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H ong Kong was relatively successful in mitigating transmission early in the outbreak of coronavirus disease . Confirmed cases were first reported in the city of Wuhan, China, in December 2019 (1). Situated at the southern tip of China, Hong Kong was at risk for importing COVID-19, given its shared border and high infrastructural and social connectivity with China. In 2019, >236 million passengers crossed the border between China and Hong Kong by land (2). Hong Kong is also vulnerable to virus transmission owing to its high population density and heavy reliance on public transportation. Despite these risks, as of March 20, 2020, transmission control efforts in Hong Kong, as reflected in the numbers of confirmed cases and deaths (256 cases, 4 deaths) (3), had been relatively successful compared with nearby countries and regions, including mainland China (80,967 cases, 3,248 deaths), South Korea (8,652 cases, 94 deaths), and Japan (950 cases, 33 deaths, in addition to the 712 cases from a cruise ship) (4).Health officials in Hong Kong have enacted multipronged interventions to slow disease spread (5). Adopted strategies include border screening (measuring body temperature, imposing a health declaration form system, imposing a 14-day mandatory quarantine period on persons entering Hong Kong from mainland China; parts of Korea, Japan, France, Germany, and Spain; and all of Italy and Iran), social distancing (shutting down the border, reducing cross-border commuting services, delaying the resumption of classes in schools, arranging telework for civil servants, and suspending of public services), and extending the Enhanced Laboratory Surveillance Program to adult patients with fever and mild respiratory symptoms at emergency departments or general outpatient clinics in the public sector.The behaviors of the public are important for outbreak management, particularly during the early phase when no treatment or vaccination is available and nonpharmaceutical interventions are the only options. The efficacy of nonpharmaceutical interventions depends on persons' degree of engagement and compliance in precautionary behaviors, such as facemask wearing, hand hygiene, and self-isolation. Willingness to engage in precautionary behaviors voluntarily depends on risk perception toward the current health threat. In fact, risk perception is a main theme in common health behavior theories (6,7). In addition, with advanced information technology in recent years comes the uncertainty of how risk perception is shaped by various information sources. Hong Kong's experience with outbreaks of novel pathogens (e.g., 2003 severe acute respiratory syndrome [SARS] and 2009 pandemic influenza) also provides a reference point to evaluate the risk perceptions of COVID-19. In comparison, Hong Kong was more affected by SARS than COVID-19 thus far. In 2003, a total of 1,755 persons in Hong Kong contracted SARS, resulting in 299 deaths (8).

17 18 Background: Community responses are important for outbreak management during the early phase 19 when non-pharmaceutical interventions are the major preventive options. Therefore, this study aims to 20 examine the psychological and behavioral responses of the community during the early phase of the 21 COVID-19 epidemic in Hong Kong.22 23 Method: A cross-sectional online survey was launched within 36 hours after confirmed COVID-19 24 cases were first reported. Councilors of all 452 district council constituency areas were approached for 25 survey dissemination. Respondent demographics, anxiety level, risk perception, sources to retrieve 26 .CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10. 1101 /2020 COVID-19 information, actual adoption and perceived efficacy of precautionary measures were 27 collected. 29Result: Analysis from 1715 complete responses indicated high perceived susceptibility (89%) and high 30 perceived severity (97%). Most respondents were worried about COVID-19 (97%), and had their daily 31 routines disrupted (slightly/greatly: 98%). The anxiety level, measured by the Hospital Anxiety and 32 Depression Scale, was borderline abnormal (9.01). Nearly all respondents were alert to the disease 33 progression (99.5%). The most trusted information sources were doctors (84%), followed by broadcast 34 (57%) and newspaper (54%), but they were not common information sources (doctor: 5%; broadcast: 35 34%; newspaper: 40%). Only 16% respondents found official websites reliable. Enhanced personal 36 hygiene practices and travel avoidance to China were frequently adopted (>77%) and considered 37 effective (>90%). The adoption of social-distancing measures was lower (39%-88%), and their drivers 38 for greater adoption include: being female (adjusted odds ratio [aOR]:1.27), living in the New 39 Territories (aOR:1.32-1.55), perceived as having good understanding of COVID-19 (aOR:1.84) and 40 being more anxious (aOR:1.07). 41 42 Discussion: Risk perception towards COVID-19 in the community was high. Most respondents are alert 43 to the disease progression, and adopt self-protective measures. This study contributes by examining the 44 psycho-behavioral responses of hosts, in addition to the largely studied mechanistic aspects, during the 45 early phase of the current COVID-19 epidemic. The timely psychological and behavioral assessment of 46 the community is useful to inform subsequent interventions and risk communication strategies as the 47 epidemic progresses.48 49

This systematic review and meta-analysis compared the effects of 131 randomized controlled trials, published between 2006 and mid-2018, for dementia caregivers with community-dwelling care-recipients. A new classification of interventions was proposed to enable a more detailed examination of the effectiveness of psychological interventions; 350 postintervention effect sizes in 128 studies and 155 follow-up effect sizes in 55 studies were computed. Postintervention effects were significant for all outcomes when all interventions are pooled together. Follow-up effects were found for all outcomes, except physical health and positive aspects of caregiving. Educational programs with psychotherapeutic components, counseling/psychotherapy, and mindfulness-based interventions had the strongest effects on reducing depressive symptoms. Multicomponent and miscellaneous interventions had the largest effects on reduction of burden/stress. Multicomponent and mindfulness-based interventions had the largest effects on enhancing subjective well-being. It should be noted that mindfulness and counseling/psychotherapy studies generally had small samples, and studies with smaller sample sizes tended to report larger effects. Metaregression analyses revealed that, overall, younger caregivers benefited more from the interventions. Although the majority of studies were from North America and Europe, there were a growing number from Asia and other parts of the world. Recommendations were made, including developing new theoretical models that address caregivers’ changing needs over time; development of interventions that can be flexibly administered and individually “tailored,” and assessing positive as well as negative aspects of caregiving to encourage development of greater resilience. We conclude with observations on the global health significance of improving the impact of psychosocial interventions on caregivers’ lives.

Teacher- and school-level factors influence the fidelity of implementation of school-based prevention and social character and development (SACD) programs. Using a diffusion of innovations framework, the relationships among teacher beliefs and attitudes towards a prevention/SACD program and the influence of a school's administrative support and perceptions of school connectedness, characteristics of a school's climate, were specified in two cross-sectional mediation models of program implementation. Implementation was defined as the amount of the programs' curriculum delivered (e.g., lessons taught), and use of program-specific materials in the classroom (e.g., ICU boxes and notes) and in relation to school-wide activities (e.g., participation in assemblies). Teachers from 10 elementary schools completed year-end process evaluation reports for year 2 (N = 171) and 3 (N = 191) of a multi-year trial. Classroom and school-wide material usage were each favorably associated with the amount of the curriculum delivered, which were associated with teachers' attitudes toward the program which, in turn, were related to teachers' beliefs about SACD. These, in turn, were associated with teachers' perceptions of school climate. Perceptions of school climate were indirectly related to classroom material usage and both indirectly and directly related to the use of school-wide activities. Program developers need to consider the importance of a supportive environment on program implementation and attempt to incorporate models of successful school leadership and collaboration among teachers that foster a climate promoting cohesiveness, shared visions, and support.

Objectives We assessed the effectiveness of a 5-year trial of a comprehensive school-based program designed to prevent substance use, violent behaviors, and sexual activity among elementary-school students. Methods We used a matched-pair, cluster-randomized, controlled design, with 10 intervention schools and 10 control schools. Fifth-graders (N=1714) self-reported on lifetime substance use, violence, and voluntary sexual activity. Teachers of participant students reported on student (N=1225) substance use and violence. Results Two-level random-effects count models (with students nested within schools) indicated that student-reported substance use (rate ratio [RR]=0.41; 90% confidence interval [CI]=0.25, 0.66) and violence (RR=0.42; 90% CI=0.24, 0.73) were significantly lower for students attending intervention schools. A 2-level random-effects binary model indicated that sexual activity was lower (odds ratio=0.24; 90% CI=0.08, 0.66) for intervention students. Teacher reports substantiated the effects seen for student-reported data. Dose-response analyses indicated that students exposed to the program for at least 3 years had significantly lower rates of all negative behaviors. Conclusions Risk-related behaviors were substantially reduced for students who participated in the program, providing evidence that a comprehensive school-based program can have a strong beneficial effect on student behavior.

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This paper reports the effects of a comprehensive elementary school-based social-emotional and character education program on school-level achievement, absenteeism, and disciplinary outcomes utilizing a matched-pair, cluster randomized, controlled design. The Positive Action Hawai‘i trial included 20 racially/ethnically diverse schools (mean enrollment = 544) and was conducted from the 2002-03 through the 2005-06 academic years. Using school-level archival data, analyses comparing change from baseline (2002) to one-year post trial (2007) revealed that intervention schools scored 9.8% better on the TerraNova (2nd ed.) test for reading and 8.8% on math; 20.7% better in Hawai‘i Content and Performance Standards scores for reading and 51.4% better in math; and that intervention schools reported 15.2% lower absenteeism and fewer suspensions (72.6%) and retentions (72.7%). Overall, effect sizes were moderate to large (range 0.5-1.1) for all of the examined outcomes. Sensitivity analyses using permutation models and random-intercept growth curve models substantiated results. The results provide evidence that a comprehensive school-based program, specifically developed to target student behavior and character, can positively influence school-level achievement, attendance, and disciplinary outcomes concurrently.