Age-Related Differences in Experiences With Social Distancing at the Onset of the COVID-19 Pandemic: A Computational and Content Analytic Investigation of Natural Language From a Social Media Survey

Factors Affecting Adherence to Social Distancing among Adults Aged 19-44 Years: Insights from a Nationwide Survey during COVID-19 Pandemic

Background and Objectives: Before COVID-19 vaccinations became available, adhering to non-pharmaceutical interventions (NPIs), like social distancing (SD), wearing masks, and hand hygiene, were crucial to mitigating viral spread. Many studies reported that younger individuals were more reluctant to follow these measures compared with older ones. We hypothesized that it would be worthwhile to find factors that influenced SD compliance among young people during the pre-vaccination phase of a pandemic. Materials and Methods: We analyzed data of adults aged 19-44 from the 2020 South Korean Community Health Survey and compared socio-demographic, health-related behavioral, and psychological factors between compliant and non-compliant cohorts. Results: A total of 59,943 participants were enrolled and we found that older age groups (30-39 and 40-44) and safety concerns (such as viral infection, virus-related death, economic damage, and transmitting virus to vulnerable people) were significantly associated with adherence to SD. Conversely, participants who were not living with a spouse, were unable to stay at home despite symptoms, smoked, drank, and had a negative attitude toward government policy statistically correlated with non-compliance. Conclusions: In times when NPIs were the primary defense against the pandemic, it is essential to identify factors that positively or negatively affect individual compliance with them, especially among young people. Using a large-scale, well-designed national survey, we could gain insights into the early recognition of risk factors for non-compliance and appropriate follow-up interventions (i.e., education campaigns, clear communication of public guidelines, and implementation of guidelines), which will help people to avoid suffering from other waves of future infectious diseases.

Factors Associated With Negative Life Changes due to COVID-19 Among Older Adults Residing in an Urban Low-Income Neighborhood in Korea: Focused on Gendered Differences

This study examined negative life changes due to coronavirus disease of 2019 (COVID-19) and its correlates in a sample of community-dwelling older adults from a low-income urban city in Korea, focusing on gendered differences. Negative life changes due to COVID-19 were categorized into four domains: behavioral/physical, psychosocial, goal-seeking, and control/freedom. Being female, not receiving basic livelihood security, and dissatisfaction with housing situation were significantly associated with negative life changes during the pandemic. Gender-stratified analyses revealed that most within-gender social disparities associated with changes due to COVID-19 occurred in older women. The odds of experiencing negative changes were higher among working women and those receiving security income aid. In low-income urban communities, those who were previously socially and economically active perceived more negative changes owing to the pandemic. The contribution of gender to negative life changes should be considered to effectively alleviate concerns among older adults during pandemics.

The Role of Collective Group Orientation and Social Norms on Physical Distancing Behaviors for Disease Prevention

To reduce the impact of communicable diseases like COVID-19, collective action is required and likely to be susceptible to normative influence as well as whether people are more or less collectively oriented. We extend the theory of normative social behavior (TNSB) to account for group orientation and predict the relationships between social norms and physical distancing behaviors. Using a rolling cross-sectional design during 17 weeks of the pandemic, a national sample of US residents from 20 states (N = 8,778) participated in the study. The findings show that perceived descriptive norms, injunctive norms, and group orientation are significantly associated with physical distancing. The descriptive norm-behavior relationship and injunctive norm-behavior relationship are moderated by group orientation and the other predicted moderators in the TNSB. The findings extend the TNSB and highlight the need to understand social norms and group orientation in formative research for health communication campaigns designed to promote prevention behaviors.

Adaptive aspects of maximizing in times of COVID-19: coping efforts linking maximization to well-being

Introduction

Maximization, the tendency to make the best choices by thoroughly searching and comparing alternatives, has long been considered a negative correlate of well-being. However, recently, it was proposed that having a maximizing tendency can lead to better coping efforts in some stressful situations and thus could be more adaptive. The objective of the present research was to demonstrate positive features of maximization and identify the coping strategies that mediate the relationship between maximization and well-being during the COVID-19 pandemic.

Methods

A sample of 3,493 participants responded to an online survey from January 20 to October 11 of 2020. The 13-item Maximization Scale assessed individuals' maximizing tendency in terms of the maximization index and its three subdimensions (i.e., high standards, alternative search, and decision difficulty). The use of four coping strategies (i.e., preventive measures, cognitive appraisal, self-distraction, and social connection) during the COVID-19 pandemic was assessed. Hedonic and eudaimonic aspects of well-being were measured. We developed a mediation model and examined both whether there was an indirect link between maximization and well-being through the coping strategies and whether there was a direct link between maximization and well-being.

Results

Path analysis revealed negative direct associations between maximization measures (i.e., an index and three subdimensions) and well-being. In addition, significant indirect paths were found with varying directions depending on maximization dimensions and coping strategy types. There were positive indirect associations between the maximization index and well-being via preventive measures, between high standards and well-being through preventive measures and cognitive appraisal, and between alternative search and well-being through self-distraction and social connection. Negative indirect associations were found between decision difficulty and well-being through cognitive appraisal, self-distraction, and social connection.

Discussion

The current study confirmed the existence of inconsistent mediation effects between maximization and well-being via coping and highlighted coping efforts as one of the positive aspects of maximization. Discussion addressed the double-edged effect of maximization on well-being and its beneficial nature in times of distress. Future studies should examine other potential situations and moderators that can delineate maximization's various characteristics with a longitudinal design and samples from diverse backgrounds.

Emergency department visits of newly diagnosed cardiovascular disease patients in Korea during the COVID-19 pandemic

This study aimed to examine the impact of the COVID-19 pandemic on the emergency department (ED) visits of cardiovascular disease (CVD) patients. The customized data of the National Health Insurance Service (NHIS) from 2017 to 2020 were analyzed. CVD patients were defined by the code 'V192' based on the NHIS coverage benefit expansion policy. The number of ED visits of CVD patients, as well as executed procedures in 2020 (during the pandemic), were compared to the corresponding average numbers in 2018 and 2019 (prepandemic). Stratification by age group, residential area and hospital location was performed. The number of ED visits of newly diagnosed CVD patients decreased by 2.1% nationwide in 2020 (2018-2019: 97,041; 2020: 95,038) and decreased the most (by 14.1%) in March (2018-2019: 8539; 2020: 7334). However, the number of executed procedures increased by 1.1% nationwide in 2020 (2018-2019: 74,696; 2020: 75,520), while it decreased by 11.9% in April (2018-2019: 6603; 2020: 5819). The most notable decreases in the number of newly diagnosed CVD patients (31.7%) and procedures (29.2%) in March 2020 were observed in the Daegu·Gyeongbuk area. CVD patients living in the epicenter of the COVID-19 pandemic may experience difficulty accessing healthcare facilities and receiving proper treatment.

Hazardous drinking by older adults with chronic conditions during the COVID-19 pandemic: Evidence from a Chicago-based cohort

BACKGROUND

It is unclear how older adults with chronic conditions, who have greater risk of alcohol-related adverse outcomes, used alcohol throughout the COVID-19 pandemic. We assess changes in hazardous drinking prevalence May 2020-December 2021 and factors associated with hazardous drinking.

METHODS

Data are from structured phone interviews of older adults (age 60+) with chronic conditions (e.g., hypertension, diabetes, pulmonary disease, heart disease) in a Chicago-based longitudinal cohort (Chicago COVID-19 Comorbidities survey, Waves 3-7, n = 247). We tested differences in the prevalence of hazardous drinking (defined as AUDIT-C score of 3+ for women and 4+ for men) across waves for the full sample, by demographic group (sex, race, and ethnicity), and by chronic condition burden (<3 conditions, 3+ conditions). Generalized estimating equations investigated associations of hazardous drinking with sociodemographic and pandemic coping-related factors (stress, loneliness, outside contacts, depression, anxiety).

RESULTS

Participants were 66.8% female; 27.9% non-Hispanic Black, 14.2% Hispanic, 4.9% other race. Hazardous drinking was reported by 44.9% of participants in May 2020, but declined to 23.1% by July-August 2020 and continued to slowly decline to 19.4% by September-December 2021. Differences from May 2020 were significant at the 0.05 level. Subgroups followed similar trajectories. Hazardous drinking prevalence was initially higher but declined more among men than women, consistently higher among non-Hispanic White respondents than among Hispanic and non-Hispanic Black respondents, and declined more rapidly among adults with 3+ chronic conditions. In adjusted models, race and ethnicity were associated with lower prevalence of hazardous drinking (non-Hispanic Black: adjusted prevalence ratio [aPR] = 0.50, 95% confidence interval [CI] = 0.33, 0.74; other race: aPR = 0.26, 95% CI = 0.09, 0.81, compared with non-Hispanic White). No coping-related factors were significantly associated with hazardous drinking.

CONCLUSION

Among a cohort of older adults with chronic conditions, almost half engaged in hazardous drinking in early summer of the COVID-19 pandemic. While prevalence fell, these rates reinforce the need for alcohol screening and intervention in clinical settings among this population.

Technical efficiency and its determinants in regulating adolescents' coronavirus infection across Asian countries

The coronavirus pandemic, besides generating health distress, influences the socio-economic conditions of humankind. Every adolescent's lifestyle is affected by the virus. Healthy adolescents are not only key contributors to the forthcoming workforce but also a source of a country's human capital. The purpose of the article is to examine the efficacy of various Asian countries in regulating the spread of the coronavirus among adolescents. In addition to that, the paper also attempts to pinpoint the prime causes of the inefficiency of a country in regulating the same. The paper also examines the behavioural changes among adolescents across Asian countries in pre-and-post pandemic times. In this context, the study identifies the impact of adolescents' tobacco consumption, female political leadership, and accreditation on a country's efficacy to regulate adolescents' coronavirus infection. The study's empirical analysis covers twenty-one Asian countries. By using the Panel Stochastic Production Frontier, the study concludes that Kazakhstan is the most efficient country and Afghanistan is the least efficient country on the list. The inefficiency effects estimates conclude that adolescents' tobacco consumption decreases and good governance practices increase the efficiency of a country in regulating the spread of adolescent coronavirus infection. Additionally, the paper finds no significant behavioural changes among adolescents in pre-and-post pandemic times across Asian countries. The paper concludes with appropriate policy recommendations supported by empirical evidence. The paper also identifies its shortcomings and suggests potential future lines of inquiry.

Lived Experiences of the COVID-19 Pandemic Among the Vietnamese Population in the Region of Peel

Racial discrimination towards Southeast Asian populations is a longstanding issue in Canada which has intensified during the COVID-19 pandemic. Although extensive work demonstrates inequities among Southeast Asian communities during the pandemic, much work categorizes Asians as one homogenous population neglecting the unique experiences of different Asian subgroups along with the ways COVID-19 differentially affects Southeast Asians. To attend to population variations, this paper explores the lived experiences among Vietnamese individuals during the pandemic in the Peel Region of Ontario Canada. Specifically, this paper examines social and economic impacts of COVID-19, access to healthcare services and vaccines, sources of vaccine information, and impacts of COVID-19 related discrimination among young and older adults. Drawing on in-depth interviews with young and older adults (n=6:8) the results reveal important social and economic impacts created by COVID-19 that vary across generations and impact health and wellbeing. These impacts are challenged further by barriers to healthcare access which were compounded by intersecting inequities experienced among Vietnamese immigrants in the Peel Region. While vaccine hesitancy was not a main concern, the findings demonstrate important generational differences with respect to commonly used and trusted information related to historical events and social media use. Although racial discrimination was a dominant concern, younger participants did not feel unsafe but expressed concern for the safety of their older family members and friends. The study underscores the need to consider historical dynamics and the ways they shape government opinions and trust, experiences of racial discrimination and socio-economic realities among racialized, immigrant populations.

Are Perceptions of Government Intervention Related to Support for Prevention? An Australian Survey Study

BACKGROUND

In Australia, despite the success of tobacco control policy interventions, policymakers remain resistant to policy-based approaches to diet, alcohol, physical inactivity and obesity, concerned about community perceptions of such interventions as "nanny-statist". We examined how people's general positions on government intervention related to their positions on different preventive policy options.

METHODS

Data were from a 2018 nationally representative cross-sectional telephone survey of 2601 Australian adults. Survey questions related to endorsement of different conceptualisations of government intervention (nanny state, paternalistic, shared responsibility and communitarian) and support for specific health interventions, using forced-choice questions about preferences for individual/treatment measures versus population/preventive health measures. We analysed associations between scores on different conceptualisations of government intervention and support of different policy options for tobacco and diet, and preferences for prevention over treatment.

RESULTS

The Nanny State Scale showed an inverse relationship with support for tobacco- and diet-related interventions, and alternative conceptualisations (paternalistic, shared responsibility and communitarian) showed a positive relationship. Effect sizes in all cases were small. Those aged 55+ demonstrated greater support for policy action on tobacco and diet, and greater preference for systemic rather than individual-level interventions.

CONCLUSION

General disposition towards government intervention, although correlated with support for specific policy actions, is not deterministic.

Self-imposed social isolation among clients of social care organisations in the COVID-19 pandemic

Although self-imposed social isolation is an important way of reducing the risk of COVID-19 infection, previous research indicates that this behaviour varies substantially between different groups and individuals. Socially marginalized people are generally less involved in protective health behaviours, but there are few studies of their COVID-19 protective behaviours. The aims of the paper are therefore to: 1) compare self-imposed social isolation to avoid COVID-19 among socially marginalized groups, and to 2) examine factors influencing this, focusing especially on the role of social capital, risk awareness and sources of information about COVID-19. The study is based on survey data (N = 173) from people who are clients of social care organisations in Estonia, Norway, Hungary and Portugal. The sample involves clients living: a) in their homes, b) in facilities, and c) on the street or under temporary arrangements. Results indicate that the level of social isolation among the marginalized groups is comparable to that of the general population in previous studies. As hypothesized, we find that respondents living on the street or under temporary arrangements engage in less self-imposed social isolation than e.g. the respondents living in their homes. We also find lower levels of risk awareness, social capital and trust in authorities' information about COVID-19 among people living on the street or under temporary arrangements. Only linking social capital and trust in authorities' information was significantly related to respondents' social isolation, and not worry for COVID-19 infection. Thus, it seems that respondents largely self-isolated because of "duty" and not worry for infection.

Adherence of those at low risk of disease to public health measures during the COVID-19 pandemic: A qualitative study

Public health measures (PHMs) proactively and reactively reduce the spread of disease. While these measures target individual behaviour, they require broad adherence to be effective. Consequently, the World Health Organization issued a special appeal to young adults, a known non-adherent population, for increased adherence with COVID-19 guidelines. However, little is known about why these low-risk individuals do or do not adhere to PHMs. This study investigates why young adults in a low-risk setting adhered to PHMs implemented during the COVID-19 pandemic. A qualitative research approach was chosen to gain an in-depth understanding of participants’ thoughts and experiences related to PHM adherence. Semi-structured interviews were conducted in April-May 2021 with 30 young adults living in Prince Edward Island (PEI), the province with the lowest COVID-19 case rate in Canada at that time. Thematic analysis was used to create a codebook based on the Theoretical Domains Framework, which was then inductively modified. The analysis identified eight themes that explained the adherence of young adults: (1) clear, purpose-driven adherence rationale, (2) developing trust in the local leadership, (3) adapting to novel measures, (4) manageable disruption, (5) adhering to reduce anxiety, (6) collective duty towards one’s community, (7) moral culpability and (8) using caution rather than compliance. Together, these themes demonstrate that young adults adhered to PHMs because of their sense of connection to their community, public health leadership, and concerns over stigma. We further argue that clear guidelines and communication from public health officials during both periods of high and low COVID-19 cases facilitate adherence. These findings are important for mitigating future public health emergencies as they explain why young adults, an important segment of the population whose adherence is critical to the success of PHMs, follow PHMs. Further, these findings can inform public health officials and other stakeholders aiming to develop successful adherence strategies.

Psychological well-being in times of COVID-19: Associated factors and levels in the general population

The COVID-19 pandemic and living under social distancing restrictions have been hypothesized to impact well-being and mental health in the general population. This study investigated the general Norwegian adult population's well-being after implementing and lifting strict social distancing restrictions. The study was conducted through digital surveys; during the implementation of strict social distancing restrictions in March 2020 (T1) and 3 months later, when the preponderance of strict distancing restrictions was discontinued (T2). Well-being was measured at T2. Four thousand nine hundred twenty-one individuals participated, and a sensitivity analysis was conducted to ensure that the sample reflects the true Norwegian adult population. Hierarchical regression analyses show that contemporaneous employment status and positive metacognitions at T2 were associated with higher well-being. Negative metacognitions and the use of unhelpful coping strategies at T2 had a contemporaneous association with lower mental well-being. Negative metacognitions at T1 were associated with lower well-being scores, while positive metacognitions at T1 were positively associated with higher well-being. An indirect association between social distancing and lower well-being was found through heightened depressive symptoms. These results contribute to understanding how social distancing restrictions relate to general well-being, which may further contribute to designing proper strategies to strengthen mental health and well-being during challenging and unavoidable societal conditions.

Age Differences in Preferred Methods of Obtaining and Understanding Health Related Information During the COVID-19 Pandemic in Australia

Methods of communications and the nature of messaging are critically important in influencing public behavior. The COVID-19 pandemic has resulted in major disruptions to all aspects of life globally and has triggered multiple approaches of health messaging to the general public to communicate COVID-19 preventative measures. This study aimed to identify: (1) differences between age groups in the main avenues used by people to obtain COVID-19 related information; and (2) whether age and information sources were associated with correct interpretation of government messaging relating to how people understand or interpret the terms “self-isolation” and “social distancing.” An online survey was conducted in 2020. Participants were aged over 18 years and grouped into age group decades. Differences in sources of COVID-19 information were compared visually between age groups. Logistic regression was used to determine whether age and each of the various methods of communication of COVID-19 information were independently associated with correct response to the self-isolation, or the social distancing statements. There were 3,300 survey respondents 85% female; age sub-groups: 18–29 (7.4%); 30–39 (10.6%); 40–49 (17.6%); 50–59 (22.9%); 60–69 (25.9%); 70–79 (13.9%); and 80+ (1.7%). People accessed public health messaging information from a wide variety of sources that changed as they aged (e.g., older people were more likely to be exposed to COVID-19 information via television news programs and less likely via social media platforms). Age was frequently associated with whether the message key terms were interpreted correctly or incorrectly, but in some cases, it promoted more correct responses whereas in others, fewer correct responses. There was no difference between being exposed to COVID-19 information via mainstream media, compared with social media, or compared with Government sources of information, in terms of whether COVID-19 messages were interpreted correctly. In order to improve future public health messaging, there is a need for multiple avenues of communication to meet the needs and preferences across and within age groups. Further investigation is warranted into the clarity of the content and method of delivery of public health messages, to ensure optimal understanding of public health messages by vulnerable populations and across the community.

Application of the protection motivation theory to understand determinants of compliance with the measure of banning gathering size >4 in all public areas for controlling COVID-19 in a Hong Kong Chinese adult general population

Background

Restriction of gathering size in all public areas is a newly and commonly exercised governmental social distancing policy during the COVID-19 pandemic. Its effectiveness depends on the general public’s compliance. This study applied the Protection Motivation Theory (PMT) to investigate determinants (i.e., perceived severity, perceived susceptibility, perceived response efficacy, and perceived self-efficacy) of compliance with the social distancing policy of banning gathering of >4 people in all public areas (BG4PA) in the Hong Kong general adult population.

Methods

300 participants were interviewed through a population-based telephone survey during April 21–28, 2020.

Results

The compliance rate of BG4PA was high (78%). Adjusted for the background factors, multiple linear regression analysis found that perceived response efficacy and perceived self-efficacy were significantly and positively associated with compliance with BG4PA (p<0.05), while the associations between perceived severity/perceived susceptibility and compliance were of marginal significance (0.05<p<0.10). A stepwise linear regression model considered four PMT constructs as candidates; its final model only selected self-efficacy but not the other three PMT constructs.

Conclusions

PMT can be applied to understand compliance with BG4PA. Perceived response efficacy and perceived self-efficacy were more influential than perceived severity and perceived susceptibility. Health promotion may focus on improving coping appraisal.

A cross-sectional examination of public health information seeking, trust, and COVID-19 prevention behaviors (Preprint)

Background

Preventative health measures such as shelter in place and mask wearing have been widely encouraged to curb the spread of the COVID-19 disease. People’s attitudes toward preventative behaviors may be dependent on their sources of information and trust in the information.

Objective

The aim of this study was to understand the relationship between trusting in COVID-19 information and preventative behaviors in a racially and politically diverse metropolitan area in the United States.

Methods

We conducted a web-based cross-sectional survey of residents in St. Louis City and County in Missouri. Individuals aged ≥18 years were eligible to participate. Participants were recruited using a convenience sampling approach through social media and email. The Health Belief Model and the Socioecological Model informed instrument development, as well as COVID-19–related questions from the Centers for Disease Control and Prevention. We performed an ordinary least squares linear regression model to estimate social distancing practices, perceptions, and trust in COVID-19 information sources.

Results

Of the 1650 eligible participants, the majority (n=1381, 83.7%) had sought or received COVID-19–related information from a public health agency, the Centers for Disease Control and Prevention, or both. Regression analysis showed a 1% increase in preventative behaviors for every 12% increase in trust in governmental health agencies. At their lowest levels of trust, women were 68% more likely to engage in preventative behaviors than men. Overall, those aged 18-45 years without vulnerable medical conditions were the least likely to engage in preventative behaviors.

Conclusions

Trust in COVID-19 information increases an individual’s likelihood of practicing preventative behaviors. Effective health communication strategies should be used to effectively disseminate health information during disease outbreaks.

Associations among political voting preference, high-risk health status, and preventative behaviors for COVID-19

BACKGROUND

We investigate the relationships among political preferences, risk for COVID-19 complications, and complying with preventative behaviors, such as social distancing, quarantine, and vaccination, as they remain incompletely understood. Since those with underlying health conditions have the highest mortality risk, prevention strategies targeting them and their caretakers effectively can save lives. Understanding caretakers' adherence is also crucial as their behavior affects the probability of transmission and quality of care, but is understudied. Examining the degree to which adherence to prevention measures within these populations is affected by their health status vs. voting preference, a key predictor of preventative behavior in the U. S, is imperative to improve targeted public health messaging. Knowledge of these associations could inform targeted COVID-19 campaigns to improve adherence for those at risk for severe consequences.

METHODS

We conducted a nationally-representative online survey of U.S. adults between May-June 2020 assessing: 1) attempts to socially-distance; 2) willingness/ability to self-quarantine; and 3) intention of COVID-19 vaccination. We estimated the relationships between 1) political preferences 2) underlying health status, and 3) being a caretaker to someone with high-risk conditions and each dependent variable. Sensitivity analyses examined the associations between political preference and dependent variables among participants with high-risk conditions and/or obesity.

RESULTS

Among 908 participants, 75.2% engaged in social-distancing, 94.4% were willing/able to self-quarantine, and 60.1% intended to get vaccinated. Compared to participants intending to vote for Biden, participants who intended to vote for Trump were significantly less likely to have tried to socially-distance, self-quarantine, or intend to be vaccinated. We observed the same trends in analyses restricted to participants with underlying health conditions and their caretakers Underlying health status was independently associated with social distancing among individuals with obesity and another high-risk condition, but not other outcomes.

CONCLUSION

Engagement in preventative behavior is associated with political voting preference and not individual risk of severe COVID-19 or being a caretaker of a high-risk individual. Community based strategies and public health messaging should be tailored to individuals based on political preferences especially for those with obesity and other high-risk conditions. Efforts must be accompanied by broader public policy.

Impacts of the Coronavirus Pandemic on the Emotional and Physical Health of Older Adults Compared with Younger Cohorts

OBJECTIVES

This study compared emotional and physical health and overall well-being related to social restrictions during the pandemic among older, middle-aged, and younger adults in the United States (n = 276).

METHODS

Online surveys collected information on mental and physical health, as well as positive and negative impacts of the pandemic. One-way MANOVAs and hierarchical regressions were used to analyze data.

RESULTS

Depressive symptoms and coronavirus anxiety differed significantly by age, with older adults reporting less depressive and anxious symptoms than younger cohorts. Negative COVID experiences significantly predicted higher levels of stress, anxiety, and insomnia symptoms in younger adults as compared to older cohorts.

CONCLUSIONS

Findings indicate that social restrictions had a more substantial negative impact amongst younger adults compared to older adults, particularly in terms of mental health and well-being.

CLINICAL IMPLICATIONS

Older adults may be more resilient to the impacts of the pandemic than younger cohorts and thus may serve as a critical resource for how to navigate crisis situations of this nature. Future studies should continue to monitor health outcomes as the pandemic subsides in conjunction with the vaccine rollout, as the long-term effects of social distancing and stay-at-home measures are yet to be determined.