Adoption and Discontinuance of Innovation Packages: A Longitudinal Study of Transitions in COVID-19 Mitigation.

The past decades have seen growing interest and application of interventions targeting the change of multiple behaviors at once. We advance this work by using the diffusion of innovations theory (DOI) to consider constellations of behaviors as innovation packages: multiple innovations that are logically related, interdependent in their use or effects, and often promoted as a set (Rogers, 2003). In addition, we embraced DOI's focus on behavioral decisions as a continual process that can include adoption and discontinuance over time, especially as new innovations (e.g., COVID-19 vaccine) appear. To that end, we conducted a latent transition analysis of COVID-19 mitigation behaviors (N = 697; 97% received a COVID-19 vaccine) across three time points in the pandemic: initial outbreak; a secondary, record-breaking rise in cases; and after the CDC recommended that fully vaccinated adults could discontinue wearing masks. This analysis allowed us to identify latent classes based on shared behavioral patterns and transitions between classes over time. The results showed evidence of three possible packages: (a) a package of traditional, symptom-management behaviors (covering coughs and sneezes, staying home if ill, and seeking medical care), (b) a package of just-novel COVID-19 behaviors (wearing masks, keeping six feet apart, and avoiding mass gatherings), and (c) a package of all COVID-19 mitigation behaviors. Movement between classes exemplified adoption and discontinuance of different packages, as well as widespread discontinuance with the replacement innovation: COVID-19 vaccines. Additional analyses showed that increases in hope were associated with sustained and delayed adoption; decreases in social approval were associated with discontinuance. Future directions in theorizing around innovation packages are discussed.

The Value of Interpersonal Network Continuity for College Students in Disruptive Times.

The COVID-19 pandemic-related social distancing practices that colleges implemented in Spring 2020 disrupted the typical mechanisms of propinquity (physical proximity) and homophily (shared characteristics) that physical institutions rely on to help students build and maintain relationships critical to learning and wellbeing. To explore how social distancing shaped students' academic and social networks and associated educational outcomes, we conceptualized it as a "network shock" and collected unique ego network data in April 2020. For participating students, maintaining interactions with the same set of individuals before and after social distancing was related to more positive outcomes across a range of self-reported wellbeing and learning indicators. On average, students experienced a loss of frequent academic contacts, while they maintained or replaced social interactions in their interpersonal networks after social distancing. Our investigation of the ways students experienced changes in their social and academic networks after a loss of physical proximity points to the role of interpersonal interaction network continuity for fostering wellbeing and learning in times of disruption, as well as the potential need for support in maintaining or rebuilding academic networks.

Evaluation of an Integrated Intervention to Address Clinical Care and Social Needs Among Patients with Type 2 Diabetes.

BACKGROUND: The Providence Diabetes Collective Impact Initiative (DCII) was designed to address the clinical challenges of type 2 diabetes and the social determinants of health (SDoH) challenges that exacerbate disease impact. OBJECTIVE: We assessed the impact of the DCII, a multifaceted intervention approach to diabetes treatment that employed both clinical and SDoH strategies, on access to medical and social services. DESIGN: The evaluation employed a cohort design and used an adjusted difference-in-difference model to compare treatment and control groups. PARTICIPANTS: Our study population consisted of 1220 people (740 treatment, 480 control), aged 18-65 years old with a pre-existing type 2 diabetes diagnosis who visited one of the seven Providence clinics (three treatment and four control) in the tri-county area of Portland, Oregon, between August 2019 and November 2020. INTERVENTIONS: The DCII threaded together clinical approaches such as outreach, standardized protocols, and diabetes self-management education and SDoH strategies including social needs screening, referral to a community resource desk, and social needs support (e.g., transportation) to create a comprehensive, multi-sector intervention. MAIN MEASURES: Outcome measures included SDoH screens, diabetes education participation, HbA1c, blood pressure, and virtual and in-person primary care utilization, as well as inpatient and emergency department hospitalization. KEY RESULTS: Compared to patients at the control clinics, patients at DCII clinics saw an increase in diabetes education (15.5%, p<0.001), were modestly more likely to receive SDoH screening (4.4%, p<0.087), and had an increase in the average number of virtual primary care visits of 0.35 per member, per year (p<0.001). No differences in HbA1c, blood pressure, or hospitalization were observed. CONCLUSIONS: DCII participation was associated with improvements in diabetes education use, SDoH screening, and some measures of care utilization.

Hospital-Based, Community Teaching Kitchen Integrates Diabetes Education, Culinary Medicine, and Food Assistance: Case Study During the COVID-19 Pandemic.

BACKGROUND: Recent USDA Economic Research Service Population Survey cites a stabilization of food insecurity overall in the USA between 2019 and 2020, but Black, Hispanic, and all households with children cited increases - underscoring that the COVID-19 pandemic caused severe disruptions to food insecurity for historically disenfranchised populations. AIM: Describe lessons learned, considerations, and recommendations from the experience of a community teaching kitchen (CTK) in addressing food insecurity and chronic disease management among patients during the COVID-19 pandemic. SETTING: The Providence CTK is co-located at Providence Milwaukie Hospital in Portland, Oregon. PARTICIPANTS: Providence CTK serves patients who report a higher prevalence of food insecurity and multiple chronic conditions. PROGRAM DESCRIPTION: Providence CTK has five components: chronic disease self-management education, culinary nutrition education, patient navigation, a medical referral-based food pantry (Family Market), and an immersive training environment. PROGRAM EVALUATION: CTK staff highlight that they provided food and education support when it was needed most, leveraged existing partnerships and staffing to sustain operations and Family Market accessibility, shifted delivery of educational services based-on billing and virtual service considerations, and repurposed roles to support evolving needs. DISCUSSION: The Providence CTK case study provides a blueprint for how healthcare organizations could design a model of culinary nutrition education that is immersive, empowering, and inclusive.

Character Perceptions of Storytellers: Investigating the Mediated Contact Hypothesis and Stories About Living With HIV.

Research into mediated contact hypothesis shows that exposure to people sharing their stories of living with a stigmatized condition can decrease negative stereotypes and improve willingness to engage in future interpersonal contact, but results are inconsistent. In this study, we offer novel reasons for why mediated intergroup contact can facilitate positive inter-group outcomes, by focusing on audience members' perceptions of the storyteller's character (i.e., perceptions of attributes or features that make up an individual). Our model was tested (N = 369, U.S. adults) with video-recorded stories from the Centers for Disease Control and Prevention's Let's Stop HIV Together campaign. The results showed that, as predicted, viewers' perceptions of the storyteller's character as more fluid and more multidimensional predicted stronger transportation into the story, which predicted greater perceptions of group variability and more intergroup ease. Implications for character perceptions as mechanisms of contact effects, communication's role in shaping character perceptions, and reducing HIV stigma are discussed.

Persuasive Messages, Social Norms, and Reactance: A Study of Masking Behavior during a COVID-19 Campus Health Campaign.

Efforts by universities to reduce the spread of COVID-19 include health campaigns intended to encourage students to wear masks. While well-intended, these efforts may produce counter-persuasion (e.g., decrease masking) if they are seen as threatening individuals' freedom to choose. In a rolling cross-sectional study of one university campaign (n = 681), we found that the presence of the campaign did instigate a form of resistance known as reactance and that reactance was negatively associated with masking behavior. Masking was also diminished by the frequency with which respondents observed others not wearing a mask (anti-masking descriptive norm) and the frequency with which respondents observed others expressing disdain for masking (anti-masking injunctive norm). Most of these findings were magnified among students who identified as politically conservative. There was no evidence that the frequency of seeing others speak in favor of masks (pro-masking injunctive norm) produced an increase in masking. The results provide valuable theoretical insights into the causes of reactance and empirical evidence of the risks associated with student-oriented COVID safety campaigns.

COVID-19 Mitigation Among College Students: Social Influences, Behavioral Spillover, and Antibody Results.

By fall 2020, students returning to U.S. university campuses were mandated to engage in COVID-19 mitigation behaviors, including masking, which was a relatively novel prevention behavior in the U.S. Masking became a target of university mandates and campaigns, and it became politicized. Critical questions are whether the influences of injunctive norms and response efficacy on one behavior (i.e. masking) spill over to other mitigation behaviors (e.g. hand-washing), and how patterns of mitigation behaviors are associated with clinical outcomes. We conducted a cross-sectional survey of college students who returned to campus (N = 837) to explore these questions, and conducted COVID-19 antibody testing on a subset of participants to identify correlations between behaviors and disease burden. The results showed that college students were more likely to intend to wear face masks as they experienced more positive injunctive norms, liberal political views, stronger response efficacy for masks, and less pessimism. Latent class analysis revealed four mitigation classes: Adherents who intended to wear face masks and engage in the other COVID-19 mitigation behaviors; Hygiene Stewards and Masked Symptom Managers who intended to wear masks but only some other behaviors, and Refusers who intended to engage in no mitigation behaviors. Importantly, the Hygiene Stewards and Refusers had the highest likelihood of positive antibodies; these two classes differed in their masking intentions, but shared very low likelihoods of physical distancing from others and avoiding crowds or mass gatherings. The implications for theories of normative influences on novel behaviors, spillover effects, and future messaging are discussed.

Extending the Theory of Normative Social Behavior: Collective Norms, Opinion Leadership, and Masking During the COVID-19 Pandemic.

Novel, public behaviors, such as masking, should be susceptible to normative influence. This paper advances the theory of normative social behavior by considering a new set of moderators of normative influence - superdiffuser traits - and by clarifying the antecedents and consequences of exposure to collective norms. We use data from a two-wave survey of a cohort living in one U.S. county during the pandemic (N = 913) to assess normative effects on masking. We also used a bipartite network (based on people shopping for food in the same stores) to examine exposure to collective norms. The results show different superdiffuser traits have distinct effects on the relationship between perceived injunctive norms and masking intentions. Exposure to collective norms influences masking, but this influence depends on how people interact with their social environments. Network analysis shows that behavioral homophily is a significant predictor of selective exposure to collective norms earlier (but not later) in the pandemic. Implications for understanding normative influence in a context where opinion leadership matters are discussed.

Sexual Minority Mothers: A Dyadic Exploration of Stigma, Identity, Support, and Parental Wellbeing.

For all couples, regardless of sexual orientation, transition to parenthood often increases stress, although, according to minority stress theory (MST), same-sex couples often experience additional stressors specifically related to their sexual orientation. In this study of 34 same-sex female couples (68 sexual minority mothers) who conceived their children with the use of sperm donation, we explored the intrapersonal and interpersonal influences of sexuality-related stigma, sexual identity, sexuality disclosure ("outness"), and social support on the wellbeing of each partner among these couples. We found support for MST, although the process worked differently based on the mother's role. Among the pregnant (gestational) mothers, personal experiences of sexuality related stigma, social support, and sexual identity disclosure were all associated with their individual wellbeing. In contrast, among the non-pregnant (non-gestational) mothers, these associations were more interpersonal in nature. Specifically, the non-gestational mothers' wellbeing was unrelated to their personal experiences of sexuality stigma but was associated with their partner's (the gestational mother's) reports of sexual identity centrality and affirmation and support from friends. In all, we found support for MST, such that greater sexuality stigma was associated with poorer wellbeing, but this relationship functioned differently depending on the mother's role.

Mixed-methods Analysis of Adults Likely versus Unlikely to Get a COVID-19 Vaccination.

Objectives: This mixed-methods study compared perspectives of those 'very likely' versus 'very unlikely' to receive a hypothetical COVID-19 vaccine. Methods: We used an explanatory, sequential, mixed- methods design to analyze quantitative data from a rural Pennsylvania sample. Of the 976 participants, 67 selected 'very unlikely' to get the COVID-19 vaccine. Responses to open-ended questions: "What worries you the most about the COVID 19 pandemic?" and "What are your thoughts about a potential COVID 19 vaccine?" were qualitatively compared to answers from the 67 participants who selected 'very likely' to get the COVID-19 vaccine. We used descriptive content analysis to compare themes across the 2 groups. Results: Both groups had thematic commonalities related to their concerns. Themes that were more common among those 'very unlikely' to get vaccinated included concern for politics overriding vaccine safety and rushed vaccine development timeline, whereas themes related to hope and optimism about vaccination were exclusive to the 'very likely' group. Conclusions: Shared beliefs existed across groups with different intents to vaccinate; yet, identification with vaccine spokespersons differed. Messaging campaigns can use these commonalities to address vaccine hesitancy.

Skeptical Health Mavens May Limit COVID-19 Vaccine Diffusion: Using the Innovation Diffusion Cycle to Interpret Results of a Cross-sectional Survey among People Who are Socially Vulnerable.

We sought to identify barriers to COVID-19 vaccine uptake among persons who are socially vulnerable in light of the natural cycle of innovation diffusion. Widespread adoption of a health innovation requires a cadre of opinion leaders to build on successes experienced by early adopters. One type of opinion leader in healthcare are health mavens: members of a community who maintain up-to-date health knowledge and share their knowledge others. We surveyed 139 persons who are socially vulnerable regarding their COVID-19 vaccination intention, and evaluated their responses based on psychological traits captured by two scales: innovativeness and health mavenism. Health mavenism was not strongly correlated with COVID-19 vaccine intention. Health mavens often relied on their own healthcare providers (n = 46) and health agency websites (n = 42) for vaccine information. Those who relied on their faith leaders (n = 4) reported a lower likelihood of getting vaccinated (31.5% vs. 76.0%, p < .05). The observed lack of support by health mavens represents a critical barrier to COVID-19 vaccine uptake; targeting campaigns to health mavens may increase COVID-19 vaccine uptake in socially vulnerable communities.

Essential and non-essential US workers' health behaviors during the COVID-19 pandemic.

We seek to quantify the relationship between health behaviors and work-related experiences during the COVID-19 pandemic by predicting health behaviors as a function of essential worker status, job loss, change in work hours, and COVID-19 experiences. We use multivariate models and survey data from 913 employed adults in a semi-rural mid-Atlantic US county, and test whether essential worker results vary by gender, parenthood, and/or university employment. Multivariate models indicate that essential workers used tobacco on more days (4.5; p <.01) and were less likely to sleep 8 h (odds ratio [OR] 0.6; p <.01) than non-essential workers. The risk of sleeping less than 8 h is concentrated among essential workers in the service industry (OR 0.5; p <.05) and non-parents (OR 0.5; p <.05). Feminine essential workers exercised on fewer days (-0.8; p <.05) than feminine non-essential workers. Workers with reduced work hours consumed more alcoholic drinks (0.3; p <.05), while workers with increased work hours consumed alcohol (0.3; p <.05) and exercised (0.6; p <.05) on more days. Essential worker status and changes in work hours are correlated with unhealthy behaviors during the COVID-19 pandemic.

Rural college graduates: Who comes home?

Many rural communities throughout the United States have experienced brain drain, or the out-migration of educated young people. Explanations for why college-educated adults leave rural communities have relied on economic rationales; however, the effects of social identities, community context, and place attachment have also been shown to influence migration decisions. Using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examines factors experienced during adolescence as well as postsecondary characteristics that promote college graduates' return to their rural communities when they are between the ages of 34 and 43. We find that among college graduates who had attended a rural public K-12 school, those who had higher levels of school attachment were significantly more likely to return home compared to graduates who had lower levels of school attachment. The findings also suggest that graduates who came from a lower college-educated community were more likely to return home than those from average or highly college-educated communities. By analyzing long-term outcomes, this study extends our understanding of the strengths of adolescent experiences and neighborhood context influencing the pull to return home and the support for policies strengthening rural communities as there may be long-term effects to returning home, even if youth leave for college.

College students' COVID-19 vaccine beliefs and intentions: Implications for interventions.

On college campuses, effective management of vaccine-preventable transmissible pathogens requires understanding student vaccination intentions. This is necessary for developing and tailoring health messaging to maximize uptake of health information and vaccines. The current study explored students' beliefs and attitudes about vaccines in general, and the new COVID-19 vaccines specifically. This study provides insights into effective health messaging needed to rapidly increase COVID-19 vaccination on college campuses-information that will continue to be informative in future academic years across a broad scope of pathogens. Data were collected from 696 undergraduate students ages 18-29 years old enrolled in a large public university in the Northeast during fall 2020. Data were collected via an online survey. Overall, we found COVID-19 vaccine hesitancy in college students correlated strongly with some concerns about vaccines in general as well as with concerns specific to COVID-19 vaccines. Taken together, these results provide further insight for message development and delivery and can inform more effective interventions to advance critical public health outcomes on college campuses beyond the current pandemic.

Unique Predictors of Intended Uptake of a COVID-19 Vaccine in Adults Living in a Rural College Town in the United States.

PURPOSE: To explore public confidence in a COVID-19 vaccine. DESIGN: Cross-sectional survey. SETTING: A rural college town in central Pennsylvania. SUBJECTS: Adult residents without minor children. MEASURES: The primary outcome was COVID-19 vaccination intention. Secondary measures included vaccination attitudes, norms, efficacy, past behavior, trust in the vaccination process, and sociodemographic variables of education, financial standing, political viewpoint, and religiosity. ANALYSIS: Descriptive statistics were used to describe quantitative data. Multivariate ordinal regression was used to model predictors of vaccine intention. RESULTS: Of 950 respondents, 55% were "very likely" and 20% "somewhat likely" to take a coronavirus vaccine, even though 70% had taken the flu vaccine since September 2019. The strongest predictors of vaccine acceptance were trust in the system evaluating vaccines and perceptions of local COVID-19 vaccination norms. The strongest predictors of negative vaccine intentions were worries about unknown side-effects and positive attitudes toward natural infection. Sociodemographic factors, political views, and religiosity did not predict vaccine intentions. CONCLUSION: Fewer adults intend to take a coronavirus vaccine than currently take the flu vaccine. Traditional sociodemographic factors may not be effective predictors of COVID-19 vaccine uptake. Although based on a small sample, the study adds to our limited understanding of COVID-19-specific vaccine confidence among some rural Americans and suggests that traditional public health vaccination campaigns based on sociodemographic characteristics may not be effective.

How Americans Make Sense of Two Novel Pandemics.

Using Galileo theory and method of multidimensional scaling (MDS), we compared the psychological distances between concepts related to two pandemic viruses, Zika and COVID-19. Surveys (Zika, N = 410; COVID-19, N = 291) were used to investigate the role of media use and interpersonal communication on the relationship between 10 concepts in multidimensional spaces. We asked these four research questions: Do the two spaces represent the two pandemics similarly? What is the relationship of me and of people to each pandemic? What is the effect of virus-related media use and interpersonal talk on the pandemic space? What are optimal messages for moving me closer to Zika and to COVID-19? Media use influenced the distances for both pandemics: With greater media use, the concepts were closer in the Zika space and further apart in the COVID-19 space. Interpersonal communication was associated with few differences in the spaces. Based on the psychological distances between concepts, optimal messages were identified: For Zika, a message with two concepts, people and women, is predicted to be most effective to move Zika to the concept me, whereas for COVID-19, a message with people is predicted to be most effective to move COVID-19 to me.

Exploring Behavioral Typologies to Inform COVID-19 Health Campaigns: A Person-Centered Approach.

As the United States continues to be ravaged by COVID-19, it becomes increasingly important to implement effective public health campaigns to improve personal behaviors that help control the spread of the virus. To design effective campaigns, research is needed to understand the current mitigation intentions of the general public, diversity in those intentions, and theoretical predictors of them. COVID-19 campaigns will be particularly challenging because mitigation involves myriad, diverse behaviors. This study takes a person-centered approach to investigate data from a survey (N = 976) of Pennsylvania adults. Latent class analysis revealed five classes of mitigation: one marked by complete adherence with health recommendations (34% of the sample), one by complete refusal (9% of the sample), and three by a mixture of adherence and refusal. Statistically significant covariates of class membership included relatively positive injunctive norms, risk due to essential workers in the household, personal knowledge of someone who became infected with COVID-19, and belief that COVID-19 was a leaked biological weapon. Additionally, trait reactance was associated with non-adherence while health mavenism was associated with adherence. These findings may be used to good effect by local healthcare providers and institutions, and also inform broader policy-making decisions regarding public health campaigns to mitigate COVID-19.

Large red cell-derived membrane particles are major contributors to hypercoagulability in sickle cell disease.

Sickle cell disease (SCD) is one of the most common inherited single gene disorders. Polymerisation of sickle hemoglobin results in erythrocytes that are inflexible and adherent, leading to coagulation, vascular and cellular activation and resultant blood vessel blockage. Previous studies have observed elevated numbers of red cell-derived particles (RCDP), also denoted extracellular vesicles, in SCD plasma. Here, imaging flow cytometry was used to quantify all RCDP in SCD plasma. A more heterogenous population of RCDP was observed than previously reported. Significantly, large right side-out red cell macrovesicles (MaV), 7 µm in diameter, were identified. Most RCDP were right side-out but a minor population of inside-out vesicles was also present. Electron micrographs confirmed the heterogenous nature of the RCDP detected. All MaV are decorated with prothrombotic phosphatidylserine (PS) and their removal from plasma lengthened clotting times by more than three-fold. Removal of all right side-out RCDP from SCD patient plasma samples resulted in a seven-fold increase in clotting time. These results indicate that MaV comprise a large area of prothrombotic membrane and are thus major contributors to hypercoagulation in SCD. Consequently, controlled removal of MaV and PS exposed RCDP from plasma could provide a novel therapy for managing this disease.

Communal Innovations: Inspiring Neighborhoods of Hope and Advocacy.

Innovations promise a better future, which may generate feelings of hope and inspire advocacy. Some innovations are more communal in nature: attempting to address a social problem, through community engagement and wide-spread adoption. For such innovations, the social processes that involve collective aspects of community life may play important roles in fostering hope and interpersonal advocacy. This study uses communication infrastructure theory and discrete emotions theory to investigate hope and advocacy within a field trial for a salient, visible, community-bound innovation to reduce transmission of malaria. Heads of households in one community (N = 119) in West Africa were interviewed. Results showed that innovation hope was predicted by appraisals of innovation attributes. Better appraisals of the innovation's attributes, greater perceived collective efficacy, and recent malaria illness predicted more innovation advocacy. The spatial analysis showed that innovation advocacy was geographically clustered within the community, but hope was not. The implications for theory and practice are discussed.

Precise Persuasion: Investigating Incentive Appeals for the Promotion of Antibiotic Stewardship with Message-induced Transitions.

Two different lines of research-interpersonal resistance and public campaign design-lead us to consider the use of incentive appeals to motivate behavior change, with a call for greater attention to and use of positive incentives. This study tests the potential to promote antibiotic stewardship through microbiome benefits. In addition, multiple analyses were used: A causal analysis allowed us to identify what moved (e.g., which beliefs and intentions), a latent transition analysis allowed us to reveal who moved (targets, nontargets, or both), and a Markov model allowed us to estimate the stable state of these moves or, in other words, where and how the repetition of the messages would ultimately lead in terms of transitions from state to state. An experiment (N = 298), grounded in the context of antibiotic stewardship, showed that incentive appeals moved people with problematic patterns of past behavior (categorized as Persuaders, Stockers, and Dissenters) to positive patterns of behavioral intentions (categorized as Stewards). The causal analysis, latent class analysis, and equilibrium values for the separate transition matrices showed the relative benefit for a message that highlighted the health and wellness benefits of the microbiome. Implications for persuasion theory and practice are discussed.