Individual costs and community benefits: Collectivism and individuals' compliance with public health interventions

Modeling predictors of behavior of American consumers suffering from food intolerances or food allergies

Food intolerances, allergies, and celiac disease cause hypersensitive reactions to certain foods, collectively termed adverse reactions to food. This study aims to identify predictors of purchasing intentions and behaviors among individuals with such reactions, using three behavioral models: the Theory of Planned Behavior, the Health Belief Model, and Protection Motivation Theory. The authors created a new, comprehensive model by integrating these theories, combining their strengths to provide a more robust framework. The survey, conducted via the Forthright platform using the Computer-Assisted Web Interview (CAWI) method, involved 1,088 respondents. This article is the first to explore predictors of consumer intentions and behaviors regarding food products suitable for individuals with intolerances or allergies, offering new insights into consumer decision-making models.

Credibility Perceptions of Information and Vaccine Intention: The Role of Collective Vs. Individual Framing Messages

After four years into the pandemic, we know that COVID-19 vaccines are effective, and it is crucial to increase public compliance with getting the COVID-19 vaccines. The current study examines the interplay of credibility perceptions, perceived benefits, and two different types of vaccine promotion messages: individual versus collective. Data was collected using an online randomized experiment. Findings demonstrated that individual versus collective frames did not influence everyone similarly. The results show a significantly moderated mediation model, such that the association between message frame and vaccine intention was mediated by the credibility of the message, and the relationship between message frame and perceived credibility was moderated by perceived benefits of the vaccine.

The Effect of Information Exposure on Stigma Toward the COVID-19 Patient Mediated by Perceived Risk, Attribution of Blame and Protection Norm Conformity

This study employed the model of stigma communication (MSC) to analyze how exposure to COVID-19-related information affected stigma-related information sharing about people who contracted COVID-19 during the pandemic and examined the cognitive process of the MSC in a collectivist culture. Based on a survey of 526 social media users during the COVID-19 pandemic in China, the study found that exposure to contact tracing information and pandemic control information had different impact on stigma-related information sharing through a series of cognitive variables. A dual-path model showed that perceived personal risk influenced stigma-related information sharing through attribution of blame toward the infected (the personal path), while perceived social risk influenced stigma-related information sharing through protection norm conformity (the social path). Compared to the personal path, the social path is more salient in shaping stigmatized attitudes and behaviors. The findings and discussions added to our understanding of the intricate stigma communication process in a collectivist culture.

A context-sensitive collectivism during the COVID-19 pandemic: Effect on the adoption of containment measures in China and the US

This study investigates individuals' adoption of containment measures (e.g., wearing masks) from the perspectives of cultural values and trust in two countries-China and the US. Distinguished from previous definitions that characterise cultural values as rigid and fixed concepts, this study reconceptualizes collectivism to be a context-sensitive construct. With survey data from a collectivism-prevalent culture (China, n = 1578) and an individualism-prevalent culture (the US, n = 1510), it unfolds the underlying mechanism by which collectivism influences people's adoption of containment measures in both countries. Results indicate that institutional trust serves as a significant mediator in this relationship. In both countries, individuals who hold a collectivistic value on the pandemic are more likely to endorse the adoption of containment measures. This endorsement is driven by their trust in public institutions, which stems from their collectivistic values. Additionally, slight distinctions emerge, revealing that collectivistic values directly predict the behaviours among Chinese individuals, whereas such a direct effect is not observed in the US. Practical implications will be offered.

Masks and respirators for prevention of respiratory infections: a state of the science review

SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.

COVID-19 Vaccine Motivation and Hesitancy among a Sample of African American, Afro-Caribbean, and African Respondents in the United States

Understanding the motivations and decisions behind COVID-19 vaccine acceptance is crucial for designing targeted public health interventions to address vaccine hesitancy. We conducted a qualitative analysis to explore COVID-19 vaccine acceptance among diverse ethnic subgroups of Black Americans in the United States. This study investigates the 2021-2022 responses of 79 African American, Afro-Caribbean, and African respondents over the age of 18 in Washington State and Texas. Respondents were asked "Do you plan to get the COVID-19 vaccination?" Qualitative responses were analyzed by content category and ethnic subgroup. Of the 79 responses, 60 expressed favorable perceptions, 16 expressed unfavorable perceptions, and 3 expressed neutral perceptions. Dominant categories among participants in favor of the vaccine included personal health (26), concern for health of family/or community members (13), and desire to protect others (11). Among the 42 vaccinated African American respondents, the primary motivation was personal health (20). The 12 unvaccinated African American respondents cited fear of side effects as their dominate motivation. Caribbean respondents cited family or elders as motivation for their decision. African respondents were nearly unanimous in taking the vaccine (13/16), citing trust in health care, protecting friends and family, and personal health as reasons. Community and personal relationships were critical decision-making factors in accepting the COVID-19 vaccine, with African Americans having the strongest hesitancy.

Willingness to pay for National Health Insurance Services and Associated Factors in Africa and Asia: a systematic review and meta-analysis

Background

Universal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia.

Methods

Database searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute's (JBI's) tools and the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement" were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI.

Results

Nineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0-77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68-75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it.

Conclusion

The WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.

Compliance with COVID-19 preventative health measures in the United Kingdom: a latent profile analysis

Governments have adopted unprecedented measures to assist in slowing the spread of the COVID-19 pandemic, but compliance varies among individuals. This UK study uses latent profile analysis to identify four classes of individuals on factors believed to influence compliance. Those who sought health information from authoritative sources and actively sought information from multiple sources were most compliant. Profile differences in compliance and vaccination status were also primarily driven by trust in healthcare institutions over trust in government. These findings contribute to understanding compliance profiles and emphasise the importance of authoritative information and trust in healthcare systems.

The role of collectivism, liberty, COVID fatigue, and fatalism in public support for the zero-COVID policy and relaxing restrictions in China

BACKGROUND

China was the last country in the world to relax COVID-19 restrictions. A successful public health policy requires public support. This analysis examined the factors associated with Chinese support for zero-COVID and relaxing COVID-19 restrictions in China.

METHOD

Two online surveys were conducted among Chinese participants in mainland China on June 10-13 (N = 460) and December 2, 2022 (N = 450). These two samples were similar based on the participants' demographics.

RESULTS

The results revealed that the perceived health consequences of a COVID-19 policy, perceived norms of approving a COVID-19 policy, and hope positively predicted the participants' support for the COVID-19 policy. The results further showed that collectivism and fatalism positively predicted support for zero-COVID and negatively predicted support for relaxing restrictions. COVID fatigue was negatively associated with support for zero-COVID and positively associated with support for relaxing restrictions. Liberty positively predicted support for relaxing restrictions in June and negatively predicted zero-COVID in December 2023. It did not positively or negatively predict support for the policy adopted by the government.

CONCLUSION

Collectivism, liberty, COVID fatigue, and fatalistic beliefs are important considerations connected to public support for a COVID-19 policy. The role of liberty was more nuanced and depended on the survey's time and whether the government adopted the policy.

How does collectivism help deal with perceived vaccine artificiality? The case of COVID-19 vaccination intent in European young adults

Vaccine "unnaturalness" (artificiality) is one of the major anti-vaccine arguments raised in public debate. Therefore, health communication should rebut unnaturalness arguments and be cautious when emphasizing human intervention (e.g., advanced vaccine technology), which may entail perceiving vaccines as artificial. Understanding how the relationship between perceived vaccine artificiality and vaccination intent differs across social groups can help enforce the above health communication efforts by focusing them on specific audiences. The objective of the current paper is to assess the moderating role of a particular socio-cultural factor-vertical collectivism (reflecting the orientation on social hierarchy)-in the relationship between perceived vaccine artificiality and vaccination intent. It is proposed that vertical collectivism diminishes the negative effect of perceived vaccine artificiality. Two studies with European young adults measured COVID-19 vaccination intent and vertical collectivism. Study 1 (N = 418) was correlational, measuring perceived vaccine artificiality. The data were analyzed with a moderation model. Study 2 (N = 203) was experimental, manipulating perceived vaccine artificiality by human-intervention appeal (i.e., emphasizing human intervention in vaccine development and operation). The data were analyzed with moderation and moderated mediation models. Study 1 demonstrated that the effect of perceived vaccine artificiality on vaccination intent was less negative when the level of vertical collectivism was higher. In Study 2, with higher levels of vertical collectivism, the effect of human-intervention appeal on vaccination intent was less negative, and the indirect effect through perceived vaccine artificiality turned even positive. Those results contribute to the fields of perceived naturalness/artificiality, vaccination behavior, health communication, and cultural dimensions theory, providing empirical evidence that the negative effect of perceived vaccine artificiality on vaccination intent is diminished by vertical collectivism, as proposed. Health practitioners are guided on how to consider different levels of collectivism of their audiences while referring to vaccine artificiality in their communication. Specifically, it is suggested that rebutting "unnaturalness" anti-vaccine arguments should be focused on people low in vertical collectivism, and messages featuring human intervention (e.g., a vaccine's technological advancement) should be targeted at people high in vertical collectivism.

Did Descriptive and Prescriptive Norms About Gender Equality at Home Change During the COVID-19 Pandemic? A Cross-National Investigation

Using data from 15 countries, this article investigates whether descriptive and prescriptive gender norms concerning housework and child care (domestic work) changed after the onset of the COVID-19 pandemic. Results of a total of 8,343 participants (M = 19.95, SD = 1.68) from two comparable student samples suggest that descriptive norms about unpaid domestic work have been affected by the pandemic, with individuals seeing mothers' relative to fathers' share of housework and child care as even larger. Moderation analyses revealed that the effect of the pandemic on descriptive norms about child care decreased with countries' increasing levels of gender equality; countries with stronger gender inequality showed a larger difference between pre- and post-pandemic. This study documents a shift in descriptive norms and discusses implications for gender equality-emphasizing the importance of addressing the additional challenges that mothers face during health-related crises.

Spousal Concordance of Hypertension Among Middle-Aged and Older Heterosexual Couples Around the World: Evidence From Studies of Aging in the United States, England, China, and India

BACKGROUND

Health concordance within couples presents a promising opportunity to design interventions for disease management, including hypertension. We compared the concordance of prevalent hypertension within middle-aged and older heterosexual couples in the United States, England, China, and India.

METHODS AND RESULTS

Cross-sectional dyadic data on heterosexual couples were used from contemporaneous waves of the HRS (US Health and Retirement Study, 2016/17, n=3989 couples), ELSA (English Longitudinal Study on Aging, 2016/17, n=1086), CHARLS (China Health and Retirement Longitudinal Study, 2015/16, n=6514), and LASI (Longitudinal Aging Study in India, 2017/19, n=22 389). Concordant hypertension was defined as both husband and wife in a couple having hypertension. The prevalence of concordant hypertension within couples was 37.9% (95% CI, 35.8-40.0) in the United States, 47.1% (95% CI, 43.2-50.9) in England, 20.8% (95% CI, 19.6-21.9) in China, and 19.8% (95% CI, 19.0-20.5) in India. Compared with wives married to husbands without hypertension, wives married to husbands with hypertension were more likely to have hypertension in the United States (prevalence ratio, 1.09 [95% CI, 1.01- 1.17), England (prevalence ratio, 1.09, 95% CI, 0.98-1.21), China (prevalence ratio, 1.26 [95% CI, 1.17-1.35), and India (prevalence ratio, 1.19 [95% CI, 1.15-1.24]). Within each country, similar associations were observed for husbands. Across countries, associations in the United States and England were similar, whereas they were slightly larger in China and India.

CONCLUSIONS

Concordance of hypertension within heterosexual couples was consistently observed across these 4 socially and economically diverse countries. Couple-centered interventions may be an efficient strategy to prevent and manage hypertension in these countries.

Beyond the surface: accounting for confounders in understanding the link between collectivism and COVID-19 pandemic in the United States

According to the parasite-stress theory, collectivism serves as a trait of ingroup assortative sociality, providing defense against infectious diseases. This study investigated the association between cultural collectivism and COVID-19 severity at the state (Study 1: N = 51), county (Study 2: N = 3,133), and daily (Study 3: N = 52,806) levels from the beginning of 2020 to the end of 2022. State-level collectivism was assessed using two distinct measures: the U.S. collectivism index, focusing on social interconnectedness and interdependence, and the subjective-culture individualism-collectivism index (reversed), capturing attitudes and beliefs related to religion, abortion, and same-sex marriage. By employing random-intercept multilevel models, the results demonstrated significant and negative effects of state-level collectivism, as measured by the U.S collectivism index, on COVID-19 cases per million, COVID-19 deaths per million, and composite COVID-19 severity index, after controlling for confounding factors, such as socioeconomic development, ecological threats, disease protective behaviors, cultural norms, and political influences. A mini meta-analysis (Study 4: N = 9) confirmed the significance of these effects across studies. These findings supported the proactive role of collectivism in defending against the novel coronavirus in the United States, aligning with the parasite-stress theory of sociality. However, the subjective-culture individualism-collectivism index (reversed) did not exhibit a significant relationship with COVID-19 severity when confounding factors were considered. The high correlation between the subjective-culture individualism-collectivism index (reversed) and the controlled variables suggested shared variance that could diminish its impact on COVID-19 outcomes. Accordingly, the present findings underscore the significance of accounting for confounding factors when examining the association between collectivism and COVID-19 severity at population level. By considering relevant confounding factors, researchers could gain a comprehensive understanding of the complex interplay between cultural collectivism and its influence on COVID-19 severity. Overall, this research contributes to our understanding of how cultural collectivism shapes the COVID-19 pandemic in the United States, emphasizing the importance of adjusting for confounding effects in population level studies.

Cultural differences in explicit and implicit support provision and underlying motivations for self-esteem, closeness, and relational concerns

This research explores how culture influences the motivations underlying explicit (emotional and instrumental) and implicit (companionship and attentiveness) support provision. Two studies (N = 1,106) compared the responses of European Americans and Japanese individuals to a close other's stressful event. The results showed that European Americans were more likely than Japanese to provide explicit support and more motivated to increase the close other's self-esteem and feeling of closeness. Conversely, Japanese individuals were more likely to provide attentiveness support, motivated by concern for an entire group and a friend. These findings support the motivation as a mediator hypothesis. On the other hand, the culture as a moderator hypothesis applied to the association between concern for an entire group motivation and implicit support provision. Specifically, concern for an entire group motivation predicted companionship support provision only in Japanese, while it predicted attentiveness support provision mainly in European Americans.

Need dissatisfaction and its consequences on support for anti-pandemic behaviors in China: The mediation of attribution and local government satisfaction, and the moderation of social class

Introduction

The COVID-19 pandemic has greatly impacted the global economy, resulting in a substantial increase in inequality. There is a need to understand need dissatisfaction in this context, its group differences, and its consequences on support for anti-pandemic behaviors.

Methods

Using data from a survey round of the Chinese Social Mentality Survey from 21 April to 26 May 2022, 6,022 participants aged between 18 and 70 years (M = 32.27; SD = 8.74; men = 46.76%) from 29 provinces of Mainland China were included in the study.

Results

1) Need dissatisfaction was negatively related with support for anti-pandemic behaviors and was completely mediated by attribution and local government satisfaction. 2) Internal/external attribution acted as a double-edged sword: they were negatively/positively related with support for anti-pandemic behaviors, while they became positively/negatively related with support for anti-pandemic behaviors via the mediation of local government satisfaction. 3) People who were unemployed and in the subjectively middle class reported higher need dissatisfaction and less support for anti-pandemic behaviors compared to their counterparts. 4) Social class moderated the relationship between need dissatisfaction and internal attribution: when needs were dissatisfied, participants with higher income and subjective social class tended to attribute more internally.

Discussion

This study contributes to the attribution theory and social identity theory in the context of major global public health events and provides practical implications for promoting behavioral compliance in the context of COVID-19. In particular, facilitating a positive interaction between the public and local governments may be helpful to create a shared identity and, ultimately, prevent and control the pandemic together.