How the social environment associates with infection prevention behavior in adults aged 40 years and older: the SaNAE study

Abstract Aim Non-pharmaceutical infection prevention behaviors (IPBs) are crucial for limiting infectious disease spread. However, most health promotion research has only focused on IPB-associated factors at the individual level, not considering the social environment, i.e., individuals’ interpersonal and community interactions. This study examines which aspects of the social environment are associated with IPBs, while also examining risk perception. Subject and methods Cross-sectional questionnaire data (2022) from adults aged ≥ 40 years living in Limburg, Netherlands, were obtained from the Dutch SaNAE (Social Network Assessment in Adults and Elderly) cohort. The outcome was self-reported IPB, divided into five types: personal IPB (individual hygiene measures, e.g., handwashing), home IPB (measures within household, e.g., cleaning), contact-restricting IPB to protect themselves, contact-restricting IPB to protect others, and COVID-19 testing. Associations with societal (urbanization), community (social and work participation), interpersonal (social network), and individual (risk perception) factors were assessed using logistic regression, adjusted for age, gender, and education. Results In total, 2023 participants were included. Factors positively associated with one or more IPBs included urbanization, social participation, larger and denser social networks, more emotional, informational or practical supporters, larger proportion of relationships rated as good, network satisfaction, greater perceived COVID-19 infection and disease susceptibility and COVID-19 symptom severity, older age, and being a woman. Conclusion The social environment was positively associated with IPB. These findings refine the prevailing policy view that interactions in social environments merely drive infectious disease spread. Policymakers should balance transmission risk mitigation with preserving social interactions that foster IPBs.