Media Messages and Perception of Risk for Ebola Virus Infection, United States

Effects of COVID-19-related worry and rumination on mental health and loneliness during the pandemic: longitudinal analyses of adults in the UK COVID-19 mental health & wellbeing study

BACKGROUND

The lasting effects of the coronavirus disease 2019 pandemic are likely to be significant.

AIMS

This study tracked worry and rumination levels during the pandemic and investigated whether periods with higher COVID-related worry and rumination were associated with more negative mental health and loneliness.

METHODS

A quota survey design and a sampling frame that permitted recruitment of a national sample were employed. Findings for waves 1 (March 2020) to 6 (November 2020) are reported (N = 1943).

RESULTS

Covid-related worry and rumination levels were highest at the beginning of the first lockdown, then declined but increased when the UK returned to lockdown. Worry levels were higher than rumination levels throughout. High levels of COVID-related worry and rumination were associated with a five- and ten-fold increase in clinically meaningful rates of depression and anxiety (respectively) together with lower well-being and higher loneliness. The effects of COVID-related worry on depression and anxiety levels were most marked and clinically meaningful in individuals living with a pre-existing mental health condition.

CONCLUSIONS

Psychological interventions should include components that specifically target COVID-related worry and rumination. Individuals with pre-existing mental health conditions should be prioritised as we emerge from the current pandemic and in any future public health crises.

Students' increased time spent on social media, and their level of coronavirus anxiety during the pandemic, predict increased social media addiction

BACKGROUND

During the COVID-19 pandemic period, the level of anxiety and the duration of social media use increased in university students.

OBJECTIVES

This study aimed to examine the relationship between coronavirus anxiety and social media addiction in university students.

METHODS

The sample consisted of 346 university students in Turkey. The data were collected online using the Sociodemographic Data Form, the Coronavirus Anxiety Scale Short Form and the Social Network Addiction Scale. The data were analysed using one-way analysis of variance, Mann-Whitney U test, Pearson correlation analysis, chi-square analysis and multiple linear regression analysis.

RESULTS

The results showed that the mean coronavirus anxiety score was higher in men than in women. Social media addiction increased as the daily time spent by the students on social media increased. A positive correlation was found between the daily time spent on social media before the pandemic and social media usage during the pandemic. It was concluded that students use social media more during the pandemic than before it and that social media addiction increases as the students' coronavirus anxiety increases.

CONCLUSION

It is important to plan initiatives to reduce coronavirus anxiety to prevent social media addiction in young people.

STUDY LOCATION AND SAMPLE

The research population consisted of 1st and 2nd year students who are studying in the Medical Services and Techniques Department of Vocational School of Health Services at a university located in the west of Turkey, during the Fall Term of academic year 2020-2021. Students in this department are studying in anaesthesia, dialysis, first and emergency aid, medical laboratory techniques, medical imaging technique, and medical documentation and secretarial programmes.

Difficulties and distress experienced by Japanese public health nurses specializing in quarantine services when dealing with COVID-19: A qualitative study in peri-urban municipality

Public health nurses (PHNs) are among the few municipal civil servants who lead community infection control and prevention initiatives in Japanese public health centers (PHCs). This study aims to investigate the distress faced by PHNs and clarify their difficulties and working environment relative to infection prevention control activities during the COVID-19 pandemic. We adopted a qualitative description methodology in this study of 12 PHNs who were involved in COVID-19 prevention and control in PHCs in Prefecture A. The distress during the early phase of the pandemic was due to the uncertainty of the SARS-CoV-2 related disease, which caused panic in medical institutions and among residents. PHNs were overwhelmed, distressed and exhausted by their inability to control the 'pandemic', lack of patient cooperation for prevention control and the unsustainable organizational environment. They were also distressed because they were one of the specialized personnel responsible for saving residents' lives with limited medical resources and while having identity crises due to an inability to carry out the PHN's role of controlling infection in the community. For future crises, rapid, drastic innovation defying conventional organizational systems is critical to reform sustainable organizations so that they play an effective role in the community. Innovation in crisis communication and strengthening the medical system will help achieve a resilient community in a health crisis.

The Impact of Information About COVID-19 on the Endocrine Stress System and Cognitive Distortions

The coronavirus disease 2019 (COVID-19) pandemic is one of the major health concerns worldwide affecting not only human physical health but also contributing to the development of many mental disorders including impairment of the cognitive function. It is highly conceivable that elevation of the stress hormones, i.e., glucocorticoids and catecholamines, due to the infection, as well as the presence of psychosocial stressors, such as COVID-19 information, play a critical role in the development of these disorders. In the present study, the potential impact of exposure to COVID-19 information on the cognitive distortion and stress levels was analyzed in a population of 32 first-year medical sciences students using the stress assessment questionnaire (SAQ) and the posttraumatic cognitions inventory (PTCI) surveys. Both surveys demonstrated no acute change in the stress and post-traumatic cognition levels between medical sciences students who were either exposed or not to information about COVID-19. Interestingly, analysis of the stress and cognition points across the first and second measurements of the SAQ categories revealed a significant change in the control group but not in the experimental group. In addition, there was no significant difference among groups when considering the time*group factor. To conclude, we found that exposure to information about COVID-19 did not contribute acutely to cognitive distortion and stress levels among participating students. The previous exposure to COVID-19-related information from media and living during the COVID-19 pandemic era might have enhanced the awareness of the students to the situation.

A multiscale modeling framework to study the interdependence of brain, behavior, and pandemic

A major constraint of the behavioral epidemiological models is the assumption that human behavior is static; however, it is highly dynamic, especially in uncertain circumstances during a pandemic. To incorporate the dynamicity of human nature in the existing epidemiological models, we propose a population-wide multi-time-scale theoretical framework that assimilates neuronal plasticity as the basis of altering human emotions and behavior. For that, variable connection weights between different brain regions and their firing frequencies are coupled with a compartmental susceptible-infected-recovered model to incorporate the intrinsic dynamicity in the contact transmission rate ( β ). As an illustration, a model of fear conditioning in conjunction with awareness campaigns is developed and simulated. Results indicate that in the presence of fear conditioning, there exists an optimum duration of daily broadcast time during which awareness campaigns are most effective in mitigating the pandemic. Further, global sensitivity analysis using the Morris method highlighted that the learning rate and firing frequency of the unconditioned circuit are crucial regulators in modulating the emergent pandemic waves. The present study makes a case for incorporating neuronal dynamics as a basis of behavioral immune response and has further implications in designing awareness campaigns.

Information seeking, mental health and loneliness: Longitudinal analyses of adults in the UK COVID-19 mental health and wellbeing study

Information seeking has generally been seen as an adaptive response to the COVID-19 pandemic. However, it may also result in negative outcomes on mental health. The present study tests whether reporting COVID-related information seeking throughout the pandemic is associated with subsequently poorer mental health outcomes. A quota-based, non-probability-sampling methodology was used to recruit a nationally representative sample. COVID-related information seeking was assessed at six waves along with symptoms of depression, anxiety, mental wellbeing and loneliness (N = 1945). Hierarchical linear modelling was used to assess the relationship between COVID-related information seeking and mental health outcomes. Information seeking was found to reduce over time. Overall, women, older and higher socioeconomic group individuals reported higher levels of information seeking. At waves 1-4 (March-June 2020) the majority of participants reported that they sought information on Covid 1-5 times per day, this decreased to less than once per day in waves 5 and 6 (July-November 2020). Higher levels of information seeking were associated with poorer mental health outcomes, particularly clinically significant levels of anxiety. Use of a non-probability sampling method may have been a study limitation, nevertheless, reducing or managing information seeking behaviour may be one method to reduce anxiety during pandemics and other public health crises.

Health-care access and utilization among HIV-infected men who have sex with men in two Chinese municipalities with or without lockdown amidst early COVID-19 pandemic

City lockdown is critical to successfully contain the COVID-19 pandemic. The impact of lockdown and COVID-19 pandemic on healthcare among vulnerable population has yet to be explicated. A cross-sectional survey was conducted among HIV-infected men who have sex with men (MSM) in Wuhan with city lockdown and Shanghai without lockdown, and healthcare interruptions were evaluated and compared. A logistic regression analysis was employed to examine associates of HIV-related healthcare interruptions and compromised mental health. Compared to participants in Shanghai (N = 440), HIV-infected MSM in Wuhan (N = 503) had significantly higher proportion of untimely availability of antiretroviral drugs (ARVs) (20.6% vs. 8.4%), obtaining ARVs from outside institutions (29.1% vs. 8.1%), postponed non-AIDS treatment (6.4% vs. 2.8%) and untimely follow-up appointments (33.4% vs. 14.5%). HIV-related healthcare interruptions were positively associated with lockdown (OR = 4.89, 95% CI: 3.49-6.85) and non-local residence (OR = 1.91, 95% CI: 1.37-2.64). Compromised mental health, including insomnia and generalized anxiety disorders, was associated with non-local residence (OR  = 1.35, 95% CI: 1.01-1.81) and healthcare interruptions (OR = 1.34, 95% CI: 1.01-1.79). HIV-infected MSM are vulnerable to healthcare interruptions and mental health problems during the COVID-19 pandemic, underscoring the need for tailored intervention strategies to minimize deleterious health consequences.

Doomscrolling during COVID-19: The negative association between daily social and traditional media consumption and mental health symptoms during the COVID-19 pandemic

OBJECTIVE

Consumption of traditional and social media markedly increased at the start of the COVID-19 pandemic as new information about the virus and safety guidelines evolved. Much of the information concerned restrictions on daily living activities and the risk posed by the virus. The term doomscrolling is used to describe the phenomenon of elevated negative affect after viewing pandemic-related media. The magnitude and duration of this effect, however, is unclear. Furthermore, the effect of doomscrolling likely varies based on prior vulnerabilities for psychopathology, such as a history of childhood maltreatment. It was hypothesized that social and traditional media exposure were related to an increase in depression and PTSD and that this increase was moderated by childhood maltreatment severity.

METHOD

Participants completed a baseline assessment for psychopathology and 30 days of daily assessments of depression, PTSD, and pandemic-related media use.

RESULTS

Using multilevel modeling, social media exposure was associated with increased depression and PTSD. This association was stronger for those with more severe maltreatment histories. Furthermore, those with more severe baseline psychopathology used more social media during this period. These relations were not observed for traditional media sources.

CONCLUSIONS

These results suggest that regular viewing of pandemic-related social media is associated with increases in psychopathology for those with existing vulnerabilities. Those with such vulnerabilities should adopt strategies to limit social media consumption. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Media use and trust during the COVID-19 pandemic: evidence from eight cross-sectional surveys in Sweden

BACKGROUND

While a lot has been written about Sweden's COVID-19 control strategy, less is known about Swedish residents' media use during the pandemic and trust in and perceived agreement among key stakeholders commenting in the media.

METHODS

Eight online, nationwide surveys were fielded between March and August 2020, during the first wave of the coronavirus pandemic in Sweden, with 8146 responses. Questions were asked on media usage, perceived tone of media, trust in key pandemic stakeholder groups commenting in the media (politicians, journalists, government officials, doctors/healthcare professionals and researchers) and perceived agreement among these key stakeholders about how the pandemic was handled in Sweden.

RESULTS

Using five or more information sources was associated with increased perceived alarmism in the media. Women and those with tertiary education were more likely to trust key pandemic actors. Trust in doctors/healthcare professionals and researchers remained high over the course of the study, trust in politicians and journalists was relatively low throughout the study period, with a slight increase in April 2020. Trust in key stakeholders was strongly associated with perceived agreement among the key stakeholders.

CONCLUSIONS

Our results show that trust in stakeholders was strongly associated with perceived consistency of messages from those stakeholders. The inverse also holds: perceived conflicting messages among stakeholders was associated with low trust in them. Taken together, this could point to the importance of building trust before a crisis. Trust-building efforts could be targeted to men and those with lower educational attainment, as they had lower trust in key stakeholders.

Exploring factors that influence COVID-19 vaccination intention in China: Media use preference, knowledge level and risk perception

Vaccine is one of the most effective means to deal with the COVID-19 pandemic in many countries, but vaccine hesitancy has been always widespread among people due to individual differences in access to vaccine information. This research aims to empirically investigate the relationship between media use preference (video-based and text-based), knowledge level, risk perception and willingness to vaccinate among Chinese residents. A cross-sectional survey of a Chinese sample (N = 885) was carried out to explore factors that influence the COVID-19 vaccination intention of Chinese residents. The empirical results show that the knowledge level and risk perception of Chinese residents positively contribute to vaccination intention. People with video-usage preference have lower levels of knowledge about the COVID-19 vaccine than those with text-usage preference. People’s risk perception of the COVID-19 pandemic is not influenced by their media use preference or knowledge level, as COVID-19 is a global pandemic and a significant social risk. The current study yields health-related implications for the role of media use preference in vaccination intention.

Media exposure, risk perceptions, and fear: Americans' behavioral responses to the Ebola public health crisis

We examined media exposure, psychological fear and worry, perceptions of risk, and health protective behaviors surrounding the 2014 Ebola virus outbreak in a probability-based, representative, national sample of Americans (N = 3447). Structural equation models examined relationships between amount (hours/day) and content (e.g., graphic images of dead bodies) of media exposure and counts of self-reported health protective behaviors that participants performed or would perform if Ebola spread to their community. Ebola-related risk perceptions and fear and worry were potential mediators. Greater total hours and more graphic media exposure positively correlated with more fear and worry; greater total hours of media exposure also positively correlated with higher perceived risk. Higher risk perceptions were associated with more health protective behaviors performed and intended. Greater fear and worry were associated with more behaviors performed. Amount and content of media exposure exhibited indirect effects on behaviors performed; amount of media exposure had indirect effects on intentions. Media may help promote health protective behaviors during public health threats; the amount and content should be congruent with threat to minimize distress and maximize resources.

“Will My Young Adult Years be Spent Socially Distancing?”: A Qualitative Exploration of Adolescents’ Experiences During the COVID-19 UK Lockdown

For older adolescents, the COVID-19 pandemic and UK restrictions arrived during a critical period in the transition to adulthood. Early research exploring impact of the pandemic paints a picture of worsened adolescent wellbeing and mental health. We explore the subjective experiences of 16- to 19-year-olds during the first UK lockdown, with an emphasis on wellbeing and coping, to complement quantitative evidence and inform strategies and provision for support. In May 2020, we invited UK-based 16- to 19-year-olds to share written accounts of their experiences of the initial UK lockdown for The TELL Study. A total of 109 participants engaged, submitting anonymous written accounts via an online survey portal. We used inductive reflexive thematic analysis to develop rich experiential themes. We constructed seven main themes: heightened emotionality; feelings of loss, change, and uncertainty; recognizing the value of self-care; efforts to think positively; opportunities for relief, growth, and development; the importance of togetherness; and frustration with government and media. Findings highlight the multifaceted nature of adolescents’ lockdown experiences, and offer insight into emotional impact and new concerns alongside the value placed on self-care and staying connected. We offer directions for supporting adolescents as pandemic consequences continue.

Explaining the Psychosocial Effects of COVID-19 Among Older Hong Kong Chinese People-A Qualitative Analysis

BACKGROUND

Social distancing and "stay-at-home" orders are essential to contain the coronavirus outbreak; however, there are growing concerns about physical and other mental distress in older people. Apart from quantitative data, their feelings, thoughts, and experience are essential to inform the implementation of patient-centered health care policy.

AIM

This study explained the psychosocial effects of COVID-19 on Hong Kong Chinese older people.

DESIGN AND SETTING

This was a qualitative study. Twenty-three participants aged between 63 and 86 were recruited in primary care through purposive sampling.

METHOD

Semi-structured in-depth telephone interviews were conducted to explore participants' experience during the COVID-19 pandemic. Grounded theory was used to analyze the data.

RESULTS

Three themes, nine subthemes, and 24 quotes were identified. The 3 themes included the psychological response of fear, annoyance, and worrisome; social isolation leading to loneliness and physical exhaustion; and the coping strategies in adversity. Fear was the major emotional response, which was not entirely explained by the uncertainty of the disease, but also the embedded routines norms and values. Loneliness was aggravated by the depleted family and community support. Physical distancing had intensified ones physical demand on self-care, especially among those with comorbid illnesses. The use of digital tools and telecommunications maintained the social connection, but the overexposure had led to a vicious cycle of anxiety and distress.

CONCLUSION

Self-isolation has disproportionately affected older individuals whose only social contact is out of the home. Online technologies can be harnessed to provide social support networks and a sense of belonging, but its adaptive and positive uses should be encouraged. Interventions can also involve more frequent telephone contact with significant others, close family and friends, voluntary organizations, or health-care professionals, or community outreach teams. Enhancing the values of older people's in calamity through active engagement may also potentially reduce the detrimental effect of social isolation.

The impact and applications of social media platforms for public health responses before and during COVID-19

Background

 Social media platforms have numerous potential benefits and drawbacks on public health, which have been described in the literature. The COVID-19 pandemic has exposed our limited knowledge regarding the potential health impact of these platforms, which have been detrimental to public health responses in many regions.

Objective

This review aims to highlight a brief history of social media in health care and report its potential negative and positive public health impacts, which have been characterized in the literature.

Methods

 We searched electronic bibliographic databases including PubMed, including Medline and Institute of Electrical and Electronics Engineers Xplore, from December 10, 2015, to December 10, 2020. We screened the title and abstracts and selected relevant reports for review of full text and reference lists. These were analyzed thematically and consolidated into applications of social media platforms for public health.

Results

 The positive and negative impact of social media platforms on public health are catalogued on the basis of recent research in this report. These findings are discussed in the context of improving future public health responses and incorporating other emerging digital technology domains such as artificial intelligence. However, there is a need for more research with pragmatic methodology that evaluates the impact of specific digital interventions to inform future health policy.

Conclusions

 Recent research has highlighted the potential negative impact of social media platforms on population health, as well as potentially useful applications for public health communication, monitoring, and predictions. More research is needed to objectively investigate measures to mitigate against its negative impact while harnessing effective applications for the benefit of public health.

What influences people's responses to public health messages for managing risks and preventing infectious diseases? A rapid systematic review of the evidence and recommendations

BACKGROUND

Individual behaviour changes, such as hand hygiene and physical distancing, are required on a population scale to reduce transmission of infectious diseases such as COVID-19. However, little is known about effective methods of communicating risk reducing information, and how populations might respond.

OBJECTIVE

To synthesise evidence relating to what (1) characterises effective public health messages for managing risk and preventing infectious disease and (2) influences people's responses to messages.

DESIGN

A rapid systematic review was conducted. Protocol is published on Prospero CRD42020188704.

DATA SOURCES

Electronic databases were searched: Ovid Medline, Ovid PsycINFO and Healthevidence.org, and grey literature (PsyarXiv, OSF Preprints) up to May 2020.

STUDY SELECTION

All study designs that (1) evaluated public health messaging interventions targeted at adults and (2) concerned a communicable disease spread via primary route of transmission of respiratory and/or touch were included. Outcomes included preventative behaviours, perceptions/awareness and intentions. Non-English language papers were excluded.

SYNTHESIS

Due to high heterogeneity studies were synthesised narratively focusing on determinants of intentions in the absence of measured adherence/preventative behaviours. Themes were developed independently by two researchers and discussed within team to reach consensus. Recommendations were translated from narrative synthesis to provide evidence-based methods in providing effective messaging.

RESULTS

Sixty-eight eligible papers were identified. Characteristics of effective messaging include delivery by credible sources, community engagement, increasing awareness/knowledge, mapping to stage of epidemic/pandemic. To influence intent effectively, public health messages need to be acceptable, increase understanding/perceptions of health threat and perceived susceptibility.

DISCUSSION

There are four key recommendations: (1) engage communities in development of messaging, (2) address uncertainty immediately and with transparency, (3) focus on unifying messages from sources and (4) frame messages aimed at increasing understanding, social responsibility and personal control. Embedding principles of behavioural science into public health messaging is an important step towards more effective health-risk communication during epidemics/pandemics.

Risk Perception of COVID-19 in Indonesia During the First Stage of the Pandemic

Community perceptions of early-stage pandemics may have significant implications for subsequent disease control and management. Perceptions of COVID-19 among Indonesian citizens were assessed 2 months after the first reported case in the country. The study used an online survey tool, which was adapted from a standardized questionnaire for risk perception of an infectious disease outbreak. The questions of the survey involved respondents' perceived level of knowledge, preparedness, efficacy of control measures, newness, infectiousness, seriousness, motivating and hindering factors, and effectiveness of prevention methods, as well as questions that assessed actual level of knowledge of respondents such as causative agents, modes of transmission, number of total cases, and available control measures. A total of 1,043 respondents participated in this study. The main sources of information of respondents were social media (85.2%) and online news (82.2%). Nearly all respondents were aware that COVID-19 is a viral disease with saliva droplets (97.1%) and contaminated surfaces (86.5%) being its main modes of transmission. Participants showed a good level of knowledge pertaining to control measures, an adequate level of belief toward their efficacy, and a willingness to implement such measures. More than 95% of the respondents perceived COVID-19 to be either serious or very serious. However, the level of anxiety among respondents was moderate, suggesting the presence of risk tolerance in the community. Individual characteristics such as gender, educational background, and occupation were found to have a statistically significant relationship with risk perception and tolerance, but voluntary participation in control measures was high and similar. This indicates that the COVID-19 health campaign during early pandemic in Indonesia was a success. This research also revealed certain areas where health promotion, education, and awareness might be improved.

Influence of the COVID-19 Lockdown on the Physical and Psychosocial Well-being and Work Productivity of Remote Workers: Cross-sectional Correlational Study

BACKGROUND

Lockdowns imposed during the COVID-19 pandemic have impacted the living and working habits of millions of people, with potentially important implications for their physical, mental, and social well-being.

OBJECTIVE

The primary objective of this study was to investigate the impact of the COVID-19 pandemic on remote workers who were not directly affected by COVID-19.

METHODS

This was a correlational cross-sectional study (with an additional qualitative component) of 184 remote workers surveyed during the first COVID-19 lockdown in the United Kingdom. Standard measures of mental health (Kessler-6 Distress Scale), productivity (Brief Instrument to Assess Workers' Productivity During a Working Day), and physical activity (International Physical Activity Questionnaire) were used, and respondents were further surveyed on changes to their dietary, exercise, smoking, drinking, and socialization habits to produce a well-being change index.

RESULTS

The results revealed associations between sedentary behavior and poorer mental health (τ b=0.14) and between poorer mental health and low work productivity (τ b=-0.39). However, both positive and negative lifestyle changes were reported; a self-reported increase in well-being (with respect to diet, exercise, smoking, alcohol consumption, and socialization) since the start of the pandemic was associated with both better mental health (τ b=-0.14) and better work productivity (τ b=0.14). Of note, among respondents without a mental health diagnosis (137/184, 74.4%), we observed rates of moderate (76/137, 55.5%) and severe (17/137, 12.4%) psychological distress, which were markedly higher than those reported in large prepandemic studies; moreover, 70.1% (129/184) of our respondents reported more sedentary behavior, 41% (69/168) increased their alcohol consumption, and 38.6% (71/184) increased their overall food intake. However, 46% (75/163), 44.8% (39/87) and 51.8% (57/110) of respondents reported spending more time walking and engaging in more moderate and vigorous exercise, respectively. Qualitative analysis revealed many positive adaptations to lockdowns (eg, decreased commuting expenses, flexibility) but also a number of structural obstacles to remote working (eg, lack of support and high expectations from employers, childcare duties).

CONCLUSIONS

These findings may be of practical importance for policy makers and employers in a world in which work involves long-term remote or hybrid employment arrangements; strategies to promote more sustainable remote working are discussed.

A Review of the Global Impact of the COVID-19 Pandemic on Public Mental Health, with a Comparison Between the USA, Australia, and Poland with Taiwan and Thailand

Coronavirus may have a negative impact not only on physical, but also on mental wellbeing. Despite the different approaches of countries to stop the spread of the virus and different infection rates, the dynamically developing pandemic has already affected the entire world. The consequences of the coronavirus for our mental health can be divided into those related to strategies for the prevention of infection, like isolation, quarantine, limitation of social contacts, and remote work, and those related to the direct impact of infection on our nervous system. This review aims to highlight the global effects of the Coronavirus Disease 2019 (COVID-19) pandemic on public mental health following social restrictions, to identify how infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have direct neurophysiological effects and to compare the impact on public mental health between the USA, Australia, and Poland with Taiwan and Thailand.

Media Exposure Related to the PTSS During COVID-19 Pandemic: The Mediating Role of Risk Perception

Objectives: The objectives of this study are to assess the relationship between media exposure and post-traumatic stress symptoms (PTSS) and to highlight the underlying mechanisms mediated by risk perception. Methods: This survey was conducted online in China from February 1st to February 10th, 2020. A total of 2,858 Chinese citizens aged ≥18 years from 31 provinces and autonomous regions were recruited to participate in a cross-sectional study. Self-report questionnaires were used to assess media exposure, PTSS, and risk perception. Results: The prevalence of respondents with heightened PTSS scores was 22.2%. After controlling for covariates, media exposure (more than five times a day) was significantly and positively associated with a high level of PTSS (B = 4.11, p < 0.001), and risk perception (worry and severity) significantly mediated the relationship between media exposure and PTSS (all 95% CIs did not include 0). Conclusions: Based on these findings, the frequency of media exposure was associated with PTSS. Risk perception (worry and severity) mediated the relationship between media exposure and PTSS. The mental health, particularly PTSS, of the general population should be closely monitored and "infodemics" should be combatted while addressing the COVID-19 outbreak; cognitive interventions may be promising.

Socio-economic impact on epilepsy outside of the nation-wide COVID-19 pandemic area

OBJECTIVE

To identify people with epilepsy (PWE) who required extensive care before the novel coronavirus disease 2019 (COVID-19) pandemic that had world-wide impacts on medical care and on socio-economic conditions.

METHODS

Consecutive PWE who were treated at the epilepsy center of Hiroshima University Hospital, which was located in the COVID-19 non-pandemic area, between March 2019 and August 2020 were enrolled. We evaluated clinical and socioeconomic factors that were associated with seizure exacerbation (an increase in seizure frequency) during the first 6 months after the COVID-19 pandemic started compared with the previous 6 months.

RESULTS

Among the 196 PWE who were evaluated (mean age was 37.8 ± 16.2 years), there were 33 PWE (16.8%) whose seizure frequency had increased after the pandemic began. People with epilepsy with a seizure increase showed a significant association with living alone (p < 0.001), a higher seizure frequency (p < 0.001), negative findings on MRI (p = 0.020), history of dissociative seizure (p < 0.001), mood disorders (p < 0.001), insomnia (p < 0.001), and high psychological stress levels (p = 0.024) at baseline compared with PWE without seizure exacerbation. Multivariate logistic regression analysis revealed that "living alone" (odds ratio (OR) 3.69; 95%CI 1.29-10.52), "high seizure frequency at baseline" (OR 4.53; 95%CI 1.63-12.57), and "comorbidity of insomnia" (OR 9.55; 95%CI 3.71-24.55) were independently associated with seizure exacerbation.

CONCLUSIONS

Even in the non-pandemic area, PWE had seizure exacerbation, suggesting that clinicians should screen patients' mental health before the outbreak to provide care, reduce the burden, and prevent social isolation in PWE. This should be addressed particularly in patients with medically refractory seizures with insomnia who live alone.

Increased generalized anxiety, depression and distress during the COVID-19 pandemic: a cross-sectional study in Germany

Background

Since the first cases of the novel coronavirus disease SARS-CoV-2 were reported in December 2019 in China, the virus has spread in most countries. The aim of the present study was to assess initial data on the mental health burden of the German public during the COVID-19 pandemic.

Methods

A cross-sectional study was conducted in Germany and collected complete datasets from 15 704 German residents aged 18 years and over. Besides demographics, generalized anxiety (GAD-7), depression (PHQ-2) and psychological distress (DT) were assessed. Furthermore, COVID-19-related fear, trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 were covered.

Results

Significantly increased symptoms were highly prevalent in all dimensions: generalized anxiety (44.9%), depression (14.3%), psychological distress (65.2%) and COVID-19-related fear (59%). Females and younger people reported higher mental burden. Trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 are negatively associated with mental health burden. However, the subjective level of information regarding COVID-19 is positively associated with increased COVID-19-related fear.

Conclusions

The provision of appropriate psychological interventions for those in need and the provision of transparency and comprehensible information are crucial during the current pandemic.

Unknown Enemy and Psychopathological Responses: A Cross-Sectional Nationwide Study Assessing the Knowledge About COVID-19

There is evidence that a lack of appropriate knowledge regarding global changes might be associated with various psychopathological responses. In this study, we tested the hypothesis that knowledge about COVID-19 correlates with the severity of psychopathological symptoms as measured by standardized questionnaires. The questionnaires were obtained using the Computer Assisted Web Interviews (CAWI) method during the second wave of the COVID-19 pandemic in Poland using the original COVID-19 knowledge questionnaire and the General Health Questionnaire-28 (GHQ-28). A series of bivariate tests and linear regression analyses were performed with a p < 0.05. All analyses were performed in Statistica 13.3. We enrolled 1,002 respondents. The rate of correct answers in the original questionnaire ranged from 44.6 to 84.1%, and the average was 60.1%. Four hundred and twenty participants (42%) met the criterion for the presence of relevant psychopathological symptoms. A significant negative correlation was found between the number of points obtained in the COVID-19 knowledge questionnaire and the GHQ-28 scores, both in relation to the total score and all its subscales. The following factors in the linear regression model were correlated with severity of somatic symptoms: knowledge about the COVID-19 pandemic (B = -0.12, P = 0.000), sex (B = 0.12, P = 0.000), use of psychiatric or psychological care (B = 0.20, P < 0.000) and chronic diseases (B = 0.09, P = 0.002). In this study, we observed a negative correlation between the knowledge about the COVID-19 pandemic and the severity of psychopathological symptoms. The results clearly indicate that the complexity of the global problem of the current pandemic is related to the development of psychopathological symptoms. However, longitudinal studies are needed to identify the direction of causality.

Risk perception, knowledge, information sources and emotional states among COVID-19 patients in Wuhan, China

BACKGROUND

The rapidly evolving COVID-19 pandemic has become a global health crisis. Several factors influencing risk perception have been identified, including knowledge of the disease, information sources, and emotional states. Prior studies on COVID-19-related risk perception primarily focused on the general public, with little data available on COVID-19 patients.

PURPOSE

To investigate COVID-19 patients' risk perception, knowledge of the disease, information sources, and emotional states in the epicenter, Wuhan, during the COVID-19 outbreak in China.

METHODS

Data were collected online using self-administered electronic questionnaire developed with reference to previous relevant studies and publications by the World Health Organization.

FINDINGS

A higher level of perceived risk was found in relation to COVID-19 as compared to other potential health threats. Knowledge gaps existed regarding transmission and prevention of COVID-19. Additionally, risk perception was negatively related to knowledge and positively related to depressive states. Moreover, social media was a primary source for COVID-19 information, whereas the most trusted sources were health professionals.

DISCUSSION

Realistic perception of risk should be encouraged considering both physical and mental health while developing relevant strategies. Furthermore, risk communication needs to be specifically tailored for various target groups, such as the elderly and mentally vulnerable individuals, with the adoption of popular media platforms.

Public Understanding, Perceptions, and Information Sources about Bioterrorism: Pilot Study from the Republic of Serbia

Bioterrorism presents a complex national, international, and human security threat, which requires a multidisciplinary approach to preparation and planning. Although the public plays an integral part of every aspect of bioterrorism, their understanding of and attitudes toward bioterrorism have not been extensively researched in the past, but are important for efficient knowledge communication. This study examines the baseline public comprehension and perceptions of bioterrorism, as well as the underpinning, trusted information sources in the Republic of Serbia. Results demonstrate overall poor understanding of bioterrorism and a notable lack of distinction between bioterrorism and infectious agents in general. These findings represent the first such body of knowledge in Europe and are in agreement with previous data from North America and Australia. Interestingly, the idea that bioterrorism agents are an intentional laboratory product of genetic engineering and synthetic biology approaches is significantly present among the surveyed population, but with contradicting views on whether such actions would be malicious or well-intended. These ideas, coupled with substantial mistrust in government institutions and news media, could inflict serious consequences and, therefore, should be taken into consideration when designing prevention and preparedness strategies, as well as interventions through knowledge communication.

The prevalence of psychological consequences of COVID-19: A systematic review and meta-analysis of observational studies

A systematic review and a meta-analysis were conducted to examine the overall prevalence of psychological health outcomes during COVID-19. Seven databases were systematically searched to include studies reporting on at least one psychological outcome. The pooled prevalence of primary psychological outcomes was 26% (95%CI: 21-32). Pooled prevalence for symptoms of PTSD was 33% (0-86), anxiety 28% (21-36), stress 27% (14-43), and depression 22% (13-33). The prevalence of psychological outcomes was similar in healthcare workers and in the general population (34% [24-44] and 33% [27-40] respectively). High prevalence figures support the importance of ensuring adequate provision of resources for mental health.

The psychological typhoon eye effect during the COVID-19 outbreak in China: the role of coping efficacy and perceived threat

Background

The influence of COVID-19 on mental health problems has received considerable attention. However, only a few studies have examined the relationship between exposure to COVID-19 and mental health problems, and no empirical study has tested the mechanisms between them.

Methods

We conducted a survey in 31 provinces of China during 3–13 March 2020 to test the effect of the exposure level on mental health problems. Our sample comprised 2987 participants who reported their perceived threat, coping efficacy, mental health problems and other demographic variables. Multiple mediators path analysis was used in the data analysis.

Results

The results showed that the level of exposure to COVID-19 in China was negatively associated with mental health problems, which confirmed the “Psychological Typhoon Eye” effect. Further analyses indicated that both perceived threat and coping efficacy partially mediated the relationship between them. However, coping efficacy explained the “Psychological Typhoon Eye” effect. Perceived threat mediated the positive relationship between exposure level and mental health problems.

Conclusion

This study detected the psychological typhoon eye effect and demonstrated the mediating role of coping efficacy and perceived threat between exposure to COVID-19 and mental health problems. Our findings suggest that policy makers and psychological workers should provide enough psychological services to low-risk areas as the high-risk areas. An important means of alleviating mental health problems is to improve coping efficacy.

Risk perception during the 2014-2015 Ebola outbreak in Sierra Leone

BACKGROUND

Perceived susceptibility to a disease threat (risk perception) can influence protective behaviour. This study aims to determine how exposure to information sources, knowledge and behaviours potentially influenced risk perceptions during the 2014-2015 Ebola Virus Disease outbreak in Sierra Leone.

METHODS

The study is based on three cross-sectional, national surveys (August 2014, n = 1413; October 2014, n = 2086; December 2014, n = 3540) that measured Ebola-related knowledge, attitudes, and practices in Sierra Leone. Data were pooled and composite variables were created for knowledge, misconceptions and three Ebola-specific behaviours. Risk perception was measured using a Likert-item and dichotomised into 'no risk perception' and 'some risk perception'. Exposure to five information sources was dichotomised into a binary variable for exposed and unexposed. Multilevel logistic regression models were fitted to examine various associations.

RESULTS

Exposure to new media (e.g. internet) and community-level information sources (e.g. religious leaders) were positively associated with expressing risk perception. Ebola-specific knowledge and hand washing were positively associated with expressing risk perception (Adjusted OR [AOR] 1.4, 95% Confidence Interval [CI] 1.2-1.8 and AOR 1.4, 95% CI 1.1-1.7 respectively), whereas misconceptions and avoiding burials were negatively associated with risk perception, (AOR 0.7, 95% CI 0.6-0.8 and AOR 0.8, 95% CI 06-1.0, respectively).

CONCLUSIONS

Our results illustrate the complexity of how individuals perceived their Ebola acquisition risk based on the way they received information, what they knew about Ebola, and actions they took to protect themselves. Community-level information sources may help to align the public's perceived risk with their actual epidemiological risk. As part of global health security efforts, increased investments are needed for community-level engagements that allow for two-way communication during health emergencies.

Collective Response to Media Coverage of the COVID-19 Pandemic on Reddit and Wikipedia: Mixed-Methods Analysis

BACKGROUND

The exposure and consumption of information during epidemic outbreaks may alter people's risk perception and trigger behavioral changes, which can ultimately affect the evolution of the disease. It is thus of utmost importance to map the dissemination of information by mainstream media outlets and the public response to this information. However, our understanding of this exposure-response dynamic during the COVID-19 pandemic is still limited.

OBJECTIVE

The goal of this study is to characterize the media coverage and collective internet response to the COVID-19 pandemic in four countries: Italy, the United Kingdom, the United States, and Canada.

METHODS

We collected a heterogeneous data set including 227,768 web-based news articles and 13,448 YouTube videos published by mainstream media outlets, 107,898 user posts and 3,829,309 comments on the social media platform Reddit, and 278,456,892 views of COVID-19-related Wikipedia pages. To analyze the relationship between media coverage, epidemic progression, and users' collective web-based response, we considered a linear regression model that predicts the public response for each country given the amount of news exposure. We also applied topic modelling to the data set using nonnegative matrix factorization.

RESULTS

Our results show that public attention, quantified as user activity on Reddit and active searches on Wikipedia pages, is mainly driven by media coverage; meanwhile, this activity declines rapidly while news exposure and COVID-19 incidence remain high. Furthermore, using an unsupervised, dynamic topic modeling approach, we show that while the levels of attention dedicated to different topics by media outlets and internet users are in good accordance, interesting deviations emerge in their temporal patterns.

CONCLUSIONS

Overall, our findings offer an additional key to interpret public perception and response to the current global health emergency and raise questions about the effects of attention saturation on people's collective awareness and risk perception and thus on their tendencies toward behavioral change.

Excessive Media Consumption About COVID-19 is Associated With Increased State Anxiety: Outcomes of a Large Online Survey in Russia

BACKGROUND

The COVID-19 pandemic has potentially had a negative impact on the mental health and well-being of individuals and families. Anxiety levels and risk factors within particular populations are poorly described.

OBJECTIVE

This study aims to evaluate confidence, understanding, trust, concerns, and levels of anxiety during the COVID-19 pandemic in the general population and assess risk factors for increased anxiety.

METHODS

We launched a cross-sectional online survey of a large Russian population between April 6 and 15, 2020, using multiple social media platforms. A set of questions targeted confidence, understanding, trust, and concerns in respondents. The State-Trait Anxiety Inventory was used to measure anxiety. Multiple linear regressions were used to model predictors of COVID-19-related anxiety.

RESULTS

The survey was completed by 23,756 out of 53,966 (44.0% response rate) unique visitors; of which, 21,364 were residing in 62 areas of Russia. State Anxiety Scale (S-Anxiety) scores were higher than Trait Anxiety Scale scores across all regions of Russia (median S-Anxiety score 52, IQR 44-60), exceeding published norms. Time spent following news on COVID-19 was strongly associated with an increased S-Anxiety adjusted for baseline anxiety level. One to two hours spent reading COVID-19 news was associated with a 5.46 (95% CI 5.03-5.90) point difference, 2-3 hours with a 7.06 (95% CI 6.37-7.74) point difference, and more than three hours with an 8.65 (95% CI 7.82-9.47) point difference, all compared to less than 30 minutes per day. Job loss during the pandemic was another important factor associated with higher S-Anxiety scores (3.95, 95% CI 3.31-4.58). Despite survey respondents reporting high confidence in information regarding COVID-19 as well as an understanding of health care guidance, they reported low overall trust in state and local authorities, and perception of country readiness.

CONCLUSIONS

Among Russian respondents from multiple social media platforms, there was evidence of higher levels of state anxiety associated with recent job loss and increased news consumption, as well as lower than expected trust in government agencies. These findings can help inform the development of key public health messages to help reduce anxiety and raise perceived trust in governmental response to this current national emergency. Using a similar methodology, comparative surveys are ongoing in other national populations.

How the Media Places Responsibility for the COVID-19 Pandemic-An Australian Media Analysis

Global pandemics are likely to increase in frequency and severity, and media communication of key messages represents an important mediator of the behavior of individuals in response to public health countermeasures. Where the media places responsibility during a pandemic is therefore important to study as blame is commonly used as a tool to influence public behavior but can also lead to the subjective persecution of groups. The aim of this paper is to investigate where the media places responsibility for COVID-19 in Australia. Specifically, we identify the key themes and frames that are present and observe how they changed over the course of the COVID-19 pandemic in relation to government actions and progression of the pandemic. Understanding media representations of the COVID-19 pandemic will provide insights into ways in which responsibility is framed in relation to health action. Newspaper articles from the Australian and the Sydney Morning Herald were sampled between January 20 and March 31 2020 on every second Monday. Factiva was used to identify and download newspaper articles using the following search criteria: "COVID-19" OR coronavirus OR "Wuhan virus" OR "corona virus" OR "Hebei virus" OR "wet market" OR (Wuhan AND virus) OR (market AND Wuhan and virus) or (China AND Virus) or (Novel AND Virus). Articles were imported into Nvivo and thematic and framing analyses were used. The results show that framing of the pandemic was largely based on societal issues with the theme of economic disruption prevalent throughout the study time period. Moral evaluations of the pandemic were infrequent initially but increased co-incident with the first signs of "flattening of the curve." Explicit examples of blame were very rare but were commonly implied based on the causal origin of the virus. The Australian printed media were slow to report on the COVID-19 pandemic, in addition they were reluctant to apportion blame until the end of the study period, after confirmed case rates had begun to slow. This is interpreted as being due to an evaluation of the pandemic risks as low by the media and therefore the tools of othering and blame were not used until after the study period when the actual risks had begun to abate, more consistent with an inquiry than a mediating mechanism.

Infectious disease, public health, and politics: United States response to Ebola and Zika

Politics, rather than disease characteristics, complicated the United States response to Ebola virus disease and Zika virus. We analyze how media and political elites shaped public opinion of the two outbreaks. We conducted a retrospective analysis of media coverage, Congressional floor speech, and public opinion polls to explain elite cueing and public perceptions of Ebola and Zika. We find evidence of elite cueing by Congress and the media on public opinion. Public opinion of both disease outbreaks initially followed partisan patterns. However, while Ebola public opinion remained partisan, ultimately, opinion emerged of a bipartisan nature for Zika, mirroring elite framing. Public health officials should be aware of how elite cueing shapes policy and prioritizes partisan strategies. Politics and public opinion can focus attention on or away from infectious disease; it can also undermine public health responses by biasing the public's view of a diseases' relative risk.

Effects of Covid-19 Lockdown on Mental Health and Sleep Disturbances in Italy

Italy was the first European country that entered a nationwide lockdown during the COVID-19 pandemic. Since quarantine can impact on mental health, this study aimed to estimate the prevalence of depressive symptoms, anxiety symptoms and sleeping disturbances in the Italian population during lockdown. The factors that might influence such outcomes were explored. A national cross-sectional survey was performed during the last 14 days of the Italian lockdown. Questionnaires assessed socio-demographics characteristic, behaviors and healthcare access. The outcomes were assessed using Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2. Participants with sleep disturbances completed the Insomnia Severity Index. The sample size was 1515. Depression and anxiety symptom prevalence was 24.7% and 23.2%; 42.2% had sleep disturbances and, among them, 17.4% reported moderate/severe insomnia. Being female, an increased time spent on the internet and an avoidance of activities through peer pressure increased the likelihood of at least one mental health outcome. Increasing age, an absence of work-related troubles and being married or being a cohabitant reduced such a probability. Females and participants with chronic conditions were associated with a higher prevalence of sleep disturbances. It is crucial to study effective interventions, specifically planning strategies, for more vulnerable groups and to consider the role of the internet.

Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.

Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on all aspects of society, including mental health and physical health. We explore the psychological, social, and neuroscientific effects of COVID-19 and set out the immediate priorities and longer-term strategies for mental health science research. These priorities were informed by surveys of the public and an expert panel convened by the UK Academy of Medical Sciences and the mental health research charity, MQ: Transforming Mental Health, in the first weeks of the pandemic in the UK in March, 2020. We urge UK research funding agencies to work with researchers, people with lived experience, and others to establish a high level coordination group to ensure that these research priorities are addressed, and to allow new ones to be identified over time. The need to maintain high-quality research standards is imperative. International collaboration and a global perspective will be beneficial. An immediate priority is collecting high-quality data on the mental health effects of the COVID-19 pandemic across the whole population and vulnerable groups, and on brain function, cognition, and mental health of patients with COVID-19. There is an urgent need for research to address how mental health consequences for vulnerable groups can be mitigated under pandemic conditions, and on the impact of repeated media consumption and health messaging around COVID-19. Discovery, evaluation, and refinement of mechanistically driven interventions to address the psychological, social, and neuroscientific aspects of the pandemic are required. Rising to this challenge will require integration across disciplines and sectors, and should be done together with people with lived experience. New funding will be required to meet these priorities, and it can be efficiently leveraged by the UK's world-leading infrastructure. This Position Paper provides a strategy that may be both adapted for, and integrated with, research efforts in other countries.

Misinformation and the US Ebola communication crisis: analyzing the veracity and content of social media messages related to a fear-inducing infectious disease outbreak

Background

The Ebola communication crisis of 2014 generated widespread fear and attention among Western news media, social media users, and members of the United States (US) public. Health communicators need more information on misinformation and the social media environment during a fear-inducing disease outbreak to improve communication practices. The purpose of this study was to describe the content of Ebola-related tweets with a specific focus on misinformation, political content, health related content, risk framing, and rumors.

Methods

We examined tweets from a random 1% sample of all tweets published September 30th - October 30th, 2014, filtered for English-language tweets mentioning “Ebola” in the content or hashtag, that had at least 1 retweet (N = 72,775 tweets). A randomly selected subset of 3639 (5%) tweets were evaluated for inclusion. We analyzed the 3113 tweets that meet inclusion criteria using public health trained human coders to assess tweet characteristics (joke, opinion, discord), veracity (true, false, partially false), political context, risk frame, health context, Ebola specific messages, and rumors. We assessed the proportion of tweets with specific content using descriptive statistics and chi-squared tests.

Results

Of non-joke tweets, 10% of Ebola-related tweets contained false or partially false information. Twenty-five percent were related to politics, 28% contained content that provoked reader response or promoted discord, 42% contained risk elevating messages and 72% were related to health. The most frequent rumor mentioned focused on government conspiracy. When comparing tweets with true information to tweets with misinformation, a greater percentage of tweets with misinformation were political in nature (36% vs 15%) and contained discord-inducing statements (45% vs 10%). Discord-inducing statements and political messages were both significantly more common in tweets containing misinformation compared with those without(p < 0.001).

Conclusions

Results highlight the importance of anticipating politicization of disease outbreaks, and the need for policy makers and social media companies to build partnerships and develop response frameworks in advance of an event. While each public health event is different, our findings provide insight into the possible social media environment during a future epidemic and could help optimize potential public health communication strategies.

A Cross-Sectional Examination of the Factors Related to Emergency Nurses' Motivation to Protect Themselves Against an Ebola Infection

Introduction

The 2014-2016 West African Ebola outbreak impacted the United States. Owing to the sporadic occurrence of the Ebola infection, there is insufficient research regarding how US emergency nurses provide care to patients potentially infected with the Ebola virus and the nurses’ motivation to protect themselves when providing care to these patients. This study aimed to investigate the predictors of emergency nurses’ protection motivation.

Methods

A cross-sectional design was employed. A survey developed based on a modified Protection Motivation Theory was administered to randomly selected members of the Emergency Nurses Association. Descriptive statistics, nonparametric Kruskal-Wallis H test (as well as post hoc Dunn-Bonferroni test), Spearman rho correlation, and stepwise multiple linear regression were conducted for data analysis.

Results

Protection motivation was found in 2 components: proactive and passive protection motivation. Regression analysis indicated that response efficacy (β = 0.27, P < 0.001) and self-efficacy (β = 0.17, P < 0.01) significantly predict emergency nurses’ proactive protection motivation, whereas perceived vulnerability (β = 0.26, P < 0.001), response cost (β = 0.19, P = 0.001), and knowledge (β = −0.15, P < 0.01) significantly predict emergency nurses’ passive protection motivation.

Discussion

The results indicate the need for interventions to improve emergency nurses’ response efficacy, self-efficacy, and knowledge, while simultaneously reducing the nurses’ perceived vulnerability and response cost. Such interventions would be expected to proactively motivate nurses to protect themselves when providing care to patients who exhibit the signs and symptoms of an Ebola infection and reduce their passive protection motivation.

Public Health Resilience Checklist for High-Consequence Infectious Diseases-Informed by the Domestic Ebola Response in the United States

CONTEXT

The experiences of communities that responded to confirmed cases of Ebola virus disease in the United States provide a rare opportunity for collective learning to improve resilience to future high-consequence infectious disease events.

DESIGN

Key informant interviews (n = 73) were conducted between February and November 2016 with individuals who participated in Ebola virus disease planning or response in Atlanta, Georgia; Dallas, Texas; New York, New York; or Omaha, Nebraska; or had direct knowledge of response activities. Participants represented health care; local, state, and federal public health; law; local and state emergency management; academia; local and national media; individuals affected by the response; and local and state governments. Two focus groups were then conducted in New York and Dallas, and study results were vetted with an expert advisory group.

RESULTS

Participants focused on a number of important areas to improve public health resilience to high-consequence infectious disease events, including governance and leadership, communication and public trust, quarantine and the law, monitoring programs, environmental decontamination, and waste management.

CONCLUSIONS

Findings provided the basis for an evidence-informed checklist outlining specific actions for public health authorities to take to strengthen public health resilience to future high-consequence infectious disease events.

Influencing Factors in the Development of State-Level Movement Restriction and Monitoring Policies in Response to Ebola, United States, 2014-15

During the 2014-15 domestic Ebola response, US states developed monitoring and movement restriction policies for potentially exposed individuals. We describe decision-making processes and factors in the development of these policies. Results may help health officials anticipate potential concerns and policy influencers in future infectious disease responses. Thirty individuals with knowledge of state-level Ebola policy development participated in semi-structured interviews conducted from January to May 2017. Interviewees represented 18 jurisdictions from diverse census regions, state political affiliations, and public health governance structures as well as the US Centers for Disease Control and Prevention (CDC). Limited and/or changing guidance and unique state-level public health, legal, and operational environments resulted in variation in policy responses. Federal guidance developed by the CDC was an important information source influencing state-level policy responses, as was available scientific evidence; however, other external factors, such as local events, contributing experts, political environment, public concern, news media, and the influence of neighboring states, contributed to additional variation. Improvements in timing, consistency, and communication of federal guidance for monitoring and movement restrictions at the state level-along with balanced approaches to addressing ethical concerns, scientific evidence, and public concern at the state level-are considerations for policy development for future disease responses.

"I Knew I Could Make a Difference": Motivations and Barriers to Engagement in Fighting the West African Ebola Outbreak Among U.S.-Based Health Professionals

The 2014 West African Ebola outbreak was unprecedented in scale and required significant international assistance. Many U.S.-based health professionals traveled to West Africa to participate in the response, whereas others considered participation, but ultimately decided against it. This study explores motivators, facilitators, and barriers to international health care worker mobilization. We conducted 24 semistructured in-depth interviews and one focus group discussion with clinical and nonclinical responders and nonresponders. Responders reported feeling duty-bound to help, confidence in their training, and prior experience in humanitarian response. Media coverage was perceived to create environments of stigma and misinformation. Supportive workplaces and clear leave of absence policies facilitated engagement, whereas unsupportive workplaces posed barriers. Although nonresponders were included in the study, the dynamics of nonresponse were less clear and warrant further exploration. Understanding how to support health professionals in responding to outbreak situations may improve mobilization in future public health crises.

Frequency of Risk-Related News Media Messages in 2016 Coverage of Zika Virus

News media plays a large role in the information the public receives during an infectious disease outbreak, and may influence public knowledge and perceptions of risk. This study analyzed and described the content of U.S. news media coverage of Zika virus and Zika response during 2016. A random selection of 800 Zika-related news stories from 25 print and television news sources was analyzed. The study examined 24 different messages that appeared in news media articles and characterized them using theories of risk perception as messages with characteristics that could increase perception of risk (risk-elevating messages; n = 14), messages that could decrease perception of risk (risk-minimizing messages; n = 8), or messages about travel or testing guidance (n = 2). Overall, 96% of news stories in the study sample contained at least one or more risk-elevating message(s) and 61% contained risk-minimizing message(s). The frequency of many messages changed after local transmission was confirmed in Florida, and differed between sources in locations with or without local transmission in 2016. Forty percent of news stories included messages about negative potential outcomes of Zika virus infection without mentioning ways to reduce risk. Findings from this study may help inform current federal, state, and local Zika responses by offering a detailed analysis of how news media are covering the outbreak and response activities as well as identifying specific messages appearing more or less frequently than intended. Findings identifying the types of messages that require greater emphasis may also assist public health communicators in responding more effectively to future outbreaks.

Information Circulation in times of Ebola: Twitter and the Sexual Transmission of Ebola by Survivors

INTRODUCTION

The 2013-2015 outbreak of Ebola was by far the largest to date, affecting Guinea, Liberia, Sierra Leone, and secondarily, Nigeria, Senegal and the United States. Such an event raises questions about the circulation of health information across social networks. This article presents an analysis of tweets concerning a specific theme: the sexual transmission of the virus by survivors, at a time when there was a great uncertainty about the duration and even the possibility of such transmission.

METHODS

This article combines quantitative and qualitative analysis. From a sample of 50,000 tweets containing the words "Ebola" in French and English, posted between March 15 and November 8, 2014, we created a graphic representation of the number of tweets over time, and identified two peaks: the first between July 27 and August 16, 2014 (633 tweets) and the second between September 28 and November 8, 2014 (2,577 tweets). This sample was divided into two parts, and every accessible publication was analyzed and coded according to the authors' objectives, feelings expressed and/or publication type.

RESULTS

While the results confirm the significant role played by mainstream media in disseminating information, media did not create the debate around the sexual transmission of Ebola and Twitter does not fully reflect mainstream media contents. Social media rather work like a "filter": in the case of Ebola, Twitter preceded and amplified the debate with focusing more than the mainstream media on the sexual transmission, as expressed in jokes, questions and criticism.

DISCUSSION

Online debates can of course feed on journalistic or official information, but they also show great autonomy, tinged with emotions or criticisms. Although numerous studies have shown how this can lead to rumors and disinformation, our research suggests that this relative autonomy makes it possible for Twitter users to bring into the public sphere some types of information that have not been widely addressed. Our results encourage further research to understand how this "filter" works during health crises, with the potential to help public health authorities to adjust official communications accordingly. Without a doubt, the health authorities would be well advised to put in place a special watch on the comments circulating on social media (in addition to that used by the health monitoring agencies).

Incentives for Bushmeat Consumption and Importation among West African Immigrants, Minnesota, USA

The knowledge, attitudes, and practices surrounding bushmeat consumption and importation in the United States are not well described. Focus groups of West African persons living in Minnesota, USA, found that perceived risks are low and unlikely to deter consumers. Incentives for importation and consumption were multifactorial in this community.