In response to the novel coronavirus 2019 (COVID-19) outbreak, states have introduced public health measures to limit community transmission of the disease. These measures include public instructions regarding home isolation and quarantine, personal hygiene, restrictions on gathering and traveling, and social distancing. The instructions' efficacy in limiting the spread of the pandemic depends on public adherence to them. Despite the potentially harmful consequences for individuals and public health, nonadherence to the instructions (non-AtI) for the COVID-19 pandemic has been frequent. 1,2 The objective of this study was to identify predictors of non-adherence. The hypothesized predictors were chosen based on the clinical literature regarding risk factors for non-adherence to medical instructions 3 and engagement in risk-taking behavior. 4 These included demographic factors (e.g., male sex), health and personality factors (e.g., psychological distress, attention-deficit/hyperactivity disorder [ADHD] symptoms, low levels of pro-sociality, past risk-taking behavior), and perceptions regarding COVID-19 risk and instruction-related variables (e.g., exposure to the instructions). This study was approved by the ethics committee of the Seymour Fox School of Education at the Hebrew University of Jerusalem. The

Objective. The COVID-19 outbreak created numerous multidimensional stressors, to which people show different levels of vulnerability. The current paper examines whether ADHD symptoms are associated with poorer adaptation. Method. 2055 adults participated in an online survey after the first quarantine in Israel. Participants completed scales probing adaptation indicators: financial status, adherence to preventive measures, mental health, and COVID-19 related perceptions. Background measures, including the level of ADHD symptoms, were collected.Results. Adaptation indicators negatively correlated with the level of ADHD symptoms. Financial decline explained a small portion of the link between ADHD and decreased mental health; background risk-taking, anti-social, and pro-social behavior partially explained the link between ADHD and non-adherence to preventive measures; COVID-19 related perceptions also partially explained the same link.Conclusion. The current study suggests that people with ADHD are more vulnerable to the challenges created by the COVID-19 pandemic and therefore deserve special attention and care.

Objective: The COVID-19 outbreak created numerous multidimensional stressors, to which people show different levels of vulnerability. The current paper examines whether symptoms of ADHD are associated with poorer adaptation. Method: After the first quarantine in Israel, 2,055 adults participated in an online survey. Participants completed scales probing adaptation indicators: financial status, adherence to preventive measures, mental health, and COVID-19 related perceptions. Background measures, including the level of symptoms of ADHD, were collected. Results: Adaptation indicators negatively correlated with the level of symptoms of ADHD. Financial decline explained a small portion of the link between ADHD and decreased mental health. Background risk-taking, anti-social, and pro-social behavior partially explained the link between ADHD and non-adherence to preventive measures. COVID-19 related perceptions also partially explained that link. Conclusion: This study suggests that people with ADHD are more vulnerable to the challenges created by the COVID-19 pandemic and therefore deserve special attention and care.

Question What factors are associated with non-adherence to public health instructions during COVID-19? FindingsIn a cross-sectional study of 654 Israeli participants, non-adherence to instructions was associated with male gender, not having children, smoking, high levels of attention-deficit/hyperactivity disorder (ADHD) symptoms, low level of pro-sociality, and high levels of past risk-taking behavior, as well as by current high psychological distress, high perceived risk of the COVID-19, high exposure to the instructions, and high perceived efficacy of the instructions.Meaning The findings suggest that in setting out and communicating public health instructions, policymakers should consider the above sociodemographic, health-related, risk-related, and instructionrelated characteristics. Abstract Importance: Identifying risk factors for adherence to public health instructions for the COVID-19 pandemic may be crucial for controlling the rate of transmission and the pandemic's health and economic impacts.Setting: Population-based study.Participants: A convenience sample completed an online survey.Exposures: Sociodemographic, health-related, risk-related, and instruction-related characteristics of the participants that have been linked to adherence to medical instructions.Main Outcome and Measure: Non-adherence to instructions defined by a mean score of less than 4 on a 1 to 5 adherence scale consisting of 19 instruction items. Results: Among 654 participants (413 [64.8%] female, age 40.14 [15.23] years), 28.7% were defined as non-adherents. Non-adherence was associated with male gender [adjusted odds ratio (aOR) = 1.54, CI 1.03-2.31], not having children [aOR = 1.73, 1.13-2.65], smoking [aOR = 2 .27, CI 1.42-3.62], high levels of ADHD symptoms [aOR = 1.55, CI 1.07-2.25], high levels of past risk-taking behavior [aOR = 1.41, CI 1.10-1.81], as well as by current high psychological distress [aOR = 1.51, CI 1.14-2.01], low perceived risk of COVID-19 [aOR = 1.52, CI 1.22-1.89], low exposure to the instructions [aOR = 1.45, CI 1.14-1.82], and low perceived efficacy of the instructions [aOR = 1.47, CI 1.16-1.85]. Adjusted OR of age, economic status, physical health status, and exposure to media did not reach the significance level. Conclusions and RelevancePeople with the above characteristics may have increased risk for nonadherence to public health instructions. There appears to be a need for setting out and communicating instructions to specifically targeted at-risk populations.

Background To determine factors that predict non-adherence to preventive measures for COVID-19 during the chronic phase of the pandemic. Methods A cross-sectional, general population survey was conducted in Israel. Sociodemographic, health-related, behavioral and COVID-19-related characteristics were collected. Results Among 2055 participants, non-adherence was associated with male gender, young age, bachelorhood, being employed, lower decrease in income, low physical activity, psychological distress, ADHD symptoms, past risk-taking and anti-social behavior, low pro-sociality, perceived social norms favoring non-adherence, low perceived risk of COVID-19, low perceived efficacy of the preventive measures, and high perceived costs of adherence to the preventive measures. Conclusion There appears to be a need for setting out and communicating preventive measures to specifically targeted at-risk populations.