Evaluating the effect of infographics on public recall, sentiment and willingness to use face masks during the COVID-19 pandemic: a randomised internet-based questionnaire study.

BACKGROUND: The use of face masks remains contentious, with international variation in practice. Their prevalence in the UK, is likely to increase due to new legislation. Clear information regarding the appropriate use of masks is needed, to ensure compliance with policies to reduce transmission of COVID-19. We aimed to assess the impact of visual representations of guidance, or infographics, upon the knowledge of appropriate face mask usage in a representative UK cohort. METHODS: Adult patients were recruited to this randomised internet-based questionnaire study during the 12-14 May 2020 from across the UK. Respondents viewed one of five public health stimuli regarding the use of face masks, or no stimulus. The groups accessed aids by the European Centre for Disease Control (EUCDC), World Health Organisation (WHO), Singaporean Ministry of Health (SMOH), text from the UK government (UK Gov), or an infographic designed by the Behavioural Insights Team (BIT). The primary outcome was to evaluate the effect of each infographic upon participants' recall of face mask technique, sentiments and willingness to wear a face covering. Secondary outcomes included the effect of symptomology and socio-demographic factors. RESULTS: 4099 respondents were randomised (1009 control, 628 EUCDC, 526 WHO, 639 SMOH, 661 UKGOV and 606 BIT). Stimuli from the WHO, SMOH and BIT demonstrated significantly higher average recall scores compared to the controls (7.40 v. 7.38 v. 7.34 v. 6.97, P < 0.001). BIT's stimulus led to the highest confidence about mask-wearing (87%). Only 48.2% of the cohort felt stimuli reduced anxiety about COVID-19. However, willingness to use a mask was high, (range 84 to 88%). CONCLUSIONS: To ensure the appropriate use of masks, as mandated by UK law, guidance must provide sufficient information, yet remain understandable. Infographics can aid the recall of correct mask techniques by highlighting salient steps and reducing cognitive burden. They have also demonstrated greater trustworthiness than text-only guidance. The effect of infographics upon COVID-19-related anxiety was poor, and they should be further developed to address this sentiment. A willingness to wear face masks has, however, been demonstrated.

Genetic and environmental correlations between subjective wellbeing and experience of life events in adolescence.

Some life events appear heritable due to the genetic influence on related behaviours. Shared genetic influence between negative behaviours and negative life events has previously been established. This study investigated whether subjective wellbeing and positive life events were genetically associated. Participants in the Twins Early Development Study (aged 16.32 ± .68 years) completed subjective wellbeing and life events assessments via two separate studies (overlapping N for wellbeing and life events measures ranged from 3527 to 9350). We conducted bivariate twin models between both positive and negative life events with subjective wellbeing and related positive psychological traits including subjective happiness, life satisfaction, optimism, hopefulness and gratitude measured at 16 years. Results suggested that the heritability of life events can partially be explained by shared genetic influences with the wellbeing indicators. Wellbeing traits were positively genetically correlated with positive life events and negatively correlated with negative life events (except curiosity where there was no correlation). Those positive traits that drive behaviour (grit and ambition) showed the highest genetic correlation with life events, whereas the reflective trait gratitude was less correlated. This suggests that gene-environment correlations might explain the observed genetic association between life events and wellbeing. Inheriting propensity for positive traits might cause you to seek environments that lead to positive life events and avoid environments which make negative life events more likely.

Exploring the Genetic Etiology of Trust in Adolescents: Combined Twin and DNA Analyses.

Behavioral traits generally show moderate to strong genetic influence, with heritability estimates of around 50%. Some recent research has suggested that trust may be an exception because it is more strongly influenced by social interactions. In a sample of over 7,000 adolescent twins from the United Kingdom's Twins Early Development Study, we found broad sense heritability estimates of 57% for generalized trust and 51% for trust in friends. Genomic-relatedness-matrix restricted maximum likelihood (GREML) estimates in the same sample indicate that 21% of the narrow sense genetic variance can be explained by common single nucleotide polymorphisms for generalized trust and 43% for trust in friends. As expected, this implies a large amount of unexplained heritability, although power is low for estimating DNA-based heritability. The missing heritability may be accounted for by interactions between DNA and the social environment during development or via gene-environment correlations with rare variants. How these genes and environments correlate seem especially important for the development of trust.

Correction: The impact of believing you have had COVID-19 on self-reported behaviour: Cross-sectional survey.

[This corrects the article DOI: 10.1371/journal.pone.0240399.].

Effect of alcohol label designs with different pictorial representations of alcohol content and health warnings on knowledge and understanding of low-risk drinking guidelines: a randomized controlled trial.

BACKGROUND AND AIMS: The UK low-risk drinking guidelines (LRDG) recommend not regularly drinking more than 14 units of alcohol per week. We tested the effect of different pictorial representations of alcohol content, some with a health warning, on knowledge of the LRDG and understanding of how many drinks it equates to. DESIGN: Parallel randomized controlled trial. SETTING: On-line, 25 January-1 February 2019. PARTICIPANTS: Participants (n = 7516) were English, aged over 18 years and drink alcohol. INTERVENTIONS: The control group saw existing industry-standard labels; six intervention groups saw designs based on: food labels (serving or serving and container), pictographs (servings or containers), pie charts (servings) or risk gradients. A total of 500 participants (~70 per condition) saw a health warning under the design. MEASUREMENTS: Primary outcomes: (i) knowledge: proportion who answered that the LRDG is 14 units; and (ii) understanding: how many servings/containers of beverages one can drink before reaching 14 units (10 questions, average distance from correct answer). FINDINGS: In the control group, 21.5% knew the LRDG; proportions were higher in intervention groups (all P < 0.001). The three best-performing designs had the LRDG in a separate statement, beneath the pictograph container: 51.1% [adjusted odds ratio (aOR) = 3.74, 95% confidence interval (CI) = 3.08-4.54], pictograph serving 48.8% (aOR = 4.11, 95% CI = 3.39-4.99) and pie-chart serving, 47.5% (aOR = 3.57, 95% CI = 2.93-4.34). Participants underestimated how many servings they could drink: control mean = -4.64, standard deviation (SD) = 3.43; intervention groups were more accurate (all P < 0.001), best performing was pictograph serving (mean = -0.93, SD = 3.43). Participants overestimated how many containers they could drink: control mean = 0.09, SD = 1.02; intervention groups overestimated even more (all P < 0.007), worst-performing was food label serving (mean = 1.10, SD = 1.27). Participants judged the alcohol content of beers more accurately than wine or spirits. The inclusion of a health warning had no statistically significant effect on any measure. CONCLUSIONS: Labels with enhanced pictorial representations of alcohol content improved knowledge and understanding of the UK's low-risk drinking guidelines compared with industry-standard labels; health warnings did not improve knowledge or understanding of low-risk drinking guidelines. Designs that improved knowledge most had the low-risk drinking guidelines in a separate statement located beneath the graphics.

'Immunity Passports' for SARS-CoV-2: an online experimental study of the impact of antibody test terminology on perceived risk and behaviour.

OBJECTIVE: To assess the impact of describing an antibody-positive test result using the terms Immunity and Passport or Certificate, alone or in combination, on perceived risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and protective behaviours. DESIGN: 2×3 experimental design. SETTING: Online. PARTICIPANTS: 1204 adults from a UK research panel. INTERVENTION: Participants were randomised to receive one of six descriptions of an antibody test and results showing SARS-CoV-2 antibodies, differing in the terms describing the type of test (Immunity vs Antibody) and the test result (Passport vs Certificate vs Test). MAIN OUTCOME MEASURES: Primary outcome: proportion of participants perceiving no risk of infection with SARS-CoV-2 given an antibody-positive test result. Other outcomes include: intended changes to frequency of hand washing and physical distancing. RESULTS: When using the term Immunity (vs Antibody), 19.1% of participants (95% CI 16.1% to 22.5%) (vs 9.8% (95% CI 7.5% to 12.4%)) perceived no risk of catching coronavirus given an antibody-positive test result (adjusted OR (AOR): 2.91 (95% CI 1.52 to 5.55)). Using the terms Passport or Certificate-as opposed to Test-had no significant effect (AOR: 1.24 (95% CI 0.62 to 2.48) and AOR: 0.96 (95% CI 0.47 to 1.99) respectively). There was no significant interaction between the effects of the test and result terminology. Across groups, perceiving no risk of infection was associated with an intention to wash hands less frequently (AOR: 2.32 (95% CI 1.25 to 4.28)); there was no significant association with intended avoidance of physical contact (AOR: 1.37 (95% CI 0.93 to 2.03)). CONCLUSIONS: Using the term Immunity (vs Antibody) to describe antibody tests for SARS-CoV-2 increases the proportion of people believing that an antibody-positive result means they have no risk of catching coronavirus in the future, a perception that may be associated with less frequent hand washing. TRIAL REGISTRATION NUMBER: Open Science Framework: https://osf.io/tjwz8/files/.

The impact of believing you have had COVID-19 on self-reported behaviour: Cross-sectional survey.

OBJECTIVES: To investigate whether people who think they have had COVID-19 are less likely to report engaging with lockdown measures compared with those who think they have not had COVID-19. DESIGN: On-line cross-sectional survey. SETTING: Data were collected between 20th and 22nd April 2020. PARTICIPANTS: 6149 participants living in the UK aged 18 years or over. MAIN OUTCOME MEASURES: Perceived immunity to COVID-19, self-reported adherence to social distancing measures (going out for essential shopping, nonessential shopping, and meeting up with friends/family; total out-of-home activity), worry about COVID-19 and perceived risk of COVID-19 to oneself and people in the UK. Knowledge that cough and high temperature / fever are the main symptoms of COVID-19. We used logistic regression analyses and one-way ANOVAs to investigate associations between believing you had had COVID-19 and binary and continuous outcomes respectively. RESULTS: In this sample, 1493 people (24.3%) thought they had had COVID-19 but only 245 (4.0%) reported having received a positive test result. Reported test results were often incongruent with participants' belief that they had had COVID-19. People who believed that they had had COVID-19 were: more likely to agree that they had some immunity to COVID-19; less likely to report adhering to lockdown measures; less worried about COVID-19; and less likely to know that cough and high temperature / fever are two of the most common symptoms of COVID-19. CONCLUSIONS: At the time of data collection, the percentage of people in the UK who thought they had already had COVID-19 was about twice the estimated infection rate. Those who believed they had had COVID-19 were more likely to report leaving home. This may contribute to transmission of the virus. Clear communications to this growing group are needed to explain why protective measures continue to be important and to encourage sustained adherence.

Social support and mental health in late adolescence are correlated for genetic, as well as environmental, reasons.

Late adolescence is a crucial, but underexplored, developmental stage with respect to the aetiology of social support. These individuals are experiencing many major life changes and social support can help them adjust to the associated environmental stressors of this time. Using 1,215 18-year-old twin pairs from the Twins Early Development Study, we collected measures of two indices of support: support quality and support quantity, as well as wellbeing and depression. Both support indices were moderately heritable (55% and 49%, respectively), an interesting finding given the many environmental changes that late adolescents are encountering that could be environmentally altering their social network structures. Finding a genetic influence on support suggests the presence of gene-environment correlation whereby individuals create and perceive their supportive environment based upon their genetic predispositions. Shared genetic influences mediated the moderate phenotypic correlation (mean r = 0.46) between support and mental health. Genetic correlations were higher between support quality and mental health (mean rA = 0.75), than between support quantity and mental health (mean rA = 0.54), reflecting the phenotypic pattern. This suggests that interventions should focus more on making late adolescents aware of the support quality around them than encouraging them to increase their social network size.