The Moderating Effects of Perceived Severity on the Generational Gap in Preventive Behaviors during the COVID-19 Pandemic in the U.S

Parent-Child Associations in COVID-19-Related Preventive Behaviors and Efficacy Expectations: A One-Year Longitudinal Survey

PURPOSE

It is necessary to identify the variables that explain the variance in preventive behaviors against COVID-19 to increase adolescents' engagement in these behaviors. We focused on efficacy expectations of preventive behaviors and their associations within families. This study examined the associations between efficacy expectations and preventive behaviors, and between adolescents and their parents in terms of efficacy expectations and preventive behaviors.

METHODS

A cross-lagged panel model was employed to analyze 281 parent-child pairs consisting of 245 children (118 girls, mean age = 17.4 years), 277 mothers (median age = 49.3 years), and 211 fathers (median age = 51.5 years). Participants completed the Prevention of COVID-19 Infection Scale at baseline (October 2020 to April 2021) and one-year follow-up to assess efficacy expectations and preventive behaviors for sanitization, contact, and hoarding factors.

RESULTS

Efficacy expectations of preventive behaviors at baseline were positively associated with preventive behaviors at one-year follow-up regarding the sanitization and contact factors. Additionally, for parents, efficacy expectations of preventive behaviors at baseline were positively associated with subsequent preventive behaviors regarding the hoarding factor. Parental efficacy expectation scores for contact at baseline were positively associated with their children's scores at one-year follow-up.

DISCUSSION

The findings highlight the association between parental efficacy expectations at an initial time point and adolescents' efficacy expectations at one-year follow-up toward COVID-19 preventive measures, particularly contact-related behaviors. These insights can inform public health interventions targeting individual expectations and parental involvement to promote effective preventive practices during future health crises.

Associations Between Social Networks and COVID-19 Vaccine Uptake in 4 Rural Alabama Counties: Survey Findings

OBJECTIVES

The COVID-19 pandemic demonstrated how vaccination decisions are influenced by misinformation, disinformation, and social pressures, leading to varied and inequitable uptake rates. In this study, we examined how COVID-19 vaccine messages received via social networks were associated with vaccine uptake in rural Alabama.

METHODS

From November 2021 through March 2022, we collected 700 responses to a telephone survey administered in 4 rural Alabama counties. We asked respondents to indicate whether certain social relationships (eg, family, businesses) tried to influence them to (1) obtain or (2) avoid a COVID-19 vaccine. We used χ2 tests, Kruskal-Wallis tests, Mantel-Haenszel χ2 tests, and Fisher exact tests to examine the associations between vaccination status and survey responses.

RESULTS

Respondents in majority-African American counties were significantly more likely than those in majority-White counties to have received ≥1 dose of COVID-19 vaccine (89.8% vs 72.3%; P < .001). Respondents who received ≥1 dose had a significantly higher mean age than those who had not (58.0 vs 39.0 years; P < .001). Respondents who were encouraged to get vaccinated by religious leaders were more likely to have received ≥1 dose (P = .001), and those who were encouraged to avoid vaccination by family (P = .007), friends (P = .02), coworkers (P = .003), and health care providers (P < .001) were less likely to have received ≥1 dose. Respondents with more interpersonal relationships that encouraged them to avoid vaccination were more likely to be unvaccinated (P < .001).

CONCLUSIONS

Interpersonal relationships and demographic characteristics appeared to be important in COVID-19 vaccine decision-making in rural Alabama. Further research needs to identify how to facilitate vaccine-positive interpersonal relationships, such as peer mentoring and trusted messenger interventions.

The Link of COVID-19-Related Beliefs and Information Sources to Ageism: Myth or Reality?

This study aimed to understand ambivalent ageism among younger adults during the pandemic by examining whether younger adults' beliefs around COVID-19 and the sources from which they received COVID-19 information were associated with the intensity of their ageism. For this aim, survey data were collected from individuals ages 18 to 44 between July and September 2021. Multiple hierarchical regression analysis revealed that benevolent ageism was more intense than hostile ageism when two subscales of ambivalent ageism-benevolent and hostile-were compared. Hispanic or Latinx respondents showed less intense ambivalent ageism than non-Hispanic and non-Latinx respondents. The respondents' beliefs about safety measures and the prioritization of medical resources were significantly associated with the intensity of their ageism. Receiving COVID-19 information via traditional media and social media was also significantly associated with more intense ageism. These findings indicate that social work advocacy should continue to combat ageism in times of crisis.

Understanding Physical Distancing and Face Mask Use Across High-Risk African American Subgroups During the COVID-19 Pandemic: Application of Health Belief Model

Physical distancing and face masks remain frontline prevention strategies due to suboptimal vaccine uptake and the highly infectious COVID-19 variants. Communities of color are disproportionately impacted by a chronic disease burden that places them at higher risk of severe COVID-19 disease. Therefore, they can greatly benefit from face mask use and physical distancing, especially if the individual(s) have not received the vaccine. We applied the Health Belief Model to explore barriers and motivators influencing physical distancing and face mask use among high-risk, Black American subgroups during the early COVID-19 pandemic stages. We conducted 62 semi-structured interviews among four Black American subgroups: young adults, individuals with underlying medical conditions, essential workers, and parents. Thematic analysis, guided by the Health Belief Model, yielded six themes: (1) Knowledge on Face Mask Use and Physical Distancing, (2) Perceived Susceptibility and Severity Varies by Subgroup, (3) Experience with and Perceived Self-Efficacy to Engage in Preventive Behavior, (4) Perceived Benefits to engaging in preventive behaviors, (5) Perceived Barriers to engage in preventive behaviors, and (6) Cues to action to increase participation. Each subgroup's unique experience informed multilevel, tailored approaches that can be used by health promotion practitioners to improve face mask use and physical distancing among uniquely vulnerable Black American subgroups in the current and future pandemic.

The Effects of Emotion, Spokesperson Type, and Benefit Appeals on Persuasion in Health Advertisements: Evidence from Macao

Enhancing public awareness for epidemic prevention is crucial for safeguarding public health. This experimental study investigated the effectiveness of a combined approach involving three persuasive elements in public health advertising. Specifically, the study examined the interplay between emotional appeals (fear messages versus efficacy messages) and spokesperson type on the public's response to health announcements. The results demonstrated that fear messages were more persuasive when conveyed by real human spokespersons (versus animated spokespersons), whereas efficacy messages were more acceptable when conveyed by animated spokespersons (versus real humans). Furthermore, the study revealed that the impact of emotional appeals and spokesperson type is moderated by benefit appeals (self-benefit or other-benefit). The joint effects of these persuasive variables on individuals' intention to adopt preventive measures indicated that the interactions significantly differed across the two types of benefit appeal. Taken together, the findings represent a pioneering contribution to the field of health communication by comparing the persuasive effects of different combinations of emotional appeals, spokesperson types, and benefit appeals on public behavior. These findings offer practical guidance for public communicators to design more appropriate health advertisements based on the results of this study, thereby enhancing public acceptance of disease prevention measures.

COVID-19 prevention and rehabilitation related knowledge and practices among Egyptian post-COVID-19 patients

BACKGROUND

Even with the mild form of COVID-19, people need to practice the proper preventive measures to achieve health, safety and control spread of infection. Few studies assessed sound disinfection and rehabilitative knowledge. This study aims to assess the self-reported, knowledge of specific disinfection measures among post-recovery COVID-19 patients and identifying the most requested knowledge items regarding the prevention and post COVID rehabilitation measures.

METHODS

This is an exploratory cross-sectional study using an electronically open survey. A pre-tested e-questionnaire was employed for data assembling. The sample size was calculated and a total of 417 people completed the questionnaire. Knowledge score was calculated for preventive and disinfection measures during and after COVID 19 infection. It comprised three sections: socio-demographics, study participants' knowledge regarding precautions, disinfection, and rehabilitation measures, as well as sources of knowledge about COVID-19.

RESULTS

All participants infected with COVID-19 (82%) reported self-isolation for ten days after confirming the infection, with only 18% required hospitalization. Regarding the information needed by the participants, the highest requests were for the rehabilitation information after COVID-19 and preventive measures. Females under 30 years old and those with a college education or higher were significantly more likely to request rehabilitation information after COVID-19 (P-value 0.05). Nevertheless, males were significantly more interested in information regarding preventive measures; They were over 30 years old and had education below university (P-value 0.05). Participants (above 30 years old) had significantly higher knowledge of preventive and disinfection measures during and after COVID-19 infection (P = 0.030).

CONCLUSION

After the COVID-19 experience, most participants demonstrated a great desire for rehabilitation information and proper preventive measures. This paves the way for delivering self-management and rehabilitation knowledge and emphasizing the significance of various prevention modalities.

Individualism-Collectivism and COVID-19 Prevention Behaviors in Young Adults: The Indirect Effects of Psychological Distress and Pandemic Fears

Stemming on the theoretical framework of individualism-collectivism, this study aims to interpret COVID-19 prevention behaviors in young adults in the light of cultural orientations, hypothesizing the mediating role of two pandemic affects (i.e., fear for COVID-19 consequences and psychological distress during pandemic). Participants were 296 young adults living in Italy (Mage = 23.96, SDage = 3.04; 79.7% women), who completed an online anonymous survey. Data were gathered from December 2020 to May 2021. A path analysis model explored direct and indirect relationships among study variables. Psychological distress significantly reduced the compliance with prevention measures, whereas pandemic fears increased it. The collectivistic orientations (Vertical Collectivism and Horizontal Collectivism) positively predicted prevention behaviors via increasing pandemic fears. The egalitarian dimensions (Horizontal Individualism and Horizontal Collectivism) were positive predictors of compliance via reducing psychological distress during pandemic. Finally, Vertical Individualism was a risk factor that negatively predicted prevention behaviors both directly and indirectly, via increasing psychological distress. The results provide new insights into the emotional mechanisms that link individualism and collectivism orientations to COVID-19 prevention behaviors, with interesting implications for public health policies, prevention, and future research.

Access to Health Care Improves COVID-19 Vaccination and Mitigates Health Disparities Among Medicare Beneficiaries

BACKGROUND

COVID-19 disproportionately impacts the elderly, particularly racial/ethnic minorities and those with low socioeconomic status (SES). These latter groups may also have higher vaccine hesitancy. We aim to evaluate if access to care improves COVID-19 vaccination rates and improves health disparities.

METHODS

We conducted a retrospective cohort study of Medicare patients receiving care in a high-touch capitated network across ten states. We collected type and date of COVID-19 vaccine and demographic and clinical data from the inpatient and outpatient electronic health records and socioeconomic status from the US census. Our primary outcome was completing vaccination using logistic regression.

RESULTS

Our cohort included 93,224 patients enrolled in the network during the study period. Sixty nine percent of all enrolled patients completed full vaccination. Those who completed vaccination did it with Pfizer (46%), Moderna (49%), and Jannsen (4.6%) vaccines. In adjusted models, we found that the following characteristics increased the odds of being vaccinated: being male, increasing age, BMI, and comorbidities, being Black or Hispanic, having had the flu vaccine in 2020, and increasing number of office primary care visits. Living in a neighborhood with higher social deprivation and having dual Medicaid/Medicare enrollment decreased the odds of completing full vaccination.

CONCLUSIONS

Increasing office visit in a high-touch primary care model is associated with higher vaccination rates among elderly populations who belong to racial/ethnic minorities or have low socioeconomic status. However, lower SES and Medicaid populations continue to have difficulty in completing vaccination.

KEY POINTS

• High COVID-19 vaccination rates of minorities enrolled in Medicare can be achieved. • Lower socioeconomic status is associated with completing vaccination. • Increasing office visits can lead to higher vaccination rates.

Compliance with COVID-19 Preventive Guidelines Among Minority Communities: the Case of Israeli Arabs

OBJECTIVES

The Arab ethnic minority makes up 21% of Israel's population and accounted for 40.5% of confirmed cases during the second wave of COVID-19. This study aims to assess the characteristics of compliance with the guidelines of the Ministry of Health and related factors that can explain the outbreak of COVID-19 among the Arab population during the second wave.

METHODS

A cross-sectional online survey was conducted among 810 respondents from the Arab community during October 2020. The survey was distributed via social media such as Facebook and WhatsApp. The health belief model items, the theory of reasoned action items, trust in formal institutions, and pandemic fatigue were assessed, and a path analysis was performed.

RESULTS

Positive correlations were demonstrated between both personal and social networks compliance (nuclear family, extended family, friends, etc.) and perceived severity of COVID-19, trust in formal institutions, attitudes toward compliance, and subjective norms (r = .12 to r = .64, p < .001, N = 810). Pandemic fatigue was negatively correlated with personal and social networks compliance, perceived severity of COVID-19, trust in institutions, attitudes toward compliance, and subjective norms (r =  - .21 to r =  - .48, p < .001). Positive correlations were evident between compliance with quarantine and perceived severity of COVID-19 and attitudes (r = .31 and r = .28, p < .001, respectively). Personal compliance was significantly lower among men (M = 3.93, SD = 0.94) and younger respondents (M = 4.14, SD = 0.71), while social networks compliance was lower among Muslims (M = 3.78, SD = 0.75). The negative relationship between pandemic fatigue and personal compliance was mediated by lower perceived severity of COVID-19, attitudes toward compliance, and subjective norms (p < .001). The negative relationship between pandemic fatigue and social network compliance was mediated by lower trust in institutions and subjective norms (p < .001). Lower perceived severity of COVID-19 mediated the relationship between higher pandemic fatigue and lower quarantine compliance (p = .003).

CONCLUSIONS

The results highlight the important of perception of the disease severity, social and subjective norms, and the central role of trust in determining adherence to guidelines. Thus, increasing trust on authorities and planning tailored-maid interventions can raise compliance with the preventive guidelines and prevent the spread of the virus. Such interventions will address the characteristics of minority populations and take into account the implications of the guidelines and the possibility that may lead to fatigue, which in turn will lead to non-compliance with those guidelines.

A multi-country survey of the socio-demographic factors associated with adherence to COVID-19 preventive measures during the first wave of the COVID-19 pandemic

BACKGROUND

Health behaviours are influenced by individual characteristics including age, gender, education and economic level. This study aimed to assess the associations between individual-level determinants and adherence to COVID-19 preventive measures.

METHODS

We performed secondary analyses of international data collected using an online survey during the first wave of the COVID-19 pandemic between June and December 2020. The dependent variables were self-reported adherence to COVID-19 preventive measures (wearing of face masks, frequent washing/sanitizing of hands, physical distancing, working remotely). The independent variables were age, sex at birth (female vs male), having a chronic disease related elevated risk for severe COVID-19 (none/little, might be at increased risk, at increased risk), educational level completed (no formal education, primary, secondary vs college/university) and employment status (retiree, students, not employed vs employed). Four multivariate logistic regression analyses were conducted to determine the associations between the dependent variables and independent variables. Interaction terms with country-income level were tested in regressions to explore its moderating effect.

RESULTS

Out of 16,866 respondents, 12,634 (74.9%) wore masks or face coverings, 12,336 (73.1%) washed or sanitized their hands frequently, 11,464 (68.0%) reported adherence to physical distancing and 5,646 (33.5%) worked remotely. In adjusted analyses, increased age, college/university education, employment, and having risks for severe COVID-19 were associated with significantly higher odds of adhering to COVID-19 preventive measures. Retirees and students had lower odds of adhering to COVID-19 prevention measures than employed individuals. Males had significantly lower odds of wearing face masks (AOR: 0.901), frequent washing/sanitizing hands (AOR: 0.774) and working remotely (AOR: 0.875) compared to females. Country-income level generally moderated the above relationships such that the associations disappeared in lower income countries.

CONCLUSION

The study findings suggest that the individual socio-demographic factors-age, sex, employment status, education status and having a chronic disease - influence adherence to COVID-19 preventive measures. Findings further reiterate the need for health education and health promotion campaigns on preventive health measures to focus on subpopulations, such as younger males, students and retirees, that require targeted or unique messaging.

Non-commuting intentions during COVID-19 in Nanjing, China: A hybrid latent class modeling approach

Non-commuting travel is essential for people to meet daily demands and regulate mental health, which is greatly disrupted due to the COVID-19 pandemic. To explore non-commuting intentions during COVID-19 across different groups of residents, this paper uses online survey data in Nanjing and constructs a hybrid latent class choice model that combines sociodemographic characteristics and psychological factors. Results showed that the respondents can be divided into two groups: the "cautious" group versus the "fearless" group. The "cautious" group with lower willingness to travel tend to be older, higher-income, higher-educated, female and full-time employees. Furthermore, the "cautious" group with higher perceived susceptibility is more obedient to government policies. In contrast, the "fearless" group is significantly affected by perceived severity and is more inclined to turn to personal protection against the pandemic. These results suggested that non-commuting trips were influenced not only by individual characteristics but also by psychological factors. Finally, the paper provides implications for the government to formulate COVID-19 management measures for the heterogeneity of different groups.

The effects of moral norms and anticipated guilt on COVID19 prevention behaviors

Studies have shown that older adolescents have a low perceived personal risk of COVID-19, and yet their ability and willingness to engage in COVID-19 prevention behaviors is imperative for community health. Thus, health communication scholars need to consider alternative psycho-social predictors of prevention behaviors that will assist in protecting others in a pandemic. Based on Schwartz's Norms Activation Model (NAM; Schwartz, 1977), we examined the relationship between moral norms and COVID-19 prevention behaviors (mask wearing and physical distancing). We predicted that anticipated guilt would mediate the relationship between moral norms and intention to engage in prevention behaviors, and that collective orientation would strengthen the association between moral norms and anticipated guilt. We tested predictions with data from a cross-sectional survey with a probability-based sample of college students at a large land grant university. These data indicated that moral norms were associated with behavioral intention, and this relationship was mediated by anticipated guilt. Collective orientation was found to moderate the relationship between moral norms and anticipated guilt in the context of physical distancing but not mask wearing. These findings suggest that making moral norms salient when designing an intervention is an effective strategy for older adolescents.

Supplementary information

The online version contains supplementary material available at 10.1007/s12144-023-04477-5.

Communication inequalities and health disparities among vulnerable groups during the COVID-19 pandemic - a scoping review of qualitative and quantitative evidence

BACKGROUND

The COVID-19 pandemic has exacerbated health disparities in vulnerable groups (e.g., increased infection, hospitalization, and mortality rates in people with lower income, lower education, or ethnic minorities). Communication inequalities can act as mediating factors in this relationship. Understanding this link is vital to prevent communication inequalities and health disparities in public health crises. This study aims to map and summarize the current literature on communication inequalities linked with health disparities (CIHD) in vulnerable groups during the COVID-19 pandemic and to identify research gaps.

METHODS

A scoping review of quantitative and qualitative evidence was conducted. The literature search followed the guidelines of PRISMA extension for scoping reviews and was performed on PubMed and PsycInfo. Findings were summarized using a conceptual framework based on the Structural Influence Model by Viswanath et al. RESULTS: The search yielded 92 studies, mainly assessing low education as a social determinant and knowledge as an indicator for communication inequalities. CIHD in vulnerable groups were identified in 45 studies. The association of low education with insufficient knowledge and inadequate preventive behavior was the most frequently observed. Other studies only found part of the link: communication inequalities (n = 25) or health disparities (n = 5). In 17 studies, neither inequalities nor disparities were found.

CONCLUSIONS

This review supports the findings of studies on past public health crises. Public health institutions should specifically target their communication to people with low education to reduce communication inequalities. More research about CIHD is needed on groups with migrant status, financial hardship, not speaking the language in the country of residence, sexual minorities, and living in deprived neighborhoods. Future research should also assess communication input factors to derive specific communication strategies for public health institutions to overcome CIHD in public health crises.

Factors Affecting Preventive Behaviors for Safety and Health at Work during the COVID-19 Pandemic among Thai Construction Workers

Occupational health and safety risks are of major concerns in construction industry. The COVID-19 outbreak provides an additional risk that could drastically affect the safety risks and health of construction workers. Understanding the factors that affect the health and safety of construction workers is significant in reducing risky behaviors and enhancing worker preventive behaviors. Via integrating the Protection Motivation Theory (PMT) and the extended Theory of Planned Behavior (TPB), this study investigates the factors that affect preventive behaviors among construction workers during the COVID-19 pandemic in Bangkok, Thailand. A total of 610 Thai construction workers participated in an online questionnaire survey, which consisted of nine factors with 43 questions. Structure equation modeling (SEM) was adopted to analyze the causal relationships among the latent variable. The SEM results indicated that organizational support and knowledge about COVID-19 had significant (p < 0.0001) direct influences on perceived vulnerability and perceived severity. In addition, perceived vulnerability and perceived severity had significant direct influences on perceived behavioral control. Perceived severity had significant (p < 0.0001) direct influence on attitude towards behavior. Moreover, perceived behavioral control and attitude towards behavior had significant (p < 0.0001) direct influence on intention to follow the preventive measure. Furthermore, the intention to follow the preventive measure had significant (p < 0.0001) direct influences on the COVID-19 preventive behavior. Of note, organizational support and knowledge about COVID-19 had significant (p < 0.0001) indirect influence on COVID-19 preventive behavior. The findings of this study may assist project managers/supervisors and authorities in the construction industry in understanding the challenge during COVID-19 and possible similar epidemics in the future. In addition, conducting effective strategies would improve construction industry safety and promote preventive behaviors among construction workers.

How health beliefs and sense of control predict adherence to COVID-19 prevention guidelines among young adults in South Korea

This study defined adherence to COVID-19 prevention guidelines as health behavior and examined whether the two constructs of the health belief model (i.e., perceived susceptibility and perceived severity) and sense of control predict the level of adherence among young adults in South Korea. An online survey (N = 200) conducted in June 2021, showed that perceived susceptibility, perceived severity, and sense of control positively predict adherence behavior. Sense of control significantly moderated the relationship between perceived susceptibility and adherence even after controlling for depression and perceived health status. Specifically, individuals with a lower level of perceived susceptibility still adhered to COVID-19 prevention guidelines if they had a higher level of sense of control. The finding demonstrates the key role of sense of control in promoting adherence to COVID-19 prevention guidelines and the relationship between sense of control and two constructs of the health belief model. Implication for public messaging targeted at young adults during pandemic situations is also discussed.

A model to understand COVID-19 preventive behaviors in young adults: Health locus of control and pandemic-related fear

This study investigated COVID-19 preventive behaviors in young adults, exploring the predictive roles of health locus of control and pandemic fear. A sample of 188 Italian young adults (Mage = 22.76, SDage = 1.95; 85% girls) completed an anonymous online survey assessing preventive behaviors, health locus of control styles (i.e. internal, chance, powerful others), and two dimensions of pandemic fear. Fear for COVID-19 consequences-but not general fear for contagion-significantly predicted prevention behaviors, and it also moderated the relationships between each health locus of control style and preventive behaviors. Our findings have relevant implications for research and social policies.

Factors Associated with COVID-19 Vaccination Acceptance Among Muslim High School Students in Jakarta Metropolitan Area, Indonesia

Purpose

This study aims to identify the factors associated with COVID-19 vaccination uptake and the intention to receive the COVID-19 vaccine among Muslim high school students in Jakarta, Indonesia.

Patients and Methods

A cross-sectional study using an online survey was conducted for high school students. The population in this study were Muslim students grade 11 and 12 at secondary high school living and studying in Jakarta Metropolitan area. A total of 440 samples have been selected using non-probability sampling. In this study, the independent variables were factors associated with vaccination behaviors that were derived from the HBM and TPB theories, while the dependent variables were vaccination uptake and vaccination intention. Factors associated with the dependent variables have been identified using chi-square and Mann-Whitney tests.

Results

About 65% respondents had received COVID-19 vaccine and 72% of those who had not received COVID-19 vaccine had the intention to receive the vaccine. Some of the behavioral model variables such as the perceived susceptibility score, perceived severity score, perceived benefits score, perceived barriers score, self-efficacy score, attitude score, and social norms score were significantly associated with COVID-19 vaccine uptake among high school students. Furthermore, all of the behavioral model variables, ie, perceived susceptibility score, perceived severity score, perceived benefits score, perceived barriers score, cues to action score, self-efficacy score, attitude score, social norms score, and perceived behavioral control score were significantly associated with an intention of being vaccinated.

Conclusion

The vaccination for students can be set in more affordable locationsfor example, in schools. In addition, efforts to increase student knowledge regarding the effectiveness and safety of vaccines and the dangers of COVID-19 should be sustained.

Career resilience of the tourism and hospitality workforce in the COVID-19: The protection motivation theory perspective

By applying the protection motivation theory, the study aims to investigate factors influencing tourism and hospitality (T&H) workers' career resilience when faced with health-related risks at work during a pandemic. Data were collected from 495 part-time and full-time employees in the Vietnamese tourism and hospitality sector. The study found that workers' perceived vulnerability and perceived severity of the pandemic were positively associated with career resilience. Perceived severity was positively related to self-efficacy and response efficacy, while perceived vulnerability was positively associated with self-efficacy only. Both self-efficacy and response efficacy positively influenced career resilience through the mediating role of health risk preventative behavior. Theoretically, the study advances the stream of research in resilience in general and career resilience in particular among T&H workers when faced with a health-related crisis. Practical implications are provided with recommendations on how to facilitate career resilience among T&H employees working in the current high-risk environment.

A Profile of Students Who Reported Mask Mandates Violate Civil Liberties during COVID-19

Objectives: In this paper, we explore differences in demographics, mask wearing attitudes and behaviors, and vaccination perceptions among students who reported that mask mandates violate their civil liberties compared to those who did not. Methods: Participants completed an online survey in April 2021 (N=619). Results: Students who reported that mask mandates violate their civil liberties were more likely to identify as male, report good health, attend in-person classes, and less likely to report being vaccinated (p<.05). These students were also more likely to endorse not wearing masks because masks make it difficult to breathe, provide a false sense of security, and because they value their independence; in addition, they were more likely to endorse not being vaccinated because they are at low perceived risk for infection, because of the unknown side effects of vaccines, and because vaccines were rushed into production (p<.05). Whereas students who reported that mask mandates violate their civil liberties were about 5.2 times more likely (p<.0001) to report being unvaccinated, vaccine status was only modestly positively correlated (r=.36, p<.0001). Conclusions: Although students who reported mask mandates violate their civil liberties were also more likely to be unvaccinated, these individuals are not necessarily the same, suggesting different public health messaging may be required to increase both mask use and vaccine uptake.

Factors Affecting Perceived Effectiveness of Government Response towards COVID-19 Vaccination in Occidental Mindoro, Philippines

The COVID-19 pandemic has caused several developing countries to fall behind on vaccination at the onset of the pandemic, thus affecting the mobility of easing restrictions and lowering virus transmission. The current study integrated the Protection Motivation Theory (PMT) and extended the Theory of Planned Behavior (TPB) to evaluate factors affecting the perceived effectiveness of government response towards COVID-19 vaccination in Occidental Mindoro. A total of 400 respondents from the municipalities of Occidental Mindoro answered the online questionnaires, which contained 61 questions. This study outlined the relationship between the dependent and independent variables using structural equation modeling (SEM). The results indicated that knowledge of COVID-19 vaccination had significant direct effects on its perceived severity. Subjective standards had significant adverse effects on willingness to follow. In addition, perceived behavioral control was discovered to impact willingness to follow positively. It also showed that perceived government response was significantly affected by adaptive behavior and actual behavior regarding the perceived government response. Meanwhile, it was found that the perceived government response had significant effects on perceived effectiveness. The current study is one of the first to study the factors that affect the perceived effectiveness of government response toward COVID- 19 vaccination.

A Spatial Adaptation Strategy for Safe Campus Open Spaces during the COVID-19 Pandemic: The Case of Korea University

Open spaces on campus offer various opportunities for students. However, the coronavirus disease (COVID-19) pandemic has affected students’ comfort when occupying open spaces on campus. The purpose of this study is to investigate possible spatial adaptation strategies for safe campus open spaces during the COVID-19 pandemic. For this research, a case study was conducted using a mixed methodology with behavioral mapping that investigated students’ perceptions at Korea University, Seoul, Korea. A qualitative approach was first conducted with behavioral mapping; the results show that despite some behavioral and spatial changes, people still occupy open spaces on campus for various meaningful activities. A quantitative approach with structural equation modeling (SEM) was also conducted to understand the required spatial modifications to improve the safety of open spaces on campus. The positive correlation between (i) social distancing measures, (ii) health protocols, and (iii) accessibility and occupational comfort with (iv) individuals’ fear of COVID-19 as a positive moderation are the four hypotheses proposed in this study. The results suggest that social distancing measures have no correlation with occupational comfort, while accessibility has the largest positive correlation. Suggestions are presented for providing accessible and equally distributed open spaces on campus to avoid overcrowding. Spatial health protocols are also found to positively correlate with occupational comfort, and the perception of the severity of COVID-19 strengthens this correlation. Tangible physical measures to prevent the spread of the virus are necessary to improve students’ sense of comfort and safety in open spaces on campus.

Perceived Severity of COVID-19 in a Longitudinal Study in Detroit, Michigan

Objective

To slow down the spread of SARS-CoV-2, many countries have instituted preventive approaches (masks, social distancing) as well as the distribution of vaccines. Adherence to these preventive measures is crucial to the success of controlling the pandemic but decreased perceptions of disease severity could limit adherence. The aim of our study was to observe changes in perceived personal severity and perceived community severity; the study also explored their predictors.

Methods

In a longitudinal study from an address-based probability survey in Detroit, we asked participants to rate their perceived severity of COVID-19 for themselves and for their community. In our analysis, 746 participants were queried across 5 waves of the Detroit Metro Area Communities Study surveys from March 31 to October 27 in 2020. We tested for trends in changes of self-reported perceived severity for themselves and for their community; we assessed the effects of different predictors of the two severities through mixed effects logistic regression models.

Results

Our results highlight that the overall levels of perceived community and personal severity were decreasing over time even though both severities were fluctuating with rising confirmed case counts. Compared with non-Hispanic (NH) White Detroiters, NH Black Detroiters reported a higher perceived personal severity (OR: 5.30, 95% CI: 2.97, 9.47) but both groups reported similar levels of perceived community severity. We found steeper declines in perceived severity in NH White than NH Black Detroiters over time; the impact of education and income on perceived severity was attenuated in NH Black Detroiters compared with NH White Detroiters.

Conclusions

Our findings suggested that perceived severity for COVID-19 decreased through time and was affected by different factors among varied racial/ethnic groups. Future interventions to slow the pace of the pandemic should take into account perceived personal and community severities among varied ethnic/racial subgroups.

Online survey of university students' perception, awareness and adherence to COVID-19 prevention measures

BACKGROUND

Determining factors correlated with protective measures against COVID-19 is important to improve public health response. This study describes student opinions related to university COVID-19 preventive measures.

METHODS

In fall 2020, 643 US university students completed an online survey on perception, awareness, and adherence to COVID-19 preventive measures. Outcomes included protocol effectiveness (self or others), protocol adherence (self or others), consequences of protocol violation, knowledge of violations, and level of concern for COVID-19. Multiple linear regression models determined correlates of outcome variables. Covariates included gender, race, residence, area of study, class, and knowledge of someone with a positive COVID-19 test.

RESULTS

Overall, students agreed with protective measures (equivalent to higher scores). In adjusted linear models, females (versus males) had significantly higher scores for protocol effectiveness (self) (p < 0.001), consequences of protocol violation (p = 0.005), and concern about COVID-19 (p < 0.001). Asian/Pacific Islander (versus white) had significantly higher scores for protocol effectiveness (self) (p < 0.001), consequences of protocol violation (p = 0.008), and concern about COVID-19 (p = 0.001). Graduate students (versus freshman) had higher scores for protocol effectiveness (self) (p < 0.001), protocol adherence (self) (p = 0.004) and concern about COVID-19 (p < 0.001). In contrast, participants who had a positive COVID-19 test had significantly lower scores for protocol effectiveness (self) (p = 0.02), protocol adherence (self) (p = 0.004), and consequences of protocol violation (p = 0.008).

CONCLUSION

Overall, females, Asian/Pacific Islanders, and graduate students were more likely to agree with or adhere to COVID-19 prevention guidelines but those who tested positive for COVID-19 were less likely to do so. These results may inform future prevention efforts.

The influence of risk perceptions on close contact frequency during the SARS-CoV-2 pandemic

Human behaviour is known to be crucial in the propagation of infectious diseases through respiratory or close-contact routes like the current SARS-CoV-2 virus. Intervention measures implemented to curb the spread of the virus mainly aim at limiting the number of close contacts, until vaccine roll-out is complete. Our main objective was to assess the relationships between SARS-CoV-2 perceptions and social contact behaviour in Belgium. Understanding these relationships is crucial to maximize interventions’ effectiveness, e.g. by tailoring public health communication campaigns. In this study, we surveyed a representative sample of adults in Belgium in two longitudinal surveys (survey 1 in April 2020 to August 2020, and survey 2 in November 2020 to April 2021). Generalized linear mixed effects models were used to analyse the two surveys. Participants with low and neutral perceptions on perceived severity made a significantly higher number of social contacts as compared to participants with high levels of perceived severity after controlling for other variables. Our results highlight the key role of perceived severity on social contact behaviour during a pandemic. Nevertheless, additional research is required to investigate the impact of public health communication on severity of COVID-19 in terms of changes in social contact behaviour.

Barriers to and Facilitators of COVID-19 Prevention Behaviors Among North Carolina Residents

COVID-19 was the third leading cause of death in the United States in 2020. Prior to the wide dissemination of SARS-CoV-2 vaccines, individual prevention behaviors, such as wearing face masks, have been the primary non-pharmaceutical interventions to reduce infections. We surveyed 404 North Carolina residents recruited through Amazon MTurk in July 2020 to assess adherence to key prevention behaviors (6-foot distancing, mask wearing, and gathering limits) and barriers to and facilitators of adherence. Participants reported past 7-day prevention behaviors and behavioral barriers and facilitators informed by the Integrated Behavior Model and the Health Belief Model (perceived risk, perceived severity, behavioral attitudes, injunctive and descriptive norms, and personal agency). Reported adherence to each behavior in the past 7 days was generally high, with lower adherence to 6-foot distancing and mask wearing in the work context. The most commonly endorsed barriers to 6-foot distancing included physical impediments, forgetting, and unfavorable descriptive norms. For mask wearing, ability to keep a distance, discomfort/inconvenience, and forgetting were most commonly endorsed. In logistic regression models, injunctive social norms followed by perceived personal agency were the strongest independent correlates of 6-foot distancing. Behavioral attitudes and injunctive social norms were independently associated with mask wearing. For gathering size limit adherence, perceived personal agency was the strongest independent predictor followed by perceived severity of COVID-19. Messaging campaigns targeting these barriers and facilitators should be tested. Interventions improving the convenience and salience of physical distancing and mask wearing in high-density public places and places of work may also promote prevention behaviors.

The social media response to twice-weekly mass asymptomatic testing in England

BACKGROUND

From 9th April 2021, everyone in England has been encouraged to take two COVID-19 tests per week. This is the first time that national mass asymptomatic testing has been introduced in the UK and the effectiveness of the policy depends on uptake with testing and willingness to self-isolate following a positive test result. This paper examines attitudes towards twice-weekly testing, as well as barriers and facilitators to engaging in testing.

METHODS

Between 5th April and 28th May 2021 we searched Twitter, Facebook, and online news articles with publicly available comment sections to identify comments relating to twice-weekly testing. We identified 5783 comments which were then analysed using a framework analysis.

RESULTS

We identified nine main themes. Five themes related to barriers to engaging in testing: low perceived risk from COVID-19; mistrust in the government; concern about taking a test; perceived ineffectiveness of twice-weekly testing policy; and perceived negative impact of twice-weekly testing policy. Four themes related to facilitators to engaging in testing: wanting to protect others; positive perceptions of tests; a desire to return to normal; and perceived efficacy for reducing asymptomatic transmission.

CONCLUSIONS

Overall, the comments identified indicated predominately negative attitudes towards the twice weekly testing policy. Several recommendations can be made to improve engagement with twice weekly testing, including: 1) communicate openly and honestly about the purpose of testing; 2) provide information about the accuracy of tests; 3) provide financial support for those required to self-isolate, and; 4) emphasise accessibility of testing.

Factors associated with preventive behaviors for COVID-19 among adolescents in South Korea

PURPOSE

COVID-19's infection rate among adolescents is increasing; hence, it is important to prevent it as it can spread in the community through transmission in schools. It is crucial to determine the extent to which adolescents follow COVID-19 preventive measures and identify factors relating to such behaviors to implement more effective health education. This study aimed to understand factors related to COVID-19 preventive behaviors using the theory of planned behavior (TPB) and the health belief model (HBM) among adolescents in South Korea.

DESIGN AND METHODS

A cross-sectional face-to-face questionnaire survey was conducted among 272 adolescents in South Korea. Structural equation modeling was used to examine the relationships between perceived susceptibility, perceived severity, attitude, subjective norms, perceived behavioral control, intention, and COVID-19 preventive behaviors.

RESULTS

Among adolescents' COVID-19 preventive behavior scores, wearing masks was the highest and distancing was the lowest. Adolescents' adherence to COVID-19 preventive behaviors was directly or indirectly associated with their perceived susceptibility, perceived severity, subjective norms, perceived behavioral control, and intention.

CONCLUSIONS

Attention to mitigate social isolation is important to improve compliance with COVID-19 preventive behaviors. Perceived susceptibility, perceived severity, subjective norms, perceived behavioral control, and intention explained 61.3% of adolescents' COVID-19 preventive behaviors, there is a need for education to promote relevant factors.

PRACTICE IMPLICATIONS

To increase adolescent awareness of COVID-19 and increase attitudes, subjective norms, and perceived behavior control, nurses need to provide education including the evidence for COVID-19 preventive behavior to increase adolescents' understanding and active implementation of those behaviors.

Association Between Awareness, Perceived Severity, and Behavioral Control of COVID -19 With Self-Care and Anxiety in Pregnancy: A Cross-Sectional Study

COVID-19 pandemic has caused a tidal wave of anxiety and stress among Iranians, especially pregnant women. This study aimed to assess the association between knowledge, perceived severity, and controllability of COVID-19 with self-care and health anxiety specially in pregnancy. This cross-sectional study was performed on 440 pregnant women. Data were collected using demographic-obstetrics characteristics, as well as the questionnaires of knowledge, perceived severity, and perceived controllability of the COVID-19, health anxiety, and self-care. Self-care was positively correlated with knowledge, perceived severity, and perceived controllability of the COVID-19. Nonetheless, health anxiety had a significant and inverse association with knowledge and perceived controllability, while there was a positive and significant correlation between perceived severity and health anxiety. Based on linear regression, three variables of knowledge, perceived severity, and perceived controllability of the COVID-19 could explain 46.3 and 17.5% of variations in self-care and health anxiety, respectively. It is suggested that due to the critical importance of prenatal care, managers, and health-care providers promote the use of such methods as telehealth and home-based caregivers, especially in areas with inadequate access to health care. So, the pregnant women can be followed up and receive medical care devoid of any stress and anxiety.

Face Mask Usage among Young Polish People during the COVID-19 Epidemic-An Evolving Scenario

The usage of face masks has been mandated in many countries in an attempt to diminish the spread of SARS-CoV-2. In this cross-sectional study, we aimed to determine face mask-wearing behaviors and practices in 1173 young Polish people during the second wave of the COVID-19 epidemic in October 2020. The majority of respondents (97.4%) declared that they wore face masks in areas/situations where it is mandatory. The most common types of utilized face masks were cloth masks (47.7%) and surgical masks (47%), followed by respirators (N95/FFP3) (3.2%) and half-face elastomeric respirators (0.9%). Over 38% reported frequently disinfecting their face masks, especially females. Respondents reporting personal atopic predisposition (64.5% vs. 72.1%; p = 0.02) or sensitive skin (65.5% vs. 74.3%; p = 0.005) declared multiple use of face masks less commonly than other individuals. Individuals suffering from facial skin lesions declared disinfecting face masks more commonly (40.8% vs. 34.9%; p = 0.04). Overall, the self-declared utilization of face masks among young people in Poland has improved since the beginning of the epidemic as compared with our previous study. Until the mass vaccination of the public is achieved and government policy is changed, face mask use remains a valuable tool to decrease the transmission of SARS-CoV-2.