Optimistic Youth: Young Adults Predicted a Faster Decrease in Risk during COVID-19 Emergency State in Portugal

Resea ch A icle Po J Public Heal h 2022;40:43–51 Op imis ic You h: Young Adul s P edic ed a Fas e Dec ease in Risk du ing COVID-19 Eme gency S a e in Po ugal Sa a Scale i a, b Inês Dua e a, c Ca a ina Sen a a Jo ge Almeida a, c An ónio Jo ge Fe ei a d Jon Walb in a, c A u Pilacinski a, c aP oac ion Lab, Facul y o Psychology and Educa ional Sciences, Uni e si y o Coimb a, Coimb a, Po ugal; bFacul y o Psychology, Uni e si y o Pado a, Pado a, I aly; cCINEICC, Facul y o Psychology and Educa ional Sciences, Uni e si y o Coimb a, Coimb a, Po ugal; dFacul y o Medicine, Uni e si y o Coimb a, Coimb a, Po ugal Recei ed: Ap il 12, 2021 Accep ed: Feb ua y 23, 2022 Published online: Ap il 20, 2022 Co espondence o: Sa a Scale i, sa a.scale i @ s uden i.unipd.i A u Pilacinski, a .pilacinski @ gmail.com © 2022 The Au ho (s). Published by S. Ka ge AG, Basel on behal o NOVA Na ional School o Public Heal h Ka ge @ka ge .com www.ka ge .com/pjp DOI: 10.1159/000524076 Keywo ds Risk pe cep ion · Public heal h · COVID-19 · Age di e ences Abs ac Pe cep ion o isk is known o change h oughou he li e- span. P e ious s udies showed ha younge adul s a e mo e p one o isk beha iou s han olde adul s. Do hese age- ela ed di e ences in luence isk pe cep ion du ing a pandemic c isis? He e, we in es iga ed how age in luenced p edic ed isk du ing he COVID-19 eme gency s a e in Po - ugal. We show ha ime-p ojec ed es ima ions (e.g., ap- p aisals based on ‘now’ s. ‘in wo weeks’ ime’, o ‘in ou weeks’ ime’) o bo h isk beha iou and impo ance o ansmission p e en ion dec ease o e ime. Impo an ly, p ojec ed isk dec eased mo e s eeply o younge han olde adul s. Ou indings sugges ha younge adul s ha e a di e en pe cep ion o epidemic- ela ed isk han olde adul s. This seems o suppo he iew ha public heal h policy making du ing epidemics should di e en ial- ly a ge younge adul s. © 2022 The Au ho (s). Published by S. Ka ge AG, Basel on behal o NOVA Na ional School o Public Heal h Ju en ude o imis a: Os jo ens adul os p e i am uma diminuição mais ápida do isco du an e o es ado de eme gência ela i o à COVID-19 em Po ugal Pala as Cha e Pe ceção do isco · Saúde pública · COVID-19 · Di e enças de idade Resumo A pe ceção do isco muda ao longo da ida. Es udos an e i- o es mos a am que os jo ens adul os são mais p opensos a compo amen os de isco do que os adul os mais elhos. Se á que es as di e enças elacionadas com a idade in luen- ciam a pe ceção de isco du an e uma c ise pandémica? Aqui, in es igámos como a idade in luenciou o isco p e- is o du an e o es ado de eme gência da COVID-19 em Po - ugal. Demons amos que as es ima i as de empo p oje a- das (e.g., a aliações baseadas em ago a s. "daqui a duas semanas", ou "daqui a qua o semanas") an o do compo - amen o de isco como da impo ância da p e enção da ansmissão diminuem ao longo do empo. É impo an e no a que o isco p oje ado diminuiu mais acen uadamen e pa a os jo ens adul os do que pa a os adul os mais elhos. Os nossos esul ados suge em que os jo ens adul os êm Sa a Scale i, Inês Dua e and Ca a ina Sen a con ibu ed equally o he manusc ip . This is an Open Access a icle licensed unde he C ea i e Commons A ibu ion-NonComme cial-4.0 In e na ional License (CC BY-NC) (h p://www.ka ge .com/Se ices/OpenAccessLicense), applicable o he online e sion o he a icle only. Usage and dis ibu ion o com- me cial pu poses equi es w i en pe mission. Scale i/Dua e/Sen a/Almeida/Fe ei a/ Walb in/Pilacinski Po J Public Heal h 2022;40:43–51 44 DOI: 10.1159/000524076 uma pe ceção do isco elacionado com epidemias di e- en e do que os adul os mais elhos e pa ecem co obo a a pe spe i a de que a elabo ação de polí icas de saúde públi- ca du an e epidemias de e isa de o ma di e en e os jo- ens adul os. © 2022 The Au ho (s). Published by S. Ka ge AG, Basel on behal o NOVA Na ional School o Public Heal h In oduc ion Risk pe cep ion e e s o an indi idual’s subjec i e judgemen s abou he likelihood o nega i e occu ences, such as inju y, illness, disease, and dea h. Risk pe cep ion is impo an in heal h and isk communica ion because i de e mines which haza ds people ca e abou and how hey deal wi h hem [1]. A common assump ion is ha knowledge and ce ain y abou isk de e mine how i is pe cei ed. Based on a ional decision-making, his as- sump ion is p edominan ly asc ibed o expe s, who ely on scien i ic in o ma ion and objec i e assessmen [2]. By con as , laypeople commonly e alua e isks by using heu is ics. Few s udies ha e examined he age- ela ed di - e ences in isk pe cep ion using hypo he ical eal-li e si - ua ions [3, 4]. Recen wo k has ocused on isk in he con- ex o he COVID-19 pandemic [5–8]. These s udies e- ealed mixed esul s, i.e., pe cei ed ulne abili y o COVID-19 ended o dec ease wi h olde age, ye olde adul s pe cei ed highe isk o dying because o CO- VID-19 [5]. Rosi e al. [9] also ound ha olde adul s (70+ yea s) pe cei ed highe isk se e i y o COVID-19 compa ed o he o he age g oups, and, con e sely, younge adul s (18–29 yea s) pe cei ed lowe isk se e - i y o COVID-19 compa ed o all o he age g oups. Risk pe cep ion and isk a i ude a e o en ea ed as dis inc ye in e dependen concep s by many au ho s (howe e , hese e ms a e some imes used in e change- ably in he li e a u e [10]). Risk a i ude e e s o a b oad- e concep – beyond me e isk- aking (i.e., he likelihood o engaging in isky beha iou s) – ha in ol es addi ion- al ac o s, such as isk pe cep ion and he pe cei ed ben- e i s o engaging in isky beha iou [11]. Al hough isk a i ude is conside ed a ela i ely s able psychological ai , he e is e idence ha i may change o e ime; peo- ple end o become mo e isk-a e se as hey age [12], al- hough he e can be a ia ions depending on he domain. Fo example, younge adul s we e ound o be mo e like- ly o ake isks in he domain o heal h and sa e y, com- pa ed o olde adul s [13]. Addi ionally, p e ious wo k shows ha isk- aking declines wi h age ac oss se e al di e en domains, including heal h [14]. These age- ela - ed di e ences in isk a i ude may be impo an when conside ing public heal h guidelines in si ua ions such as he ecen COVID-19 pandemic. Mos heo e ical models on isk pe cep ion ecognize ha i has wo main dimensions [1]: he cogni i e dimen- sion, which ela es o how much people know and unde - s and abou he isk, and he emo ional dimension, which ela es o how hey eel abou isk. Indi iduals o en e al- ua e isk acco ding o subjec i e app aisals, in ui i e judgemen s, and in e ences d awn om he media [15]. Fu he mo e, ce ain cogni i e biases may also po en ial- ly in luence isk pe cep ion (e.g., he op imism bias – he endency o belie e ha isks pose a less se ious h ea o onesel han hey do o o he people [16]). The ampli ica ion o pe cei ed isk du ing a pandem- ic is pa ially accoun ed o by a model p oposed by Po- le i e al. [17] ha desc ibes he dynamics o isk pe cep- ion du ing he H1N1 in luenza pandemic in I aly, in 2009. These au ho s p oposed he suscep ible-in ec ed- eco e ed model [17], which emphasizes ha suscep ible indi iduals may pe o m “no mal” o “al e ed” beha - iou s, based on he pe cei ed isk o in ec ion. In pa icu- la , he au ho s p opose ha , based on he pe cei ed isk o in ec ion, some indi iduals adop “al e ed” beha iou s o educe i al exposu e and in ec ion. These beha iou s include a educ ion in physical con ac wi h o he s, e- quen hand washing, s ong adhe ence o espi a o y e i- que e (e.g., minimizing sneezing o coughing in public places), a oidance o c owded en i onmen s, o limi ing a el. The au ho s desc ibe an ini ial o e es ima ion o isk, accompanied by “al e ed” beha iou s (such as pu - chasing la ge amoun s o cold/ lu medicine) aimed a educing he sp ead o he in ec ion. Subsequen ly, he e was a no ed dec ease in pe cei ed isk, due o he slow inc ease in he numbe o cases, ha was accompanied by a educ ion in “al e ed” beha iou s which, in u n, con- ibu ed o a e-accele a ion o in ec ion a e. Li le is known abou whe he he dynamics o isk pe cep ion (and isk a i ude), as desc ibed in he model o Pole i e al. [17], di e ac oss di e en age g oups. P e ious esea ch has shown ha younge adul s ake mo e isks, especially heal h-associa ed isks (e.g., using d ugs o alcohol o ha ing unp o ec ed sex) [18–24] when compa ed o o he adul s [21, 25]. This endency o isk- aking migh also in luence u u e p edic ions o isk among young adul s du ing he pandemic. Adhe ence o he go e nmen -manda ed p e en i e measu es is shown o be c i ical o cu b he sp ead o he in ec ion, bu he e a e indi idual di e ences in he ex- Op imis ic You h 45 Po J Public Heal h 2022;40:43–51 DOI: 10.1159/000524076 en people apply hese p e en i e measu es. Fo exam- ple, a su ey by Uni e si y College London including da a om o e 10 weeks showed ha guideline adhe ence de- c eased subs an ially, om 70% a he s a o he su ey, o 50% a he end [26]. Howe e , his decline di e ed be- ween age g oups: while mo e han 60% o adul s epo - ed ollowing he guidelines en i ely, app oxima ely only 40% o younge adul s epo ed doing he same. O he s udies du ing p io epidemics ha e shown simila e- sul s; du ing he SARS epidemic in Canada in 2003, younge adul s epo ed ollowing he guidelines less, and also pe cei ed he si ua ion o be less isky, compa ed wi h olde adul s [27]. P io esea ch also shows ha old- e adul s pe cei e highe isk and beha e mo e cau ious- ly han younge adul s conce ning heal h- ela ed ac i i- ies [28] and ha sel - epo ed isk pe cep ion in social, inancial and ec ea ional domains inc eases wi h age [29]. Fu he mo e, olde adul s epo pe cei ing mo e isk o mo ali y i in ec ed wi h COVID-19 [5]. Toge he , hese indings indica e a clea end o lowe isk pe cep- ion in younge adul s, ela i e o olde adul s. The go e nmen -manda ed p e en i e measu es and he e ec o he pandemic mo e gene ally caused d ama - ic changes in he li es o all ci izens [30]. These measu es ha e been pa icula ly ha d o accep o he younge peo- ple, namely, hose who could no a end classes, mee iends, o engage in spo [30, 31]. Olde people we e likewise ins uc ed o emain a home and sel -isola e since hey cons i u e a high- isk g oup o COVID-19 [31, 32]. These social es ic ions may in u n play an im- po an ole in how he popula ion pe cei es he changes o he pandemic si ua ion and he isk o in ec ion o e ime. In his wo k, we in es iga ed age di e ences ega ding he pe cep ion o isk ela ed o e e yday beha iou s du - ing he ea ly epidemic eme gency s a e in Po ugal (Po - ugal was in a s a e o eme gency om Ma ch 18 o May 2, 2020). Speci ically, we ocus on indi idual judgemen s o isk and o he ac o s du ing he COVID-19 pandem- ic: (1) beha iou s ca ying isk in ec ion ( isk beha iou s, e.g. “ isi ing iends”, “using an ele a o ”); (2) beha iou s aimed a p e en ing disease sp eading and p epa edness o c ises (p e en ion beha iou s, e.g. “using a ace mask”, “ha ing enough medical supplies”); and (3) ole ance o dep i a ion o social needs (social needs, e.g. “social dis- ancing om amily”, “no going o wo k”). We in es i- ga ed indi iduals’ subjec i e pe cep ion ac oss 4 ime- p ojec ed in e als: (1) 2 weeks ago; (2) now; (3) in 2 weeks; and (4) in 4 weeks. Speci ically, we compa e di - e ences in he pe cep ion o p ojec ed isk p e en ion beha iou s and social needs dep i a ion among wo age g oups: eme ging adul s (younge adul s in he 18–25 yea s age ange) and adul s (adul s aged 26 yea s and old- e ). We hypo hesize ha : (1) he p ojec ed pe cep ion o isk will dec ease o e u u e-p ojec ed ime poin s [17], and ha his educ ion will be enhanced (i.e., dec ease mo e sha ply) o younge adul s; (2) he impo ance gi - en o p e en ion beha iou s will dec ease ac oss u u e- p ojec ed ime poin s, and ha his dec ease will be en- hanced o younge adul s; (3) he dep i a ion o social needs will be pe cei ed o be less ole able o e successi e p ojec ed ime poin s, and ha his will be mo e p o- nounced (i.e., ole ance educes mo e sha ply) among younge adul s. Me hods Pa icipan s E hical app o al was g an ed om he Facul y o Psychology and Educa ional Sciences o he Uni e si y o Coimb a, Po ugal. Ini ially, a o al o 199 online pa icipan s we e ec ui ed. Due o he quickly e ol ing na u e o he pandemic si ua ion, pa icipan s we e ec ui ed h ough di e en channels (e.g., email, social me- dia) and he esponse a e was no measu ed. Subjec s ga e consen and we e in o med o hei igh o wi hd aw hei pa icipa ion a any ime and ha hei da a would be anonymous. Subjec s we e deb ie ed abou he aims o he s udy upon comple ion o he ques- ionnai e o no sys ema ically in luence hei answe s. 26 subjec s we e excluded o no esiding in Po ugal. Addi ionally, ano he 16 we e excluded o missing demog aphic in o ma ion. The inal sample consis ed o 157 pa icipan s esiding in Po ugal, ac oss a ious egions o he coun y. Mos pa icipan s esided in owns be ween 5,000 and 150,000 (n = 101) inhabi an s, abou a i h in owns wi h 150,000 o mo e inhabi an s (n = 33), and he emain- ing pa icipan s esided in owns wi h 5,000 o less (n = 23). Pa - icipan s wi hin he age ange o 18–25 (n = 85) we e designa ed as “younge adul s” [33], while pa icipan s aged 26+ (n = 72) we e designa ed as “adul s”. The o al sample comp ised 33 male and 124 emale pa icipan s. P ocedu e Th ee ques ionnai es we e cons uc ed o ou su ey. Fo each o hese ques ionnai es, we pooled se e al ep esen a i e i ems o di e en isk beha iou s, p e en ion beha iou s and social needs. I ems o he ques ionnai es we e based on public heal h in o ma- ion a ailable a he ime om heal h au ho i ies and media (e.g., washing hands, main aining physical dis ance om o he s). Those i ems we e hen ansla ed in o Po uguese. A e he de ini ion o he pool o ques ions o be included in he su ey, he English and Po uguese e sions we e se up in he pla o m PsyToolKi [34, 35]. The ec ui men p ocess consis ed o wo pa allel ph ases. Uni- e si y s uden s we e ec ui ed ia email. Addi ionally, he links o he su ey we e sha ed on social media o each a b oade sam- ple (in e ms o age ange and geog aphical loca ion). Da a collec- ion ook place be ween Ap il 13 and May 15, 2020, app oxima e- Scale i/Dua e/Sen a/Almeida/Fe ei a/ Walb in/Pilacinski Po J Public Heal h 2022;40:43–51 46 DOI: 10.1159/000524076 ly 4–9 weeks a e he onse o he na ional s a e o eme gency (i.e., manda o y sel -qua an ine). We e i ied ha he da e o da a col- lec ion did no bias he ob ained a ings (see online suppl. ma e- ial 2, o all online suppl. ma e ial, see www.ka ge .com/ doi/10.1159/000524076). We adop ed a c oss-sec ional design; all da a om a gi en indi idual we e ob ained in a single session, whe e hey p oduced p ojec ed es ima es ac oss he ollowing 4 ime poin s: (1) 2 weeks ago, (2) now, (3) in 2 weeks, (4) in 4 weeks. As such, we in es iga ed changes in he p ojec ed isk pe cep ion ac oss ime. Ques ionnai e Pa icipan s we e asked o comple e a ques ionnai e ha ook app oxima ely 15 min. Fi s , hey answe ed se e al demog aphic ques ions (see below, also see online suppl. Appendix 2), ollowed by he h ee main ques ionnai es. We de ised i ems based on el- e an public heal h ad ice (e.g., minimizing he isk o in ec ion by washing hands, social dis ancing, e c.). Because hese i ems we e no p e iously alida ed, and because we had no p io knowledge o which speci ic con ex s we e mos ele an o es ima ing each measu e (e.g., hand washing o isk minimiza ion), we sough o cap u e each measu e in a ela i ely b oad ashion. To his end, we gene a ed a ela i ely la ge se o i ems o each measu e, o e ain i ems ha collec i ely yielded high C onbach’s alpha. Due o high in e -i em co ela ions o each ques ionnai e, we e ained all i ems wi hin and gene a ed a single sco e pe pa icipan (pe each ques ionnai e and ime poin ). Demog aphic Da a We collec ed subjec s’ basic demog aphic in o ma ion, such as age, gende , p o ession, eligion, and own size (popula ion) and whe he hey had a known medical condi ion ha migh place hem a highe isk o COVID-19. The impac o he media upon hei pe cep ion o ques ionnai e ou come measu es was e alua ed wi h dicho omous yes/no ques ions ega ding he use o a ious sou ces o in o ma ion (TV/ adio, in e ne , social media o o he s, u he asking which o he sou ces hey used) and wi h a 5-poin Like scale o he pe cei ed c edibili y o na ional news in gen- e al. Risk Pe cep ion Risk pe cep ion was measu ed wi h a 10-poin scale, whe e 1 was “low pe cei ed isk” and 10 was “high pe cei ed isk”. The ques ionnai e consis ed o 29 i ems – co esponding o 29 isk be- ha iou s. Fo each i em, esponses we e equi ed o sepa a e 4 ime poin s (2 weeks ago, now, in 2 weeks, and in 4 weeks). See online supplemen a y Table 1 o mos and leas a ed i ems o all ime poin s (Fig.1). In ec ion P e en ion Beha iou s The impo ance a ibu ed o 9 in ec ion p e en ion beha - iou s was measu ed in a simila way o he p e ious ques ionnai e (e.g., ac oss all 4 ime poin s), whe e 1 was “low impo ance” and 10 was “high impo ance”. See online supplemen a y Table 2 o mos and leas highly a ed i ems o all ime poin s (Fig.2). Social Needs The measu emen o social needs (i.e., ole ance o es ic ed social con ac ) was assessed wi h 6 i ems whe e 1 was “low ole - ance” and 10 was “high ole ance”. Again, a ings we e ob ained o all 4 ime poin s. See online supplemen a y Table 3 o mos and leas highly a ed i ems o all ime poin s. S a is ical Analysis S a is ical analyses we e pe o med using IBM SPSS S a is ics ( e sion 25). Missing alues we e eplaced using he ‘se ies means’ 8.0 7.5 Risk beha iou s a ing 7.0 6.5 2 weeks ago In 2 weeks In 4 weeks Time Now No e. A e age isk pe cep ion a ings ac oss 4 ime poin s, o each age g oup. E o ba s deno e he s anda d e o o he mean (SEM). Age ca ego y 18–25 >26 6.6 6.4 P e en ion beha iou s a ing 6.2 Age ca ego y 18–25 >26 2 weeks ago In 2 weeks In 4 weeks Time Now No e. A e age a ings o p e en ion beha iou s ac oss 4 ime poin s, o each age g oup. E o ba s deno e he s anda d e o o he mean (SEM). Fig. 1. Risk pe cep ion ac oss p ojec ed ime poin s. Fig. 2. Pe cei ed impo ance o p e en ion beha iou s ac oss p o- jec ed ime poin s. Colo e sion a ailable online Colo e sion a ailable online Op imis ic You h 47 Po J Public Heal h 2022;40:43–51 DOI: 10.1159/000524076 me hod (i.e., eplacing missing alues wi h column means). Fo each ques ionnai e, he in e i em co ela ions (C onbach’s alpha) we e conduc ed ( o each ime poin sepa a ely) o e alua e he in e nal consis ency ac oss i ems ( he equencies o he highes - sco ed and lowes -sco ed i ems a e p esen ed in he Resul s sec- ion). Because in e i em co ela ions we e consis en ly high o each ques ionnai e (and ime poin ), we calcula ed i em mean al- ues pe ques ionnai e, ime poin , and subjec , and used hese da a in he main analyses. Two-way mixed ANOVAs (age g oup × ime poin ) we e pe - o med on subjec s’ mean ques ionnai e i em alues (pe ime poin and ques ionnai e). Fo conciseness, we epo only he highes signi ican ANOVA e ms (e.g., in e ac ions bu no main e ec s when in e ac ions a e signi ican ; and when no , bo h in e - ac ions and main e ec s a e epo ed ins ead). Follow-up analyses we e conduc ed o es i linea ends (i.e., a linea educ ion in p ojec ed a ing ac oss he 4 ime poin s) was signi ican ; speci i- cally, o each subjec , a linea eg ession slope (i.e., be a coe i- cien ) was gene a ed o he 4 ime poin s (i.e., dec easing linea ends yield nega i e alues), and g oup le el e ec s we e es ed ia es s on subjec s’ eg ession slope alues. Las ly, explo a o y anal- yses we e conduc ed o see i he obse ed age di e ences in isk pe cep ion and p e en ion beha iou s in e ac ed wi h o he de- mog aphic a iables (see online supplemen 1) and also, whe he hese measu es in e ac ed wi h he da e o subjec s’ da a collec ion (online supplemen 2). Resul s Risk Pe cep ion Fi s , we analysed he isk pe cep ion (C onbach’s al- pha alues anged om 0.952 o 0.967 o he 4 sepa a e ime poin s, indica ing e y high in e -i em co ela ions, hus jus i ying mean a e aging o i ems in o indi idual measu es [pe ime poin ]). A wo-way mixed ANOVA e ealed a signi ican in e ac ion be ween age g oup and ime poin (F(1.36, 210.65) = 7.39, p = 0.003). A ollow-up independen samples es on linea slopes o each age g oup demons a ed a g ea e dec ease in p ojec ed isk a ings o younge adul s han o adul s ( (155) = –2.957, p = 0.002). In ec ion P e en ion Beha iou s Nex , we analysed in ec ion p e en ion beha iou s (high C onbach’s alpha alues o each ime poin we e obse ed, anging be ween 0.782 and 0.814). A wo-way mixed ANOVA e ealed a signi ican in e ac ion e ec be ween age g oup and ime poin (F(1.56, 242.36) = 4.96, p = 0.013). A ollow-up independen es on subjec s’ linea slopes yielded a signi ican g oup di e ence, indi- ca ing a sha pe educ ion in he pe cei ed impo ance o p e en ion beha iou s in younge adul s ( (155) = –2.438, p = 0.008). Social Needs Finally, we analysed ole ance o dep i a ion o social needs esul ing om manda o y qua an ine and o he p e en i e policies ( ime poin -speci ic C onbach’s al- pha alues anged be ween 0.827 and 0.855). A wo-way mixed ANOVA e ealed ha he in e ac ion be ween age g oup and ime poin was no signi ican (F(1.263, 195.742) = 1.03, p = 0.329). The end owa ds a main e ec o age g oup was also no signi ican (F(1, 155) = 2.17, p = 0.143), while he main e ec o ime poin was signi ican (F(1.263, 195.74) = 152.15, p < 0.001). A ol- low-up one-sample es on all subjec s’ slope alues e- ealed a linea dec ease in ole ance owa ds dep i ed social needs o e ime ( (156) = –13.451, p < 0.001; Fig.3). Discussion The cen al aim o he p esen s udy was o in es iga e po en ial age- ela ed di e ences in he pe cep ion o isk, along wi h p e en a i e beha iou , and dep i a ion o so- cial needs ela ed o e e yday beha iou s du ing he CO- VID-19 pandemic. Ou esul s p o ide e idence o age- ela ed di e ences in how isk pe cep ion is p ojec ed ac oss di e en ime poin s. Bo h he adul s and younge adul s g oups showed a simila le el o pe cei ed p esen 7.5 7.0 6.5 Social needs a ing 6.0 5.5 5.0 2 weeks ago In 2 weeks In 4 weeks Time No e. A e age a ings o ole ance o es ic ed social needs ac oss 4 ime poin s, o each age g oup. E o ba s deno e he s anda d e o o he mean (SEM). Now Age ca ego y 18–25 >26 Fig. 3. Tole ance o dep i a ion o social needs ac oss ime poin s. Colo e sion a ailable online Scale i/Dua e/Sen a/Almeida/Fe ei a/ Walb in/Pilacinski Po J Public Heal h 2022;40:43–51 48 DOI: 10.1159/000524076 isk (i.e., a he ime he su ey was illed in). Impo an - ly, howe e , he p ojec ed isk pe cep ion dec eased o e ime and his dec ease was signi ican ly mo e p onounced o he younge adul s. P e en ion beha iou s also showed he same e ec , sugges ing ha eme gen adul s, as compa ed o olde adul s, end o pe cei e he ime- p ojec ed impo ance o p e en ion beha iou s o de- c ease mo e sha ply o e ime. Finally, unlike he 2 p e- ceding measu es, when conside ing dep i a ion o social needs, bo h g oups showed a simila dec ease in in ole - ance ac oss p ojec ed ime poin s. Rega ding isk pe cep ion, he obse ed dec eases o e ime pa allel changes in eal isk beha iou de- sc ibed by Pole i e al. [17] du ing he H1N1 in luenza pandemic in I aly, in 2009, demons a ing ha o bo h eal and p ojec ed da a, pe cei ed isk ends o be highe a he beginning o pandemic s a es, be o e g adually e- ducing. Mo e speci ically, he obse ed age di e ence in he p ojec ed isk pe cep ion is in ag eemen wi h p e i- ous wo k showing ha olde adul s end o be mo e cau- ious han younge adul s in heal h- ela ed con ex s [28], and ha olde adul s end o show a highe le el o sel - epo ed isk [29] and a e mo e isk-a e se in gene al [12]. This sha pe educ ion in p ojec ed isk in younge adul s is po en ially ela ed o expe ien ial di e ences be- ween he wo age g oups du ing he COVID-19 pan- demic. Bi di e al. [36] ound ha younge adul s e- po ed highe le els o pandemic- ela ed s ess, mo e li e changes, and a g ea e sense o social isola ion, and ha con ibu ed o o e all poo e psychological well-being. Po en ially, hese indings indica e ha he COVID-19 pandemic was o e all less ole able o younge adul s han o olde adul s, which migh con ibu e o a sha p- e dec ease o he p ojec ed isk pe cep ion. I is impo - an o no e, howe e , ha while Bi di e al. [36] mea- su ed he ac ual well-being o hei subjec s, in he p es- en s udy we used ime-p ojec ed measu es, showing people’s pe cep ions abou he u u e; he e, we did no ind a subs an ial age di e ence in p ojec ed ole ance o dep i ed social needs ac oss ime (Fig.3). We p opose an al e na i e explana ion o ou esul , conside ing pe - sonali y di e ences be ween age g oups, po en ially a - ec ing hei es ima ions abou he u u e. Se e al s udies ha e ound ha olde adul s a e less op imis ic abou he u u e in gene al [37–39]. Acco ding o hese indings, di e ences in ai le els o disposi ional op imism migh be a be e explana ion o he p esen ly obse ed sha p- e dec ease in p ojec ed isk pe cep ion among he younge adul s. Se e al o he ac o s may also explain age di e ences in isk pe cep ion. I has been sugges ed ha in ec ion- ela ed isk is modula ed by he pe cei ed se iousness o a pa icula disease, such ha he pe cei ed likelihood o de eloping a disease may pa ly depend on how se ious i s consequences a e conside ed o be [30]. This could happen o many easons, such as a gene al endency o unde es ima e ha m ul exposu e in younge adul s [20], o a ailu e o ecognize pe sonal ulne abili y o nega i e ou comes associa ed wi h he isk beha iou s – so-called “un ealis ic op imism” [16, 25, 40]. Simila ly, Commo- da i and La Rosa [30] and Commoda i e al. [41] showed ha younge adul s unde es ima e he isk o in ec ion because o he widesp ead e idence ha younge people a e gene ally less ulne able o he ad e se consequences o COVID-19. In addi ion o disposi ional op imism, di e ences in isk pe cep ion a e po en ially in luenced by socio-demo- g aphic ac o s, such as gende , educa ion and employ- men . Indeed, ecen s udies conduc ed du ing he CO- VID-19 pandemic ound ha hese ac o s p edic ed bo h isk pe cep ion [5, 42] and he adop ion o p e en i e/ p o ec i e beha iou s [43, 44]. Ano he a iable ha is likely o in luence isk pe cep ion (and subsequen deci- sion-making) is an indi idual’s emo ional s a e [45]. In- deed, indi iduals in a nega i e emo ional s a e end o e alua e e en s mo e nega i ely han indi iduals in a pos- i i e emo ional s a e [46]. These indings a e ele an o he cu en esul s because changes in he emo ional ex- pe ience a e obse ed wi h age: olde adul s a ibu e g ea e impo ance o emo ions han younge adul s [47]. In pa icula , indi iduals wi h high le els o anxie y end o pe cei e nega i e ou comes as mo e likely and se e e [48]. We, he e o e, specula e ha olde adul s exhibi ed a less s eep decline in he p ojec ed es ima es o isk pe - cep ion based on hese socio-emo ional ac o s. Finally, we specula e ha isk pe cep ion (in he p esen s udy) also depends on knowledge and p e ious expe ience: The “a ailabili y heu is ic” sugges s ha people wi h a ecen pe sonal expe ience o a speci ic e en ha e a highe isk pe cep ion o ha e en [49]. In pa icula , p e ious wo k shows ha indi iduals who knew someone in ec ed wi h COVID-19 may show an inc eased pe cep ion o isk [7, 50]. I is wo h no ing ha subjec i e isk pe cep ion is a key ac o in modula ing heal h beha iou s and migh in luence he adop ion o p e en i e measu es [30, 41, 51, 52], such as social dis ancing. As such, i is o i al impo ance o add ess subjec i e aspec s o isk pe cep- ion ac oss popula ions ha migh pe cei e i di e en ly. Op imis ic You h 49 Po J Public Heal h 2022;40:43–51 DOI: 10.1159/000524076 In pa allel o he p ojec ed dec ease in isk, we obse ed a p ojec ed dec ease in he impo ance o in ec ion p e- en ion beha iou s, especially in younge adul s. This could be a by-p oduc o he dec ease in pe cei ed isk, in u n, leading o a educ ion in he need o adop ing p e en i e measu es. Con a y o wha one migh in ui- i ely expec , and wha he da a om Bi di e al. [36] would sugges , we did no ind any age- ela ed di e - ences in he ole ance o social dep i a ion (al hough a weak end was e iden o he main e ec o age; see Fig.3). We sugges ha his may ela e o he gene al use o digi al communica ion (e.g., ideo calls o ins an messaging) by he wo age g oups ha was widely used o educe eelings o social isola ion du ing he ea lie s ages o he COVID-19 pandemic [53]. We u he spec- ula e ha he lack o g oup di e ences may a ise om di e ences in he equency o use be ween ages g oups; ha is, younge adul s, who end o use digi al commu- nica ion mo e equen ly o suppo ela i ely wide so- cial ne wo ks, may ely mo e on digi al communica ion o egula e eelings o social isola ion, compa ed o o he adul s ha end o use i less, and may ha e mo e es ic- i e social ne wo ks. Limi a ions We acknowledge se e al limi a ions o ou indings. Fi s , we used ime-p ojec ed measu es o assess how pa - icipan s p edic ed ha isk would change h oughou ime and he ex en o which hese esponses e lec eal- ime pe cep ion (i.e., app aisals ob ained a di e en ime in e als). Second, we deployed an in e ne -based sel - e- po ques ionnai e ha may pa ially be subjec o a deg ee o sel - epo bias. Thi d, he echnical challenge o con- duc ing a su ey and collec ing da a quickly du ing he s a e o eme gency esul ed in a ela i ely low sample size, hus limi ing he gene alizabili y o ou esul s o he o e - all popula ion; u he , because o hese cons ain s, we did no pe o m ex ensi e alida ion o he ques ionnai e i ems (al hough we did demons a e high in e -i em eli- abili y wi hin each ques ionnai e). Las ly, since pa ici- pan s we e ec ui ed p edominan ly h ough uni e si y- ela ed channels, ou indings a e la gely con ined o a sample o uni e si y-a ilia ed indi iduals (s uden s and s a ). Fu u e Di ec ions The obse ed sha pe educ ion o p ojec ed isk pe - cep ion in younge adul s is pa icula ly impo an in he con ex o accina ion campaigns. Indeed, al hough many people ecei ed a COVID-19 accine, a high a e o non-complian people could unde mine accine e o s. Case o i e al. [54] demons a e ha a pe cei ed highe isk o he i us p edic ed accine up ake and ha as eme gency measu es we e li ed (e.g., lockdown), indi- iduals we e less likely o op o accina ion. We, he e- o e, highligh he impo ance o isk pe cep ion in a pol- icy-making con ex . These esul s a e pa icula ly impo - an gi en ha adhe ence o ecommended sa e y p ac ices depends on indi iduals’ isk pe cep ion, ac- co ding o se e al heal h beha iou models, such as he Heal h Belie Model [55], he Theo y o Reasoned Ac ion [56], he Theo y o Planned Beha iou [57], and he Sub- jec i e Expec ed U ili y Theo y [58], which, oge he , demons a e ha isk pe cep ion is a c ucial ac o in shaping isk beha iou . Concluding Rema ks The p esen esul s ha e se e al social, psychological, and poli ical implica ions. In pa icula , hese indings may se e o in luence policymake s and o he social o - ganiza ions o design campaigns ha conside age- ela - ed di e ences in he pe cep ion o isk [20] hus enhanc- ing he e ec i eness o heal h campaigns a ge ing young people [59, 60]. Acknowledgmen s We would like o hank he membe s o P oac ion Lab and es- pecially Daniel Ribei o and S ephanie K is ensen o hei sugges- ions while c ea ing he i em lis o his s udy. S a emen o E hics S udy app o al s a emen : E hical app o al was g an ed by he Facul y o Psychology and Educa ional Sciences o he Uni e si y o Coimb a and he s udy was conduc ed e hically in acco dance wi h he Wo ld Medical Associa ion Decla a ion o Helsinki. Consen o pa icipa e s a emen : Subjec s ga e consen and we e in o med o hei igh o wi hd aw hei pa icipa ion a any ime and ha hei da a would be anonymised. Subjec s we e de- b ie ed abou he aims o he s udy upon comple ion o he ques- ionnai e in o de o no sys ema ically in luence hei answe s. 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