The aims of the present study were to assess changes in lifestyles in the general population in response to coronavirus disease 2019 (COVID-19) lockdown and the influence of COVID-19 perceptions, as ...assessed by the Extended Parallel Process Model (EPPM), on these changes.
Data were collected from 4005 individuals through an online survey conducted 3-4 weeks after the nationwide lockdown implementation in France. Participants were asked whether they practiced five behaviors (i.e., screen watching, snacking, eating fruits and vegetables, exercising, and walking) less often, as often as, or more often than prior to the lockdown. Beliefs and expectations toward the COVID-19 epidemic were also assessed using an adapted version of Witte's EPPM, together with sociodemographic and environmental variables. Among the respondents consuming regularly alcohol and tobacco, logistic regressions were performed to estimate the Odds ratios (ORs) of increase (yes/no) and decrease (yes/no) in drinking and smoking since the lockdown.
More than 8 in 10 respondents reported unhealthy changes in lifestyle since the lockdown, mostly in relation to physical activity. The unhealthy changes were positively associated with male sex (RR = 1.17; confidence interval 95% CI = 1.10-1.24), living urban density, having a garden (RR = 1.16 1.07-1.26), financial difficulties because of COVID-19 (RR = 1.09 1.02-1.18), and lack of fear control (RR = 1.04 1.01-1.09) and negatively with cognitive avoidance (RR = 0.92 0.89-0.95). Less than 4 in 10 respondents reported healthy changes over the same period, mostly in relation to better eating habits. They were positively associated with living with more than two persons (RR = 1.22 1.02-1.45), having a terrace (RR = 1.14 1.02-1.29, and perceived efficacy (RR = 1.11 1.04-1.08) and negatively with being aged 40 or higher. Alcohol consumption overall declined in regular drinkers, while a slight increase in tobacco use was observed in regular smokers.
The COVID-19 pandemic and lockdown resulted in frequent and mostly unhealthy changes in lifestyle among the general population. These changes were related to individual and environmental characteristics but also to EPPM appraisals in the wake of fear appeal from COVID-19 campaigns. Communication and preventive measures should include messages and initiatives toward the maintenance of healthy lifestyles during pandemics such as the adaptation of physical activity and eating guidelines to the particular contexts of mobility restriction and infection control.
The reasons for vaccine hesitancy and its relation to individual socioeconomic status (SES) must be better understood. Areas covered: This review focused on developed countries with programs ...addressing major financial barriers to vaccination access. We systematically reviewed differences by SES in uptake of publicly funded childhood vaccines and in cognitive determinants (beliefs, attitudes) of parental decisions about vaccinating their children. Using the PRISMA statement to guide this review, we searched three electronic databases from January 2000 through April 2016. We retained 43 articles; 34 analyzed SES differences in childhood vaccine uptake, 7 examined differences in its cognitive determinants, and 2 both outcomes. Expert commentary: Results suggest that barriers to vaccination access persist among low-SES children in several settings. Vaccination programs could be improved to provide all mandatory and recommended vaccines 100% free of charge, in both public organizations and private practices, and to reimburse vaccine administration. Multicomponent interventions adapted to the context could also be effective in reducing these inequalities. For specific vaccines (notably for measles, mumps, and rubella), in UK and Germany, uptake was lowest among the most affluent. Interventions carefully tailored to respond to specific concerns of vaccine-hesitant parents, without reinforcing hesitancy, are needed.
This study aimed to assess: 1) vaccine hesitancy (VH) prevalence among French general practitioners (GPs) through the frequency of their vaccine recommendations, and 2) the determinants of these ...recommendations.
Cross-sectional observational study in 2014 nested in a national panel of 1712 randomly selected GPs in private practice in France. We constructed a score of self-reported recommendation frequency for 6 specific vaccines to target populations.
16% to 43% of GPs sometimes or never recommended at least one specific vaccine to their target patients. Multivariable logistic regressions of the dichotomized score showed that GPs recommended vaccines frequently when they felt comfortable explaining their benefits and risks to patients (OR=1.87; 1.35–2.59), or trusted official sources of information highly (OR=1.40; 1.01–1.93). They recommended vaccines infrequently when they considered that adverse effects were likely (OR=0.71; 0.52–0.96) or doubted the vaccine's utility (OR=0.21; 0.15–0.29).
Our findings show that after repeated vaccine controversies in France, some VH exists among French GPs, whose recommendation behaviors depend on their trust in authorities, their perception of the utility and risks of vaccines, and their comfort in explaining them. Further research is needed to confirm these results among health care workers in other countries.
•We assessed attitudes and behaviours of French GPs for 6 vaccine situations for which coverage in France is suboptimal.•The variation of vaccine recommendations according to vaccine suggests the existence of vaccine hesitancy among GPs.•GPs’ beliefs about vaccine risks and trust in health authorities are linked to vaccine hesitancy for controversial vaccines.•Vaccine hesitancy is also related to GPs' beliefs about vaccines’ utility, regardless of whether they are controversial.
The outbreak of COVID-19 has been a major interrupting event, challenging how societies and individuals deal with risk. An essential determinant of the virus' spread is a series of individual ...decisions, such as wearing face masks in public space. Those decisions depend on trade-offs between costs (or benefits) and risks, and beliefs are key to explain these.
We elicit beliefs about the COVID-19 pandemic during lockdown in France by means of surveys asking French citizens about their belief of the infection fatality ratio (IFR) for COVID-19, own risk to catch the disease, risk as perceived by others, and expected prevalence rate. Those self-assessments were measured twice during lockdown: about 2 weeks after lockdown started and about 2 weeks before lockdown ended. We also measured the quality of these beliefs with respect to available evidence at the time of the surveys, allowing us to assess the calibration of beliefs based on risk-related socio-demographics. Finally, comparing own risk to expected prevalence rates in the two successive surveys provides a dynamic view of comparative optimism with respect to the disease.
The risk perceptions are rather high in absolute terms and they increased between the two surveys. We found no evidence for an impact of personal experience with COVID-19 on beliefs and lower risk perceptions of the IFR when someone in the respondent's family has been diagnosed with a disease. Answers to survey 1 confirmed this pattern with a clear indication that respondents were optimistic about their chances to catch COVID-19. However, in survey 2, respondents revealed comparative pessimism.
The results show that respondents overestimated the probabilities to catch or die from COVID-19, which is not unusual and does not necessarily reflect a strong deviation from rational behavior. While a rational model explains why the own risk to catch COVID-19 rose between the two surveys, it does not explain why the subjective assessment of the IFR remained stable. The comparative pessimism in survey 2 was likely due to a concomitant increase in the respondents' perceived chances to catch the disease and a decreased expected prevalence rate.
In 2009–2010, the H1N1 episode occurred in a general context of decreasing public confidence in vaccination. We assumed opposition to vaccination in general to be an ‘unfounded fear’, reflecting ...ignorance and perceived vulnerability among low-socioeconomic status (SES) people, and opposition to the H1N1 vaccine a ‘legitimate concern’ reflecting the elite's commitment to ‘risk culture’ in a ‘risk society’. We indirectly tested these assumptions by investigating the socioeconomic profiles associated with opposition to vaccination in general and opposition to the H1N1 vaccine specifically. Our second aim was to determine whether or not opposition to the H1N1 vaccine fuelled opposition to vaccination in general. We used data from a telephone survey conducted in 2009–2010 among a random sample of French people aged 15–79 (N = 9480). Attitudes toward vaccination in general and toward the H1N1 vaccine specifically varied significantly between October 2009 and June 2010 with strong correlation being observed between these attitudes throughout the whole period. In multivariable analysis attitudes toward vaccination in general remained a significant predictor of attitudes to the H1N1 vaccine and vice versa, for distinct profiles as follows: males, older people, low-SES people for opposition to vaccination in general, versus females, people aged 35–49 and those with an intermediate SES for opposition to the H1N1 vaccine. Results also differed regarding indicators of social vulnerability, proximity to preventive medicine and vaccination history. The first profile supported the “unfounded fears expressed by low-SES people” hypothesis, while the second echoed previous work related to middle-classes’ “healthism”. Opposition to vaccination should not be reduced to irrational reactions reflecting ignorance or misinformation and further research is needed to acquire a greater understanding of the motives of opponents.
•Attitudes toward vaccination in general shaped public's reactions to H1N1 vaccine.•The H1N1 episode undermined French public's attitudes toward vaccination.•People with a low socioeconomic status were more prone to oppose vaccination.•Educated middle-classes were more prone to oppose the H1N1 vaccine specifically.
The COVID-19 epidemic highlighted the necessity to integrate dynamic human behaviour change into infectious disease transmission models. The adoption of health protective behaviour, such as ...handwashing or staying at home, depends on both epidemiological and personal variables. However, only a few models have been proposed in the recent literature to account for behavioural change in response to the health threat over time. This study aims to estimate the relevance of TELL ME, a simple and frugal agent-based model developed following the 2009 H1N1 outbreak to explain individual engagement in health protective behaviours in epidemic times and how communication can influence this. Basically, TELL ME includes a behavioural rule to simulate individual decisions to adopt health protective behaviours. To test this rule, we used behavioural data from a series of 12 cross-sectional surveys in France over a 6-month period (May to November 2020). Samples were representative of the French population (N = 24,003). We found the TELL ME behavioural rule to be associated with a moderate to high error rate in representing the adoption of behaviours, indicating that parameter values are not constant over time and that other key variables influence individual decisions. These results highlight the crucial need for longitudinal behavioural data to better calibrate epidemiological models accounting for public responses to infectious disease threats.
•Agent-based modelling might be useful to predict protective COVID behaviours.•The TELL ME model was tested using French cross-sectional behavioural data.•The TELL ME behavioural rule is associated with a persistent error in prediction.•The effects of epidemiological and personal variables should be individualised.•Longitudinal data are required to assess the existing agent-based models.
During the last decade, French Guiana has been affected by major dengue fever outbreaks. Although this arbovirus has been a focus of many awareness campaigns, very little information is available ...about beliefs, attitudes and behaviors regarding vector-borne diseases among the population of French Guiana. During the first outbreak of the chikungunya virus, a quantitative survey was conducted among high school students to study experiences, practices and perceptions related to mosquito-borne diseases and to identify socio-demographic, cognitive and environmental factors that could be associated with the engagement in protective behaviors.
A cross-sectional survey was administered in May 2014, with a total of 1462 students interviewed. Classrooms were randomly selected using a two-stage selection procedure with cluster samples. A multiple correspondence analysis (MCA) associated with a hierarchical cluster analysis and with an ordinal logistic regression was performed. Chikungunya was less understood and perceived as a more dreadful disease than dengue fever. The analysis identified three groups of individual protection levels against mosquito-borne diseases: "low" (30%), "moderate" (42%) and "high" (28%)". Protective health behaviors were found to be performed more frequently among students who were female, had a parent with a higher educational status, lived in an individual house, and had a better understanding of the disease.
This study allowed us to estimate the level of protective practices against vector-borne diseases among students after the emergence of a new arbovirus. These results revealed that the adoption of protective behaviors is a multi-factorial process that depends on both sociocultural and cognitive factors. These findings may help public health authorities to strengthen communication and outreach strategies, thereby increasing the adoption of protective health behaviors, particularly in high-risk populations.
Abstract Background Several concepts are available to explain vaccine decision making by individual and inter-individual factors, including risk perception, social conformism and altruism. However, ...only a few studies have quantified the weight of these determinants in vaccine acceptance. Using a conjoint analysis tool, we aimed at eliciting preferences in a student population regarding vaccination against a rare, severe and rapidly evolving hypothetical disease, similar to meningococcal serogroup C meningitis or measles. Methods During March-May 2016, we conducted an emailing survey among university students aged 18–24 years (N = 775) in Rennes, France. Participants were asked to decide for or against immediate vaccination in 24 hypothetical scenarios, containing various levels of four attributes: epidemic situation, adverse events, information on vaccination coverage, and potential for indirect protection. Data were analysed using random effect estimator logit models. Results Participants accepted on average 52% of scenarios and all attributes significantly impacted vaccination acceptance. The highest positive effects were seen with an epidemic situation (OR 3.81, 95%-CI 3.46–4.19), 90% coverage in the community (3.64, 3.15–4.20) and potential for disease elimination from the community (2.87, 2.53–3.26). Information on “insufficient coverage” was dissuasive (vs. none of friends vaccinated: 0.65, 0.56–0.75). Controversy had a significantly greater negative effect than a confirmed risk of severe adverse events (OR 0.05 vs. 0.22). In models including participant characteristics, preference weights were unchanged, while trust in health authorities and vaccination perceptions strongly influenced acceptance themselves. The greatest significant variation of preference weights between subgroups was observed with controversy among students using alternative medicine daily (OR 0.28) and among students relying on scientific vaccine information (OR 0.02). Conclusions Among young adults, potential for indirect protection and factual information on coverage in the community and potential side effects positively impact theoretical vaccine acceptance. Conjoint analyses should be conducted to understand vaccine hesitancy in specific vaccination programs.
Because the effectiveness of a coronavirus disease lockdown in curbing coronavirus disease spread depends on public support, acquiring real-time information about the way populations reacted to the ...lockdown is crucial. In France, such public support remained fragile among low-income persons, probably because the lockdown exacerbated preexisting social inequalities and conflicts.
Support for vaccine decision-making requires a tailored approach taking into account psychological antecedents of vaccine acceptance. We aimed at validating an extended 7C-model of antecedents in ...three different target population groups (healthcare workers n = 3870, parents n = 2002 and adolescents n = 7118) and two vaccinations (COVID-19, HPV) in France. We performed a secondary analysis of questionnaires collecting sociodemographic characteristics, attitudes and knowledge on vaccination, and vaccine status and intention. We used standard psychometric techniques to validate a first and second order latent structure, and evaluated their association with vaccine intentionality in three levels (refusal, indecision, acceptance). In all populations, the 7C-model yielded a very good model fit (CFI and TLI > 0.90) and, in comparison with non-nested and nested 5C-models, significantly improved the model performance (Ω
, p < 0.05; Wald's test, p < 0.05). The resulting vaccine readiness score was strongly associated with vaccine intentionality (acceptance vs. indecision: β
= 2.93, β
= 2.41, β
= 1.34; refusal vs. indecision: β
= - 1.68, β
= - 0.16, β
= - 0.89.). The addition of confidence in the system and social conformism among antecedents of vaccine acceptance allowed a finer understanding of the continuum moving from refusal to indecision and acceptance. To work with these antecedents in interventional research, appropriate questionnaire items should be developed for various vaccines and target populations.
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