COVID-19 vaccination hesitancy for children: A pilot assessment of parents in the United States.

Background: Coronavirus disease 2019 (COVID-19) vaccine hesitancy has remained a significant concern among adults worldwide. However, not much is known about parental vaccine hesitancy for getting children vaccinated for COVID-19 in the U.S. Thus, the purpose of this study was to conduct a national assessment of parents' preferences for COVID-19 vaccination of children using the evidence-based Multi-Theory Model (MTM) and explore the predictors of vaccine hesitancy. Methods: To participate in this study, a national random sample of parents (n=263) took a valid and reliable online questionnaire based on the MTM. Independent samples t test, chi-square test, multiple logistic regression was utilized to analyze data. Results: More than two-fifths (42%) of the participating parents were not willing to get their children vaccinated for COVID-19. Parental vaccination status, booster dose acceptance, education, and political affiliation were significant predictors of willingness to get children vaccinated for COVID-19. In the multiple logistic regression analyses, behavioral confidence and participatory dialogue (i.e., perceived advantages versus disadvantages) were statistically significant predictors of COVID-19 vaccination hesitancy for children among the participating parents. Conclusion: Given the multiple factors that were found influential in parental hesitancy for COVID-19 vaccination among children, multimodal and evidence-based interventions are needed to increase the uptake of COVID-19 vaccines among children by influencing the parents' perceptions, increasing their confidence, dispelling misinformation, and reducing constraints for vaccination. Such interventions should emphasize communication and messaging that is truthful, interactive, scientifically correct, and to be delivered in a variety of community-based settings.

Mental Health System Responsiveness during COVID-19 in People with Pre-Existing Psychiatric Disorders: Experiences from Iran.

Mental health system responsiveness (MHSR) is one of the important indicators in measuring the performance of mental health systems. Recognizing this function can be effective in responding appropriately to the needs of People with Pre-Existing Psychiatric Disorders (PPEPD). This study aimed to investigate MHSR during the COVID-19 period in PPEPD in Iran. Using stratified random sampling, 142 PPEPD who were admitted to a Psychiatric Hospital in Iran one year before the onset of the COVID-19 pandemic were recruited for this cross-sectional study. Participants completed a demographic and clinical characteristics questionnaire as well as a Mental Health System Responsiveness Questionnaire through telephone interviews. The results show that the indicators of prompt attention, autonomy, and access to care were reported as the worst-performing and the confidentiality indicator as the best-performing. The type of insurance affected the access to care and the quality of basic amenities. MHSR has been reported to be poor in Iran in general and this problem worsened during the COVID-19 pandemic. Considering the prevalence of psychiatric disorders in Iran and the degree of disability of these disorders, structural and functional changes are needed for adequate MHSR.

Early effects of COVID-19 on physical activity and screen time use among elementary school students in Columbus, New Mexico.

Adherence to national physical activity guidelines among youth ages 6-11 in the United States is low. The emergence of COVID-19 and the public health measures implemented in response may have decreased children's physical activity even further. We conducted an online survey among parents of students attending Columbus Elementary School in Columbus, New Mexico, a rural community on the US-Mexico border, to assess changes in children's physical activity and screen time use from summer 2019 to summer 2020. We also sought to identify important covariates. All parents (N = 55) and children (N = 87) identified as Hispanic; most parents were born in Mexico, while most children were born in the United States. Most parents (79.3%) reported a decrease in their children's physical activity from 2019 to 2020, and the vast majority of these parents reported that the changes were due to COVID-19 home confinement. The mean number of days children were physically active for >60 minutes significantly decreased, while daily screen time use increased. Having parents born in Mexico, infrequent family meals (<3/week), and not having community spaces for physical activity close by protected children from decreases in their level of physical activity from 2019 to 2020. Home-based exercise may serve as a suitable method of physical activity when public health responses to COVID-19 restrict community spaces. Future interventions should also be mindful of the role that parental nativity and related cultural factors may play in children's physical activity levels.

COVID-19 and Americans' Perceptions of Change in Diet Quality

The objective of this research was to conduct an assessment of perceived diet quality from a national random sample of American adults and explore how the perceived change in diet quality varied by key sociodemographic characteristics during the COVID-19 pandemic. A total of 835 adults across the United States completed a multi-item online survey. Statistically significant differences were observed with diets worsening during the pandemic for females, young adults, racial minorities (except Asians), unemployed individuals, widowed/divorced or engaged/cohabitating individuals, those not working from home, non-healthcare professionals, and overweight and obese individuals, the pandemic had an impact on the diet quality of these groups.

Masks, Gloves, and the COVID-19 Pandemic: Rapid Assessment of Public Behaviors in the United States.

The COVID-19 outbreak was declared a national emergency in the U.S. in March 2020, and in April 2020, the U.S. government authorities issued recommendations on the use of masks and gloves as protective measures. Despite such recommendations, popular media reports highlighted a lack of compliance. However, no systematic study has examined the use of protective strategies (e.g., wearing a mask) by the American public to prevent the spread of COVID-19 during early stages of the pandemic. The purpose of this study was to conduct a rapid national assessment of public behaviors to prevent COVID-19 spread during the early stages of the pandemic and to assess how these behaviors may have differed based on selected sociodemographic characteristics. A total of 835 adult Americans nationwide took a multi-item survey and were asked about wearing masks, gloves, and their demographic background. The majority of the study participants reported wearing a mask more often during the pandemic (76%), but the majority did not wear gloves more often during the pandemic (30%). Significant differences (p < 0.05) for wearing masks were found based on sex, age, ethnicity, marital status, living arrangements, and employment status. For gloves, significant differences were found based on sex, age, marital status, and employment. While the pandemic continues to unfold and with recent reports of a surge in cases in the U.S., public health practitioners and policymakers must emphasize COVID-19 prevention strategies for the general public and explore pragmatic options to increase compliance of protective behaviors among the general public.

Early Effects of COVID-19 on Physical Activity and Screen Time Use Among Elementary School Students in Columbus, New Mexico

Adherence to national physical activity guidelines among youth ages 6-11 in the United States is low. The emergence of COVID-19 and the public health measures implemented in response may have decreased children’s physical activity even further. We conducted an online survey among parents of students attending Columbus Elementary School in Columbus, New Mexico, a rural community on the US-Mexico border, to assess changes in children’s physical activity and screen time use from summer 2019 to summer 2020. We also sought to identify important covariates. All parents (N = 55) and children (N = 87) identified as Hispanic;most parents were born in Mexico, while most children were born in the United States. Most parents (79.3%) reported a decrease in their children’s physical activity from 2019 to 2020, and the vast majority of these parents reported that the changes were due to COVID-19 home confinement. The mean number of days children were physically active for >60 minutes significantly decreased, while daily screen time use increased. Having parents born in Mexico, infrequent family meals (<3/week), and not having community spaces for physical activity close by protected children from decreases in their level of physical activity from 2019 to 2020. Home-based exercise may serve as a suitable method of physical activity when public health responses to COVID-19 restrict community spaces. Future interventions should also be mindful of the role that parental nativity and related cultural factors may play in children’s physical activity levels.

COVID-19 Infection among Family and Friends: The Psychological Impact on Non-Infected Persons.

Little is known about the mental health impact of having a family member or friend infected with COVID-19. Thus, the purpose of this study was to conduct a comprehensive national assessment of the psychological impact of COVID-19 infection, hospitalization, or death among family members and friends. A multi-item valid and reliable questionnaire was deployed online to recruit adults in the U.S. A total of 2797 adult Americans without a history of COVID-19 infection participated in the study and reported that they had a family member or friend infected with (54%), hospitalized due to (48%), or die (36%) of COVID-19 infection. Symptoms of depression, anxiety, or both (i.e., psychological distress) were statistically significantly higher among those who had family members/friends infected, hospitalized, or die due to COVID-19. Also, this study found that the greater the number of family members/friends affected by COVID-19, or the more severe the COVID-19 infection outcome (i.e., hospitalization vs. death), the higher the odds of symptoms of depression, anxiety, or both. There is an urgent need to develop educational interventions and implement policy measures that address the growing mental health needs of this subgroup of the population that was not infected but indirectly affected by COVID-19 infections among social networks.

COVID-19 Booster Vaccination Hesitancy in the United States: A Multi-Theory-Model (MTM)-Based National Assessment.

Background: Despite the availability of COVID-19 vaccines and the proven benefits of vaccinations outweighing the potential risks, hesitancy to accept vaccines and additional doses remains a persistent problem. Therefore, the purpose of the study was to investigate hesitancy, confidence, literacy, and the role of the multi-theory model (MTM) constructs in COVID-19 booster uptake. Methods: This cross-sectional study utilized a 52-item psychometric valid web-based survey conducted during the month of October 2021 to recruit a nationally representative sample of U.S. adults. Univariate, bivariate, and multivariate statistical tests were used to analyze the data. Results: Among the booster hesitant group (n = 209, 41.7%), a significantly larger proportion of respondents were unvaccinated with the primary series (43.5% vs. 11%, p < 0.001), were among 18-44 years age group (51.2% vs. 31.8%, p < 0.001), single or never married (33.0% vs. 24.3%, p = 0.04), had lower education with some high school (6.2% vs. 2.4%, p = 0.03), and identified themselves as Republicans (31.6% vs. 20.5%, p = 0.01). The hesitant group had lower mean scores of vaccine literacy, and vaccine confidence, and had 19% lower odds of behavioral confidence than their non-hesitant counterparts (adjusted odds ratio = 0.81, 95% CI: 0.71-0.92). Conclusions: The findings of this study underscore the need of raising public awareness through effective multi-theory-model-based communication campaigns.

Coronavirus Outbreak and Stress in Iranians.

Iran has faced one of the worst COVID-19 outbreaks in the world, and no studies to date have examined COVID-19-related stress in the general Iranian population. In this first population-based study, a web-based survey was conducted during the peak of the outbreak to assess stress and its correlates in the Iranian population. A 54-item, valid, and reliable questionnaire, including items on demographic characteristics and past medical history, stress levels, awareness about signs and symptoms of COVID-19, knowledge about at-risk groups and prevention methods, knowledge about transmission methods, trust in sources of information, and availability of facemasks and sanitizers, was deployed via social and mass media networks. A total of 3787 Iranians participated in the study where the majority of the participants were females (67.4%), employed (56.1%), from developed provinces (81.6%), without chronic diseases (66.6%), and with ≥13 years of formal education (87.9%). The mean age of study participants was 34.9 years (range = 12-73), and the average stress score was 3.33 (SD = ±1.02). Stress score was significantly higher for females, those who were 30-39 years old, housewives, those with chronic diseases, individuals who were aware that there is no vaccine to prevent COVID-19, those who could not get facemasks or sanitizers, and individuals with higher knowledge about at-risk groups (p < 0.05). There was a significant correlation of stress scores with knowledge about prevention methods for COVID-19 (r = 0.21, p = 0.01) and trust in sources of information about COVID-19 (r = -0.18, p = 0.01). All of the predictors, except knowledge of two important at-risk groups and education, had a significant effect on stress scores based on a multivariate regression model. The COVID-19 outbreak could increase stress among all population groups, with certain groups at higher risk. In the high-risk groups and based on experience with previous pandemics, interventions are needed to prevent long-term psychological effects. Professional support and family-centered programs should be a part of pandemic mitigation-related policymaking and public health practices.

COVID-19 pandemic and weight gain in American adults: A nationwide population-based study.

BACKGROUND: The COVID-19 pandemic has affected the lives of people in many ways. However, little is known about weight gain in American adults during the pandemic. AIMS AND METHODS: The purpose of this study was to conduct a national assessment of weight gain in adult Americans after the first year of the pandemic. An online questionnaire was employed to explore perceptions of adults regarding pandemic weight gain and the relationship between weight gain and sociodemographic characteristics, pre-pandemic weight status, and psychological distress. Multiple methods were used to assess the psychometric properties of the questionnaire (i.e., face validity, content validity, and internal consistency reliability testing). Chi-Square tests and logistic regression analysis were used to assess group differences and predictors of weight gain in the study participants. RESULTS: A total of 3,473 individuals participated in the study with weight changes distributed as: gained weight (48%), remained the same weight (34%), or lost weight (18%). Those who reported being very overweight before the pandemic were most likely to gain weight (65%) versus those who reported being slightly overweight (58%) or normal weight (40%) before the pandemic. Weight gain was statistically significantly higher in those with anxiety (53%), depression (52%), or symptoms of both (52%). The final multiple regression model found that the statistically significant predictors of pandemic weight gain were psychological distress, pre-pandemic weight status, having children at home; and time since last bodyweight check. CONCLUSIONS: Population health promotion strategies in the pandemic should emphasize stress reduction to help individuals manage body weight and avoid chronic diseases in the future.

COVID-19 Vaccine Refusal among Nurses Worldwide: Review of Trends and Predictors.

COVID-19 vaccination hesitancy has become a major concern around the world. Recent reports have also highlighted COVID-19 vaccination hesitancy in healthcare workers. Despite media reports and scientific publications, little is known about the extent and predictors of COVID-19 vaccination refusal among nurses. Thus, the purpose of this study was to assess COVID-19 vaccine refusal rates among nurses globally and to explore the reasons for refusal and factors associated with the uptake of the vaccines. A scoping review of the published literature was conducted, and a final pool of 51 studies (n = 41,098 nurses) from 36 countries was included in this review. The overall pooled prevalence rate of COVID-19 vaccine refusal among 41,098 nurses worldwide was 20.7% (95% CI = 16.5-27%). The rates of vaccination refusal were higher from March 2020-December 2020 compared to the rates from January 2021-May 2021. The major reasons for COVID-19 vaccine refusal were concerns about vaccine safety, side effects, and efficacy; misinformation and lack of knowledge; and mistrust in experts, authorities, or pharmaceutical companies. The major factors associated with acceptance of the vaccines were: male sex, older age, and flu vaccination history. Evidence-based strategies should be implemented in healthcare systems worldwide to increase the uptake of COVID-19 vaccines among nurses to ensure their safety and the safety of their patients and community members.

COVID-19 pandemic and weight gain in American adults: A nationwide population-based study

Background The COVID-19 pandemic has affected the lives of people in many ways. However, little is known about weight gain in American adults during the pandemic. Aims and methods The purpose of this study was to conduct a national assessment of weight gain in adult Americans after the first year of the pandemic. An online questionnaire was employed to explore perceptions of adults regarding pandemic weight gain and the relationship between weight gain and sociodemographic characteristics, pre-pandemic weight status, and psychological distress. Multiple methods were used to assess the psychometric properties of the questionnaire (i.e., face validity, content validity, and internal consistency reliability testing). Chi-Square tests and logistic regression analysis were used to assess group differences and predictors of weight gain in the study participants. Results A total of 3473 individuals participated in the study with weight changes distributed as: gained weight (48%), remained the same weight (34%), or lost weight (18%). Those who reported being very overweight before the pandemic were most likely to gain weight (65%) versus those who reported being slightly overweight (58%) or normal weight before the pandemic (40%). Weight gain was statistically significantly higher in those with anxiety (53%), depression (52%), or symptoms of both (52%). The final multiple regression model found that the statistically significant predictors of pandemic weight gain were psychological distress, pre-pandemic weight status, having children at home;and time since last bodyweight check. Conclusions Population health promotion strategies in the pandemic should emphasize stress reduction to help individuals manage body weight and avoid chronic diseases in the future.

COVID-19 Pandemic and the Burden of Internet Addiction in the United States

Despite the extensive usage of the internet, little is known about internet addiction among Americans during the pandemic. A valid and reliable questionnaire was deployed online via MTurk to recruit a national sample of adult Americans to understand the nature and extent of internet addiction. A total of 1305 individuals participated in the study where the majority were males (64%), whites (78%), non-Hispanic (70%), married (72%), 18–35 years old (57%), employed full time (86%), and with a Bachelor’s degree or higher (83%). The prevalence of internet addiction was distributed as no addiction (45%), probable addiction or risk of addiction (41%), and definite or severe addiction (14%). More than a fourth of the population had depression (28%) or anxiety (25%). Despite adjusting for sociodemographic characteristics, definite/severe internet addiction was strongly predictive of depression, anxiety, and psychological distress in multiple regression analyses. Those who were probably addicted or at risk of addiction were also more likely to have depression or anxiety. Compared to estimates before the pandemic, this study suggests an increase in internet addiction among U.S. adults during the COVID-19 pandemic. Population-based interventions and mental health promotion strategies should focus on a reduction in internet consumption and screen time.

COVID-19 vaccination hesitancy in India: State of the nation and priorities for research.

BACKGROUND: Few COVID-19 vaccines were anticipated in India in early 2021. However, little was known about COVID-19 vaccination acceptance among the public. We conducted a nationwide study to understand the public's perception about COVID-19 vaccines in December 2020. METHOD: An online survey was deployed using a multi-item validated questionnaire via social media websites and networking platforms for adults in India. We asked participants about vaccination willingness, concerns about vaccination, and their sociodemographic characteristics. RESULTS: Nationwide, 1638 participants from 27 states/union territories took the survey where the majority of the participant were males (55%), 18-30 years old (52%), urban dwellers (69%), college-educated (81%), without a history of COVID-19 infection (92%). More than a fifth were either unaware of the vaccines (20.63%) or were not sure if they will get the vaccine (27%), and 10% refused to obtain the vaccine. Almost 70% of the population had concerns regarding the vaccines. Statistically significant differences (p<0.01) in awareness about vaccine and acceptability were observed based on age, educational qualifications, and employment status. CONCLUSION: While the majority of Indians would accept the vaccine, given the large population of India, even a small proportion of hesitant individuals would translate to millions of unvaccinated individuals. Strategic measures and policy decisions to enhance the rate of COVID-19 vaccination should be continuously planned and implemented in India.

COVID-19 Morbidity and Mortality in Social Networks: Does It Influence Vaccine Hesitancy?

The impact of COVID-19 morbidity and mortality among family and friends on vaccination preferences is not well explored. A valid and reliable questionnaire was deployed online via mTurk to recruit a national random sample of adult Americans to understand COVID-19 vaccination preferences and its relationship with COVID-19 infection in social networks. A total of 1602 individuals participated in the study where the majority had taken at least one dose of the COVID-19 vaccine (79%) and almost a tenth were planning to do so (10%) or did not want to take the vaccine (11%). Compared to those who knew family members or friends affected by COVID-19, those who did not know anyone infected with (AOR = 3.20), hospitalized for (AOR = 3.60), or died of COVID-19 (AOR = 2.97) had statistically significantly higher odds of refusing the vaccines. Most strategies for reducing COVID-19 vaccination hesitancy focus on highlighting the benefits of COVID-19 vaccines. We suggest that the dangers of not getting the vaccine should also be emphasized as many people who do not know someone who was affected with COVID-19 are also hesitant towards vaccination. These individuals may not fully appreciate the morbidity and mortality impact of COVID-19 infections and the messaging can be tailored to highlight the risk of not having vaccines.