Motivating Protective Behavior against COVID-19: Fear Versus Hope

OBJECTIVES

Based on protection motivation theory, we investigate how indicators of threat perception (perceived severity, perceived vulnerability, and fear arousal) and coping appraisal (hope) are associated with older people's motivation to engage in protective behavior after the outbreak of COVID-19.

METHODS

We use multivariate regression analyses with a sample of 40,282 individuals from 26 countries participating in the SHARE Corona Survey.

RESULTS

We find that 15% of all respondents stayed home completely-mainly the oldest and vulnerable people with prior health risk conditions. On average, older Europeans responded strongly to the recommended protective behavior measures (6 out of 7 measures adopted). Among the threat perception indicators, fear arousal is the main motivator for protective behavior, whereas the coping appraisal indicator hope shows an equally strong association.

DISCUSSION

Given the negative health effects of fear, our findings may help evaluate and revise governmental policy responses and communication strategies.

"Oh no, they caught it!": Vicarious experience of COVID-19, protection motivation and protective behaviors

Utilizing the components of the protection motivation theory, this study investigated the role of close others' diagnosis of COVID-19 (as a vicarious experience) in individuals' adherence to protective behavior against COVID-19. Path analysis of online survey data from 3695 participants showed that the presence of a diagnosed close other was positively related to perceived vulnerability, while being negatively related to perceived response efficacy and self-efficacy. In addition, perceived severity and efficacy appraisals were positively associated with protective behavioral tendencies. Although efficacy appraisal mediated the relationship between vicarious experience and protective behavior, threat appraisal did not mediate this relationship. In sum, the results suggest that efficacy appraisal derived from vicarious experiences can be more consequential for protective behaviors than threat appraisal. Implications of these results on future large-scale health crises are discussed along with limitations and future directions.

Individual heat adaptation: Analyzing risk communication, warnings, heat risk perception, and protective behavior in three German cities

Extreme heat poses severe health threats, as the increased numbers of hospitalizations and fatalities during heat waves show, though little is known about adaptive behavior toward heat. We conducted a household survey on individual perceptions of heat stress and individual heat protection in the summer and autumn of 2019. In total, 1417 people from three medium-sized German cities participated via telephone or online. Based on the Protective Action Decision Model (PADM), which we adapted to heat stress, we analyzed links between risk perception, environmental and demographic factors, perceptions of stakeholders, different heat warning messages, as well as actual and intended adaptive behavior. Overall, the PADM constructs explained around 16% of the variance in protection motivation, 19% in protective response, and 23% in emotion-focused coping. Context factors (i.e., temperature, risk communication, gender, age, and homeownership) were significant predictors of the addressed outcome variables as were psychological factors (i.e., perceived personal vulnerability, response efficacy, response costs, preparedness, and perceived external responsibility). We further explored the effect of different warning messages on situational knowledge and intended behavioral adaptation in an experimental setting. Results showed that respondents felt significantly better informed after receiving a warning with action recommendations and reported more intended specific behaviors. Our research gives insights into individual protective action decision-making processes. Based on our findings, we recommend tailoring risk communication strategies and combining heat warnings with action recommendations whenever possible to increase understanding and individual adaptation.

Daily positive and negative affect during the COVID-19 pandemic

The COVID-19 pandemic influenced emotional experiences globally. We examined daily positive and negative affect between May/June 2020 and February 2021 (N = 151,049; 3,509,982 observations) using a convenience sample from a national mobile application-based survey that asked for daily affect reports. Four questions were examined: (1) How did people in the United States feel from May/June 2020 to February 2021?; (2) What demographic variables are related to positive and negative affect?; (3) What is the relationship between experienced stressors and daily affect?; and (4) What is the relationship between daily affect and preventive behavior? Positive affect increased, and negative decreased over time. Demographic differences mirrored those from before the pandemic (e.g., younger participants reported more negative and less positive affect). Stressors such as feeling unwell, experiencing COVID-19 symptoms, exposure to COVID-19, and lack of sleep were associated with less positive and more negative affect. Exercising protective behaviors predicted future affect, and affect also predicted future protective behaviors (e.g., less protective behavior when happy but more when grateful and thoughtful). The implications for public health communication were discussed.

Factors Associated With Levels of Public Engagement in Protective Behaviors During the Early COVID-19 Pandemic: Causal-Comparative Study Based on the Health Belief Model

BACKGROUND

While the challenges of COVID-19 are still unfolding, the enhancement of protective behavior remains a top priority in global health care. However, current behavior-promoting strategies may be inefficient without first identifying the individuals with lower engagement in protective behavior and the associating factors.

OBJECTIVE

This study aimed to identify individuals with and potential contributing factors to low engagement in protective behavior during the COVID-19 pandemic.

METHODS

This is a causal-comparative study. A theory-based web-based survey was used to investigate individuals' protective behavior and potential associating factors. During June 2020, the distribution of the survey was targeted to 3 areas: Taiwan, Japan, and North America. Based on the theory of the health belief model (HBM), the survey collected participants' various perceptions toward COVID-19 and a collection of protective behaviors. In addition to the descriptive analysis, cluster analysis, ANOVA, and Fisher exact and chi-square tests were used.

RESULTS

A total of 384 responses were analyzed. More than half of the respondents lived in Taiwan, followed by Japan, then North America. The respondents were grouped into 3 clusters according to their engagement level in all protective behaviors. These 3 clusters were significantly different from each other in terms of the participants' sex, residency, perceived barriers, self-efficacy, and cues of action.

CONCLUSIONS

This study used an HBM-based questionnaire to assess protective behaviors against COVID-19 and the associated factors across multiple countries. The findings indicate significant differences in various HBM concepts among individuals with varying levels of behavioral engagement.

New species of the dancing semislug Cryptosemelus Collinge, 1902 (Eupulmonata, Ariophantidae) from Loei Province, northeastern Thailand with a key to genera of mainland Southeast Asian semislugs and a key to species of the genus

In this study, we describe a new dancing semislug from a limestone hill area in northeastern Thailand. Cryptosemelusnigersp. nov. differs from the three recognized congener species from western and southern Thailand, due to differences in their body and shell lobes coloration, appearance of penial caecum, shape and surface texture of penis and epiphallus, and radula formula and morphology.

Cross-temporal relations of conditional risk perception measures with protective actions against COVID-19

Two decades ago a research team clarified that cross-sectional associations of risk perceptions and protective behavior can only test an “accuracy” hypothesis: e.g., people with higher risk perceptions at T_i should also exhibit low protective behavior and/or high risky behavior at T_i. They argued that these associations are too often interpreted wrongly as testing two other hypotheses, only testable longitudinally: the “behavioral motivation” hypothesis, that high risk perception at T_i increases protective behavior at T_i+1, and the “risk reappraisal” hypothesis, that protective behavior at T_i reduces risk perception at T_i+1. Further, this team argued that risk perception measures should be conditional (e.g., personal risk perception if one's behavior does not change). Yet these theses have garnered relatively little empirical testing. An online longitudinal panel study of U.S. residents' COVID-19 views across six survey waves over 14 months in 2020–2021 tested these hypotheses for six behaviors (hand washing, mask wearing, avoiding travel to infected areas, avoiding large public gatherings, vaccination, and [for five waves] social isolation at home). Accuracy and behavioral motivation hypotheses were supported for both behaviors and intentions, excluding a few waves (particularly in February–April 2020, when the pandemic was new in the U.S.) and behaviors. The risk reappraisal hypothesis was contradicted—protective behavior at one wave increased risk perception later—perhaps reflecting continuing uncertainty about efficacy of COVID-19 protective behaviors and/or that dynamic infectious diseases may yield different patterns than chronic diseases dominating such hypothesis-testing. These findings raise intriguing questions for both perception-behavior theory and behavior change practice.

Umgang mit subjektiv erlebten Coronarisiken: Sichtweisen junger chronisch kranker Erwachsener

Hintergrund

Junge Erwachsene mit chronischen Erkrankungen gelten als Gruppe, die durch Corona gefährdet ist. Ob und wie die Betroffenen sich zu schützen versuchen, welche Risikowahrnehmungen sie verdeutlichen und wie der Lockdown erlebt wird, dazu mangelt es an Erkenntnissen primär im deutschen Sprachraum.

Ziele und Fragestellung

Im Beitrag wird analysiert, welches Coronaschutzverhalten junge chronisch kranke Erwachsene berichten, welche Risikowahrnehmungen sie aufweisen und wie sie den Lockdown erleben.

Material und Methoden

Mit n = 59 jungen Erwachsenen (häufig Studierende oder Auszubildende), die von Typ‑1-Diabetes (n = 16), Krebs (n = 18), chronisch-entzündlichen Darmerkrankungen (n = 21) oder von bestimmten seltenen, komplexen Erkrankungen (n = 4) betroffen sind, wurden episodische Interviews geführt. Die Datenauswertung erfolgt mittels thematischen Kodierens.

Ergebnisse

Wenige Befragte meinen, durch Corona kaum persönlich gefährdet zu sein, so dass auch Schutzmaßnahmen wie Impfungen sekundär sind. Die meisten Interviewten jedoch berücksichtigen Schutzmaßnahmen penibel. Sie können sich hierzu entweder verpflichtet fühlen, um z. B. andere vulnerable Personen zu schützen, oder sie erleben sich als sehr anfällig für schwere Coronainfektionen. Ungeachtet von erlebten Einschränkungen im Lockdown ist dieser für viele Interviewte auch mit neuen Möglichkeiten verbunden. Online-Formate erleichtern ihnen, Studium/Ausbildung trotz chronischer Erkrankung fortzusetzen und Kontakte mit Freund*innen zu halten.

Schlussfolgerung

Coronarisikowahrnehmungen und Schutzverhalten junger chronisch kranker Erwachsener sollten in ihrem subjektiven Sinn verstärkt in der Versorgung und Begleitung dieser Zielgruppen berücksichtigt werden. Hybride Lehre sollte über den Lockdown hinaus beibehalten werden, damit die jungen Erwachsenen trotz ihrer chronischen Erkrankung sozial teilhaben können und zugleich vor Corona- und weiteren Infektionen geschützt sind.

Past lesson works: SARS memory moderates the relationship between media use and protective behavior during COVID-19 pandemic in China

COVID-19 has become one of the top global health concerns. The present research examined the relationship between media use and protective behavior. The moderating role of SARS memory was also examined. A cross-sectional study found that media use was associated with more protective behaviors (i.e. preventive behavior, and avoidant behavior). We further found that SARS memory moderated the association between media use and avoidant behavior. Moreover, the moderating role of SARS memory on the relationship between daily media use and daily protective behavior was again tested using a daily design in Study 2. Theoretical and practical implications are discussed.

Protective and Overprotective Behaviors against COVID-19 Outbreak: Media Impact and Mediating Roles of Institutional Trust and Anxiety

This study aims to explore how pandemic-related media use relates to both protective and overprotective behaviors and to probe the underlying mechanisms. The data were collected online during the early outbreak of COVID-19 in China, and a total of 1118 valid cases, which covered the 30 provincial administrative divisions in mainland China, were collected. Results showed that official government media use was positively associated with protective behaviors and institutional trust was an important mediator. Commercial media use was also found to be positively associated with overprotective behavior, and anxiety mediated this relationship. Findings of this study suggested that different media sources could play completely different roles. Institutional trust in government institutions and medical care systems were equally critical in translating the media effect into public compliance with the preventive measures advocated by the relevant departments. Media outlets and practitioners should also be responsible in order to avoid causing unnecessary anxiety among the public so as to reduce irrational overprotective behaviors.

Development and Validation of the COVID-19 Worries and Fears Scale

Objectives: How individuals perceive the risk of COVID-19 influences their mental health and protective behaviors. Therefore, the development of an instrument to capture COVID-19-related worries and fears is relevant. This study aims to develop and validate the CoV-WoFe to measure COVID-19-related worries and fears. Methods: An online questionnaire was completed by 593 participants during Christmas 2020 and by 328 participants during Summer 2021, from which 88 participants formed a longitudinal sample. Results: Analyses confirmed a robust adjustment for consistency over time and a gender-invariant bifactorial structure. Factor 1 represented worry about the health consequences of COVID-19 and Factor 2 represented the perceived physiological symptoms associated with fear of COVID-19. Construct validity was evidenced by: the expected relations between the CoV-WoFe and other theoretically related constructs; the serial mediating role of both dimensions in the relationship that security values establish with protective behaviors against COVID-19 and with anxiety; and the expected gender differences in the Cov-WoFe. Conclusion: The CoV-WoFe represents a short, valid, reliable, gender-invariant tool that is easy to apply in both the health professional and research context to assessCOVID-19-related worries and fears, which are variables of relevance for spread of the virus and for mental health.

Impact of mental health, job insecurity, and COVID-19 symptoms on protective behavior changes among White, Black, and other minorities in the US

INTRODUCTION

Job insecurity such as loss of jobs or reduced wages has become a serious social problem in the US since COVID-19 started. Combined with psychological distress and experience of COVID-19 symptoms, the changes of people's protective behaviors vary across states in the US.

METHODS

This research investigated racial differences in the COVID-19 related factors among White, Black, and other minorities in the US, and examined how mental health mediated the impact of job insecurity on protective behaviors, and how the COVID-19 symptoms moderated the mediation effect of mental health. The 731 valid responses in a cross-sectional survey from May 23 to 27, 2020, in the US were analyzed with independent sample t-tests, Pearson's chi-square tests, and path analysis.

RESULTS

The findings showed that there were significant differences in job insecurity and Nonpharmaceutical Interventions (NPIs) practice among White, Black, and other minorities. Job insecurity was significantly negatively associated with NPIs practice and was significantly positively associated with mental health. Mental health significantly partially mediated the effect of job insecurity on NPIs practice, in that job insecurity is a better predictor of NPIs practice for individuals with worse mental health than that for individuals with better mental health. Experience of COVID-19 symptoms moderates the mediation effect of mental health on the relationship between job insecurity and NPIs practice, in that mental health is a better predictor of NPIs practice for individuals with a higher experience of COVID-19 symptoms than for individuals with a lower experience of COVID-19 symptoms.

DISCUSSION

The findings in this study shed lights on psychological and behavioral studies of people's behavior changes during a pandemic. The study indicates the importance of treating mental health to promote protective behaviors during a pandemic, as well as advocating for employees by identifying the needs for those whose jobs were negatively impacted the most.

Stratified Impacts of the Infodemic During the COVID-19 Pandemic: Cross-sectional Survey in 6 Asian Jurisdictions

Background

Although timely and accurate information during the COVID-19 pandemic is essential for containing the disease and reducing mental distress, an infodemic, which refers to an overabundance of information, may trigger unpleasant emotions and reduce compliance. Prior research has shown the negative consequences of an infodemic during the pandemic; however, we know less about which subpopulations are more exposed to the infodemic and are more vulnerable to the adverse psychological and behavioral effects.

Objective

This study aimed to examine how sociodemographic factors and information-seeking behaviors affect the perceived information overload during the COVID-19 pandemic. We also investigated the effect of perceived information overload on psychological distress and protective behavior and analyzed the socioeconomic differences in the effects.

Methods

The data for this study were obtained from a cross-national survey of residents in 6 jurisdictions in Asia in May 2020. The survey targeted residents aged 18 years or older. A probability-based quota sampling strategy was adopted to ensure that the selected samples matched the population’s geographical and demographic characteristics released by the latest available census in each jurisdiction. The final sample included 10,063 respondents. Information overload about COVID-19 was measured by asking the respondents to what extent they feel overwhelmed by news related to COVID-19. The measure of psychological distress was adapted from the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Protective behaviors included personal hygienic behavior and compliance with social distancing measures.

Results

Younger respondents and women (b=0.20, 95% CI 0.14 to 0.26) were more likely to perceive information overload. Participants self-perceived as upper or upper-middle class (b=0.19, 95% CI 0.09 to 0.30) and those with full-time jobs (b=0.11, 95% CI 0.04 to 0.17) tended to perceive higher information overload. Respondents who more frequently sought COVID-19 information from newspapers (b=0.12, 95% CI 0.11 to 0.14), television (b=0.07, 95% CI 0.05 to 0.09), and family and friends (b=0.11, 95% CI 0.09 to 0.14) were more likely to feel overwhelmed. In contrast, obtaining COVID-19 information from online news outlets and social media was not associated with perceived information overload. There was a positive relationship between perceived information overload and psychological distress (b=2.18, 95% CI 2.09 to 2.26). Such an association was stronger among urban residents, full-time employees, and those living in privately owned housing. The effect of perceived information overload on protective behavior was not significant.

Conclusions

Our findings revealed that respondents who were younger, were female, had a higher socioeconomic status (SES), and had vulnerable populations in the household were more likely to feel overwhelmed by COVID-19 information. Perceived information overload tended to increase psychological distress, and people with higher SES were more vulnerable to this adverse psychological consequence. Effective policies and interventions should be promoted to target vulnerable populations who are more susceptible to the occurrence and negative psychological influence of perceived information overload.

Psychological Distress and Protective Behaviors During the COVID-19 Pandemic Among Different Populations: Hong Kong General Population, Taiwan Healthcare Workers, and Taiwan Outpatients

PURPOSE

The novel coronavirus disease 2019 (COVID-19) caused psychological distress and changed human living styles. However, rare studies have examined the psychological distress and protective behaviors across different populations. Therefore, the present study aimed to assess psychological distress, protective behaviors, and potential predictors of psychological distress and protective behaviors across the Hong Kong general population, Taiwan healthcare workers, and Taiwan outpatients.

METHODS

A cross-sectional design was used to recruit participants from Hong Kong and Taiwan. Telephone interviews were carried out for Hong Kong participants (n = 1,067; 30.2% male participants); online surveys were used for Taiwan healthcare workers (n = 500; 8.0% male participants) and Taiwan outpatients (n = 192; 32.8% male participants). All the participants completed questions on psychological distress and protective behaviors. Multiple linear regressions and multivariable logistic regressions were employed to explore the potential predictors of psychological distress and protective behaviors, respectively.

RESULTS

Hong Kong participants had significantly lower levels of psychological distress than Taiwan participants [mean (SD) = 0.16 (0.39) vs. 0.47 (0.59) in healthcare workers and 0.46 (0.65) in outpatients; p < 0.001]. Hong Kong participants (51.7%) and Taiwan outpatients had more people showing fear of COVID-19 (52.0%) than Taiwan healthcare providers (40.8%; p < 0.001). Moreover, Hong Kong participants engaged the most in protective behaviors, followed by Taiwan healthcare providers and Taiwan outpatients (p < 0.001). Moreover, being a female, fear of COVID-19 and worry about personal savings were associated with protective behaviors in general.

CONCLUSIONS

Despite the greater COVID-19 severity and fear of COVID-19 in Hong Kong, the general population in Hong Kong experienced less psychosocial distress with higher compliance to protective behaviors than the other groups in Taiwan.

Trends and Factors Associated With Risk Perception, Anxiety, and Behavior From the Early Outbreak Period to the Controlled Period of COVID-19 Epidemic: Four Cross-Sectional Online Surveys in China in 2020

Background: The first wave of the COVID-19 epidemic in China was brought under with 3 months-from mid-January 2020 to the end of March 2020. Less studies examined dynamic psychological effect and behaviors during COVID-19 pandemic. This study aims to examine perceived risk, anxiety, and behavioral response of the general public related to the outbreak of COVID-19 in four cross-sectional surveys conducted throughout China. Methods: In 2020, four cross-sectional, population-based online survey were conducted from January 28 to February 3, from February 10 to 12, from February 20 to 22, and from March 1 to 10, respectively. Convenience sampling was used for easy recruiting survey participants under the long-term impact of the COVID-19 epidemic. The four independent online questionnaires were sent from the same approach (WeChat and MicroBlog), and anyone who receives the questionnaire on the Internet or mobile phone and meets the inclusion criteria could fill in it. The same questionnaires repeatedly used in the four surveys. Socio-demographic information and individual protective practice were collected and the state-trait anxiety inventory (STAI) was used for measuring anxiety. Propensity score matching was used to adjust for differences in baseline characteristics among the four surveys. Wilcoxon signed ranks test was used to compare people's perceived risk, anxiety and protective behaviors changes in four stages. General linear model was used to identify associations between some demographic factors and perceived risk, anxiety scores, and protective behaviors. Results: The proportion of high perceived risk has dropped from 24.7 to 4.7%. The proportion of severe anxiety has declined from 12.2 to 1.2%. The proportion of people wore masks when they went out has increased from 97.0 to 98.3%. Women were more likely to develop anxiety (OR = 1.5, 95%CI: 1.4-1.6) and more positively adopted recommended behaviors (OR = 2.1, 95%CI: 1.3-3.4) than men. People at age 30-39 years, with high-degree education, with married status, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Perceived risk was significantly associated with anxiety over the entire periods. Anxiety levels had stronger associations with adoption of protective behaviors (wearing mask and avoiding crowed place) in the early epidemic periods than in the late epidemic periods. Conclusions: The levels of perceived risk and anxiety showed a trend of rising first and then falling. Gradually upward trend on initiative preventive behaviors including wearing mask and avoiding visiting crowded places also was observed through scanning data at four stages. People at age 30-39 years, with high-degree education, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Our findings showed that people simultaneously presented both high-level risk perception and anxiety across the four wave surveys, leading to their positive self-prevention and protective behavior.

Cannibalism and protective behavior of eggs in Arctic charr (Salvelinus alpinus)

From video recordings of spawning events, we quantified protective and cannibalistic behavior of Arctic charr occurring immediately after spawning. The number of fish cannibalizing on stray eggs was examined regarding (a) whether more than one male shed milt during the spawning event, that is, whether sperm competition occurred, (b) whether the sperm competition included few or many males, that is, the intensity of sperm competition, and (c) the density of fish at the spawning site. Response behavior toward egg cannibalism was also examined among females and dominant males in order to determine any parental investment toward protecting the eggs after spawning. Cannibalistic behavior was seen in almost 50% of the spawnings, and the multiple spawning events showed the highest numbers of fish cannibalizing on eggs. Both the number of males releasing milt and the number of fish approaching the spawning site were positively correlated with egg cannibalism. Sperm competition was, however, not a prerequisite for egg cannibalism. Although we also observed partial filial cannibalism, protective behavior of eggs was seen both among dominant males and females, suggesting that charr actually conduct parental care.

Challenges in Preventive Practices and Risk Communication towards COVID-19: A Cross-Sectional Study in Bangladesh

Bangladesh recently experienced a COVID-19 second wave, resulting in the highest number of new cases and deaths in a single day. This study aims to identify the challenges for COVID-19 preventive practices and risk communications and associated factors among Bangladeshi adults. A cross-sectional survey was conducted between December 2020 and January 2021 involving 1382 Bangladeshi adults (aged ≥ 18-years) in randomly selected urban and rural areas from all eight divisions in Bangladesh. Descriptive data analysis was conducted to highlight the challenges for preventive practices and risk communications for COVID-19. Multiple logistic regression analysis was used to determine the sociodemographic groups vulnerable to these challenges. Lack of availability of protective equipment (44.4%), crowded living situations/workspaces (36.8%), inadequate information on the proper use of protective measures (21.9%), inadequate handwashing and sanitation facilities (17.6%), and negative influences on family/friends (17.4%) were identified as barriers to COVID-19 preventive practices. It was also found that males (OR = 1.3, 95% CI = 1.01, 1.7), rural residents (OR = 1.5, 95% CI = 1.2, 2), respondents with a low level of education: no schooling vs. ≥higher secondary (OR = 3.5, 95% CI = 2.3, 5.2), primary vs. ≥higher secondary (OR = 2.5, 95% CI = 1.7, 3.8), respondents engaged in agricultural (OR = 1.7, 95% CI = 1.2, 2.4), laboring (OR = 3.2, 95% CI = 2, 5), and domestic works (OR = 1.6, 95% CI = 1.07, 2.5), and people with disabilities (OR = 1.7, 95% CI = 1.1, 2.6) were all likely to have difficulty in practicing effective COVID-19 protective behaviors. Respondents' education and occupation were significant predictors of inadequate understanding of COVID-19 risk communications and was identified as a problem among 17.4% of the respondents. A substantial percentage of Bangladeshi adults have difficulty practising COVID-19 protective behaviours and have poor comprehension of risk communications, particularly in rural areas and among those with low education. This research can aid policymakers in developing tailored COVID-19 risk communications and mitigation strategies to help prevent future waves of the pandemic.

Protective and Risk Factors for Mental Distress and Its Impact on Health-Protective Behaviors during the SARS-CoV-2 Pandemic between March 2020 and March 2021 in Germany

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is posing a global public health burden. These consequences have been shown to increase the risk of mental distress, but the underlying protective and risk factors for mental distress and trends over different waves of the pandemic are largely unknown. Furthermore, it is largely unknown how mental distress is associated with individual protective behavior. Three quota samples, weighted to represent the population forming the German COVID-19 Snapshot Monitoring study (24 March and 26 May 2020, and 9 March 2021 with >900 subjects each), were used to describe the course of mental distress and resilience, to identify risk and protective factors during the pandemic, and to investigate their associations with individual protective behaviors. Mental distress increased slightly during the pandemic. Usage of cognitive reappraisal strategies, maintenance of a daily structure, and usage of alternative social interactions decreased. Self-reported resilience, cognitive reappraisal strategies, and maintaining a daily structure were the most important protective factors in all three samples. Adherence to individual protective behaviors (e.g., physical distancing) was negatively associated with mental distress and positively associated with frequency of information intake, maintenance of a daily structure, and cognitive reappraisal. Maintaining a daily structure, training of cognitive reappraisal strategies, and information provision may be targets to prevent mental distress while assuring a high degree of individual protective behaviors during the COVID-19 pandemic. Effects of the respective interventions have to be confirmed in further studies.

Construction and Validation of a Brief Pandemic Fatigue Scale in the Context of the Coronavirus-19 Public Health Crisis

Objectives: The chronic restrictions to mitigate the new SARS-CoV-2 virus may result in pandemic fatigue. This study set out to develop a short, reliable, valid, and gender-invariant instrument-the Pandemic Fatigue Scale (PFS). Methods: In the first phase, 300 students responded to a pilot questionnaire that allowed the reduction and refinement of the items. In the second phase, the validity, reliability, and invariance of the scale were explored among a sample of 596 participants. Results: Factor exploratory and confirmatory analyses confirmed a robust adjustment for the bifactorial structure that explained 79,36% of the variance. The two factors identified were 1) people's demotivation in continuing to follow the recommended protective behaviors (neglect) and 2) people's boredom regarding the pandemic-related information (boredom). The pattern of relations between the Pandemic Fatigue Scale and other variables-find through correlation, mediation, and path analyses-and the gender differences-find in the ANOVA analyses-provided strong evidence of the construct validity. Moreover, the PFS was shown to be invariant regarding gender in a multigroup factor confirmatory analysis. Conclusion: The instrument can be of utility for professionals and researchers to assess pandemic fatigue, a variable that can affect the adoption of protective measure to avoid catching and spreading the virus.

One Hundred and Sixty-One Days in the Life of the Homopandemicus in Serbia: The Contribution of Information Credibility and Alertness in Predicting Engagement in Protective Behaviors

COVID-19 pandemic is a long-lasting process associated with dynamic changes within society and in individual psychological responses. Effective communication of measures by credible sources throughout the epidemic is one of the crucial factors for the containment of the disease, and the official communication about pandemics is straightforwardly directed toward changes in behavior via engagement in (self-)protective measures. Calls for the adherence to these measures are aimed at the general population, but people's reactions to these calls vary depending on, for example, their individual differences in cognitive and emotional responses to the situation. The focus of our study was the general narrative about the epidemic as conveyed by both state officials and media outlets in times of decreased social contacts due to the quarantine, in which relying on these sources of information is even more pivotal. Our aim was to explore the stability of the proposed mediational model during the course of the epidemic in Serbia. In the model, we tested the relationship between perceived credibility of information (PCI) and two types of protective behavior-the actual self-protective behavior (ASPB) and the hypothetical protective behavior (HPB), as well as the potential mediating role of alertness in these relationships time-wise. A cross-sectional study (N = 10,782, female = 79.1%) was being administered daily during the first epidemic wave and in three more 2-week time frames during the second wave. Based on the variability of these measures during the first epidemic wave, three stages of psychological responses were mapped (acute, adaptation, and relaxation stage), which were observed, with some deviations, also in the second wave. The mediational model was relatively robust after the initial few weeks, but the strength of pairwise relationships was more changeable. With both types of protective behaviors, the predictive power of PCI was partially mediated through alertness. This suggests that, while individual differences in cognitive and affective responses are important, so is coherent, focused, and credible communication in all stages of the epidemic, which emphasizes the communality aspect of the social containment of the infection. Our findings can thus be valuable in informing the planning of effective future communication.

From Isolation to Containment: Perceived Fear of Infectivity and Protective Behavioral Changes during the COVID-19 Vaccination Campaign

In the ongoing COVID-19 pandemic, maintenance of protective behavior is a continued challenge in the effort to contain the spread of the virus. A cross-sectional study via an internet questionnaire was utilized to elucidate changes in compliance to protective behavior among the Israeli population (n = 1120), after the beginning of the vaccination campaign. Comparison was made between individuals who were previously infected with the virus, those who received one dose of inoculation with the vaccine, and individuals that were neither infected or vaccinated. The study results indicate that those who were previously infected with the COVID-19 virus were less careful about mask wearing (18.8%) and social distancing (29.7%), as compared to the other examined groups (regarding mask wearing, 8.2% and 11.6% respectively, and with regard to social distancing 12.8% and 19.2%), and may require targeted risk communication campaigns to address this population. Furthermore, the study revealed that those that were non-Jewish (as compared to Jewish study counterparts) or that were older (19+) were more vigilant in their protective behavior (29.6% vs. 11.2% respectively for social distancing and 29.6% vs. 11.1% respectively for mask wearing). Despite a successful initial vaccination campaign in Israel, public health officials need to engage all members of the public to unremittingly observe compliance to directed health guidelines, to ensure that the results of previous governmental efforts in fighting the pandemic (such as lockdowns) will be effectively sustained, and the road to containment will be hastened.

From Information Exposure to Protective Behaviors: Investigating the Underlying Mechanism in COVID-19 Outbreak Using Social Amplification Theory and Extended Parallel Process Model

Ever since the outbreak of the coronavirus disease (COVID-19), people have been flooded with vast amounts of information related to the virus and its social consequences. This paper draws on social amplification theory and the extended parallel process model (EPPM) and assesses the following: (a) how two amplification stations-news media and peoples' personal networks-influence the risk-related perceptions of people (perceived efficacy and perceived threat) and (b) how these risk-related perceptions impact people's health-protective behaviors. This study surveyed 1,946 participants. The results indicate that peoples' exposure to news media significantly and positively predicted both perceived efficacy and perceived threat. It also shows that peoples' exposure to risk-related information through their personal networks negatively predicted their perceived efficacy, but it positively predicted their perceived threat. The mediating effect of fear was examined, and the result was contradictory to the EPPM. In short, this study reveals the underlying mechanism of individuals' exposure to risk information, processing, and precautionary measures.

Novel Predictors of COVID-19 Protective Behaviors Among US Adults: Cross-sectional Survey

Background

A central component of the public health strategy to control the COVID-19 pandemic involves encouraging mask wearing and social distancing to protect individuals from acquiring and transmitting the virus.

Objective

This study aims to understand the psychological factors that drive adoption or rejection of these protective behaviors, which can inform public health interventions to control the pandemic.

Methods

We conducted an online survey of a representative sample of 1074 US adults and assessed three novel potential predictors of COVID-19 behaviors: trait reactance, COVID-19 conspiracy beliefs, and COVID-19 apocalypse beliefs. Key outcomes (dependent variables) included an index of COVID-19 protective behaviors, the number of trips taken from the home, and COVID-19 knowledge.

Results

In bivariate analyses, all three predictors were significantly correlated in the hypothesized direction with the three COVID-19 outcomes. Specifically, each predictor was negatively (P<.01) correlated with the COVID-19 protective behaviors index and COVID-19 knowledge score, and positively correlated with trips taken from home per week (more of which was considered higher risk). COVID-19 protective behaviors and COVID-19 knowledge were significantly lower in the top median compared to the bottom median for all three predictors. In general, these findings remained significant after adjusting for all novel predictors plus age, gender, income, education, race, political party, and religiosity. Self-identified Republicans (vs other political affiliations) reported the highest values for each of the novel predictors.

Conclusions

This study can inform the development of health communication interventions to encourage the adoption of COVID-19 protective behaviors. Interestingly, we found that higher scores of all three novel predictors were associated with lower COVID-19 knowledge, suggesting that lack of an accurate understanding of the virus may be driving some of these attitudes; although, it is also possible that these attributes may interfere with one’s willingness or ability to seek and absorb accurate health information. These individuals may be particularly immune to accepting new information and yielding their beliefs. Health communication professionals may apply lessons learned from countering similar beliefs around climate change and vaccine hesitancy. Messages designed for individuals prone to reactance may be more effective if they minimize controlling language and emphasize the individual’s independence in adopting these behavioral recommendations. Messaging for those who possess conspiracy beliefs should similarly not assume that providing evidence contrary to these beliefs will alone alter behavior. Other communication techniques such as rolling with resistance, a strategy used in motivational interviewing, may be helpful. Messaging for those with apocalyptic beliefs may require using religious leaders as the message source and using scripture that would support the adoption of COVID-19 protection behaviors.

The Importance of Understanding COVID-19: The Role of Knowledge in Promoting Adherence to Protective Behaviors

Background: Past research suggests that knowledge supports- but strong illness expectations thwart- adoption of protective behaviors (e.g., handwashing). Strong illness expectations may place COVID-19 essential workers at risk. It is unclear, however, whether knowledge can moderate the negative effects of pessimistic illness expectations on protective behaviors. We test COVID-19 knowledge as a moderator of the effects of (1) pessimistic illness expectations and (2) essential worker status on adherence to protective behaviors. Methods: Participants (n = 350) completed measures of knowledge, illness expectations, and protective behaviors. We used chi-square tests to examine associations between variables and logistic regressions to test the moderation models predicting adherence (low, high) while controlling for demographics. Results: Knowledge, illness expectations, and adherence were significantly associated with each other (p < 0.05). Essential workers had stronger illness expectations and lower knowledge than did non-essential workers (p < 0.001). Logistic regressions showed a non-significant Worker Status × Knowledge interaction (p = 0.59) but a significant Knowledge × Illness Expectations interaction (p < 0.05) indicating that those with strong illness expectations and low knowledge were disproportionately at risk of failing to adhere to recommended behaviors. Conclusions: Knowledge promotes protective behaviors by buffering the negative effects of pessimistic illness expectations. Essential workers are more likely to have low levels of knowledge with strong illness expectations, suggesting that educational policies may be warranted.

Attitude Toward Protective Behavior Engagement During COVID-19 Pandemic in Malaysia: The Role of E-government and Social Media

The coronavirus disease 2019 (COVID-19) pandemic is still evolving and affecting millions of lives. E-government and social media have been used widely during this unprecedented time to spread awareness and educate the public on preventive measures. However, the extent to which the 2 digital platforms bring to improve public health awareness and prevention during a health crisis is unknown. In this study, we examined the influence of e-government and social media on the public's attitude to adopt protective behavior. For this purpose, a Web survey was conducted among 404 Malaysian residents during the Recovery Movement Control Order (RMCO) period in the country. Descriptive and multiple regression analyses were conducted using IBM SPSS software. Social media was chosen by most of the respondents (n = 331 or 81.9%) as the source to get information related to COVID-19. Multiple regression analysis suggests the roles of e-government and social media to be significantly related to people's attitudes to engage in protective behavior. In conclusion, during the COVID-19 outbreak, public health decision makers may use e-government and social media platforms as effective tools to improve public engagement on protective behavior. This, in turn, will help the country to contain the transmission of the virus.

COVID-19-Induced Anxiety and Associated Factors Among Urban Residents in West Shewa Zone, Central Ethiopia, 2020

BACKGROUND

The COVID-19 pandemic affects the public overall psychological status including anxiety. Assessing the perceived risk and preventive behaviors and COVID-19-induced anxiety of every individual is crucial to be more effective in handling the outbreak.

PURPOSE

This study intends to determine the status of perceived risk, preventive behavior, and induced anxiety regarding COVID-19 among urban residents in Ethiopia.

METHODS

In this research a population-based, cross-sectional design was employed among 801 urban residents in West Shewa Zone, Ethiopia from June to October 2020. COVID-19 Induced Anxiety Scale (CIAS) was used, with CIAS score ≥80% taken as having anxiety. A Preventive Behavior towards COVID-19 Scale (PBCS) was used to measure the level of protective behavior. The data were gathered using CS Entry and analyzed with SPSS version 23.0. Basic descriptive analysis was conducted, and binary logistic regression analysis was carried out to determine the predictors associated with anxiety.

RESULTS

Most of the study population, 716 (89.4%), had moderate risk perception, and around 497 (62.0%) of them had moderate preventive behavior against the pandemic. The proportion of COVID-19-induced anxiety disorder was found to be 18.1%. The identified predictors associated with COVID-induced anxiety were: being widowed (AOR=3.5; 95% CI: 1.7-7.6), lacking formal education (AOR=1.9; 95% CI: 1.3-3.3), having history of psychoactive substance use (AOR=3.0; 95% CI: 1.6-5.8), high protective behavior (AOR=2.2; 95% CI:1.5-3.3), low perceived risk (OR=3.7; 95% CI: 1.5-12.4), and family history of mental illness (AOR=1.6; 95% CI:0.7-3.8).

CONCLUSION AND RECOMMENDATION

COVID-19-induced anxiety prevalence was 18.1%. Risk perception regarding COVID was moderate. However, only 38.0% of the population had high preventive behavior against the pandemic. Hence, it is important to provide the continuous public health education necessary to promote preventive measures and minimize risky behaviors. Basic psychosocial help should be also provided for individuals suffering with COVID-19-induced anxiety.

Information Sources, Risk Perception, and Efficacy Appraisal's Prediction of Engagement in Protective Behaviors Against COVID-19 in China: Repeated Cross-sectional Survey

Background

As the COVID-19 pandemic has become a major public health threat worldwide, it is critical to understand what factors affect individual engagement in protective actions. Because of its authoritarian political system and state-owned media system, how Chinese individuals engaged in protective actions against COVID-19 might be different compared to other countries.

Objective

The purpose of this study is to examine how the source of information about COVID-19, Chinese individuals’ risk perception of COVID-19 (ie, perceived severity and perceived susceptibility), and their efficacy appraisal in controlling COVID-19 (ie, response efficacy and self-efficacy) affected their engagement in protective actions. Additionally, this study aims to investigate whether there is any difference in these relationships throughout the duration of this pandemic.

Methods

A six-wave repeated cross-sectional survey (N=1942) was conducted in six major cities in China between February 7 and April 23, 2020. Participants’ reliance on expert versus inexpert sources for information about COVID-19, their perceived severity of and susceptibility to COVID-19, their response efficacy and self-efficacy, and their engagement in protective actions (staying at home, wearing a face mask, and washing hands) were measured. Demographic variables (sex, age, income, education, and city of residence), knowledge of COVID-19, and self-rated health condition were controlled.

Results

Reliance on expert sources did not become the major factor that motivated these actions until wave 3, and the negative effect of inexpert sources on these actions was limited to wave 2. Perceived severity encouraged some protective behaviors but its effect varied depending on the specific behavior. In addition, perceived severity exhibited a stronger effect on these behaviors compared to perceived susceptibility. The positive effect of response efficacy was only significant at waves 1 and 2, and limited to certain behaviors.

Conclusions

Chinese individuals’ engagement in protective behaviors might not entirely be their autonomous decision but a result of compliance with executive orders. After the early outbreak, expert sources started to facilitate protective behaviors, suggesting that it might take time to develop trust in these sources. The facilitating effect of perceived severity lasted throughout the duration of the pandemic, but that of response efficacy was limited to the early stage.

COVID-19 Increases Online Searches for Emotional and Health-Related Terms

Background

The COVID‐19 pandemic has powerfully shaped people’s lives. The current work investigated the emotional and behavioral reactions people experience in response to COVID‐19 through their internet searches. We hypothesised that when the prevalence rates of COVID‐19 increase, people would experience more fear, which in turn would predict more searches for protective behaviors, health‐related knowledge, and panic buying.

Methods

Prevalence rates of COVID‐19 in the United States, the United Kingdom, Canada, and Australia were used as predictors. Fear‐related emotions, protective behaviors, seeking health‐related knowledge, and panic buying were measured using internet search volumes in Google Trends.

Results

We found that increased prevalence rates of COVID‐19 were associated with more searches for protective behaviors, health knowledge, and panic buying. This pattern was consistent across four countries, the United States, the United Kingdom, Canada, and Australia. Fear‐related emotions explained the associations between COVID‐19 and the content of their internet searches.

Conclusions

Findings suggest that exposure to COVID‐19 prevalence and fear‐related emotions may motivate people to search for relevant health‐related information so as to protect themselves from the pandemic.

Residential Location and Psychological Distance in Americans' Risk Views and Behavioral Intentions Regarding Zika Virus

Two 2017 experiments with a U.S. national opportunity sample tested effects of location, psychological distance (PD), and exposure to location-related information on Americans' Zika risk views and behavioral intentions. Location-distance from mosquito transmission of the virus in Florida and Texas; residence within states with 100+ Zika infections; residence within potential mosquito vector ranges-had small, inconsistent effects. Hazard proximity weakly enhanced personal risk judgments and concern about Zika transmission locally. It also increased psychological proximity, and intentions of mosquito control, avoiding travel to Zika-infected areas, and practicing safe sex. PD-particularly social and geographical distance, followed by temporal distance, with few effects for uncertainty-modestly and inconsistently decreased risk views and intentions. Exposure to location-related information from the U.S. Centers for Disease Control and Prevention website-naming states with 100+ Zika cases; maps of potential mosquito vector habitat-increased risk views and psychological closeness, but not intentions; maps had slightly stronger if inconsistent effects versus prevalence information. Structural equation modeling (SEM) of a location > PD > risk views > intention path explained modest variance in intentions. This varied in degree and kind (e.g., which location measures were significant) across behaviors, and between pre- and postinformation exposure analyses. These results suggest need for both theoretical and measurement advances regarding effects of location and PD on risk views and behavior. PD mediates location effects on risk views. Online background information, like that used here, will not enhance protective behavior without explicitly focused communication and perhaps higher objective risk.

Risk Perceptions and Protective Behaviors Toward Bovine Tuberculosis Among Abattoir and Butcher Workers in Ethiopia

Bovine Tuberculosis (BTB) is a serious cause of economic losses and public health threat, especially in developing countries. Humans acquire BTB through consumption of raw or undercooked meat, inhalation of aerosol and occupational exposure. A cross-disciplinary approach to study diseases connecting society and biology helps to understand the ways in which social, cultural, behavioral, and economic circumstances influence a healthy life. The objective of this study was to assess the risk perceptions and protective behaviors toward BTB among abattoir and butcher workers in central Ethiopia. A health belief model was used to generate the desired data following health belief model constructs. A total of 300 meat handlers working in local abattoirs, export abattoirs and butcher houses in Bishoftu, Modjo, Dukem, and Akaki towns of central Ethiopia were selected using a systematic random sampling method. Univariate and multivariable logistic regression analysis were used to assess factors associated with risk of exposure to BTB through the consumption of raw meat. The results showed that among the study participants, 95% heard about BTB and 93% knew that eating raw meat could be a source of BTB for humans. More than 62.7% of the respondents in the high risk group strongly agreed that contracting BTB would prevent them from coming to work, keep them in bed for an extended period of time and cause death. The majority of the respondents believed that free provision of personal protective clothing, compensation with test and slaughter campaigns, television and radio advertisements, educational programs and government-imposed penalties would help in prevention of BTB. Despite the high perceived severity and risk perception, the multivarable logistic regression model showed low-risk protective behavior among male (OR: 2.3, 95% CI: 1.2–4.3) and older age (>30) individuals (OR: 14.4 95% CI: 2.1–125.8). The study also noted the importance of media for health education as means for prevention of BTB. The authors strongly recommended the need of promotion of behavioral change toward the consumption of raw meat wich would have potential implications for the public health impacts of zoonotic tuberculosis and ultimately help national and global efforts toward prevention and control of tuberculosis.

Factors Influencing the Safety Behavior of German Equestrians: Attitudes towards Protective Equipment and Peer Behaviors

Simple Summary

The handling and riding of horses can be quite dangerous. Although the use of protective gear among equestrians is increasing, a high number of incidents occur and the voluntary use of safety equipment is described as inconsistent to low. Therefore, this study looks at the safety behavior of German equestrians and at factors influencing this behavior to decrease the high number of horse-related injuries. The results reveal that attitudes towards safety products as well as the protective behavior of other horse owners and riding pupils from the stable are key factors that might alter the safety behavior of equestrians.

Abstract

Human interactions with horses entail certain risks. Although the acceptance and use of protective gear is increasing, a high number of incidents and very low or inconsistent voluntary use of safety equipment are reported. While past studies have examined factors influencing the use of safety gear, they have explored neither their influence on the overall safety behavior, nor their relative influence in relation to each other. The aim of the present study is to fill this gap. We conducted an online survey with 2572 participants. By means of a subsequent multiple regression analysis, we explored 23 different variables in view of their influence on the protective behavior of equestrians. In total, we found 17 variables that exerted a significant influence. The results show that both having positive or negative attitudes towards safety products as well as the protective behavior of other horse owners or riding pupils from the stable have the strongest influence on the safety behavior of German equestrians. We consider such knowledge to be important for both scientists and practitioners, such as producers of protective gear or horse sport associations who might alter safety behavior in such a way that the number of horse-related injuries decreases in the long term.

Chimpanzees facing a dangerous situation: A high-traffic asphalted road in the Sebitoli area of Kibale National Park, Uganda

Despite the spread of road infrastructures throughout Africa to support regional development, industry, and tourism, few studies have examined how wild animals adapt their behavior and ecology in road-forest ecotones. Indeed, while numerous studies have demonstrated chimpanzee adaptability in anthropogenic landscapes, none have examined the effects of asphalted highways on wild chimpanzee behaviors. In a 29-month survey, we assessed the dangers posed by an asphalted road crossing the Sebitoli area of Kibale National Park (Uganda). We analyzed 122 individual chimpanzee crossings. Although the asphalted road represents a substantial threat to crossing animals (89 motorized vehicles per hour use this road and individuals of six different primate species were killed in 1 year), chimpanzees took into account this risk. More than 90% of the individuals looked right and left before and while crossing. Chimpanzees crossed in small subgroups (average 2.7 subgroups of 2.1 individuals per crossing event). Whole parties crossed more rapidly when chimpanzees were more numerous in the crossing groups. The individuals most vulnerable to the dangers of road crossing (females with dependents, immature, and severely injured individuals) crossed less frequently compared with non-vulnerable individuals (lone and healthy adolescents and adults). Moreover, healthy adult males, who were the most frequent crossing individuals, led progressions more frequently when crossing the road than when climbing or descending feeding trees. Almost 20% of the individuals that crossed paid attention to conspecifics by checking on them or waiting for them while crossing. These observations are relevant for our understanding of adaptive behavior among chimpanzees in human-impacted habitats. Further investigations are needed to better evaluate the effects of busy roads on adolescent female dispersal and on their use of territories. Mitigation measures (e.g., bridges, underpasses, reduced speed limits, speed-bumps, signposts, or police controls) should be established in this area.

Longitudinal influence of perceptions of peer and parental factors on African American adolescent risk involvement

To explore the long-term contributions of perceived peer and parental influences on adolescent risk and protective behaviors (sexual involvement, condom use, and drug use), we assessed self-reported behaviors and perceptions of peer risk involvement and parental supervision and communication among 383 low-income, urban African Americans aged 9 to 15 years at baseline over a 4-year period. Baseline perceptions of peer sexual involvement were significantly associated with youth sexual behavior at baseline and were predictive of sexual involvement through all 4 years of follow-up. Perceived parental monitoring was inversely correlated with sexual involvement through 3 years of follow-up. Perceptions of peer condom use were associated with increased levels of condom use at baseline and through 6 months of follow-up. Positive parental communication was correlated with increased condom use. Drug use was higher among youths who perceived peers or family members to be using drugs and was inversely correlated with increased parental monitoring and supervision. Stepwise regression revealed peer and parental influences for all three behaviors. Perceptions of both peer and parental behaviors influence long-term risk and protective behaviors of adolescents. Therefore, parents should be included in adolescent risk-reduction intervention efforts. Inclusion of friends and/or changing youth perceptions of peer involvement may also be effective intervention strategies.