An Angus Reid Institute analysis (August 17, 2020) on COVID-19 compliance in Canada suggests that age is a leading factor in the COVID-19 Compliance Index. The younger Canadians are, the less likely they are to follow recommended COVID-19 public health measures (e.g., avoiding travel, minimizing their social bubble) and this non-compliance has been identified as a contributor to Canada’s increasing COVID-19 cases. Similarly, a Swiss study (Sept 13, 2020) on young adults’ non-compliance with COVID-19 public health measures generally identified adolescents and young adults as a group with low compliance, especially with respect to physical distancing measures. In mid-March 2020, the World Health Organization (WHO) recognized that young people have a high potential for spreading the virus and issued a special appeal for their increased compliance, largely because they display mild or no symptoms of COVID-19, while still being infectious.

According to an Ottawa Public Health report (June 2020) on promoting adherence to social distancing, young people’s non-compliance with public health measures may be attributed to their difficulty coping with the changes in their lifestyles and routines imposed by the pandemic (e.g., in-person school, sports, and socializing with friends/peers decreasing), and challenges with managing the resulting feelings of desperation, boredom, and uncertainty. A review (August 2020) on peer influence on adolescence during COVID-19 suggests that the period of life between the ages of 10 and 24 years is associated with increased risk taking, increased need for social connection and peer acceptance, and heightened sensitivity to peer influence.

These factors may result in difficulty adhering to physical distancing rules among young people.

The Ottawa Public Health report (June 2020) suggests that young adults may be receptive to COVID-19 information pertaining to public health measures if the messaging, tone, and style are adapted to optimize reach across age groups. In particular, findings to consider when developing initiatives/interventions include:

• Young people respond to a tone and style that is more hopeful, emphasizing how one’s actions can have an impact or make a difference.
• Young people are more receptive to succinct, highly visual formats (i.e., videos, graphics).
• Family and friends play a key role in influencing behaviour and compliance, along with entertainers, sports figures, online personalities, and public health officials.
• Positive reinforcement provides encouragement, particularly for the younger group, ages 16-24 years.

This section summarizes jurisdictional experiences on the factors that contribute to compliance or non- compliance with COVID-19 public health measures, and strategies or best practices used to increase compliance with COVID-19 public health measures. In terms of jurisdictional experience, information is presented on Ireland, Israel, Switzerland (Zurich), United Kingdom, United States (Wisconsin). No scientific evidence or information from other Canadian jurisdictions was identified.

International Scan

• Compliance and Non-Compliance with Public Health Measures: Reports of youth and young adult compliance/non-compliance were identified regarding physical distancing, mask wearing, and other public health measures (i.e., washing hands, sleeve sneeze, cough into elbow).
  • Compliance: Some research suggests that a minority of youth and young adults have been found to adhere to mask wearing (Wisconsin, United States [US]), and other public health measures (e.g., hygiene practices) (Ireland; Zurich, Switzerland). With regard to the following measures, youth and young adults:
    • Mask Wearing: Adhere to mask wearing due to employment in public spaces and their sense of responsibility to others (e.g., parents, grandparents, immunocompromised individuals).
    • Other Public Health Measures: Comply with other protective measures, such as avoiding groups, coughing or sneezing into one’s elbow, and washing one’s hands regularly.
  • Non-Compliance: Other research suggests that youth and young adults are generally non-compliant with physical distancing (Ireland; US), along with mask wearing (Wisconsin, US), and other public health measures (e.g., hygiene practices) (Israel; Zurich, Switzerland). The male gender, young age, being single, employed, and decreased income are largely associated with non-compliance. With regard to the following measures, youth and young adults:
    • Physical Distancing: Are non-compliant to physical distancing in unavoidable and avoidable situations:
      • Unavoidable Situations: Work requirements for non-essential industries.
      • Avoidable Situations: Engaging in social activities to manage unease from “cabin fever”; meeting with friends; engaging in sports with friends (e.g., playing football, cycling); spending time with friends at different places (e.g., meeting at a shopping centres); travelling to other towns, counties, and cities for socializing; and the belief that other precautions, such as handwashing are sufficient in protecting themselves from COVID-19.

• Mask Wearing: Report not wearing a mask when socializing with friends due to those interactions eliciting a sense of security and acceptance when interacting with friends, and the assumption that they will be unaffected if they contract COVID-19.

• Strategies or Best Practices Increasing Compliance to COVID-19 Public Health Measures: Communications and messaging (Wisconsin, US; Zurich, Switzerland) and social influences (United Kingdom) are used to increase compliance among youth and young adults. Most strategies aim at increasing physical distancing compliance.
  • Communications and Messaging: Provide clear and consistent messages about the effectiveness public health measures and how they can increase young adults’ responsibility to protect others. Smartphones can be used to disseminate awareness about the virus and its methods of transmission.
  • Social Influences: When it comes to physical distancing, family and friends are most influential, especially among younger cohorts, along with various spokespeople such as politicians, experts in the field, entertainers/celebrities, and social media influencers.

Ontario Scan

• Compliance and Non-Compliance with Public Health Measures: Reports of youth and young adult compliance/non-compliance in Ontario were identified regarding physical distancing.
  • Compliance: Some research suggests that a minority of youth and young adults have been found to adhere to physical distancing (Ottawa, Canada). With regard to the following measures, youth and young adults:
    • Physical Distancing: Are slightly more likely to comply with physical distancing restrictions compared to other hygiene measures (e.g., hand washing). Parents are an important factor instilling physical distance compliance through encouraging youth and young adults to stay at home.
  • Non-Compliance: Other research also suggest that youth and young adults are generally non-compliant with physical distancing (Ottawa, Canada). With regard to the following measures, youth and young adults:
    • Physical Distancing: Are non-compliant to physical distancing in unavoidable and avoidable situations:
      • Unavoidable Situations: Building corridors; an elevator; public washrooms; a small grocery store aisle; when taking public transit; workplaces; dense urban settings; circumstances with children; and when living between two homes.
      • Avoidable Situations: The belief that other precautions, such as handwashing are sufficient in protecting themselves from COVID-19; couples in separate households not physically distancing.

• Strategies or Best Practices Increasing Compliance to COVID-19 Public Health Measures: Communications and messaging (Ottawa, Canada) is used to increase compliance among youth and young adults.
  • Communications and Messaging: Those designing initiatives aimed at increasing compliance should consider the use of different key messages, tone, and delivery directed to particular cohorts of youth and young adults. Communication should be clear, accessible, motivational, positive, and outline the consequences of not complying to public health measures.
  • Behavioural Changes and Skill Development: Empowering youth and young adults to physically distance requires developing a range skills and capabilities such as: patience, discipline, and self-awareness; empathy, compassion, and sense of community; becoming more informed; and spatial awareness; and relaxation and positive mental health.

Individual peer-reviewed articles and review articles were identified through PubMed, the Cochrane Library, and Google Scholar. Grey literature was identified through Google and relevant government websites. The search was limited to English sources and therefore may not capture the full extent of initiatives in non-English speaking countries. Full-text results extracted were limited to those available through Open Access or studies made available to the Ministry by our partners.

The COVID-19 Evidence Synthesis Network is comprised of groups specializing in evidence synthesis and knowledge translation. The group has committed to provide their expertise to provide high-quality, relevant, and timely synthesized research evidence about COVID-19 to inform decision makers as the pandemic continues. The following members of the Network provided evidence synthesis products that were used to develop this Evidence Synthesis Briefing Note:

• Evidence Synthesis Unit, Research, Analysis and Evaluation Branch, Ministry of Health. 889. Youth Compliance with COVID-19 Public Health Measures 10-DEC-2020 (SurajbaliK-RAE).

For more information, please contact the Research, Analysis and Evaluation Branch (Ministry of Health).