Reporting on one's behavior: a survey experiment on the nonvalidity of self-reported COVID-19 hygiene-relevant routine behaviors

Association between triglyceride-glucose index and phenotypic age acceleration: a cross-sectional study based on NHANES database

Objective

To investigate the association between triglyceride-glucose (TyG) index and phenotypic age acceleration (PhenoAgeAccel), given the emerging importance of biological aging as a health determinant and the role of insulin resistance in aging-related processes.

Methods

This cross-sectional study analyzed data from 13,291 adults aged ≥20 years in the National Health and Nutrition Examination Survey (1999-2010). The TyG index served as the exposure variable, calculated from fasting triglycerides and glucose levels. PhenoAgeAccel, derived from clinical biomarkers, was the outcome variable. Analyses adjusted for demographic, socioeconomic, and health-related covariates.

Results

A significant non-linear relationship was observed between TyG index and PhenoAgeAccel, with an inflection point at 9.60. In the fully adjusted model, each unit increase in TyG index was associated with 2.21 years increase in PhenoAgeAccel (95% CI: 1.99, 2.43). The association was stronger above the inflection point (β = 8.21, 95% CI: 7.59, 8.82) compared to below it (β = 0.56, 95% CI: 0.29, 0.83).

Conclusion

Higher TyG index levels are significantly associated with accelerated biological aging, particularly above a threshold of 9.60. These findings suggest the importance of metabolic health in biological aging processes and potential interventional strategies.

Association Between Social Distancing Compliance and Public Place Crowding During the COVID-19 Pandemic: Cross-Sectional Observational Study Using Computer Vision to Analyze Surveillance Footage

Background

Social distancing behavior has been a critical nonpharmaceutical measure for mitigating the COVID-19 pandemic. For this reason, there has been widespread interest in the factors determining social distancing violations, with a particular focus on individual-based factors.

Objective

In this paper, we examine an alternative and less appreciated indicator of social distancing violations: the situational opportunity for maintaining interpersonal distance in crowded settings. This focus on situational opportunities is borrowed from criminology, where it offers an alternative to individual-based explanations of crime and rule violations. We extend this approach to the COVID-19 pandemic context, suggesting its relevance in understanding distancing compliance behavior.

Methods

Our data comprise a large collection of video clips (n=56,429) from public places in Amsterdam, the Netherlands, captured by municipal surveillance cameras throughout the first year of the pandemic. We automatized the analysis of this footage using a computer vision algorithm designed for pedestrian detection and estimation of metric distances between individuals in the video still frames. This method allowed us to record social distancing violations of over half a million individuals (n=539,127) across more and less crowded street contexts.

Results

The data revealed a clear positive association between crowding and social distancing violations, evident both at the individual level and when aggregated per still frame. At the individual level, the analysis estimated that each additional 10 people present increased the likelihood of a distancing violation by 9 percentage points for a given pedestrian. At the aggregated level, there was an estimated increase of approximately 6 additional violations for every 10 additional individuals present, with a very large R² of 0.80. Additionally, a comparison with simulation data indicated that street spaces should, in principle, provide sufficient room for people to pass each other while maintaining a 1.5-meter distance. This suggests that pedestrians tend to gravitate toward others, even when ample space exists to maintain distance.

Conclusions

The direct positive relationship between crowding and distancing violations suggests that potential transmission encounters can be identified by simply counting the number of people present in a location. Our findings thus provide a reliable and scalable proxy measure of distancing noncompliance that offers epidemiologists a tool to easily incorporate real-life behavior into predictive models of airborne contagious diseases. Furthermore, our results highlight the need for scholars and public health agencies to consider the situational factors influencing social distancing violations, especially those related to crowding in public settings.

Lived experiences and insights of Chinese patients with symptomatic osteoporosis on a patient-reported outcome (PRO) programme: a qualitative phenomenological study in Southwest China

OBJECTIVES

To explore the lived experiences of patients with symptomatic osteoporosis on a patient-reported outcomes (PROs) programme for symptom management and quality of life (QoL) improvement.

DESIGN

This is a qualitative phenomenological study.

SETTING

PARTICIPANTS: 14 active participants in the PROs programme were recruited and interviewed through semi-structured face-to-face interviews. Colaizzi's seven-step method was employed for thematic analysis.

RESULTS

Four overarching themes and two sub-themes emerged, including (1) varied perceptions of the PROs programme, where some participants found it beneficial for tracking symptoms while others cited challenges such as technological barriers and lack of actionable outcomes; (2) PROs as a tool for enhancing communication and facilitating appointments by enabling more efficient doctor-patient interactions and quicker scheduling; (3) emotional support provided by regular doctor-patient communication, with sub-themes of fostering a sense of belonging and offering psychological comfort; and (4) limitations of remote communication, highlighting challenges in addressing complex medical needs and providing immediate solutions for medication adjustments.

CONCLUSIONS

PROs programmes facilitate symptom tracking, enhance communication and provide emotional support for patients with osteoporosis. However, limitations such as technological barriers and reliance on remote communication must be addressed. Ethical considerations, including potential over-reporting of symptoms to expedite care, require careful management. Future research should include patients who discontinue participating in the PROs programme prematurely and the perspectives of healthcare providers to provide a more balanced, comprehensive understanding.

Lifestyle, Environmental, Occupational, and Dietary Risk Factors in Small-Cell vs. Non-Small-Cell Advanced Lung Cancer Patients: Is There a Connection?

OBJECTIVES

(i) To evaluate the possible exposure of newly diagnosed lung cancer patients to selected lifestyle, environmental, occupational, and dietary risk factors and (ii) to assess the differences in exposures of small-cell (SCLC) and non-small-cell (NSCLC) lung cancer patients to those risk factors.

METHODS

In this study, 205 newly diagnosed patients with IIIB/IV stage of either SCLC or NSCLC (111 men vs. 94 women) from Vojvodina, Serbia, were surveyed for selected demographic characteristics, dietary and lifestyle habits, and environmental factors.

RESULTS

Most patients were long-term heavy smokers. The body mass index values of SCLC patients were higher than those of NSCLC patients. Women reported higher stress levels compared to men. Women diagnosed with lung adenocarcinoma were more often exposed to traffic pollution compared to men. Individual indoor coal combustion systems were more often used by SCLC patients of both sexes compared to other cancer types. Men were more frequent consumers of canned foods, which are potential sources of endocrine disruptors. Occupational exposure to lung cancer risk factors, in addition to tobacco smoking, may be crucial in lung cancer development with specific occupations.

CONCLUSIONS

Further research on environmental and occupational risk factors for lung cancer is urgent in order to unveil the etiopathogenesis of specific lung cancer types.

Impact of COVID-19 on the Self-Report Assessment of Obsessive-Compulsive Disorder

Background The COVID-19 pandemic and subsequent guidelines have had a substantial effect on social norms. This likely affected self-report assessment of psychopathology, namely those that assess obsessive-compulsive tendencies routinely used to screen for obsessive-compulsive disorder (OCD). It was hypothesized that self-report assessment of OCD likely produces inflated, non-discriminating scale scores. Methods Data collection occurred prior to the COVID-19 pandemic with the aim of validating a new psychological test; however, data collection was abruptly halted in March 2020. Data collection was allowed to resume in the latter half of the year. Both groups were racio-ethnically and gender diverse. Results Self-report measures of OCD yielded inflated scores. For instance, the total obsessive-compulsive inventory-revised (OCI-R) average score of all participants went from normative levels prior to COVID-19 (M = 13.69, SD = 10.32) to an average score that was above the clinical cut-off on the OCI-R (M = 32.89; SD = 12.95) during the pandemic (t(135) = 9.66, p < 0.001, Cohen's d = 1.66). Conclusions OCD-related scale scores likely produced false positives in research and practice due to COVID-19 health guidelines put in place to protect against infection that may otherwise be considered contamination fears on OCD measures.

How using light touch immersion research revealed important insights into the lack of progress in malaria elimination in Eastern Indonesia

BACKGROUND

By 2022, the Government of Indonesia had successfully eliminated malaria in 389 out of 514 districts but continues to face a challenge in Eastern Indonesia where 95% of the total 2021 malaria cases were reported from Papua, West Papua and Nusa Tenggara Timur provinces. There is an increased recognition that malaria elimination will require a better understanding of the human behavioural factors hindering malaria prevention and treatment, informed by local context and local practice.

METHODS

This research used a light-touch immersion research approach. Field researchers lived in communities over several days to gather data through informal conversations, group-based discussions using visual tools, participant observation and direct experience. The study was conducted in four high malaria endemic areas in Papua, West Papua, and Sumba Islands in Nusa Tenggara Timur.

RESULTS

The research highlights how people's perception of malaria has changed since the introduction of effective treatment which, in turn, has contributed to a casual attitude towards early testing and adherence to malaria treatment. It also confirms that people rarely accept there is a link between mosquitoes and malaria based on their experience but nevertheless take precautions against the annoyance of mosquitoes. There is widespread recognition that babies and small children, elderly and incomers are more likely to be seriously affected by malaria and separately, more troubled by mosquitoes than indigenous adult populations. This is primarily explained by acclimatization and strong immune systems among the latter.

CONCLUSIONS

Using immersion research enabled behaviour research within a naturalistic setting, which in turn enabled experiential-led analysis of findings and revealed previously unrecognized insights into attitudes towards malaria in Eastern Indonesia. The research provides explanations of people's lack of motivation to consistently use bed nets, seek early diagnosis or complete courses of treatment. The felt concern for the wellbeing of vulnerable populations highlighted during light touch immersion provides an entry point for future social behaviour change communication interventions. Rather than trying to explain transmission to people who deny this connection, the research concludes that it may be better to focus separately on the two problems of malaria and mosquitoes (especially for vulnerable groups) thereby resonating with local people's own experience and felt concerns.

How well do surveys on adherence to pandemic policies assess actual behaviour: Measurement properties of the Dutch COVID-19 adherence to prevention advice survey (CAPAS)

BACKGROUND

Survey data on adherence to COVID-19 prevention measures have often been used to inform policy makers and public health professionals. Although behavioural survey data are often considered to suffer from biases, there is a lack of studies critically examining the validity, reliability and responsiveness of population-survey data on behaviour throughout the COVID-19 pandemic.

AIM

We studied the measurement properties of the COVID-19 Adherence to Prevention Advice Survey (CAPAS), a novel questionnaire implemented in a repeated cross-sectional (i.e., 'Trend') Study and a Cohort Study in the Netherlands during the COVID-19 pandemic.

METHODS

The CAPAS is a novel questionnaire developed in March 2020, with the aim to assess social activity and adherence to COVID-19 prevention measures. Items were formulated to minimise social desirability and aid memory retrieval. Based on the COSMIN framework, we selected the most suitable test for each behavioural question. We investigated criterion validity of vaccination, testing behaviour and mobility by comparing (aggregate) trends of self-reported behaviour to trends in objective data. Responsiveness of mobility and ventilation behaviour was assessed by studying whether self-reported behaviour changed following contextual (e.g., policy) changes. Test-retest reliability of hygienic behaviour, wearing face masks, ventilation behaviour and social distancing was examined during a period in which the context was stable.

RESULTS

Overall, aggregate trends in self-reported behaviour closely corresponded to trends in external objective data. Self-reported behaviours were responsive to contextual changes and test-retest reliabilities were adequate. For infrequent behaviours reliability improved when measures were dichotomised. We were able to examine national representativeness for vaccination, which suggested a modest overestimation of on average 3.7%.

CONCLUSIONS

This study supports the suitability of using carefully designed, self-reported surveys (and the CAPAS specifically) to study changes in protective behaviours in a dynamic context.

Descriptive norms caused increases in mask wearing during the COVID-19 pandemic

Human sociality is governed by two types of social norms: injunctive norms, which prescribe what people ought to do, and descriptive norms, which reflect what people actually do. The process by which these norms emerge and their causal influences on cooperative behavior over time are not well understood. Here, we study these questions through social norms influencing mask wearing during the COVID-19 pandemic. Leveraging 2 years of data from the United States (18 time points; n = 915), we tracked mask wearing and perceived injunctive and descriptive mask wearing norms as the pandemic unfolded. Longitudinal trends suggested that norms and behavior were tightly coupled, changing quickly in response to public health recommendations. In addition, longitudinal modeling revealed that descriptive norms caused future increases in mask wearing across multiple waves of data collection. These cross-lagged causal effects of descriptive norms were large, even after controlling for non-social beliefs and demographic variables. Injunctive norms, by contrast, had less frequent and generally weaker causal effects on future mask wearing. During uncertain times, cooperative behavior is more strongly driven by what others are actually doing, rather than what others think ought to be done.

Epidemic modelling of monitoring public behavior using surveys during pandemic-induced lockdowns

BACKGROUND

Implementing a lockdown for disease mitigation is a balancing act: Non-pharmaceutical interventions can reduce disease transmission significantly, but interventions also have considerable societal costs. Therefore, decision-makers need near real-time information to calibrate the level of restrictions.

METHODS

We fielded daily surveys in Denmark during the second wave of the COVID-19 pandemic to monitor public response to the announced lockdown. A key question asked respondents to state their number of close contacts within the past 24 hours. Here, we establish a link between survey data, mobility data, and hospitalizations via epidemic modelling of a short time-interval around Denmark's December 2020 lockdown. Using Bayesian analysis, we then evaluate the usefulness of survey responses as a tool to monitor the effects of lockdown and then compare the predictive performance to that of mobility data.

RESULTS

We find that, unlike mobility, self-reported contacts decreased significantly in all regions before the nation-wide implementation of non-pharmaceutical interventions and improved predicting future hospitalizations compared to mobility data. A detailed analysis of contact types indicates that contact with friends and strangers outperforms contact with colleagues and family members (outside the household) on the same prediction task.

CONCLUSIONS

Representative surveys thus qualify as a reliable, non-privacy invasive monitoring tool to track the implementation of non-pharmaceutical interventions and study potential transmission paths.

Self-uniqueness beliefs and adherence to recommended precautions. A 5-wave longitudinal COVID-19 study

RATIONALE

Research on health-related self-uniqueness beliefs suggested that these beliefs might predict adherence to precautions against COVID-19.

OBJECTIVE

We examined if comparative optimism (believing that one is less at less than others), self-superiority (believing that one already adheres better to precautions than others), and egocentric impact perception (believing that adverse events affect oneself more than others) predicted intended adherence to precautions.

METHOD

We measured self-reported intentions, optimism for self and others, perceived past adherence by self and others, and perceived impact of the measures and the disease on self and others in a 5-wave longitudinal study in December 2020-May 2021 (N ≈ 5000/wave). The sample was in key respects representative for the Belgian population. We used joint models to examine the relationship between self-uniqueness beliefs and intended adherence to the precautions.

RESULTS

Believing that COVID-19 would affect one's own life more than average (egocentric impact perception) was associated with higher intentions to adhere to precautions, as was believing that the precautions affected one's life less than average (allocentric impact perception). Self-superiority concerning past adherence to precautions and comparative optimism concerning infection with COVID-19 were associated with higher intended adherence, regardless of whether their non-comparative counterparts (descriptive norm, i.e., perceived adherence to precautions by others, and personal optimism, respectively) were controlled for. Comparative optimism for severe disease and for good outcome were associated with lower intended adherence if personal optimism was not controlled for, but with higher intended adherence if it was controlled for.

CONCLUSION

Self-uniqueness beliefs predict intended adherence to precautions against COVID-19, but do so in different directions.

A Network Approach to Compliance: A Complexity Science Understanding of How Rules Shape Behavior

To understand how compliance develops both in everyday and corporate environments, it is crucial to understand how different mechanisms work together to shape individuals' (non)compliant behavior. Existing compliance studies typically focus on a subset of theories (i.e., rational choice theories, social theories, legitimacy theories, capacity theories, and opportunity theories) to understand how key variables from one or several of these theories shape individual compliance. The present study provides a first integrated understanding of compliance, rooted in complexity science, in which key elements from these theories are considered simultaneously, and their relations to compliance and each other are explored using network analysis. This approach is developed by analyzing online survey data (N = 562) about compliance with COVID-19 mitigation measures. Traditional regression analysis shows that elements from nearly all major compliance theories (except for social theories) are associated with compliance. The network analysis revealed groupings and interconnections of variables that did not track the existing compliance theories and point to a complexity overlooked in existing compliance research. These findings demonstrate a fundamentally different perspective on compliance, which moves away from traditional narrow, non-network approaches. Instead, they showcase a complexity science understanding of compliance, in which compliance is understood as a network of interacting variables derived from different theories that interact with compliance. This points to a new research agenda that is oriented on mapping compliance networks, and testing and modelling how regulatory and management interventions interact with each other and compliance within such networks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10551-022-05128-8.

Citizens and the state during crisis: Public authority, private behaviour and the Covid-19 pandemic in France

How do democratic states induce citizens to comply with government directives during times of acute crisis? Focusing on the onset of the Covid-19 pandemic in France, I argue that the tools states use to activate adherence to public health advice have predictable and variable effects on citizens' willingness to change their routine private behaviours, both because of variation in their levels of restrictiveness but also because of differences in people's political motivations to comply with them. Using data collected in March 2020, I show that people's reports of changes in their behavioural routines are affected by the signals governments send, how they send them and the level of enforcement. I find that a nationally televised speech by President Macron calling for cooperative behaviour and announcing new restrictions elevated people's willingness to comply. Moreover, while co-partisanship with the incumbent government increased compliance reports before the President's primetime television address, presidential approval boosted reports of compliance after.

A brief forewarning intervention overcomes negative effects of salient changes in COVID-19 guidance

During the COVID-19 pandemic, public health guidance (e.g., regarding the use of non-medical masks) changed over time. Although many revisions were a result of gains in scientific understanding, we nonetheless hypothesized that making changes in guidance salient would negatively affect evaluations of experts and health-protective intentions. In Study 1 (N = 300), we demonstrate that describing COVID-19 guidance in terms of inconsistency (versus consistency) leads people to perceive scientists and public health authorities less favorably (e.g., as less expert). For participants in Canada (n = 190), though not the U.S. (n = 110), making guidance change salient also reduced intentions to download a contact tracing app. In Study 2 (N = 1399), we show that a brief forewarning intervention mitigates detrimental effects of changes in guidance. In the absence of forewarning, emphasizing inconsistency harmed judgments of public health authorities and reduced health-protective intentions, but forewarning eliminated this effect.

Effective but fragile? Responses to repeated nudge-based messages for preventing the spread of COVID-19 infection

Nudge-based messages have been employed in various countries to encourage voluntary contact-avoidance and infection-prevention behaviors to control the spread of COVID-19. People have been repeatedly exposed to such messages; however, whether the messages keep exerting a significant impact over time remains unclear. From April to August 2020, we conducted a four-wave online survey experiment to examine how five types of nudge-based messages influence Japanese people's self-reported preventive behaviors. In particular, we investigate how their behaviors are affected by repeated displays over time. The analysis with 4241 participants finds that only a gain-framed altruistic message, emphasizing their behavioral adherence would protect the lives of people close to them, reduces their frequency of going out and contacting others. We do not find similar behavioral changes in messages that contain an altruistic element but emphasize it in a loss-frame or describe their behavioral adherence as protecting both one's own and others' lives. Furthermore, the behavioral change effect of the gain-framed altruistic message disappears in the third and fourth waves, although its impact of reinforcing intentions remains. This message has even an adverse effect of worsening the compliance level of infection-prevention behaviors for the subgroup who went out less frequently before the experiment. The study's results imply that when using nudge-based messages as a countermeasure for COVID-19, policymakers and practitioners need to carefully scrutinize the message elements and wording and examine to whom and how the messages should be delivered while considering their potential adverse and side effects.