Using the precaution adoption process model to understand decision-making about the COVID-19 booster vaccine in England.

BACKGROUND: COVID-19 continues to pose a threat to public health. Booster vaccine programmes are critical to maintain population-level immunity. Stage theory models of health behaviour can help our understanding of vaccine decision-making in the context of perceived threats of COVID-19. PURPOSE: To use the Precaution Adoption Process Model (PAPM) to understand decision-making about the COVID-19 booster vaccine (CBV) in England. METHODS: An online, cross-sectional survey informed by the PAPM, the extended Theory of Planned Behaviour and Health Belief Model administered to people over the age of 50 residing in England, UK in October 2021. A multivariate, multinomial logistic regression model was used to examine associations with the different stages of CBV decision-making. RESULTS: Of the total 2,004 participants: 135 (6.7%) were unengaged with the CBV programme; 262 (13.1%) were undecided as to whether to have a CBV; 31 (1.5%) had decided not to have a CBV; 1,415 (70.6%) had decided to have a CBV; and 161 (8.0%) had already had their CBV. Being unengaged was positively associated with beliefs in their immune system to protect against COVID-19, being employed, and low household income; and negatively associated with CBV knowledge, a positive COVID-19 vaccine experience, subjective norms, anticipated regret of not having a CBV, and higher academic qualifications. Being undecided was positively associated with beliefs in their immune system and having previously received the Oxford/AstraZeneca (as opposed to Pfizer/BioNTech) vaccine; and negatively associated with CBV knowledge, positive attitudes regarding CBV, a positive COVID-19 vaccine experience, anticipated regret of not having a CBV, white British ethnicity, and living in East Midlands (vs London). CONCLUSIONS: Public health interventions promoting CBV may improve uptake through tailored messaging directed towards the specific decision stage relating to having a COVID-19 booster.

A comparison of seasonal influenza and novel Covid-19 vaccine intentions: A cross-sectional survey of vaccine hesitant adults in England during the 2020 pandemic.

We compared intention to receive the seasonal influenza vaccine with a prospective coronavirus (COVID-19) vaccine among undecided or COVID-19 vaccine hesitant individuals to better understand the underlying differences and similarities in factors associated with vaccine intention. We delivered a cross-sectional online survey in October-November 2020. We included psychological constructs and sociodemographic variables informed by theory. We conducted pairwise comparisons and multiple linear regression models to explore associations between vaccine intention and psychological constructs. We recruited 1,660 participants, where 47.6% responded that they would likely receive the influenza vaccine, 31.0% that they would probably not accept the vaccination and 21.4% were unsure. In relation to the prospective COVID-19 vaccine, 39.0% responded that they would likely receive the vaccination, 23.7% that they would probably not accept the vaccination and 37.3% were unsure. Unique factors positively associated with COVID-19 vaccine intention were: perceived knowledge sufficiency about vaccine safety, beliefs about vaccine safety, and living in an area of low deprivation. The only unique factor positively associated with influenza intention was past influenza behavior. The strongest common predictors positively associated with intention were: favorable vaccine attitudes, the anticipated regret they may feel following infection if they were not to receive a vaccine, and the expectation from family or friends to accept the vaccine. Despite overall similarities in those factors associated with vaccination intention, we identified unique influences on intention. This additional insight will help support the planning and tailoring of future immunizations programmes for the respective viruses.

Changes in children's physical fitness, BMI and health-related quality of life after the first 2020 COVID-19 lockdown in England: A longitudinal study.

We aimed to assess one-year changes in physical fitness, health-related quality of life (HRQoL) and body mass index (BMI), encompassing the 2020 COVID-19 UK lockdowns. Data were collected (October 2019, November 2020) from 178 8-10-year-olds in Newcastle-upon-Tyne, England, 85% from England's most deprived quintile. Twenty-metre shuttle run test performance (20mSRT), handgrip strength (HGS), standing broad jump (SBJ), sit-and-reach, height, body mass, HRQoL (Kidscreen-27 questionnaire) and sports club participation were measured. BMI z-scores and overweight/obesity were calculated (≥85th centile). Paired t-tests and linear regression assessed change, adjusting for baseline BMI. Significant (p<0.001) changes were observed: increases in mean BMI (+1.5kg·m-2), overweight/obesity (33% to 47%), SBJ (+6.8cm) and HGS (+1.5kg); decreases in 20mSRT performance (-3 shuttles), sit-and-reach (-1.8cm). More children at follow-up were categorized "very low" for 20mSRT performance (35% baseline v 51%). Increased BMI z-score was associated with decreased "Physical Wellbeing" HRQoL. Follow-up sports club participation was associated with better 20mSRT performance (p=0.032), and "Autonomy & Parents" (p=0.011), "Social Support & Peers" (p=0.038) HRQoL. Children's 20mSRT performance and BMI changed adversely over one year; national lockdowns potentially made negative contributions. Physical fitness, physical activity and sports programmes should be part of children's physical and mental recovery from the pandemic.

Factors associated with vaccine intention in adults living in England who either did not want or had not yet decided to be vaccinated against COVID-19.

Early studies showed that 28-36% of UK adults were unsure or unwilling to be vaccinated against COVID-19. We wanted to identify which socio-demographic, socio-economic, personal health and psychological factors were associated with COVID-19 vaccine intentions (CVI) in adults living in England who did not want, yet to consider, or not sure whether to vaccinate. In October/November 2020, prior to vaccine availability, we surveyed adults stratified by gender, region, and deprivation, with additional purposive sampling of those aged 50 and over and those from an ethnic minority. Two hundred and ten did not want; 407 had yet to consider; and 1,043 were not sure whether to be vaccinated. Factors positively associated with CVI were: favorable vaccine views, trust in institutions associated with vaccine approval, vaccine subjective norms, anticipated regret of not having a vaccine, perceived vaccine benefits, perceived safety knowledge sufficiency, and a history of having an influenza vaccine. Factors negatively associated were: anti-lockdown views, and being a health or social care worker. Whilst showing significant relationships with CVI when analyzed in isolation, neighborhood deprivation and ethnicity did show an independent relationship to intention when all study measures were controlled for. Our findings suggest vaccine promotion focusing on the anticipated regret of not having a vaccine, the benefits of a mass COVID-19 immunization program, and the safety of a vaccine whilst ensuring or engendering trust in those bodies that brand a campaign may be most supportive of COVID-19 vaccine uptake.

How to support COVID-19 vaccine uptake in those that are either undecided or more resistant to receiving a vaccine in England? Content analysis of survey open text responses

BackgroundAs of 15 February 2021, over 20 million people in England have received their first dose of a COVID-19 vaccine. Population-level immunological protection requires the large majority to be vaccinated, though given the spread of misinformation and vaccine hesitancy concerns, this may be challenging. Therefore, this study aimed to elicit from those either undecided or more resistant to having a COVID-19 vaccine, what would make them more likely to have a vaccine when made available to them.MethodsIn October/November 2020 we delivered an online population-wide survey of COVID-19 vaccine intention in England. Sampling was stratified by gender, geographical region, and deprivation, with additional purposive sampling of those from an ethnic minority background. An open question ‘What might make it more likely that you, your family, or friends would have a coronavirus vaccine when one is ready?’ was included. We used content analysis to identify and code emergent themes.ResultsWe recruited 1660 participants, who did not want (210), had yet to consider (407), or were not sure (1043) whether to be vaccinated. Of these: 946 (57%) were female, 363 (22%) were of an ethnic minority, and 453 (27%) lived in the lowest three Index of Multiple Deprivation (small area deprivation statistic) deciles. We received 922 (56%) open-text responses, with 733 (44%) detailing at least one factor that would increase their likelihood of receiving a vaccine. The most common concerns expressed was the safety and efficacy of a vaccine, particularly potential side-effects. Participants wanted to see the evidence that supported vaccine approval as many were worried about how quickly vaccines had been developed. Distrust in the Government, specific ministers, and the pharmaceutical companies was a consideration. Some stipulated that it would take mandating for them to have a vaccine. Others wanted it to be free and easy to access. The broader implications of an immunisation programme were of interest, participants wanted to know if the vulnerable would be prioritised and protected and that restrictive conditions would be removed enabling them to engage in a greater range of social activities.ConclusionPromotional campaigns that focus on COVID-19 vaccine safety and effectiveness, should be prioritised. Provision of accessible comprehendible information that accurately and transparently reports the findings from COVID-19 vaccine trials through a trusted source will be required. Contextualising how vaccines will support the ending of the pandemic and increasing personal and population benefits will be of value.

Evaluating the impact of planning guidance on the food environment, health outcomes, and inequalities: a quasi-experimental analysis using longitudinal data for a local authority in the North East of England

BackgroundIn light of the Covid-19 pandemic, the government has prioritised reducing obesity rates. Many local authorities have employed planning guidance to manage the local food environment and promote a healthy environment. There is a lack of evidence on the effectiveness of this type of guidance on the food environment and subsequently health outcomes in particular inequalities. The primary aim of this paper is to examine the impact of planning guidance on the number and type of food outlets, health outcomes in particular obesity rates for children, and inequalities in these outcomes in a local authority in the North East of England. Gateshead implemented a blanket ban on all new takeaways in 2015.MethodsThe datasets consist of yearly number and type of food outlets in Gateshead from the Food Standards Agency Food Hygiene Rating System, Index of Multiple Deprivation 2015/2019, population density from the Office for National Statistics, childhood obesity data from the National Child Measurement Programme, and type 2 diabetes and hypertension data from Public Health England. The data is merged and analysed at lower layer super output area level across 8 years from 2012–2019. We use fixed effects and difference in difference models to investigate the impact of planning guidance on the food environment in Gateshead. The control groups are the neighbouring local authorities where did not implement the guidance. A fixed effects model will be employed to test the relationship between the density of food establishments and incidence of the relevant health conditions such as childhood obesity.ResultsOur preliminary results show the planning guidance significantly reduced the proportion of takeaways compared to all other types of food outlets (p-value: 0.000). However, there was no statistically significant reduction in takeaways.ConclusionThis study provides preliminary evidence on the effectiveness of policy to manage the food environment. Our next step will be to explore how changes to the food environment impact on health outcomes and inequalities.

Public understanding of COVID-19 antibody testing and test results: A qualitative study conducted in the U.K. early in the pandemic.

BACKGROUND: During the COVID-19 pandemic, antibody testing was proposed by several countries as a surveillance tool to monitor the spread of the virus and potentially to ease restrictions. In the UK, antibody testing originally formed the third pillar of the UK Government's COVID-19 testing programme and was thought to offer hope that those with a positive antibody test result could return to normal life. However, at that time scientists and the public had little understanding of the longevity of COVID-19 antibodies, and whether they provided immunity to reinfection or transmission of the virus. OBJECTIVE: This paper explores the UK public's understanding of COVID-19 testing, perceived test accuracy, the meaning of a positive test result, willingness to adhere to restrictive measures in response to an antibody test result and how they expect other people to respond. METHODS: On-line synchronous focus groups were conducted in April/May 2020 during the first wave of the pandemic and the most stringent period of the COVID-19 restrictive measures. Data were analysed thematically. RESULTS: There was confusion in responses as to whether those with a positive or negative test should return to work and which restrictive measures would apply to them or their household members. Participants raised concerns about the wider public response to positive antibody test results and the adverse behavioural effects. There were worries that antibody tests could create a divided society particularly if those with a positive test result were given greater freedoms or chose to disregard the restrictive measures. CONCLUSION: Should these tests be offered more widely, information should be developed in consultation with the public to ensure clarity and address uncertainty about test results and subsequent behaviours.