Social Distancing and Stigma: Association Between Compliance With Behavioral Recommendations, Risk Perception, and Stigmatizing Attitudes During the COVID-19 Outbreak

Introduction: Following behavioral recommendations is key to successful containment of the COVID-19 pandemic. Therefore, it is important to identify causes and patterns of non-compliance in the population to further optimize risk and health communication. Methods: A total of 157 participants [80% female; mean age = 27.82 years (SD = 11.01)] were surveyed regarding their intention to comply with behavioral recommendations issued by the German government. Latent class analysis examined patterns of compliance, and subsequent multinomial logistic regression models tested sociodemographic (age, gender, country of origin, level of education, region, and number of persons per household) and psychosocial (knowledge about preventive behaviors, risk perception, stigmatizing attitudes) predictors. Results: Three latent classes were identified: high compliance (25%) with all recommendations; public compliance (51%), with high compliance regarding public but not personal behaviors; and low compliance (24%) with most recommendations. Compared to high compliance, low compliance was associated with male gender [relative risk ratio (RRR) = 0.08 (0.01; 0.85)], younger age [RRR = 0.72 (0.57; 0.93)], and lower public stigma [RRR = 0.21 (0.05; 0.88)]. Low compliers were also younger than public compliers [RRR = 0.76 (0.59; 0.98)]. Discussion: With 25% of the sample reporting full compliance, and 51% differing in terms of public and personal compliance, these findings challenge the sustainability of strict regulatory measures. Moreover, young males were most likely to express low compliance, stressing the need for selective health promotion efforts. Finally, the positive association between public stigma and compliance points to potential othering effects of stigma during a pandemic, but further longitudinal research is required to examine its impact on health and social processes throughout the pandemic

Polysubstance use in adolescence and emerging adulthood: Use patterns, trajectories, and determining factors

Ziel. Ziel der Arbeit ist, einen Überblick über bisherige Forschung zum multiplen Substanzkonsum (mS) in der Adoleszenz zu schaffen, und diese durch den Blick auf deutsche Jugendliche zu ergänzen Methode. Erstens, Durchführung einer systematischen Übersichtsarbeit zu latenten Klassen von mS in der Adoleszenz (10-19 Jahre). Zweitens, latente Klassenanalyse von mS des frühen Jugendalters (N=2.490) im Mehrebenenmodell. Drittens, latente Transitionsanalyse von mS bei Auszubildenden (N=5.214). Prädiktoren von mS wurden mittels multinomialer Regressionen geprüft. Ergebnisse. Die 23 in der Übersichtsarbeit eingeschlossenen Studien fanden drei bis vier latente Klassen des Substanzkonsums (kein Konsum; nur eine Substanz (v. a. Alkohol); mS; erweiterter Konsum). Zumeist umfasste mS die Substanzen Alkohol, Tabak und Cannabis und hing mit höherem Alter, Konsum der Eltern/Peers und schwachen Schulleistungen zusammen. Im frühen Jugendalter war mS (Alkohol und Binge Drinking, Zigaretten) mit Konsum der Eltern/Peers, höherem Alter, Bullying und niedrigem sozioökonomischem Status (SES) assoziiert. Bei Auszubildenden bestand ein Zusammenhang zwischen mS (Alkohol, Zigaretten, Cannabis) und Stress. Die Transitionen zwischen den latenten Klassen waren gering (2-10 %); die Stabilität von mS lag bei 92 %. In den meisten Studien stellte mS die kleinste Klasse dar. Diskussion und Schlussfolgerung. Nur wenige Jugendliche praktizieren mS, gleichwohl bestehen erhöhte Gesundheitsrisiken, sowie Zusammenhänge mit Konsum der Eltern/Peers und niedrigem SES für diese Gruppe. Prävention sollte daher gezielt sozial Benachteiligte adressieren und dabei deren Eltern/Peers berücksichtigen. Die Befunde legen eine hohe Stabilität von mS legt nahe, weshalb gerade Entstehung und Entwicklung von mS im Jugendalter genauer beobachtet werden müssen. Überdies ist der Zusammenhang von Produkten wie E-Zigaretten mit mS bislang unklar und könnte, etwa über Gateway-Modelle, hinsichtlich seiner Bedeutung eruiert werden.Aim. This thesis aims to review existing research on polysubstance use (PU) in adolescence, and provide a closer look at PU – and predictors thereof – in German adolescents. Methods. First, a systematic review of latent classes of PU in adolescence (10-19 years) was conducted. Second, PU in early adolescence was investigated in a longitudinal sample of 2,490 students via multilevel latent class models. Third, late adolescents’ PU was examined in a longitudinal sample of 5,214 vocational students via latent transition analysis. Predictors of PU were investigated via multinomial logistic regressions. Results. The systematic review identified 23 studies that mostly found three or four latent classes of substance use (no use; single substance use (alcohol); polysubstance use; advanced use). PU commonly comprised a combination of alcohol, tobacco, and cannabis. It was univocally associated with age, parental/peer substance use, and poor academic performance. In early adolescence, PU (alcohol use and binge drinking, cigarette smoking) was associated with parental/peer substance use, age, bullying, and low socio-economic status. Among late adolescents, PU (alcohol, cannabis, cigarettes) was connected to high stress. Transition rates between latent classes were small (2% to 10%), particularly for PU, with 92% remaining in the latent class over time. In most studies, PU was the smallest latent class. Discussion and conclusion. A small proportion of adolescents practices PU. Nevertheless, it is connected to elevated health risks, low socio-economic status, and peer/parental substance use. Thus, preventive efforts should target socially disadvantaged adolescents, and include parents and peers. Longitudinal models suggest stability of PU. Therefore, the progression of PU in adolescence needs to be examined closely. Also, with an increase in the use of potentially harmful products, e.g., e-cigarettes, the impact on PU should be studied, for example by investigating gateway models

More Than a Glance: Investigating the Differential Efficacy of Radicalizing Graphical Cues with Right-Wing Messages

In recent years, online radicalization has received increasing attention from researchers and policymakers, for instance, by analyzing online communication of radical groups and linking it to individual and collective pathways of radicalization into violent extremism. But these efforts often focus on radical individuals or groups as senders of radicalizing messages, while empirical research on the recipient is scarce. To study the impact of radicalized online content on vulnerable individuals, this study compared cognitive and affective appraisal and visual processing (via eye tracking) of three political Internet memes (empowering a right-wing group, inciting violence against out-groups, and emphasizing unity among human beings) between a right-wing group and a control group. We examined associations between socio-political attitudes, appraisal ratings, and visual attention metrics (total dwell time, number of fixations). The results show that right-wing participants perceived in-group memes (empowerment, violence) more positively and messages of overarching similarities much more negatively than controls. In addition, right-wing participants and participants in the control group with a high support for violence directed their attention towards graphical cues of violence (e.g., weapons), differentness, and right-wing groups (e.g., runes), regardless of the overall message of the meme. These findings point to selective exposure effects and have implications for the design and distribution of de-radicalizing messages and counter narratives to optimize the efficacy of prevention of online radicalization

Internalizing and externalizing symptoms in Spanish children aged 6-8: Results of a latent profile analysis

Background Internalizing and externalizing problems are widely addressed in research. However, most studies use variable-centred approaches and ignore the possible co-occurrence of both types of symptoms. This study aimed to identify homogeneous groups of children with similar psychological difficulties and strengths, using latent profile analysis as a person-centred approach. Methods The parents of 107 Spanish children aged 6 to 8 years completed the Strengths and Difficulties Questionnaire (SDQ). Results The results revealed the existence of four latent groups. The children who belonged to the high difficulties group showed the most severe symptoms in emotional problems, peer problems and hyperactivity. The children classified in the externalizing group showed high levels of hyperactivity, behavioral problems, and emotional problems. On another hand, the internalizing profile grouped children with emotional and peer problems. Finally, the well-adjusted group showed an adequate psychological adjustment in all evaluated variables. High difficulties were associated with lower educational attainment of their parents. Limitations Data were reported from a single source of information, father or mother. Also, the socio-demographic variables that were related to each one of the four profiles only considered the age and educational level of the main informant. Conclusions These data suggest that co-occurrence of symptoms is very high in young Spanish children. It is essential to carry out clinical assessments that include both types of symptoms. Considering externalization and internalization as independent and exclusive phenomena can compromise the effectiveness of psychological treatments and preventive programs

Validity and psychometric properties of the self-identification as having a mental illness scale (SELF-I) among currently untreated persons with mental health problems

Conceptualizing own symptoms as potential signs of a mental illness is an important, yet underresearched step towards appropriate help. Few validated measures address recognition and identification of own mental illness. Aim of this study is to investigate performance and correlates of the ‘Self-Identification as Having a Mental Illness’ scale (SELF-I) in a group of 229 currently untreated individuals with mental health problems, predominantly depression. Measures included: self-identification with having a mental illness (SELF-I), depressive and somatic symptom severity (PHQ-9 and PHQ-15), illness perceptions (B-IPQ-R-C), and sociodemographic variables. Principal-component analysis revealed in a unidimensional factor structure. The SELFI showed good reliability in terms of internal consistency (Cronbach’s alpha, 0.85-0.87) and retest reliability over three months (Intraclass correlation coefficient, 0.74). Associations with depressive symptoms, previous treatment experiences and self-labelling demonstrated construct and criterion validity. Low associations with somatic symptoms and with illness-perceptions as measured by the B-IPQ-R-C indicated discriminant validity. We did not observe any floor or ceiling effects. The SELF-I scale is a brief, unidimensional and reliable measure of selfidentification as having a mental illness that offers useful research perspectives

The effects of causal and self-efficacy beliefs on help-seeking for people with depressive complaints: a quasi-experimental online study

BackgroundOnly approximately a third of people with depressive symptoms seek professional health care. Furthermore, people labelled as mentally ill may experience stigmatisation, which can impede help-seeking behaviour.AimTo examine the effects of three vignette-based interventions endorsing biopsychosocial causal beliefs and strengthening self-efficacy on help-seeking intention and behaviour, as well as the predictive values of these variables and previous treatment experience.MethodA quasi-experimental online study utilising a fractioned factorial design was carried out. People were screened for depressive symptoms and their current treatment status. After baseline assessment, they were randomly allocated into one of 24 groups receiving a combination of interventional messages. Actual help-seeking behaviour was measured at follow-ups 3 and 6 months after baseline.ResultsAltogether, N = 1,368 participants were included in the final analyses and N = 983 provided data on their help-seeking behaviour within 3 to 6 months after the baseline assessment. The intention to seek help from a general practitioner or a mental health professional was significantly influenced by the interventions. However, help-seeking behaviour was not influenced by the interventions. On a conceptual level, biopsychosocial causal beliefs (β = 0.09–0.23) and self-efficacy to seek help (β = 0.16–0.25) predicted help-seeking intention. There was a negative interaction effect of both self-efficacy beliefs on intention and behaviour, which changed depending on depression severity. In all models, the intention was the main predictor of actual behaviour. Treatment experience predicted both help-seeking intention and behaviour.ConclusionBiopsychosocial causal beliefs and self-efficacy have a direct effect on help-seeking intention. Interventions should include information on how to actually seek help as a means to strengthen self-efficacy beliefs and simulate previous treatment experience. Further research is needed to investigate the respective interaction effects on intention and behaviour.Clinical Trial Registrationhttps://drks.de/search/de/trial/DRKS00023557, German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021

Baseline study for improving diagnostic stewardship at secondary health care facilities in Nigeria

Background: Blood culture diagnostics are critical tools for sepsis management and antimicrobial resistance (AMR) surveillance. A baseline study was conducted to assess reported sepsis case finding, blood culture diagnostics, antimicrobial susceptibility testing (AST) and antimicrobial use at secondary health care facilities to inform the development of diagnostic stewardship improvement strategies in Nigeria. Methods: A cross-sectional online survey was conducted among 25 public secondary health care facilities in Abuja, Federal Capital Territory (FCT) and Lagos State in Nigeria to evaluate the capacity for pathogen identification and AST. Data were then prospectively extracted on all patients with reported suspected sepsis from electronic medical records from selected departments at two facilities in the Federal Capital Territory from October 2020 to May 2021 to further assess practices concerning sepsis case-finding, clinical examination findings, samples requested, and laboratory test results. Data were descriptively analysed, and a multivariate logistic regression analysis was conducted to determine factors associated with blood culture requests. Results: In the online survey, 32% (8/25) of facilities reported performing blood cultures. Only one had access to a clinical microbiologist, and 28% (7/25) and 4% (1/25) used standard bacterial organisms for quality control of media and quality control strains for AST, respectively. At the two facilities where data abstraction was performed, the incidence of suspected sepsis cases reported was 7.1% (2924/41066). A majority of these patients came from the paediatrics department and were outpatients, and the median age was two years. Most did not have vital signs and major foci of infection documented. Blood cultures were only requested for 2.7% (80/2924) of patients, of which twelve were positive for bacteria, mainly Staphylococcus aureus. No clinical breakpoints were used for AST. Inpatients (adjusted odds ratio [aOR]: 7.5, 95% CI: 4.6–12.3) and patients from the urban health care facility (aOR:16.9, 95% CI: 8.1–41.4) were significantly more likely to have a blood culture requested. Conclusion: Low blood culture utilisation remains a key challenge in Nigeria. This has implications for patient care, AMR surveillance and antibiotic use. Diagnostic stewardship strategies should focus on improving access to clinical microbiology expertise, practical guidance on sepsis case finding and improving blood culture utilisation and diagnostics.Peer Reviewe

Appsolutely secure? Psychometric properties of the German version of an app information privacy concerns measure during COVID-19

Introduction Privacy concerns are an important barrier to adoption and continued use of digital technologies, particularly in the health sector. With the introduction of mobile health applications (mHealth apps), the construct of app information privacy concerns has received increased attention. However, few validated measures exist to capture said concerns in population samples, although they can help to improve public health efforts. Methods Using a cross-sectional survey of German adults (mean age = 35.62; 63.5% female), this study examined psychometric properties of the app information privacy concerns scale (AIPC). Analyses comprised confirmatory factor analysis, factorial validity (exploratory factor analysis), internal consistency, convergent validity (i.e., correlations with privacy victimhood, and app privacy concerns), and discriminant validity (i.e., daily app use, adoption intentions, and attitudes toward COVID-19 contact tracing app use). Results The analysis did not support the proposed three-factor structure of the AIPC (i.e., anxiety, personal attitude, and requirements). Instead, a four-factor model was preferable that differentiated requirements regarding disclosure policies, and personal control. In addition, factors mirroring anxiety and personal attitude were extracted, but shared a significant overlap. However, these factors showed good reliability, convergent and discriminant validity. Discussion The findings underline the role of app information privacy concerns as a significant barrier to mHealth app use. In this context, anxiety and personal attitudes seemed particularly relevant, which has implications for health communication. Moreover, the observed differentiation of external (disclosure) and internal (control) requirements aligns with health behavior change models and thus is a promising area for future research

The impact of media reports on COVID-19 conspiracy theories on consensus beliefs and agreement with public action

Since the beginning of the COVID-19 pandemic, numerous theories have accompanied us about the origin and supposed purpose of the novel virus. As the duration of the pandemic increased, so did the visibility of conspiracy myths in public discourse. Reports about conspiracy myths, about demonstrations or interviews with COVID-deniers may have led people to misjudge the distribution of opinion in society. The aim of this study is to investigate the relationship between news coverage of conspiracy myths and perceptions of consensus in society. In the past, the development of the Gateway Belief Model has shown that the assessment of consensus among scientists and in the social environment has a decisive influence on one's own attitudes and behavior (van der Linden et al., 2019). However, since the model does not make assumptions about the origin of the perception of consensus, this study focuses on extending the model and adapting it to the context of the COVID-19 pandemic. According to the Gateway Belief Model, misperceptions of perceived consensus are a “gateway” cognition as they influence individual beliefs and actions (van der Linden et al., 2019). For example, if people mistakenly believe that the majority of scientists or the majority of their social environment do not believe in human-caused climate change, then they are likely to not believe in it either and are much less likely to perceive climate change as a serious risk or support policies to reduce it. The model basis on the assumption that consensus can serve as a decision heuristic when there is no motivation to elaborate on a message, since it can usually be assumed that the majority is correct in its assessments (Chaiken, 2014; van der Linden, 2015). The effect that perceived scientific and social consensus has on our attitudes and behavior has been demonstrated in numerous studies (Bode et al., 2020; van der Linden et al., 2015, 2017). However, the Gateway Belief Model does not provide information on how the perceived scientific or social consensus is formed by an individual. To this end, Elisabeth Noelle-Neumann developed the spiral of silence theory, which is based on the assumption that public opinion is partly assessed through the mass media. Noelle-Neumann explains the human interest in public opinion by the inherent fear of isolation in humans (Noelle-Neumann & Petersen, 2004). Isolation must be expected if a person's opinion or behavior differs from that of others (Noelle‐Neumann, 1974). To prevent isolation, people observe their social environment and the mass media in order to behave socially adaptive (Noelle-Neumann, 1991). Thus, mass media provide a normative orientation. However, the theory does not answer the question of how mass media convey cues about the climate of opinion and how these cues affect our perception of public opinion. The persuasive press inference, developed by Gunther (1998), could provide an answer to this question. Gunther’s theory proposes that people make judgments about public opinion by drawing inferences from the general content of press coverage. Therefore, when people perceive a positive tenor in the news, they estimate the opinion in the population more favorably (Zerback, 2016). Hence, the tenor of the news is a cue for the viewer to assess public opinion. Interestingly, however, it could be observed that people evaluate the tenor differently (Arpan & Raney, 2003; Hansen & Kim, 2011; Vallone et al., 1985). The perception of the tenor depends on individual attitudes (Feldman, 2011). When people are asked to assess the tenor of a news story, people who have an established stance on a particular topic often perceive the tenor contrary to their own opinion (Hansen & Kim, 2011). This phenomenon is called the hostile media effect. Furthermore, Gunther claims that people assume that media coverage has a powerful impact on other people (1998). This premise is based on the so-called third person effect, which states that people overestimate the effect of media on other people’s attitudes and behaviors (Davison, 1983). Consequently, Gunther’s main assertion is that “people assume that what mass media are saying today must be what the public will be thinking tomorrow” (Gunther, 1998, p. 487). But not only the tenor of news reports can have an influence on the assessment of consensus in society, but also the frequency with which certain topics are displayed in the news (Windzio & Kleimann, 2006). “To draw an audience’s attention and make the news a more lucrative business, news producers lean toward sensationalism and take full advantage of the drama embedded in social conflict […]” (Han & Yzer, 2020, p. 71). Placing the focus on audience-friendly content, however, can bias the perception of a viewer as the frequency with which such content is broadcast is no indication of how often something actually happens or what the distribution of opinions actually looks like. Nevertheless, viewers draw conclusions from news content that also affect attitudes. In the proposed study, we want to examine the effects discussed above in the context of the ongoing COVID-19 pandemic due to the current importance of the crisis. The aim of the study is to investigate the influence of news coverage on individual perceptions of consensus in society and through that on attitudes and behavior. In order to test this influence, we adapted the Gateway Belief Model to the new context and added media coverage as a possible influence on perceived consensus in society (see Figure 1), focusing on the spread of conspiracy theories through news coverage. Figure 1 illustrates the main hypotheses (H1 to H3) of the study. Throughout the pandemic, people were confronted with conflicting opinions about COVID. The news reported differing opinions from scientists, politicians, and residents. Anti-COVID demonstrations and extreme opinions were also the subject of reports. These reports could have led to a misperception of the distribution of opinions among the viewers. The first studies assume that about 10% of the German population endorses COVID-related conspiracy beliefs (Kuhn et al., 2021). However, excessive coverage of COVID deniers, demonstrations etcetera may have created the impression that the population is more polarized in its views than is actually the case. This could make people believe that the consensus in society is lower than it actually is (H1). For example, getting exposed to conspiracy theories and conspiracy friendly opinions over and over again in the news could make people belief that a larger percentage of people must belief in conspiracy theories instead of a scientific consensus. This perception could then also reduce risk perceptions and efficacy beliefs (H2), as expressed by many conspiracy theories. Lowered risk perceptions can negatively influence compliance with behavioral measures (H3), because they are deemed irrelevant or unnecessary if COVID is not considered a substantial threat. The study tests these hypotheses via an online experiment, where exposure to conspiracy theories is manipulated by presenting different news reports (focusing on conspiracy theories, scientific or neutral reports about the pandemic), and assessing subsequent risk appraisal and behavioral compliance intentions