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Governments, public health officials and pharmaceutical companies have all mobilized resources to address the COVID-19 pandemic. Lockdowns, social distancing, and personal protective behaviours have been helpful but have shut down economies and disrupted normal activities. Vaccinations protect populations from COVID-19 and allow a return to pre-pandemic ways of living. However, vaccine development, distribution and promotion have not been sufficient to ensure maximum vaccine uptake. Vaccination is an individual choice and requires acceptance of the need to be vaccinated in light of any risks. This paper presents a behavioural sciences framework to promote vaccine acceptance by addressing the complex and ever evolving landscape of COVID-19. Effective promotion of vaccine uptake requires understanding the context-specific barriers to acceptance. We present the AACTT framework (Action, Actor, Context, Target, Time) to identify the action needed to be taken, the person needed to act, the context for the action, as well as the target of the action within a timeframe. Once identified a model for identifying and overcoming barriers, called COM-B (Capability, Opportunity and Motivation lead to Behaviour), is presented. This analysis identifies issues associated with capability, opportunity and motivation to act. These frameworks can be used to facilitate action that is fluid and involves policy makers, organisational leaders as well as citizens and families.

The Substance Use Risk Profile Scale (SURPS) identifies four personality dimensions related to reinforcement-specific patterns of substance use. Gaming literature has identified similar personalities and game-related reinforcement properties as core risk factors of problematic play. Given similarities, we investigated whether the SURPS model could be confirmed in a recreational video game playing population as a predictive model of problematic gaming. We recruited participants through gaming forums and Amazon Mechanical Turk to complete an online survey that focused on the SURPS and indicators of problematic gaming. Confirmatory factor analysis indicated that the SURPS is a valid instrument measuring four distinct personality dimensions with minor modifications. Regression analyses did not confirm all four at-risk personality dimensions as predictors of problematic play. The Impulsive personality was a significant predictor of lifetime frequency and problematic gaming, whereas the Hopelessness personality was a significant predictor of time spent playing. Future studies will need to assess this model using outcome variables grouped based on reinforcement-related gaming taxonomy.

Introduction Comorbid insomnia and perceived cognitive impairments (PCI) affect up to 26% of individuals diagnosed with cancer. Given the association between sleep and cognition, and the lack of interventions to improve PCI, the present study examined the impact of cognitive behavioral therapy for insomnia (CBT-I) on PCI among cancer survivors with insomnia disorder and cognitive complaints (clinicaltrials.gov:NCT04026048). Methods Cancer survivors (N=122) with insomnia and PCI were randomized to 7 weekly virtual CBT-I treatment sessions (n=56) or waitlist control (WLC: n=66). Participants completed the Insomnia Severity Index and the Functional Assessment of Cancer Therapy – Cognitive Function upon entering the study (baseline; T0), and then again at 4 (T1), and 8 (T2) weeks. A series of 2 (treatment group: CBT-I and WLC) by 3 (time: T0, T1, T2) mixed ANOVAs were performed to assess changes in insomnia symptoms, PCI, perceived cognitive abilities (PCA), and impact of cognitive function on quality of life (QOL). Results Participants were, on average, aged 60 years, had 16 years of education, and 79% were female. Breast cancer was the most reported cancer type (46%). No significant differences were observed between groups at T0 for demographic or clinical variables (p>.05). There was a significant group by time interaction for insomnia [p= Conclusion In addition to improving insomnia, CBT-I significantly improve perceived cognitive functioning and quality of life among cancer survivors. Further research is needed to understand the mechanisms underlying improvements in cognition following CBT-I. Support (if any) Dr. Sheila Garland is supported by a Canadian Cancer Society Emerging Scholar Award (Survivorship) (grant #707146). This project was funded through a grant from the Canadian Institutes of Health Research (CIHR) (grant number: PJT 162428) and the Beatrice Hunter Cancer Research Institute.

Background Women with breast cancer are more likely to develop cognitive impairment (CI), insomnia, fatigue, and mood disturbance than individuals with other cancers. The main objectives of this study were to establish the prevalence of CI and examine the relationships between CI, insomnia, fatigue, and mood over the first year of breast cancer treatment. Methods Participants were recruited after diagnosis and completed validated measures of insomnia, objective and perceived CI, fatigue, and mood disturbance at four time points during the first year of treatment. A random intercepts cross‐lagged panel model assessed relationships among symptoms over time. Results The sample included 98 women. Prevalence of objective CI ranged from 3.1% to 8.2% throughout the year, whereas 36.7% demonstrated a clinically meaningful decline in perceived CI from baseline to 4 months, which remained relatively stable. Greater perceived CI was associated with more fatigue (β = −0.78, z = 17.48, p, This study recruited 98 women with non metastatic breast cancer shortly after diagnosis and assessed their objective and perceived cognitive function alongside their levels of insomnia, fatigue, and mood disturbance at 4 time points: shortly after diagnosis and 4 months, 8 months, and 12 months later. Subjective impairment was more prevalent than objective impairment and both remained stable across the year. Perceived impairment in cognition was associated with fatigue and insomnia symptoms, suggesting the need for interventions that can address co‐occurring symptoms.

ObjectiveTo examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study.Design and settingCross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021.ParticipantsTotal of 1166 Australians from general population aged 18–90 years (mean 52, SD of 19).Main outcome measuresPrimary outcome: responses to question ‘If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?’.Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions.ResultsSeventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine.ConclusionsMost Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor’s recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates.

ObjectivesThis paper (1) sought to compare sleep, mood and physical symptom profiles of men with prostate cancer (PCa) who experienced subjective and objective cancer-related cognitive impairment (CRCI) during the first year of treatment and (2) examine if fluctuations in mood and physical symptoms are associated with change in subjective or objective CRCI.MethodsThis prospective observational cohort study examined 24 new patients with PCa receiving androgen deprivation therapy (ADT) and radiation therapy (RT) during the first 12 months of treatment. Participants completed subjective and objective assessments of cognition, sleep continuity and self-report measures of insomnia, fatigue, depression and anxiety. Independent sample t-tests, correlations and hierarchical regressions were used to compare groups, explore associations, and assess change over time. Effects are reported as corrected Cohen’s d (dc).ResultsMen with objective CRCI reported worse subjective time asleep (dc=0.47) and more depression (dc=0.55). Men with subjective CRCI reported worse insomnia (dc=0.99), hot flashes (dc=0.76), sleep quality (dc=0.54), subjective total sleep time (dc=0.41), wake after sleep onset (dc=0.71), sleep efficiency (dc=0.49), fatigue (dc=0.67) and objectively estimated sleep latency (dc=0.72) than men without subjective CRCI. Declines in perceived cognition was associated with higher anxiety (p=0.05), fatigue (p≤0.01) and symptoms of insomnia (p=0.01). Finally, subjective time awake during the night (p=0.03) and fatigue (p=0.02) were associated with subjective cognitive decline, controlling for objective change.ConclusionsSubjective concerns of CRCI appear more critical to patient experience than objective measurements in men with PCa who have received RT and ADT. Interventions to improve sleep may result in an improved perception of cognition.

Introduction Women may enter in breast cancer (BCa) treatment with poor sleep, or it may begin during treatment. We assessed how subjective and objective sleep changes during the first year of treatment for women with BCa. Further, we examined whether this differs between previously good and poor sleepers and whether there was agreement between subjective and objective measures of sleep. Methods Sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST), and sleep efficiency (SE) were measured among 100 patients with newly diagnosed, non-metastatic BCa using 7 days of diary and actigraphy collected at 4 time points: pre-treatment, 4, 8, and 12 months. Women with a score ≥5 on the Pittsburgh Sleep Quality Index at treatment onset were classified as poor sleepers. A 4 (time: 0-, 4-, 8-, 12-months) by 2 (sleep measure: sleep diary, actigraphy) by 2 (group: good, poor sleepers) mixed model ANOVAs was performed for each sleep parameter. Results There was a time by sleep measure by group interaction for TST, [F(3,294)= 3.014, p = .03). Good sleepers reported greater TST on diaries- than actigraphy at pre-treatment and 12 months, whereas there were no differences in poor sleepers. There was a group by time effect for good vs. poor sleepers [F(3,294)= 2.909, p = .035]. Good sleepers experienced decreased TST and SE from pre-treatment through 4-mo, followed by increases. Poor sleepers showed the opposite pattern. Neither group returned to pre-treatment levels. Sleep diaries and actigraphy are concordant over time for TST, but not SOL, WASO, or SE. Conclusion Sleep parameters worsen during the first year following onset of BCa and concordance between sleep diaries and actigraphy differ between good or poor sleepers. Support Dr. Garland is supported by a Scotiabank New Investigator Award and seed funding from the Beatrice Hunter Cancer Research Institute (BHCRI).

Introduction Insomnia symptoms are a common problem and are often comorbid with hot flashes, fatigue, anxiety, and depression following a breast cancer diagnosis. The present study examined changes in insomnia severity and comorbid symptoms in the year following diagnosis. Methods This study is part of a larger prospective observational cohort study of 100 women with early stage breast cancer. Insomnia symptoms were measured using the Insomnia Severity Index, fatigue was measured using the Multidimensional Fatigue Symptom Inventory-Short Form, anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and hot flashes were assessed using the Hot Flash Related Daily Interference Scale. Assessments were performed shortly after diagnosis, 4, 8, and 12 months. A series of repeated measures within subjects ANOVAs were performed to assess changes in symptoms over time. Results Among 100 women with breast cancer, 45% reported at least mild insomnia symptoms. There were significant quadratic effects of time on insomnia severity, F(3, 297)= 12.776, p ≤ .001, depression (F[3, 297]= 4.409, p = .005), and fatigue (F[3, 297]= 7.995, p ≤ .001). These symptoms initially worsen and then improve throughout the year, but they do not rebound to pre-treatment levels. Interference from hot flashes worsens and endures for longer than other symptoms but does begin to show improvement one year post-diagnosis (F[3, 297]= 12.110, p ≤ .001). The were no time effects for anxiety (F[3, 297] = 1.4, p = .243). Conclusion In general, women treated for breast cancer can expect insomnia and comorbid symptoms to worsen then improve, but not recover, during the first year after a breast cancer diagnosis. Early efforts to educate women and manage symptoms could prevent insomnia and other issues from becoming persistent problems. Support Dr. Garland is supported by a Scotiabank New Investigator Award and seed funding from the Beatrice Hunter Cancer Research Institute (BHCRI).

Introduction Sleep disturbances are a prevalent and enduring problem in women who have completed treatment for breast cancer. Less is known about whether sleep during and after cancer treatment is influenced by pre-treatment sleep quality and menopausal status. The present study aims to examine the trajectory of sleep quality in the 12 months following a cancer diagnosis and assess whether trajectory is influenced by pre-treatment sleep quality and menopausal status. Methods Newly-diagnosed women (N=88) with non-metastatic BCa were recruited before beginning treatment. They completed the Pittsburgh Sleep Quality Index (PSQI) before treatment and 4, 8, and 12 months later. Women with a score ≥5 on the Pittsburgh Sleep Quality Index at treatment onset were classified as poor sleepers. Menopausal status (pre- or post-menopausal) was chart abstracted. A mixed ANOVA assessed the impact of pre-treatment sleep quality and menopausal status on sleep quality trajectory. Results The mean age of the sample was 60 years, 70% were classified as poor sleepers, and 72% were post-menopausal. There was a significant linear time by sleep quality interaction, F(1, 83)= 5.79, p =.02. Good sleepers experienced a greater initial worsening of sleep quality than poor sleepers. At 12 months, poor sleepers had returned to baseline levels whereas scores in good sleepers remained higher than baseline. The 3-way time x sleep quality x menopausal status and the 2-way time by menopausal status interactions were not significant. Conclusion Baseline sleep quality is a more powerful determinant of sleep trajectory during treatment than menopausal status. Early intervention is necessary to treat existing sleep problems and prevent the development of sleep problems in women with a history of good sleep. Support Dr. Garland is supported by a New Investigator Award and seed funding from the Beatrice Hunter Cancer Research Institute (BHCRI).