The Effect of Being Vaccinated and National Vaccination Rates on Individuals' Cognitions, Emotions, and Economic Expectations: Evidence from Israel.

BACKGROUND: Israel was the first nation to establish a vaccination program during the COVID-19 pandemic. Thus, its citizens could look to no other country to help them judge its influence. People's predictions of their safety should depend on whether they were vaccinated, whereas their predictions regarding the COVID-19 pandemic should be based on the degree of progress of the vaccination program. We expected people to understand that the program would improve their safety by reducing the number of infected people around them. METHOD: An original panel survey was conducted covering the pandemic's first year. Respondents reported their vaccination status, emotions, evaluations of their safety, and predictions about the spread of COVID-19 and the Israeli gross domestic product. RESULTS: Estimates of fixed-effects models using the survey data suggest that being vaccinated affected people's cognitions about their own safety and their emotions but not their expectations regarding the situation in Israel as a whole. In contrast, the vaccination rate in Israel affected only the respondents' expectations about the spread of COVID-19, their own income, and Israel's gross domestic product. CONCLUSIONS: Being vaccinated is important for people's personal emotional and cognitive relief during a pandemic. A high vaccination rate improves people's economic expectations, which is important to the recovery of economic activity.

State Anxiety and Procrastination: The Moderating Role of Neuroendocrine Factors.

Procrastination is prevalent among students, as well as the general population, and has negative impacts on various domains. Several models aimed to understand factors associated with procrastination, with some suggesting that anxiety plays a significant role. Biological factors have been shown to contribute to individual differences in procrastination; however, little attention has been paid to the role of neuroendocrine factors on procrastination. The primary question addressed in the present study is whether neuroendocrine factors (testosterone and cortisol) moderate the association between state anxiety and procrastination. Eighty-eight participants (29 men; 32 women using oral contraceptives; and 27 women not using oral contraceptives and in their luteal phase) were tested for biomarkers and completed questionnaires. Results show that state anxiety is positively correlated with procrastination. Furthermore, testosterone levels moderate the correlation between state anxiety and procrastination. As testosterone levels drop, the positive correlation between state anxiety and procrastination becomes stronger, but when testosterone levels are higher, no significant association between state anxiety and procrastination is found. Cortisol levels do not moderate the relationship between state anxiety and procrastination. The role of neuroendocrine factors for psychological outcomes is discussed.

Compliance with Ministry of Health Regulations among Israeli Nurses during the COVID-19 Pandemic: The Mediating Role of Risk Perception.

The COVID-19 pandemic has created a sustained state of emergency, causing uncertainty and risk taking. Israeli nurses were required to follow new regulations and safety measures issued by the Israeli Ministry of Health (MOH). This study aimed to examine nurses' compliance with MOH regulations and its association with their risk and threat perceptions and their positive and negative emotions. A cross-sectional online survey was conducted among 346 Israeli nurses. The study model was examined with path analysis. Most nurses reported complying with MOH regulations either fully (49%) or very often (30%). Negative emotions were positively associated with perceptions of both threat and risk, yet only risk perception was positively associated with nurses' compliance. A significant mediated relationship was found between negative emotions and nurses' compliance, with the possible mediator being risk perception. Hence, higher negative emotions were associated with a greater risk perception, which was associated with higher compliance. Health systems leaders must strategize to deal with the wave-like character of the pandemic. Solutions to nursing teams' negative emotions must be provided to keep the balance between feelings of complacency and a situation of high-level, intense negative feelings, which might lead to abstention, burnout, or emotional injury.

Physicians' Compliance with COVID-19 Regulations: The Role of Emotions and Trust.

(1) Background: Medical teams are at the forefront of the COVID-19 pandemic. Decision making among medical staff is important for promoting and maintaining the health of patients and staff. This study examines factors associated with physicians' decision making and preventive behavior during the COVID-19 pandemic in Israel. (2) Methods: An online survey was conducted among 187 Israeli physicians in April and May 2020 during the COVID-19 pandemic. The questionnaire included the levels of physicians' perceived threat and perceived risk during the epidemic, trust in the health system, emotions, and the degree of compliance with hygiene rules and mandated behaviors. (3) Results: Most physicians reported complying with the rules of hygiene at work (73%) and full compliance with Ministry of Health guidelines (61%). The findings show that higher levels of trust, positive emotions, and threat and risk perceptions were associated with a higher degree of compliance with Ministry of Health guidelines and more careful decision making among physicians. (4) Conclusions: Levels of trust in the health system and positive emotions among healthcare staff during the pandemic are related to careful adherence to guidelines. Taking steps to maintain physical and mental health among healthcare staff is important for their functioning and for maintaining public health.

Is stronger religious faith associated with a greater willingness to take the COVID-19 vaccine? Evidence from Israel and Japan.

Achieving high vaccination rates is important for overcoming an epidemic. This study investigates the association between religious faith and intentions to become vaccinated against COVID-19 in Israel and Japan. Most of Israel's population is monotheistic, whereas most Japanese are unaffiliated with any religion. Therefore, our findings might be applicable to various countries that differ in their religions and levels of religiosity. We conducted almost identical large-scale surveys four times in Israel and five times in Japan from March to June 2020 to obtain panel data. We found that intentions of getting vaccinated depend on people's level of religiosity in a non-linear way. Those who have strong religious beliefs are less likely to become vaccinated than those who say they are less religious. Two other factors that play a role in this relationship are religious denomination in Israel and identifying with a religion in Japan.

The Willingness to Pay for a Hypothetical Vaccine for the Coronavirus Disease 2019 (COVID-19).

This study investigates how people in Japan perceived the severity of and probability of infection from coronavirus disease 2019 (COVID-19), and how their willingness to purchase a hypothetical vaccine depends on these perceptions and their risk attitudes. We conducted a large-scale panel survey three times between 13 March to 13 April 2020 in Japan. By analyzing the data, we found that the perception of COVID-19 became more serious. The estimation of the fixed effect model reveals that a person becomes more willing to pay for a vaccine as the person evaluates COVID-19 as a more severe disease, considers a higher probability of infection, and becomes more risk averse. Since the sensitivity of willingness to pay for the vaccine on risk aversion increased during the period, the change in risk attitude contributed to an increase in willingness through the sensitivity channel, while it decreased through the magnitude channel.

Optimism and precautionary measures during the COVID-19 outbreak in China.

OBJECTIVE: The current study uses the unique setting created by the coronavirus crisis in China during the peak period of the pandemic to examine the behavioral factors affecting the decision of the Chinese people to adopt the precautionary actions recommended by the government. METHODS: Using the social app WeChat, we conducted a cross sectional study of the Chinese people in mid-February 2020. RESULTS: Our results show that higher levels of dispositional optimism and support for the government's actions for managing the epidemic were positively correlated with the compliance level. In addition, women and married participants were more likely to comply with the recommendations. CONCLUSIONS: Optimism and support for government actions should be considered when promoting policies related to health behavior such as social distancing.

The impact of Israel's Front-of-Package labeling reform on consumers' behavior and intentions to change dietary habits.

BACKGROUND: In January 2020, Israel launched a reform mandating Front-of-Package (FOP) labeling on food products. The current study examined the factors affecting consumers' decision-making regarding the use of FOP labels a year after the reform was implemented. METHODS: The survey was conducted between December 2020 and January 2021 and included a sample of 507 participants age 21 and over. The questionnaire included Health Belief Model (HBM) constructs related to food labeling, nutrition habits, media exposure and extent of support for the reform, frequency of using FOP labels, intention to change purchasing and consumption habits in the coming year, and personal details. RESULTS: The study found that 58.5% reported using the FOP labels to some extent. In addition, 70% indicated willingness to change to healthier products in the coming year. The results of the analytical model confirm the validity of the HBM and the other behavioral constructs. In particular, the frequency of using FOP labels increases as the following factors increase: levels of perceived benefits and perceived importance of reading FOP labels, level of perceived importance of healthy nutrition, frequency of conforming to healthy nutrition, and support for the reform. CONCLUSIONS: The study's findings are important for understanding the impact of the new reform and for guiding future complementary actions to increase people's motivation to use FOP labels. More advertisement about the FOP labels in the media and also through the HMOs is needed to increase people's awareness of the reform. In addition, information about the reform provided to the public should emphasize the benefits and health implications of using FOP labels.

Determinants of Israeli consumers' decision to use food label information more frequently: a national survey study.

BACKGROUND: Food labeling to encourage healthier food choices may have positive long-term effects. Yet previous studies point to challenges in terms of how consumers understand and use labeling information. The current study seeks to determine how psychological factors related to health and nutrition, food label perceptions, nutrition habits and sociodemographic factors are associated with consumers' decisions to seek and use the information on nutrition food labels more frequently. METHODS: The survey was conducted by a polling company in Israel between November 11 and December 12, 2019. Participants comprised a representative sample of the adult population in Israel age 21 and over. A total of 513 people returned the completed questionnaires, which included the following parts: personal details; frequency of searching for information on food product labels; perceived health risks of foods high in sodium, sugar and saturated fats; Health Belief Model constructs related to food labeling. The statistical analysis entailed ordinal logistics regressions. RESULTS: While 59.3% of the sample reported that the information on food labels often or always affects their decision to purchase a food product, more than 20% reported often or always consuming products that are high in sugar (32.0%), saturated fats (31.3%) and salt (20.4%). The results of the analytical model show the following HBM variables to be significantly associated with frequency of using information on food labels: higher levels of perceived benefit (OR = 1.72, CI 95% = 1.12-2.64); higher confidence in reading and understanding food labels (OR = 2.48, CI 95% = 1.62-3.78); and higher perceptions of the importance of nutrition (OR = 2.76, CI 95% =1.97-3.87). In addition, women and married people were found to use food label information more frequently. CONCLUSIONS: General public information campaigns and HMOs campaigns with messages to motivate the use of food labels should emphasize the benefits of using labels to select food products. These messages should aim at increasing individuals' perceived confidence in understanding the information on nutrition labels. The recent front-of-package labeling reform could be an important policy step for achieving healthier nutrition.

Determinants of women's decision to undergo early mammography: A survey study.

For young women, mammography has limited effectiveness and entails exposure to radiation, discomfort, and additional expense. This study identifies factors associated with women's willingness to undergo mammography despite official guidelines to the contrary. Using the Health Belief Model, we surveyed Israeli women aged 40-51 who are not at high risk of breast cancer and who had or had never undergone mammography. The results show that sociodemographic characteristics, private insurance coverage, out-of-pocket payments to physicians, and three Health Belief Model categories - lower perceived barriers to mammography, higher expectations of benefits, and stronger health motivation - are associated with the decision to undergo mammography. In addition, higher levels of perceived susceptibility to illness and experience with mammography are significant predictors of intentions to undergo early mammography. Understanding the determinants of women's tendency to undergo mammography contrary to recommendations may help nurses and healthcare policymakers to create health promotion programs targeting this group of women. Preventing unnecessary mammograms may reduce costs to households and health maintenance organizations, mitigate ineffective use of medical facilities, and alleviate the burden on the healthcare system.

Factors affecting oral examinations and dental treatments among older adults in Israel.

BACKGROUND: Routine dental examinations are important for early diagnosis and treatment of dental problems among older adults in order to improve their quality of life and avoid costly future treatments. In Israel, a significant percentage of adults do not seek dental care. METHODS: The study is based on a 2017 telephone survey conducted among people aged 50-75 from different population groups in Israel to examine their health beliefs and attitudes toward dental treatments. RESULTS: The results show that among older adults the decision to undergo routine dental checkups is affected by socio-demographic status and health beliefs regarding dental health. Lower age, higher income levels, and Jewish religion predicted higher chances of frequent checkups. In addition, those who saw the benefits of routine checkups, believed that dentists were readily available, and had higher levels of health motivation were more likely to seek out routine dental care. CONCLUSIONS: According to the recent dental reform in Israel, people aged 75 and over are eligible for subsidized dental treatments. To enhance the frequency of dental checkups among older adults, it is recommended to provide this subsidized coverage for adults under age 75. In addition, planning dental health services for individuals in this age group should be based upon their accepted beliefs and values. Moreover, systematic health education through the media and health maintenance organizations should specifically target this population group to encourage them to undergo dental checkups more frequently.

Sex Hormone/Cortisol Ratios Differentially Modulate Risk-Taking in Men and Women.

The present study aimed to extend the original focus of the dual-hormone hypothesis on testosterone and cortisol involvement in risk-taking to other sex hormones: estrogen and progesterone. The study also examined two alternative models for the proposed relationship between cortisol and sex steroids and for their joint influence on risk-taking: interaction and ratio terms. In all, 40 women and 37 men were tested for circulating sex hormones and provided self-reports on risk-taking. The findings suggest that sex hormone-cortisol ratios differentially modulate risk-taking in men and women: In men, high ratios were associated with risk-taking, whereas in women the opposite pattern was found. The findings are discussed in light of evolutionary assumptions regarding sex differences in neuroendocrine mechanisms, suggesting sex differences in neural sensitivity to sex hormones in risk-taking.

Factors affecting compliance with use of online healthcare services among adults in Israel.

BACKGROUND: The use of online health services (henceforth, OHS) among middle-aged to older adults can make health-related actions more accessible to this population group as well as help reduce the burden on the health system and avoid unnecessary costs. The study's objectives were to examine the responsiveness and willingness of individuals aged 45+ to use different OHS and to characterize the attitudes and main factors influencing that responsiveness. METHODS: We conducted a telephone survey among a sample of 703 individuals constituting a representative sample of the Israeli population of individuals aged 45+. The research questionnaire integrates the principles of the Adopting Medical Information Technologies model and includes socio-demographic attributes. RESULTS: The results indicate that 78 % of internet users claimed to use at least one OHS (79 % of the Jewish sector and 66 % of the non-Jewish sector). Nevertheless, 22 % of internet users do not use OHS. Most online use is on Health Maintenance Organizations (HMO) websites to obtain administrative information. Frequency of OHS use increases as the following factors increase: perceived ease of online use; extent of encouragement for online use; perceived reliability of online health services; and extent of advertisement exposure. The study found that OHS use is much more prevalent among wealthy populations. In addition, individuals' attitudes and the extent of their exposure to advertisement influence their use and intention to use OHS. CONCLUSIONS: A number of recommendations emerge from the study: 1) For OHS use to increase online health websites should be made more accessible to middle aged-older adults individuals and those of different languages and cultures. 2) Programs should be developed to teach HMO staff to encourage patients to use OHS. 3) Media advertising that encourages the use of OHS should be expanded.

The use of dental services for children: implications of the 2010 dental reform in Israel.

Routine dental examinations for children are important for early diagnosis and treatment of dental problems. The level of dental morbidity among Israeli children is higher than the global average. A July 2010 reform of Israel's National Health Insurance Law gradually offers free dental services for children up to age 12. The study examines the use of dental services for children and the factors affecting mothers' decision to take their children for routine checkups. In addition, the study examines the impact of the reform on dental checkups for children in various populations groups. A national representative sample comprising 618 mothers of children aged 5-18 was surveyed by telephone. The survey integrated the principles of the health beliefs model and socio-demographic characteristics. The results show that mothers' decision to take their children for dental checkups is affected by their socio-demographic status and by their health beliefs with respect to dental health. After the reform, the frequency of children's dental checkups significantly increased among vulnerable populations. Therefore, the reform has helped reduce gaps in Israeli society regarding children's dental health. Raising families' awareness of the reform and of the importance of dental health care together with expanding national distribution of approved dental clinics can increase the frequency of dental checkups among children in Israel.

Factors affecting the intention and decision to be treated for obstructive sleep apnea disorder.

BACKGROUND AND PURPOSE: Obstructive sleep apnea (OSA) disorder has a deleterious impact on health. Using the continuous positive airway pressure (CPAP) device effectively lessens OSA. The purpose of this study was to examine the factors affecting patients' intention and actual decision to get treatment. METHODS: Questionnaires were distributed at three sleep laboratories in Israel among 633 participants suspected of having OSA. Six months later, 194 OSA patients were contacted to verify whether they had purchased a CPAP device. RESULTS: Factors affecting intention to use the device included Health Belief Model variables, income level, and sleep laboratory location. The decision to get treatment was positively affected by the intention to use CPAP, the number of CPAP trial days, age, and number of years in the country. CONCLUSIONS: Patients' attitudes and health beliefs prior to diagnosis may predict their intention to be treated for OSA, and in turn, affect their actual decision to get treatment. Awareness of behavioral intention can enable decision makers developing targeted interventions to promote treatment.

How experience shapes health beliefs: the case of influenza vaccination.

This study examines the impact of past experience with influenza and the influenza vaccine on four categories of the Health Belief Model: beliefs about susceptibility to contracting influenza, severity of illness, perceived benefits of the vaccine in preventing influenza, and perceived barriers to getting vaccinated. The study population comprised employees at different workplaces in Israel. The results indicate that individuals who took flu shots in the past perceived higher levels of benefits from the vaccine and lower barriers to getting the vaccine than those who had not been vaccinated. In addition, those who had influenza over the last 2 years exhibited higher levels of perceived susceptibility and lower levels of perceived benefits from the vaccine. These results imply that an individual's health beliefs regarding the flu vaccine can be changed as a result of accumulated experience with the illness and the vaccine. Therefore, recommendations for first-time vaccination may have implications on decisions to be vaccinated over the long run.

Factors affecting the decision to be treated with continuous positive airway pressure for obstructive sleep apnea syndrome.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder characterized by excessive daytime sleepiness, accidents and high medical expenses. The first line of treatment for OSAS is continuous positive airway pressure (CPAP). OBJECTIVES: To examine attitudes and beliefs as well as physiological and sociodemographic factors affecting OSA patients' decision whether or not to purchase a CPAP device. METHODS: The study was divided into two stages; in the first, 83 subjects completed self-administered questionnaires prior to sleep examination (polysomnography, PSG). The questionnaires related to sleep habits, sleep disorders, questions organized around health belief model (HBM) concepts, sociodemographic information, health status and PSG examination. In the second stage, 3 months later, 50 OSAS patients were interviewed by telephone, which included questions about their reasons for purchasing/not purchasing the CPAP device. RESULTS: Only 48% of the OSAS patients purchased the CPAP device. The significant factors positively affecting the decision included higher levels of physiological factors such as body mass index (coefficient 0.36, P < 0.05) and respiratory disturbance index (coefficient 0.16, P < 0.05), higher income levels (coefficient 3.26, P < 0.05), and higher levels of knowledge about OSAS (coefficient -2.98, P < 0.1). CONCLUSIONS: Individuals who are more aware of their own health condition, are better informed about OSAS and have higher incomes are more likely to purchase the device. We suggest reducing the level of co-payment and providing patients with more information about the severe effects of OSAS.

Factors Affecting Intention among Students to Be Vaccinated against A/H1N1 Influenza: A Health Belief Model Approach.

The outbreak of A/H1N1 influenza (henceforth, swine flu) in 2009 was characterized mainly by morbidity rates among young people. This study examined the factors affecting the intention to be vaccinated against the swine flu among students in Israel. Questionnaires were distributed in December 2009 among 387 students at higher-education institutions. The research questionnaire included sociodemographic characteristics and Health Belief Model principles. The results show that the factors positively affecting the intention to take the swine flu vaccine were past experience with seasonal flu shot and three HBM categories: higher levels of perceived susceptibility for catching the illness, perceived seriousness of illness, and lower levels of barriers. We conclude that offering the vaccine at workplaces may raise the intention to take the vaccine among young people in Israel.

Workplace vaccination and other factors impacting influenza vaccination decision among employees in Israel.

The study examined the factors affecting the decision to be vaccinated against influenza among employees in Israel. The research, conducted in 2007/2008, included 616 employees aged 18-65 at various workplaces in Israel, among them companies that offered their employees influenza vaccination. The research questionnaire included socio-demographic characteristics, and the Health Belief Model principles. The results show that the significant factors affecting vaccination compliance include a vaccination program at workplaces, vaccinations in the past, higher levels of vaccine's perceived benefits, and lower levels of barriers to getting the vaccine. We conclude that vaccine compliance is larger at companies with workplace vaccination programs providing easier accessibility to vaccination.

A policy to promote influenza vaccination: a behavioral economic approach.

The aims of this study were to identify the predictors of people's willingness to be vaccinated against influenza and to determine how to improve the inoculation rate. The study was based upon the results of our original large-scale survey conducted in the USA in 2005. A model of bounded rationality can explain vaccination behavior fairly well: (a) people evaluate the costs and benefits of vaccination by applying risk aversion and time preference; (b) the 'status quo bias' of those who were vaccinated in the past affects their decision to be vaccinated in the future; and (c) overconfidence indirectly affects the decision through the moderation of perceived variables. Policy implications include: (a) dissemination of information about the vaccine is especially important among people who are inexperienced with the vaccine since they undervalue the effectiveness of vaccination; (b) lowering the total cost of vaccination, including time costs (for example, by offering the vaccine at workplaces) may raise the inoculation rate, especially among those inexperienced with the vaccine, since those who have experience with the vaccine tend to take it on a regular basis.