Abstract
BACKGROUND: During the early phase of the COVID-19 pandemic, the province of Ontario enacted restrictions and recommendations that changed over time. These measures were effective in reducing COVID-19-related illness and deaths, but adherence to these non-pharmaceutical interventions may be modified by individual factors including demographics and health status which shape exposure risk behaviors. METHODS: A total of 348 participants completed baseline questionnaires (to assess demographics, pre-pandemic exposure risk, and health status), weekly illness reports, and monthly social distancing behavior questionnaires to evaluate exposure risk over time in response to changing levels of government restrictions. Exposure risk behaviors were calculated using seven categories: attendance at social events, receiving care (hospital, etc.), visiting or volunteering at care facilities, public transportation use, hours working outside of the home, hours volunteering outside of the home, and handwashing frequency. The impact of individual and environmental factors on exposure risk over time was evaluated by a Poisson family generalized linear mixed model. RESULTS: Participants across all age groups and health statuses adapted their behaviors in response to evolving regulations, but older individuals and those with pre-existing conditions had the largest change in behavior. These individuals also had the most severe symptoms when they developed COVID-19 or other influenza-like illnesses. Participants who were older or had pre-existing health conditions had lower levels of exposure risk overall, and this was largely driven by a lower prevalence and frequency of in-person work. Female participants also had lower levels of exposure risk overall, consistent with an increased frequency of handwashing in this group. Unexpectedly, we found no effect of vaccination on total exposure risk. CONCLUSIONS: Participant behavior was generally responsive to government-imposed restrictions, with increased stringency coinciding with decreased exposure risk among participants. Demographic-associated differences in exposure risk behaviors appear to be driven by systemic factors (i.e., a return to in-person work) to a greater extent than personal choices (i.e., social gatherings). These findings emphasize the interplay between demographic factors and government interventions in shaping individual behaviors over the course of the pandemic. Understanding these dynamics is crucial for informing interventions and mitigating the impact of future pandemics.