiratory hygiene.

RESULTS

socioeconomic variables, psychological variables, and the use of information sources are significantly associated with the adoption of preventive measures. The more information sources one uses, the more likely one is to adopt preventive measures. Trust in healthcare professionals is positively associated with adopting preventive measures. On the other hand, negative correlations between trust in social media and preventive behaviors were observed.

CONCLUSIONS

encouraging access to multiple information sources, utilizing communication channels, and modifying messaging according to target groups are essential to promote COVID-19 preventive measures.

Demographic and COVID Experience Predictors of COVID-19 Risk Perception among Chinese Residents in Canada

The current study aimed to identify demographic and COVID experience predictors for COVID-19 risk perception among Chinese residents in Canada. A final sample of 653 participants aged 18 and up completed an online survey in simplified Chinese during the peak of the first wave of COVID-19 (25 April-10 June 2020). After removing those with missing data on demographic covariates, as missing data cannot be imputed, 444 were included in the structural equation model, and COVID-19 risk perception was indexed by three outcome variables: self-infection risk perception (i.e., likelihood of personal infection of COVID-19); threat perception (i.e., whether the pandemic is a real threat); and future infection rate prediction (i.e., a latent variable for community, Ontario, Canada, and World infection rate predictions). Predictors included demographic (i.e., income, gender, education, age, household size, employment status, and life satisfaction) and COVID experience variables (i.e., personal connection with confirmed or suspected COVID-19 cases, self-isolation experience, perceived anti-Chinese discrimination, and confusion over COVID-19 information). In the structural equation model, we found increased risk perception for the following demographic and COVID experience predictors; women, relatively higher education, living alone, working in a medical field, lower in life satisfaction, having personal connection with confirmed or suspected COVID-19 cases, with perceived anti-Chinese discrimination, or showing high confusion over COVID-19 information.

The social ecology of COVID-19 prevalence and risk in Montreal, QC, Canada

This descriptive study examined the social ecology of COVID-19 risk exposure across Montreal (Quebec, Canada) by comparing fifteen neighborhoods with contrasting COVID-19 prevalence. Census 2016 data were combined with an online survey (n = 502) of residents living in the targeted neighborhoods. Chi-square and t-test were used to analyze the differences in sample proportions and means. As of October 1, 2020, compared to the least affected Montreal neighborhoods, the most Impacted neighborhoods had a 2.6 times higher COVID-19 prevalence (2370.9 active cases per 100,000 residents) and a 2.5 times higher death rate (260.6 deaths per 100,000 people). High prevalence neighborhoods were lower income, more highly racialized, denser, and had a larger share of public transit users than least affected neighborhoods. Compared with respondents from the least affected neighborhoods, survey respondents in high prevalence neighborhoods were more likely to report a lower income, hold at-risk occupations, live in apartment buildings, use public transit, and perceive themselves at risk of becoming infected with COVID-19 and less capable of avoiding COVID-19 transmission, but less likely to comply with stay-at-home recommendations. No significant differences between neighborhoods were found in terms of compliance with recommended COVID-19 hygiene preventive measures (mask wearing and hand washing). RESULTS: suggest that at-risk occupations and a lower capacity to avoid COVID-19 exposure, but not differences in compliance with public sanitary directives, were key factors associated with higher neighborhood prevalence of COVID-19.

Assessing the spatial variability of raising public risk awareness for the intervention performance of COVID-19 voluntary screening: A spatial simulation approach

The rapid spread of a (re)emerging pandemic (e.g., COVID-19) is usually attributed to the invisible transmission caused by asymptomatic cases. Health authorities rely on large-scale voluntary screening to identify and isolate invisible spreaders as well as symptomatic people as early as possible to control disease spread. Raising public awareness is beneficial for improving the effectiveness of epidemic prevention because it could increase the usage and demand for testing kits. However, the effectiveness of testing could be influenced by the spatial demand for medical resources in different periods. Spatial demand could also be triggered by public awareness in areas with two geographical factors, including spatial proximity to resources and attractiveness of human mobility. Therefore, it is necessary to explore the spatial variations in raising public awareness on the effectiveness of COVID-19 screening. We implemented spatial simulation models to integrate various levels of public awareness and pandemic dynamics in time and space. Moreover, we also assessed the effects of the spatial proximity of testing kits and the ease of human mobility on COVID-19 testing at various levels of public awareness. Our results indicated that high public awareness promotes high willingness to be tested. This causes the demand to not be fully satisfied at the peak times during a pandemic, yet the shortage of tests does not significantly increase pandemic severity. We also found that when public awareness is low, concentrating on unattractive areas (such as residential or urban fringe areas) could promote a higher benefit of testing. On the other hand, when awareness is high, the factor of distances to testing stations is more important for promoting the benefit of testing; allocating additional testing resources in areas distant from stations could have a higher benefit of testing. This study aims to provide insights for health authorities into the allocation of testing resources against disease outbreaks with respect to various levels of public awareness.

Using the Health Belief Model to Examine Adherence to Preventive Measures Among Nursing Students During COVID-19: A Cross-Sectional Analysis

Associations between health belief model constructs and engagement in COVID-19 preventive practices were examined in a population of 234 nursing students. Most (93 percent/68 percent, respectively) reported occasionally/frequently performing 6-feet physical distancing and wearing face masks/covering in public. Among health belief model constructs, perceived benefits were significantly associated with practicing physical distancing; perceived barriers were associated with lower likelihood. Perceived self-efficacy was associated with a greater likelihood of wearing face masks/covering in public. Nursing students should be provided timely and relevant information on preventive measures based on the recognition of different risk appraisals among students.

Impact of COVID-19 Awareness on Protective Behaviors during the Off-Peak Period: Sex Differences among Chinese Undergraduates

COVID-19 remains an extreme threat in higher education settings, even during the off-peak period. Appropriate protective measures have been suggested to prevent the spread of COVID-19 in a large population context. Undergraduate students represent a highly vulnerable fraction of the population, so their COVID-19 protective behaviors play critical roles in enabling successful pandemic prevention. Hence, this study aims to understand what and how individual factors contribute to undergraduate students' protective behaviors. After building multigroup structural equation models using data acquired from the survey taken by 991 undergraduates at a large research university in eastern China, I found that students' COVID-19 awareness was positively associated with their protective behaviors, such as wearing a mask, using hand sanitizer, and maintaining proper social distance, but not with getting vaccinated. In addition, I found students with higher COVID-19 awareness were more likely to have more COVID-19 knowledge than those with less awareness. Furthermore, sex differences were observed in the mediation effects of COVID-19 awareness on wearing a mask and getting vaccinated, via COVID-19 knowledge, respectively. The results of this study have implications in helping higher education stakeholders enact effective measures to prevent the spread of the pandemic.

COVID-19 preventive practice and associated factors in Ethiopia: A systematic review and meta-analysis

Objectives

COVID-19 is a global health concern due to its rapid spread and impact on morbidity and mortality. Implementing preventive measures plays an essential role in curbing the spread of COVID-19 infection. This study aimed to assess COVID-19 preventive practice and associated factors in Ethiopia.

Study design

This study was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.

Methods

Medline, PubMed, Scopus, Cochrane, EMBASE, African Journal Online (AJOL) and Science Direct search engines were used to identify relevant articles published up to early December 2021. The Joana Brigg's Institute (JBI) checklist was used for quality appraisal. A random-effect model was fitted to calculate the pooled estimates. Higgins I² statistics and Egger's test with funnel plots were analysed to check heterogeneity and publication bias, respectively. Due to significant heterogeneity, subgroup analysis by region, study population, study design and publication year, as well as sensitivity analysis, were done to assess the source of heterogeneity.

Results

The pooled level of poor preventive practice for COVID-19 in Ethiopia was 51.60% (95% confidence interval [CI]: 40.30-62.90). Poor COVID-19 preventive practice declined from 61% in studies published in 2020 to 45% in 2021. Lack of knowledge about COVID-19 (adjusted odds ratio [AOR] = 4.61 [95% CI: 2.49-10.73]), a negative attitude towards COVID-19 management (AOR = 2.64 [95% CI: 1.82-3.82]), rural residence (AOR = 2.95 [95% CI: 2.12-4.12]), a low educational level (AOR = 2.93 [95% CI: 2.16-3.98]) and being female (AOR = 1.75 [95% CI: 1.27-2.40]) were significantly associated with a poor level of COVID-19 preventive practice in Ethiopia.

Conclusions

The level of poor COVID-19 preventive practice in Ethiopia was relatively high. Poor COVID-19 prevention practices were significantly correlated with inadequate COVID-19 knowledge, a negative attitude towards COVID-19 management, low educational attainment, living in a rural area and being female. Creating awareness and health education programmes targeting COVID-19 prevention should be strengthened, especially in the target populations identified in this study.

Trust in social media and COVID-19 beliefs and behaviours

The study investigates the relationship between trust in social media and beliefs and preventive behaviours in the context of the COVID-19 pandemic. We surveyed 1008 respondents in South Africa to study how trust in social media relative to other information sources predicts perceived risk and adoption of preventive behaviours. Although engagement with and trust in social media do not predict less adoption of preventive behaviours, trusting information from social media more than information from mass media or scientists is associated with less risk perception from COVID-19 and reduces the adoption of preventive behaviours (including vaccines).

Assessing the impact of the COVID-19 pandemic among Venezuelan refugees and migrants in Colombia using respondent-driven sampling (RDS)

OBJECTIVES

To determine factors associated with adherence to COVID-19 mitigation measures, related symptoms and testing, as well as pandemic-related income loss among Venezuelan refugee and migrant adults in urban and border areas of Colombia.

DESIGN

Phone-based respondent-driven sampling SETTING: Bogotá and Norte de Santander, Colombia.

PARTICIPANTS

605 adult Venezuelan refugees and migrants residing in Bogotá (n=305) and Norte de Santander (n=300), who arrived in Colombia after 2014 and completed the survey in August and September 2020.

PRIMARY AND SECONDARY OUTCOME MEASURES

Full COVID-19 compliance (vs incomplete or no compliance), any COVID-19-related symptoms (vs none) and income loss due to isolation measures in Colombia (vs no income change or increase in income).

RESULTS

Older age was associated with lower odds of compliance with physical distancing measures (0.94, 0.90-0.99; p=0.01) for those in Bogotá. Nearly 15% of refugees and migrants in both locations (81 of 605) experienced at least one symptom consistent with COVID-19. Having a health condition was associated with higher odds of experiencing COVID-19-related symptoms in Bogotá (4.00, 1.22-13.06; p=0.02) and Norte de Santander (6.99, 1.95-24.99; p=0.003). Around 8% in both locations (48 of 605) were tested for COVID-19. Around 90% in both locations (537 of 605) had trouble earning an income after the introduction of isolation measures, and the median reported monthly income decreased by half in Bogotá and by 30% in Norte de Santander. A higher level of education (3.46, 1.02-11.75; p=0.05) was associated with higher odds of income loss among participants in Norte de Santander.

CONCLUSIONS

Results indicate high compliance with COVID-19 mitigation measures, low testing rates and high pandemic-related income loss among Venezuelan refugees and migrants in Colombia. This study provides insights into a hard-to-reach refugee and migrant population in Colombia; additional study on the effects of the pandemic on hidden populations is warranted.

Complexity awareness among university students in Switzerland during the Covid-19 pandemic

Public health challenges relating to Covid-19 are highly complex and reasons behind preventive measures can be difficult to understand. Complexity awareness, an important part of healthy literacy, may help young people to understand the situation and act accordingly. However, we could not find any tools to assess complexity awareness during a pandemic in the literature. The purpose of this study was to develop pandemic-specific items to assess complexity awareness and explore relationships with sociodemographic characteristics in university students. Based on critical health literacy concepts and expert knowledge from public health, we developed four survey items, which were answered by 3616 Swiss university students online as part of the COVID-19 International Student Well-Being Study. Relationships between awareness and sociodemographic characteristics were explored using logistic regression and odds ratio (OR). Results showed that 49.6% of the students demonstrated limited and 50.4% demonstrated high complexity awareness. Being female (OR = 1.26; 95% CI 1.07–1.47), having highly educated parents (OR = 1.29; 95% CI 1.06–1.57), and being at a practically oriented university (OR = 0.79; 95% CI 0.64–0.97) was associated with high awareness. Covid-19-related complexity awareness varied significantly among university students, indicating that they have difficulties in dealing with complex information and processes in this pandemic. The results call for action to support students in understanding the complexity of this pandemic and to investigate complexity awareness in the general population.

To know or not to know? Exploring COVID-19 information seeking with the risk information seeking and processing model

To cope with the COVID-19 pandemic and reduce uncertainty, the public needs accurate and timely information. Inspired by the risk information seeking and processing (RISP) model, this article discovers the significant predictors of individuals’ COVID-19 information-seeking intention and behaviour. Overall, 394 adult participants from 47 states completed this study’s online survey. The hierarchical regression analysis reveals that risk experience and informational subjective norms are the most substantial predictors of individuals’ online information-seeking behaviour about COVID-19. Information insufficiency did not predict information seeking, and participants tend to overestimate their knowledge about COVID-19. RISP variables tend to share power in explaining the variances of information-seeking behaviour. Moreover, both channel beliefs and perceived information gathering capacity moderate information insufficiency’s prediction of information-seeking intention. These findings will assist researchers in discovering the fundamental motivation of information seeking. This article can guide pragmatic interventions to reduce the public’s uncertainty and mitigate the risk.

Assessment of Health Literacy and Health Promoting Behaviors among the Urban Adult Population

Background

The main criteria of health determinants are Health Promoting Behaviors (HPBs) and Health Literacy (HL). This study aimed to assess HL and HPBs among the urban population of adults.

Methods

This study was conducted as a cross-sectional study with 379 adults in Iran. The inclusion criteria was that participants were randomly selected from health centers using health records. Data were collected by demographic information questionnaire, Health Literacy for Iranian Adults (HELIA) and Health Promoting Lifestyle Profile II (HPLP-II). Descriptive statistics, independent samples t-test, and Pearson's r correlation coefficient were used to analyze the data. Also, the hierarchical regression analysis was used to adjust for confounders.

Results

There was a significant association between HL and demographic factors, including age, gender and education level. HL dimensions were significantly correlated with HPBs of adults (p <0.05). Decision-making was the strongest HL dimension to predictive HPBs (β=0.606). In this study, 49.7% of the variation in HPBs is predicted by the HL, and the demographic characteristics.

Conclusions

It can be advantageous to design programs to promote HL and HPBs in adults, focusing on the aging group, gender, and education level.

A high level of vaccine knowledge increases people's behavioral risks for contracting COVID-19 in Japan

BACKGROUND

There has been no study in which the association between levels of vaccine knowledge and preventive behaviors was examined during the COVID-19 pandemic. We examined the transition to risky (transmission) behavior according to level of vaccine knowledge over a seven-month period when vaccines became widely available in Japan.

METHODS

A series of cross-sectional surveys were conducted using rapid online surveys of residents in Iwate Prefecture from December 4 to 7 in 2020 (the first survey) and from July 2 to 4 in 2021 (the fourth survey). We calculated each individual's risk of acquiring SARS-CoV-2 infection using a quantitative assessment tool (the microCOVID calculator). The respondents' level of knowledge regarding the COVID-19 vaccine was assessed by a questionnaire and was divided into four groups: very low level, low level, moderate level, and high level of vaccine knowledge.

RESULTS

People with a high-level knowledge about the vaccine had significantly higher odds ratios (ORs) of transitioning to high-risk behavior compared to people with a low level of vaccine knowledge (OR [95% confidence interval (CI)], 1.50 [1.17-1.93]; P = 0.001). There was a dose-response association according to the four levels of vaccine knowledge, while engagement in preventive measures in the first survey was not associated with high-risk behavior in the follow-up survey.

CONCLUSIONS

Since new variants of SARS-CoV-2 have evolved, policy makers should continue to communicate strong messages to keep a high level of consciousness and maintain basic preventive measures even after widespread vaccination.

Components Affecting the Promotion of COVID-19 Disease Prevention Behaviors among Iranian Students: A Qualitative Study by Using the PRECEDE Model

Background

COVID-19 is a social health problem. Several risk factors threaten students, and schools can provide a suitable environment for managing and performing health promotion programs. Given the extensive spread of the disease and the existence of multilevel components affecting the adoption of preventive behaviors, understanding the views and opinions of the audience about the barriers and facilitators affecting the behavior using qualitative studies can be one of the ways to have a successful intervention.

Materials and Methods

This was a qualitative study performed by a directed content analysis method while using the PRECEDE model (predisposing, reinforcing, enabling constructs in educational diagnosis and evaluation). In total, 38 individuals (teachers, parents, and students) were entered into the study using the purposive sampling method. Data were collected by semistructured interviews, and the implemented data were systematically classified into five stages (condensed meaning units, code, subcategory, category, and theme) and were arranged and analyzed.

Results

The findings are classified into three themes of predisposing, enabling, and reinforcing factors. In addition, perceived sensitivity, perceived intensity, mental beliefs, behavior outcome evaluation, and perceived power were considered as subcategories of predisposing factors, whereas normative beliefs and motivation for adherence to protocols were subcategories of reinforcing factors, and control beliefs were subcategories of enabling factors.

Conclusion

Our findings could be used as a guide to design educational interventions aiming at promoting COVID-19 prevention behaviors in schools.

Visiting parents in times of COVID-19: The impact of parent-adult child contacts on the psychological health of the elderly

Using the 8th wave of the SHARE and the SHARE Corona Survey, we investigated whether the disruption of parent-adult child contacts due to social distancing restrictions increased the symptoms of depression among old age individuals during the first wave of the COVID-19 pandemic. We model the relationship between the disruption of parent-adult child contacts and the mental health of the elderly using a recursive simultaneous equation model for binary variables. Our findings show that the likelihood of disruption of parent-adult child contacts was higher with adult children who do not live with or close to their parents (i.e., in the same household or in the same building) for whom contact disruption increases about 15 %. The duration of restrictions to movement and lockdowns also has a positive and significant effect on parent-child contact disruption: an additional week of lockdown significantly increases the probability of parent-child contact disruption, by about 1.5 %. The interventions deemed essential to reduce the spread of the pandemic, such as the "stay-at-home" order, necessarily disrupted personal parent-child contacts and the social processes that facilitate psychological well-being, increasing the probability of suffering from a deepening depressed mood by about 17 % for elderly parents.

Older Adults' Preventive Behaviors During COVID-19 Outbreak: Application of Multiple Disadvantage Model

This study explored older adults' preventive behaviors during the pandemic. A sample of 2982 community-dwelling older adults was extracted from the United States National Health and Aging Trends Study. Results showed that number of preventive behaviors was decreased with rundown neighborhood and age; but increased with Blacks, Hispanics, other ethnic minorities, income, female, number of persons in household, social cohesion, social network, family/peer support, severity of COVID-19 symptoms, and anxiety during COVID-19 outbreak. The study results imply that joint effort of government and ethnic minority advocacy groups in public health education should focus on preventive measures as well as racial disparities in health, and that rejuvenating rundown neighborhoods, promoting neighboring, providing stimulus checks and unemployment insurance, and maintaining connection with family and friends will promote preventive behaviors.

Risk Perception, Media, and Ordinary People's Intention to Engage in Self-Protective Behaviors in the Early Stage of COVID-19 Pandemic in China

Objective

This study aims to examine how risk perception is associated with engagement in preventative behaviors and testing during the COVID-19 pandemic in the early stage of the COVID-19 pandemic in China.

Methods

A cross-sectional survey was conducted in February 2020, eventually obtaining 1613 participants, participants'risk perceptions, demographics (sex, age, education level, marital status, and employment status), as well as their engagement in self-protective behaviors and testing were assessed.

Results

Risk perception significantly affected intention to engage in self-protective behaviors, the more risk people feel, the more likely they intend to take self-protective actions(β =0.0423; P < 0.01), and simultaneously, people obtaining information on COVID-19 from Official microblogs and public accounts(OMPA) (β =0.189; P < 0.01)and Online websites(OW) (β =0.143; P < 0.1)were more inclined to take self-protective behaviors during the COVID-19 pandemic. It also showed that the interaction of risk perception and Online websites negatively affected the intention to engage in self-protective behaviors(β = -0.0374; P < 0.05), and conversely, the interaction of risk perception and Overseas media(OM) positively affected self-protective intention(β = 0.0423; P < 0.1).

Conclusion

There was a close relationship between the risk perception and the intention to engage in self-protective behaviors. At the same time, the use of media not only directly affected the intention to engage in self-protective behaviors but also moderated the impact of risk perception on the self-protection intention. Specifically, official media directly strengthened the intention to engage in self-protective behaviors. Online websites not only directly affected self-protection intention but also moderated the effect of risk perception on it. Although overseas media had no direct effect on self-protection intention, they moderated the effect of risk perception on it. These conclusions have policy implications for governments' response to the COVID-19 epidemic.