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Dr. Anli Leng
Shandong University

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Journal article
Published: 11 May 2021 in Vaccines
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(1) Background: By April 2021, over 160 million Chinese have been vaccinated against coronavirus disease 2019 (COVID-19). This study analyzed the impact of vaccination on discrimination against recovered COVID-19 patients and the determinants of discrimination among intended vaccinated people. (2) Methods: A self-designed questionnaire was used to collect data on COVID-19 associated discrimination from nine provinces in China. Pearson chi-square tests and a multivariate ordered logistic regression analyzed the determinants of COVID-19-related discrimination. (3) Results: People who intended to be COVID-19 vaccinated displayed a high level of discrimination against recovered COVID-19 patients, with only 37.74% of the intended vaccinated without any prejudice and 34.11% displaying severe discrimination. However, vaccinations reduced COVID-19-related discrimination against recovered COVID-19 patients from 79.76% to 62.26%. Sex, age, education level, occupation, geographical region, respondents’ awareness of vaccine effectiveness and infection risk, and COVID-19 knowledge score had a significant influence on the COVID-19 related discrimination (p < 0.05). (4) Conclusions: Vaccination significantly reduced COVID-19 associated discrimination, but discrimination rates remained high. Among the intended vaccinated respondents, females, the older aged, people with high school and above education level, retirees, migrant workers, and residents in central China were identified as key targets for information campaigns to reduce COVID-19 related discrimination.

ACS Style

Lu Li; Jian Wang; Anli Leng; Stephen Nicholas; Elizabeth Maitland; Rugang Liu. Will COVID-19 Vaccinations End Discrimination against COVID-19 Patients in China? New Evidence on Recovered COVID-19 Patients. Vaccines 2021, 9, 490 .

AMA Style

Lu Li, Jian Wang, Anli Leng, Stephen Nicholas, Elizabeth Maitland, Rugang Liu. Will COVID-19 Vaccinations End Discrimination against COVID-19 Patients in China? New Evidence on Recovered COVID-19 Patients. Vaccines. 2021; 9 (5):490.

Chicago/Turabian Style

Lu Li; Jian Wang; Anli Leng; Stephen Nicholas; Elizabeth Maitland; Rugang Liu. 2021. "Will COVID-19 Vaccinations End Discrimination against COVID-19 Patients in China? New Evidence on Recovered COVID-19 Patients." Vaccines 9, no. 5: 490.

Journal article
Published: 02 May 2021 in Vaccines
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(1) Background: More coronavirus disease 2019 (COVID-19) vaccines are gradually being developed and marketed. Improving the vaccination intention will be the key to increasing the vaccination rate in the future; (2) Methods: A self-designed questionnaire was used to collect data on COVID-19 vaccination intentions, protection motivation and control variables. Pearson Chi-square test and multivariate ordered logistic regression models were specified to analyze the determinants of intention to receive COVID-19 vaccine; (3) Results: Although the vaccine was free, 17.75% of the 2377 respondents did not want, or were hesitant, to receive the COVID-19 vaccine. Respondents’ cognition of vaccine safety, external reward and response efficacy were positively related to COVID-19 vaccination intention, while age, income and response cost were negatively related to the intention to receive the COVID-19 vaccine. Professionals and people without medical insurance had the lowest intention to vaccinate; (4) Conclusions: The older aged, people without health insurance, those with higher incomes and professionals should be treated as the key intervention targets. Strengthening publicity and education about the safety and efficacy of COVID-19 vaccines, training vaccinated people and community leaders as propagandists for the vaccine, and improving the accessibility to the COVID-19 vaccine are recommended to improve COVID-19 vaccination intention.

ACS Style

Lu Li; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Anli Leng; Rugang Liu. The Intention to Receive the COVID-19 Vaccine in China: Insights from Protection Motivation Theory. Vaccines 2021, 9, 445 .

AMA Style

Lu Li, Jian Wang, Stephen Nicholas, Elizabeth Maitland, Anli Leng, Rugang Liu. The Intention to Receive the COVID-19 Vaccine in China: Insights from Protection Motivation Theory. Vaccines. 2021; 9 (5):445.

Chicago/Turabian Style

Lu Li; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Anli Leng; Rugang Liu. 2021. "The Intention to Receive the COVID-19 Vaccine in China: Insights from Protection Motivation Theory." Vaccines 9, no. 5: 445.

Journal article
Published: 21 March 2021 in Vaccines
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(1) Background: China will provide free coronavirus disease 2019 (COVID-19) vaccinations for the entire population. This study analyzed the COVID-19 vaccination willingness rate (VWR) and its determinants under China’s free vaccination policy compared to a paid vaccine. (2) Methods: Data on 2377 respondents were collected through a nationwide questionnaire survey. Multivariate ordered logistic regression models were specified to explore the correlation between the VWR and its determinants. (3) Results: China’s free vaccination policy for COVID-19 increased the VWR from 73.62% to 82.25% of the respondents. Concerns about the safety and side-effects were the primary reason for participants’ unwillingness to be vaccinated against COVID-19. Age, medical insurance and vaccine safety were significant determinants of the COVID-19 VWR for both the paid and free vaccine. Income, occupation and vaccine effectiveness were significant determinants of the COVID-19 VWR for the free vaccine. (4) Conclusions: Free vaccinations increased the COVID-19 VWR significantly. People over the age of 58 and without medical insurance should be treated as the target intervention population for improving the COVID-19 VWR. Contrary to previous research, high-income groups and professional workers should be intervention targets to improve the COVID-19 VWR. Strengthening nationwide publicity and education on COVID-19 vaccine safety and effectiveness are recommended policies for decision-makers.

ACS Style

Rugang Liu; Yuxun Zhang; Stephen Nicholas; Anli Leng; Elizabeth Maitland; Jian Wang. COVID-19 Vaccination Willingness among Chinese Adults under the Free Vaccination Policy. Vaccines 2021, 9, 292 .

AMA Style

Rugang Liu, Yuxun Zhang, Stephen Nicholas, Anli Leng, Elizabeth Maitland, Jian Wang. COVID-19 Vaccination Willingness among Chinese Adults under the Free Vaccination Policy. Vaccines. 2021; 9 (3):292.

Chicago/Turabian Style

Rugang Liu; Yuxun Zhang; Stephen Nicholas; Anli Leng; Elizabeth Maitland; Jian Wang. 2021. "COVID-19 Vaccination Willingness among Chinese Adults under the Free Vaccination Policy." Vaccines 9, no. 3: 292.

Journal article
Published: 11 December 2020 in International Journal of Environmental Research and Public Health
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(1) Background: The management of multiple chronic diseases challenges China’s health system, but current research has neglected how multimorbidity is associated with poor health-related quality of life (HRQOL) and high health service demands by middle-aged and older adults. (2) Methods: A cross-sectional study was conducted in Shandong province, China in 2018 across three age groups: Middle-aged (45 to 59 years), young-old (60 to 74 years), and old-old (75 or above years). The information about socio-economic, health-related behaviors, HRQOL, and health service utilization was collected via face-to-face structured questionnaires. The EQ-5D-3L instrument, comprising a health description system and a visual analog scale (VAS), was used to measure participants’ HRQOL, and χ2 tests and the one-way ANOVA test were used to analyze differences in socio-demographic factors and HRQOL among the different age groups. Logistic regression models estimated the associations between lifestyle factors, health service utilization, and multimorbidity across age groups. (3) Results: There were 17,867 adults aged 45 or above in our sample, with 9259 (51.82%) female and 65.60% living in rural areas. Compared with the middle-aged adults, the young-old and old-old were more likely to be single and to have a lower level of education and income, with the old-old having lower levels than the young-old (P < 0.001). We found that 2465 (13.80%) suffered multimorbidities of whom 75.21% were older persons (aged 60 or above). As age increased, both the mean values of EQ-5D utility and the VAS scale decreased, displaying an inverse trend to the increase in the number of chronic diseases (P < 0.05). Ex-smokers and physical check-ups for middle or young-old respondents and overweight/obesity for all participants (P < 0.05) were positively correlated with multimorbidity. Drinking within the past month for all participants (P < 0.001), and daily tooth-brushing for middle (P < 0.05) and young-old participants (P < 0.001), were negatively associated with multimorbidity. Multimorbidities increased service utilization including outpatient and inpatient visits and taking self-medicine; and the probability of health utilization was the lowest for the old-old multimorbid patients (P < 0.001). (4) Conclusions: The prevalence and decline in HRQOL of multimorbid middle-aged and older-aged people were severe in Shandong province. Old patients also faced limited access to health services. We recommend early prevention and intervention to address the prevalence of middle-aged and old-aged multimorbidity. Further, the government should set-up special treatment channels for multiple chronic disease sufferers, improve medical insurance policies for the older-aged groups, and set-up multiple chronic disease insurance to effectively alleviate the costs of medical utilization caused by economic pressure for outpatients and inpatients with chronic diseases.

ACS Style

Qinfeng Zhao; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Jingjie Sun; Chen Jiao; Lizheng Xu; Anli Leng. Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province. International Journal of Environmental Research and Public Health 2020, 17, 9261 .

AMA Style

Qinfeng Zhao, Jian Wang, Stephen Nicholas, Elizabeth Maitland, Jingjie Sun, Chen Jiao, Lizheng Xu, Anli Leng. Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province. International Journal of Environmental Research and Public Health. 2020; 17 (24):9261.

Chicago/Turabian Style

Qinfeng Zhao; Jian Wang; Stephen Nicholas; Elizabeth Maitland; Jingjie Sun; Chen Jiao; Lizheng Xu; Anli Leng. 2020. "Health-Related Quality of Life and Health Service Use among Multimorbid Middle-Aged and Older-Aged Adults in China: A Cross-Sectional Study in Shandong Province." International Journal of Environmental Research and Public Health 17, no. 24: 9261.

Journal article
Published: 05 December 2020 in Vaccine
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Vaccinations are an effective choice to stop disease outbreaks, including COVID-19. There is little research on individuals' COVID-19 vaccination decision-making. We aimed to determine individual preferences for COVID-19 vaccinations in China, and to assess the factors influencing vaccination decision-making to facilitate vaccination coverage. A D-efficient discrete choice experiment was conducted across six Chinese provinces selected by the stratified random sampling method. Vaccine choice sets were constructed using seven attributes: vaccine effectiveness, side-effects, accessibility, number of doses, vaccination sites, duration of vaccine protection, and proportion of acquaintances vaccinated. Conditional logit and latent class models were used to identify preferences. Although all seven attributes were proved to significantly influence respondents’ vaccination decision, vaccine effectiveness, side-effects and proportion of acquaintances vaccinated were the most important. We also found a higher probability of vaccinating when the vaccine was more effective; risks of serious side effects were small; vaccinations were free and voluntary; the fewer the number of doses; the longer the protection duration; and the higher the proportion of acquaintances vaccinated. Higher local vaccine coverage created altruistic herd incentives to vaccinate rather than free-rider problems. The predicted vaccination uptake of the optimal vaccination scenario in our study was 84.77%. Preference heterogeneity was substantial. Individuals who were older, had a lower education level, lower income, higher trust in the vaccine and higher perceived risk of infection, displayed a higher probability to vaccinate. Preference heterogeneity among individuals should lead health authorities to address the diversity of expectations about COVID-19 vaccinations. To maximize COVID-19 vaccine uptake, health authorities should promote vaccine effectiveness; pro-actively communicate the absence or presence of vaccine side effects; and ensure rapid and wide media communication about local vaccine coverage.

ACS Style

Anli Leng; Elizabeth Maitland; Siyuan Wang; Stephen Nicholas; Rugang Liu; Jian Wang. Individual preferences for COVID-19 vaccination in China. Vaccine 2020, 39, 247 -254.

AMA Style

Anli Leng, Elizabeth Maitland, Siyuan Wang, Stephen Nicholas, Rugang Liu, Jian Wang. Individual preferences for COVID-19 vaccination in China. Vaccine. 2020; 39 (2):247-254.

Chicago/Turabian Style

Anli Leng; Elizabeth Maitland; Siyuan Wang; Stephen Nicholas; Rugang Liu; Jian Wang. 2020. "Individual preferences for COVID-19 vaccination in China." Vaccine 39, no. 2: 247-254.

Journal article
Published: 28 November 2020 in International Journal of Environmental Research and Public Health
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(1) Background: The association between multimorbidity and mental health is well established. However, the role of gender in different populations remains unclear. Currently, China is facing an increased prevalence of multimorbidity, especially in its disease-causing poverty population. The present study explores the gender-based differences in the relationship between multimorbidity and mental health using data from the rural, disease-causing poverty, older-age population in Shandong province, China, as a case study. (2) Methods: The data were obtained from the survey on the health and welfare of disease-causing poverty households in rural Shandong province. We identified 936 rural participants who were over 60 years old from disease-causing poverty households. The mental health status was measured using the Kessler Psychological Distress Scale (K10) instrument. Using a multivariable linear regression model, including the interaction of gender and multimorbidity, gender differences in the association between multimorbidity and mental health were explored. (3) Results: Multimorbidity was a serious health problem in rural, disease-causing poverty, older-age households, with the prevalence of multimorbidity estimated as 40% for women and 35.4% for men. There was a strong association between multimorbidity and mental health, which was moderated by gender. Women had higher K10 scores than men, and the mean K10 score was highest in women with three or more chronic diseases. Compared with men, women with multimorbidity had a higher risk of mental health problems. (4) Conclusions: The prevalence of multimorbidity in older-age rural disease-causing poverty subpopulations is a severe public health problem in China. The association between multimorbidity and mental health differed by gender, where multimorbid women suffered an increased mental health risk compared with men. Gender differences should be addressed when delivering effective physical and mental healthcare support to disease-causing poverty, older-age, rural households.

ACS Style

Chen Jiao; Anli Leng; Stephen Nicholas; Elizabeth Maitland; Jian Wang; Qinfeng Zhao; Lizheng Xu; Chaofan Gong. Multimorbidity and Mental Health: The Role of Gender among Disease-Causing Poverty, Rural, Aged Households in China. International Journal of Environmental Research and Public Health 2020, 17, 8855 .

AMA Style

Chen Jiao, Anli Leng, Stephen Nicholas, Elizabeth Maitland, Jian Wang, Qinfeng Zhao, Lizheng Xu, Chaofan Gong. Multimorbidity and Mental Health: The Role of Gender among Disease-Causing Poverty, Rural, Aged Households in China. International Journal of Environmental Research and Public Health. 2020; 17 (23):8855.

Chicago/Turabian Style

Chen Jiao; Anli Leng; Stephen Nicholas; Elizabeth Maitland; Jian Wang; Qinfeng Zhao; Lizheng Xu; Chaofan Gong. 2020. "Multimorbidity and Mental Health: The Role of Gender among Disease-Causing Poverty, Rural, Aged Households in China." International Journal of Environmental Research and Public Health 17, no. 23: 8855.