H1N1 preventive health behaviors in a university setting

Applying the health belief model to examine college students' early stage adoption of non-pharmaceutical interventions in response to COVID-19

OBJECTIVE

Amidst the COVID-19 pandemic, colleges worked to minimize transmission through non-pharmaceutical interventions (NPIs). The objective of this study was to apply the Health Belief Model to assess correlates of US college students' early stage NPI uptake.

PARTICIPANTS

Sample includes 1,223 students from a medium-sized university who participated in an anonymous health survey.

METHODS

Logistic regression assessed associations between HBM factors and consistent adoption of five individual NPI strategies. Multivariate linear regression assessed HBM correlates of NPI adoption overall.

RESULTS

Correlates of NPI uptake varied by strategy. Only perceived NPI benefits were significantly associated with NPI adoption individually and overall. Perceived susceptibility was associated with use of hand sanitizer, facemasks, and general NPI adoption. Perceived severity was associated with avoidance of large social gatherings only.

CONCLUSION

The HBM appears valuable for understanding students' NPI adoption. Results suggest university health initiatives should prioritize education on the efficacy of particular preventive behaviors.

Intramuscular versus intradermal administration for influenza vaccination in college students: A pilot study

OBJECTIVE

College student populations are considered at greater risk of contracting influenza due to their close living conditions. Despite this increased risk, college students are reluctant to obtain annual vaccination. This pilot study sought to determine perceptions of students on a college campus who received the annual influenza vaccination via an intradermal route. Participants and methods: Forty-nine college students participated in the IRB approved study. After receiving the intradermal influenza vaccination, participants completed a demographic survey and vaccination perceptions questionnaire. Results: Participants were more likely to want to have an intradermal injection in the future and reported less pain with the intradermal injection. Additionally, individuals who reported greater pain with the intramuscular injection in the past were significantly more likely to want to receive an intradermal injection in the future (p < 0.019). Conclusions: Results suggest that intradermal route of vaccination may be more appealing to the college population.

College students' influenza vaccination adoption: Self-reported barriers and facilitators

OBJECTIVE

Influenza attack rates among college students are high. However, little is known about the determinants of students' flu vaccine adoption from their own perspectives. To fill this gap, this study aims to investigate barriers and facilitators to college students' flu vaccine adoption.

METHODS

A total of 545 students offered complete answers to an online survey. Thematic analysis was used for analyzing open-ended questions.

RESULTS

Students' flu vaccine adoption was hindered by their fear associated with the flu vaccine, lack of pertinent knowledge, perceived lack of necessity, negative social influence, and time constraints and convenience concerns. Students were motivated to adopt the flu vaccine for their interest in self-care, positive experience with the flu vaccine adoption, good flu vaccine habits, and recommendations from trusted sources.

CONCLUSIONS

Understanding determinants of students' flu vaccine adoption provides the first step in developing tailored health interventions that may increase students' flu vaccine adoption rates.

Making Sense or Non-Sense? Communicating COVID-19 Guidelines to Young Adults at Danish Folk High Schools

Little is known about young people's behaviors and responses under outbreaks of infectious diseases such as the COVID-19 pandemic, especially in institutional settings. This research investigated the reactions of young adults residing at Danish folk high schools (FHSs) towards COVID-19 guidelines and the communicative styles used to enforce COVID-19 guidelines. The qualitative data consists of focus group discussions (FGDs) with students, interviews with staff, and participant observations, as well as survey data from 1800 students. This study showed that young adults reacted negatively when first faced with the new reality of COVID-19 restrictions. They expressed distress over the loss of meaning (non-sense), loss of sense of community, as well as uncertainty. Hygiene guidelines, however, made immediate sense and were socially well accepted. Most FHSs actively involved students in risk communication and creative examples of community-building communication were identified. This study demonstrates that successful risk communication at educational institutions must take into consideration how young adults make sense of and cope with the uncertainties of life during crisis situations including epidemics.

Stay-at-home orders during COVID-19 pandemic: an experience from general population in Damietta Governorate, Egypt

Background

The COVID-19 pandemic in Egypt triggered national preparedness, public engagement, and an integrated response that included social distancing measures, for example, staying at home. We aimed to investigate community awareness of and commitment to complying with the stay-at-home orders in Damietta Governorate, Egypt, during the COVID-19 pandemic.

Methods

A web-based cross-sectional survey was designed and completed by 500 adult participants from Damietta, Egypt, between April 10 and July 15, 2020. Participants were asked about their sociodemographics, sources of knowledge about COVID-19, awareness of COVID-19 prevention methods, commitment to stay-at-home orders, and their trust in governmental measures, community resources, and emergency services. The participants were classified as stay-at-home responders or nonresponders.

Results

Of the participants, 18.4% responded to stay-at-home orders; the main reasons for leaving home were buying essentials, especially food, and going to work. Compliance was significant among elderly individuals and those with a history of chronic illness. Nonresponse was significant among individuals who were married, working, or had low family income. More than one-third (39.2%) had good knowledge of effective methods of COVID-19 prevention, and the overall accepted knowledge was significantly higher among stay-at-home responders than nonresponders. Their trust in governmental measures, community resources, and emergency services to manage the pandemic was poor—84.6%, 71.8%, and 79%, respectively—with no significant differences between the groups.

Conclusions

Participants’ compliance with and engagement in stay-at-home orders in Damietta Governorate, Egypt, was poor. Public response to stay-at-home orders is affected by sociodemographics, and the public’s trust in governmental measures, community resources, and emergency services was poor. Understanding how social distancing is perceived in Egypt is important to provide public support and improve pandemic disease containment.

Risk Perception, Media, and Ordinary People’s Intention to Engage in Self-Protective Behaviors in the Early Stage of COVID-19 Pandemic in China

Objective

This study aims to examine how risk perception is associated with engagement in preventative behaviors and testing during the COVID-19 pandemic in the early stage of the COVID-19 pandemic in China.

Methods

A cross-sectional survey was conducted in February 2020, eventually obtaining 1613 participants, participants’risk perceptions, demographics (sex, age, education level, marital status, and employment status), as well as their engagement in self-protective behaviors and testing were assessed.

Results

Risk perception significantly affected intention to engage in self-protective behaviors, the more risk people feel, the more likely they intend to take self-protective actions(β =0.0423; P < 0.01), and simultaneously, people obtaining information on COVID-19 from Official microblogs and public accounts(OMPA) (β =0.189; P < 0.01)and Online websites(OW) (β =0.143; P < 0.1)were more inclined to take self-protective behaviors during the COVID-19 pandemic. It also showed that the interaction of risk perception and Online websites negatively affected the intention to engage in self-protective behaviors(β = −0.0374; P < 0.05), and conversely, the interaction of risk perception and Overseas media(OM) positively affected self-protective intention(β = 0.0423; P < 0.1).

Conclusion

There was a close relationship between the risk perception and the intention to engage in self-protective behaviors. At the same time, the use of media not only directly affected the intention to engage in self-protective behaviors but also moderated the impact of risk perception on the self-protection intention. Specifically, official media directly strengthened the intention to engage in self-protective behaviors. Online websites not only directly affected self-protection intention but also moderated the effect of risk perception on it. Although overseas media had no direct effect on self-protection intention, they moderated the effect of risk perception on it. These conclusions have policy implications for governments’ response to the COVID-19 epidemic.

Determinants of health behaviours intended to prevent spread of respiratory pathogens that have pandemic potential: A rapid review

Effective public health messages to encourage behaviours to reduce the spread of COVID-19 should be informed by existing research that identifies the factors that are associated with these preventive behaviours. This rapid review summarises the existing research on the determinants of behaviours that aim to prevent the spread of COVID-19. The review focuses on the body of research (excluding research conducted with health care workers) that was produced in the context of viruses other than SARS CoV-2 that cause severe respiratory illness and are transmitted in a similar way. A total of 58 published peer-reviewed studies included in the review were identified through searches of Medline, Embase, PsychInfo and CINAHL. Most were conducted in the context of the influenza A (H1N1) pandemic in 2009. Most studies examined the determinants of wearing a face covering, handwashing and social or physical distancing. The findings suggest that public health messages to encourage preventive behaviours should emphasise the potential seriousness of COVID-19 to elicit appropriate concern, strengthen perceptions of risk or threat from COVID-19, enhance self-efficacy about preventive behaviours, and improve knowledge about SARS-CoV-2, how it is transmitted, and how preventive behaviours can reduce the risk of transmission.

The effectiveness of the information-motivation-behavioral skills model-based intervention on preventive behaviors against respiratory infection among community-dwelling older adults

OBJECTIVE

To evaluate the effectiveness of an information-motivation-behavioral skills (IMB) model-based multi-component intervention on engagement and the quality of preventive behaviors against respiratory infections among community-dwelling older adults.

METHODS

This study was a controlled pretest-posttest study in which 91 community-dwelling older adults aged above 65 years were included. The intervention group (n = 42) received the six-week intervention theoretically based on the IMB model that comprised weekly group education and 5-10 min of tele-counseling per week.

RESULTS

The results showed that, after the intervention, the improvement in the level of knowledge, self-efficacy, self-reported engagement, and the quality of respiratory infection preventive behaviors was significantly greater in the intervention group compared to the control group. There was no significant difference between the two groups for the perceived threat of respiratory infection.

CONCLUSION

The IMB model-based intervention improved the engagement and quality of preventive behaviors by increasing the level of knowledge and self-efficacy in community-dwelling older adults.

PRACTICE IMPLICATIONS

The IMB model-based multi-component intervention can be an effective approach to improve preventive behaviors and will contribute to the preparation of communities for outbreaks of respiratory infections.

Thinking of future as an older individual increases perceived risks for age-related diseases but not for COVID-19

Actively thinking of one's future as an older individual could increase perceived risk and risk aversion. This could be particularly relevant for COVID‐19, if we consider the common representation of the risk of being infected by COVID‐19 as associated with being older. Increased perceived risk could bear consequences on the adoption of preventive behaviours. Thus, we investigated whether increasing the salience of individuals' future as an older adult would impact on their perceived risk for COVID‐19 and medical conditions varying for age‐relatedness. One hundred and forty‐four Italian adults (M_age = 27.72, range: 18–56) were randomly assigned to either a future as older adult thinking or control condition. Perceived risk for COVID‐19 and other strongly, and weakly age‐related medical conditions during the lifetime was measured. Results showed that thinking about the future as an older adult increased perceived risk for strongly and weakly age‐related diseases, but not for COVID‐19. The salience of the COVID‐19 outbreak may have raised the perceived risks in both experimental conditions, making the manipulation ineffective. In conclusion, manipulating future‐oriented thinking might be a successful communication strategy to increase people's perceived risk of common diseases, but it might not work for highly salient pathologies such as COVID‐19.

How to Improve Compliance with Protective Health Measures during the COVID-19 Outbreak: Testing a Moderated Mediation Model and Machine Learning Algorithms

In the wake of the sudden spread of COVID-19, a large amount of the Italian population practiced incongruous behaviors with the protective health measures. The present study aimed at examining psychological and psychosocial variables that could predict behavioral compliance. An online survey was administered from 18-22 March 2020 to 2766 participants. Paired sample t-tests were run to compare efficacy perception with behavioral compliance. Mediation and moderated mediation models were constructed to explore the association between perceived efficacy and compliance, mediated by self-efficacy and moderated by risk perception and civic attitudes. Machine learning algorithms were trained to predict which individuals would be more likely to comply with protective measures. Results indicated significantly lower scores in behavioral compliance than efficacy perception. Risk perception and civic attitudes as moderators rendered the mediating effect of self-efficacy insignificant. Perceived efficacy on the adoption of recommended behaviors varied in accordance with risk perception and civic engagement. The 14 collected variables, entered as predictors in machine learning models, produced an ROC area in the range of 0.82-0.91 classifying individuals as high versus low compliance. Overall, these findings could be helpful in guiding age-tailored information/advertising campaigns in countries affected by COVID-19 and directing further research on behavioral compliance.

Willingness to Self-Isolate When Facing a Pandemic Risk: Model, Empirical Test, and Policy Recommendations

Infected people are isolated to minimize the spread of pandemic diseases. Therefore, the factors related to self-isolation (SI) should not be neglected, and it is important to investigate the factors leading the infected (or possibly infected) people to choose to self-isolate. In this paper, we tried to show that the theory of planned behavior provides a useful conceptual framework for SI when facing a pandemic risk, and a regression method with Chinese provincial (Guangdong Province) data was applied to investigate how attitude (ATT), subjective norms (SN), and perceived behavioral control (PBC) influence SI when facing a pandemic emergency. The results and the robustness tests confirm that ATT, SN, and PBC have a significant positive influence on SI when facing a pandemic emergency. ATT plays the most important role, followed by SN and then PBC. Based on the factors of SI, we found, through theoretical and empirical analyses, at least three important aspects that local governments need to consider to encourage citizens to self-isolate when facing a pandemic.

University Students' Knowledge, Attitudes, and Sources of Information About Zika Virus

Colleges and universities are valuable partners for community health education outreach targeted to young adults. After the outbreak of Zika virus infection in the Americas was declared to be a Public Health Emergency of International Concern on February 1, 2016, postsecondary institutions played an important role in educating at-risk communities about health promotion and disease prevention strategies. In April 2016, we recruited 613 undergraduate students from a large public university to complete a survey about their Zika-related knowledge, attitudes, and information seeking behaviors. We standardized the results so that the participants' reports would be representative of the age, sex, major (course of study), and other characteristics of the university's student population. Most students knew that Zika virus is spread by mosquitoes (88.1%), but only about half knew that the virus could be transmitted through sexual intercourse (56.8%). Students perceived Zika to be a health risk for pregnant women in Zika-affected countries (83.0%), but did not personally feel at risk (12.1%). Many students (43.8%) reported not knowing where to get accurate information about Zika. Identifying gaps in scientific knowledge, misperceptions about personal susceptibility, and opportunities for behavioral risk reduction is an important foundation for designing community-based health interventions when future emerging infectious disease events occur.

Tuning in and catching on? Examining the relationship between pandemic communication and awareness and knowledge of MERS in the USA

Background

Large-scale influenza outbreaks over the last decade, such as SARS and H1N1, have brought to global attention the importance of emergency risk communication and prompted the international community to develop communication responses. Since pandemic outbreaks are relatively infrequent, there is a dearth of evidence addressing the following questions: (i) Have the resources invested in strategic and routine communication for past pandemic outbreaks yielded public health preparedness benefits? (ii) Have past efforts sensitized people to pay attention to new pandemic threats? The Middle East Respiratory Syndrome (MERS) that was followed closely by major media outlets in the USA provides an opportunity to examine the relationship between exposure to public communication about epidemics and public awareness and knowledge about new risks.

Methods

In December, 2013, we surveyed a nationally representative sample of 627 American adults and examined the associations between people's awareness to prior pandemics and their awareness of and knowledge about MERS.

Results

Awareness of prior pandemics was significantly associated with awareness and knowledge of MERS. The most common sources from which people first heard about MERS were also identified.

Conclusions

Communication inequalities were observed between racial/ethnic and socioeconomic positions, suggesting a need for more effective pandemic communication.

Evaluation of the spread of pandemic influenza A/H1N1 2009 among Japanese university students

The pandemic influenza A/H1N1 2009 virus is commonly known to affect younger individuals. Several epidemiological studies have clarified the epidemic features of university students in Japan. In this study, we reviewed these studies in Japan in comparison with reports from other countries. The average cumulative incidence rate among university students was 9.6 %, with the major symptoms being cough, sore throat, and rhinorrhea. These epidemiological features were similar between Japan and other countries. Attitudes and behaviors toward pandemic influenza control measures were different before and improved during and after the epidemic. These features were also similar to those in other countries. On the other hand, the epidemic spread through club activities or social events, and transmission was attenuated after temporary closure of such groups in Japan. This transmission pattern was inconsistent among countries, which may have been due to differences in lifestyle and cultural habits. Based on these results, infection control measures of pandemic influenza for university organizations in Japan should be considered.

The Role of Public Trust During Pandemics

The present review examined the importance of trust when preparing for and during a pandemic. The reviewed literature suggests that trust in health agencies positively influenced people’s willingness to adopt recommended behavior. Most of these studies are atheoretical, and due to the lack of a common framework for trust and its antecedents, finding commonalities among the studies may seem difficult. The trust, confidence, and cooperation model was used to uncover the commonalities among the various studies on trust. This framework suggests that a distinction between values and past performance may be helpful to better understand the impact of trust on risk perception and behavior. Based on the reviewed literature, the following five recommendations relevant for crisis communication during pandemics were identified: A diverse set of experts should be used as communicators, medical personnel need to model the recommended behavior, a transparent information strategy should be used, the focus should be not only on trust but also on confidence, and establishing trust in health authorities before a pandemic occurs is important. Furthermore, research gaps were identified that should be addressed to better understand the role of trust when dealing with pandemics.

Mycoplasma pneumoniae outbreak at a university - Georgia, 2012

On October 17, 2012, the Georgia Department of Public Health (DPH) was notified by the Fulton County Department of Health and Wellness that a local university, the Georgia Institute of Technology, was experiencing a pneumonia outbreak among students. DPH epidemiologists investigated to identify the etiology, find additional cases, and recommend control measures. Respiratory swabs collected from students with pneumonia and tested at CDC using a quantitative real-time polymerase chain reaction (qPCR) assay were positive for Mycoplasma pneumoniae. The university alerted students, faculty, and staff members to the outbreak and recommended prevention measures by e-mail, social media, and posters. A survey administered to students assessed illness prevention behaviors, outbreak awareness, and communication preferences. Eighty-three cases were diagnosed among students during September 1-December 4, 2012, making this outbreak the largest reported at a U.S. university in 35 years. No cases were reported among faculty or staff members. Of the 83 patients, 19 had specimens tested by qPCR, of which 12 (63%) were positive for M. pneumoniae. Despite university communication efforts, approximately half of students surveyed were unaware of the outbreak when surveyed in December. DPH recommendations included implementing university policies that facilitate students staying home and seeking medical care when ill and refining health messages and communication methods to improve awareness of disease outbreaks among students.