Aging and the COVID-19 pandemic: The inter-related roles of biology, physical wellbeing, social norms and global health systems.

The coronavirus disease 2019 (COVID-19) pandemic has had a devastating and disproportionate impact on the elderly population. As the virus has swept through the world, already vulnerable elderly populations worldwide have faced a far greater burden of deaths and severe disease, crippling isolation, widespread societal stigma, and wide-ranging practical difficulties in maintaining access to basic health care and social services - all of which have had significant detrimental effects on their mental and physical wellbeing. In this paper, we present an overview of aging and COVID-19 from the interrelated perspectives of underlying biological mechanisms, physical manifestations, societal aspects, and health services related to the excess risk observed among the elderly population. We conclude that to tackle future pandemics in an efficient manner, it is essential to reform national health systems and response strategies from an age perspective. As the global population continues to age, elderly-focused health services should be integrated into the global health systems and global strategies, especially in low- and middle-income countries with historically underfunded public health infrastructure and insufficient gerontological care.

"I'll never sacrifice my well-being again:" The journey from negative to positive body image among women who perceive their body to deviate from societal norms.

We conducted one-on-one interviews with 25 Canadian cisgender women who self-identified as having (a) a condition or characteristic causing their body to deviate from societal norms and (b) overcome a negative body image to develop a positive body image. Using coding reliability thematic analyses, we identified 12 themes (italicised) involving processes and experiences associated with shifts in body image. Women had moments that sparked and confirmed the importance of building positive body image (Enough is Enough). They experienced accepting Social Connections and Community and Accessed Critical Knowledge conducive to body positivity. They engaged in Joyful Movement, Adaptive Appearance Investment, and Joyful and Intuitive Eating. They identified how Changing Societal Norms, Becoming Older and Wiser, COVID-19 Pandemic, having Illnesses and Medical Conditions, Pregnancy and Motherhood, and Spirituality, Religion, and Nature affected their body image, values, and valued action. As women engaged in these processes and experiences, shifts occurred in their perceptions of their embodied selves in the world, represented by four "Bigger Lessons:" I Am More Than My Looks, I Am More Than My Body, I am More Than My Self, and I am Inherently Worthy of Love, Respect, and Joy. These findings can inform body image programmes and clinical interventions.

[Severity, susceptibility and social norms perceived as antecedents of the intention to be vaccinated against COVID-19]. / Severidad, susceptibilidad y normas sociales percibidas como antecedentes de la intención de vacunarse contra COVID-19.

OBJECTIVE: To evaluate the effect of perceived risk and social norms on COVID-19 and on the intention to be vaccinated if a vaccine were available to prevent infection. METHODS: A quantitative, explanatory and cross-sectional research was developed. The data was collected through a structured questionnaire applied electronically to inhabitants over 18 years of age in the state of Puebla in Mexico. An analysis with structural equations was used to identify the effects among the constructs studied. RESULTS: The results showed that both the perceived severity and susceptibility of contracting COVID-19 had a positive effect on the perceived social norms about the virus. Also, while the perceived severity had a positive effect on the intention to vaccinate, the perceived susceptibility was not significant on the intention to vaccinate against COVID-19. CONCLUSION: Intention to be vaccinated against COVID-19 is affected by the severity and perceived social norms of contracting the infection. However, the perceived susceptibility to the virus does not have an effect on the intention to be vaccinated.

The roles of social norms and leadership in health communication in the context of COVID-19.

The global struggle with the COVID-19 pandemic has lasted for almost three years. Although national and local leaders have often called on the public to comply with preventive measures through health communication, large sections of society sometimes violated precautions and did not adequately follow these calls. We propose that social norms and leaders' identity entrepreneurship characteristics could be essential in effective health communication. In line with this notion, we investigated the effects of social norm types and leadership on complying with preventive measures, the intention to be vaccinated, and prosocial behavioral tendency through a high-powered experiment that focused on three factors: leadership quality (presence/lack of entrepreneurship), descriptive norm (supportive/obstructive), and injunctive norm (supportive/obstructive). Results showed that when support for injunctive and descriptive norms was present, people tended to more readily adhere to preventive measures, get vaccinated, and engage in prosocial behavior. There was also a significant effect of the interaction between descriptive and injunctive norms on compliance with preventive measures. The compliance level was highest when both norm types were supportive and lowest when both were obstructive. The effect decreased in the discrepant norms condition, where one type of norm was supportive and the other obstructive. There is also a significant interaction between leadership and the descriptive norm, indicating that a combination of an entrepreneur leader and a supportive descriptive norm increases compliance with the preventive measure. We discussed the role of leadership and social norms in effective health communication.

The role of social norms on adolescent family planning in rural Kilifi county, Kenya.

PURPOSE: Despite Kenya's encouraging progress in increasing access to modern contraception among youth, several barriers remain preventing large-scale efforts to reduce demand-side unmet need for family planning. Shifting social norms around the use and acceptability of modern contraception may represent a potent target for future interventions. However, the structure of normative influence on individual modern contraceptive use among youth needs to be determined. Therefore, our aim was to estimate the influence of individual and group-level normative influence on modern contraceptive use among adolescents from two villages in rural Kenya. METHODS: Trained enumerators collected data from individuals aged 15-24 who provided oral informed consent, or parental informed consent, in two villages in rural Kilifi county. Participants completed a questionnaire related to modern contraceptive use and were asked to nominate one to five people (referents) with whom they spend free time. The enumerators photographed each individual who nominated at least one referent using Android phones and matched them with their nominated referents. Using this social network data, we estimated group-level normative influence by taking an average of referents' modern contraception use. We then explored associations between descriptive norms, injunctive norms, and network modern contraceptive use on individual modern contraceptive use, controlling for known confounders using logistic regression models. We also conducted sensitivity analyses to test a pattern of differential referent influence on individual modern contraceptive use. RESULTS: There was a positive association between pro-modern contraception descriptive and injunctive norms and individual modern contraception use (adjusted Odds Ratio (aOR) = 1.29, 95% confidence interval (CI) = 1.05-1.6, and aOR = 1.31, CI = 1.06-1.62, respectively). Network modern contraceptive use was associated with individual use in the bivariate model (aOR = 2.57, CI = 1.6-4.12), but not in the multivariable model (aOR = 1.67, CI = 0.98-2.87). When stratified by sex and marital status, network modern contraceptive use was associated with individual modern contraceptive use among female participants (aOR = 2.9, CI = 1.31-6.42), and unmarried female participants (aOR = 5.26, CI = 1.34-20.69), but not among males. No interactive effects between norms variables were detected. Sensitivity analyses with a different estimate of network modern contraceptive use showed similar results. CONCLUSIONS: Social norms are multilevel phenomena that influence youth modern contraceptive use, especially among young women in rural Kenya. Unmarried women with modern contraceptive users in their social network may feel less stigma to use contraception themselves. This may reflect gendered differences in norms and social influence effects for modern contraceptive use. Future research should investigate group-level normative influence in relation to family planning behaviors.

Pilot randomized controlled clinical trial of an adherence social norms intervention for adolescents with epilepsy.

OBJECTIVE: Non-adherence to anti-seizure medications (ASMs) is common for adolescents with epilepsy, with potentially devastating consequences. Existing adherence interventions in epilepsy do not meet the unique challenges faced by adolescents. Leveraging social norms capitalizes on the increased importance of peer influence while simultaneously targeting the low motivation levels of many adolescents. The current study examined the feasibility, acceptability, and satisfaction of a social norms adherence intervention in adolescents with epilepsy. METHODS: A pilot RCT of a mHealth social norms intervention was conducted with adolescents with epilepsy who demonstrated non-adherence (≤95% adherence) during baseline. Adolescents were randomized to either (1) mHealth social norms (reminders, individualized and social norms adherence feedback) or (2) control (reminders and individualized adherence feedback). Primary outcomes included feasibility, acceptability, and satisfaction. Exploratory outcomes included electronically monitored adherence, seizure severity, and health-related quality of life (HRQOL). RESULTS: One hundred four adolescents were recruited (53% female; Mage = 15.4 ± 1.4 years; 81% White: Non-Hispanic; 5% Black, 10% Bi/Multiracial; 2% White: Hispanic; 1% Other: Hispanic; 1% Bi/Multiracial-Hispanic). Forty-five percent screen-failed due to high adherence, 16% withdrew, and 38% were randomized to treatment (n = 19) or control (n = 21). Recruitment (75%), retention (78%), and treatment satisfaction were moderately high. Engagement with the intervention was moderate, with 64% of participants engaging with intervention notifications. Exploratory analyses revealed that after controlling for COVID-19 impact, the social norms intervention group maintained higher adherence over time compared to the control group. Small to moderate effect sizes were noted for seizure severity and HRQOL between groups. CONCLUSION: This pilot intervention appeared feasible and acceptable. Increases in adherence in the treatment versus control group were modest, but a future larger more adequately powered study is needed to detect effects. Notably, it appeared the COVID pandemic influenced adherence behaviors during our trial.

Hand Hygiene Social Norms Among Healthcare Workers During Early COVID-19: Results of a Global Survey.

Objectives: Poor hand hygiene among healthcare workers is an important driver of infectious disease transmission. Although social norms are considered a key determinant of hand hygiene behaviour, little is known about them among healthcare workers. This study describes hand hygiene social norms among health workers, assesses their predictors, and tests if social expectations increased during the early stages of COVID-19. Methods: We conducted a cross-sectional survey of healthcare workers from 77 countries (n = 1,233) from April to August 2020 assessing healthcare workers' hand hygiene social expectations, personal normative beliefs, punishment and reward, and demographic factors. Linear regressions and hierarchical linear modelling were used to analyse the responses. Results: We find high social expectations, personal beliefs, punishment, and rewards. Doctors tend to have lower social expectations than other occupation groups (e.g., nurses/midwives) and older respondents have higher social expectations. Social expectations increased during our survey, which may have been driven by COVID-19. Conclusion: Our findings suggest that hand hygiene social norms are strong among healthcare workers with variation across occupation and age; their strength increased during the COVID-19 pandemic. These have implications for behaviour change in healthcare environments that could leverage more norm-targeting interventions.

An epidemic context elicits more prosocial decision-making in an intergroup social dilemma.

Societal challenges such as the COVID-19 pandemic have the quality of a social dilemma, in that they compel people to choose between acting in their own interests or the interests of a larger collective. Empirical evidence shows that the choices people make in a social dilemma are influenced by how this decision is framed. In four studies, we examined how context of an epidemic influences resource allocation decisions in a nested social dilemma task, where participants share resources between themselves, their subgroup, and a larger collective. Participants consistently allocated more resources to the collective in the context of the Ebola epidemic than in the context of a neighborhood improvement project, and these choices were strongly associated with prescriptive social norms. Together, the findings provide an experimental demonstration that the context of a quickly spreading disease encourages people to act more prosocially.

Exposure to images showing (non)adherence to physical distancing rules: Effect on adherence behavior and perceived social norms.

INTRODUCTION: Adherence to behavioral measures such as physical distancing are key to mitigating the effects of viral pandemics such as the COVID-19 pandemic. Adherence depends in part on people's perception of what others do (descriptive norms) or approve of (injunctive norms). This study examines the effects that exposure to images depicting people following or breaking physical distancing rules have on perceptions of descriptive and injunctive norms and subsequent adherence behavior. METHODS: An online between-subjects experiment (n = 315) was conducted, in which participants were exposed to a set of five photographs of different public spaces in which people either did or did not adhere to physical distancing rules (pre-registration: https://www.osf.io/uek2p). Participants' adherence behavior was measured using a triangulation of measures (incentivized online behavioral task, vignettes, intention measure). Perceptions of relevant social norms were also measured. RESULTS: Mann-Whitney tests showed no effects of condition on perceptions of descriptive and injunctive norms or on adherence behavior. Linear regressions showed that both component paths of the indirect effect (condition on norm perceptions, and norm perceptions on adherence behavior) were non-significant, hence mediation analyses were not conducted. CONCLUSIONS: Exposure to images of people following (compared to breaking) physical distancing rules did not affect adherence to such rules or perceived norms. We surmise that a single exposure to such images, especially in the context of COVID-19, is insufficient to affect behavior. We therefore recommend performing a comparable experiment in which participants are exposed repeatedly to images showing people (non)adhering to a specific behavior in a particular context for a longer period.

Determinants of self-reported adherence to COVID-19 regulations in Spain: social norms, trust and risk perception.

Failure of individuals to voluntarily observe regulations and recommendations around mitigating COVID-19 (e.g. social distancing; frequent handwashing) is often cited as a reason why some countries struggled to curtail the spread of the virus. Understanding the factors that are associated with people's willingness to comply with COVID-19 regulations and recommendations is an important step in helping policy makers and health officials reduce the impact of this (and future) pandemics. In the current study we examined this question in one of the countries hardest hit by the pandemic: Spain. A large, representative survey (N = 2100) revealed that several factors were positively associated with willingness to comply to COVID-19 regulations and recommendations. In decreasing order of predictive value, these were: (i) perceptions of whether friends and family were complying (i.e. norms), (ii) trust in science as a basis for lawmaking, (iii) perceived effectiveness of regulations and (iv) perception of risk of infection. These results point to the importance of influencing social norms as the primary way to improve adherence to the health regulations of COVID-19; more important than intrapsychic considerations such as efficacy and risk.

Responding effectively to a pandemic such as COVID-19 requires citizens to voluntarily comply with certain recommendations and regulations; for example, social distancing and frequent handwashing. The current study examined a large, representative sample of over 2000 residents of Spain to find out what factors are associated with compliance (or non-compliance) with COVID-19 regulations and recommendations. The factor most closely associated with compliance was perceptions of whether friends and family were complying (i.e. the 'social norm'). The second most important factor was trust in science as a basis for lawmaking. Two psychological factors that are normally considered important in driving health behaviours­perceived effectiveness of regulations and perception of risk of infection­had a much weaker relationship with compliance behaviours. The data suggest that social norms are a more important driver of compliance behaviour than individualistic, cost-benefit analyses such as whether the recommended strategies are perceived to be effective in reducing virus spread, and whether people feel they are personally at risk of contracting SARS-CoV-2. In sum, the results point to the importance of influencing social norms as a key way to improve adherence to health regulations associated with COVID-19.

Appealing to Individual Fears or Social Norms: How Can the Public Be Persuaded to Accept COVID-19 Vaccination through Risk Communication?

In the context of the COVID-19 pandemic, improving the public's understanding of the increased efficacy and safety of the COVID-19 vaccines through scientific risk communication campaigns, promoting the public's acceptance and willingness to receive COVID-19 vaccines, and forming collective actions at the social level will deeply impact on the effect of COVID-19 prevention in various countries, which is also a key factor that governments need to address urgently. Previous research on risk communication has mostly focused on microscopic perspectives of how to stimulate individual self-protection behaviors by awakening threat and efficacy perceptions; however, a lack of observation of social collective actions means there is a risk of failure regarding COVID-19 epidemic reduction and prevention. In this regard, this study was based on the issue of vaccination in the context of the COVID-19 epidemic through a highly regulated and controlled research experiment in China (n = 165), which was designed to examine the impact of two risk communication frameworks, appealing to individual fears and appealing to social norms, on the public's acceptance and recommendations of COVID-19 vaccines, thus outlining the path of action from individual protection to collective epidemic prevention. Both the "fear appeals" framework and the "social norms" framework were found to have a positive effect on the Chinese public's vaccination acceptance. Specifically, social norms information may increase vaccination acceptance by enhancing the public's perceptions of social responsibility, while fear appeals information may reduce their perceptions of threat and social pressure to get the vaccine. Female and highly educated groups were more likely to refuse to recommend vaccination after reading the risk communication information. These results can be a useful supplement to the theory and practice of risk communication.

The contribution of social norms and religious practices towards low death registration in 3 HDSS sites of Uganda.

BACKGROUND: Uganda has low levels of death registration, estimated at two per cent by the National Identification and Registration Authority (NIRA). There are 56 tribes and over 5 religious denominations with so many social norms and religious practices that could have contributed to low death registration in Uganda. Previous studies on the factors affecting death registration have not assessed the contribution of social norms and religious practices toward low death registration in developing countries. METHODS: A qualitative study design was adopted to examine the contribution of social norms and religious practices toward low death registration in the 3 Health and Demographic Surveillance systems (HDSS) sites of Uganda. The methods of data collection included: focus group discussions, key informant interviews, and a document review of the death registration booklet. 6 FGDs, 2 from each HDSS site were conducted comprising 1 female FGD of 10 participants and 1 male FGD of 10 participants. In addition, 26 key informant interviews were conducted with the district leaders, local council leaders, health care workers, cultural leaders, elderly, HDSS scouts and religious leaders in the 3 HDSS sites. RESULTS: In the 4 sub-counties and 1 town council where the study was conducted, only 32 deaths were registered with NIRA, the Civil Registration authority in Uganda for the entire year from 1st January to 31st December 2020. The study shows that social norms and religious practices have contributed to the low death registration in the 3 HDSS sites in Uganda. Social norms and religious practices either hinder or discourage death registration initiatives by the government of Uganda. It was found out that burials that take place on the same day of death discourage death registration. Cultural taboo to announcing the death of infants, neonates, twins and suicides in the community hinder death registration. The burying of a woman at her parent's house after bride price payment default by the family of a husband discourages death registration. The religious institutions have their own set of rules, practices, and norms, which in most cases discourage death registration. For example, religious leaders refuse to lead funeral prayers for non-active members in religious activities. Results also showed that mixed religions in families bring about conflicts that undermine death registration. Lastly, results showed that traditionalists do not seek medical treatment in hospitals and this hinders death registration at the health facilities. CONCLUSION: The study shows that death registration is very low in the 3 HDSS sites in Uganda and that social norms and religious practices contribute greatly to the low death registration. To overcome the negative effects of social norms and religious practices, a social behaviour campaign is proposed. In addition, community dialogue should be conducted to identify all negative social norms and religious practices, how they are perpetuated, their effects, and how they can be renegotiated or eliminated to bring about high death registration in the 3 HDSS sites of Uganda. Lastly, there is a need for partnerships with cultural and religious leaders to sensitize community members on the effect of social norms and religious practices on low death registration in the 3 HDSS sites in Uganda.

Perception of strong social norms during the COVID-19 pandemic is linked to positive psychological outcomes.

Social norms can coordinate individuals and groups during collective threats. Pandemic-related social norms (e.g., wearing masks, social distancing) emerged to curb the spread of COVID-19. However, little is known about the psychological consequences of the emerging norms. We conducted three experiments cross-culturally, during the early period of the COVID-19 pandemic in China (Study 1), the recovery period in China (Study 2), and the severe period in the United States and Canada (Study 3). Across the three studies, we first distinguished the opposite effects of social norms and risk perception on individuals' psychological characteristics during the COVID-19 pandemic and further revealed that individuals who perceived stronger pandemic norms reported a lower level of COVID-19 risk perception, which in turn would be associated with fewer negative emotions, lower pressure, more positive emotions, higher levels of trusts, and more confidence in fighting against COVID-19. Our findings show that perceived tighter social norms are linked to beneficial psychological outcomes. This research helps governments, institutions, and individuals understand the mechanism and benefits of social norms during the pandemic, thereby facilitating policy formulation and better responses to social crises.

The influence of social norms varies with "others" groups: Evidence from COVID-19 vaccination intentions.

The theory that health behaviors spread through social groups implies that efforts to control COVID-19 through vaccination will succeed if people believe that others in their groups are getting vaccinated. But "others" can refer to many groups, including one's family, neighbors, fellow city or state dwellers, or copartisans. One challenge to examining these understudied distinctions is that many factors may confound observed relationships between perceived social norms (what people believe others do) and intended behaviors (what people themselves will do), as there are plausible common causes for both. We address these issues using survey data collected in the United States during late fall 2020 (n = 824) and spring 2021 (n = 996) and a matched design that approximates pair-randomized experiments. We find a strong relationship between perceived vaccination social norms and vaccination intentions when controlling for real risk factors (e.g., age), as well as dimensions known to predict COVID-19 preventive behaviors (e.g., trust in scientists). The strength of the relationship declines as the queried social group grows larger and more heterogeneous. The relationship for copartisans is second in magnitude to that of family and friends among Republicans but undetectable for Democrats. Sensitivity analysis shows that these relationships could be explained away only by an unmeasured variable with large effects (odds ratios between 2 and 15) on social norms perceptions and vaccination intentions. In addition, a prediction from the "false consensus" view that intentions cause perceived social norms is not supported. We discuss the implications for public health policy and understanding social norms.

Reasons for COVID-19 vaccine refusal among people incarcerated in Canadian federal prisons.

BACKGROUND: Vaccine uptake rates have been historically low in correctional settings. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among people in federal prisons. METHODS: Three maximum security all-male federal prisons in British Columbia, Alberta, and Ontario (Canada) were chosen, representing prisons with the highest proportions of COVID-19 vaccine refusal. Using a qualitative descriptive design and purposive sampling, individual semi-structured interviews were conducted with incarcerated people who had previously refused at least one COVID-19 vaccine until data saturation was achieved. An inductive-deductive thematic analysis of audio-recorded interview transcripts was conducted using the Conceptual Model of Vaccine Hesitancy. RESULTS: Between May 19-July 8, 2021, 14 participants were interviewed (median age: 30 years; n = 7 Indigenous, n = 4 visible minority, n = 3 White). Individual-, interpersonal-, and system-level factors were identified. Three were particularly relevant to the correctional setting: 1) Risk perception: participants perceived that they were at lower risk of COVID-19 due to restricted visits and interactions; 2) Health care services in prison: participants reported feeling "punished" and stigmatized due to strict COVID-19 restrictions, and failed to identify personal benefits of vaccination due to the lack of incentives; 3) Universal distrust: participants expressed distrust in prison employees, including health care providers. INTERPRETATION: Reasons for vaccine refusal among people in prison are multifaceted. Educational interventions could seek to address COVID-19 risk misconceptions in prison settings. However, impact may be limited if trust is not fostered and if incentives are not considered in vaccine promotion.

Preventing erosion of oral polio vaccine acceptance: A role for vaccinator visits and social norms.

BACKGROUND: With continued challenges to the timeline for polio transmission interruption in Pakistan, including COVID-19, there is a risk of oral polio vaccine campaign fatigue among caregivers of young children. Renewed efforts to minimize oral polio vaccine acceptance erosion may be needed. This study examines the possible role of social norms in protecting against acceptance erosion and the role of vaccinators in promoting these social norms. METHODS: Data were analyzed from a poll conducted by local interview teams between February 23 and April 5, 2016, among 4,070 parents and other caregivers of children under age 5 living in areas at high-risk for polio transmission in Pakistan. The sample was drawn via a stratified multistage cluster design utilizing random route methods at the household level. We calculated the prevalence of subjective and descriptive social norms around vaccine acceptance; vaccine acceptance and commitment to vaccinate in future; and experiences and views of polio vaccinators across the population. We examined the relationship between these social norms and vaccination behaviors as well as the relationship between experiences with and views of vaccinators and social norms using uncontrolled comparisons (t-tests of proportion) and logistic repressions to control for demographics. RESULTS: Both descriptive and subjective positive social norms were associated with vaccine acceptance and future commitment. Positive experiences with and views of vaccinators (trust, perceived technical knowledge, compassion, and overall pleasantness of the interaction) were associated with both descriptive and subjective positive social norms. CONCLUSIONS: These data support the idea that positive social norms could be protective against erosion of oral polio vaccine acceptance and that positive experiences with, and views of, vaccinators could help promote these positive social norms. Creative community engagement efforts may be able to leverage positive experiences with vaccinators to help foster social norms and protect against the risk of acceptance erosion.

Children's judgments of interventions against norm violations: COVID-19 as a naturalistic case study.

The coronavirus pandemic has had a significant influence on social interactions, introducing novel social norms such as mask-wearing and social distancing to protect people's health. Because these norms and associated practices are completely novel, it is unknown how children assess what kinds of interventions are appropriate under what circumstances and what principles they draw on in their decisions. We investigated children's reasoning about interventions against individuals who failed to adhere to COVID-19 norms. In this pre-registered study (N = 128), 4- to 7-year-olds heard stories about a norm violator, that is, a person who refuses to wear a mask in class (COVID condition) or wear indoor shoes in class when his or her shoes are muddy (Muddy Shoes condition). Children evaluated four different interventions-giving a mask/indoor shoes (Giving), preventing the person from entering (Exclusion), throwing a paper ball at the person (Throwing), and not intervening (Doing Nothing)-in terms of their rightness, niceness, and effectiveness. We found that across measures children evaluated Giving most positively, whereas they viewed Throwing most negatively. Doing Nothing and Exclusion received mixed evaluations across measures, revealing nuanced judgments of these interventions in children. In most measures, there was no difference between the COVID and Muddy Shoes conditions, suggesting that children's evaluations are not specific to the novel COVID-19 context. Together, our results show that children dynamically evaluate each intervention, taking multiple factors into account. The current study has implications for the development of interventions against norm violations.