Behavioral Factors Associated with COVID-19 Risk: A Cross-Sectional Survey in Japan.

Background: Behaviors to avoid infection are key to minimizing casualties of the COVID-19 pandemic, as well as to avoid excessive interventions that are less effective. This study aims to identify behavioral patterns associated with SARS-CoV-2 infection in the real world.

Methods: A questionnaire-based cross-sectional study was conducted targeting a research panel of NTTCom Online Marketing Solutions Corporation or its affiliates. Data were extracted so that their demographic composition ratios matched the population estimates. Individuals who answered with consistency to have been diagnosed with SARS-CoV-2 at a medical facility were categorized into a SARS-CoV-2 group. Differences in lifestyles were compared using multiple regression and inverse probability weighing.

Results: In total 13,277 participants were included, of whom 44 (0.33%) were categorized as the SARS-CoV-2 group. Diagnosis of SARS-CoV-2 was negatively correlated with crowd avoidance, mask wearing, and hand-washing behavior. On the contrary, the diagnosis was positively correlated with some behaviors that appear to be preventive actions against the infection, such as changing clothes frequently, sanitizing belongings, and remote working.

Conclusions: It is important to conduct evidence-based intervention on people's behaviors and to avoid excessive interventions that are less effective, so that people can minimize the indirect harm, such as exhaustion and economic loss.