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Digital surveys, such as mobile phone ecological momentary assessment (EMA), bear the potential to assess and target individual wellbeing in a personalized, real-time approach and allow for interaction in situations when in-person contact is not possible, such as during the coronavirus pandemic. While the use of digital technology might especially benefit research in older adults who find themselves in circumstances of reduced mobility, little is known about their barriers to adherence. We investigated baseline and structural factors that predict study withdrawal and adherence from daily smartphone EMA self-report surveys in the StayWELL Study. The StayWELL study is a longitudinal, observational study on the relationship between social restrictions during the coronavirus pandemic and mental well-being in 95 community-dwelling older aged adults (67-87 years) who were participants in a randomized clinical trial using EMA. Withdrawal was associated with less research staff changes and less likely in participants that reached the study mid-point. No baseline characteristics predicted withdrawal. Main reasons for withdrawal were communication issues, i.e. staff not being able to contact participants. We found an adherence rate of 82% and no fatigue effects. Adherence was predicted by education status, study participation duration, reaching the study midpoint and time between study start and enrollment. COVID infections or supporting people in the household was not related to adherence. To conclude, it is feasible to conduct an EMA study in older people without impacting engagement during a pandemic. Furthermore, personal characteristics and smartphone operating system (Android vs. iOS) used did not relate to engagement, allowing for a broad distribution of digital health technologies. Our study adds information on single predictive variables relevant for adherence and withdrawal from EMA smartphone surveys in older people that can inform the design of future digital EMA research to maximize engagement and reliability of study results.

BackgroundThis study sought to determine the impact of coronavirus disease 2019 stay-at-home (SAH) and reopening orders on trends and types of firearm violence in California, Ohio, and the United States, hypothesizing increased firearm violence after SAH.Materials and methodsRetrospective data (January 1, 2018, to July 31, 2020) on firearm incidents/injuries/deaths and types of firearm violence were obtained from the Gun Violence Archive. The periods for SAH and reopening for the US were based on dates for California. Ohio dates were based on Ohio's timeline. Mann-Whitney U analyses compared trends and types of daily firearm violence per 100,000 legal firearm owners across 2018-2020 periods.ResultsIn California, SAH and reopening orders had no effect on firearm violence in 2020 compared with 2018 and 2019 periods, respectively. In Ohio, daily median firearm deaths increased during 2020 SAH compared with 2018 and 2019 and firearm incidents and injuries increased during 2020 reopening compared with 2018, 2019 and 2020 SAH. In the United States, during 2020, SAH firearm deaths increased compared with historical controls and firearm incidents, deaths and injuries increased during 2020 reopening compared with 2018, 2019 and 2020 SAH (all P

The recent spread of COVID-19 across the U.S. led to concerted efforts by states to ``flatten the curve" through the adoption of stay-at-home mandates that encourage individuals to reduce travel and maintain social distance. Combining data on changes in travel activity with COVID-19 health outcomes and state policy adoption timing, we characterize nationwide changes in mobility patterns and isolate the portion attributable to statewide mandates. We find evidence of dramatic nationwide declines in mobility prior to adoption of any statewide mandates. Once states adopt a mandate, we estimate further mandate-induced declines between 2.1 and 7.0 percentage points across methods that account for states' differences in travel behavior prior to policy adoption. In addition, we investigate the effects of stay-at-home mandates on changes in COVID-19 health outcomes while controlling for pre-trends and observed pre-treatment mobility patterns. We estimate mandate-induced declines between 0.13 and 0.17 in deaths (5.6 to 6.0 in hospitalizations) per 100 thousand across methods. Across 43 adopting states, this represents 23,366-30,144 fewer deaths (and roughly one million averted hospitalizations) for the months of March and April - which indicates that death rates could have been 42-54% higher had states not adopted statewide policies. We further find evidence that changes in mobility patterns prior to adoption of statewide policies also played a role in reducing COVID-19 mortality and morbidity. Adding in averted deaths due to pre-mandate social distancing behavior, we estimate a total of 48-71,000 averted deaths from COVID-19 for the two-month period. Given that the actual COVID-19 death toll for March and April was 55,922, our estimates suggest that deaths would have been 1.86-2.27 times what they were absent any stay-at-home mandates during this period. These estimates represent a lower bound on the health impacts of stay-at-home policies, as they do not account for spillovers or undercounting of COVID-19 mortality. Our findings indicate that early behavior changes and later statewide policies reduced death rates and helped attenuate the negative consequences of COVID-19. Further, our findings of substantial reductions in mobility prior to state-level policies convey important policy implications for re-opening.Take Away Link https://are.berkeley.edu/sites/are.berkeley.edu/files/PolicyTakeAway_Web.pdf