Taiyo Fukai

Abstract Background Public health depends largely on people’s knowledge, beliefs, or behaviors regarding their health and medical treatments. Although works based on the health belief model have shown that public beliefs about medical treatments affect willingness to take the treatments, little is known about the effects of changes in beliefs on attitudes toward treatment. How one’s past experiences relate to one’s beliefs about a given medical treatment is worth considering. Methods We implemented an online panel survey in February 2021 and March 2022 in Japan before and after COVID-19 vaccines were administered to the public within the country. We exploited delayed localized hypersensitivity reactions to COVID-19 vaccines, namely, “COVID arm”, as an exogenous shock to investigate the relationship between past negative experiences and current beliefs about medical treatments or science. “COVID arm” was an unexpected side effect and thus likely caused updated beliefs about the vaccine. Out of the nonprobability sample of 15,000 respondents in the first wave in February 2021, 9,668 respondents also responded to the second wave conducted in March 2022. Outcome variables were whether experiencing “COVID arm” affected the respondents’ 1) confidence in vaccine safety, 2) willingness to take the next dose of COVID-19 vaccines, 3) acknowledgment of the importance of vaccination, and 4) confidence in science. We measured the impact of experience with “COVID arm” on changes in the probability that survey respondents would respond affirmatively to questions posed about the issues listed above. Results Experiencing “COVID arm” significantly lowered confidence in the safety of vaccination by 4.3 percentage points, which was approximately 6% of the sample mean for the first wave, and lowered the probability of taking a second dose of the COVID-19 vaccine by 1.5 percentage points. These adverse impacts were observed after conditioning background characteristics and prior confidence in vaccination. Experiencing “COVID arm” affected neither the acknowledged importance of vaccination nor confidence in science in a statistically significant way. Conclusions An unexpected and uncomfortable shock regarding beliefs about a treatment decreases willingness to take the treatment. An appropriate public health policy should account for this effect. Trial registration The survey was preregistered with the American Economic Association’s RCT Registry (Fukai et al., 2022).

Importance Although a growing number of studies have reported negative associations of the COVID-19 pandemic with academic performance among school-aged children, less is known about the pandemic’s association with early childhood development. Objective To examine the association between the COVID-19 pandemic and early childhood development. Design, Setting, and Participants In this cohort study conducted in all accredited nursery centers in a Japanese municipality, baseline surveys of children aged 1 and 3 years (1000 and 922, respectively) were conducted between 2017 and 2019, and participants were followed up for 2 years. Exposure Children’s development was compared at age 3 or 5 years between cohorts that were exposed to the pandemic during the follow-up and a cohort that was not. Main Outcome and Measure Children’s developmental age was measured by nursery teachers using the Kinder Infant Development Scale (KIDS). Data were analyzed between December 8, 2022, and May 6, 2023. Results A total of 447 children (201 girls [45.0%] and 246 boys [55.0%]) aged 1 year at baseline were followed up to age 3 years, and 440 children (200 girls [45.5%] and 240 boys [54.5%]) aged 3 years at baseline were followed up to age 5 years. During the follow-up, the cohorts that were exposed to the pandemic were 4.39 months behind in development at age 5 compared with the cohort that was not (coefficient, −4.39; 95% credible interval, −7.66 to −1.27). Such a negative association was not observed in development at age 3 years (coefficient, 1.32; 95% credible interval, −0.44 to 3.01). Variations in development were greater during the pandemic than before the pandemic regardless of age. Additionally, the quality of care at nursery centers was positively associated with development at age 3 years during the pandemic (coefficient, 2.01; 95% credible interval, 0.58-3.44), while parental depression appeared to amplify the association between the pandemic and delayed development at age 5 (coefficient of interaction, −2.62; 95% credible interval, −4.80 to −0.49; P = .009). Conclusions and Relevance The findings of this study showed an association between exposure to the pandemic and delayed childhood development at age 5 years. Variations in development widened during the pandemic regardless of age. It is important to identify children with developmental delays associated with the pandemic and provide them with support for learning, socialization, physical and mental health, and family support.

This study presents the first quantitative evaluation of the quality of early childhood education and care (ECEC) in Japan to make a significant contribution to the body of knowledge accumulated on ECEC in countries where research has been limited. We observed 30 classes comprising 3-year-olds, 28 classes comprising 5-year-olds, and 30 classes comprising mixed-ages from publicly provided nursery centers under the jurisdiction of the Kanto metropolitan area, Japan. An internationally-recognized quality rating scale for ECEC called the Early Childhood Environment Rating Scale, 3rd edition, which consists of six subscales, was used for this study. In contrast to previous studies conducted in the US, the results of this study showed that the Japanese ECEC is characterized as showing higher scores in the two subscales, “Personal Care Routines” and “Interaction,” and showing lower score in the subscale, “Learning Activities.” In addition, this study showed that the quality of ECEC varied across nursery centers. Furthermore, with regard to the two subscales, “Interaction” and “Language and Literacy,” the degree of variation within centers differed across nursery centers. This study analyzed how these characteristics of Japanese ECEC can be partly produced by the existence of national guideline for nursery centers authorized by the Japanese government. In addition, mechanisms producing differences in the quality of ECEC among and within centers were also discussed.