Does receiving a SARS-CoV-2 antibody test result change COVID-19 protective behaviors? Testing risk compensation in undergraduate students with a randomized controlled trial.

BACKGROUND: Risk compensation, or matching behavior to a perceived level of acceptable risk, can blunt the effectiveness of public health interventions. One area of possible risk compensation during the SARS-CoV-2 pandemic is antibody testing. While antibody tests are imperfect measures of immunity, results may influence risk perception and individual preventive actions. We conducted a randomized control trial to assess whether receiving antibody test results changed SARS-CoV-2 protective behaviors. PURPOSE: Assess whether objective information about antibody status, particularly for those who are antibody negative and likely still susceptible to SARS-CoV-2 infection, increases protective behaviors. Secondarily, assess whether a positive antibody test results in decreased protective behaviors. METHODS: In September 2020, we enrolled 1076 undergraduate students, used fingerstick tests for SARS-CoV-2 antibodies, and randomized participants to receive their results immediately or delayed by 4 weeks. Two weeks later, participants completed a survey about their engagement in 4 protective behaviors (mask use, social event avoidance, staying home from work/school, ensuring physical distancing). We estimated differences between conditions for each of these behaviors, stratified by antibody status. For negative participants at baseline, we also estimated the difference between conditions for seroconversion over 8 weeks of follow-up. RESULTS: For the antibody negative participants (n = 1029) and antibody positive participants (n = 47), we observed no significant differences in protective behavior engagement between those who were randomized to receive test results immediately or after 4 weeks. For the baseline antibody negative participants, we also observed no difference in seroconversion outcomes between conditions. CONCLUSIONS: We found that receiving antibody test results did not lead to significant behavior change in undergraduate students whether the SARS-CoV-2 antibody result was positive or negative.

The association between social factors and COVID-19 protective behaviors and depression and stress among midwestern US college students.

PURPOSE: The aim of this cross-sectional study was to examine the relationship between social factors and COVID-19 protective behaviors and two outcomes: depressive and perceived stress symptoms. METHODS: In September 2020, 1,064 randomly selected undergraduate students from a large midwestern university completed an online survey and provided information on demographics, social activities, COVID-19 protective behaviors (i.e., avoiding social events and staying home from work and school), and mental health symptoms. Mental health symptoms were measured using the Center for Epidemiological Studies Depression-10 questionnaire for depression and the Perceived Stress Scale-10 for stress symptoms. RESULTS: The results showed respondents who were males and also the respondents who were "hanging out" with more people while drinking alcohol reported significantly lower depressive symptoms and lower stress symptoms. On the contrary, staying home from work or school "very often" was associated with higher stress symptoms, compared with "never/rarely" staying home from work/school. Similarly, having a job with in-person interaction was also associated with increased stress. CONCLUSIONS: These findings suggest that lack of social engagement was associated with depression and stress symptoms among college students during the COVID-19 pandemic. Planning social activities that align with recommended safety precautions, as well as meet students' social needs, should be an important priority for higher education institutions.

The relationship between acquaintance with a SARS-CoV-2 death, positive SARS-CoV-2 test results, and sleep duration among college students in fall 2020.

Background: The aim of this study was to test whether two SARS-CoV-2 experiences, knowing someone who had died of SARS-CoV-2 infection and having received a positive SARS-CoV-2 test result, were associated with shorter sleep duration among undergraduate students. Methods: An online cross-sectional study was conducted at a large public Midwestern university in September 2020 (fall semester). Self-reported average sleep duration and the exposures of interest, knowing someone who died from a SARS-CoV-2 infection and their own SARS-CoV-2 test result, were collected from 1,058 undergraduate study participants. Results: Respondents who knew someone who had died of a SARS-CoV-2 infection were more likely to report having a short sleep duration, compared to respondents who did not know someone who had died of a SARS-CoV-2 infection (aOR = 1.80, 95% CI: 1.14, 2.79). However, those with a positive SARS-CoV-2 test result were less likely to report a short sleep duration, compared to respondents without a positive test history (aOR = 0.47, 95% CI: 0.21, 0.91). Conclusions: These findings suggest that college students' knowing someone who had died of SARS-CoV-2 infection and having received a positive SARS-CoV-2 test result are associated with sleep duration. However, different experiences may impact sleep differently, so further research is warranted to better understand how unusual events impact the sleep of college students.

Does cigarette or E-cigarette use increase the risk for SARS-CoV-2 seroconversion among Midwestern college students?

OBJECTIVE: This longitudinal study tested the relationship between cigarette and e-cigarette use and SARS-CoV-2 seroconversion among US college students. PARTICIPANTS: Undergraduate students (n = 764), drawn from a randomly selected invitation-only pool from a large Midwestern university, that were initially negative for SARS-CoV-2 antibodies and were re-tested in November were included in this study conducted in Fall 2020. METHODS: Demographics and cigarette and e-cigarette use behaviors (nicotine use) were collected in a baseline survey. SARS-CoV-2 antibody tests were administered in September (baseline) and November (endline) of 2020. Log-binomial regression analyses were conducted to test the association between nicotine use and SARS-CoV-2 seroconversion. RESULTS: SARS-CoV-2 seroconversion was 5.2%. No statistically significant associations were found between nicotine use and SARS-CoV-2 seroconversion. CONCLUSIONS: Contrary to prior results, we found no association between nicotine use and SARS-CoV-2 seroconversion. Nicotine use may not be a key risk factor for COVID-19 acquisition in predominantly healthy college-aged populations.

Relationship between high-risk alcohol consumption and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroconversion: a prospective sero-epidemiological cohort study among American college students.

AIMS: To estimate the associations between high-risk alcohol consumption and (1) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroconversion, (2) self-reported new SARS-CoV-2 infection and (3) symptomatic COVID-19. DESIGN: Prospective cohort study. SETTING: Indiana University Bloomington (IUB), IN, USA. PARTICIPANTS: A total of 1027 IUB undergraduate students (64% female), aged 18 years or older, residing in Monroe County, Indiana, seronegative for SARS-CoV-2 at study baseline. MEASUREMENTS: Primary exposure was high-risk alcohol consumption measured with an Alcohol Use Disorders Identification Test (AUDIT) questionnaire score of 8 or more. Primary outcome was SARS-CoV-2 seroconversion since baseline, assessed with two SARS-CoV-2 antibody tests, at baseline (September 2020) and end-line (November 2020). Secondary outcomes were (a) self-reported new SARS-CoV-2 infection at the study end-line and (b) self-reported symptomatic COVID-19 at baseline. FINDINGS: Prevalence of high-risk alcohol consumption was 32 %. In models adjusted for demographics, students with high-risk alcohol consumption status had 2.44 [95% confidence interval (CI) = 1.35, 4.25] times the risk of SARS-CoV-2 seroconversion and 1.84 (95% CI = 1.04, 3.28) times the risk of self-reporting a positive SARS-CoV-2 infection, compared with students with no such risk. We did not identify any association between high-risk alcohol consumption and symptomatic COVID-19 (prevalence ratio = 1.17, 95% CI = 0.93, 1.47). Findings from sensitivity analyses corroborated these results and suggested potential for a dose-response relationship. CONCLUSIONS: Among American college students, high-risk alcohol consumption appears to be associated with higher risk for severe acute respiratory syndrome coronavirus 2 seroconversion/infection.

Use of research electronic data capture (REDCap) in a COVID-19 randomized controlled trial: a practical example.

BACKGROUND: Randomized controlled trials (RCT) are considered the ideal design for evaluating the efficacy of interventions. However, conducting a successful RCT has technological and logistical challenges. Defects in randomization processes (e.g., allocation sequence concealment) and flawed masking could bias an RCT's findings. Moreover, investigators need to address other logistics common to all study designs, such as study invitations, eligibility screening, consenting procedure, and data confidentiality protocols. Research Electronic Data Capture (REDCap) is a secure, browser-based web application widely used by researchers for survey data collection. REDCap offers unique features that can be used to conduct rigorous RCTs. METHODS: In September and November 2020, we conducted a parallel group RCT among Indiana University Bloomington (IUB) undergraduate students to understand if receiving the results of a SARS-CoV-2 antibody test changed the students' self-reported protective behavior against coronavirus disease 2019 (COVID-19). In the current report, we discuss how we used REDCap to conduct the different components of this RCT. We further share our REDCap project XML file and instructional videos that investigators can use when designing and conducting their RCTs. RESULTS: We reported on the different features that REDCap offers to complete various parts of a large RCT, including sending study invitations and recruitment, eligibility screening, consenting procedures, lab visit appointment and reminders, data collection and confidentiality, randomization, blinding of treatment arm assignment, returning test results, and follow-up surveys. CONCLUSIONS: REDCap offers powerful tools for longitudinal data collection and conduct of rigorous and successful RCTs. Investigators can make use of this electronic data capturing system to successfully complete their RCTs. TRIAL REGISTRATION: The RCT was prospectively (before completing data collection) registered at ClinicalTrials.gov; registration number: NCT04620798 , date of registration: November 9, 2020.

A Cross-Sectional Analysis of Demographic and Behavioral Risk Factors of Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity Among a Sample of U.S. College Students.

PURPOSE: Colleges and universities across the United States are developing and implementing data-driven prevention and containment measures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Identifying risk factors for SARS-CoV-2 seropositivity could help to direct these efforts. This study aimed to estimate the associations between demographic factors and social behaviors and SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 diagnostic test. METHODS: In September 2020, we randomly sampled Indiana University Bloomington undergraduate students. Participants completed a cross-sectional online survey about demographics, SARS-CoV-2 testing history, relationship status, and risk behaviors. Additionally, during a subsequent appointment, participants were tested for SARS-CoV-2 antibodies using a fingerstick procedure and SARS-CoV-2 IgM/IgG rapid assay kit. We used unadjusted modified Poisson regression models to evaluate the associations between predictors of both SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 infection history. RESULTS: Overall, 1,076 students were included in the serological testing analysis, and 1,239 students were included in the SARS-CoV-2 infection history analysis. Current seroprevalence of SARS-CoV-2 was 4.6% (95% confidence interval: 3.3%, 5.8%). Prevalence of self-reported SARS-CoV-2 infection history was 10.3% (95% confidence interval: 8.6%, 12.0%). Greek membership, having multiple romantic partners, knowing someone in one's immediate environment with SARS-CoV-2 infection, drinking alcohol more than 1 day a week, and hanging out with more than five people when drinking alcohol increased both the likelihood of seropositivity and SARS-CoV-2 infection history. CONCLUSION: Our findings have implications for American colleges and universities and could be used to inform SARS-CoV-2 prevention and control strategies on such campuses.

Depression and loneliness during April 2020 COVID-19 restrictions in the United States, and their associations with frequency of social and sexual connections.

PURPOSE: To estimate the prevalence of depression and loneliness during the US COVID-19 response, and examine their associations with frequency of social and sexual connections. METHODS: We conducted an online cross-sectional survey of a nationally representative sample of American adults (n = 1010), aged 18-94, running from April 10-20, 2020. We assessed depressive symptoms (CES-D-10 scale), loneliness (UCLA 3-Item Loneliness scale), and frequency of in-person and remote social connections (4 items, e.g., hugging family member, video chats) and sexual connections (4 items, e.g., partnered sexual activity, dating app use). RESULTS: One-third of participants (32%) reported depressive symptoms, and loneliness was high [mean (SD): 4.4 (1.7)]. Those with depressive symptoms were more likely to be women, aged 20-29, unmarried, and low-income. Very frequent in-person connections were generally associated with lower depression and loneliness; frequent remote connections were not. CONCLUSIONS: Depression and loneliness were elevated during the early US COVID-19 response. Those who maintained very frequent in-person, but not remote, social and sexual connections had better mental health outcomes. While COVID-19 social restrictions remain necessary, it will be critical to expand mental health services to serve those most at-risk and identify effective ways of maintaining social and sexual connections from a distance.