Socioeconomic Status, Crowding, COVID-19 Perceptions, and Protective Behavior

Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women's breast cancer risk perception. This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5% vs 32.5% before COVID-19; difference 0.24, 95% CI -0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54% (95% CI 0.75%-2.33%; P<.001), 4.28% (95% CI 3.30%-5.25%; P<.001), and 3.67% (95% CI 1.94%-5.40%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic.

Public transport (PT) usage was severely impacted during the COVID-19 pandemic, resulting in up to a 90% reduction in many cities in 2020. Numerous studies have been conducted since then to determine the relationship between individual-level factors (such as gender, attitudes, etc.) and the decrease in PT usage during the pandemic. Despite the evidence provided, findings are dispersed, and for several factors contradictory, making it challenging to reach any generalised conclusion. Furthermore, a comprehensive comparison of the effect sizes among travellers’ factors affecting PT use during this period is yet to be compiled. This paper aims to address these gaps by systematically reviewing the existing evidence and synthesising the effect sizes of travellers’ factors through a meta-analysis. We first identified 36 studies that statistically assessed the contribution of 15 individual-level factors on PT usage during the COVID-19 pandemic. By merging the empirical evidence of those studies, the direction of the association between those factors and PT usage was analysed. Then, after selecting comparable studies, meta-analyses were conducted for each factor to estimate the corresponding pooled effect sizes. The meta-analysis established that car availability, teleworking opportunities and high educational level contributed the most to reducing PT use during the pandemic. These factors increased the odds of reducing PT usage compared with the pre-pandemic by about three times. Factors such as COVID-19 risk perception, gender, high income and health had a moderate effect on the decision to stop using PT. PT habits, travel distance and physical accessibility also influenced PT use during the pandemic. Geographical location and the pandemic period explained part of the heterogeneity found. The findings provided in this study can help policy-makers understand the impacts of travellers’ factors on the decision to reduce PT usage during future pandemics/epidemics and guide public policies accordingly.

BackgroundOwing to crowded and unsanitary conditions, internally displaced persons (IDPs) have an increased risk of COVID-19 infection. Adoption of COVID-19 preventive measures among this population is premised on accurate information, adequate knowledge, and risk perception. We assessed COVID-19 knowledge and risk perception and investigated the association between risk perception and COVID-19 preventive measures, including vaccination among IDPs in Northeast Nigeria.MethodsWe conducted a cross-sectional study during July–December 2022 and sampled 2,175 IDPs using stratified sampling. We utilized a 12-point assessment tool to evaluate COVID-19 knowledge. Participants who scored ≥ 6 points were considered to have adequate knowledge. We used a 30-item Risk Behavior Diagnosis Scale to assess COVID-19 risk perception and evaluated each item on a 5-point Likert scale. Participants were divided into risk perception categories by the median of Likert scale scores. We performed weighted logistic regression analysis to identify factors associated with risk perception. Pearson’s chi-squared with Rao-Scott adjustment was used to determine the relationship between risk perception and COVID-19 preventive measures.ResultsOf 2,175 participants, 55.7% were 18–39 years old, 70.9% were females, and 81.7% had no formal education. Among the IDPs, 32.0% (95% CI: 28.8 – 35.0) were considered to have adequate COVID-19 knowledge, and 51.3% (95% CI: 47.8 – 54.8) perceived COVID-19 risk as high. Moreover, 46.3% (95% CI: 42.8 – 50.0) had received one dose of COVID-19 vaccine, and 33.1% (95% CI: 29.8 – 36.0) received two doses. Adequate knowledge (Adjusted Odds Ratio (AOR) = 2.10, [95% CI: 1.46 – 3.03]) and post-primary education (AOR = 3.20, [95% CI: 1.59 – 6.46]) were associated with risk perception. Furthermore, high risk perception was significantly associated with wearing face masks (χ2 = 106.32, p-value < .001), practicing hand hygiene (χ2 = 162.24, p-value < .001), physical distancing (χ2 = 60.84, p-value < .001) and vaccination uptake (χ2 = 46.85, p-value < .001).ConclusionsThis study revealed gaps in COVID-19 knowledge, risk perception, and vaccination uptake but demonstrated a significant relationship between risk perception and COVID-19 preventive practices. Health education and risk communication should be intensified to improve knowledge, elicit stronger risk perception, and enhance COVID-19 preventive practices.

During the Covid-19 pandemic, individual and collective public health measures were undertaken to control the spread of the virus. Their effectiveness relies on people’s abilities to understand and adopt the correct behaviors. This study aims to evaluate the role of Health Literacy (HL) in influencing the adherence to Covid-19 preventive measures and risk perception of a sample of workers employed in various activities involving close contact with the population in the province of Prato (Tuscany, Italy) in the second pandemic wave (November-December 2020). A cross-sectional survey was conducted on a sample of public workers (e.g., teachers, educators, assistants/aides, other health personnel). Data on knowledge, attitudes and practices towards (KAP) Covid-19 preventive measures and risk perception were collected. HL was measured with the HLS-EU-Q6 tool. Spearman correlation analysis was used to assess the correlation between HL and KAP and Covid-19 risk perception. Multivariate linear regression analyses were performed to evaluate the role of HL in predicting KAP and Covid-19 risk perception, adjusted for sex, age, comorbidity, educational level, country of birth. A total of 402 people participated in this study; 47.8% had a problematic HL level. The HL level was correlated with KAP and practices towards Covid-19 prevention measures; no significant associations were found with Covid-19 risk perception. In multivariate models, HL significantly and positively predicted a higher level of knowledge of Covid-19 preventive measures (B = 0.413 for problematic HL; B = 0.542 for sufficient HL). Confirming a previous study conducted in Prato in the first pandemic wave, HL did not predict adherence to Covid-19 infection control measures, probably due to fear of the disease and attention towards prevention behaviors being still higher in the second pandemic wave. Key messages • HL skills are linked to understanding of public health measures. • HL skills should be improved to favor the adherence to correct behaviors.

Identifying and understanding risk perceptions—“how bad are the harms” to humans or to what they value that people see as potentially or actually arising from entities or events—has been critical for risk analysis, both for its own sake, and for expected associations between risk perceptions and subsequent outcomes, such as risky or protective behavior, or support for hazard management policies. Cross-sectional surveys have been the dominant method for identifying and understanding risk perceptions, yielding valuable data. However, cross-sectional surveys are unable to probe the dynamics of risk perceptions over time, which is critical to do while living in a dynamically hazardous world and to build causal understandings. Building upon earlier longitudinal panel studies of Americans’ Ebola and Zika risk perceptions using multi-level modeling to assess temporal changes in these views and inter-individual factors affecting them, we examined patterns in Americans’ COVID-19 risk perceptions in six waves across 14 months. The findings suggest that, in general, risk perceptions increased from February 2020 to April 2021, but with varying trends across different risk perception measures (personal, collective, affective, affect, severity, and duration). Factors in baseline risk perceptions (Wave 1) and inter-individual differences across waves differed even more: baseline ratings were associated with how immediate the threat is (temporal distance) and how likely the threat would affect people like oneself (social distance), and following the United States news about the pandemic. Inter-individual trend differences were shaped most by temporal distance, whether local coronavirus infections were accelerating their upward trend, and subjective knowledge about viral transmission. Associations of subjective knowledge and risk trend with risk perceptions could change signs (e.g. from positive to negative) over time. These findings hold theoretical implications for risk perception dynamics and taxonomies, and research design implications for studying risk perception dynamics and their comparison across hazards.

The interesting scenario involving COVID-19's breakout in multiple nations is still serious in many areas of the world. This perceived risk can significantly increase compliance with COVID-19 prevention behaviors during the next pandemic. The purpose of this study was to explore how people perceive COVID-19 risk, disease severity, and COVID-19 prevention in Samut Songkhram province, Thailand. A study examined the relationship between people's perceptions of risk, COVID-19 severity, and COVID-19 prevention activity. The COVID-19 issue was the subject of this cross-sectional investigation, using a Geographic Information System. A cross-sectional study on perception of COVID-19 risk, disease severity, and COVID-19 prevention. Explore the relationship between the people's perception of COVID-19 risk, disease severity, and COVID-19 prevention behaviors. Descriptive statistics, such as frequency distribution methods, mean, standard deviation. Analytical statistics, such as correlation and multiple regression, were used to analyze the data. This study found that the female to male ratio is around 1:2. The age group with the most representation was 15-26 years old. The results showed that people's perception of COVID-19 risk had no relationship to COVID-19 preventive behaviors. People's perception of COVID-19 severity was shown to be significantly associated with COVID-19 prevention behaviors at 0.001. The multiple regression equation to estimate COVID-19 prevention behaviors in a new epidemic; P (the COVID-19 prevention) = 4.344 – 0.115 Female(X1) + 0.141 Farmer(X2) +0.356 Trading(X3) + 0.733 Traveled to an endemic area(X4) + 0.253 Age, 28-36 years(X5) – 0.546 Age, 37-46 years(X6) + 0.317 Age, 47-56 years(X7) + 0.151 Age, &gt;56 years(X8) + 0.318 The perception of COVID-19 severity(X9) – 0.092 The perceptions of COVID-19 risk(X10). The results of this study will be used to establish an intervention model for encouraging and establishing effective COVID-19 preventive practices, as well as maintaining and continuing them.

BackgroundActive transportation is a crucial sort of physical activity for developing sustainable environments and provides essential health benefits. This is particularly important in Latin American countries because they present the highest burden of non-communicable diseases relative to other worldwide regions. This study aimed to examine the patterns of active transportation and its association with sociodemographic inequities in Latin American countries.MethodsThis cross-sectional study was conducted in eight countries. Participants (n = 8547, 18–65 years) self-reported their active transportation (walking, cycling, and total) using the International Physical Activity Questionnaire. Sex, age, ethnicity, socioeconomic level, education level, public and private transport use, and transport mode were used as sociodemographic inequities.ResultsParticipants spent a total of 19.9, 3.1, and 23.3 min/day with walking, cycling, and total active transportation, respectively. Mixed and other ethnicity (Asian, Indigenous, Gypsy, and other), high socioeconomic level as well as middle and high education level presented higher walking than Caucasian, low socioeconomic and education level. Private transport mode and use of ≥ 6 days/week of private transport showed lower walking than public transport mode and ≤ 2 days/week of private transport. Use of ≥ 3 days/week of public transport use presented higher walking than ≤ 2 days/week of public transport. Men had higher cycling for active transportation than women. Use of ≥ 3 days/week of public transport use presented higher cycling than ≤ 2 days/week of public transport. ≥6 days/week showed lower cycling than ≤ 2 days/week of private transport use. Men (b: 5.57: 95 %CI: 3.89;7.26), black (3.77: 0.23;7.31), mixed (3.20: 1.39;5.00) and other ethnicity (7.30: 2.55;12.04), had higher total active transportation than women and Caucasian. Private transport mode (-7.03: -11.65;-2.41) and ≥ 6 days/week of private transport use (-4.80: -6.91;-0.31) showed lower total active transportation than public transport mode and ≤ 2 days/week of private transport use. Use of 3–5 (5.10: 1.35;8.85) and ≥ 6 days/week (8.90: 3.07;14.73) of public transport use presented higher total active transportation than ≤ 2 days/week of public transport use. Differences among countries were observed.ConclusionsSociodemographic inequities are associated differently with active transportation across Latin American countries. Interventions and policies that target the promotion of active policies transportation essential to consider sociodemographic inequities.Trial registrationClinicalTrials.Gov NCT02226627. Retrospectively registered on August 27, 2014.

This study explores the levels of COVID-19 knowledge, risk perception, and preventive behavior practice in Seoul, to determine whether knowledge and risk perception are significantly associated with the full adoption of preventive behaviors, for the delivery of a customized public campaign to Seoul’s citizens. A total of 3000 Seoul residents participated in this study through an online questionnaire survey. They had a mean score of 84.6 for COVID-19 knowledge (range: 0–100 points) and 4.2 (range: 1–7 points) for risk perception. Of the participants, 33.4% practiced full adoption of all three preventive behaviors: hand hygiene, wearing a face mask, and social distancing; wearing a face mask was practiced the most (81.0%). Women significantly adopted these three preventive behaviors more often compared with men. Both COVID-19 knowledge and risk perception were found to be significantly associated with the full adoption of preventive behaviors; however, this association differed by the type of preventive behavior. This indicates that city-level information on the levels of COVID-19 knowledge, risk perception, and preventive behaviors should be clearly and periodically communicated among public officers and healthcare professionals to continually raise the public’s awareness of the full adoption of non-pharmaceutical preventive behaviors.

Neighbourhood socio-economic disparities in active and sedentary transport

Background: The effectiveness of pandemic control measures requires a broad understanding from the population. This study aimed to evaluate the role played by health literacy (HL) in influencing the adherence to COVID-19 preventive measures and risk perception of essential frontline workers during the lockdown period. Methods: A cross-sectional survey was conducted on a population-based sample of frontline workers from Prato Province (Italy). Data on knowledge, attitudes and practices towards COVID-19 preventive measures and risk perception were collected. HL was measured with the HLS-EU-Q6 tool. Multivariate linear regression analyses were performed. Results: A total of 751 people participated in this study, and 56% of the sample showed a sufficient level of HL. In the multivariate models, HL resulted in being positively correlated with both knowledge (beta 0.32 for sufficient HL, 0.11 for problematic HL) and attitudes (beta 0.33 for sufficient HL, 0.17 for problematic HL) towards the importance of COVID-19 preventive measures. The HL level was not associated with the adoption of preventive behaviors and COVID-19 risk perception. Conclusions: HL may play a key role in maintaining a high adherence to infection prevention behaviors and may be a factor to take into account in the implementation of public health interventions in pandemic times.

The epidemic novel coronavirus disease 2019, abbreviated as COVID-19, has changed people’s mobility choices significantly, which has had a great impact on public transportation because of the public’s risk perception. The pandemic forced many people to shift toward private transport modes, which resulted in a decrease in public transport ridership and significantly altered travel behavior in urban areas. In this context, the present study investigated the public’s COVID-19 risk perception when public transportation is used (i.e., risk-taking behavior) and factors that significantly affect the use of public transportation. To fulfill this objective, a Google form-based questionnaire was prepared and circulated online. A total of 1,720 responses were collected using the survey form. These responses were processed for outliers and incomplete responses, and a total of 1,486 data samples were used for the analysis. A factor-based regression model was developed to study the risk-taking behavior of travelers while using public transportation during the COVID-19 pandemic. From the analysis, it is inferred that the travelers’ attitude negatively correlated with risk-taking behavior, whereas technology, motivation, concerns, and education positively affected COVID-19 risk perception when using public transit. Further, the study concluded that the behavior of travelers has a significant impact on their risk-taking behavior through their attitude and social norms. The findings of this study will be useful to urban transport planners in making suitable policies to increase public transportation ridership during pandemics.

e24135 Background: Obstacles to access to care due to the perceptions of the risk posed by COVID-19 have led to unprecedented disruptions in cancer care. Yet, little is understood about whether perceived COVID-19 risk influences perceptions of cancer risk. We examined how COVID-19 risk perception was associated with perceptions of breast cancer risk over one year of the pandemic among women enrolled in the WISDOM study, a PCORI-funded pragmatic trial testing risk-based cancer screening that began before the pandemic. Methods: We conducted four longitudinal surveys among the 13,002 women enrolled in the WISDOM study from May - December 2020. Responses from 8,285 women are eligible for inclusion in this analysis leading to a total sample size of 16,859 survey responses. Surveys were conducted online and asked women’s perceived lifetime chance of developing breast cancer (0-100%). COVID-19 risk perception was reported on a 5-point scale from Very Low to Very High. We computed the difference between breast cancer risk perception at each COVID-19 survey to pre-COVID breast cancer risk perception, measured as a secondary aim of the WISDOM study, and compared that to COVID-19 risk perception at each time point. Results: Across the four survey waves, most women perceived low COVID risk: 29% very low, 42% moderately low, 23% neither high nor low and 6% high or very high. Overall, breast cancer risk perception declined for those with very low COVID-19 risk perception and rose for women in the highest levels of COVID-19 risk perception. However, changes in breast cancer risk perception associated with COVID risk perception were small. For example, in survey wave 4, breast cancer risk change was -2.4% very low, -1.4% low, 2.5% not high or low and 3.1% high or very high. (Table). Conclusions: Among women participating in a pragmatic trial testing risk-based cancer screening, COVID risk perception had a small relationship with change in breast cancer risk perception. Change in breast cancer risk perception paralleled COVID-19 risk perception. This calls for exploration of the underpinnings of these risk changes and may have implications for changes in cancer screening behavior related to COVID-19.[Table: see text]

Background In the absence of definitive treatment, vaccination against COVID-19 emerged as an effective solution to the spread of the pandemic. This study aimed to investigate the factors impacting the rates of COVID-19 vaccine acceptance in Jordan, in addition to examining the relationship between COVID-19 risk perception and vaccine acceptance among the Jordanian population. Methods This cross-sectional study was conducted among a sample of adults (aged ≥18) residing in Jordan. Data were collected using an online questionnaire disseminated using social media platforms between December 2nd and December 29th, 2020. Results A total of 2,268 (72.3%) participants demonstrated willingness to receive the COVID-19 vaccine. The mean COVID-19 risk perception score among the participants was 4.65 out of 10 (median 5; IQR 3–6). Higher risk perception scores were significantly associated with being female (p = .001), young (p < .001), or a smoker (p = .005). A significant positive correlation was identified between COVID-19 vaccine acceptance and risk perception scores (OR = 1.319, 95%, CI = 1.261–1.380, p < .001). Moreover, male participants (75%, OR = 1.220, 95% CI = 1.007–1.479, p = .043), participants aged 18–24 years (78.1%, OR = 1.635, 95% CI = 1.189–2.246, p = .002), and participants with children aged under 18 years (73.9%, OR = 1.210, 95% CI = 1.010–1.450, p = .039) were more willing than their counterparts to get vaccinated. Conclusion COVID-19 risk perception and certain sociodemographic characteristics (i.e., being male, being young, and having children aged under 18 years) were found to be significantly associated with vaccine acceptance. Policymakers are recommended to develop public educational campaigns to enhance people’s trust in and willingness to take the COVID-19 vaccine.

Demand for mitigating the risk of COVID-19 infection in public transport: The role of social trust and fatalistic beliefs

This study aims to look at risk communication behavior and its relationship with the perception of Covid-19 risk in the coffee shop community in Banda Aceh City. This study uses a quantitative approach with a sample of 829 respondents, namely coffee shop visitors. The study results indicate a relationship between Covid-19 risk communication and the coffee shop community's perception of risk in Banda Aceh City. The value of the closeness of the relationship is 0.723. Meaning has an extreme level of intimacy. This study also found that risk communication and perception positively affect the association. Thus, it can be said that if risk communication increases, the community's perception of Covid-19 risk will increase as well. However, if Risk Communication decreases, the perception of Covid-19 risk that the coffee shop community in Banda Aceh City has will also decrease.