Lapses in the person radar: Attentional traits predict difficulty in interpersonal distancing (preprint)

Within the psychological literature and during the COVID-19 pandemic, the regulation of interpersonal distance has typically been viewed as a voluntary choice, with implications for public health interventions. Here we highlight that lapses in interpersonal distancing can also occur unintentionally. Using a novel measure across 3 undergraduate samples (total N = 1225) we found that almost all (>97%) participants reported unintentional lapses in maintaining interpersonal distance, with 16% experiencing such lapses frequently. Thirty percent of the variance in these reports was accounted for by attentional traits: Inattentive and hyperactive-impulsive ADHD symptoms jointly predicted difficulties with interpersonal distancing, with the former relationship fully mediated by hyperfocus and spontaneous mind-wandering. The results are consistent with a view of interpersonal distancing as attentionally demanding and hence vulnerable to unintentional lapses due to inattention. We discuss the implications for epidemiology, social cognition and functioning, and design of social spaces.

Specific pandemic-related worries predict higher attention-related errors and negative affect independent of trait anxiety (preprint)

Recent surveys have revealed a rise in anxiety levels, in response to the COVID-19 pandemic. Based on cognitive-emotional models of anxiety, we predict this increase may be underpinned by pandemic-related worry (PRW), characterised by repetitive negative thinking about pandemic-specific outcomes. We also predicted that PRW would occupy limited capacity cognitive resources required for attentional control, needed for the regulation of worry. We developed a novel instrument to measure the contents of PRW, and to explore its independent relationship with cognitive functioning and negative affect. A five-factor model of PRW was identified in Study 1 (N = 255) and validated in Study 2 (N = 382). In Study 2, regression analyses revealed that worries about the declining quality of life and the probability of COVID-19 infection were the strongest predictors of attention and memory-related errors. We also found that attention-related errors partially mediated the positive relationship between PRW and negative affect. Importantly, all analyses remained significant when controlling for recalled pre-pandemic trait anxiety and worry, suggesting that the relationships reflected elevated anxiety even in those with low levels of trait anxiety. The findings suggest that to support psychological wellbeing in the wake of the COVID-19 pandemic, support should target specific PRWs.

Disparities in COVID-19 Fatalities among Working Californians (preprint)

Background: Information on the occupational distribution of COVID-19 mortality is limited. Objective: To characterize COVID-19 fatalities among working Californians. Design: Retrospective study of laboratory-confirmed COVID-19 fatalities with dates of death from January 1 to December 31, 2020. Setting: California. Participants: COVID-19 accounted for 8,050 (9.9%) of 81,468 fatalities among Californians 18-64 years old. Of these decedents, 2,486 (30.9%) were matched to state employment records and classified as confirmed working. The remainder were classified as likely working (n=4,121 [51.2%]) or not working (n=1,443 [17.9%]) using death certificate and case registry data. Measurements: We calculated age-adjusted overall and occupation-specific COVID-19 mortality rates using 2019 American Community Survey denominators. Results: Confirmed and likely working COVID-19 decedents were predominantly male (76.3%), Latino (68.7%), and foreign-born (59.6%), with high school or less education (67.9%); 7.8% were Black. The overall age-adjusted COVID-19 mortality rate was 30.0 per 100,000 workers (95% confidence interval [CI], 29.3-30.8). Workers in nine occupational groups had mortality rates higher than this overall rate, including those in farming (78.0; 95% CI, 68.7-88.2); material moving (77.8; 95% CI, 70.2-85.9); construction (62.4; 95% CI, 57.7-67.4); production (60.2; 95% CI, 55.7-65.0); and transportation (57.2; 95% CI, 52.2-62.5) occupations. While occupational differences in mortality were evident across demographic groups, mortality rates were three-fold higher for male compared with female workers and three- to seven-fold higher for Latino and Black workers compared with Asian and White workers. Limitations: The requirement that fatalities be laboratory-confirmed and the use of 2019 denominator data may underestimate the occupational burden of COVID-19 mortality. Conclusion: Californians in manual labor and in-person service occupations experienced disproportionate COVID-19 mortality, with the highest rates observed among male, Latino, and Black workers.

The relationship between COVID-19-specific health risk beliefs and the motivation to quit smoking: a UK-based survey (preprint)

Background: In some individuals who smoke the COVID-19 pandemic has triggered an increase in the motivation to quit smoking, due to the higher risk of severe COVID-19 infection. However, this change is not universal, and the motivation to quit appears dependent upon factors such as fear of COVID-19 and perceived risk from COVID-19. In the current investigation, both COVID-19 severity and infection probability beliefs were measured to isolate which beliefs correlated with the motivation to quit smoking. Methods: UK-based smokers (N = 243) completed an online survey between September and October 2020, in which they reported their current motivation to quit smoking, fear of COVID-19, and their beliefs about how severe COVID-19 infection would be and how probable COVID-19 infection was. Results: The only significant predictor of the motivation to quit smoking was the perceived probability of COVID-19 infection, β = .22, p < .001, 95CI[.10, .34]. This relationship remained when controlling for the general perceived probability and severity of other smoking-related health conditions, β = .20, p = .002, 95CI[.08,.32], suggesting a COVID-19-specific effect. Further, perceived probability of COVID-19 infection mediated the positive impact of fear of COVID-19 on motivation, β = .07, p = .006, 95CI[.03,.13]. Conclusions: The result places the perceived probability of COVID-19 infection as a central predictor of motivation to quit during the pandemic. Based on this evidence, messaging aiming to facilitate smoking cessation during the pandemic should focus on the highly contagious nature of the virus to increase the motivation to quit.

Smokers’ Affective Responses to COVID-19-Related Health Warnings on Cigarette Packets: The Influence of Delay Discounting (preprint)

Introduction: The addition of graphic health warnings on cigarette packets can facilitate smoking cessation, primarily through their ability to elicit a negative affective response. Smoking is linked to COVID-19 mortality, thus making it likely to elicit a strong affective response in smokers. COVID-19-related health warnings (C19HW) may therefore enhance graphic health warnings, when compared to traditional health warnings (THW). Further, because impulsivity influences smoking behaviours, we also examined whether these affective responses were associated with delay discounting. Methods: In a between-subjects design, 240 smokers rated the valence and arousal elicited by tobacco packaging that contained either a C19HW or THW (both referring to death). Participants also completed questionnaires to quantify delay discounting and attitudes towards COVID-19 and smoking (eg, health risks, motivation to quit). Results: There were no differences between the two health warning types on either valence or arousal, nor any secondary outcome variables. There was, however, a significant interaction between health warning type and delay discounting on arousal ratings. Specifically, in smokers who exhibit low delay discounting, C19HWs elicited significantly greater subjective arousal rating than did THWs, whereas there was no significant effect of health warning type on arousal in smokers who exhibited high delay discounting. Conclusion: The results suggest that in smokers who exhibit low impulsivity (but not high impulsivity), C19HWs may be more arousing than THWs. Future work is required to explore the long-term utility of C19HWs, and to identify the specific mechanism by which delay discounting moderates the impact of tobacco health warnings.

Excess mortality associated with the COVID-19 pandemic among Californians 18–65 years of age, by occupational sector and occupation: March through October 2020 (preprint)

Background Though SARS-CoV-2 outbreaks have been documented in occupational settings and though there is speculation that essential workers face heightened risks for COVID-19, occupational differences in excess mortality have, to date, not been examined. Such information could point to opportunities for intervention, such as workplace modifications and prioritization of vaccine distribution. Methods and findings Using death records from the California Department of Public Health, we estimated excess mortality among Californians 18–65 years of age by occupational sector and occupation, with additional stratification of the sector analysis by race/ethnicity. During the COVID-19 pandemic, working age adults experienced a 22% increase in mortality compared to historical periods. Relative excess mortality was highest in food/agriculture workers (39% increase), transportation/logistics workers (28% increase), facilities (27%) and manufacturing workers (23% increase). Latino Californians experienced a 36% increase in mortality, with a 59% increase among Latino food/agriculture workers. Black Californians experienced a 28% increase in mortality, with a 36% increase for Black retail workers. Asian Californians experienced an 18% increase, with a 40% increase among Asian healthcare workers. Excess mortality among White working-age Californians increased by 6%, with a 16% increase among White food/agriculture workers. Conclusions Certain occupational sectors have been associated with high excess mortality during the pandemic, particularly among racial and ethnic groups also disproportionately affected by COVID-19. In-person essential work is a likely venue of transmission of coronavirus infection and must be addressed through strict enforcement of health orders in workplace settings and protection of in-person workers. Vaccine distribution prioritizing in-person essential workers will be important for reducing excess COVID mortality.

The effect of school closures and reopening strategies on COVID-19 infection dynamics in the San Francisco Bay Area: a cross-sectional survey and modeling analysis (preprint)

Background Large-scale school closures have been implemented worldwide to curb the spread of COVID-19. However, the impact of school closures and re-opening on epidemic dynamics remains unclear. Methods We simulated COVID-19 transmission dynamics using an individual-based stochastic model, incorporating social-contact data of school-aged children during shelter-in-place orders derived from Bay Area (California) household surveys. We simulated transmission under observed conditions and counterfactual intervention scenarios between March 17-June 1, and evaluated various fall 2020 K-12 reopening strategies. Findings Between March 17-June 1, assuming children <10 were half as susceptible to infection as older children and adults, we estimated school closures averted a similar number of infections (13,842 cases; 95% CI: 6,290, 23,040) as workplace closures (15,813; 95% CI: 9,963, 22,617) and social distancing measures (7,030; 95% CI: 3,118, 11,676). School closure effects were driven by high school and middle school closures. Under assumptions of moderate community transmission, we estimate that fall 2020 school reopenings will increase symptomatic illness among high school teachers (an additional 40.7% expected to experience symptomatic infection, 95% CI: 1.9, 61.1), middle school teachers (37.2%, 95% CI: 4.6, 58.1), and elementary school teachers (4.1%, 95% CI: -1.7, 12.0). Results are highly dependent on uncertain parameters, notably the relative susceptibility and infectiousness of children, and extent of community transmission amid re-opening. The school-based interventions needed to reduce the risk to fewer than an additional 1% of teachers infected varies by grade level. A hybrid-learning approach with halved class sizes of 10 students may be needed in high schools, while maintaining small cohorts of 20 students may be needed for elementary schools. Interpretation Multiple in-school intervention strategies and community transmission reductions, beyond the extent achieved to date, will be necessary to avoid undue excess risk associated with school reopening. Policymakers must urgently enact policies that curb community transmission and implement within-school control measures to simultaneously address the tandem health crises posed by COVID-19 and adverse child health and development consequences of long-term school closures.