The effect of exposure to COVID-19 on life satisfaction: The mediating role of hyperarousal and moderating/mediating role of affective forecasting.

BACKGROUND: As a global trauma event, the Coronavirus disease (COVID-19) hugely impacts people's mental health and well-being. The purpose of our study is threefold: first, investigate the relationship between exposure to COVID-19 and life satisfaction among a large sample in China; second, test the mediating role of hyperarousal in the association between exposure to COVID-19 and life satisfaction; third, explore the moderating/mediating role of affective forecasting in the association between hyperarousal and life satisfaction. METHOD: The current study recruited 5546 participants to complete a set of self-report questionnaires online from April 22, 2020 to April 24, 2020. The moderated mediation and chain mediation model analyses were conducted using the SPSS software and PROCESS macro program. RESULTS: Exposure to COVID-19 negatively predicted life satisfaction (Effect = -0.058, p < 0.001). This relationship was partially mediated by the hyperarousal level (Effect = -0.018, CI = [-0.024, -0.013]). The moderating role of forecasted positive affect (PA)/forecasted negative affect (NA) between hyperarousal and life satisfaction was significant (ß = 0.058, CI = [0.035, 0.081]; ß = 0.037, CI = [0.014, 0.06]). The chain mediating effect of hyperarousal and forecasted PA/forecasted NA on the relationship between exposure to COVID-19 and life satisfaction was also significant (Effect = -0.003, CI = [-0.004, -0.002]; Effect = -0.006, CI = [-0.008, -0.004]). LIMITATIONS: The cross-sectional design precludes causal inference. CONCLUSION: Greater exposure to COVID-19 was associated with more severe hyperarousal symptoms, decreased life satisfaction. Forecasted PA and forecasted NA could moderate and mediate the negative impact of hyperarousal on life satisfaction. The moderating/mediating role of forecasted PA/NA implied that future interventions targeting at improving affective forecasting and reducing hyperarousal might be helpful to improve life satisfaction during the post-COVID-19 era.

Mental distress, COVID19 vaccine distrust and vaccine hesitancy in South Africa: A causal mediation regression analysis.

AIM: Within the context of increasing mental distress noted since the beginning of the COVID19 pandemic, the study aims at analysing the relationship between mental health, vaccine distrust and vaccine hesitancy in South Africa. SUBJECT AND METHODS: The study uses nationally representative panel data of 3241 individuals interviewed prior to and during the COVID19 pandemic. The study uses a range of regression techniques including logit, mediation and gradient-boosted causal mediation models to identify the causal relationship while accounting for selection bias. RESULTS: The results of multivariate logit regression reveal that vaccine distrust is the most important predictor of vaccine hesitancy [Coeff: 3.420, CI 3.122, 3.717]. Mental distress is not found to be a significant driver in a fully specified logit model, pointing to the need to analyse the pathways through which mental distress impacts vaccine hesitancy. The mediation regression undertaken for this purpose finds that the mental distress has a positive and significant association with vaccine distrust [Coeff: 0.027, CI: 0.0029, 0.052]. The increased vaccine distrust in turn results in increased vaccine hesitancy [Coeff: 0.661, CI: 0.611, 0.711]. The results of mediation regression therefore indicate strong and significant mediation effects, whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. These results are robust to the gradient boosted causal mediation model which establishes strong and significant indirect effects [Coeff: 0.015, CI: 0.01, 0.019], whereby mental health effects vaccine hesitancy through the mediating variable of vaccine distrust. CONCLUSION: The study concludes that mental health impacts on vaccine intention through the mediating role of vaccine distrust. The findings indicate that individuals at high risk of depression are more concerned regarding the safety of vaccines, which in turn feeds into vaccine hesitancy. Therefore, depressive symptoms impact on vaccine hesitancy through the mediating factor of vaccine distrust.

Child Tax Credit, Spending Patterns, and Mental Health: Mediation Analyses of Data from the U.S. Census Bureau's Household Pulse Survey during COVID-19.

This study examined the relationship between the receipt of COVID-19 child tax credit and adult mental health problems in the United States, and we explored whether and the extent to which a wide range of spending patterns of the credit-15 patterns regarding basic necessities, child education, and household expenditure-mediated the relationship. We used COVID-19-specialized data from the U.S. Census Bureau's Household Pulse Survey, a representative population sample (N = 98,026) of adult respondents (18 and older) who participated between 21 July 2021 and 11 July 2022. By conducting mediation analyses with logistic regression, we found relationships between the credit and lower levels of anxiety (odds ratio [OR] = 0.914; 95% confidence interval [CI] = 0.879, 0.952). The OR was substantially mediated by spending on basic necessities such as food and housing costs (proportion mediated = 46% and 44%, respectively). The mediating role was relatively moderate in the case of spending on child education and household expenditure. We also found that spending the credit on savings or investments reduces the effect of the child tax credit on anxiety (-40%) while donations or giving to family were not a significant mediator. Findings on depression were consistent with anxiety. The child tax credit-depression relationships were substantially mediated by spending on food and housing (proportion mediated = 53% and 70%). These mediation analyses suggested that different patterns of credit spending are important mediators of the relationship between the receipt of the child tax credit and mental illnesses. Public health approaches to improve adult mental health during and after the COVID-19 pandemic need to consider the notable mediating role of spending patterns.

Mediation analysis of conspiratorial thinking and anti-expert sentiments on vaccine willingness.

OBJECTIVE: Vaccines are an effective means to reduce the spread of diseases, but they are sometimes met with hesitancy that needs to be understood. METHOD: In this study, we analyzed data from a large, cross-country survey conducted between June and August 2021 in 43 countries (N = 15,740) to investigate the roles of trust in government and science in shaping vaccine attitudes and willingness to be vaccinated. RESULTS: Despite significant variability between countries, we found that both forms of institutional trust were associated with a higher willingness to receive a COVID-19 vaccine. Furthermore, we found that conspiratorial thinking and anti-expert sentiments predicted reduced trust in government and science, respectively, and that trust mediated the relationship between these two constructs and ultimate vaccine attitudes. Although most countries displayed similar relationships between conspiratorial thinking and anti-expert sentiments, trust in government and science, and vaccine attitudes, we identified three countries (Brazil, Honduras, and Russia) that demonstrated significantly altered associations between the examined variables in terms of significant random slopes. CONCLUSIONS: Cross-country differences suggest that local governments' support for COVID-19 prevention policies can influence populations' vaccine attitudes. These findings provide insight for policymakers to develop interventions aiming to increase trust in the institutions involved in the vaccination process. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Knowledge, attitude and practice survey towards COVID-19 vaccination: A mediation analysis.

BACKGROUND AND AIM: The COVID-19 pandemic has significantly impacted human lives across the world. In a country like India, with the second highest population in the world, impact of COVID-19 has been diverse and multidimensional. Under such circumstances, vaccination against COVID-19 infection is claimed to be one of the major solutions to contain the pandemic. Understanding of Knowledge, Attitude and Practice (KAP) measures are essential prerequisites to design suitable intervention programs. This paper examines the different KAP factors in Indians towards their decision of vaccine uptake. METHOD: An online questionnaire was administered to Indian respondents. (Pilot study: n = 100, Main study: n = 221) to assess their existing knowledge on COVID-19 infections and vaccination, attitude and intentions towards COVID-19 vaccines and their decision towards COVID-19 vaccine uptake. RESULT: The findings highlighted that existing knowledge on COVID-19 infections and vaccination directly impacted their attitude and intention towards vaccination. The attitude and intention towards COVID-19 vaccines directly impacted their practice of undergoing COVID-19 vaccination. Further, there was a statistically significant and considerably large indirect effect of existing knowledge on COVID-19 infections and vaccination on the practice of undergoing COVID-19 vaccination through attitude and intention towards the vaccine. There was no direct effect of Knowledge (existing knowledge on COVID-19 infections and vaccination) on Practice (decision to undergo COVID-19 vaccination). Therefore, Attitude and intention towards COVID-19 vaccine is the primary mediator between Knowledge (existing knowledge on COVID-19 infections and vaccination) and Practice (decision to undergo COVID-19 vaccination). CONCLUSION: Participants decision towards COVID-19 vaccination decisions are strongly related to their attitude and intentions that confirms the strong role of attitude towards success of COVID-19 vaccination programme. Therefore, 'person-centric' attitude based positive intervention strategies that links their prior knowledge on COVID-19 infections and vaccination must be designed for greater vaccine acceptance amongst Indians.

Impact of Social Support on Depressive Symptoms among Postgraduates during the Coronavirus Disease 2019 Pandemic: A Moderated Mediation Analysis.

The coronavirus disease (COVID-19) pandemic continues to spread worldwide, and its related stressors are causing a high prevalence of mental health problems among graduate students. This has the potential for long-term effects on their mental well-being. However, few large-scale studies have been conducted on multiple risk and protective factors. Therefore, we aimed to test the impact of social support on depressive symptoms among graduate students and analyze the mediating role of positive coping and the regulatory role of neuroticism. From 1-8 October 2021, 1812 Chinese graduate students were surveyed online. We used a structural equation model to study the mediating role of positive coping in the relationship between social support and depressive symptoms and used the Hayes PROCESS macro to conduct mediating analysis. The incidence of depressive symptoms was 10.40%. These results showed that positive coping influenced the social support's influence on depression symptoms to some extent. Moreover, neuroticism regulates the indirect relationship between social support and depressive symptoms through active coping. Further research is needed to assess the impact of various forms of social support on graduate students' mental health and to develop strategies for maintaining their well-being, such as network mindfulness.

The Impact of COVID-19 on the Academic Life of Social Work Students: Resilience as a Mediating Variable.

PURPOSE: The aim of this study is to analyze the relationship between emotions and concerns stemming from COVID-19 and the academic engagement of social work students, taking into account the mediating role played by resilience. METHOD: We carried out a cross-cutting quantitative study by means of an online questionnaire. The participants comprised a total of 474 students currently enrolled on the Degree in Social Work at the University of Valencia (Spain). RESULTS: The results show that the effects of emotions and concerns stemming from COVID-19 on student engagement were fully mediated by resilience. Indeed, positive emotions and concerns about the future had a positive impact on student engagement through resilience. DISCUSSION: Resilience stands as a potential protective factor against the social and academic challenges generated by COVID-19. The pandemic could therefore be seen as a real opportunity for sweeping change in the teaching and practice of social work.

WITHDRAWN: Associations between family support, loneliness, and underlying depression among children and adolescents in the China family panel studies: A mediation analysis.

OBJECTIVE: This study aimed to assess the association between depression and family support among Chinese children and adolescents and to investigate whether loneliness could mediate this relationship. METHODS: There were 2755 children and adolescents aged 18 and below from the China Family Panel Studies (CFPS) that participated in our study. Depression in children and adolescents was assessed by the Center for Epidemiologic Studies Depression Scale (CESD). Binary logistic regression combined with mediation analysis was used to examine the association between family support and depression and the mediating effect of loneliness on this relationship. RESULTS: Of the 2755 children and adolescents, 848 (30.8 %) reported feeling lonely and 310 (11.3 %) reported feeling depressed. Multivariate logistic regression analysis showed that compared with children and adolescents with family support, children and adolescents without family support had a higher risk of loneliness (odds ratio (OR) = 1.668, 95 % confidence interval (CI): 1.318-2.111) and depression (odds ratio (OR) = 2.252, 95 % confidence interval (CI) 1.669-3.039). Mediation analysis revealed that loneliness played a partial mediating role in the association between family support and depression (ß = -0.109, P < 0.001), and the mediation proportion was 38.11 %. CONCLUSION: Family support affects depression directly and indirectly through loneliness. The results suggest that parents should provide more support to children and adolescents to reduce the risk of loneliness and underlying depression during the COVID-19 pandemic.

Are psychological status and trust in information related to vaccine hesitancy during COVID-19 pandemic? A latent class and mediation analyses in Italy.

Despite the recognized benefits of the COVID-19 vaccination, vaccine hesitancy (VH) remains one of the biggest challenges of the mass vaccination campaign. Most studies investigating VH determinants focused on socio-demographics and direct relationships. In this study, we aimed at: 1) identifying subgroups of people differently affected by the pandemic, in terms of psychological status; 2) investigating the role of psychological status and trust in information as possible mediators of the relationship between individual characteristics and VH. To this purpose, a latent class analysis (LCA) followed by a mediation analysis were carried out on data from a survey conducted in January 2021 on 1011 Italian citizens. LCA identified four different subgroups characterized by a differential psychological impact of the pandemic: the extremely affected (21.1%), the highly affected (49.1%), the moderately affected (21.8%) and the slightly affected (8%). We found that VH decreased with the increase of psychological impact (from 59.3% to 23.9%). In the mediation analysis, past vaccination refusal, age 45-54 years and lower-than-average income, were all indirectly related to higher VH through mistrust in COVID-19 information. Differently, the psychological impact counteracted the greater VH in females, the negative effect of social media among youngest (<35 years) and the negative effect of mistrust in the lower-than-average-income subgroup. Knowledge of psychological profile of hesitant individuals, their level of trust and the sources of information they access, together with their sociodemographic characteristics provides a more comprehensive picture of VH determinants that can be used by public health stakeholders to effectively design and adapt communication campaigns.

Mediation analysis with multiple mediators under unmeasured mediator-outcome confounding.

It is often of interest in the health and social sciences to investigate the joint mediation effects of multiple post-exposure mediating variables. Identification of such joint mediation effects generally require no unmeasured confounding of the outcome with respect to the whole set of mediators. As the number of mediators under consideration grows, this key assumption is likely to be violated as it is often infeasible to intervene on any of the mediators. In this article, we develop a simple two-step method of moments estimation procedure to assess mediation with multiple mediators simultaneously in the presence of potential unmeasured mediator-outcome confounding. Our identification result leverages heterogeneity of the population exposure effect on the mediators, which is plausible under a variety of empirical settings. The proposed estimators are illustrated through both simulations and an application to evaluate the mediating effects of post-traumatic stress disorder symptoms in the association between self-efficacy and fatigue among health care workers during the COVID-19 outbreak.

Associations of connectedness and parental behaviors with adolescent physical activity and mental health during COVID-19: A mediation analysis using the 2021 adolescent behaviors and experiences survey.

The purpose of this study was to examine the associations of connectedness and parental behaviors with adolescent physical activity (PA) and mental health during COVID-19. Participants were a representative sample of US high school students who completed the 2021 Adolescent Behaviors and Experiences Survey (ABES; N = 7705; 50.4% female). ABES was completed online during the spring of 2021 and data were analyzed during the spring of 2022. Independent variables were items asking about perceived school and virtual connectedness, parental emotional abuse, and parental monitoring. Latent variables represented both PA and mental health. Two weighted structural equation models tested the associations between connectedness, parental behaviors, and mental health mediated through PA (Model 1) and between connectedness, parental behaviors, and PA mediated through mental health (Model 2) with indirect effect confidence intervals obtained using Monte Carlo simulations. School connectedness directly associated with better mental health in Model 1 (ß = 0.17, p < 0.001) and with higher PA in Model 2 (ß = 0.19, p < 0.001) while virtual connectedness directly associated with higher PA in Model 2 (ß = 0.08, p < 0.001). Parental emotional abuse directly associated with poorer mental health in Model 1 (ß = -0.43, p < 0.001). Standardized indirect effects to better mental health mediated through higher PA were observed for school connectedness (IE = 0.017, p < 0.001) and virtual connectedness (IE = 0.007, p < 0.001) and indirect effects to lower PA mediated through poorer mental health were observed for parental emotional abuse (IE = -0.050, p < 0.001). Perceptions of school and virtual connectedness and parental emotional abuse both directly and indirectly impacted adolescent PA and mental health during the COVID-19 pandemic.

A Parallel Mediation Analysis on the Effects of Pandemic Accentuated Occupational Stress on Hospitality Industry Staff Turnover Intentions in COVID-19 Context.

The purpose of this research was to analyze how different effects of the COVID pandemic, expressed through pandemic accentuated occupational stress, perceived job insecurity, occupational safety and health perception and perceived organizational effectiveness, may impact turnover intentions of the personnel in the hospitality industry. Our research team designed an online questionnaire which was analyzed with network analysis to depict the relationship between factors, and, then, a confirmatory factor analysis was employed to confirm the distribution of the items to the envisaged five factors. Based on a sample of 324 randomized Romanian hospitality industry staff, the results of our cross-sectional study revealed that occupational safety and health perception, perceived organizational effectiveness and perceived job insecurity in the pandemic accentuated occupational stress to indirectly and significantly impact hospitality industry staff turnover intentions (TI). The results indicated that, while the total effect of PAOS on TI was significant, the direct effect was still significant, while all three mediators remained significant predictors. Overall, mediators partially mediated the relationship between PAOS and TI, indicating that employees with low scores on occupational safety and health perception (OSHP), and perceived organizational effectiveness (POE) and high scores on perceived job insecurity (PJI) were more likely to have higher levels of TI turnover intentions.

Pathway linking health information behaviors to mental health condition during the COVID-19 infodemic: A moderated mediation analysis.

Background: The COVID-19 outbreak is no longer a pure epidemiological concern but a true digital infodemic. Numerous conflicting information and misinformation occupy online platforms and specifically social media. While we have lived in an infodemic environment for more than 2 years, we are more prone to feel overwhelmed by the information and suffer from long-term mental health problems. However, limited research has concentrated on the cause of these threats, particularly in terms of information processing and the context of infodemic. Objective: This study proposed and tested moderated mediation pathways from two types of health information behaviors (social media engagement and interpersonal communication) on information overload and mental health symptoms-long-term stress. Methods: We conducted a cross-sectional online survey between May and June of 2021 among the Malaysian public. The final sample size was 676 (N = 676). A conceptual model was built to guide the data analysis. We conducted structural equation modeling (SEM), moderation and mediation analyses to examine each direct pathway, moderating and mediating effects. Results: According to the pathway analysis, we found that, during the infodemic period, engaging COVID-19 information on social media positively associated with information overload, but interpersonal communication was negatively related to it. As the proximal outcome, there was also a positive association between information overload and the final outcome, perceived stress. The moderation analysis only reported one significant interaction: risk perception weakened the association between social media engagement and information overload. A conditional indirect effect was demonstrated and the indirect associated between social media engagement and perceived stress mediated through information overload was further moderated by COVID-19 risk perception. Conclusion: This research offers new grounds for understanding health information behaviors and their consequences in the COVID-19 infodemic. We particularly highlighted the distinct functions of health information behaviors in causing information overload, as well as the importance of personal health belief in this process. Our proposed model contributes to the strategies of developing health messaging strategies that may be utilized by public health researchers and health educators in the future.

Perceived health literacy and COVID-19 vaccine acceptance among Chinese college students: A mediation analysis.

BACKGROUND: Although COVID-19 vaccines hold the potential to dramatically alter the COVID-19 pandemic, vaccine hesitancy remains a serious threat to the management and control of COVID-19 infections. Vaccination of young adults plays a crucial role in achieving herd immunity. However, the determinants of COVID-19 vaccine acceptance among the youth in China have not been fully explored. Our study aims to investigate the direct and indirect effects of perceived health literacy on COVID-19 vaccine acceptance. METHODS: This survey was conducted among Chinese college students during September and October, 2020. COVID-19 vaccine acceptance was defined as the likelihood that participants would get a COVID-19 vaccine. A mediation analysis was employed to explore the direct and indirect effects of perceived health literacy on COVID-19 vaccine acceptance. RESULTS: A total of 2,587 college students were included in our study. The results of the survey revealed that the majority (80.40%) of the participants expressed high COVID-19 vaccine acceptance. After controlling for demographic characteristics, the relationship between perceived health literacy and COVID-19 vaccine acceptance was mediated by positive attitudes toward general vaccination (std.ß = 0.004, p = 0.037) and self-efficacy of COVID-19 vaccine (std.ß = 0.053, p < 0.001). CONCLUSIONS: The findings suggest that interventions targeting health literacy to promote COVID-19 vaccination coverage might consider placing greater emphasis on enhancing the positive attitude towards and self-efficacy of vaccines among youth.

Association of depression symptoms and sleep quality with state-trait anxiety in medical university students in Anhui Province, China: a mediation analysis.

BACKGROUND: The prevalence of depression symptoms among medical students is particularly high, and it has increased during the COVID-19 epidemic. Sleep quality and state-trait anxiety are risk factors for depression, but no study has yet investigated the mediating role of state-trait anxiety in the relationship between poor sleep quality and depression symptoms in medical students. This study aims to investigate the relationship among depression symptoms, sleep quality and state-trait anxiety in medical university students in Anhui Province. METHODS: This was a cross-sectional survey of 1227 students' online questionnaires collected from four medical universities in Anhui Province using a convenience sampling method. We measured respondents' sleep quality, state-trait anxiety, and depression symptoms using three scales: the Pittsburgh Sleep Quality Index (PSQI), the State-Trait Anxiety Inventory (STAI) and the Self-rating Depression Scale (SDS). We analysed the mediating role of STAI scores on the association between PSQI scores and SDS scores through the Sobel-Goodman Mediation Test while controlling for covariates. P < 0.05 was considered statistically significant. RESULTS: A total of 74.33% (912) and 41.40% (518) of the respondents reported suffering from poor sleep quality and depression symptoms. Sleep quality, state-trait anxiety, and depression symptoms were positively associated with each other (ß = 0.381 ~ 0.775, P < 0.001). State-trait anxiety partially mediated the association between sleep quality and depression symptoms (Sobel test Z = 15.090, P < 0.001), and this mediating variable accounted for 83.79% of the association when adjusting for potential confounders. Subgroup analysis further revealed that STAI scores partially mediated the association between PSQI scores and SDS scores in females and rural students and fully mediated the association between PSQI scores and SDS scores in males and urban students. CONCLUSIONS: This study found that sleep quality and state-trait anxiety have a significant predictive effect on depression symptoms. State-trait anxiety mediated the relationship between sleep quality and depression symptoms, with a more complex mechanism observed among rural and female medical students. Multiple pathways of intervention should be adopted, such as encouraging students to self-adjust, providing professional psychological intervention and timely monitoring, enriching extracurricular activities, and making changes in policies regarding long shifts and working hours.

A Moderated Mediation Analysis of New Work-Related Stressors, Psychological Distress, and Absenteeism in Health Care During a Pandemic: Is Recognition the Cure for Preventing Falling in Battle?

OBJECTIVES: We aimed to evaluate the effects of new work-related stressors on psychological distress and absenteeism and the role of recognition in these relationships. METHODS: Moderated path analyses were carried out on a sample of 1128 health care workers. RESULTS: Increased workload related to COVID-19 (coronavirus disease 2019) ( ß = 1.511, P ≤ 0.01) and fear of COVID-19 ( ß = 0.844, P ≤ 0.01) were directly associated with a higher level of psychological distress and indirectly ( ß = 2.306, P ≤ 0.01; and ß = 1.289, P ≤ 0.05, respectively) associated with a higher level of absenteeism. Recognition ( ß = 0.260, P ≤ 0.001) moderated the association between teleworking and psychological distress. Furthermore, this significant moderation effect had a significant impact on absenteeism ( ß = 0.392, P ≤ 0.05). Regardless of the workplace (on site or teleworking), high recognition was beneficial for psychological distress. This effect seems more important when working on site. CONCLUSIONS: The results propose that specific new work-related stressors should be addressed in the context of organizational change (eg, a pandemic).

Family Caregiving during the COVID-19 Pandemic in Canada: A Mediation Analysis.

Family caregiving is a public health issue because of caregivers' significant contribution to the health and social care systems, as well as the substantial impact that giving and receiving care has on the health and quality of life of care receivers and caregivers. While there have been many studies that associate caregivers' care work, financial difficulty, navigation, and other caregiving factors with family caregivers' psychological distress, we were interested not only in the factors related to family caregiver anxiety but also in hypothesizing how those effects occur. In this study, we used Andrew Hayes' PROCESS moderation analysis to explore the link between caregiver frailty, weekly care hours, and perceptions of financial difficulty, social support, and anxiety. In this analysis, we included 474 caregivers with relatively complete data on all of the variables. In regression analysis after controlling for gender and age, social loneliness (ß = 0.245), frailty (ß = 0.199), financial difficulty (ß = 0.196), care time (ß = 0.143), and navigation confidence (ß = 0.131) were all significant. We then used PROCESS Model 6 to determine the significance of the direct, indirect, and total effects through the serial mediation model. The model pathway from frailty to care time to financial difficulty to social loneliness to anxiety was significant. The proportions of family caregivers who were moderately frail, anxious, and experiencing social loneliness after eighteen months of the COVID-19 pandemic found in this survey should be of concern to policymakers and healthcare providers.

Vaccination Intention and Behavior of the General Public in China: Cross-sectional Survey and Moderated Mediation Model Analysis.

BACKGROUND: Promoting vaccination and eliminating vaccine hesitancy are key measures for controlling vaccine-preventable diseases. OBJECTIVE: We aimed to understand the beliefs surrounding and drivers of vaccination behavior, and their relationships with and influence on vaccination intention and practices. METHODS: We conducted a web-based survey in 31 provinces in mainland China from May 24, 2021 to June 15, 2021, with questions pertaining to vaccination in 5 dimensions: attitude, subjective norms, perceived behavioral control, intention, and behavior. We performed hierarchical regression analysis and structural equation modeling based on the theory of planned behavior-in which, the variables attitude, subjective norms, and intention each affect the variable intention; the variable intention mediates the relationships of attitude and subjective norms with behavior, and the variable perceived behavioral control moderates the strength of this mediation-to test the validity of the theoretical framework. RESULTS: A total of 9924 participants, aged 18 to 59 years, were included in this study. Vaccination intention mediated the relationships of attitude and subjective norms with vaccination behavior. The indirect effect of attitude on vaccination behavior was 0.164 and that of subjective norms was 0.255, and the difference was statistically significant (P<.001). The moderated mediation analysis further indicated that perceived behavioral control would affect the mediation when used as moderator, and the interaction terms for attitude (ß=-0.052, P<.001) and subjective norms (ß=-0.028, P=.006) with perceived behavioral control were significant. CONCLUSIONS: Subjective norms have stronger positive influences on vaccination practices than attitudes. Perceived behavioral control, as a moderator, has a substitution relationship with attitudes and subjective norms and weakens their positive effects on vaccination behavior.

Relationship between perceived threat of COVID-19 and burnout among frontline nurses: A mediation analysis.

BACKGROUND: Burnout of nurses during the Coronavirus of 2019 pandemic can end up extremely expensive for societies. It is found that positive religious coping (PRC) and a secure God attachment are effective for shielding against the adverse consequences of being exposed to stressful situations. METHODS: This research explores the relationships among God attachment, religious coping, and burnout among nurses who are confronted with COVID-19 as a perceived threat through a model based on the combination of attachment theory and the Job Demands-Resources model. Analysis was done using SMART-PLS. RESULTS: The results reveal that perceived threat of COVID-19 (PTC) positively correlates with burnout among nurses and that secure attachment to God and PRC can buffer this relationship, while insecure attachment to God, including anxious and avoidant attachment, along with negative religious coping positively mediates the relationship between PTC and burnout. CONCLUSION: Finally, this study suggests managerial implications of these findings for healthcare organizations and a recommendation for helping out staff to help them manage such threats and their attachment to God.

Do racial and ethnic disparities in following stay-at-home orders influence COVID-19 health outcomes? A mediation analysis approach.

Racial/ethnic disparities are among the top-selective underlying determinants associated with the disproportional impact of the COVID-19 pandemic on human mobility and health outcomes. This study jointly examined county-level racial/ethnic differences in compliance with stay-at-home orders and COVID-19 health outcomes during 2020, leveraging two-year geo-tracking data of mobile devices across ~4.4 million point-of-interests (POIs) in the contiguous United States. Through a set of structural equation modeling, this study quantified how racial/ethnic differences in following stay-at-home orders could mediate COVID-19 health outcomes, controlling for state effects, socioeconomics, demographics, occupation, and partisanship. Results showed that counties with higher Asian populations decreased most in their travel, both in terms of reducing their overall POIs' visiting and increasing their staying home percentage. Moreover, counties with higher White populations experienced the lowest infection rate, while counties with higher African American populations presented the highest case-fatality ratio. Additionally, control variables, particularly partisanship, median household income, percentage of elders, and urbanization, significantly accounted for the county differences in human mobility and COVID-19 health outcomes. Mediation analyses further revealed that human mobility only statistically influenced infection rate but not case-fatality ratio, and such mediation effects varied substantially among racial/ethnic compositions. Last, robustness check of racial gradient at census block group level documented consistent associations but greater magnitude. Taken together, these findings suggest that US residents' responses to COVID-19 are subject to an entrenched and consequential racial/ethnic divide.