Examining How Young Adults Perceive, Understand, and Respond to SARS-CoV-2 Variants in Canada and France: Implications for Public Health Preparedness Efforts

How young adults (ages 18-29) perceive, understand, and respond to the emergence of new Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) variants has significant implications for how public health practitioners and decision makers should prepare for possible new variants of concern. ¹ For example, previous research involving young adults from early phases of the pandemic showed that risk perception, personal affective responses (eg, protection of family/friends), and knowledge about coronavirus disease (COVID-19) are predictors for engagement with COVID-19 preventive behaviors (eg, social distancing), including willingness to be vaccinated. ^2–4 These previous findings underscore the need for targeted public health campaigns that can increase young adults’ knowledge about COVID-19 risks to improve their adherence to public health guidelines.

In the spring of 2021, a time at which the more severe Delta variant had become dominant, ⁵ most public health communication efforts continued to focus on increasing vaccination coverage over disseminating up-to-date information about the Delta variant. ^6,7 At this time, even nations with well-resourced public health systems, including Canada and France, experienced significant difficulties in accurately tracking and communicating the spread of the Delta variant in real time (eg, difficulties in sequencing). ⁸ As a consequence, and especially at the beginning of the spread of the variant in these countries, we hypothesized that the resulting lack of public health communication messaging about the Delta variant meant that individuals needed to seek out information about risks on their own.

The objectives of this research letter are to describe the perceptions and understandings of young adults toward the emerging SARS-CoV-2 variants, and to examine how young adults’ frequency of seeking COVID-19 information during this time influenced their level of cautiousness with regard to emerging variants.

Methods

We conducted an online cross-sectional survey with young adults (ages 18-29) in Canada and France from July to November 2021, a period when the Delta variant had become dominant and preceding the spread of the Omicron variant that occurred in late 2021, early 2022. ⁵ Most participants (84.4%) were recruited via a spectrum of diverse online ads on social media platforms (Facebook, Instagram, Reddit). This study was approved by the University of British Columbia’s Behavioral Research Ethics Board (H20-02053) and is reported following the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guideline. Using both Canada and France census data, survey weights were applied to produce young adults’ population-level estimates by age, gender, and province of residence to improve the representativeness of our sample.

Perceptions and attitudes toward the emerging SARS-CoV-2 variants at the time of the survey were self-reported measures. Change in level of cautiousness was assessed by asking the following question: Has the emergence of new COVID-19 variants (since December 2020) made you more cautious around preventing your chance of getting or transmitting COVID-19? The 5 response options were recoded into 2 categories: decreased/no change (“not at all,” “less,” and “neither more nor less cautious”) and increased level of cautiousness (“a little bit more,” and “much more cautious”). Participants who reported seeking for information about COVID-19 in the past 6 months daily were classified as regular information seekers and those who did on a weekly/monthly basis were classified as occasional. In each country, weighted multivariable logistic regression was performed to examine the association between seeking for COVID-19 information and increased level of cautiousness about emerging variants, controlling for demographics (eg, age, gender, education, living arrangements) and potential confounders (eg, COVID-19 testing, vaccination status).

Results

A total of 5278 young adults (51.1% from France) were included. One quarter (23.9%) in Canada and 12.6% in France reported being very concerned about the emergence of SARS-CoV-2 variants (Figure 1). In both countries, more than 75% agreed that the COVID-19 pandemic will take longer to end because of new variants. High levels of general knowledge about new variants were observed in both countries (see Figure 1).

Figure 1. Perceptions, general knowledge, and level of cautiousness regarding the emergence of new COVID-19 variants among young adults in Canada and France.

Overall, 41.3% in Canada and 19.7% in France indicated that they were more cautious with regard to COVID-19 risks due to the emerging variants (Table 1). After demographic adjustment, participants were more likely to report increased level of cautiousness about emerging variants when having a high level of concern (adjusted odds ratio [AOR], Canada: 95% CI: 5.56 [4.57-6.75]; France: 95% CI: 2.93 [2.42-3.55]) and occasionally or regularly seeking for COVID-19 information (AORs > 2 in both countries). However, those who reported not being vaccinated nor intended to be vaccinated against COVID-19 (Canada: 0.16 [0.10-0.27], France: 0.26 [0.19-0.35]) had lower odds of being more cautious due to the emerging variants. In both countries, we also observed significant differences in terms of geography, gender, and sexual orientation, including those living in Quebec, those who self-identified as men, and those who self-identified as heterosexual as being less likely to be more cautious. In the French sample, those living in the northern regions and overseas, those who had attained lower education, and those living with their parents had higher odds of being more cautious.

Table 1. Factors associated with level of caution with regard to the emerging COVID-19 variants among young adults in Canada and France: Results from weighted multivariable logistic regression models

Notes: Survey weights were used in the calculation of all percentages.1:¹P-values calculated from Chi-squared test with Rao & Scott’s second-order correction. 2: AOR = Adjusted Odds Ratio, CI = Confidence Interval. Bold: Statistically significant (p<0.05). $Other gender identity included intersex, Two-spirit (only for Canada), and other gender identity with an open-text box. £Other sexual minority included asexual, pansexual, queer, Two-spirit (only for Canada) and other sexual identity with an open-text box. §Participants who selected any ethno-racial identity (one or more) other than white and those who selected Indigenous were classified as racialized. The category “non-racialized” includes those who selected “white” only. *Due to the prohibition of collecting ethno-racial identity data in France, we created the variable “descendants of immigrants” based on the definition from the French National Institute of Statistics and Economic Studies (INSEE) as a proxy for ethno-racial identity. French participants who reported that at least one of their parents or two of their grandparents from the same side were born outside France or Europe were considered as descendants of immigrants. ¶Atlantic: New Brunswick, Newfoundland and Labrador, Prince Edward Island, Nova Scotia; Prairies: Alberta, Manitoba, Saskatchewan; Territories: Nunavut, Yukon, Northwest Territories. ^Nord Est: Grand-Est, Hauts-de-France, Bourgogne Franche-Comté; Sud Est: Auvergne-Rhône-Alpes, Provence-Alpes-Côte-d’Azur, Corse; Sud Ouest: Nouvelle Aquitaine, Occitanie; Ouest: Bretagne, Centre Val-de-Loire, Pays de la Loire, Normandie. Participants from overseas departments were included in the sub-category Sud Est.

Discussion

While the cross-sectional study design does not allow us to infer causation, our findings provide a helpful snapshot into the perceptions, understandings, and responses regarding emerging SARS-CoV-2 variants among young adults during a time at which a more severe and transmissible variant became dominant. Specifically, we found that those who actively sought information about COVID-19 were more likely to report being cautious. As such, these findings suggest that acquiring information about SARS-CoV-2 variants might influence individual risk behavior change, thereby underscoring the importance for public health preparedness with regard to risk communication as new SARS-CoV-2 variants emerge. Consistent with previous studies conducted among health care workers, ^9,10 young adults who were not vaccinated at the time of our survey and who intended to stay unvaccinated were less likely to be cautious as new variants emerged, highlighting how social patterns in risk perception may continue to replicate along lines of vaccination status—a particularly important finding given that future variants may disproportionately burden those who are not vaccinated (eg, via ease of transmission or severity of illness). Regardless, these findings underscore the importance of continuing to assess how social and behavioral patterns will impact future public health preparedness efforts regarding the risks of SARS-CoV-2 variants.