Did the prevalence of traditional school bullying increase after COVID-19? Evidence from a two-stage cross-sectional study before and during COVID-19 pandemic.

BACKGROUND: COVID-19 has had a range of adverse effects on the behavior and mental health of adolescents globally, including bullying, anxiety and depression. However, there is a lack of comparative studies on the changes of school bullying before and during COVID-19 pandemic. OBJECTIVE: To examine the changes in traditional bullying before and during COVID-19 pandemic and reveal the related risk factors in Shantou, China. PARTICIPANTS AND SETTING: Two samples of secondary school students were collected in 2018 and 2021 in Shantou, respectively. METHODS: Bullying history and risk behaviors of students were measured in the past six months. The χ2 test was used to analyze differences in baseline information and bullying types. The binary logistic regression with Forward LR method was used to analyze factors that affect the risk of bullying victimization and perpetration before and during COVID-19. RESULTS: A total of 5782 secondary school students were included, 3071 before COVID-19 pandemic and 2711 during COVID-19. The prevalence of different types of victimization and perpetration all increased during COVID-19 (P < 0.001). Boarding, being a lower secondary school student (as opposed to upper secondary school), being male (as opposed to female), drinking, and playing violent video games were shared risk factors for bullying victimization and perpetration. Living in an urban (as opposed to rural and island) was a risk factor for perpetration. Smoking was a risk factor for perpetration. All differences were statistically significant (P < 0.05). CONCLUSIONS: We found that the prevalence of bullying victimization as well as perpetration increased during COVID-19. It suggests that we need to pay more attention to traditional school bullying prevention and control in China in the pandemic context.

Development of an Indirect Enzyme-Linked Immunosorbent Assay Based on the Yeast-Expressed CO-26K-Equivalent Epitope-Containing Antigen for Detection of Serum Antibodies against Porcine Epidemic Diarrhea Virus.

Porcine epidemic diarrhea (PED) is a severe contagious intestinal disease caused by the porcine epidemic diarrhea virus (PEDV), which leads to high mortality in piglets. In this study, by analyzing a total of 53 full-length spike genes and COE domain regions of PEDVs, the conserved COE fragment of the spike protein from the dominant strain SC1402 was chosen as the target protein and expressed successfully in Pichia pastoris (P. pastoris). Furthermore, an indirect enzyme-linked immunosorbent assay (iELISA) based on the recombinant COE protein was developed for the detection of anti-PEDV antibodies in pig sera. The results showed that under the optimized conditions, the cut-off value of COE-based indirect ELISA (COE-iELISA) was determined to be 0.12. Taking the serum neutralization test as standard, the relative sensitivity of the COE-iELISA was 94.4% and specificity 92.6%. Meanwhile, no cross-reactivity to other porcine pathogens was noted with this assay. The intra-assay and inter-assay coefficients of variation were less than 7%. Moreover, 164 vaccinated serum samples test showed that overall agreement between COE-iELISA and the actual diagnosis result was up to 99.4%. More importantly, the developed iELISA exhibited a 95.08% agreement rate with the commercial ELISA kit (Kappa value = 0.88), which suggested that the expressed COE protein was an effective antigen in serologic tests and the established COE-iELISA is reliable for monitoring PEDV infection in pigs or vaccine effectiveness.

A Cross-Sectional Survey of Different Types of School Bullying before and during COVID-19 in Shantou City, China.

BACKGROUND: Since the end of 2019, the COVID-19 pandemic has had serious wide-ranging effects on academic, occupational and other daily activities. Like other types of institutions, schools are facing unprecedented challenges. Students may face a variety of adverse consequences, including sleep disturbances and school bullying, if they are unable to adjust to the current learning and living environment. This study explored the effects of the COVID-19 pandemic on school bullying. METHODS: A total of 5782 middle school students were enrolled in this multi-stage, cross-sectional study (3071 before and 2711 during the pandemic). The pre-pandemic group had a mean age of 14.9 ± 1.73, the pandemic group of 14.75 ± 1.47. Three models were set up using binary logistic regression to adjust for confounding variables (gender, school type, alcohol consumption, smoking, playing violent video games). RESULTS: All types of bullying victimization and perpetration (physical, verbal, social and property bullying) were more common during the pandemic than before the pandemic. In terms of bullying victimization, property bullying victimization (crude odds ratio [OR]: 2.398, 95% CI: 2.014-2.854, p < 0.001; model 2 adjusted OR: 2.344, 95% CI: 1.966-2.795, p < 0.001; model 3 adjusted OR: 2.818, 95% CI: 2.292-3.464, p < 0.001) increased the most. In terms of bullying perpetration, verbal bullying perpetration (crude OR: 3.007, 95% CI: 2.448-3.693, p <0.001; model 2 adjusted OR: 2.954, 95% CI: 2.399-3.637, p < 0.001; model 3 adjusted OR:3.345, 95% CI: 2.703-4.139, p < 0.001) increased the most. CONCLUSION: This study corroborate the significance of the pandemic on traditional school bullying and suggests that we should further consider other types of bullying and establish and improve the response and prevention mechanisms during public health emergencies such as the COVID-19 pandemic.

Generalized anxiety disorder among rural primary and middle school students during the outbreak of COVID-19: a multicenter study in three southern Chinese cities.

BACKGROUND: The major public health crisis caused by the rapid spread of the coronavirus disease 2019 (COVID-19) and the large-scale public health measures such as social isolation and school closures enforced by some countries have severely affected on the physical and mental wellbeing of children and adolescents globally. This study aimed to estimate the prevalence of the psychological impact and investigate the similarities and differences in the influential factors for generalized anxiety disorder among rural adolescents as a relatively lesser noticed population the outbreak of COVID-19. METHODS: From May 11 to 22, 2020, a total of 1,179 adolescents, including Grade 5-6 in primary school and Grade 7-8 in middle school, were selected by multistage sampling in three Southern Chinese cities (Shantou, Guangdong Province; Hezhou, Guangxi Province; Nanchong, Sichuan Province), and completed the questionnaires including sociodemographic, generalized anxiety disorder, academic stress, coronaphobia, knowledge of COVID-19, and precautionary measures. ANOVA, Chi-square test, Kruskalwallis H test and multivariate linear regression were performed in the statistical analysis. RESULTS: The average scores of generalized anxiety disorder during the past two weeks were 3.43 (SD 4.46), 4.47 (SD 5.15), and 4.10 (SD 4.94) in Shantou, Hezhou and Nanchong, respectively. For the pooled data, academic stress (P < 0.001), coronaphobia (P < 0.001), and precautionary measures (P = 0.002) contributed to the prediction of anxiety scores. Academic stress was significantly associated to anxiety symptoms in all cities (P all < 0.001). Coronaphobia was also significantly associated to anxiety symptoms in all cities (P all < 0.001). CONCLUSION: This study highlights the urgent need for researchers and policymakers to focus on the mental health of rural children and adolescents during the COVID-19 epidemic. The adolescents with academic stress and coronaphobia, the greater the risk that adolescents will suffer from anxiety, suggesting mental health counseling and professional family support are needed.

A novel Energy Resources Allocation Management model for air pollution reduction.

Although air pollution has been reduced in various industrial and crowded cities during the COVID-19 pandemic, curbing the high concentration of the crisis of air pollution in the megacity of Tehran is still a challenging issue. Thus, identifying the major factors that play significant roles in increasing contaminant concentration is vital. This study aimed to propose a mathematical model to reduce air pollution in a way that does not require citizen participation, limitation on energy usage, alternative energies, any policies on fuel-burn style, extra cost, or time to ensure that consumers have access to energy adequately. In this study, we proposed a novel framework, denoted as the Energy Resources Allocation Management (ERAM) model, to reduce air pollution. The ERAM is designed to optimize the allocation of various energies to the recipients. To do so, the ERAM model is simulated based on the magnitude of fuel demand consumption, the rate of air pollution emission generated by each energy per unit per consumer, and the air pollution contribution produced by each user. To evaluate the reflectiveness and illustrate the feasibility of the model, a real-world case study, i.e., Tehran, was employed. The air pollution emission factors in Tehran territory were identified by considering both mobile sources, e.g., motorcycles, cars, and heavy-duty vehicles, and stationary sources, e.g., energy conversion stations, industries, and household and commercial sectors, which are the main contributors to particulate matter and nitrogen dioxide. An elaborate view of the results indicates that the ERAM model on fuel distribution could remarkably reduce Tehran's air pollution concentration by up to 14%.

The Roles of Information Valence, Media Literacy and Perceived Information Quality on the Association Between Frequent Social Media Exposure and COVID-19 Vaccination Intention.

PURPOSE: This study aimed to examine the associations between frequent exposure to positive/negative information about vaccine efficacy/safety on social media and intention of COVID-19 vaccination, and to test if media literacy and perceived information quality would moderate such associations. DESIGN: A multi-city cross-sectional survey. SETTING: At five universities in different regions of China. SUBJECTS: 6922 university students (a response rate of 72.3%). MEASURES: frequency of exposure to social media information about COVID-19 vaccination, media literacy, perceived information quality, intention of COVID-19 vaccination, and sociodemographic characteristics. ANALYSIS: Logistic regression analysis was conducted to test main and interaction effects. RESULTS: Higher exposure to positive information about vaccine efficacy (adjusted odds ratio [AOR] = 1.30, P < .001) and vaccine safety (AOR = 1.27, P < .001) were positively associated with vaccination intention. No significant associations were shown between exposure to negative information about vaccine efficacy/safety and vaccination intention. Higher net exposure to negative vs positive information was negatively associated with vaccination intention (AOR = .82, P < .001). High media literacy was further found to attenuate the effect of negative information exposure and strengthen that of positive information exposure. Perceived information quality was not a significant moderator. CONCLUSION: The valence of social media information regarding the efficacy and safety of COVID-19 vaccines and individuals' media literacy jointly shaped COVID-19 vaccination intention. The findings can inform the development of effective health promotion strategies for enhancing COVID-19 vaccination.

Adoption of Preventive Measures During the Very Early Phase of the COVID-19 Outbreak in China: National Cross-sectional Survey Study.

BACKGROUND: The outbreak of COVID-19 in China occurred around the Chinese New Year (January 25, 2020), and infections decreased continuously afterward. General adoption of preventive measures during the Chinese New Year period was crucial in driving the decline. It is imperative to investigate preventive behaviors among Chinese university students, who could have spread COVID-19 when travelling home during the Chinese New Year break. OBJECTIVE: In this study, we investigated levels of COVID-19-related personal measures undertaken during the 7-day Chinese New Year holidays by university students in China, and associated COVID-19-related cognitive factors. METHODS: A cross-sectional anonymous web-based survey was conducted during the period from February 1 to 10, 2020. Data from 23,863 students (from 26 universities, 16 cities, 13 provincial-level regions) about personal measures (frequent face-mask wearing, frequent handwashing, frequent home staying, and an indicator that combined the 3 behaviors) were analyzed (overall response rate 70%). Multilevel multiple logistic regression analysis was performed. RESULTS: Only 28.0% of respondents (6684/23,863) had left home for >4 hours, and 49.3% (11,757/23,863) had never left home during the 7-day Chinese New Year period; 79.7% (19,026/23,863) always used face-masks in public areas. The frequency of handwashing with soap was relatively low (6424/23,863, 26.9% for >5 times/day); 72.4% (17,282/23,863) had frequently undertaken ≥2 of these 3 measures. COVID-19-related cognitive factors (perceptions on modes of transmission, permanent bodily damage, efficacy of personal or governmental preventive measures, nonavailability of vaccines and treatments) were significantly associated with preventive measures. Associations with frequent face-mask wearing were stronger than those with frequent home staying. CONCLUSIONS: University students had strong behavioral responses during the very early phase of the COVID-19 outbreak. Levels of personal prevention, especially frequent home staying and face-mask wearing, were high. Health promotion may modify cognitive factors. Some structural factors (eg, social distancing policy) might explain why the frequency of home staying was higher than that of handwashing. Other populations might have behaved similarly; however, such data were not available to us.

A biomedical knowledge graph-based method for drug-drug interactions prediction through combining local and global features with deep neural networks.

Drug-drug interactions (DDIs) prediction is a challenging task in drug development and clinical application. Due to the extremely large complete set of all possible DDIs, computer-aided DDIs prediction methods are getting lots of attention in the pharmaceutical industry and academia. However, most existing computational methods only use single perspective information and few of them conduct the task based on the biomedical knowledge graph (BKG), which can provide more detailed and comprehensive drug lateral side information flow. To this end, a deep learning framework, namely DeepLGF, is proposed to fully exploit BKG fusing local-global information to improve the performance of DDIs prediction. More specifically, DeepLGF first obtains chemical local information on drug sequence semantics through a natural language processing algorithm. Then a model of BFGNN based on graph neural network is proposed to extract biological local information on drug through learning embedding vector from different biological functional spaces. The global feature information is extracted from the BKG by our knowledge graph embedding method. In DeepLGF, for fusing local-global features well, we designed four aggregating methods to explore the most suitable ones. Finally, the advanced fusing feature vectors are fed into deep neural network to train and predict. To evaluate the prediction performance of DeepLGF, we tested our method in three prediction tasks and compared it with state-of-the-art models. In addition, case studies of three cancer-related and COVID-19-related drugs further demonstrated DeepLGF's superior ability for potential DDIs prediction. The webserver of the DeepLGF predictor is freely available at http://120.77.11.78/DeepLGF/.

Prevalence and factors of influenza vaccination during the COVID-19 pandemic among university students in China.

BACKGROUND: Previous outbreaks of emerging infectious diseases (e.g., SARS) had increased the uptake of influenza vaccination (IV). It is uncertain whether such was also true for COVID-19. This study hence investigated prevalence of IV behavior/intention prior to and during the COVID-19 pandemic and associated cognitive factors. METHODS: A self-administered, online, and anonymous cross-sectional survey was conducted among 6,922 university students of five provinces in China during November 1-28, 2020 (response rate: 72.3%). RESULTS: Of all the participants, 35.1% self-reported behavioral intention of IV (next 12 months), while 62.9% reported an increased intention of IV due to COVID-19. However, only 4.7% and 2.9% had taken up IV during the 12-month period prior to the outbreak (1/2019-12/2019) and during the COVID-19 outbreak (1-11/2020), respectively. Adjusted for the background factors, the multivariable logistic regression analysis showed that in general the COVID-19 related perceptions (perceived susceptibility, perceived severity, and perceived chance of having another wave of COVID-19 outbreak) were significantly and positively associated the IV behavior (during the COVID-19 outbreak) and intention of IV uptake in the next 12 months. CONCLUSIONS: The COVID-19 pandemic may have influenced actual behavior and intention of IV uptake among university students during the pandemic. Efforts are warranted to reduce the intention-behavior gap of IV uptake; modification of perceived susceptibility and perceived severity regarding COVID-19 may help. Future longitudinal and intervention studies are needed to confirm the findings of this study and explore other factors affecting IV uptake during the COVID-19 period.

Factors associated with behavioral intention of free and self-paid severe acute respiratory coronavirus virus 2 (SARS-CoV-2) vaccination based on the social cognitive theory among nurses and doctors in China.

OBJECTIVE: To examine the associations between factors based on the social cognitive theory (SCT) and behavioral intention among doctors and nurses in China toward free and self-paid (600 RMB or US$91) severe acute respiratory coronavirus virus 2 (SARS-CoV-2) vaccination given 80% effectiveness and rare mild side effects. DESIGN: Cross-sectional study. SETTING: Public hospitals. PARTICIPANTS: The study included 362 doctors and 1,702 nurses in major departments of 5 hospitals of 3 Chinese provinces. METHODS: An anonymous online survey was conducted from October to November 2020, facilitated by hospital administrators through online WeChat/QQ working groups. Data on outcome expectations, self-efficacy, norms, and COVID-19-related work experiences were collected. Multivariate logistic regression models were used for data analyses. RESULTS: The logistic regression analysis showed that physical (eg, protective effect of vaccination) and self-evaluative outcome expectations (eg, anticipated regret), self-efficacy, norms (eg, descriptive norm, subjective norm, professional norm, and moral norm), and job satisfaction were significantly and positively associated with the free and self-paid SARS-CoV-2 vaccination intention outcomes among doctors and nurses, adjusted for background variables. Doctors who had engaged in COVID-19-related work reported higher self-paid vaccination intention. CONCLUSIONS: Health promotion is needed to improve the uptake of SARS-CoV-2 vaccination among healthcare workers. Such interventions may consider modifying the identified factors of vaccination intention, including strengthening perceived efficacy, positive feelings about vaccination, the need to avoid future regret, self-efficacy, and social norms. Future studies should examine the actual behavior patterns of SARS-CoV-2 vaccination, and the efficacy of promotion intervention should be tested in randomized controlled studies.

The Impact of Social Media Exposure and Interpersonal Discussion on Intention of COVID-19 Vaccination among Nurses.

COVID-19 vaccine hesitancy among nurses is a global public health concern and it is imperative to understand associated factors. Information environment plays a critical role in shaping health behaviors, while few studies explored such effects in the context of COVID-19 vaccination. A cross-sectional survey was conducted among 1902 nurses in China. The study investigated the effects of social media exposure/interpersonal discussion on intention of COVID-19 vaccination and tested whether perceived effectiveness of COVID-19 vaccines (perceived vaccine efficacy, perceived duration of protection, and perceived effectiveness in preventing resurgences) mediated such associations. Results showed that about 68.0% and 56.5% of the participants had an intention of free and self-paid COVID-19 vaccinations, respectively. Frequent social media exposure and interpersonal discussion were positively associated with vaccination intentions. Perceived vaccine efficacy significantly mediated the effects of frequent social media exposure and interpersonal discussion, whereas perceived effectiveness in preventing resurgences suppressed the effects of frequent social media exposure. In conclusion, the prevalence of intention of COVID-19 vaccination was relatively low among Chinese nurses and health promotion is needed. Frequent social media exposure and interpersonal discussion potentially enhanced vaccination intentions via increased perceived vaccine efficacy. The findings can help inform the development of relevant health communication interventions.

Dualistic Determinants of COVID-19 Vaccination Intention among University Students in China: From Perceived Personal Benefits to External Reasons of Perceived Social Benefits, Collectivism, and National Pride.

Vaccination is one of the most effective ways of controlling the COVID-19 pandemic. However, vaccine hesitancy is prevalent, and relatively few studies have explored how variables related to personal and external motives have affected the intention to vaccinate. The present study investigated the association between perceived personal benefits, variables reflecting external motives (i.e., perceived social benefits, collectivism, and national pride) and intention to receive COVID-19 vaccination among university students in China. The interaction between perceived personal benefits and the three factors reflecting external motives on intention to receive COVID-19 vaccination was also examined. A total of 6922 university students from five provinces of China completed a cross-sectional survey. Results showed that adjusting for significant background variables, perceived personal benefits, perceived social benefits, collectivism, and national pride were all significant factors of intention to receive COVID-19 vaccination. Results from interaction analyses also showed that the association between perceived personal benefits and COVID-19 vaccination intention was stronger among those with lower levels of national pride. Findings highlighted the important role of self-directed interest and external motives in promoting uptake of COVID-19 vaccination.

Emergency management and process of diagnosis and treatment for tumor patients during COVID-19 epidemic

The treatment of tumor has a strong timeliness and periodicity. Due to the duration of COVID-19 outbreak of is uncertain, patients with malignant tumors may have recurrent or progressive disease if they are not treated effectively for a long time. Several studies have shown that delayed chemotherapy and endocrine therapy may have adverse effects on the prognosis of cancer patients. Under the epidemic situation, it has become the key problem to be solved urgently by oncologists that how to better serve cancer patients, prevent and control the infection of cancer patients and their families, how to adjust and optimize the hospital treatment process, so as to ensure the scientific and orderly development of clinical work, and minimize the impact of the epidemic on the treatment of cancer patients. This paper focuses on effectively guiding the emergency management, diagnosis and treatment process, reasonable follow-up, scientific epidemic prevention, reducing the risk of transmission and paying close attention to the mental health of tumor patients, to provide the reference for improving the prognosis of tumor patients during the epidemic situation.

Prosociality and Social Responsibility Were Associated With Intention of COVID-19 Vaccination Among University Students in China.

BACKGROUND: Coronavirus disease 2019 (COVID-19) vaccination is expected to end the pandemic; a high coverage rate is required to meet this end. This study aimed to investigate the prevalence of behavioral intention of free/self-paid COVID-19 vaccination and its associations with prosociality and social responsibility among university students in China. METHODS: An anonymous online cross-sectional survey was conducted among 6922 university students in five provinces in China during November 1-28, 2020. With informed consent, participants filled out an online survey link distributed to them via WeChat study groups. The response rate was 72.3%. RESULTS: The prevalence of behavioral intentions of free COVID-19 vaccination was 78.1%, but it dropped to 57.7% if the COVID-19 vaccination involved self-payment (400 RMB; around 42 USD). After adjusting for background factors, prosociality (free vaccination: adjusted odds ratio [ORa] = 1.10, 95% CI: 1.09-1.12; self-paid vaccination: ORa = 1.08, 95% CI: 1.07-1.09) and social responsibility (free vaccination: ORa = 1.17, 95% CI: 1.14-1.19; self-paid vaccination: ORa = 1.13, 95% CI: 1.11-1.14) were positively associated with the two variables of COVID-19 vaccination intention. CONCLUSION: The present study demonstrated the positive effects of prosociality and social responsibility on the intention of COVID-19 vaccination. Accordingly, modification of prosociality and social responsibility can potentially improve COVID-19 vaccination. Future longitudinal and intervention studies are warranted to confirm such associations across populations and countries.

Behavioural intention of receiving COVID-19 vaccination, social media exposures and peer discussions in China.

The study aimed to investigate behavioural intentions to receive free and self-paid COVID-19 vaccinations (BICV-F and BICV-SP) among Chinese university students if the vaccine was 80% effective with rare mild side effects, to examine their associations with social media exposures and peer discussions regarding COVID-19 vaccination, and to explore the mediational role of perceived information sufficiency about COVID-19 vaccination. An online anonymous survey (N = 6922) was conducted in November 2020 in five Chinese provinces. Logistic regression and path analysis were adopted. The prevalence of BICV-F and BICV-SP were 78.1% and 57.7%. BICV-F was positively associated with the frequencies of passive social media exposure (adjusted odds ratio (AOR) = 1.32, P < 0.001), active social media interaction (AOR = 1.13, P < 0.001) and peer discussions (AOR = 1.17, P < 0.001). Indirect effects of the three factors on BICV-F via perceived information sufficiency were all significant (P < 0.001). The direct effect of active social media interaction on BICV-F was significantly negative (P < 0.001). Similar associations/mediations were observed for BICV-SP. The COVID-19 vaccination intention of Chinese university students needs improvement. Boosting social media exposures and peer discussions may raise students' perceived information sufficiency and subsequently increase their vaccination intention. Considering the potential negative effect of active social media interaction, caution is needed when using social media to promote COVID-19 vaccination.

A longitudinal study on psychological burden of medical students during COVID-19 outbreak and remission period in China.

BACKGROUND AND OBJECTIVES: Due to their professional characteristics and future career orientation, medical students have a deeper understanding of COVID-19 and enact disease prevention and control measures, which may cause psychological burden. We aimed to assess the psychological impact during the COVID-19 outbreak period(OP) and remission period(RP) among medical students. METHODS: We surveyed the medical students in Shantou University Medical College twice-during the OP and the RP, surveying psychological burden of COVID-19 lockdowns and its associated factors. 1069 respondents were recruited in OP and 1511 participants were recruited in RP. We constructed nomograms to predict the risk of psychological burden using risk factors that were screened through univariate analysis of the surveyed data set. RESULTS: There was a statistically significant longitudinal increment in psychological burden from OP to RP, and stress as well as cognition in psychological distress were the most dominant ones. Common impact factors of the depression, anxiety and stress included frequency of outdoor activities, mask-wearing adherence, self-perceived unhealthy status and exposure to COVID-19. In addition, the high frequency of handwashing was a protective factor for depression and anxiety. The C-index was 0.67, 0.74 and 0.72 for depression, anxiety and stress, respectively. CONCLUSION: The psychological impact of COVID-19 was worse during the RP than during the OP. Thus, it's necessary to continue to emphasize the importance of mental health in medical students during the pandemic and our proposed nomograms can be useful tools for screening high-risk groups for psychological burden risk in medical students.

Parental acceptability of COVID-19 vaccination for children under the age of 18 years among Chinese doctors and nurses: a cross-sectional online survey.

This study investigated parental acceptability of COVID-19 vaccination for children under the age of 18 years among Chinese parents who are healthcare workers. A closed online survey among full-time doctors or nurses employed by the five collaborative hospitals who had access to smartphones was conducted. Facilitated by the hospital administrators, prospective participants received an invitation sent by the research team via the existing WeChat/QQ groups to complete an online questionnaire. A total of 2,281 participants completed the survey. This study was a sub-analysis of 1332 participants who had at least one child under the age of 18 years. Among the participants, 44.5% reported that they would likely or very likely to have their children under the age of 18 years take up COVID-19 vaccination in the next six months. After adjusting for significant background characteristics, perceived higher vaccine efficacy, longer protection duration, perceived high/very high chance for China to prevent another wave of COVID-19 outbreak with vaccines in place and willingness to receive a COVID-19 vaccination for themselves were associated with higher parental acceptability of COVID-19 vaccination. At interpersonal level, higher frequency of information exposure through social media and direct interpersonal communication were associated with higher parental acceptability of COVID-19 vaccination, while knowing some people who experienced serious side effects following COVID-19 vaccination were associated with lower parental acceptability of COVID-19 vaccination. Despite their important roles in vaccination promotion, Chinese doctors and nurses showed low parental acceptability of COVID-19 vaccination. Effective health promotion is needed when COVID-19 vaccination become available.

Prevalence and associated factors of intention of COVID-19 vaccination among healthcare workers in China: application of the Health Belief Model.

Healthcare workers (HCWs) are at an increased risk of coronavirus disease 2019 (COVID-19) and warrant COVID-19 vaccination to reduce nosocomial infections. This study investigated: (1) the prevalence of behavioral intention of COVID-19 vaccination (BICV) under eight scenarios combining vaccines' effectiveness/safety/cost, plus two general scenarios of free/self-paid vaccination given governmental/hospital recommendations, (2) perceptions involving preferred timing of COVID-19 vaccination and impacts of various attributes on BICV, and (3) factors of BICV based on the Health Belief Model. An anonymous online cross-sectional survey was conducted among 2,254 full-time doctors/nurses in three Chinese provinces during 10/2020-11/2020. The prevalence of BICV was 75.1%/68.0% among nurses/doctors under the most optimum scenario of this study (free/80% effectiveness/rare mild side effects); it dropped to 64.6%/56.5% if it costed 600 Yuan (USD90). Similar prevalence was obtained (72.7%/71.2%) if the vaccination was recommended by the government/hospitals but dropped to <50% if effectiveness was 50% or mild side effects were common; 13.0% preferred to take up COVID-19 vaccination at the soonest (81.8% would wait and see). Scientific proof (completion of phase III clinical trials and approval from health authorities) was rated the highest in its impacts on vaccination decision, followed by vaccines' performance, and then logistics. Multivariable logistic regression analyses showed that perceived severity, perceived barriers, cues to action, and self-efficacy (but neither perceived susceptibility nor perceived barriers) were significantly associated with the two BICV outcomes. The coverage of COVID-19 vaccination would be high only if the vaccines perform well. Health promotion may take the findings into account.

Factors Influencing Depression and Mental Distress Related to COVID-19 Among University Students in China: Online Cross-sectional Mediation Study.

BACKGROUND: The COVID-19 epidemic may elevate mental distress and depressive symptoms in various populations in China. OBJECTIVE: This study investigates the levels of depression and mental distress due to COVID-19, and the associations between cognitive, behavioral, and psychosocial factors, and depression and mental distress due to COVID-19 among university students in China. METHODS: A large-scale online cross-sectional study (16 cities in 13 provinces) was conducted among university students from February 1 to 10, 2020, in China; 23,863 valid questionnaires were returned. The Patient Health Questionnaire-9 was used to assess depression. Structural equation modeling was performed to test mediation and suppression effects. RESULTS: Of the 23,863 participants, 47.1% (n=11,235) reported high or very high levels of one or more types of mental distress due to COVID-19; 39.1% (n=9326) showed mild to severe depression. Mental distress due to COVID-19 was positively associated with depression. All but one factor (perceived infection risks, perceived chance of controlling the epidemic, staying at home, contacted people from Wuhan, and perceived discrimination) were significantly associated with mental distress due to COVID-19 and depression. Mental distress due to COVID-19 partially mediated and suppressed the associations between some of the studied factors and depression (effect size of 6.0%-79.5%). CONCLUSIONS: Both mental distress due to COVID-19 and depression were prevalent among university students in China; the former may have increased the prevalence of the latter. The studied cognitive, behavioral, and psychosocial factors related to COVID-19 may directly or indirectly (via mental distress due to COVID-19) affect depression. Interventions to modify such factors may reduce mental distress and depressive symptoms during the COVID-19 epidemic.