Compliance with COVID-19 Physical Distancing Mandates in Oman: The Role of Health Literacy and Internal Health Locus of Control.

BACKGROUND: Research indicates that the effectiveness of coronavirus disease 2019 (COVID-19) physical distancing mandates is influenced by several individual factors, including health literacy; internal health locus of control (IHLOC), the belief that physical distancing can reduce COVID-19 risk; social norms; self-efficacy; and perceptions of the benefits and barriers associated with distancing. However, further investigation is needed to understand the links between these factors and compliance intentions. OBJECTIVE: This study investigates the mechanism linking these factors with the intentions to comply with physical distancing mandates. METHODS: A total of 759 participants (Mean age = 29.13, standard deviation [SD] = 8.33; 68.5% women) were surveyed online from September 2020 to October 2020. Data were analyzed using ANOVA (analysis of variance) and structural equation modeling. KEY RESULTS: Health literacy was associated with more perceived benefits (ß = .175, p = .001), greater self-efficacy (ß = .193, p < .001), and less perceived barriers (ß = -.391, p < .001). IHLOC was significantly associated with greater perceived benefits (ß = .156, p = .007) and self-efficacy (ß = .294, p < .001). Family descriptive norms were significantly associated with fewer perceived barriers (ß = -.276, p < .001), while injunctive norms were associated with more perceived benefits (ß = .202, p = .001) and higher self-efficacy (ß = .299, p < .001). Intentions to adhere to physical distancing mandates were significantly associated with past compliance (ß = .427, p < .001) and perceived barriers (ß = -.205, p < .001) and benefits (ß = .295, p < .001). Post-hoc mediation analyses revealed several small yet significant indirect effects, highlighting the complex pathways shaping adherence intentions. CONCLUSIONS: This study identifies how health literacy, IHLOC, social norms, perceived benefits and barriers, and self-efficacy intricately shape intentions to comply with physical distancing mandates. These findings offer valuable implications for public health policy and interventions. [HLRP: Health Literacy Research and Practice. 2024;8(2):e69-e78.].

PLAIN LANGUAGE SUMMARY: This study examined the factors associated with Omanis' intentions to comply with physical distancing mandates during COVID-19. Results revealed that individuals with higher health literacy perceived fewer barriers and more benefits to physical distancing, making them more willing to comply with mandates. Those who believed their actions could reduce the risk of contracting the virus also reported greater benefits and were more likely to comply.

Ethnic differences in meat consumption attitudes, norms and behaviors: A survey of White, South Asian and Black ethnic groups in the UK.

A reduction in meat consumption is necessary to mitigate negative impacts of climate change and adverse health outcomes. The UK has an increasingly multi-ethnic population, yet there is little research on meat consumption habits and attitudes among ethnic groups in the UK. We ran a survey (N = 1014) with quota samples for ethnic groups and analyzed attitudes, behaviors and norm perceptions of White, South Asian and Black British respondents. Most respondents believe overconsumption of red and processed meat has negative impacts on health (73.3%) and the environment (64.3%).South Asian respondents were statistically significantly less likely to be meat eaters than White respondents (OR = 0.44, 95% CIs: 0.30-0.65, t = -4.15, p = 0.000), while there was no significant difference between White and Black respondents (OR = 1.06, 95% CIs: 0.63-1.76, t = 0.21, p = 0.834). Both South Asian (OR = 2.76, 95% CIs: 1.89-4.03 t = 5.25, p = 0.000) and Black respondents (OR = 2.09, 95% CIs: 0.1.30-3.35, t = 3.06, p = 0.002) were significantly more likely to express being influenced by friends and family in their food choices than White respondents. South Asian (OR = 3.24,95% CIs: 2.17-4.84, t = 5.74, p = 0.000) and Black (OR = 2.02,95% CIs: 1.21-3.39, t = 2.69, p = 0.007) respondents were also both significantly more likely to report they would want to eat similarly to their friends and family than White respondents. Statistical analyses suggested some gender and socioeconomic differences across and among ethnic groups, which are reported and discussed. The differences in meat consumption behaviors and norm conformity between ethnic groups raises the prospect that interventions that leverage social norms may be more effective in South Asian groups than Black and White groups in the UK.

I'll have what She's having (but not what They're having): The moderating role of group membership in the effect of social norms on food choice in an online environment.

The modern food-rich environment has contributed to the rise of unhealthy diets linked to noncommunicable diseases. Previous in-person research has found that the effect of social norms on food intake is greater when set by a perceived in-group member relative to an out-group member. Given recent increased social media use, we investigated whether this effect of group membership extends to food choices and to normative information presented remotely online. Participants (N = 179 female university students, 18-32 years) viewed a Facebook page pertaining to either their university (in-group) or a rival university (out-group). They were presented with either a healthy or an unhealthy norm via a post in which a student discussed their order at a café on the relevant campus. Food choice was assessed through an online menu where participants were asked to order one main, side, and dessert dish. As predicted, participants who viewed the healthy norm ordered a higher percentage of healthy items (especially in the desserts category) relative to those who viewed the unhealthy norm. However, this effect was significant only for those in the in-group condition; there was no such pattern for participants in the out-group condition. These findings provide insight into the role of group membership in the effect of social norms, and have practical implications regarding the design of identity-based social media health campaigns to promote healthier eating behaviours.

The model of norm-regulated responsibility for proenvironmental behavior in the context of littering prevention.

Previous research suggests that descriptive norms positively influence proenvironmental behavior, including littering prevention. However, in some behavioral contexts, a weak descriptive norm may increase individuals' feelings of responsibility by signaling a need for action. We examined this effect in the context of litter prevention by conducting structural equation modeling of survey data from 1400 Singapore residents. The results showed that descriptive norms negatively predicted ascription of responsibility and were negatively related to littering prevention behavior via ascription of responsibility and personal norms. It also showed that strong injunctive norms can reduce the inhibitory effect of descriptive norms on ascription of responsibility. These findings were consistent with several hypotheses constituting the model of norm-regulated responsibility, a novel explanatory framework offering new insights and a more nuanced and comprehensive understanding of social norms' influence on proenvironmental behavior.

Neural Tracking of Perceived Parent, but Not Peer, Norms Is Associated with Longitudinal Changes in Adolescent Attitudes about Externalizing Behaviors.

Adolescents' perceptions of parent and peer norms about externalizing behaviors influence the extent to which they adopt similar attitudes, yet little is known about how the trajectories of perceived parent and peer norms are related to trajectories of personal attitudes across adolescence. Neural development of midline regions implicated in self-other processing may underlie developmental changes in parent and peer influence. Here, we examined whether neural processing of perceived parent and peer norms in midline regions during self-evaluations would be associated with trajectories of personal attitudes about externalizing behaviors. Trajectories of adolescents' perceived parent and peer norms were examined longitudinally with functional neuroimaging (n = 165; ages 11-16 years across three waves; 86 girls, 79 boys; 29.7% White, 21.8% Black, 35.8% Latinx, 12.7% other/multiracial). Behavioral results showed perceived parent norms were less permissive than adolescents' own attitudes about externalizing behaviors, whereas perceived peer norms were more permissive than adolescents' own attitudes, effects that increased from early to middle adolescence. Although younger adolescents reported less permissive attitudes when they spontaneously tracked perceived parent norms in the ventromedial and medial pFCs during self-evaluations, this effect weakened as they aged. No brain-behavior effects were found when tracking perceived peer norms. These findings elucidate how perceived parent and peer norms change in parallel with personal attitudes about externalizing behaviors from early to middle adolescence and underscore the importance of spontaneous neural tracking of perceived parent norms during self-evaluations for buffering permissive personal attitudes, particularly in early adolescence.

Exploring the influence of context on social norms around Australian parents' food provision using story completion.

OBJECTIVE: To explore the differences in social norms around parents' food provision in different provision contexts and by demographics. DESIGN: Qualitative study using story completion methodology via an online survey in September 2021. Adults 18+ with or without children were randomised to one of three story stems focusing on food provision in different contexts; food provision at home (non-visitor), with visitors present and with the involvement of sport. Stories were coded and themed using thematic analysis. A content analysis was performed to determine count and frequency of codes in stories by participant demographics and story assumptions. SETTING: Australia. PARTICIPANTS: Adults (n 196). RESULTS: Nine themes were identified from the data resulting in four social norms around providing healthy foods and justifying non-adherence to healthy eating guidelines, evolution of family life and mealtime values, the presence of others influencing how we engage with food provision and unhealthy foods used as incentives/rewards in sport. Following content analysis, no differences of themes or norms by participant demographics or story assumptions were found. CONCLUSIONS: We identified pervasive social norms around family food provision and further identified how contextual factors resulted in variations or distinct norms. This highlights the impact context may have on the social norms parents face when providing food to their children and the opportunities and risks of leveraging these social norms to influence food choice in these contexts. Public health interventions and practitioners should understand the influence of context and social environments when promoting behaviour change and providing individualised advice. Future research could explore parents' experiences of these norms and to what extent they impact food choice.

Source-credibility information and social norms improve truth discernment and reduce engagement with misinformation online.

Misinformation on social media is a pervasive challenge. In this study (N = 415) a social-media simulation was used to test two potential interventions for countering misinformation: a credibility badge and a social norm. The credibility badge was implemented by associating accounts, including participants', with a credibility score. Participants' credibility score was dynamically updated depending on their engagement with true and false posts. To implement the social-norm intervention, participants were provided with both a descriptive norm (i.e., most people do not share misinformation) and an injunctive norm (i.e., sharing misinformation is the wrong thing to do). Both interventions were effective. The social-norm intervention led to reduced belief in false claims and improved discrimination between true and false claims. It also had some positive impact on social-media engagement, although some effects were not robust to alternative analysis specifications. The presence of credibility badges led to greater belief in true claims, lower belief in false claims, and improved discrimination. The credibility-badge intervention also had robust positive impacts on social-media engagement, leading to increased flagging and decreased liking and sharing of false posts. Cumulatively, the results suggest that both interventions have potential to combat misinformation and improve the social-media information landscape.

One step too far: social cerebellum in norm-violating navigation.

Social norms are pivotal in guiding social interactions. The current study investigated the potential contribution of the posterior cerebellum, a critical region involved in perceiving and comprehending the sequential dynamics of social actions, in detecting actions that either conform to or deviate from social norms. Participants engaged in a goal-directed task in which they observed others navigating towards a goal. The trajectories demonstrated either norm-violating (trespassing forbidden zones) or norm-following behaviors (avoiding forbidden zones). Results revealed that observing social norm-violating behaviors engaged the bilateral posterior cerebellar Crus 2 and the right temporoparietal junction (TPJ) from the mentalizing network, and the parahippocampal gyrus (PHG) to a greater extent than observing norm-following behaviors. These mentalizing regions were also activated when comparing social sequences against non-social and non-sequential control conditions. Reproducing norm-violating social trajectories observed earlier, activated the left cerebellar Crus 2 and the right PHG compared to reproducing norm-following trajectories. These findings illuminate the neural mechanisms in the cerebellum associated with detecting norm transgressions during social navigation, emphasizing the role of the posterior cerebellum in detecting and signaling deviations from anticipated sequences.

Electronic cigarette social norms among adolescents in New South Wales, Australia.

The use of electronic cigarettes (e-cigarettes) is common and increasing, especially among youth. In 2022/2023, 30% of 12- to 17-year-olds reported ever using e-cigarettes in Australia-a >50% increase from 2017 (14%). Several adverse e-cigarette health effects have been identified and most effects remain unknown. Social norms, rules that govern social behaviours, are associated with current and future adolescent e-cigarette use. Understanding social norms in Australian adolescents is critical to the development of targeted and effective e-cigarette prevention activities. This study aims to explore e-cigarette social norms among adolescents living in New South Wales, Australia. A total of 32 online single or paired semi-structured qualitative interviews were conducted involving 46 participants aged 14-17 years, as part of the Generation Vape project. Reflexive thematic analysis was applied within a constructivist perceptive. Adolescents perceived e-cigarettes use as prolific among their peers, with use considered common, acceptable and normal. Fuelled by social exposure to e-cigarettes, 'everyone' was generally thought to be using them (descriptive norms). E-cigarette use was considered so entrenched that it was part of adolescent identity, with abstinence regarded as atypical. Use was driven by an internalised desire to fit it (injunctive norm), rather than being attributed to overt/external 'peer-pressure'. Positive e-cigarette norms exist among Australian adolescents with norm formation strongly influenced by social exposure, including e-cigarette promotion. Prevention efforts should include limiting adolescent exposure to e-cigarette marketing to help redefine existing pro-e-cigarette social norms and protect health.

Persistent interaction patterns across social media platforms and over time.

Growing concern surrounds the impact of social media platforms on public discourse1-4 and their influence on social dynamics5-9, especially in the context of toxicity10-12. Here, to better understand these phenomena, we use a comparative approach to isolate human behavioural patterns across multiple social media platforms. In particular, we analyse conversations in different online communities, focusing on identifying consistent patterns of toxic content. Drawing from an extensive dataset that spans eight platforms over 34 years-from Usenet to contemporary social media-our findings show consistent conversation patterns and user behaviour, irrespective of the platform, topic or time. Notably, although long conversations consistently exhibit higher toxicity, toxic language does not invariably discourage people from participating in a conversation, and toxicity does not necessarily escalate as discussions evolve. Our analysis suggests that debates and contrasting sentiments among users significantly contribute to more intense and hostile discussions. Moreover, the persistence of these patterns across three decades, despite changes in platforms and societal norms, underscores the pivotal role of human behaviour in shaping online discourse.

"People will talk about her if she is not circumcised": Exploring the patterning, drivers and gender norms around female genital mutilation in Ethiopia's Somali region.

Over the past decade there has been a burgeoning literature on social norms and the need to understand their context-specific patterning and trends to promote change, including to address the harmful practice of female genital mutilation (FGM), which affects around 200 million girls and women globally. This article draws on mixed-methods data collected in 2022 and 2023 with 1,020 adolescents and their caregivers, as well as key informants, from Ethiopia's Somali region to explore the patterning, drivers, and decision-making around FGM. Findings indicate that almost all Somali girls can expect to undergo FGM before age 15, and that infibulation is near universal. Critically, however, we find that respondents' understanding of infibulation is rooted in traditional practice, and many girls are now "partially" infibulated-an invasive procedure that girls nonetheless see as an improvement over the past. These shifts reflect religious leaders' efforts to eliminate traditional infibulation--and the health risks it entails--by promoting "less invasive" types of FGM as a requirement of Islam. We also find evidence of emergent medicalization of the practice, as mothers-who are the primary decision-makers-seek to further reduce risks. Adult and adolescent respondents agree that FGM is a deeply embedded social norm, but distinguish between FGM as a perceived religious requirement, and infibulation as a cultural requirement. For girls and women, the importance of FGM is framed around social acceptance, whereas boys and men focus on FGM as a requirement for marriage as it allows families to control girls' sexuality. The article concludes by reflecting on the implications of our findings for programming in high-prevalence contexts. Key conclusions include that FGM interventions should not rely on empowering individuals as "champions of change" but rather prioritize engagement with whole communities, and should be open in the short term to incremental harm-reduction approaches.

Effectiveness of combined interventions to empower girls and address social norms in reducing child marriage in a rural sub-district of Bangladesh: A Cluster Randomised Controlled Trial of the Tipping Point Initiative.

Background: Elimination of girl child marriage (CM) globally at the current pace is projected to take about 300 years. Thus, innovative and effective solutions are urgently warranted. Bangladesh reports one of the highest rates of CM in the world. We present the impact of Tipping Point Initiative (TPI), a combined intervention to empower girls and to address social norms on CM in Bangladesh. Methods: A three-arm non-blinded Cluster Randomised Controlled Trial was conducted in 51 villages/clusters in a sub-district of Bangladesh. Clusters were randomly assigned to the arms: Tipping Point Program (TPP), Tipping Point Program Plus (TPP+), and Pure Control. TPP conducted 40 weekly single-gender group sessions with never-married adolescent girls and boys recruited at 12 -<16 years; and 18-monthly gender-segregated group sessions with the parents. On top of TPP, TPP+ included cross-gender and -generation dialogues, girls' movement building and girl-led community sensitisation. Intention-to-treat analysis was performed to assess the impact of TPI on the hazard of CM, the primary outcome. The impact of girls' session attendance on CM was also assessed. At baseline 1275 girls (TPP = 412; TPP+ = 420; Control = 443) were interviewed between February-April 2019. At endline 1123 girls (TPP = 363; TPP + = 366; Control = 394) were interviewed and included in the analyses. Results: No intervention impact was detected on the full sample (TPP vs. Control: adjusted hazard ratio (aHR) = 1.14; 95% CI = 0.79-1.63, P = 0.47), (TPP + vs. Control: aHR = 1.24; 95% CI = 0.89-1.71, P = 0.19, (TPP vs. TPP+: aHR = 1.03; 95% CI = 0.72-1.47, P = 0.87). However, in the TPP arm, the hazard of CM was reduced by 54% (aHR = 0.46; 95% CI = 0.23-0.92, P = 0.03) among the girls in the highest tertile of session attendance, compared to the lowest. In the TPP+ arm, this hazard was reduced by 49% (aHR = 0.51; 95% CI = 0.23-0.92, P = 0.03) among girls in the highest tertile, compared to the lowest tertile. Conclusions: Although TPI did not show an effect on CM in any of the intervention arms, within each intervention arm, a positive effect was detected in reducing CM among girls in the highest tertile of session attendance despite implementation challenges due to COVID-19. Registration: Clinicaltrials.gov: NCT03965273; Date: 29 May 2019.

Peer effects in weight-related behaviours of young people: A systematic literature review.

Individual preferences and beliefs are perpetually shaped by environmental influences, with peers playing a key role in this dynamic process. Compelling evidence from qualitative and quantitative studies has highlighted the significant impact of peer influence on health-related decisions. This systematic literature review critically synthesises findings from 45 studies published between 2011 and 2022, providing a comprehensive understanding of the nature of peer effects on dietary, physical activity and sleep behaviours during youth. The majority of studies indicated that social norms drive directional changes in eating and physical activity. Yet, our analysis revealed a notable gap in exploring alternative mechanisms, including social comparison and social identity, despite their potential relevance. Studies, generally classified as moderate to high quality, predominantly relied on self-reported data, potentially affecting the validity and reliability of measures. Meta-regression analyses suggest a small, but significant association of sample size with the magnitude, sign and significance of the reported peer effects. Moreover, studies focusing on physical activity are more likely to report significant outcomes, whereas findings on peer influence on sleep-related studies tend to reveal less pronounced effects, compared to studies on dietary behaviours. Experimental designs do not appear to increase the likelihood of finding significant effects when compared to other study designs. In conclusion, this synthesis emphasises the need for further research into the underlying mechanisms on peer effects to better inform policy-makers in designing effective policies for improving weight-related behaviours in young people.

Situations of anomie and the health workforce crisis: Policy implications of a socially sensitive and inclusive approach to human resources.

Health systems in most jurisdictions are facing an unprecedented workforce crisis, manifesting as labour shortages, high staff turnover, and increasing rates of absenteeism and burnout. These issues affect professional and occupational groups in both health and social care and individuals at early and later stages of their career. The intensity and pervasiveness of the crisis suggests that it is a multicausal phenomenon. Studies have focused on the relationship between working environments and worker satisfaction and well-being. However, these are of limited use in understanding the deeper mechanisms behind the large-scale workforce crisis. The subjective experience of work, while rooted in a particular work context, is also shaped by broader social and cultural phenomena that put social norms and individuals' ability to conform to them in tension. The concept of anomie, initially developed by Durkheim and redefined by Merton, focuses on the way social norms that guide conduct and aspirations lose influence and become incompatible with each other or unsuited to contemporary work contexts. Understanding the workforce crisis from the perspective of anomie enables the development and implementation of novel policies based on co-production strategies where concerned publics engage collaboratively in framing the problem and searching for solutions.

Changes in social norms during the early stages of the COVID-19 pandemic across 43 countries.

The emergence of COVID-19 dramatically changed social behavior across societies and contexts. Here we study whether social norms also changed. Specifically, we study this question for cultural tightness (the degree to which societies generally have strong norms), specific social norms (e.g. stealing, hand washing), and norms about enforcement, using survey data from 30,431 respondents in 43 countries recorded before and in the early stages following the emergence of COVID-19. Using variation in disease intensity, we shed light on the mechanisms predicting changes in social norm measures. We find evidence that, after the emergence of the COVID-19 pandemic, hand washing norms increased while tightness and punishing frequency slightly decreased but observe no evidence for a robust change in most other norms. Thus, at least in the short term, our findings suggest that cultures are largely stable to pandemic threats except in those norms, hand washing in this case, that are perceived to be directly relevant to dealing with the collective threat.

Preverbal infants' understanding of social norms.

Social norms are foundational to human cooperation and co-existence in social groups. A crucial marker of social norms is that a behavior is not only shared, but that the conformity to the behavior of others is a basis for social evaluation (i.e., reinforcement and sanctioning), taking the is, how individuals usually behave, to an ought, how individuals should behave to be socially approved by others. In this preregistered study, we show that 11-month-old infants grasp this fundamental aspect about social norms already in their first year. They showed a pupillary surprise response for unexpected social responses, namely the disapproval and exclusion of an individual who showed the same behavior like others or the approval and inclusion of an individual who behaved differently. That preverbal infants link the conformity with others' behavior to social evaluations, before they respond to norm violations themselves, indicates that the foundations of social norm understanding lie in early infancy.

Assessing the effects of pandemic risk on cooperation and social norms using a before-after Covid-19 comparison in two long-term experiments.

How does threat from disease shape our cooperative actions and the social norms that guide such behaviour? To study these questions, we draw on a collective-risk social dilemma experiment that we ran before the emergence of the Covid-19 pandemic (Wave 1, 2018) and compare this to its exact replication, sampling from the same population, that we conducted during the first wave of the pandemic (Wave 2, 2020). Tightness-looseness theory predicts and evidence generally supports that both cooperation and accompanying social norms should increase, yet, we mostly did not find this. Contributions, the probability of reaching the threshold (cooperation), and the contents of the social norm (how much people should contribute) remained similar across the waves, although the strength of these social norms were slightly greater in Wave 2. We also study whether the results from Wave 1 that should not be affected by the pandemic-the relationship between social norms and cooperation and specific behavioural types-replicate in Wave 2 and find that these results generally hold. Overall, our work demonstrates that social norms are important drivers of cooperation, yet, communicable diseases, at least in the short term, have little or no effects on either.

Scope, range and effectiveness of interventions to address social norms to prevent and delay child marriage and empower adolescent girls: a systematic review.

OBJECTIVES: Harmful gender and social norms prescribe divergent opportunities for girls and boys and drive child marriage. This systematic review examines the scope, range and effectiveness of interventions to change social norms and delay child marriage. DESIGN: We systematically assess the contributions made by interventions that work to shift norms to prevent child marriage or to limit its harmful consequences. Our analysis classifies each study's quality in evaluation and implementation design regarding shifting norms. DATA SOURCES: We conducted a search of electronic databases (PubMed, PsycINFO, Embase, CINAHL Plus, Popline, Web of Science and Cochrane Library) and grey literature (targeted hand-searches of 15 key organisations and Google Scholar). ELIGIBILITY CRITERIA: Included interventions sought to change norms related to child marriage, were evaluated in experimental or quasi-experimental evaluations, collected data on age at marriage and norms/attitudes, and were published in English from January 2000 to September 2021. DATA EXTRACTION AND SYNTHESIS: We used a standardised form to extract data from all eligible studies, and double-screened to validate coding and reporting. We classified the studies by low, medium and high quality for evaluation and risk of bias, and separately by the extent to which they addressed social norms. RESULTS: Our assessment of the 12 eligible studies identified revealed little evidence of a systematic relationship between social norms related to marriage and changes in child marriage behaviours. We found stronger evidence of programme effect on child marriage outcomes than on social norms, though only a minority of studies found an effect for either. Studies that appeared effective in changing child marriage norms varied greatly in scale and extent of programming, and few attempted to identify the appropriate reference groups for measuring social norms. CONCLUSION: The studies evaluated by our review provide only weak evidence on the impact of interventions on norms, and on the link between shifts in norms and marriage behaviour.