JMIR Public Health and Surveillance (Oct 2021)

Adoption of Preventive Measures During the Very Early Phase of the COVID-19 Outbreak in China: National Cross-sectional Survey Study

  • Joseph Lau,
  • Yanqiu Yu,
  • Meiqi Xin,
  • Rui She,
  • Sitong Luo,
  • Lijuan Li,
  • Suhua Wang,
  • Le Ma,
  • Fangbiao Tao,
  • Jianxin Zhang,
  • Junfeng Zhao,
  • Dongsheng Hu,
  • Liping Li,
  • Guohua Zhang,
  • Jing Gu,
  • Danhua Lin,
  • Hongmei Wang,
  • Yong Cai,
  • Zhaofen Wang,
  • Hua You,
  • Guoqing Hu

DOI
https://doi.org/10.2196/26840
Journal volume & issue
Vol. 7, no. 10
p. e26840

Abstract

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BackgroundThe outbreak of COVID-19 in China occurred around the Chinese New Year (January 25, 2020), and infections decreased continuously afterward. General adoption of preventive measures during the Chinese New Year period was crucial in driving the decline. It is imperative to investigate preventive behaviors among Chinese university students, who could have spread COVID-19 when travelling home during the Chinese New Year break. ObjectiveIn this study, we investigated levels of COVID-19–related personal measures undertaken during the 7-day Chinese New Year holidays by university students in China, and associated COVID-19–related cognitive factors. MethodsA cross-sectional anonymous web-based survey was conducted during the period from February 1 to 10, 2020. Data from 23,863 students (from 26 universities, 16 cities, 13 provincial-level regions) about personal measures (frequent face-mask wearing, frequent handwashing, frequent home staying, and an indicator that combined the 3 behaviors) were analyzed (overall response rate 70%). Multilevel multiple logistic regression analysis was performed. ResultsOnly 28.0% of respondents (6684/23,863) had left home for >4 hours, and 49.3% (11,757/23,863) had never left home during the 7-day Chinese New Year period; 79.7% (19,026/23,863) always used face-masks in public areas. The frequency of handwashing with soap was relatively low (6424/23,863, 26.9% for >5 times/day); 72.4% (17,282/23,863) had frequently undertaken ≥2 of these 3 measures. COVID-19–related cognitive factors (perceptions on modes of transmission, permanent bodily damage, efficacy of personal or governmental preventive measures, nonavailability of vaccines and treatments) were significantly associated with preventive measures. Associations with frequent face-mask wearing were stronger than those with frequent home staying. ConclusionsUniversity students had strong behavioral responses during the very early phase of the COVID-19 outbreak. Levels of personal prevention, especially frequent home staying and face-mask wearing, were high. Health promotion may modify cognitive factors. Some structural factors (eg, social distancing policy) might explain why the frequency of home staying was higher than that of handwashing. Other populations might have behaved similarly; however, such data were not available to us.