The impact of COVID-19 on the lives of Canadians with and without non-communicable chronic diseases: Results from the iCARE Study (preprint)

Background: The COVID-19 pandemic and its prevention policies have taken a toll on Canadians, and certain subgroups may have been disproportionately affected, including those with non-communicable disease (NCDs; e.g., heart and lung disease) due to their risk of COVID-19 complications. Aims/Objectives: We investigated the impacts of COVID-19 on mental health, lifestyle habits, and access to healthcare among Canadians with NCDs compared to those without, and the extent to which women with NCDs were disproportionately affected. Methods: As part of the iCARE study (www.icarestudy.com), data from seven Canadian representative samples (total n=24,028) was collected via online surveys between June 4, 2020 to February 2, 2022 and analyzed using general linear models. Results: A total of 45.6% (n=10,570) of survey respondents indicated having at least one physician-diagnosed NCD, the most common of which were hypertension (24.3%), chronic lung disease (13.3%) and diabetes (12.0%). In fully adjusted models, those with NCDs were 1.18-1.24 times more likely to reporting feeling lonely, irritable/frustrated, and angry ‘to a great extent’ compared to those without (p’s <.001). Similarly, those with NCDs were 1.22-1.24 times more likely to report worse eating and drinking habits and cancelling medical appointments/avoiding the emergency department compared to those without (p’s <.001). Moreover, although there were no sex differences in access to medical care, women with NCDs were more likely to report feeling anxious and depressed, and report drinking less alcohol, compared to men with NCDs (p’s <.01). Conclusion: Results suggest that people with NCDs and women have been disproportionately impacted by the pandemic, and that women with NCDs have suffered greater psychological distress compared to men, and men with NCDs have increased their alcohol consumption compared to women. Findings point to potential intervention targets among patients with NCDs.

How Well do Covariates Perform When Adjusting for Sampling Bias in Online COVID-19 Research? Insights from Multiverse Analyses (preprint)

Background. COVID-19 research has relied heavily on convenience-based samples, which—though often necessary—are susceptible to important sampling biases. We begin with a theoretical overview and introduction to the dynamics that underlie sampling bias. We then empirically examine sampling bias in online COVID-19 surveys and evaluate the degree to which common statistical adjustments for demographic covariates successfully attenuate such bias. Methods. We analysed responses to identical questions from three convenience and three largely representative samples (total N = 13,731) collected online in Canada within the International COVID-19 Awareness and Responses Evaluation Study (www.icarestudy.com). We compared samples on 11 behavioural and psychological outcomes (e.g., adherence to COVID-19 prevention measures, vaccine intentions) across three time points and employed multiverse-style analyses to examine how 512 combinations of demographic covariates (e.g., sex, age, education, income, ethnicity) impacted sampling discrepancies on these outcomes.Results. Significant discrepancies emerged between samples on 73% of outcomes. Participants in the convenience samples held more positive thoughts towards and engaged in more COVID-19 prevention behaviours. Covariates attenuated sampling differences in only 55% of cases and increased differences in 45%. No covariate performed reliably well. Conclusion. Our results suggest that online convenience samples may display more positive dispositions towards COVID-19 prevention behaviours being studied than would samples drawn using more representative means. Adjusting results for demographic covariates frequently increased rather than decreased bias, suggesting that researchers should be cautious when interpreting adjusted findings. Using multiverse-style analyses as extended sensitivity analyses is recommended.

Understanding national trends in COVID-19 vaccine hesitancy in Canada - April 2020 to March 2021 (preprint)

ObjectiveKey to reducing COVID-19 morbidity and mortality and reducing the need for further lockdown measures in Canada and worldwide is widespread acceptance of COVID-19 vaccines. Vaccine hesitancy has emerged as a key barrier to achieving optimal vaccination rates, for which there is little data among Canadians. This study examined rates of vaccine hesitancy and their correlates among Canadian adults. MethodsThis study analyzed data from five age, sex and province-weighted population-based samples to describe rates of hesitancy between April 2020 and March 2021 among Canadians who completed online surveys as part of the iCARE Study, and various sociodemographic, clinical and psychological correlates. Vaccine hesitancy was assessed by asking: "If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?" Responses were dichotomized into very likely, unlikely, somewhat unlikely (reflecting some degree of vaccine hesitancy) vs extremely likely to get the vaccine, which was the comparator. ResultsOverall, 15,019 respondents participated in the study. A total of 42.2% of respondents reported vaccine hesitancy over the course of the study, which was lowest during surveys 1 (April 2020) and 5 (March 2021) and highest during survey 3 (November 2020). Fully adjusted multivariate logistic regression analyses revealed that women, those aged 50 and younger, non-Whites, those with high school education or less, and those with annual household incomes below the poverty line in Canada (i.e., $60,000) were significantly more likely to report being vaccine hesitant over the study period, as were essential and healthcare workers, parents of children under the age of 18, and those who do not get regular flu vaccines. Believing engaging in infection prevention behaviours (like vaccination) is important for reducing virus transmission and high COVID-19 health concerns (being infected and infecting others) were associated with 77% and 54% reduction in vaccine hesitancy, respectively, and having high personal financial concerns (worried about job or income loss) was associated with 1.33 times increased odds of vaccine hesitancy. ConclusionResults point to the importance of targeting vaccine efforts to women, younger people and socioeconomically disadvantaged groups, and that vaccine messaging should emphasize the benefits of getting vaccinated, and how the benefits (particularly to health) far outweigh the risks. Future research is needed to monitor ongoing changes in vaccine intentions and behaviour, as well as to better understand motivators and facilitators of vaccine acceptance, particularly among vulnerable groups.

Determinants of adherence to COVID-19 preventive behaviours in Canada: Results from the iCARE Study (preprint)

Objective: Key to slowing the spread of SARS-Cov-2 is adherence to preventive behaviours promoted through government policies, which may be influenced by policy awareness, attitudes and concerns about the virus and its impacts. This study assessed determinants of adherence to major coronavirus preventive behaviours, including demographics, attitudes and concerns, among Canadians during the first pandemic wave. Methods: As part of the iCARE study (www.iCAREstudy.com), we weighted data from two population-based, online surveys (April and June, 2020) of Canadian adults. Questions tapped into behaviour change constructs. Multivariate regression models identified determinants of adherence. Results: Data from 6,008 respondents (51% female) were weighted for age, sex, and province. Awareness of government policies was high at both time points (80-99%), and adherence to prevention behaviours was high in April (87.5%-93.5%) but decreased over time, particularly for avoiding social gatherings (68.1%). Adherence was worse among men, those aged 25 and under, and those currently working. Aligned with the Health Beliefs Model, perceptions of the importance of prevention behaviours and the nature of peoples COVID-19-related concerns were highly predictive of adherence. Interestingly, health and social/economic concerns predicted better adherence, but having greater personal financial concerns predicted worse adherence at both time points. Conclusion: Adherence to COVID-19 prevention behaviours was worse among men, younger adults, and workers, and deteriorated over time. Perceived importance of prevention behaviours measures and health and social/economic concerns predicted better adherence, but personal financial concerns predicted worse adherence. Results have implications for tailoring policy and communication strategies during subsequent pandemic waves.