Weakening personal protective behavior by Chinese university students after COVID-19 vaccination

Investigating the causal effects of COVID-19 vaccination on the adoption of protective behaviors in Japan: Insights from a fuzzy regression discontinuity design

BACKGROUND

During the COVID-19 pandemic, concerns emerged that vaccinated individuals might engage less in infection-preventive behaviors, potentially contributing to virus transmission. This study evaluates the causal effects of COVID-19 vaccination on such behaviors within Japan, highlighting the significance of understanding behavioral dynamics in public health strategies.

METHODS

Utilizing Japan's age-based vaccination priority for those born before April 1, 1957, this research employs a regression discontinuity design (RDD) to assess the vaccination's impact. Data from the fourth round of a longitudinal online survey, conducted from July 20 to 27, 2021, served as the basis for analyzing 14 infection-protective behaviors, including mask usage, handwashing, and avoiding crowds.

RESULTS

A total of 12067 participants completed the survey. The analyzed sample size varied by outcome variable, ranging from 1499 to 5233. The analysis revealed no significant differences in the 14 behaviors examined among fully vaccinated, partially vaccinated, and unvaccinated individuals. This consistency across groups suggests that vaccination status did not significantly alter engagement in protective behaviors during the observation period.

CONCLUSIONS

Empirical findings highlight the complexity of behavioral responses following vaccination, indicating that such responses may be influenced by various factors, rather than by vaccination status alone. Additionally, this result underscores the importance of crafting public health policies that account for the intricate interplay between vaccination and behavior. This study contributes to the broader discourse on managing responses to the pandemic and tailoring interventions to sustain or enhance protective health behaviors amid vaccination rollouts.

The dental COVID-19 paradox: Disparity in behaviors inside and outside dental schools in Canada

OBJECTIVE

To describe the personal and professional behavior and assess the perceptions of protection and fear of contracting coronavirus disease 2019 (COVID-19) among faculty, staff, and students from all 10 Canadian dental schools during the second year of the pandemic.

METHOD

Participants from a Pan-Canadian prospective study answered monthly questionnaires about their activities between April 2021 and March 2022. In May 2022, additional questions were asked about their perception of protection, fear of infection, and instances of COVID-19 testing.

RESULTS

Six hundred participants were initially recruited. Over time, the participants spent less time at home and increased their participation in indoor social activities, a trend influenced by the fluctuations in COVID-19 cases (β = ‒0.02). Over 90% of the participants were fully vaccinated, which decreased their fear of contracting the virus (χ2[4, 241‒243] = 196.07, p < 0.0001). Yet, their attitude toward protective measures did not change, and they followed them within school.

CONCLUSIONS

This work shows a paradoxical behavior among dental students, staff, and faculty members in Canadian dental schools. While factors such as the vaccine's limited efficacy and a desire to protect others may contribute to stringent protective behaviors within dental schools, the mandatory nature of these measures was likely the primary motivator for the compliance. Despite potential efforts to minimize exposure to the virus during risk periods and the frequent COVID-19 testing, this paradoxical behavior raises questions about professional responsibilities extending beyond the workplace. Thus, dental schools should incorporate education about the rationale behind following different protocols and the potential consequences of outside school behaviors.

Surname order and revaccination intentions during the COVID-19 pandemic

Teachers in Japanese schools employ alphabetical surname lists that call students sooner, with surnames appearing early on these lists. We conducted Internet surveys nearly every month from March 2020 to September 2022 with the same participants, wherein we asked participants where the alphabetical columns of their childhood and adult surnames were located. We aimed to identify how surname order is important for the formation of noncognitive skills. During the data collection period, the COVID-19 vaccines became available; Japanese people could receive their third dose starting in December 2021. The 19th wave of the survey was conducted in January 2022. Therefore, to examine how a surname's alphabetical order could influence intention to revaccinate, we used a subsample of data from December 2021 to September 2022. The major findings were as follows. Women with early surnames had an approximately 4% stronger likelihood of having such intentions than men with early surnames. Early name order was more strongly correlated with revaccination intention among women than among men. The surname effect for women was larger when a mixed-gender list was used compared with when it was not used. This effect was only observed for childhood surnames and not for adult surnames.

Meta-analysis on application of Protection Motivation Theory in preventive behaviors against COVID-19

The present study aims to conduct a systematic review and meta-analysis on quantitative conclusion and appraisal of findings from Protection Motivation Theory to predict protective behaviors against COVID-19. This meta-analysis covered the period between 2019 and 2022. Web of Science, Science Direct, Scopus, Emerald, PubMed, Springer, Sage, Online Wiley Library, Taylor & Francis and ProQuest were searched to find related articles to the study topic. Using Effect Size of Random model, the quality of each study, homogeneous of studies and Publication bias of data were analyzed and assessed by CMA2 software. The results indicate that perceived severity (β=0.197), perceived vulnerability (β=0.160), response efficacy (β=0.251) and self-efficacy (β=0.270) are positively associated with COVID-19 disease. In addition, the results show that Response cost (β=-0.074) is a negative and weak predictor of motivation to protect against COVID-19. The results of this study regarding Protection Motivation Theory (PMT)- as a very strong and flexible theory during outbreak of COVID-19- may suggest that despite positive protection, the mean of Effect Size of total PMT elements is less than average size. Meta-analysis of studies shows that coping appraisal variables provide the strongest predictors of behavior and intention. Furthermore, self-efficacy was identified as the most important determinant in protective behaviors against COVID-19.

Student close contact behavior and COVID-19 transmission in China's classrooms

Classrooms are high-risk indoor environments, so analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in classrooms is important for determining optimal interventions. Due to the absence of human behavior data, it is challenging to accurately determine virus exposure in classrooms. A wearable device for close contact behavior detection was developed, and we recorded >250,000 data points of close contact behaviors of students from grades 1 to 12. Combined with a survey on students' behaviors, we analyzed virus transmission in classrooms. Close contact rates for students were 37 ± 11% during classes and 48 ± 13% during breaks. Students in lower grades had higher close contact rates and virus transmission potential. The long-range airborne transmission route is dominant, accounting for 90 ± 3.6% and 75 ± 7.7% with and without mask wearing, respectively. During breaks, the short-range airborne route became more important, contributing 48 ± 3.1% in grades 1 to 9 (without wearing masks). Ventilation alone cannot always meet the demands of COVID-19 control; 30 m3/h/person is suggested as the threshold outdoor air ventilation rate in a classroom. This study provides scientific support for COVID-19 prevention and control in classrooms, and our proposed human behavior detection and analysis methods offer a powerful tool to understand virus transmission characteristics and can be employed in various indoor environments.

Association between the COVID-19 Vaccine and Preventive Behaviors: Panel Data Analysis from Japan

The coronavirus (COVID-19) vaccine is key to reducing the probability of contracting COVID-19. The vaccine is generally known to prevent severe illness, death, and hospitalization as a result of the disease and for considerably reduce COVID-19 infection risk. Accordingly, this might significantly change an individual's perceived risk of altering everyday behaviors. For instance, the proliferation of vaccination is anticipated to reduce preventive behaviors such as staying at home, handwashing, and wearing a mask. We corresponded with the same individuals monthly for 18 months from March 2020 (early stage of COVID-19) to September 2021 in Japan to independently construct large sample panel data (N = 54,007), with a participation rate of 54.7%. We used a fixed effects model, controlling for key confounders, to determine whether vaccination was associated with a change in preventive behaviors. The major findings are as follows. Contrary to the prediction, (1) based on the whole sample, being vaccinated against COVID-19 led people to stay at home; however, it did not change the habit of handwashing and wearing a mask. Especially after the second shot, respondents were likelier to stay at home by 0.107 (95% CIs: 0.059-0.154) points on a 5-point scale compared to before the vaccination. Dividing the entire sample into young and old, (2) those aged ≤ 40 years were more likely to go out after being vaccinated, and (3) people over 40 years of age were more likely to stay at home (similar to the first result). Preventive behaviors impact all individuals during the current pandemic. Informal social norms motivate people to increase or maintain preventive behaviors even after being vaccinated in societies where these behaviors are not enforced.

Cessation of Face Mask Use after COVID-19 Vaccination in Patients with Diabetes: Prevalence and Determinants

Studies on the cessation of face mask use after a COVID-19 vaccine in patients with diabetes are not available, despite their greater predisposition to complications. We estimated the prevalence of cessation of face mask use after receiving the COVID-19 vaccine in patients with diabetes and identified which factor was most strongly associated with non-use. This was a cross-sectional study in patients with diabetes 18-70 years with at least one dose of vaccine against COVID-19 (n = 288). Participants were asked to respond face-to-face to a questionnaire in a primary care center. Descriptive statistics, chi-square tests, and multivariate binary logistic regression were used for analyzing the association between vulnerability, benefits, barriers, self-efficacy, vaccine expectations (independent variables), and cessation of use (dependent variable), controlling for sociodemographic, smoking, medical, vaccine, and COVID-19 history. The prevalence of cessation of face masks was 25.3% (95% CI 20.2, 30.5). Not feeling vulnerable to hospitalization increased the odds of non-use (adjusted OR = 3.3, 95% CI 1.2, 8.6), while perceiving benefits did the opposite (adjusted OR = 0.4, 95% CI 0.2, 0.9). The prevalence was low, and only two factors were associated with the cessation of face mask use after COVID-19 vaccination in patients with type 2 diabetes.

Impact of the COVID-19 on electricity consumption of open university campus buildings - The case of Twente University in the Netherlands

Since the COVID-19 outbreak, the restrictive policies enacted by countries in response to the epidemic have led to changes in the movement of people in public places, which has had a direct impact on the use and energy consumption of various public buildings. This study was based on electricity consumption data for 25 on-campus public buildings at 1-hour intervals between January 2020 and June 2022 at Tewnte University in the Netherlands, and after the data were climate-corrected by multiple regression analysis, the changes in EU and EUI for various types of buildings were compared for different restriction periods using ANOVA, LSD and t-tests. And additionally, further analyzed the changes and reasons for the electricity consumption of various public buildings on campus and customers' electricity consumption behavior in a period of time after the lifting of the epidemic restriction policy. The results of ANOVA analysis show that the restriction policy has a significant effect on teaching, sports, and cultural buildings, and the electricity intensity of the three types of buildings is reduced by 0.28, 0.09, and 0.07 kwh/m²/day respectively under the strict restriction policy; The t-test results show that during the restriction period, all building types, except for living and academic buildings, show a significant decreasing trend, with the teaching buildings having the greatest energy saving potential, with an average daily EU reduction of 1088kwh/day and an EUI reduction of 0.075kwh/ m²/day. The above findings provide a case study of a complete cycle of energy consumption changes in university buildings under similar epidemic restriction policies before and after the epidemic restriction, and inform the electricity allocation policies of university and government energy management authorities.

COVID-19 Risk Perception and Adherence to Preventive Measures among Medical Students after Receiving COVID-19 Vaccination: A Multicenter Cross-Sectional Study in Egypt

This study aimed to assess the perception of COVID-19 risk and the adherence to protective measures among medical students after vaccination. We conducted a cross-sectional survey on a convenience sample of students from all the 18 governmental medical schools in Egypt. A total of 2273 students participated in the online self-administered questionnaire. Around 8 in 10 (83.2%) students were fully vaccinated, of which 17.9% received the booster dose. Only 36.9% believed that COVID-19 is serious on the individual level. The majority (73.9%) strongly or slightly agreed they may become infected after vaccination if they do not follow the preventive measures. We observed a slow decline in the perceived risk of vulnerability and susceptibility to COVID-19 infection among students in parallel to a growing perception of self-efficacy and controllability. Less than one-third (28.9%) of students showed good adherence to protective measures. However, this was lower than the previously reported adherence in the same population before vaccination. Female students, those in the first academic year, those who did not contract COVID-19 infection before, and those with a higher perception of susceptibility and perceived controllability were more likely to perform better at protective measures.

Dwelling in times of COVID-19: An analysis on habitability and environmental factors of Spanish housing

In the wake of the SARS-CoV-2 pandemic, promoted by the World Health Organization (WHO), governments urged people to stay at home. For this reason, practically all human activity took place inside the houses. The research question established if housing quality responded to people’s needs in the context of confinement. Specifically, the purpose was to taxonomize the dwelling stock occupied by confined households during the first COVID-19 wave in Spain, as well as to deepen in features and subjective perceptions on Indoor Environmental Quality (IEQ). As an exploratory study, an online questionnaire was disseminated in the Spring of 2020, obtaining 1,673 valid responses. A descriptive statistical analysis included sociodemographic, territorial and housing variables, related to indoor environmental quality, the availability of outdoor spaces, and the prospects for changes in. Also, a logistic regression stablished multivariate relations for the dependent variable “general dwelling satisfaction”. The results associated urban habitat, tenancy regime, higher incomes, and fewer cohabitants, with worse perceived IEQ, and lack of own outdoor space. Same variables showed relations with people’s desire for domestic changes. In conclusion, it is remarkable the determining role of housing design for dwellers’ satisfaction, especially in uncertain times like COVID-19 pandemic. This not only conditioned the different ways of inhabiting and occupying dwellings, but also the people’s capacity to face lockdown. The built environment, the habitat, and households’ circumstances also influenced. The latter did on people's perception of their experience, and how they lived and expressed it. Additionally, resilient building design and renovation opportunities were identified.

Impact of the eHealth literacy, knowledge and attitudes on COVID-19 prevention behavior among residents in the second year of the COVID-19 pandemic: A cross-sectional study in Anhui Province, China

Objective

The pandemic of COVID-19 continues to challenge people's health worldwide. In the second year of the pandemic, adherence to COVID-19 preventive behavior is key to continuing efforts to overcome the epidemic. This study aims to assess the COVID-19-related knowledge, attitude, and prevention behavior (KAP) and electronic health literacy (eHealth literacy) among Anhui residents in China.

Methods

From January 30 to March 27, 2021, the cross-sectional study was performed among Anhui residents in China, including 16 cities. An online survey was adopted to assess KAP regarding COVID-19, and eHealth, involving a total of 2,122 citizens. Following informed consent, residents were recruited by convenience sampling. Frequencies and proportions were calculated. Additionally, Mann-Whitney U tests were used to analyze the variables. Independent predictors of preventive behavior of COVID-19 were ascertained using a multivariable logistic regression model.

Result

Residents demonstrated good knowledge, positive attitudes, acceptable practices, and good eHealth literacy. Online news and WeChat are the main health information resources. Citizens who had good knowledge, a positive attitude, good eHealth, and did not participate in the online lectures or training COVID-19 were more likely to take preventive measures. Those with poor health, who were male, did not have family members working in health care facilities, and did not work in a face-to-face environment were less likely to take precautions. Compared with a master's degree and above, participants with middle school education level and below took preventive behavior sometimes. Residents who browse the COVID-19 webpage <15 min weekly seldom took preventive actions.

Conclusion

The study showed that in the second year of the COVID-19 pandemic, Chinese residents had adequate knowledge of COVID-19, positive attitudes, appropriate preventive practices, and basic eHealth literacy. To prevent the rebound of the COVID-19 epidemic, the government and health agencies should inform citizens concerning which information channels or websites to use and assist the underprivileged population who lacks basic infrastructure. In addition, increasing the level of knowledge and attitude, enhancing eHealth literacy and the Health Belief Model (HBM), and implementing the Health Code were seen as ways to reinforce adherence to preventive behavior. Targeting men, implementing public awareness campaigns, community engagement strategies, and health education programs are recommended.

Effect of availability and COVID-19 vaccination on food shopping and consumption behaviors among Jordan universities students

The COVID-19 pandemic influenced the lives of university students all across the globe. Indeed, the pandemic has impacted many aspects of their daily routine, changing their social and health habits and food-related behaviors. There is now no approved therapy, and vaccination is the only clinical preventative measure that provides the highest protection against the virus. While these vaccines have been beneficial in curbing the pandemic's effect, they may also influence food-related behaviors. Accordingly, this paper aims to investigate the impact of vaccination availability on university students' food shopping and consumption habits, vaccine-related opinions, and back on-campus behaviors in Jordan. The research is based on an online survey conducted in Jordan using a structured questionnaire and distributed through Google Forms between January 1 and March 20, 2022. A total of 624 valid answers were collected. The findings revealed no significant changes in the way students consumed, shopped, and handled food compared to the pre-vaccine period. However, there is a slight post-vaccine trend toward shopping more groceries online and ordering more meals via delivery apps and takeout services. Regarding health-related food choices, there was an increase in the consumption of healthy food, water, and fruits and vegetables. Further, following the availability of the vaccination, students' adoption of COVID-19 food-related habits was maintained. Gender, engagement in food preparation activities, and living status (e.g., whether or not living with parents) substantially affected several food-related behaviors. The findings are expected to guide both current emergency preparations and long-term food-related policies in Jordan. This information may also be helpful to researchers interested in the effects of COVID-19 vaccination on student nutrition and related food behaviors.

Duration of protection of CoronaVac plus heterologous BNT162b2 booster in the Omicron period in Brazil

To date, no information has been published on the effectiveness of inactivated whole-virus COVID-19 vaccines plus heterologous booster against symptomatic infection and severe outcomes (hospitalization or death) during the dominance of the SARS-CoV-2 Omicron variant period. We evaluated the vaccine effectiveness (VE) of CoronaVac plus BNT162b2 booster during the period of dominance of the Omicron variant in Brazil (January to April 2022). Using a test-negative design, we analysed data for 2,471,576 individuals tested during the Omicron variant’s dominant period using a nationally linked database from Brazil. Compared to unvaccinated, vaccinees maintained protection against severe outcomes, with an estimated VE of 84.1% (95% CI:83.2–84.9) at more than 120 days after BNT162b2 booster. Furthermore, while we detected a high level of protection against severe outcomes for individuals up to 79 years old, waning was observed for individuals aged ≥80 years, with VE decreasing from 81.3% (95% CI:77.9–84.2) at 31–60 days to 72.9% (95% CI:70.6–75.1) at 120 days or more after the booster dose. However, no significant protection against symptomatic infection was observed at this time period. In conclusion, except for individuals aged ≥80 years, CoronaVac plus a BNT162b2 booster dose offered high and durable protection against severe outcomes due to Omicron.

Primary CoronaVac vaccination followed by a BNT162b2 booster dose confers protection against some SARS-CoV-2 variants but its effectiveness against Omicron is unknown. Here, the authors show that this combination confers a high level of protection against severe outcomes for up to 120 days, with evidence of waning for those aged 80 or older.

The Impact of COVID-19 Vaccination in Changing the Adherence to Preventive Measures: Evidence from Italy

The objectives of the survey were to explore any changes in the adherence to the three main COVID-19 preventive measures (social distancing, washing hands, wearing face-masks) among 795 individuals who received the COVID-19 vaccine booster dose in Italy and to identify the predictors associated. The concern of contracting COVID-19 before the vaccination, after the primary COVID-19 vaccine series, and after the booster dose resulted with a mean value of 7.7, 4.6, and 4.2, respectively. Females, those who had a lower mean self-perceived health status, who perceived COVID-19 as a very serious health problem, who decided to receive the booster dose because they perceived to be at risk of getting COVID-19, and who expressed interest in acquiring more information regarding the COVID-19 vaccine booster dose were more likely to report a higher concern of contracting COVID-19 after the booster dose. Over two-thirds were willing to respect the three main COVID-19 preventive measures following the booster dose. The multinomial logistic regression analysis showed that those who had used all three main preventive measures before and after the second or single dose were less likely to perceive COVID-19 as a serious illness. Those who had used them irregularly were less likely to have used official government organizations and scientific journals as sources of information. This survey provided an understanding regarding the adherence to COVID-19 preventive measures that may help to target policy interventions needed to reduce the spread of SARS-CoV-2.

COVID-19 Vaccination Did Not Change the Personal Protective Behaviors of Healthcare Workers in China

Personal protective behaviors of healthcare workers (HCWs) and dynamic changes in them are known to play a major role in the hospital transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, 1,499 HCWs in Chinese hospitals completed an online survey about their knowledge on SARS-CoV-2 transmission and their personal protective behaviors before and after coronavirus disease 2019 (COVID-19) vaccination. Of all the respondents, 89% were vaccinated at the time of the survey and 96% believed that the vaccine was effective or highly effective. Further, 88% of the vaccinated HCWs expressed that they would get revaccinated if the vaccination failed. Compared with HCWs with a lower education level, those with a higher education level had less fear of being infected with SARS-CoV-2 and reported a lower negative impact of the pandemic on how they treated patients. Physicians and nurses were willing to believe that short-range airborne and long-range fomite are possible transmission routes. HCWs with a higher education level had a better knowledge of COVID-19 but worse personal protective behaviors. The fact that HCWs with a longer work experience had worse personal protective behaviors showed that HCWs gradually relax their personal protective behaviors over time. Moreover, vaccination reduced the negative effects of the COVID-19 pandemic on how the HCWs treated patients. Importantly, the survey revealed that after vaccination, HCWs in China did not relax their personal protective behaviors, and it may bring a low potential risk for following waves of variant virus (e.g., delta).

COVID-19 Vaccination Compliance and Associated Factors among Medical Students during an Early Phase of Vaccination Rollout-A Survey from Israel

COVID-19 is "a once-in-a-century" pandemic, bringing with it unparalleled health, social, and economic ramifications. As part of the world's efforts to restrain the pandemic, vaccine development has been expedited. This population-representative survey in Israel aimed to investigate whether the knowledge, attitudes, and vaccination status of medical students affect their intention to recommend COVID-19 vaccination (as well as reasons for refusal and acceptance of the vaccine). The questionnaire was anonymous, via Google Forms app in December 2021. One-hundred and four medical students completed the survey. Overwhelmingly, (91.3%) COVID-19 vaccination status and intention to receive the vaccine were positively associated with intention to recommend. Twenty-five percent of the students replied that they lacked knowledge regarding the vaccine. A statistically significant association was found between experiencing quarantine and the intention to be vaccinated (p = 0.034). There was a significant positive relationship between the number of symptoms from previous vaccines and the fear of COVID-19 (rs = 0.272, p < 0.01). Prior vaccination did not have an effect on COVID-19 vaccine hesitancy. This first study evaluating COVID-19 vaccine hesitancy among Israeli medical students highlighted the need for medical programs to emphasize the benefits of COVID-19 vaccination in the protection of healthcare workers and patient safety. Education, awareness campaigns, and regulation of vaccine trials could further decrease COVID-19 vaccine hesitancy and increase vaccine rates among medical students.