Mobile health technology as a solution to self-control problems: The behavioral impact of COVID-19 contact tracing apps in Japan.

RATIONALE: Mobile technology has been widely utilized as an effective healthcare tool during the COVID-19 pandemic. Notably, over 50 countries have released contact-tracing apps to trace and contain infection chains. While earlier studies have examined obstacles to app uptake and usage, whether and how this uptake affects users' behavioral patterns is not well understood. This is crucial because uptake can theoretically increase or decrease behavior that carries infection risks. OBJECTIVE: The goal of this study is to evaluate the impact of app uptake on the time spent out of home in Japan. It tests four potential underlying mechanisms that drive the uptake effect: compliance with stay-at-home requirements, learning about infection risk, reminders, and commitment device. METHOD: We use unique nationwide survey data collected from 4,379 individuals aged between 20 and 69 in December 2020 and February 2021 in Japan. Japan has features suitable for this exercise. The Japanese government released a contact tracing app in June 2020, which sends a warning message to users who have been in close contact with an infected person. We conduct a difference-in-differences estimation strategy combined with the entropy balancing method. RESULTS: App uptake reduces the time spent out of home. Sensitivity analysis shows that it cannot be explained by unobserved confounders. Importantly, the impact is large even among users who have not received a warning message from the app, and even larger for those with poor self-control ability. Furthermore, individuals' self-control ability is negatively associated with the uptake decision, supporting our hypothesis that the apps serve as a commitment device. CONCLUSIONS: It may be beneficial to encourage citizens to uptake contact tracing apps and other forms of commitment devices. This study also contributes to the literature on mobile health (mHealth) by demonstrating its efficacy as a commitment device.

Vaccination and altruism under the COVID-19 pandemic.

OBJECTIVES: The goal of this study is to examine the role of altruism and sensitivity to public shame in individuals' willingness to pay for a COVID-19 vaccine. STUDY DESIGN: We apply expected utility theory to predict the role of individuals' altruism and public shame in the willingness to pay for vaccines. Subsequently, we test the prediction by using a unique cross-sectional survey. METHODS: We use online survey data collected from those aged 30-49 in Japan between June 18th and 25th, 2020 (n = 1686). The selection of respondents follows quota sampling with regard to age group, gender, and prefecture of residence. We employ an ordinary least square (OLS) model to regress respondents' willingness to pay for a hypothetically-effective vaccine for COVID-19 on binary indicators of altruism and sensitivity to public shame, as well as socio-demographic characteristics. RESULTS: The willingness to pay for the vaccine is higher among those with stronger altruistic concerns and sensitivity to shaming. CONCLUSION: Voluntary vaccinations may be inefficient, because the uptake of vaccines could be low for selfish individuals who often violate social distancing requirements. To improve the efficiency of vaccine uptake, some interventions, such as nudges and a vaccine passport, may be needed.

Social media infodemics and social distancing under the COVID-19 pandemic: public good provisions under uncertainty.

This debate examines the impact of infodemics - an over-abundance of information - on social distancing during the COVID-19 pandemic. Because of its external effects, social distancing behavior (SDB) shares fundamental properties with public goods, whose potential for undersupply has been examined extensively in the social sciences. Although the negative effects of infodemics have been emphasized by governments and international organizations, theoretical models suggest that infodemics may work as a mitigation mechanism. That is, infodemics may enhance people's SDBs. Based on original survey data, we show that media exposure can positively increase SDB. We conclude by discussing two public health implications. First, the media plays an important role in motivating SDB. Second, even if infodemics can increase SDB, we must be wary of their ability to pose other, non-negligible dangers.

Prosociality and the Uptake of COVID-19 Contact Tracing Apps: Survey Analysis of Intergenerational Differences in Japan.

BACKGROUND: To control the COVID-19 pandemic, it is essential to trace and contain infection chains; for this reason, policymakers have endorsed the usage of contact tracing apps. To date, over 50 countries have released such apps officially or semiofficially, but those that rely on citizens' voluntary uptake suffer from low adoption rates, reducing their effectiveness. Early studies suggest that the low uptake is driven by citizens' concerns about security and privacy, as well as low perceptions of infection risk and benefits from the usage. However, these do not explore important generational differences in uptake decision or the association between individuals' prosociality and uptake. OBJECTIVE: The objective of our study was to examine the role of individuals' prosociality and other factors discussed in the literature, such as perceived risk and trust in government, in encouraging the usage of contact tracing apps in Japan. We paid particular attention to generational differences. METHODS: A web-based survey was conducted in Japan 6 months after the release of a government-sponsored contact tracing app. Participants were recruited from individuals aged between 20 and 69 years. Exploratory factor analyses were conducted to measure prosociality, risk perception, and trust in government. Logistic regression was used to examine the association between these factors and uptake. RESULTS: There was a total of 7084 respondents, and observations from 5402 respondents were used for analysis, of which 791 respondents (14.6%) had ever used the app. Two factors of prosociality were retained: agreeableness and attachment to the community. Full-sample analysis demonstrated app uptake was determined by agreeableness, attachment to the community, concern about health risks, concern about social risks, and trust in the national government; however, important differences existed. The uptake decision of respondents aged between 20 and 39 years was attributed to their attachment to the community (odds ratio [OR] 1.28, 95% CI 1.11-1.48). Agreeable personality (OR 1.18, 95% CI 1.02-1.35), concern about social risk (OR 1.17, 95% CI 1.02-1.35), and trust in national government (OR 1.16, 95% CI 1.05-1.28) were key determinants for those aged between 40 and 59 years. For those aged over 60 years, concerns about health risks determined the uptake decision (OR 1.49, 95% CI 1.24-1.80). CONCLUSIONS: Policymakers should implement different interventions for each generation to increase the adoption rate of contact tracing apps. It may be effective to inform older adults about the health benefits of the apps. For middle-age adults, it is important to mitigate concerns about security and privacy issues, and for younger generations, it is necessary to boost their attachment to their community by utilizing social media and other web-based network tools.

The bright and dark sides of social media usage during the COVID-19 pandemic: Survey evidence from Japan.

The spread of misinformation on the internet regarding the COVID-19 pandemic, such as unproven or fake cures, has been a serious concern. However, the extent to which social media usage affects individuals' health behavior, particularly when reliable information is scarce, is not well understood. This study evaluates the impact of social media usage on individuals' responses to the COVID-19 pandemic, such as demand for necessities and social distancing. We conduct an original online survey of 1804 Japanese respondents in March 2020. Japan is suitable because it confirmed COVID-19 cases earlier than most other countries. Scientific evidence about the coronavirus and protective measures was scarce in the initial pandemic phase, despite the spread of unconfirmed rumors. Our analysis focuses on the usage of Twitter, Facebook, and Instagram. We use the entropy balancing method to control for heterogeneity in observed characteristics between social media users and non-users. The results show that while users are more likely to maintain social distancing practices, they are also more likely to take measures whose reliability is not scientifically confirmed, such as eating fermented soybeans. Although previous studies emphasize the negative effects of social media, our results suggest that it has both bright and dark sides.