Masks, Gloves, and the COVID-19 Pandemic: Rapid Assessment of Public Behaviors in the United States

Factors Associated With Levels of Public Engagement in Protective Behaviors During the Early COVID-19 Pandemic: Causal-Comparative Study Based on the Health Belief Model

BACKGROUND

While the challenges of COVID-19 are still unfolding, the enhancement of protective behavior remains a top priority in global health care. However, current behavior-promoting strategies may be inefficient without first identifying the individuals with lower engagement in protective behavior and the associating factors.

OBJECTIVE

This study aimed to identify individuals with and potential contributing factors to low engagement in protective behavior during the COVID-19 pandemic.

METHODS

This is a causal-comparative study. A theory-based web-based survey was used to investigate individuals' protective behavior and potential associating factors. During June 2020, the distribution of the survey was targeted to 3 areas: Taiwan, Japan, and North America. Based on the theory of the health belief model (HBM), the survey collected participants' various perceptions toward COVID-19 and a collection of protective behaviors. In addition to the descriptive analysis, cluster analysis, ANOVA, and Fisher exact and chi-square tests were used.

RESULTS

A total of 384 responses were analyzed. More than half of the respondents lived in Taiwan, followed by Japan, then North America. The respondents were grouped into 3 clusters according to their engagement level in all protective behaviors. These 3 clusters were significantly different from each other in terms of the participants' sex, residency, perceived barriers, self-efficacy, and cues of action.

CONCLUSIONS

This study used an HBM-based questionnaire to assess protective behaviors against COVID-19 and the associated factors across multiple countries. The findings indicate significant differences in various HBM concepts among individuals with varying levels of behavioral engagement.

Trust in public health institutions moderates the effectiveness of COVID-19 vaccine discussion groups on Facebook

BACKGROUND

Distrust and partisan identity are theorized to undermine health communications. We examined the role of these factors on the efficacy of discussion groups intended to promote vaccine uptake.

METHOD

We analyzed survey data from unvaccinated Facebook users (N = 371) living in the US between January and April 2022. Participants were randomly assigned to Facebook discussion groups (intervention) or referred to Facebook's COVID-19 Information Center (control). We used Analysis of Covariance to test if the intervention was more effective at changing vaccination intentions and beliefs compared to the control in subgroups based on participants' partisan identity, political views, and information trust views.

RESULTS

We found a significant interaction between the intervention and trust in public health institutions (PHIs) for improving intentions to vaccinate (P = .04), intentions to encourage others to vaccinate (P = .03), and vaccine confidence beliefs (P = .01). Among participants who trusted PHIs, those in the intervention had higher posttest intentions to vaccinate (P = .008) and intentions to encourage others to vaccinate (P = .002) compared to the control. Among non-conservatives, participants in the intervention had higher posttest intentions to vaccinate (P = .048). The intervention was more effective at improving intentions to encourage others to vaccinate within the subgroups of Republicans (P = .03), conservatives (P = .02), and participants who distrusted government (P = .02).

CONCLUSIONS

Facebook discussion groups were more effective for people who trusted PHIs and non-conservatives. Health communicators may need to segment health messaging and develop strategies around trust views.

Understanding Sociodemographic Factors and Reasons Associated with COVID-19 Vaccination Hesitance among Adults in Tanzania: A Mixed-Method Approach

Although studies on COVID-19 vaccine hesitancy are being undertaken widely worldwide, there is limited evidence in Tanzania. This study aims to assess the sociodemographic factors associated with COVID-19 vaccine hesitancy and the reasons given by unvaccinated study participants. We conducted a mixed-method cross-sectional study with two components-health facilities and communities-between March and September 2022. A structured questionnaire and in-depth interviews were used to collect quantitative and qualitative data, respectively. A total of 1,508 individuals agreed to participate in the survey and explained why they had not vaccinated against COVID-19. Of these participants, 62% indicated they would accept the vaccine, whereas 38% expressed skepticism. In a multivariate regression analysis, adult study participants 40 years and older were significantly more likely to report not intending to be vaccinated (adjusted odds ratio [AOR], 1.28; 95% CI, 1.01-1.61; P = 0.04) than youth and middle-aged study participants between 18 and 40 years. Furthermore, female study participants had a greater likelihood of not intending to be vaccinated (AOR, 1.51; 95% CI, 1.19-1.90; P = 0.001) than male study participants. The study identified fear of safety and short-term side effects, and lack of trust of the COVID-19 vaccine; belief in spiritual or religious views; and belief in local remedies and other precautions or preventive measures as the major contributors to COVID-19 vaccine hesitancy in Tanzania. Further empirical studies are needed to confirm these findings and to understand more fully the reasons for vaccine hesitancy in different demographic groups.

Collective health behavior and face mask utilization during the COVID-19 pandemic in Oklahoma, USA

BACKGROUND

Face mask use offers an important public health tool for reducing the spread of coronavirus disease 2019 (COVID-19), yet the politicization of COVID-19 has resulted in uneven adherence. This study assesses the effects of setting characteristics and the sociodemographic composition of crowds on group-level masking rates.

METHODS

We conducted 123 site observations of masking behavior at public locations across Oklahoma (USA) between June and September 2020. We used analyses of variance and t-tests to examine variation in masking and ordinary least squares regression to model the effect of setting and sociodemographic characteristics on site-level masking rates.

RESULTS

The masking rate across all sites averaged 34% but varied widely. Site-level masking rates were higher at metropolitan sites and sites with a store or municipal masking mandate. The masking rate at sites where women or older adults (60+) were the predominant group did not differ significantly from other sites. Ethnically diverse sites exhibited significantly higher masking rates compared with predominantly white sites. Findings indicate that setting characteristics explained a greater amount of variation in collective masking rates than sociodemographic differences.

CONCLUSIONS

This study underscores the importance of place and policy for mask adherence. In the absence of state-level mandates, masking policies at a more local level may be effective.

Barriers to COVID-19 vaccine uptake among resource-limited adults diagnosed with chronic illness

Background

Despite the use of interventions (e.g., monetary incentives, educational campaigns, on-site workplace vaccination) to increase COVID-19 vaccination, differences in uptake persist by poverty level, insurance status, geography, race, and ethnicity, suggesting that these interventions may not be adequately addressing the barriers faced by these populations. Among a sample of resource-limited individuals with chronic illnesses, we (1) described the prevalence of different types of barriers to the COVID-19 vaccination and (2) identified associations between patients' sociodemographic characteristics and barriers to vaccination.

Methods

We surveyed a national sample of patients with chronic illness and demonstrated healthcare affordability and/or access challenges about barriers to COVID-19 vaccination in July 2021. We categorized participant responses into cost, transportation, informational, and attitudinal barrier domains and assessed the prevalence of each domain, both overall and by self-reported vaccination status. Using logistic regression models, we examined unadjusted and adjusted associations between respondent characteristics (sociodemographic, geographic, and healthcare access) and self-reported barriers to vaccination.

Results

Of 1,342 respondents in the analytic sample, 20% (264/1,342) reported informational barriers and 9% (126/1,342) reported attitudinal barriers to COVID-19 vaccination. Transportation and cost barriers were reported much less commonly, by only 1.1% (15/1,342) and 0.7% (10/1,342) of the sample, respectively. Controlling for all other characteristics, respondents with either a specialist as their usual source of care or no usual source of care had an 8.4 (95% CI: 1.7-15.1) and 18.1 (95% CI: 4.3-32.0) percentage point higher predicted probability, respectively, of reporting informational barriers to care. Compared to females, males had an 8.4% point (95% CI: 5.5-11.4) lower predicted probability of reporting attitudinal barriers. Only attitudinal barriers were associated with COVID-19 vaccine uptake.

Conclusion

Among a sample of adults with chronic illnesses who had received financial assistance and case management services from a national non-profit, informational and attitudinal barriers were more commonly reported than logistical or structural access barriers (i.e., transportation and cost barriers). Interventions should target attitudinal barriers among patients with chronic illness, who may have particular concerns about the interaction of the vaccine with ongoing medical care. Additionally, interventions targeting informational barriers are particularly needed among individuals without a usual source of care.

Mask Adherence and Social Distancing in Houston, TX from January to April 2021

Shortly after the identification of COVID-19, public health experts recommended the use of face masks and social distancing to slow the spread of the virus. Early research indicates that there are associations between gender, age, and mask-wearing behavior. The primary aim of this paper was to explore how demographics, location, and mask mandates may affect COVID-19 mitigation strategies such as mask-wearing and social distancing. A prospective, cross-sectional observational study was conducted in Houston, TX from January to April 2021 at three outdoor locations: an urban park, an urban park with a trail, and a farmer's market. During each two-hour data collection period, trained observers recorded the total number of people in the designated spaces; people were categorized by approximate age, sex, race/ethnicity, physical activity level, social distancing, and mask adherence using the Systematic Observation of Mask Adherence and Distancing (SOMAD) protocol. Multivariable logistic regression was used to determine associations with gender, race, age, location, and the mask mandate. A total of 7778 observations were recorded after exclusion of inconclusive demographic data. Females had higher odds, reported as an odds ratio, of mask use than males (OR = 1.35, 95% CI 1.18-1.54). Compared to White individuals, Asian individuals had higher odds of mask use (OR = 1.84, 95% CI 1.48-2.30). The odds of mask use were higher while the Texas mask mandate was in effect (OR = 1.60, 95% CI 1.40-1.84). Regarding location, the odds of mask use were much higher in the urban park than in the urban park with a trail (OR = 13.33). Individuals had higher odds of social distancing at the urban park with a trail compared to the farmer's market (OR = 4.61, 95% CI 4.10-5.17). Mask wearing and social distancing behaviors differ by demographics, locality, and mask mandate. Thus, state policies can be effective tools to encourage mask wearing for disease mitigation.

Economic risk framing increases intention to vaccinate among Republican COVID-19 vaccine refusers

OBJECTIVE

To determine if framing communications about COVID-19 vaccines in economic terms can increase Republicans' likelihood to get vaccinated.

METHODS

We examined Twitter posts between January 2020 and September 2021 by Democratic and Republican politicians to determine how they framed the COVID-19 pandemic. Based on these posts, we carried out a survey study between September and November 2021 to examine whether motivations for COVID-19 vaccine uptake matched message frames that were widely used by these politicians. Finally, we conducted a randomized controlled experiment to examine how these frames (economic vs. health) affected intentions to vaccinate by vaccine refusers in both parties.

RESULTS

Republican politicians were more likely to frame the pandemic in economic terms, whereas Democrats predominantly used health frames. Accordingly, vaccinated Republicans' choices were more likely to be motivated by economic consideration (β = 0.25, p = 0.02) and personal financial rationales (β = 0.24, p = 0.03). Among vaccine refusers, Republicans exposed to messages using economic rationales to encourage vaccination reported higher vaccination intentions compared to those exposed to messages using public health rationales (F1,119 = 4.16, p = 0.04).

CONCLUSION

Messages highlighting economic and personal financial risks could increase intentions to vaccinate for vaccine-hesitant Republicans.

PUBLIC HEALTH IMPLICATIONS

Agencies should invest in developing messages that are congruent with frames that are already widely used by co-partisans. Social media may be helpful in eliciting these frames.

A hand-targeted auxiliary personal protective equipment for intervention of fomite transmission of viruses

In COVID-19, fomite transmission has been shown to be a major route for the spreading of the SARS-CoV-2 virus due to its ability to remain on surfaces for extended durations. Although glove wearing can mitigate the risk of viral transmission especially on high touch points, it is not prevalent due to concerns on diversion of frontline medical resources, cross-contamination, social stigma, as well as discomfort and skin reactions derived from prolonged wearing. In this study, we developed FlexiPalm, a hand-targeted auxiliary personal protective equipment (PPE) against fomite transmission of viruses. FlexiPalm is a unique palmar-side hand protector designed to be skin-conforming and transparent, fabricated from medical-grade polyurethane transparent film material as a base substrate. It serves primarily as a barrier to microbial contamination like conventional gloves, but with augmented comfort and inconspicuousness to encourage a higher public adoption rate. Compared to conventional glove materials, FlexiPalm demonstrated enhanced mechanical durability and breathability, comparable hydrophobicity, and displayed a minimal adsorption of SARS-CoV-2 spike protein and virus-like particles (VLP). Importantly, FlexiPalm was found to bind significantly less viral protein and VLP than artificial human skin, confirming its ability to reduce viral contamination. A pilot study involving participants completing activities of daily living showed a high level of comfort and task completion, illustrating the usability and functionality of FlexiPalm. Moreover, we have demonstrated that surface modification of FlexiPalm with microtextures enables further reduction in viral adsorption, thereby enhancing its functionality. An effective implementation of FlexiPalm will bolster PPE sustainability and lead to a paradigm shift in the global management of COVID-19 and other infectious diseases in general.

Knowledge and Acceptance of the COVID-19 Vaccine for COVID-19 Disease Prevention among the Indian Population: A Mixed-Method Study

Aim: To assess the Knowledge and Acceptance of the COVID vaccine among the Indian population. Materials and methods: The present mixed-method study was conducted in two phases. The first phase: quantitative assessment of knowledge and acceptance for the COVID-19 vaccine using an E survey (N = 606). The second phase: qualitative assessment using semi-structured face-to-face interviews with the study participants (N = 30) and assessment was done using a thematic approach. Study participants were selected using the convenience sampling method. Results: It was found that a large proportion of subjects in the 16−25 year of age group knew the cause of disease. But knowledge about its transmission process was found to be more in >60 years of age gap and almost all the participants in all the age group preferred Covishield. The vaccine acceptance rate was found to be low as compared to the knowledge. Conclusion: Most study participants were found to have satisfactory knowledge, but acceptance rate was comparatively lesser. Hence, more information and awareness campaigns must be launched reassuring the population about vaccine safety.

Explaining racial/ethnic and socioeconomic differences in COVID protective behavior

COVID-19 has had a disproportionate impact on Black, Hispanic, and lower socioeconomic status communities. Using data from the Community, Health and Politics Study (CHAPS 2021), collected in the midst of the pandemic, we examine differences in COVID-19 health promotion behavior (i.e., avoiding large gatherings, mask wearing, and vaccination status) across racial, ethnic, and socioeconomic status subgroups of the population. Moreover, we examine the degree to which observed differences are robust to controls for other health-related disparities, such as access to health insurance, underlying health conditions, personal exposure to COVID-19 (i.e., own diagnoses, knowing persons who have died from COVID-19), and perceived COVID-19 threat. Findings are consistent with arguments proposed by fundamental cause theory and disease stage theory as they indicate fewer differences on the basis of socioeconomic status or race and ethnicity for masking and social distancing, which may be thought of as less effective measures. In contrast, disparities were prominent in vaccination outcomes. Specifically, racial and ethnic minorities, those with lower levels of education, and those with lower incomes had lower odds of vaccination, after controlling for covariates. Private insurance and older age were also associated with higher odds of vaccination. Higher perceived threat of COVID-19 increased the likelihood of all protective behaviors. Our findings suggest that the need for ongoing efforts to increase vaccination uptake in socially disadvantaged communities.

COVID information and masking behaviors in U.S. adolescents: Findings from the Adolescent Brain Cognitive Development (ABCD) Study

Adolescents are particularly vulnerable to health misinformation and are at risk for suboptimal adherence to protective health behaviors in the COVID-19 pandemic. Guided by factors consistent with the theories of planned behavior and rumor transmission, this study sought to analyze the impact of multiple information sources, including social media, television media, internet and parental counseling, on masking behaviors in adolescents. Responses from the December 2020 COVID-19 survey, representing 4,106 U.S. adolescents ages 12-14 from the Adolescent Brain Cognitive Development Study (ABCD) were analyzed. The majority of parents (61.1%) reported counseling their children on the importance of wearing masks all the time in the past week. A minority of adolescents reported more than one hour of daily exposure to COVID-19 related information on social media (9.1%), the internet (4.3%) and television (10.2%). In unadjusted and adjusted models, greater frequency of parental counseling and exposure to COVID-19 television or social media were associated with 'always masking' behaviors. Our findings provide support for the importance of parent counseling and suggest that socialmedia and television may overall support rather than dissuade protective COVID-19 health behaviors in adolescents.

Perceptions of COVID-19 vaccines in a predominantly Hispanic patient population from the Texas-Mexico border

BACKGROUND

Compared with nationwide averages, Hispanic individuals have experienced lower routine vaccination rates and have been disproportionately hospitalized for coronavirus disease 2019 (COVID-19). Few, if any, studies have examined the health beliefs surrounding the COVID-19 vaccines and adult vaccines among this population.

OBJECTIVES

This study aimed to (1) describe perceptions of COVID-19 vaccines in a predominantly Hispanic patient population in a federally qualified health center (FQHC) situated on the United States-Mexico border and (2) compare patient confidence in recommendations made by local clinic and government to obtain adult and COVID-19 vaccines.

METHODS

A bilingual (English or Spanish) written survey was administered to participants recruited from a convenience sample of patients in waiting areas of 4 clinic sites in an FQHC system on the Texas-Mexico border between March and May 2021. Survey items were derived from the Health Belief Model and captured beliefs surrounding perceived effectiveness, perceived harms, protection from the influenza vaccine, trust in the local clinic, and trust in the government.

RESULTS

A total of 58 participants aged 19-90 years, with a mean age of 57.28 years, completed the survey between March and May 2021, with 77.6% of respondents indicating they would accept a COVID-19 vaccine for themselves. Results revealed a trend among older adults in the study cohort to be more likely to trust the government in recommending vaccines than younger adults (r = 0.33, P ≤ 0.05) and a tendency toward higher vaccine acceptance among male survey participants (P = 0.026). The highest correlation that emerged was between perceived trust in local clinic provider and the perceived effectiveness of vaccines (r = 0.74, P < 0.01).

CONCLUSION

Trends related to perceptions of adult vaccines among Hispanic patients extend to the COVID-19 vaccines: especially trust in local clinic providers. Increased age may correlate to higher trust in a government-recommended vaccine. Results highlight the importance of the pharmacist giving the patient a clear recommendation to receive vaccination and strong local clinic messaging.

The effect of health literacy on COVID-19 vaccine hesitancy among community population in China: The moderating role of stress

Background

The public’s hesitant attitude is a major subjective barrier in promoting vaccination against COVID-19 to build herd immunity. The current study aimed to address how individual factors such as health literacy and perceived stress affect people’s vaccine hesitancy of COVID-19 vaccine, and to provide insights for tailoring vaccine-promotion strategies.

Methods

With structured questionnaires, an online survey was conducted to address the relationship between the health literacy, perceived stress, and COVID-19 vaccine hesitancy among community population in mainland, China. Moderated analysis was conducted to test the effect of health literacy on vaccine hesitancy among people with different levels of perceived stress.

Results

560 responses were collected in total. 39.8% of the participants reported vaccine hesitancy, and this rate was higher among younger people and female. Moreover, people with higher level of health literacy showed reduced vaccine hesitancy, while this effect was only significant among those with low or moderate level of stress. For people with high level of stress, no significant effect of health literacy was found.

Conclusions

The findings suggest that increasing people’s health literacy could lead to reduced vaccine hesitancy in community sample. However, this effect disappeared when the stress level was high, suggesting other promotion services may need to be developed to increase the acceptance of COVID-19 vaccine. In conclusion, vaccine promotion strategies should be tailored for different populations, with taking account of individual’s health literacy and perceived stress.

Public health guideline compliance and perceived government effectiveness during the COVID-19 pandemic in Canada: Findings from a longitudinal cohort study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has imposed enormous adversity worldwide. Public health guidelines have been a first line of defense but rely on compliance with evolving recommendations and restrictions. This study sought to characterize adherence to and perceptions of public health guidelines over a one-year timeframe during the pandemic.

METHODS

Participants were 1435 community adults in Ontario who completed assessments at five time points (April 2020, July 2020, October 2020, January 2021, and April 2021; 92% retention). Participants were assessed for self-reported adherence to government protocols and perceptions of government response (importance, compliance, and effectiveness). Analyses used general linear mixed-effects modelling of overall changes by time and examined differences based on age and sex.

FINDINGS

Over time, participants reported high or increasing behavioural engagement in public health guidelines, including physical distancing, restricting activity, and masking. In contrast, participants exhibited significant reductions in perceived importance and compliance, with evidence of more negative changes in younger participants. The largest changes were a substantial reduction in perceived government effectiveness, from predominantly positive perceptions to predominantly negative perceptions.

INTERPRETATION

These results illuminate evolving trends in public health compliance and perceptions over the course of the pandemic in Canada, revealing the malleability of public perceptions of public health recommendations and government effectiveness.

FUNDING

This research was funded by a grant from the Canadian Institutes of Health Research (CIHR). CIHR had no role in study design, data collection, data analysis, interpretation, or writing of the report.

Multilevel determinants of COVID-19 vaccination hesitancy in the United States: A rapid systematic review

Vaccine hesitancy is a challenge for the success and optimal implementation of COVID-19 immunization programs in the US. The objective of this study was to summarize multilevel determinants of COVID-19 vaccination intention in the US to inform future intervention opportunities. To this end, we conducted a rapid systematic review by searching published articles via PubMed published by October 5, 2021, following the PRISMA guidelines. One hundred and six articles were included. According to nationally representative studies, the overall COVID-19 acceptance rate ranges from 53.6% to 84.4%. Individual (demographics, health history, behaviors and health beliefs), interpersonal (having a close friend/family member impacted by COVID-19), healthcare and societal level factors (healthcare provider recommendations, source/credential of COVID-19 related information, and COVID-19 related conspiracy theories) all contributed to COVID-19 vaccine hesitancy in the US. This study demonstrates that the acceptance to COVID-19 vaccines is influenced by various factors, particularly the role of healthcare providers in enhancing public intent to vaccination. Potential interventions to mitigate people's concerns over the vaccines and address vaccine-related conspiracy/misinformation from social media are also critical to encourage vaccine uptake in the US.

Assessing the efficacy of 3D-printed ear protectors on mask adherence at an academic ophthalmology center

PURPOSE

In the ophthalmology setting, given the close proximity required for the clinical exam, appropriate mask usage and fit is essential. This study aims to assess how a simple, cost-effective 3D-printed face mask ear protectors (EP) attachment may decrease discomfort, increase compliance, and improve fit in an academic institution's Ophthalmology department.

METHODS

Face mask EPs were distributed to patients and providers in the Ophthalmology department. A validated questionnaire was administered before and 2 weeks after EP usage. The survey included questions on demographics and frequency of mask usage during a spectrum of activities. Descriptive statistics were performed with Fischer's t test.

RESULTS

Post-EP responses demonstrated an increased likelihood of mask usage across all activities, although not statistically significant. The greatest change was during outdoor activities, with a 14.3% increase in highest utilization. Post-EP, all subjects were very likely to wear masks while shopping and 91.7% while in the workplace. EP usage decreased the number of noncompliant individuals while spending time with friends and family by 93.3%. Almost no subjects reported mask removal of >15 times per hour post-EP. The increase in mask compliance was greatest for low mask utilizers. 91.9% reported improved comfort, 91.9% reported improved fit, and 81.6% reported increased mask usage.

CONCLUSION

Our results suggest that simple cost-effective 3D-printed ear protectors may improve fit, comfort, and overall mask compliance. The results of this study should drive broader public health efforts to further investigate whether mask attachments can improve overall mask compliance through better comfort and fit.

Factors influencing the protective behavior of individuals during COVID-19: a transnational survey

To slow the spread of infectious disease, it is crucial to understand the engagement of protective behavior among individuals. The purpose of this study was to systematically examine individuals' protective behaviors and the associated factors across countries during COVID-19. This causal-comparative study used a self-developed online survey to assess individuals' level of engagement with six protective behaviors. Analysis of variance and McNemar's test were employed for data analysis. Three hundred and eighty-four responses were analyzed. The majority of participants lived in three areas: Taiwan, Japan, and North America. Overall, the participants reported a high level of engagement in protective behaviors. However, engagement levels varied according to several demographic variables. Hand hygiene and cleaning/ventilation are two independent behaviors that differ from almost all other protective behaviors. There is a need to target the population at risk, which demonstrates low compliance. Different strategies are needed to promote specific protective behaviors.

Attitude towards Covid-19 Vaccine: A Cross-Sectional Urban and Rural Community Survey in Punjab, Pakistan

The study's objective was to ascertain the general public's attitudes regarding the covid-19 vaccine in Pakistan. A cross sectional design and e-survey was conducted by 1647 general public. The sample was divided into two sections: urban (702) and rural (945). The majority of participants were between the ages of 18 and 45. The urban participants believe it is safe. Those who live in large cities and have a college degree or above have a positive attitude towards vaccines and do not find any religious reason not to be vaccinated. Individuals from rural areas seem to be skeptical of getting vaccines and they refuse to receive them. Individuals with little education, little information, and a low annual income express a strong mistrust of the vaccine's benefits.

The healthy behaviours and COVID-19 mortality among Iranian women: a case-control study

BACKGROUND

Women are among the susceptible groups to Coronavirus disease-19 (COVID-19) in Ardabil, north-west of Iran, despite the current global status. The underlying causes of high incidence and fatality rate of women in Ardabil are not fully understood. Hence, this study aimed to investigate the healthy behaviours in women of Ardabil and its relationship with COVID-19 mortality.

METHODS

We conducted a case-control study to compare the adherence to health protocols and behaviours with respect to COVID-19 between the infected (261 patients) and healthy (515 persons) women. Health protocols and behaviours such as using mask, gloves, disinfectants, history of travelling and contacting, and attending various gatherings and places during the COVID-19 pandemic along with demographic variables were defined as independent variables, and COVID-19 death rate was defined as the dependent variable. Multivariable logistic regression methods were used to explore the risk factors associated with COVID-19 mortality.

RESULTS

Chi-square and Fisher tests showed significant differences between infected and healthy women in terms of history of contact and traveling (p < 0.05), wearing mask (p < 0.001), going to work place (p < 0.001), and attend public gatherings (p = 0.038). Multivariable logistic regression disclosed that the age group over 80 years: 8.97 times (95% CI 2.27-29.85), women with underlying chronic diseases: 4.14 times (95% CI 1.61-10.64), and obese women: 3.01 times (95% CI 1.04-6.03) were more likely to die from COVID-19 than other women.

CONCLUSION

Considering the high incidence and mortality rate in Ardabil women due to COVID-19 and the corresponding health behavioural factors, special emphasis should be given to the increase of women awareness on the importance of healthy behaviours, diet, and life-style.

COVID-19 Vaccination Hesitancy in the United States: A Rapid National Assessment

Given the results from early trials, COVID-19 vaccines will be available by 2021. However, little is known about what Americans think of getting immunized with a COVID-19 vaccine. Thus, the purpose of this study was to conduct a comprehensive and systematic national assessment of COVID-19 vaccine hesitancy in a community-based sample of the American adult population. A multi-item valid and reliable questionnaire was deployed online via mTurk and social media sites to recruit U.S. adults from the general population. A total of 1878 individuals participated in the study where the majority were: females (52%), Whites (74%), non-Hispanic (81%), married (56%), employed full time (68%), and with a bachelor's degree or higher (77%). The likelihood of getting a COVID-19 immunization in the study population was: very likely (52%), somewhat likely (27%), not likely (15%), definitely not (7%), with individuals who had lower education, income, or perceived threat of getting infected being more likely to report that they were not likely/definitely not going to get COVID-19 vaccine (i.e., vaccine hesitancy). In unadjusted group comparisons, compared to their counterparts, vaccine hesitancy was higher among African-Americans (34%), Hispanics (29%), those who had children at home (25%), rural dwellers (29%), people in the northeastern U.S. (25%), and those who identified as Republicans (29%). In multiple regression analyses, vaccine hesitancy was predicted significantly by sex, education, employment, income, having children at home, political affiliation, and the perceived threat of getting infected with COVID-19 in the next 1 year. Given the high prevalence of COVID-19 vaccine hesitancy, evidence-based communication, mass media strategies, and policy measures will have to be implemented across the U.S. to convert vaccines into vaccinations and mass immunization with special attention to the groups identified in this study.

Testing Surgical Face Masks in an Emergency Context: The Experience of Italian Laboratories during the COVID-19 Pandemic Crisis

The first wave of the COVID-19 pandemic brought about a broader use of masks by both professionals and the general population. This resulted in a severe worldwide shortage of devices and the need to increase import and activate production of safe and effective surgical masks at the national level. In order to support the demand for testing surgical masks in the Italian context, Universities provided their contribution by setting up laboratories for testing mask performance before releasing products into the national market. This paper reports the effort of seven Italian university laboratories who set up facilities for testing face masks during the emergency period of the COVID-19 pandemic. Measurement set-ups were built, adapting the methods specified in the EN 14683:2019+AC. Data on differential pressure (DP) and bacterial filtration efficiency (BFE) of 120 masks, including different materials and designs, were collected over three months. More than 60% of the masks satisfied requirements for DP and BFE set by the standard. Masks made of nonwoven polypropylene with at least three layers (spunbonded-meltblown-spunbonded) showed the best results, ensuring both good breathability and high filtration efficiency. The majority of the masks created with alternative materials and designs did not comply with both standard requirements, resulting in suitability only as community masks. The effective partnering between universities and industries to meet a public need in an emergency context represented a fruitful example of the so-called university "third-mission".