Predicting intention to vaccinate against COVID-19 in older Syrian refugees in Lebanon: Findings from a multi-wave study

BACKGROUND

COVID-19 vaccine acceptance among refugees in the Arab region remains low. This study aimed to examine the prevalence, reasons and predictors of intention to refuse the COVID-19 vaccine among older Syrian refugees in Lebanon.

METHODS

A nested cross-sectional study within a longitudinal study among older Syrian refugees in Lebanon. The sampling frame was a complete listing of beneficiary households of a humanitarian organization with at least one adult aged 50 years or older. Telephone surveys were completed at months 1 starting September 2020 (wave 1), months 2 (wave 2), months 5 (wave 3), months 6 (wave 4) and months 17 (wave 5) in March 2022. Logistic regression models were used to identify predictors of intention to refuse the COVID-19 vaccine. Models were internally validated using bootstrap methods and the models' calibration and discrimination were presented.

FINDINGS

Of 3167 Syrian refugees, 61.3% intended to receive the COVID-19 vaccine, 31.3% refused, and 7.4% were undecided. Reasons for vaccine refusal were: preference to follow preventive measures (27.4%) and belief that the vaccine is not essential (20.7%). Furthermore, 57.1% of participants registered to take the COVID-19 vaccine in wave 5. Irrespective of vaccination intention, reasons for not registering included: not wanting to receive the vaccine, and being unsure whether to take it. Predictors of intention to refuse the COVID-19 vaccine included: being a female, older age, having elementary education or above, living outside informal tented settlements, perceiving COVID-19 as not severe and vaccines as not safe or effective, and using social media for information on COVID-19. After adjusting for optimization, the final model showed moderate discrimination (C-statistic: 0.651 (95% CI:0.630-0.672)) and good calibration (C-slope: 0.93 (95% CI: 0.823-1.065)).

CONCLUSIONS

This study developed a predictive model for vaccination intention with a moderate discriminative ability and good calibration. Prediction models in humanitarian settings can help identify refugees at higher risk of not intending to receive the COVID-19 vaccine for public health targeting.

The determinants of sustained adherence to COVID-19 preventive measures among older Syrian refugees in Lebanon

INTRODUCTION

Lebanon has battled the COVID-19 pandemic in the midst of an economic crisis. The evolution of the pandemic and a fragile health system have meant that public health policy has had to rely heavily on non-pharmaceutical interventions for disease control. However, changes in disease dynamics, an unraveling economy, and pandemic fatigue have meant that disease control policies need to be updated.

METHODS

Using recent and timely data on older (50 years and above) Syrian refugees in Lebanon, this paper uses multivariate linear probability models to explore the determinants of adherence to two non-pharmaceutical COVID-19 prevention measures (wearing a mask and avoiding social gatherings) among this high-risk subgroup in a vulnerable population. Among respondents who report adhering to these measures, the paper also investigates the determinants of sustained adherence over a period of 6 months.

RESULTS

The findings suggest that no individual-level characteristics were robustly associated with mask wearing. For avoiding social gatherings, education was inversely associated with adherence to this preventive measure. Avoiding social gatherings was also significantly lower for residents of informal tented settlements (ITSs). Among initial adherents, and for both preventive practices, ITS dwellers were also significantly less likely to maintain adherence.

CONCLUSION

Identifying variables associated with adherence to non-pharmaceutical preventive practices, particularly for vulnerable groups, can help inform and refine interventions in the face of changing conditions. The material, physical, administrative and socio-economic constraints of life in an ITS suggest that avoiding social gatherings is hardly feasible. Yet despite the challenging conditions of ITSs, the indication to wear a mask is initially complied with, suggesting that tailoring policies to the limits and constrains of context can lead to successful outcomes even in very adverse settings.

Hymen protection and the sexual practices, perceptions, and attitudes of female university students from Lebanon

OBJECTIVE

To investigate associations between hymen protection and women's alternative sexual practices, perceptions, and attitudes.

METHODS

A cross-sectional online survey was administered among university students (aged 18-30 years) in Lebanon between April 30 and August 31, 2012. The present analysis focused on female students who had engaged in oral/anal sex.

RESULTS

Among 416 included women, 163 (39.3%) reported anal/oral sex to protect their hymen. Women ever concerned with hymen protection were less likely to be non-Lebanese and not religious/spiritual, but more likely to report unwanted sexual activities, a relationship in which they felt things were moving too fast physically, and to feel guilty about sexual feelings (all P<0.01). They were two-to-three times more likely to agree that it is harder to refuse sex after the first time and that oral sex is not as big of a deal as sexual intercourse (both P<0.001). Concerned women who later engaged in vaginal sex (n=75) were less religious and more accepting of premarital sex than were those who continued to protect their hymen (n=88; all P<0.005).

CONCLUSION

Women concerned about hymen-breaking engage in alternative sexual practices, yet experience pressure, guilt, worry, and indecisiveness regarding their sex-related decisions. The navigation of sexual decisions is a more vulnerable process for these women because of prevailing patriarchal values and discriminating gender norms in Lebanon.

Time Trends and Policy Gaps: The Case of Alcohol Misuse Among Adolescents in Lebanon

BACKGROUND

Monitoring studies are crucial for informing and reforming local policies.

OBJECTIVES

Using the Lebanon 2005 and 2011 Global School-based Student Health Surveys (GSHS), alcohol time trends were described, policy gaps were identified, and harm reduction policy recommendations were made.

METHODS

In 2005 and 2011, 100 (n = 5109 students) and 44 (n = 2784 students) middle schools were surveyed, respectively. Self-reported cross-sectional data on alcohol use among 7-9th graders in private and public schools was collected including 30-day prevalence, lifetime drunkenness, alcohol-related problems, and sources of alcohol.

RESULTS

In 2011, the majority (87%) had alcohol before turning 14. Between 2005 and 2011, past 30-day alcohol use had increased by 40% and lifetime drunkenness by 50% in the total sample (122% among females with a narrowing in the gender gap). Drinking was regular for more than a third of the past 30-day drinkers (drank two or more drinks on the days they drank). Male adolescents were more likely to obtain alcohol from "stores" or "through their friends" whereas females' main source was their "family." One in twenty reported experiencing alcohol-related problems (e.g., getting into fights with family/friends and skipping school). Conclusion/Importance: Evidence-informed policy implications include enforcing a minimum legal drinking age, regulating alcohol advertising, and marketing particularly those targeting youth and women, and ensuring the availability of youth-friendly services. Public messages to increase awareness among all stakeholders including youth, their parents, and larger community are also needed.

Postponing sexual debut among university youth: how do men and women differ in their perceptions, values and non-penetrative sexual practices?

This study aimed to investigate gender differences in reasoning influencing the postponing of sexual debut among university youth in Lebanon. Findings aimed to develop understandings that might help inform future research on, and programme implementation of, young people's reproductive and sexual health. A cross-sectional survey of sexuality and sexual practices, attitudes and perceptions was conducted among private university students in Lebanon using a secure online method. Of 1838 participating students, 48.7% indicated they had never engaged in oral, anal or vaginal sex (i.e., penetrative sexual activity) during their lifetime (n =  895). Common socio-cultural concerns regarding sexual initiation included: gaining a bad reputation (47%), social rejection (58%), religion (70%) and parental disapproval (61%). Women were four times more concerned than men regarding loss of reputation and self-respect, six times more so regarding parental disapproval and three times more likely to be concerned with societal disapproval. Intrapersonal concerns included fear of contradicting one's own beliefs (67%), feeling guilty afterwards (62%) and losing self-respect (55%). Women were four times more likely to feel loss of self-respect and six times more likely to think sex was disgusting. Underlying reasons for postponing sexual intercourse are linked to adopted fears and social pressures that are internalised, and reinforce existing gender inequalities and reaffirm discriminatory gender norms.