Does the Integration of Migrants in the Host Society Raise COVID-19 Vaccine Acceptance? Evidence From a Nationwide Survey in Japan.

Research indicates that integration contributes to maintaining health among migrants, yet little is known about the association between integration and vaccination acceptance. This study aimed to explore COVID-19 vaccine intention and acceptance, and the association between integration and vaccine hesitancy among migrants in Japan. We conducted an internet survey among migrants in Japan from October 5 to October 14, 2021. Among 1,455 participants, 11.6% reported hesitancy toward COVID-19 vaccination. We found that the overall integration and social integration were associated with the vaccination intention. Some commonly identified barriers (e.g., financial difficulties, language) were not related to COVID-19 vaccination acceptance among migrants in Japan. Highly integrated migrants were less likely to report vaccine hesitancy against COVID-19. To promote COVID-19 acceptance among migrants, customized intervention policies should focus on the migrants with a lower level of integration, especially those with little social connection with the locals.

Psychological determinants of COVID-19 vaccine acceptance: A comparison between immigrants and the host population in Japan.

This study explored the differences in COVID-19 vaccination readiness based on the 7C model and its association with vaccine acceptance among foreign-born immigrants, Japan-born immigrants, and locals in Japan. A cross-sectional survey was conducted in October 2021 (n = 3,690). Our results show that COVID-19 vaccination readiness, acceptance, and their relationship differ according to migratory status and nativity. Immigrant participants reported higher general vaccination readiness and acceptability for vaccination against COVID-19 than the Japanese participants, but had lower vaccination coverage, particularly among those born in Japan. The psychological determinants of Japan-born immigrants were more similar to those of Japanese participants than those of foreign-born immigrants. The effects of confidence, complacency, and constraints on COVID-19 vaccine acceptance were strong among all three groups. However, the role of collective responsibility and conspiracy varied by migratory status. This study highlighted the importance of culturally tailored interventions in vaccine delivery to immigrants.

Development of a method for walking step observation based on large-scale GPS data.

BACKGROUND: Widespread use of smartphones has enabled the continuous monitoring of people's movements and physical activity. Linking global positioning systems (GPS) data obtained via smartphone applications to physical activity data may allow for large-scale and retrospective evaluation of where and how much physical activity has increased or decreased due to environmental, social, or individual changes caused by policy interventions, disasters, and infectious disease outbreaks. However, little attention has been paid to the use of large-scale commercial GPS data for physical activity research due to limitations in data specifications, including limited personal attribute and physical activity information. Using GPS logs with step counts measured by a smartphone application, we developed a simple method for daily walking step estimation based on large-scale GPS data. METHODS: The samples of this study were users whose GPS logs were obtained in Sendai City, Miyagi Prefecture, Japan, during October 2019 (37,460 users, 36,059,000 logs), and some logs included information on daily step counts (731 users, 450,307 logs). The relationship between land use exposure and daily step counts in the activity space was modeled using the small-scale GPS logs with daily step counts. Furthermore, we visualized the geographic distribution of estimated step counts using a large set of GPS logs with no step count information. RESULTS: The estimated model showed positive relationships between visiting high-rise buildings, parks and public spaces, and railway areas and step counts, and negative relationships between low-rise buildings and factory areas and daily step counts. The estimated daily step counts tended to be higher in urban areas than in suburban areas. Decreased step counts were mitigated in areas close to train stations. In addition, a clear temporal drop in step counts was observed in the suburbs during heavy rainfall. CONCLUSIONS: The relationship between land use exposure and step counts observed in this study was consistent with previous findings, suggesting that the assessment of walking steps based on large-scale GPS logs is feasible. The methodology of this study can contribute to future policy interventions and public health measures by enabling the retrospective and large-scale observation of physical activity by walking.

Individual-level social capital and COVID-19 vaccine hesitancy in Japan: a cross-sectional study.

To reduce vaccine hesitancy, it is important to identify factors that can intervene at the individual or community level. Social capital is a possible factor because it is associated with various vaccine hesitancy, such as for measles and influenza. However, limited studies have explored the association between social capital and vaccination for COVID-19, which is an unprecedented pandemic and infodemic. Therefore, this study aimed to clarify the association between social capital and COVID-19 vaccination during the pandemic. This cross-sectional study used quota sampling for an online-based survey. Participants were asked whether they had previously been vaccinated for COVID-19 and their intention to receive a COVID-19 vaccine booster. Social capital was evaluated using three measures (individual-level civic participation, social cohesion, and reciprocity). Multiple logistic regression analysis was performed to clarify the association between social capital and previous COVID-19 vaccination status as well as intention to receive a COVID-19 booster. Participants were 2,313 individuals, of whom 87.2% had received a COVID-19 vaccine; 72.3% intended to obtain a COVID-19 booster. Individuals with any social capital are more likely to receive a COVID-19 vaccination than those with none (OR: 1.73, 95%CI: 1.18-2.54; OR: 1.58, 95%CI: 1.22-2.05; OR: 3.05, 95%CI: 2.15-4.33). These indicators were also associated with the intention to receive a COVID-19 booster. Thus, our results suggest that among the general public, those with individual-level social capital are more likely to receive a COVID-19 vaccination than those with none. Social capital may be a factor that can reduce vaccine hesitancy during a pandemic.

Relationships among changes in walking and sedentary behaviors, individual attributes, changes in work situation, and anxiety during the COVID-19 pandemic in Japan.

Studies from many countries, including Japan, have reported decreased physical activity during the coronavirus disease 2019 (COVID-19) pandemic. However, the individual attributes as related to changes in physical activity during the pandemic in Japan have been scarcely investigated. The present study explored the relationships among individual attributes including demographic, socioeconomic, and geographic characteristics, work situation changes, perception of anxiety, and changes in walking and sedentary behaviors, during the pandemic in Japan. To obtain data indicating individual circumstances during the first wave of the pandemic in Japan, we conducted a nationwide online survey from May 19 to May 23, 2020 (n = 1,200). To observe changes in walking behavior objectively and retrospectively, we collected data on the number of daily steps as measured by the iPhone's Health application. Path analysis was employed to examine relationships between individual attributes and changes in walking and sedentary behaviors. Decreased physical activity, especially, decreased walking behavior among younger individuals and those living in highest-density neighborhoods were identified. There was increased sedentary behavior among females. Moreover, individuals with higher socioeconomic status (SES) tended to become inactive due to work-from-home/standby-at-home and individuals with lower SES tended to become inactive due to decreased amount of work. Decreased walking behavior and increased sedentary behavior were associated with a perception of strong anxiety related to the pandemic. Our findings would be helpful in considering measures to counteract health risks during the pandemic by taking into account individual backgrounds.

Trends in COVID-19 vaccination intent from pre- to post-COVID-19 vaccine distribution and their associations with the 5C psychological antecedents of vaccination by sex and age in Japan.

Vaccine hesitancy regarding the coronavirus disease 2019 (COVID-19) vaccine is widespread during the COVID-19 pandemic. Many recent studies have reported that the confidence of the vaccination and perceived risk were associated with vaccination intent, yet few studies have focused on other psychological factors. This study aimed to clarify the trends in COVID-19 vaccination intent and to identify the association between the 5C psychological antecedents and COVID-19 vaccination intent by sex and age in Japan. This was a longitudinal study conducted through an Internet-based survey from January 2021 to April 2021 before and after vaccine distribution in Japan, including 2,655 participants recruited by quota sampling. Participants were asked to indicate how likely they were to get vaccinated against COVID-19. In the second survey, the participants responded to questions regarding the 5C psychological antecedents: confidence, complacency, constraints (structural and psychological barriers), calculation (engagement in extensive information searching), and collective responsibility (willingness to protect others). Multiple logistic regression analysis was performed to clarify the association between the 5C psychological antecedents and COVID-19 vaccination intent in the second wave survey. COVID-19 vaccination intent improved from 62.1% to 72.4% after vaccine distribution, but no significant difference was found in young men. Confidence and collective responsibility were positively associated with vaccination intent, and calculation was negatively associated among all generations. COVID-19 vaccination intent may be affected not only by confidence and constraints but also by calculation and collective responsibility, and further research is needed.

How Frequently Do Ordinary Citizens Practice Hand Hygiene at Appropriate Moments during the COVID-19 Pandemic in Japan?

We aimed to clarify the status of hand hygiene practices among ordinary citizens during the COVID-19 pandemic in Japan, as well as the frequency of daily hand hygiene as an indicator of education and evaluation. This cross-sectional study was based on an internet survey completed by 2,149 participants (age range: 20-79 years, men: 51.0%, response rate: 89.5%), selected from June 23 to 28, 2020. The participants responded regarding the frequency of implementing hand hygiene at 5 moments (after returning from a public place, after using the toilet, after touching something outside, before eating food, and after blowing the nose, coughing, or sneezing). Additionally, the participants responded to the number of daily hand hygiene events. The cutoff value of the total number of daily hand hygiene events to determine whether hand hygiene was performed at all 5 time points was determined using receiver operating characteristic analysis. The mean number of hand hygiene events was 10.2 times/day. The prevalence of implementing hand hygiene at each moment ranged from 30.2% to 76.4%; only 21.1% of respondents practiced hand hygiene at all times. Both Youden Index and specificity were high when the cut-off value was 11 times/day. Therefore, the criterion of hand hygiene (≥11 times/day) may be useful in education and evaluation.

Survey on usage and concerns of a COVID-19 contact tracing application in Japan.

OBJECTIVES: We aimed to identify the concerns, current implementation status and correct usage, and factors inhibiting implementation and correct use of a COVID-19 contact tracing application among the ordinary citizens in Japan. STUDY DESIGN: This was a cross-sectional study based on an internet survey completed by 2013 participants who were selected among registrants of an Internet research company between September 8 and 13, 2020. METHODS: Participants completed an online survey that included thoughts and concerns about the application, status of use, and questions about whether the application was being used correctly. We performed multiple logistic regression analysis to clarify the association between the use of the app and sociodemographic factors and user concerns. RESULTS: Of the 2013 respondents, 429 (21.3%) participants reported using this application, but only 60.8% of them used it correctly. The percentage of those having some concerns about the application ranged from 45.9% to 75.5%, with the highest percentage being 'doubts about effectiveness of apps for preventing spread of infection'. Multiple logistic regression analysis revealed, the main concerns inhibiting application use were insufficient knowledge of how to use it, privacy concerns, doubts about the effectiveness of the app, and concerns about battery consumption and communication costs. Additionally, the prevalence of the application was lower for lower-income individuals. CONCLUSIONS: The findings suggest that income may create inequalities in the efficacy and effectiveness of COVID-19 contact tracing applications. Awareness activity strategies to dispel such concerns and support low-income individuals may be needed.

Urbanization level and neighborhood deprivation, not COVID-19 case numbers by residence area, are associated with severe psychological distress and new-onset suicidal ideation during the COVID-19 pandemic.

BACKGROUND: Recent studies indicate an urgent need to take action against mental health issues during the COVID-19 pandemic. However, the association between larger-scale environmental factors such as living conditions and mental health problems during the pandemic is currently unknown. METHODS: A nationwide, cross-sectional internet survey was conducted in Japan between August and September 2020 to examine the association between urbanization level and neighborhood deprivation as living conditions and COVID-19 case numbers by prefecture. Prevalence ratios (PRs) for severe psychological distress, suicidal ideation, and new-onset suicidal ideation during the pandemic were adjusted for potential confounders. RESULTS: Among 24,819 responses analyzed, the prevalence of mental health problems was 9.2% for severe psychological distress and 3.6% for new-onset suicidal ideation. PRs for severe psychological distress were significantly associated with higher urbanization level (highest PR = 1.30, 95% CI = 1.08-1.56). PRs for new-onset suicidal ideation were significantly associated with higher urbanization level (highest PR = 1.83, 95% CI = 1.37-2.45) and greater neighborhood deprivation (highest PR = 1.35, 95% CI = 1.06-1.72). Severe psychological distress and new-onset suicidal ideation were significantly more prevalent when there was higher urbanization plus lower neighborhood deprivation (PR = 1.34 [1.15-1.56], and 1.57 [1.22-2.03], respectively). CONCLUSION: These findings suggest that it is not the number of COVID-19 cases by residence area but higher urbanization level and greater neighborhood deprivation (lower neighborhood-level socioeconomic status) that are associated with severe psychological distress and new-onset suicidal ideation during the pandemic. These findings differ in part from evidence obtained before the pandemic.

Relationship between Internet use and out-of-home activities during the first wave of the COVID-19 outbreak in Japan.

Following the first wave of the COVID-19 outbreak, the Japanese government announced the declaration of a state of emergency in April 2020, which aimed to decrease contact between people and requested that residents refrain from outings. Even in the absence of penalties, outings decreased under the declaration. We are interested in how outings declined and studied the substitution relationship between Internet use and outings. A web-based survey was conducted to collect data on Internet use and outings in a retrospective manner. The period covered by our data is from mid-February to mid-May 2020. Multilevel analysis and binomial logistic regression analysis were performed to examine the relationship between Internet use and outings. The results clearly show that Internet use replaced outings. In particular, Internet use for socializing, exercise, and leisure/entertainment had a strong substitution relationship with outings. Internet use for socializing and leisure/entertainment was also associated with refraining from visiting restaurants. In contrast, there was a weak substitution relationship between Internet use for daily shopping and outings. Although telework tends to be an accepted focus of Internet use under the COVID-19 outbreak, it should not be overlooked that other uses of the Internet, such as for leisure/entertainment, also supported the decline in outings.

Acceptance of a COVID-19 Vaccine in Japan during the COVID-19 Pandemic.

Vaccination could be a key protective measure against coronavirus disease 2019 (COVID-19), and it is important to understand the acceptability of the COVID-19 vaccine among the general public. However, there is no study on the acceptance of a COVID-19 vaccine in Japan. Therefore, this study aimed to describe the COVID-19 vaccine acceptance and hesitancy situation in Japan and assess the factors associated with such issues. This was a cross-sectional study based on an internet survey completed by 2956 people. Participants were asked to indicate how likely they were to get vaccinated for COVID-19. In addition, the participants responded to questions regarding sociodemographic factors, attitudes, and beliefs regarding COVID-19 infection and vaccination. The proportion of participants with a high likelihood of getting a COVID-19 vaccine was 62.1%. Multiple logistic regression analysis showed that vaccine acceptance was lower among several sociodemographic groups, such as women, adults aged 20-49 years, and those with a low-income level. Several psychological factors, especially the perceived effectiveness of the COVID-19 vaccine, and willingness to protect others by getting oneself vaccinated, were associated with vaccine acceptance. Our results indicate that the perceived effectiveness of the vaccine and willingness to protect others may play an important role in the acceptance of the COVID-19 vaccine.

Who is staying home and who is not? Demographic, socioeconomic, and geographic differences in time spent outside the home during the COVID-19 outbreak in Japan.

Studies have reported that many people changed their going-out behavior in response to the declaration of a state of emergency related to the coronavirus disease 2019 (COVID-19) in Japan. However, individual attributes of those who tended to stay home have not been examined. Therefore, this study examined the demographic, socioeconomic, and geographic characteristics of people who refrained from going out both before and after a state of emergency was declared. Using data from a nationwide online survey, this study retrospectively investigated the relative amount of time spent outside the home between mid-February and mid-May 2020. Multilevel linear regression analysis was performed to examine the association of time outside with demographic, socioeconomic, and geographic characteristics, and with the anxiety related to going out, in each period. Overall, respondents significantly reduced their time spent outside during the study period, especially after a state of emergency was declared. Those who were young, female, living with two or more people, had lower income, were not working, used public transportation, had chronic disease, and lived in large metropolitan areas were more likely to reduce time outside during a part of the study period. However, no significant differences were observed for occupational class, education, and neighborhood population density. Thus, the results showed a reduction in time outside during the COVID-19 outbreak and the existence of demographic, socioeconomic, and geographic differences in going-out behavior. Socioeconomic disparities and neighborhood differences in going-out behavior, and their influence on health should be continuously monitored.

Incorrect Use of Face Masks during the Current COVID-19 Pandemic among the General Public in Japan.

Since the emergence of the COVID-19 pandemic, the use of face masks by healthy individuals for prevention has been attracting public attention. However, efficacy depends on proper usage. We set out to determine the prevalence of wearing masks to prevent COVID-19 and compliance with appropriate measures for the correct use of face masks among the general public in Japan where wearing medical masks is a "cultural" normality. This cross-sectional study was based on an internet-based survey completed by 2141 people (50.8% men, aged 20-79 years) who were selected among registrants of an Internet research company between 1 April and 6 April 2020. Participants were asked to indicate how often they wore masks for prevention and to what extent they practiced appropriate measures suggested by the World Health Organization. The prevalence of wearing masks was 80.9% and compliance rates with appropriate measures ranged from 38.3% to 83.5%. Only 23.1% complied with all recommendations. Compliance rates were overall low in men and persons with low household incomes. Our results, hence show that many citizens implement inaccurate measures when using face masks. Therefore, providing guidance on correct usage is essential when encouraging the use of face masks to prevent COVID-19.

The actual implementation status of self-isolation among Japanese workers during the COVID-19 outbreak.

BACKGROUND: Self-isolation is an important personal protective measure in inhibiting the transmission of coronavirus disease 2019 (COVID-19) as people carry out economic and social activities amid its spread. Yet few studies have clarified the actual implementation status of self-isolation during an outbreak. This study aimed to reveal the actual implementation of self-isolation among Japanese workers during the COVID-19 outbreak and the factors inhibiting this measure. METHODS: This was a cross-sectional study based on an internet survey completed by 1,226 workers (60.0% men) living in 7 prefectures (i.e., Tokyo, Kanagawa, Saitama, Chiba, Ibaraki, Tochigi, and Gunma) who were selected among registrants of an Internet research company, between May 12 and 17, 2020. Participants were asked whether they had experienced fever or other cold symptoms between February 17, 2020 and the date of the survey. Those who responded affirmatively were asked where they had visited (e.g., hospital, work, and shopping for groceries or necessities) to clarify whether they had left the house within 7 days after symptom onset. We performed multivariate logistic regression analysis to clarify the relationship between going to work within 7 days after symptom onset and both sociodemographic factors and employment-related constraints. RESULTS: Of the survey participants, 82 had experienced fever or other cold symptoms (6.7%). Among these participants, 51 (62.2%) went to work within 7 days after symptom onset. A mere 17.1% practiced strict self-isolation. Multivariate logistic regression analysis revealed that those living outside the metropolitan area (i.e., Ibaraki, Tochigi, and Gunma), working as a company employee, and being unable to work from home were associated with going to work within 7 days after symptom onset. CONCLUSIONS: The prevalence of strict self-isolation among participants who experienced cold-like symptoms during the COVID-19 outbreak was extremely low, and 62.2% of these participants went to work within 7 days after symptom onset. This study highlights the need for further public awareness regarding self-isolation and countermeasures against factors that obstruct it.

Adoption of personal protective measures by ordinary citizens during the COVID-19 outbreak in Japan.

OBJECTIVES: To clarify the implementation status of personal protective measures by ordinary citizens in Japan during the coronavirus disease 2019 (COVID-19) outbreak. METHODS: This was a cross-sectional study based on internet-based survey. A total of 2400 people (50% male: 20-79 years) were selected between February 25 and 27, 2020, from registrants of an Internet research company, to complete a questionnaire. Participants were asked to indicate how often they implemented the following five personal protective measures recommended by the World Health Organization (hand hygiene, social distancing measures, avoiding touching the eyes, nose and mouth, respiratory etiquette, and self-isolation). In addition, the participants responded to questions regarding the daily frequency of hand hygiene events. RESULTS: The prevalence of the five personal protective measures ranged from 59.8% to 83.8%, with the lowest being avoiding touching the eyes, nose, and mouth. In total, 34.7% implemented all personal protective measures. The median daily hand hygiene events were 5 per day (25th percentile, 75th percentile: 3,8). CONCLUSIONS: The protective measures implemented by ordinary citizens are insufficient and further public awareness activities are required.