Influence of Health Beliefs on Adherence to COVID-19 Preventative Practices: International, Social Media-Based Survey Study.

BACKGROUND: Health behavior is influenced by culture and social context. However, there are limited data evaluating the scope of these influences on COVID-19 response. OBJECTIVE: This study aimed to compare handwashing and social distancing practices in different countries and evaluate practice predictors using the health belief model (HBM). METHODS: From April 11 to May 1, 2020, we conducted an online, cross-sectional survey disseminated internationally via social media. Participants were adults aged 18 years or older from four different countries: the United States, Mexico, Hong Kong (China), and Taiwan. Primary outcomes were self-reported handwashing and social distancing practices during COVID-19. Predictors included constructs of the HBM: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Associations of these constructs with behavioral outcomes were assessed by multivariable logistic regression. RESULTS: We analyzed a total of 71,851 participants, with 3070 from the United States, 3946 from Mexico, 1201 from Hong Kong (China), and 63,634 from Taiwan. Of these countries, respondents from the United States adhered to the most social distancing practices (χ23=2169.7, P<.001), while respondents from Taiwan performed the most handwashing (χ23=309.8, P<.001). Multivariable logistic regression analyses indicated that self-efficacy was a positive predictor for handwashing (odds ratio [OR]United States 1.58, 95% CI 1.21-2.07; ORMexico 1.5, 95% CI 1.21-1.96; ORHong Kong 2.48, 95% CI 1.80-3.44; ORTaiwan 2.30, 95% CI 2.21-2.39) and social distancing practices (ORUnited States 1.77, 95% CI 1.24-2.49; ORMexico 1.77, 95% CI 1.40-2.25; ORHong Kong 3.25, 95% CI 2.32-4.62; ORTaiwan 2.58, 95% CI 2.47-2.68) in all countries. Handwashing was positively associated with perceived susceptibility in Mexico, Hong Kong, and Taiwan, while social distancing was positively associated with perceived severity in the United States, Mexico, and Taiwan. CONCLUSIONS: Social media recruitment strategies can be used to reach a large audience during a pandemic. Self-efficacy was the strongest predictor for handwashing and social distancing. Policies that address relevant health beliefs can facilitate adoption of necessary actions for preventing COVID-19. Our findings may be explained by the timing of government policies, the number of cases reported in each country, individual beliefs, and cultural context.

Development and Validation of Age-Specific Resilience Instruments for Early Childhood Assessment: A Taiwan Birth Cohort Study.

BACKGROUND: We sought to develop and validate age-specific instruments for measuring early childhood resilience at ages 3, 5 and 8 in the Taiwan Birth Cohort Study, a national longitudinal study. METHODS: Using data from 18,553 mother-infant pairs, we conducted exploratory factor analysis (EFA) on a simple random half of our sample. We then used the remaining half of these data for confirmatory factor analysis (CFA) to further assess the fit of 3 CFA models (ie, first-order, second-order, and bifactor). Psychometric properties, distributions, and inter-item and inter-factor correlations of each instrument were also evaluated. RESULTS: EFA and CFA showed that the bifactor model of resilience (which included a general resilience factor and 5 specific factors) had the best fit for all 3 resilience scales, with 19 items at year 3, 18 items at year 5, and 19 items at year 8. All 3 resilience scales showed good psychometric properties, including construct validity, internal consistency, and normal distributions. For predictive validity, we found that in the face of adversity (measured by the High Risk Family Score), individuals with high resilience scores at age 3 had better general health scores at ages 3, 5, and 8 compared to those with low resilience scores. CONCLUSIONS: We describe the development and validation of age-appropriate survey instruments to assess resilience in young children at the population level. These instruments can be used to better understand how resilience can impact child health over time, and to identify key factors that can foster resilience.

Prospective Pilot Study Evaluating SARS-CoV-2 Transmission-Limiting Measures in an On-Site School.

OBJECTIVES: The purpose of our study is to evaluate the feasibility and reliability of a comprehensive set of preventive measures in limiting secondary transmission of COVID-19 in schools. METHODS: A prospective cohort study was conducted to evaluate SARS-CoV-2 transmission in an independent K-8 school in San Mateo County, California. The research was conducted between September 14, 2020 through March 22, 2021 and consisted of: 1) demographic and epidemiological questionnaires; 2) daily symptom reporting; 3) weekly RT-PCR testing; and 4) periodic on-site qualitative observations. RESULTS: One hundred eighty (79%) students and 63 (74%) on-site staff/contractors were enrolled. Participants reported symptoms in 144 (<1%) daily surveys of the 19,409 collected. Among those who reported symptoms and exposures, none tested positive during the 22-week study period. Of all participants, a total of 6 tested positive for SARS-CoV-2 at least once by RT-PCR; all were asymptomatic at time of testing. No in-school transmission occurred. Mask adherence was high among all grades, and incidents of improper mask use mostly occurred during noninstruction time. Physical distancing was well-enforced during class time and snack breaks, although adherence during noninstruction time waned as the school year progressed. CONCLUSIONS: Our comprehensive, prospective study following COVID-19 transmission over 22 weeks in a K-8 school demonstrates that: 1) surveillance testing is important for detecting asymptomatic infections in schools; 2) monitoring symptoms may not be necessary and/or sufficient for COVID-19; and 3) younger children can adhere to key mitigation measures (eg, masking) which have the potential to limit transmission.

Feasibility of Specimen Self-collection in Young Children Undergoing SARS-CoV-2 Surveillance for In-Person Learning.

Importance: There is an urgent need to assess the feasibility of COVID-19 surveillance measures in educational settings. Objective: To assess whether young children can feasibly self-collect SARS-CoV-2 samples for surveillance testing over the course of an academic year. Design, Setting, and Participants: This prospective pilot cohort study was conducted from September 10, 2020, to June 10, 2021, at a K-8 school in San Mateo County, California. The research consisted of quantitative data collection efforts: (1) demographic data collected, (2) student sample self-collection error rates, and (3) student sample self-collection time durations. Students were enrolled in a hybrid learning model, a teaching model in which students were taught in person and online, with students having the option to attend virtually as needed. Data were collected under waiver of consent from students participating in weekly SARS-CoV-2 testing. Main Outcomes and Measures: Errors over time for self-collection of nasal swabs such as contaminated swabs and inadequate or shallow swabbing; time taken for sample collection. Results: Of 296 participants, 148 (50.0%) were boys and 148 (50.0%) were girls. A total of 87 participants (29.2%) identified as Asian; 2 (0.6%), Black or African American; 13 (4.4%), Hispanic/Latinx; 103 (34.6%), non-Hispanic White; 87 (29.2%), multiracial; and 6 (2.0%), other. The median school grade was fourth grade. From September 2020 to March 2021, a total of 4203 samples were obtained from 221 students on a weekly basis, while data on error rates were collected. Errors occurred in 2.7% (n = 107; 95% CI, 2.2%-3.2%) of student encounters, with the highest rate occurring on the first day of testing (20 [10.2%]). There was an overall decrease in error rates over time. From April to June 2021, a total of 2021 samples were obtained from 296 students on a weekly basis while data on encounter lengths were collected. Between April and June 2021, 193 encounters were timed. The mean duration of each encounter was 70 seconds (95% CI, 66.4-73.7 seconds). Conclusions and Relevance: Mastery of self-collected lower nasal swabs is possible for children 5 years and older. Testing duration can be condensed once students gain proficiency in testing procedures. Scalability for larger schools is possible if consideration is given to the resource-intensive nature of the testing and the setting's weather patterns.

Theory-Based Health Behavior Interventions for Pediatric Chronic Disease Management: A Systematic Review.

Importance: Pediatric chronic conditions have become a major public health challenge, and behavioral change plays an important role in overcoming this problem. Many health behavior interventions are described as theory-based, but evidence that such programs properly use theoretical constructs is scant. Objective: To identify effective theory-based behavioral interventions that motivate patients and families to adopt better self-management behaviors for chronic disease, to review theoretical constructs from each theory and identify the common elements for action, and to rate the level of evidence for each theory-based chronic disease intervention. Evidence Review: Medline and PsycINFO electronic databases were searched for relevant randomized clinical trial articles published between January 1, 2000, and June 30, 2016, with English language and article type restrictions. These articles reported original data on children and young adults aged 21 years or younger, measured interventions for a pediatric chronic health problem, and assessed the association between interventions and health behavior, knowledge, and outcomes. The Jadad scale was used to evaluate the methods of each article. Articles that explicitly identified the theoretical basis for the intervention and scored 3 points or higher on the Jadad scale were included in the final analysis. Findings: The database search yielded a total of 36 187 articles, from which duplicates and those that did not meet the inclusion criteria were eliminated, leaving 129 studies for the full review. Of the 129 studies, 29 (22.5%) had higher Jadad scale scores of 3 or 4 points and underwent the final detailed data abstraction and qualitative synthesis. Five chronic conditions were represented, including asthma (55% [16 of 29]), type 1 diabetes (21% [6 of 29]), obesity (14% [4 of 29]), attention-deficit/hyperactivity disorder (7% [2 of 29]), and autistic spectrum disorder (3% [1 of 29]). Most studies (55% [16 of 29]) used Social Cognitive Theory as the theoretical basis for intervention. The following intervention outcomes were reported: 23 (80%) saw a positive association with health-related behaviors (eg, adherence), 8 (28%) with knowledge, 7 (24%) with attitudes, and 26 (90%) with clinical outcomes. Ten studies (34%) showed results in both health behaviors and health outcomes. Twenty-two studies (76%) demonstrated short-term effects (within 6 months), whereas 12 (41%) reported longer-term changes. Conclusions and Relevance: Identifying effective theory-based behavioral interventions can empower those who are involved in the care of children and young adults with chronic conditions.