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Showing content from https://pubmed.ncbi.nlm.nih.gov/33722226/ below:

Early public adherence with and support for stay-at-home COVID-19 mitigation strategies despite adverse life impact: a transnational cross-sectional survey study in the United States and Australia

doi: 10.1186/s12889-021-10410-x. Early public adherence with and support for stay-at-home COVID-19 mitigation strategies despite adverse life impact: a transnational cross-sectional survey study in the United States and Australia

Affiliations

¹ Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia. mark.czeisler@fulbrightmail.org.
² Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, 3084, Australia. mark.czeisler@fulbrightmail.org.
³ Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, 02115, USA. mark.czeisler@fulbrightmail.org.
⁴ Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia.
⁵ Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, 3084, Australia.
⁶ Department of Medicine, University of Melbourne, Melbourne, VIC, 3010, Australia.
⁷ Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
⁸ Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA.

PMID: 33722226
PMCID: PMC7957462
DOI: 10.1186/s12889-021-10410-x

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Early public adherence with and support for stay-at-home COVID-19 mitigation strategies despite adverse life impact: a transnational cross-sectional survey study in the United States and Australia

Mark É Czeisler et al. BMC Public Health. 2021.

doi: 10.1186/s12889-021-10410-x. Affiliations

¹ Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia. mark.czeisler@fulbrightmail.org.
² Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, 3084, Australia. mark.czeisler@fulbrightmail.org.
³ Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, 02115, USA. mark.czeisler@fulbrightmail.org.
⁴ Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, 3800, Australia.
⁵ Institute for Breathing and Sleep, Austin Health, Melbourne, VIC, 3084, Australia.
⁶ Department of Medicine, University of Melbourne, Melbourne, VIC, 3010, Australia.
⁷ Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
⁸ Division of Sleep Medicine, Harvard Medical School, Boston, MA, 02115, USA.

PMID: 33722226
PMCID: PMC7957462
DOI: 10.1186/s12889-021-10410-x

Item in Clipboard

Abstract

Background: Governments worldwide recommended unprecedented measures to contain the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As pressure mounted to scale back measures, understanding public priorities was critical. We assessed initial public adherence with and support for stay-at-home orders in nations and cities with different SARS-CoV-2 infection and COVID-19 death rates.

Methods: Cross-sectional surveys were administered to representative samples of adults aged ≥18 years from regions with different SARS-CoV-2 prevalences from April 2-8, 2020. Regions included two nations [the United States (US-high prevalence) and Australia (AU-low prevalence)] and two US cities [New York City (NY-high prevalence) and Los Angeles (LA-low prevalence)]. Regional SARS-CoV-2 and COVID-19 prevalence (cumulative SARS-CoV-2 infections, COVID-19 deaths) as of April 8, 2020: US (363,321, 10,845), AU (5956, 45), NY (81,803, 4571), LA (7530, 198). Of 8718 eligible potential respondents, 5573 (response rate, 63.9%) completed surveys. Median age was 47 years (range, 18-89); 3039 (54.5%) were female.

Results: Of 5573 total respondents, 4560 (81.8%) reported adherence with recommended quarantine or stay-at-home policies (range of samples, 75.5-88.2%). Additionally, 29.1% of respondents screened positive for anxiety or depression symptoms (range of samples, 28.6-32.0%), with higher prevalences among those of younger age, female gender, and those in quarantine or staying at home most of the time versus those who did not report these behaviours. Despite elevated prevalences of adverse mental health symptoms and significant life disruptions, 5022 respondents (90.1%) supported government-imposed stay-at-home orders (range of samples, 88.9-93.1%). Of these, 90.8% believed orders should last at least three more weeks or until public health or government officials recommended, with support spanning the political spectrum.

Conclusions: Public adherence with COVID-19 mitigation policies was highly prevalent, in both highly-affected (US, NY) and minimally-affected regions (AU, LA). Despite disruption of respondents' lives, the vast majority supported continuation of extended stay-at-home orders. Despite common support, these two countries diverged in stringent mitigation implementation, which may have contributed to subsequent outcomes. These results reveal the importance of surveillance of public support for and adherence with such policies during the COVID-19 pandemic and for future infectious disease outbreaks.

Keywords: COVID-19; Coronavirus; Insomnia; Mental health; Mitigation strategies; Pandemic; Public health policy; Qualtrics; SARS-CoV-2; Stay-at-home orders.

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Conflict of interest statement

CAC reports grants from Cephalon Inc., Jazz Pharmaceuticals Plc., Inc., Philips Respironics, Inc., Regeneron Pharmaceuticals, and Sanofi S.A.; and personal fees from Institute of Digital Media and Child Development, Klarman Family Foundation, Teva Pharma Australia, and Vanda Pharmaceuticals. In addition, CAC holds an equity interest in Vanda Pharmaceuticals, Inc. CAC receives royalties from Philips Respironics, Inc. for the Actiwatch-2 and Actiwatch-Spectrum devices. Interests for CAC were reviewed and managed by Brigham and Women’s Hospital and Mass General Brigham in accordance with their conflict of interest policies. MÉC, MEH, RR, LKB, ERF-C, and SMWR declare no potential conflicts of interest.

Figures
Fig. 1

Flow of Survey Respondents. The…

Fig. 1

Flow of Survey Respondents. The survey was managed through an online respondent panel…

Fig. 1

Flow of Survey Respondents. The survey was managed through an online respondent panel by Qualtrics. A priori quota limits were determined prior to study initiation to ensure nationally representative samples were collected and included the following: age, gender, and either race and ethnicity (US, NY, LA) or ancestry (AU), based on 2010 US and 2016 Australian census population estimates, respectively. Of 8718 eligible potential respondents, 5573 completed surveys, providing a 63.9% response rate

Fig. 2

Public COVID-19 Mitigation Adherence, Concerns,…

Fig. 2

Public COVID-19 Mitigation Adherence, Concerns, Policy Support, and Experience. Percentage of respondents by…

Fig. 2

Public COVID-19 Mitigation Adherence, Concerns, Policy Support, and Experience. Percentage of respondents by region who reported: adherence with recommended mitigation strategies; support for a government-mandated stay-at-home order; perceived risk of eventual infection with SARS-CoV-2; personal experience with COVID-19 (ie, knowing someone who was infected with SARS-CoV-2 or who died from COVID-19); and moderate to extreme concerns regarding: one’s own or others’ risk of infection with SARS-CoV-2 or risk for death from COVID-19, personal financial loss, and possible economic recession

Fig. 3

Life Disruption Due to COVID-19…

Fig. 3

Life Disruption Due to COVID-19 and Mitigation Strategies. Impact by region of COVID-19…

Fig. 3

Life Disruption Due to COVID-19 and Mitigation Strategies. Impact by region of COVID-19 and mitigation strategies on social life, family life, work and/or study, productivity, sleep patterns, physical activity, and sexual activity; percentage of respondents reporting that the indicated behavioural category was moderately to extremely disrupted or improved is shown

Fig. 4

Behavioural Changes Comparing Before and…

Fig. 4

Behavioural Changes Comparing Before and During the COVID-19 Pandemic. Percentage of respondents reporting…

Fig. 4

Behavioural Changes Comparing Before and During the COVID-19 Pandemic. Percentage of respondents reporting decreases or increases in six categories [virtual interactions vs. face-to-face interactions; time spent outdoors during daylight hours; time on light-emitting screens; weekly work hours (among respondents employed in the fourth quarter of 2019, n = 3328); commute time; and weight] at the time of the survey in April, 2020 (after the COVID-19 pandemic was declared and mitigation policies were implemented) as compared to the fourth quarter of 2019 (before the COVID-19 pandemic was declared)