Background: During the coronavirus disease (COVID-19) pandemic, harsh social distancing measures were taken in China to contain viral spread. We examined their impact on the lives of medical students. Methods: A nation-wide cross-sectional survey of college students was conducted from 4–12 February 2020. We enrolled medical students studying public health in Beijing and Wuhan to assess their COVID-19 awareness and to evaluate their mental health status/behaviors using a self-administered questionnaire. We used the Patient Generalized Anxiety Disorder-7 and Health Questionnaire-9 to measure anxiety disorders and depression. We used multivariable logistic regression and path analysis to assess the associations between covariates and anxiety disorder/depression. Results: Of 933 students, 898 (96.2%) reported wearing masks frequently when going out, 723 (77.5%) reported daily handwashing with soap, 676 (72.5%) washed hands immediately after arriving home, and 914 (98.0%) reported staying home as much as possible. Prevalence of anxiety disorder was 17.1% and depression was 25.3%. Multivariable logistic regression showed anxiety to be associated with graduate student status (odds ratio (aOR) = 2.0; 95% confidence interval (CI): 1.2–3.5), negative thoughts or actions (aOR = 1.6; 95% CI: 1.4–1.7), and feeling depressed (aOR = 6.8; 95% CI: 4.0–11.7). Beijing students were significantly less likely to have anxiety than those in the Wuhan epicenter (aOR = 0.9; 95% CI: 0.8–1.0), but depression did not differ. Depression was associated with female students (aOR = 2.0; 95% CI: 1.2–3.3), negative thoughts or actions (aOR = 1.7; 95% CI: 1.5–1.9), and anxiety disorder (aOR = 5.8; 95% CI: 3.4–9.9). Path analysis validated these same predictors. Conclusions: Despite medical students’ knowledge of disease control and prevention, their lives were greatly affected by social distancing, especially in the Wuhan epicenter. Even well-informed students needed psychological support during these extraordinarily stressful times.

To address the novel coronavirus disease (COVID-19) pandemic, development and regulatory evaluations have been accelerated for vaccines, authorizing emergency use. To anticipate vaccine preparedness in adolescents, we studied COVID-19 vaccination awareness and willingness to vaccinate before the vaccine became available. We conducted a cross-sectional survey among 9153 (4575 boys, 50%) students with a mean age of 14.2 years old in four cities in China to collect information on demographic characteristics and their COVID-19 vaccination concerns. Multinomial logistic regression was used to analyze the influencing factors of vaccine hesitancy (“not sure”) and resistance (“do not want it”). The results showed that 2891 (31.6%) were hesitant and 765 (8.4%) were resistant to being vaccinated. Additionally, multivariable analyses showed that vaccine hesitancy and vaccine resistance were associated with living in the Beijing area (OR = 1.62; 95% CI: 1.40–1.88; OR = 1.81; 95% CI: 1.44–2.28), lack of influenza vaccination experience (OR = 1.33; 95% CI: 1.14–1.55; OR = 1.57; 95% CI: 1.25–1.98), no perceived susceptibility (OR = 1.72; 95% CI: 1.50–1.97; OR = 3.57; 95% CI: 2.86–4.46), and perceiving no cues to action (OR = 3.24; 95% CI: 2.56–4.11; OR = 27.68; 95% CI: 21.81–35.13). Postulating a highly effective vaccine (OR = 0.84; 95% CI: 0.72–0.98; OR = 0.66; 95% CI: 0.52–0.83) decreased both vaccine hesitancy and resistance. Vaccine hesitancy alone was associated with girls (OR = 1.21; 95% CI: 1.09–1.36) and was less common among students boarding at school (OR = 0.79; 95% CI: 0.68–0.92), postulating convenient vaccine access (OR = 0.84; 95% CI: 0.73–0.96), and having doctors’ recommendation (OR = 0.86; 95% CI: 0.76–0.98). In conclusion, the results of the study showed that vaccine hesitancy among students in China was associated with limited health literacy and lower risk awareness. Our findings in China suggest that educating youth regarding COVID-19 and the safety and effectiveness of immunization help reduce concerns and increase vaccine confidence and acceptance.

In our recently published article

Background: Emergency cesarean section (EMCS) and breastfeeding difficulties increase the risk of postpartum depressive (PPD) symptoms. Early initiation of breastfeeding (EIBF) may not only alleviate PPD symptoms but also facilitate subsequent breastfeeding success. EMCS is a risk factor for not practicing EIBF. Therefore, it is important to understand the relationship between EMCS, EIBF, and PPD symptoms. Methods: We conducted a prospective cohort study in three areas of China. At baseline, a total of 965 mothers completed electronic questionnaires within 72 h postpartum. Women were screened for PPD symptoms using the Edinburgh Postpartum Depression Scale (EPDS). Multivariate logistic regression was used to identify the determinants of PPD symptoms. Mediation analysis was used to determine if EIBF mediated the relationship between delivery mode or breastfeeding education source and PPD symptoms. Results: The prevalence of EIBF was 40.6%; 14% of 965 mothers experienced EMCS, and 20.4% had PPD symptoms. The risk factors for developing PPD symptoms were excessive gestational weight gain (adjusted odds ratio [aOR] = 1.55, confidence interval [95% CI]: 1.03–2.33, p = 0.037) and EMCS (aOR = 2.05, 95% CI: 1.30–3.25, p = 0.002). The protective factors for developing PPD symptoms were monthly household income over CNY 10000 (aOR = 0.68, 95% CI: 0.47–0.97, p = 0.034), EIBF (aOR = 0.49, 95% CI: 0.34–0.72, p < 0.001), and prenatal breastfeeding education from nurses (aOR = 0.46, 95% CI: 0.29–0.73, p = 0.001). EIBF indirectly affected PPD symptoms in patients who had undergone EMCS (percentage mediated [PM] = 16.69, 95% CI: 7.85–25.25, p < 0.001). The source of breastfeeding education through EIBF also affected PPD symptoms (PM = 17.29, 95% CI: 3.80–30.78, p = 0.012). Conclusion: The association between EMCS on PPD symptoms was mediated by EIBF. By providing breastfeeding education, nurses could also help alleviate PPD symptoms.