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ObjectivesThe COVID-19 pandemic has been associated with sleep quality impairment and psychological distress, and the general public has responded to the pandemic and quarantine requirements in a variety of ways. We aimed to investigate whether sleep quality is low during a short-term (circuit break) quarantine restriction, and whether sleep quality is associated with respondents' overall attitudes to the pandemic using a validated scale.Design and SettingOnline cross-sectional study in England in November 2020.ParticipantsThe study included 502 respondents over the age of 18.MeasurementsSleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), and pandemic attitudes were assessed using the Oxford Pandemic Attitudes Scale–COVID-19 (OPAS-C), a validated 20-item, 7-domain scale that assesses pandemic-related stress, fear, loneliness, sense of community, sense of exaggerated concern, non-pharmaceutical interventions, and vaccine hesitancy. Unadjusted and multivariable logistic regression odds ratios of association were assessed between the dependent variable of poor sleep quality (PSQI>5) and risk factors, including OPAS-C score, age, sex, educational status, and income.ResultsThe mean (SD) PSQI score was 7.62 (3.49). Overall, 68.9% of respondents met criteria for poor sleep quality using the PSQI cutoff of >5. The mean (SD) OPAS-C score was 60.3 (9.1). There was a significantly increased odds of poor sleep quality in the highest vs. lowest OPAS-C quartiles (OR 4.94, 95% CI [2.67, 9.13], p < 0.0001). Age, sex, income, political leaning, employment status, and education attainment were not associated with poor sleep quality.ConclusionsMore than two-thirds of respondents met criteria for poor sleep quality. The odds of poor sleep quality increased in a dose-response relationship with pandemic attitudes (such as higher levels of pandemic-related stress, fear, or loneliness). The association between poor sleep quality and pandemic attitudes suggests opportunities for public health and sleep medicine interventions, and highlights the need for further research.

Objectives To develop and validate the Oxford Pandemic Attitude Scale-COVID-19 (OPAS-C), a multidimensional scale that addresses seven domains over 20 items including stress, fear, loneliness, sense of community, belief that the pandemic is a hoax or exaggerated, the use of and attitude to non-pharmaceutical interventions and vaccine hesitancy, in a single measure.Design Cross-sectional validation study.Setting Internet based with respondents in the USA and UK.Participants General community respondents using the Prolific Academic platform.Main outcome measures Exploratory factor analyses with promax oblique rotation and confirmatory factor analysis including goodness of fit indices: root mean square error of approximation (RMSEA), standardised root mean square residual (SRMR) and comparative fit index (CFI). Reliability as internal consistency using Cronbach’s alpha. Convergent and discriminant validity using Pearson correlation coefficients.Results The sample included 351 respondents in the USA and the factorial structure was confirmed using a separate set of 348 respondents in the UK. The OPAS-C had excellent goodness of fit characteristics, with an RMSEA of 0.047 (90% CI 0.037 to 0.056), SRMR of 0.043 and CFI of 0.962. Reliability was excellent, demonstrating Cronbach’s alpha of 0.87 in both the US and UK samples. Convergent validity showed correlation coefficients of 0.54 and 0.49 in the US and UK samples, respectively. Discriminant validity demonstrated correlations of 0.21 and 0.26 in the US and UK samples, respectively.Conclusions The OPAS-C represents the first validated scale that addresses mental health measures and public health-relevant responses to COVID-19, and may be a useful measure for use in future longitudinal and cross-sectional studies. Further international validation beyond the USA and UK may be helpful.

Previous research has suggested that the general public is divided over their willingness to consider consuming cultured meat (CM) products. As commercial backing for cultured meat startups increases and the public interest in the US, Europe, and developing countries expands, formally evaluating attitudes to these products will become increasingly important. Willingness to pay (WTP) may provide insight into the level of acceptability of CM products, highlight latent societal preferences, and suggest commercial opportunities. To date, no studies have evaluated the societal WTP for CM products. A cross-sectional internet-based survey was distributed to 300 respondents in the US general population using a survey panel design. The mean age was 30 (range: 18–76), and 47% of respondents were male. We presented respondents with a series of scenarios relating to CM products, framing CM burgers as environmentally friendly vs. as a better alternative to traditional burgers. Prior research has highlighted taste and price as areas of societal concern, but no studies have rigorously evaluated the intersection between these considerations. When CM products were framed as being equivalent in taste to conventional meat, and where their environmental benefits were stressed, respondents were willing to pay significantly more than for a traditional burger ($2.11 vs. $1.00). This WTP jumped to $2.66 when framing the CM burger as the best burger, reflecting a 266% premium that consumers were willing to pay for an appropriately framed CM burger. Framing CM burgers as a better alternative to traditional burgers, rather than focusing on their environmental impact, similarly led to the highest desirability ratings. These preferences were also reflected in a contingent valuation discrete choice experiment examining preferences for paying $1 for a traditional burger vs. $2 for a CM burger. These findings support our hypothesis regarding the existence of what we term the gold-standard bias, a cognitive bias that systematically favors a product or service framed as the best available choice over and above its marginal benefit, and has significant and broad implications for feasibility, pricing, and marketing, suggesting the need for further research in this area.

Pandemic coronavirus disease 2019 (COVID-19) may lead to significant mental health stresses, potentially with modifiable risk factors. We performed an internet-based cross-sectional survey of an age-, sex-, and race-stratified representative sample from the US general population. Degrees of anxiety, depression, and loneliness were assessed using the 7-item Generalized Anxiety Disorder-7 scale (GAD-7), the 9-item Patient Health Questionnaire, and the 8-item UCLA Loneliness Scale, respectively. Unadjusted and multivariable logistic regression analyses were performed to determine associations with baseline demographic characteristics. A total of 1,005 finished surveys were returned of the 1,020 started, yielding a completion rate of 98.5% in the survey panel. The mean (standard deviation) age of the respondents was 45 (16) years, and 494 (48.8%) were male. Overall, 264 subjects (26.8%) met the criteria for an anxiety disorder based on a GAD-7 cutoff of 10; a cutoff of 7 yielded 416 subjects (41.4%), meeting the clinical criteria for anxiety. On multivariable analysis, male sex (odds ratio [OR] = 0.65, 95% confidence interval [CI] [0.49, 0.87]), identification as Black (OR = 0.49, 95% CI [0.31, 0.77]), and living in a larger home (OR = 0.46, 95% CI [0.24, 0.88]) were associated with a decreased odds of meeting the anxiety criteria. Rural location (OR 1.39, 95% CI [1.03, 1.89]), loneliness (OR 4.92, 95% CI [3.18, 7.62]), and history of hospitalization (OR = 2.04, 95% CI [1.38, 3.03]) were associated with increased odds of meeting the anxiety criteria. Two hundred thirty-two subjects (23.6%) met the criteria for clinical depression. On multivariable analysis, male sex (OR = 0.71, 95% CI [0.53, 0.95]), identifying as Black (OR = 0.62, 95% CI [0.40, 0.97]), increased time outdoors (OR = 0.51, 95% CI [0.29, 0.92]), and living in a larger home (OR = 0.35, 95% CI [0.18, 0.69]) were associated with decreased odds of meeting depression criteria. Having lost a job (OR = 1.64, 95% CI [1.05, 2.54]), loneliness (OR = 10.42, 95% CI [6.26, 17.36]), and history of hospitalization (OR = 2.42, 95% CI [1.62, 3.62]) were associated with an increased odds of meeting depression criteria. Income, media consumption, and religiosity were not associated with mental health outcomes. Anxiety and depression are common in the US general population in the context of the COVID-19 pandemic and are associated with potentially modifiable factors.

Non-pharmaceutical interventions (NPIs) represent the primary mitigation strategy for the COVID-19 pandemic. Despite this, many government agencies and members of the general public may be resistant to NPI adoption. We sought to understand public attitudes and beliefs regarding various NPIs and self-reported adoption of NPIs, and to explore associations between NPI performance and the baseline characteristics of respondents. We performed a cross-sectional age-, sex-, and race- stratified survey of the general US population. Of the 1,005 respondents, 37% (95% CI 34.0, 39.9) felt that NPIs were inconvenient, while only 0.9% (95% CI 0.3, 1.5) of respondents believed that NPIs would not reduce their personal risk of illness. Respondents were most uncertain regarding the efficacy of mask and eye protection use, with 30.6 and 22.1%, respectively, unsure whether their use would slow disease spread. On univariate logistic regression analyses, NPI adherence was associated with a belief that NPIs would reduce personal risk of developing COVID-19 [OR 3.06, 95% CI [1.25, 7.48], p = 0.014] and with a belief that NPIs were not difficult to perform [OR 1.79, 95% CI [1.38, 2.31], p < 0.0001]. Respondents were compliant with straightforward, familiar, and heavily-encouraged NPI recommendations such as hand-washing; more onerous approaches, such as avoiding face touching, disinfecting surfaces, and wearing masks or goggles, were performed less frequently. NPI non-adherence is associated with both outcome expectations (belief that NPIs are effective) and process expectations (belief that NPIs are not overly inconvenient); these findings have important implications for designing public health outreach efforts, where the feasibility, as well as the effectiveness, of NPIs should be stressed.