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Objectives: This study aimed to investigate (1) definitions of self-isolation used during the COVID-19 pandemic; (2) measures used to quantify adherence and their reliability, validity, and acceptability; (3) rates of self-isolation adherence; and (4) factors associated with adherence., Study Design: This was a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-analysis (PRISMA) guidelines (PROSPERO record CRD42022377820)., Methods: MEDLINE, PsycINFO, Embase, Web of Science, PsyArXiv, medRxiv, and grey literature sources were searched (1 January 2020 to 13 December 2022) using terms related to COVID-19, isolation, and adherence. Studies were included if they contained original, quantitative data of self-isolation adherence during the COVID-19 pandemic. We extracted definitions of self-isolation, measures used to quantify adherence, adherence rates, and factors associated with adherence., Results: We included 45 studies. Self-isolation was inconsistently defined. Four studies did not use self-report measures. Of 41 studies using self-report, one reported reliability; another gave indirect evidence for the lack of validity of the measure. Rates of adherence to self-isolation for studies with only some concerns of bias were 51%-86% for COVID-19 cases, 78%-94% for contacts, and 16% for people with COVID-19-like symptoms. There was little evidence that self-isolation adherence was associated with sociodemographic or psychological factors., Conclusions: There was no consensus in defining, operationalising, or measuring self-isolation, resulting in significant risk of bias in included studies. Future definitions of self-isolation should state behaviours to be enacted and duration. People recommended to self-isolate should be given support. Public health campaigns should aim to increase perceived effectiveness of self-isolation and promote accurate information about susceptibility to infection., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: In the UK, during the study period (April to July, 2021), all contacts of people with COVID-19 were required to self-isolate for 10 days, which had adverse impacts on individuals and society. Avoiding the need to self-isolate for those who remain uninfected would be beneficial. We investigated whether daily use of lateral flow devices (LFDs) to test for SARS-CoV-2, with removal of self-isolation for 24 h if negative, could be a safe alternative to self-isolation as a means to minimise onward transmission of the virus., Methods: We conducted a randomised, controlled, non-inferiority trial in adult contacts identified by COVID-19 contact tracing in England. Consenting participants were randomly assigned to self-isolation (single PCR test, 10-day isolation) or daily contact testing (DCT; seven LFD tests, two PCR tests, no isolation if negative on LFD); participants from a single household were assigned to the same group. Participants were prospectively followed up, with the effect of each intervention on onward transmission established from routinely collected NHS Test and Trace contact tracing data for participants who tested PCR-positive for SARS-CoV-2 during the study period and tertiary cases arising from their contacts (ie, secondary contacts). The primary outcome of the study was the attack rate, the percentage of secondary contacts (close contacts of SARS-CoV-2-positive study participants) who became COVID-19 cases (tertiary cases) in each group. Attack rates were derived from Bernoulli regression models using Huber-White (robust) sandwich estimator clustered standard errors. Attack rates were adjusted for household exposure, vaccination status, and ability to work from home. The non-inferiority margin was 1·9%. The primary analysis was a modified intention-to-treat analysis excluding those who actively withdrew from the study as data from these participants were no longer held. This study is registered with the Research Registry (number 6809). Data collection is complete; analysis is ongoing., Findings: Between April 29 and July 28, 2021, 54 923 eligible individuals were enrolled in the study, with final group allocations (following withdrawals) of 26 123 (52·6%) participants in the DCT group and 23 500 (47·4%) in the self-isolation group. Overall, 4694 participants tested positive for SARS-CoV-2 by PCR (secondary cases), 2364 (10·1%) in the self-isolation group and 2330 (8·9%) in the DCT group. Adjusted attack rates (among secondary contacts) were 7·5% in the self-isolation group and 6·3% in the DCT group (difference of -1·2% [95% CI -2·3 to -0·2]; significantly lower than the non-inferiority margin of 1·9%)., Interpretation: DCT with 24 h exemption from self-isolation for essential activities appears to be non-inferior to self-isolation. This study, which provided evidence for the UK Government's daily lateral flow testing policy for vaccinated contacts of COVID-19 cases, indicated that daily testing with LFDs could allow individuals to reduce the risk of onward transmission while minimising the adverse effects of self-isolation. Although contacts in England are no longer required to isolate, the findings will be relevant for future policy decisions around COVID-19 or other communicable infections., Funding: UK Government Department of Health and Social Care., Competing Interests: Declaration of interests IO, GJR, and LY participate in the UK Scientific Advisory Group for Emergencies and its subgroups, where this and related work were discussed. CT also contributed to these groups, presenting analysis as part of work on the COVID response. GJR has been paid by Bayer as a legal expert witness, not related to this manuscript. GJR received payment for peer review of research grants and manuscripts related to COVID-19, but not related to this manuscript. Several authors (IO, SH, NL, DR, AFM, SD, LY, GJR, RA, and CT) carried out previous studies funded by the Department of Health and Social Care investigating testing of contacts of COVID-19 cases by PCR or LFD. Several authors (IO, LY, and JR) were funded by UK Research and Innovation or the National Institute for Health and Care Research (NIHR) to undertake research related to COVID-19, outside of the current study. IO, DR, CEF, IO, RA, SD, and LY receive funding from the NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation at the University of Bristol. NL receives funding from the NIHR HPRU in Gastrointestinal Infections at the University of Liverpool. LY is an NIHR Senior Investigator, and her research programme is partly supported by NIHR Applied Research Collaboration West and NIHR Biomedical Research Centre at the University of Southampton. RA and GJR receive payments from the NIHR HPRU in Emergency Preparedness and Response. LY, SD, and IO receive payments from the Department of Health and Social Care. All other authors declare no competing interests., (Copyright © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Objective: Public health control measures at borders have long been central to national strategies for the prevention and containment of infectious diseases. Travel was inevitably associated with the rapid global transmission of COVID-19. In the UK, public health authorities tried to reduce the risks of travel-associated spread by providing public health information at ports of entry. This study investigates risk assessment processes, decision-making and adherence to official advice among international travellers, to provide evidence for future policy on the provision of public health information to facilitate safer international travel., Study Design: This study is a qualitative study evaluation., Method: International air passengers arriving at the London Heathrow Airport on scheduled flights from China and Singapore were approached for interview after consenting to contact in completed surveys. Semi-structured interviews were conducted by telephone, using two topic guides to explore views of official public health information and self-isolation. Interview transcripts were coded and analysed thematically., Results: Participants regarded official advice from Public Health England as adequate at the time, despite observing differences with intervention measures implemented in their countries of departure. Most participants also described adopting precautionary measures, including self-isolation and the use of face coverings that went beyond official advice, but reported adherence to guidance on contacting health authorities was more variable. Adherence to the official guidance was informed by the perceived salience of specific transmission possibilities and containment measures assessed in relation to participants' local social and institutional environments., Conclusion: Analysis of study findings demonstrates that international air travellers' responses to public health advice constitute a proactive process of risk assessment and rationalised decision-making to guide preventive action. This process incorporates consideration of the current living situation, trust in information sources, correspondence with cultural logics and willingness to accept potential risk to self and significant others. Our findings concerning international passengers' understanding of, and compliance with, official advice and mitigation measures provide valuable evidence to inform future policy and generate recommendations on the presentation of public health information to facilitate safer international travel. Access to a central source of regularly updated official information would help minimise confusion between different national guidelines. Greater attention to the differentiated information needs of diverse groups in creating future public-facing guidance would help to minimise the uncertainties generated by the receipt of generic information., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: Investigate factors associated with the intention to have the COVID-19 vaccination following initiation of the UK national vaccination programme., Study Design: An online cross-sectional survey completed by 1500 adults (13th-15th January 2021)., Methods: Linear regression analyses were used to investigate associations between intention to be vaccinated for COVID-19 and sociodemographic factors, previous influenza vaccination, attitudes and beliefs about COVID-19 and COVID-19 vaccination and vaccination in general. Participants' main reasons for likely vaccination (non-)uptake were also solicited., Results: 73.5% of participants (95% CI 71.2%, 75.7%) reported being likely to be vaccinated against COVID-19, 17.3% (95% CI 15.4%, 19.3%) were unsure, and 9.3% (95% CI 7.9%, 10.8%) reported being unlikely to be vaccinated. The full regression model explained 69.8% of the variance in intention. Intention was associated with: having been/intending to be vaccinated for influenza last winter/this winter; stronger beliefs about social acceptability of a COVID-19 vaccine; the perceived need for vaccination; adequacy of information about the vaccine; and weaker beliefs that the vaccine is unsafe. Beliefs that only those at serious risk of illness should be vaccinated and that the vaccines are just a means for manufacturers to make money were negatively associated with vaccination intention., Conclusions: Most participants reported being likely to get the COVID-19 vaccination. COVID-19 vaccination attitudes and beliefs are a crucial factor underpinning vaccine intention. Continued engagement with the public with a focus on the importance and safety of vaccination is recommended., (Copyright © 2021 The Royal Society for Public Health. All rights reserved.)

Background: People who inject drugs may experience difficulty accessing or maintaining involvement with traditional healthcare services. This is associated with increased health inequalities and bio-psychosocial difficulties. Embedding physical healthcare services within community-based drug services may provide a practical and feasible approach to increase access and delivery of healthcare. This study explored the acceptability of, and barriers and facilitators to, embedding a pilot physical healthcare service within a community-based drug service in the United Kingdom (Bristol, England)., Methods: Semi-structured interviews were conducted with service users (people who inject drugs) (n = 13), and a focus group was conducted with service providers (n = 11: nine harm reduction workers, two nurses, one service manager). Topic guides included questions to explore barriers and facilitators to using and delivering the service (based on the COM-B Model), and acceptability of the service (using the Theoretical Framework of Acceptability). Transcripts were analysed using a combined deductive framework and inductive thematic analysis approach., Results: The service was viewed as highly acceptable. Service users and providers were confident they could access and provide the service respectively, and perceived it to be effective. Barriers included competing priorities of service users (e.g. drug use) and the wider service (e.g. equipment), and the potential impact of the service being removed in future was viewed as a barrier to overall healthcare access. Both service users and providers viewed embedding the physical health service within an existing community-based drug service as facilitating accessible and holistic care which reduced stigma and discrimination., Conclusions: The current study demonstrated embedding a physical health service within an existing community-drug based and alcohol service was acceptable and beneficial. Future studies are required to demonstrate cost-effectiveness and ensure long-term sustainability, and to determine transferability of findings to other settings, organisations and countries., Competing Interests: Declarations of Interest None., (Copyright © 2021. Published by Elsevier B.V.)

Objectives: In the containment phase of the response to the COVID-19 outbreak, Public Health England (PHE) delivered advice to travellers arriving at major UK ports. We aimed to rapidly evaluate the impact and effectiveness of these communication materials for passengers in the early stages of the pandemic., Study Design: The study design used is the mixed-methods evaluation., Methods: A questionnaire survey and follow-up interviews with passengers arriving at London Heathrow Airport on scheduled flights from China and Singapore. The survey assessed passengers' knowledge of symptoms, actions to take, and attitudes towards PHE COVID-19 public health information; interviews explored their views of official public health information and self-isolation., Results: One hundred and twenty-one passengers participated in the survey and 15 in follow-up interviews. Eighty three percentage of surveyed passengers correctly identified all three COVID-19 associated symptoms listed in PHE information at that time. Most could identify the recommended actions and found the advice understandable and trustworthy. Interviews revealed that passengers shared concerns about the lack of wider official action, and that passengers' knowledge had been acquired elsewhere as much from PHE. Respondents also noted their own agency in choosing to self-isolate, partially as a self-protective measure., Conclusion: PHE COVID-19 public health information was perceived as clear and acceptable, but we found that passengers acquired knowledge from various sources and they saw the provision of information alone on arrival as an insufficient official response. Our study provides fresh insights into the importance of taking greater account of diverse information sources and of the need for public assurance in creating public health information materials to address global health threats., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Human studies investigating the efficacy of emergency decontamination protocols for chemical incidents require the use of non-hazardous chemical simulants. Methyl salicylate (MeS) has almost exclusively been used for this purpose. Whilst MeS is a simulant of the chemical warfare agent (CWA) sulphur mustard, it is not an ideal simulant for many other chemical threats with greater persistence and lower volatility. Benzyl salicylate (BeS) has been investigated here as a low toxicity simulant for lower volatility, persistent chemical threat agents and toxic industrial chemicals (TICs). To evaluate the suitability of BeS as a simulant for human decontamination studies a gas chromatography-triple quadrupole mass spectrometry method was designed, optimised and validated, for the analysis of human skin and hair. Quantification was achieved using isotope-dilution, EI and collision-induced dissociation and multiple reaction monitoring for both qualifier and quantifier ion transitions. The mass transitions were m/z 285 → 91 and m/z 210 → 181, respectively for the quantifier and qualifier ions of BeS, and m/z 289 → 91 and m/z 214 → 185 for the quantifier and qualifier ions for the BeS-d4 internal standard, respectively. The method exhibited excellent coefficients of determination (R 2  = 0.9992-0.9999) with LOD and LOQ values at 0.023 ng/ml and 0.23 ng/ml. Across three Quality Controls (QCs), 11.5 ng/ml, 115 ng/ml and 1150 ng/ml) average accuracy (intra-day 95.6-100.3%, inter-day 98.5-104.91%) and precision (intra-day RSD (%) 2-13.7%, inter-day RSD (%) 3.3-8.8%) were determined. The validated method was applied in a proof of principle volunteer study for the determination of total BeS recovered from skin and hair. The average total BeS recovery after 70 min was 37.9% from skin and there was a significant increase between baseline and post-intervention levels for hair. These data demonstrate that BeS is an appropriate simulant for persistent chemicals and that the analytical method employed here is suitable for BeS analysis in human studies., (Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)

Methyl salicylate has a long history of use as a chemical warfare agent simulant for volatile lipophilic compounds such as sulphur mustard. An improved isotope dilution GC-MS/MS method was developed, optimised and validated for the analysis of methyl salicylate in human skin and hair samples, for use in emergency decontamination volunteer studies. Following derivatisation, quantification was measured on a triple quadrupole mass spectrometer, set to EI mode and conducting multiple reaction monitoring of target ions. The mass transitions were 209 → 179 and 213 → 161 for quantitation of methyl salicylate and methyl salicylate D4, respectively whereas qualifier ion transitions used to verify identity were 209 → 169 and 213 → 89. The method achieved excellent coefficient of determination (R 2  > 0.9968 to 0.9999) over the range of 0.5-5000 ng/ml and the LOD and LOQ were 0.05 ng/ml and 0.5 ng/ml. The method was further validated for accuracy (intra-day and inter-day average 100.28% to 102.03% and 99.48% to 102.33%, respectively) and precision (intra-day RSD 1.43% to 2.35%, inter-day RSD 1.91% to 2.97%) at three concentrations (25, 250 and 2500 ng/ml). The validated method was successfully used to identify methyl salicylate in samples of human skin generated during volunteer studies of emergency decontamination systems and in hair of staff conducting these studies., (Crown Copyright © 2019. Published by Elsevier B.V. All rights reserved.)

Studying how the public behaves after a nuclear emergency will help to assess overall morbidity and mortality. Pre-event education might help to shape behaviour, but how best to engage people with emergency communications for low likelihood, high-impact events is unknown. We did a systematic review to identify factors that predict behaviour in preparation for a nuclear incident, factors that predict behaviour in the immediate aftermath of a nuclear incident, and preferences among members of the public for information designed to educate them about which actions to take in the event of a nuclear incident. In general preparedness, behaviour was predicted by factors including perceived coping effectiveness and having children, among others, but absence of preparedness was attributed to fatalistic attitudes. Importantly, for pre-incident communications to be accepted and recommendations adhered to, the source had to be trusted and perceived to be credible. However, it is notable that family needs, such as picking up children from school, were a stronger predictor of behaviour in a nuclear emergency than communicated directives from authorities. If pre-incident education about nuclear incidents is to be used, several factors-including the source and method of communication, the content, and format of messaging-might increase public engagement with messages and promote the uptake of protective behaviours in a radiation event., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The objective of this research was to determine the most appropriate protective behaviours to promote in order to protect members of the public from Lyme borreliosis, to identify the drivers and barriers for these behaviours, and to determine the strongest predictors of tick-protective behaviour. We used a mixed methods study with qualitative interviews and a quantitative web survey. Interviews with topic experts and members of the public suggested that predictors of tick checking included perceived disease likelihood and severity as well as overall awareness of ticks and tick-borne disease. Twenty-four percent of participants regularly checked for ticks after walking in a tick-endemic area. The strongest predictors of checking for ticks were greater levels of knowledge, perceived likelihood of being bitten, self-efficacy about tick removal, and lower levels of disgust about ticks. Barriers to checking included forgetfulness and lacking time. At-risk members of the UK public require information to increase awareness of ticks and protective behaviours, particularly tick checking. Information may be most effective if it focuses on increasing self-efficacy while also reducing disgust., (Copyright © 2014 Elsevier GmbH. All rights reserved.)

Background: The way in which different communities respond to similar threats to their health can vary, from outrage to indifference and public health agencies are often taken by surprise leading to potential loss of public confidence. The objective of this systematic literature review was to seek to better understand the community-level drivers that might explain the variability in response., Methods: A vigorous systematic cross-disciplinary literature review was undertaken searching thirteen bibliographic databases and a variety of grey sources were screened. The social amplification of risk framework and the risk perception management theoretical models were used to assess evidence and data were synthesised by Narrative review., Findings: Sixteen studies meeting the agreed inclusion criteria described eleven different threats ranging from: infectious disease outbreaks to environmental disasters to cancer clusters, affecting two or more communities were identified from medical, psychological, social science and environmental science literature. There was wide heterogeneity between the type and quality of the studies. There was a general absence of theoretical underpinning community responses. Most studies did not report sufficient data to allow an appropriate amount of validity. Very low response rates in particular were common. Potential explanatory drivers suggested included, prior experience and visibility of threat, sociodemographic characteristics, volume and type of media coverage, government reaction and availability of social support., Conclusions: This review confirmed that there are significant differences. Further work is needed to develop theoretical models that apply to the community level and do not assume that a community's response is simply the aggregate of individual level responses., (© 2013.)

The existence of primary pneumonic plague outbreaks raises concerns over the use of the causative bacteria as an aerosol-based bioweapon. We employed an individual-based model, parameterised using published personal contact information, to assess the severity of a deliberate release in a discrete community, under the influence of two proposed intervention strategies. We observed that the severity of the resulting epidemic is determined by the degree of personal compliance with said strategies, implying that prior preparedness activities are essential in order that public awareness and willingness to seek treatment is achieved quickly., (Copyright © 2011 Elsevier B.V. All rights reserved.)