key: cord-0793009-ntarvrvk
authors: Yan, Adam; Howden, Kaitlyn; Mahar, Alyson L.; Glidden, Camille; Garland, Sheila N.; Oberoi, Sapna
title: Gender differences in adherence to COVID-19 preventative measures and preferred sources of COVID-19 information among adolescents and young adults with cancer
date: 2022-01-06
journal: Cancer Epidemiol
DOI: 10.1016/j.canep.2022.102098
sha: 0426c9f10062a48bbbc9748b0898c580acfc9bcc
doc_id: 793009
cord_uid: ntarvrvk

The COVID-19 pandemic has greatly altered the behavior of adolescents and young adults with cancer. No data exists as to the impact of gender on adherence of individuals with cancer to COVID-19 related public health guidelines and their preferred methods of receiving COVID-19 related information. Methods We conducted a cross-sectional survey of adolescents and young adults with cancer. Data were summarized using descriptive statistics. Multiple logistic regression was used to assess differences in adherence to COVID-19 preventative behaviors, and differences in preferred information sources of COVID-19 related information between men and women. Results Among 633 participants, adherence to key preventative measures was 44.9-58.8% for males and 53.4-68.1% for females. After adjusting for key confounding variables in multivariable analysis, males were less likely to adhere to frequent hand washing (AOR 1.45, CI 1.03-2.03), not touching face (AOR 1.82, CI 1.29-2.56) and social distancing (AOR 1.93, CI 1.37-2.71) than females. Both genders preferred to receive information from their cancer institutes and social media. Discussion: Gender-specific interventions are needed to improve adherence amongst males to COVID-19 precautionary measures. Information should be disseminated via cancer institutes and social media as these are the preferred sources of COVID-19 related information.

Adolescents and Young adults (AYAs) with cancer have altered their behavior to protect themselves from COVID-19. Gender influences adherence to COVID-19 protective measures and may impact preferred modes of communication of COVID-19 related information among individuals without cancer. 1- 2 We previously reported that among AYAs with cancer females are more likely to comply to social distancing rules compared to males during this pandemic. 3 However, no data exist as to the impact of gender on adherence to other COVID-19 precautionary measures such as mask wearing and hand washing and preferred sources of COVID-19 related information among AYA patients with cancer. Pre-COVID-19, individuals with cancer were just as likely to engage in risky health behaviors as noncancer peers. 4 Understanding the behaviors of this cohort during the COVID-19 pandemic can help cancer organizations and governments develop gender-adapted strategies to provide COVID-19 related information to cancer patients at heightened risk of COVID-19 related morbidity and mortality. 5 Therefore, this report assesses the influence of gender on adherence to preventative COVID-19 measures and preferred modes of communication of COVID-19 related information among AYAs with cancer using the Impact of COVID-19 on AYAs with Cancer (ICOVIDAYA) survey.

We conducted a self-administered anonymous online survey of AYAs with cancer in Canada. Participants had to be at least 18 years old and diagnosed with cancer between the ages of 15-39. The 49-item questionnaire was administered via REDCap in English and French. Both participants receiving cancer directed therapies and those who had completed treatment were included. Online consent was completed prior to participation. Enrollment occurred during January and February 2021 which coincided with a second wave of COVID-19 in most Canadian provinces. Participants were recruited via the social media sites of national AYA cancer support groups and clinics at CancerCare Manitoba. Full survey methodology has been published previously. 3, 6 Participants reported adherence to COVID-19 preventative measures and preferred sources of COVID-19 related information. Adherence to preventative measures was assessed by asking "What sort of behavioral modifications or preventative measures have you been regularly doing during the pandemic?". Participants could select as many behaviors as were applicable to them from a list of frequent hand washing, not touching the face, wearing a protective face mask, wearing gloves, avoiding crowds or populated places, abiding by social distancing rules in your jurisdiction, complete isolation from members outside of your household, avoiding public transport, avoiding visit to any stores including grocery stores, and other. Sources of information related to COVID-19 was assessed by asking participants "where have you been getting information about the COVID-19 pandemic?". Participants could select all sources of information they had used from the choices of medical professionals, news reports, social media, patient organizations/support groups, relatives/friends and other. Gender was measured by asking "What is your gender?" and individuals could select male, female, transgender, gender variant/non-conforming, I prefer not to answer or other. Sociodemographic, health-and cancer-related data were also collected.

Demographic information, clinical factors, behavior modifications and information sources were summarized using descriptive statistics. Simple logistic regression was used to test the association of gender and COVID-19 preventative behaviours and preferred sources of COVID-19 related information. Multiple logistic regression was used to estimate the independent association between gender (male vs. female) and adherence to COVID-19 precautions, and preferred sources of COVID-19 related information, after adjusting for key confounders such as age, race/ethnicity, relationship status, province, location, employment status, personal income in year 2020, type of cancer, cancer treatment status, selfreported mental health condition and presence of self-reported chronic physical health condition; No significant correlation existed between the variables entered in the regression ( variable inflation factor < 4). Participants with missing information for included variables were excluded. All tests were two-sided, and a p-value less than 0.05 was considered statistically significant. Analysis was done using SPSS version 28.0. The University of Manitoba Ethics Board approved this study (HS:24501). 7

Of the 805 AYAs between 18-39 years of age, who completed the survey, this analysis included 633 participants; 352 males (55.8%), 279 females (44.2%) and 2 (0.3%) gender variant/non-conforming. The full cohort characteristics has been published. 3, 6 We excluded 168 participants for having missing data for even one of the confounding variables (N=168). The mean age was 30.4 (range 19 to 39 years), 601 (94.9%) were Caucasian, 525 (82.9%) had a non-hematologic malignancy, and 200 (31.6%) were on active cancer therapy. Wearing a mask was the most adhered to public health measure for both males (N=207, 58.8%) and females (N=190, 68.1%). On univariable analysis, females were more adherent to frequent hand washing (OR 1.43, CI 1.04-2.00), not-touching face (OR 1.73, CI 1.23-2.39) and wearing a protective mask (OR 1.52, CI 1.09-2.21) than males. The adjusted odds ratio (AOR) of frequent hand washing (AOR 1.45, CI 1.03-2.03), not touching face (AOR 1.82, CI 1.29-2.56), and abiding by social distancing rules (AOR 1.93, OR 1.37-2.71) were significantly higher among females compared to males (Table 1 ). Males and females had a similar odd of wearing masks and gloves, avoiding crowded and public places, completely isolating themselves, avoiding public transport, and avoiding all stores. The most preferred source of information for both genders was online information on the website of a cancer institute (males N=160, 45.4%, and females N=150, 53.8%). Females had a higher odds of preferring information from medical professionals (AOR2 1.62, CI 1.14-2.30) than males, but a similar odds of preferring information from all other sources (Table 2 ).

Our study demonstrates that for AYAs with cancer, adherence to COVID-19 precautions is worse among males compared to females. When comparing the key protective measures recommended by the Public Health Agency of Canada (wearing masks, avoiding crowds, social distancing, and hand washing) between our study of AYAs with cancer and a cohort of Canadians without cancer, adherence was similar (~60%). 8 Adherence for AYAs with cancer to protective health measures is low given their vulnerability to severe infection. Future studies must examine the reasons for non-adherence among males to public health measures to maximize adherence to safety guidelines. Gender-adapted strategies to improve adherence must be developed such as increasing targeted education towards men, engaging their partners and families, and eliminating barriers to healthcare utilization for men 9 .

Studies have shown that the perceived risk of COVID-19 influences adherence to COVID-19 preventative measures. 10 Therefore, it is vital to provide reliable COVID-19 related information to patients with cancer to influence their perceived risk and adherence to preventative measures. Given the preference for online resources for both genders, ongoing efforts are essential to communicate the importance of preventative COVID-19 measures and COVID-19 vaccine-related information via these platforms. Since 47% of females and 37% of males prefer to receive COVID-19 information from their health care providers, it is essential that health care providers continue to provide COVID-19 specific information to these patients during their regular visits.

Our study has several important limitations. First, we did not capture enough gender-variant/non-binary individuals to examine their adherence to public health measures and preferred sources of information. Their pandemic experiences and behaviors may differ from those who identify as male or female and is important to capture in further studies. Secondly, we relied on self-reported adherence to public health guidelines which may differ from actual adherence. Finally, there may be significant differences between responders and non-responders. Our study was conducted online, which may have limited those without access to technology from participating. 

Gender differences in COVID-19 attitudes and behavior: Panel evidence from eight countries

The influence of sex and gender domains on COVID-19 cases and mortality

COVID-19 related information sources, behavior changes, and adherence to social distancing among adolescents and young adults with cancer

Risky health behvior among adolescents in the childhood cancer survivor study cohort

Patients with Cancer Appear More Vulnerable to SARS-CoV-2: A Multicenter Study during the COVID-19 Outbreak

A Cross-sectional Survey Exploring the Impact of the COVID-19 Pandemic on the Cancer Care of Adolescents and Young Adults

Released 2020. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp 8

Risk perception of COVID-19 infection and adherence to preventative measures among adolescents and young adults

Men and COVID-19: A biopsychosocial approach to understanding sex differenes in mortality and recommendations for practice and policy interventions

Who complies with the restrictions to reduce the spread of COVID-19?: Personality and perceptions of the COVID-19 situation

No conflicts of interest to declare by any of the above named authors Highlights: Adherence to COVID-19 precautionary measures is poor for both men and women  Males are less likely to adhere to COVID-19 precautionary measures  Both men and women prefer information from their cancer institutes and from social media