Exploration of Chinese Parental Awareness About COVID-19 Outbreaks

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The aim of this research was to investigate Chinese parents’ awareness of pediatric COVID-19 in relation to protecting their children. Methods: A cross-sectional study was conducted in Fujian and Jiangsu provinces in China using a web-based research questionnaire to investigate parents with children aged 6 to 16 years old. Results: Research samples included 1222 participants. 99.2% of participants were aware of respiratory transmission of COVID-19, and 75.6% also believed fecal-oral transmission to be possible. Although 98.3% of participants reported knowing how to properly wear and remove masks, most parents were unaware of good handwashing technique and answered incorrectly regarding cough etiquette. Research participants seemed uncertain of children’s symptoms. Awareness scores of participants significantly differed across parental role, educational attainment levels, and social-economic levels (P<0.005), with fathers, the better educated, and those of higher income showing higher levels of awareness. Conclusion: Research results suggest an urgent need for parental education regarding COVID-19 in children, especially regarding handwashing techniques and cough etiquette; educational facilities and outreach to parents and schoolchildren are particularly important. Health Economics & Outcomes Research Infectious Diseases Health Policy Parental Awareness COVID-19 Prevention Schoolchildren Outbreak Background The recent novel coronavirus outbreak was first detected in Wuhan, China in late December 2019. By July. 2020, it has spread to 216 countries and territories, resulting in over 12 million confirmed cases and fifty-five thousand deaths [ 1 – 2 ]. This new pandemic was officially determined by World Health Organization (WHO) to be an novel coronavirus disease (abbreviated as COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [ 2 ]. Where infection rate is concerned, young children seem to be less susceptible to COVID-19 infection than adults; additionally, children with COIVD-19 became less ill and demonstrated less obvious symptom and classic [ 3 ]. Current investigations have confirmed that SARS- CoV‐2 enters cells by binding to the angiotensin‐converting enzyme 2 (ACE‐2) cell receptor and facilitate internalization of the virus into human cells. That may explain this different infection rate between adults and children because of low ACE2 expression in children [ 3 – 5 ]. However, evidence has proved children can get COVID-19 like adults, and pediatric COVID-19 cases are now gradually increasing in different countries. 6–9 The most common clinical manifestations of pediatric cases are fever, cough, or shortness of breath (over 60%) followed by headache (15% in 0–9 year old pediatric patients, 42% in 10–19 year old pediatric patients) [ 7 – 8 ]. According to clinical characteristics of existing pediatric cases, children with COVID-19 can be divided into five clinical types: asymptomatic infection, mild, common, severe, and critically severe [ 8 – 10 ]. In comparison adult patients, most children diagnosed with the disease experience mild symptoms, faster recovery, shorter detoxification time, and good prognosis [ 8 – 9 ]. However, a rare new serious multisystem inflammatory syndrome, related to COVID-19 and apparently caused by overactive immune responses in old children and adolescents, can occur, and the number of these atypical cases in pediatric patients has been increasing since the middle of April. 2020 in Europe, Canada, and the United States [ 11 – 12 ]. COVID-19 is highly contagious and transmits mainly from person-to-person contact with respiratory droplets of an infected person and usually through coughing and sneezing [ 13 – 16 ]. Currently, experts believe that SARS-CoV‐2 can be transmitted through direct, indirect, or close contact with infected secretions (saliva, respiratory droplets, eye discharge, feces or urine) [ 17 – 18 ]. Infection can occur by multiple routes including contact and droplet transmission, touch contaminated surfaces and objects (Fomite transmission), aerosols transmission, fecal-oral, and waterborne routes [ 14 – 17 ]. WHO has acknowledged that the coronavirus can be spread by tiny particles suspended in the air [ 16 – 17 ]. A South Korea’s study found that children, younger than 10, transmit COVID-19 to others much less often than adults do; however, children, between 10–19 years old seemed to transmit the virus as well as adults do [ 19 ]. This research, conducted during school closure, also found that the highest COVID-19 rate in school-aged children and the lowest for household contacts of children 0–9 years [ 19 ]. In contract, an investigation in Wuhan and Shanghai, China, found that school closures and social distancing significantly reduced COVID-19 rates among school-age children [ 16 ]. Based on above research, personal protective measures, personal hygiene, and appropriate social distance remain the most viable options for prevention among children [ 6 , 19 , 21 – 26 ]. In recent months schools around the world have gradually begun to reopen, including in most provinces in China, causing many parents to fear for their children’s safety in the midst of a pandemic. To keep students safe, self-protection measures and educational facilities and outreach are particularly important, and parental awareness regarding COVID-19 must first be evaluated. As schools reopen in China and around the world, such studies will be essential to a safe reopening process. The aim of this research was to investigate the awareness of parents regarding pediatric COVID-19 in relation to protecting their children. Methods Study design and setting A cross-sectional research was conducted in Fujian province provinces from 25th. May. through 25th. June. 2020, as most schools in China reopened after COVID-19 outbreak. Study population and participant selection Because literature found that school-age children may transmit the COVID-19 virus more easily than younger children or adults [ 19 – 20 ], the criteria of inclusive sampling for this study were parents of children aged 6 to 16 years old who could read Chinese. The criteria of exclusive sampling were the parents of younger ( 16 y/o), or parents unable to read Chinese. Sample size calculation To estimate the sample size needed for this study, we used the “Multiple Linear Regression: Fixed model, R 2 deviation from zero” in the G-Power 3.1 [ 27 – 28 ] with small effect size (0.01), power = 0.8, type I error = 0.05, and number of predictors = 5. The total sample size was 1289. The estimated incomplete data was 10%, the final sample sized we needed were 1428. Instrument and measurement The questionnaire was constructed and developed based on literature [ 8 – 9 , 18 – 21 ]. It comprised 8 demographic questions and 25 questions assess parental awareness regarding COVID-19 in children, with Sect. 1 (7 questions) covering transmission routes, Sect. 2 (4 questions) covering preventive measures, and Sect. 3 (14 questions) covering symptoms of COVID-19 in children. For each question of Sect. 1 and 2, the response options were on a 5- point Likert-type scale (1 = strong disagreement, 2 = disagreement, 3 = unsure, 4 = agreement, 5 = strong agreement). For each question of in Sect. 3, the response options were no (1) and yes (2). Two questions in Sect. 2 were negatively worded (Question 9 and Question 11). In Sect. 3, the correct answer to five questions was false (yes) (S9, S11-S14). In this research, dependent variable was total score of awareness and independent variables were parental role, educational attainment, and socio-economic status. Reliability and Validity The content validity Index (CVI) of research questionnaire was 0.85 to evaluate by a panel of five experts including three clinical experts (two doctors and one nursing manager) and two pediatric scholars. Internal consistency reliability evaluated with overall Cronbach’s alpha coefficient was 0.8, 0.858 for questions of transmission routes (Sect. 1), 0.794 for questions on preventive measurements (Sect. 2), and 0.746 for questions on symptoms of COVID-19 (Sect. 3). Data Collection The study was reviewed and approved by the Institutional Review Board of Putain University (approval number: 2020-33). Research data was collected via an online survey. Participants were recruited via the snowball sampling techniques and a consent form was including a link to the web survey platform. All participants had to answer a yes or no question to voluntarily confirm their willingness to participate before data were collected. Statistical Analysis Data were analyzed using the Statistical Package for Social Sciences (SPSS) software version 26. The research data were described by number and frequency for categorical data and mean, standard deviations and range were used for continuous variables. Multiple linear regression models were used to explore the possible factors affecting participants’ awareness regarding children COVID-19. A p value of less than 0.05 was considered as statistically significant. Research Results Participants’ demographic data A total of 1360 participants completed the online questionnaire. After detailed review of the responses 138 questionnaires were excluded to missing data or duplications, for the final total of 1222 responses from Fujian province. The average age of participants was 39.3 y/o (range: 23–58, standard deviation: 5.161). The educational attainment of the majority of participants was junior high school (55.6%) and 53.3% were farmers. Most reported middle-class household social-economic status. Table 1 summarizes the demographic profile of participants in this study. Table 1 Characteristics of Participants (N = 1222) Characteristic Numbers of Participants Percentage Gender Male 419 34.3% Female 803 65.7% Parental Role Father 419 34.3% Mother 803 65.7% Marital status Single 54 4.4% Married 1168 95.6% Numbers of Children One 142 11.6% Two 683 55.9% Three or more 397 32.5% Occupation Civil Servant, Teacher 48 3.9% Farmer 651 53.3% Labor 259 21.2% Businessman 124 10.1% Clinician 72 5.9% Other 68 5.6% Educational Attainment Primary School or Under 245 20% Junior High School 679 55.6% High School 140 11.5% Undergraduate 139 11.4% Postgraduate 19 1.6% Residential Status Houseowner 1081 87.3% Renter 155 12.7% Socio-Economic Status Poor 85 7% Middle-class 908 74.3% Well-off 227 18.6% Rich 2 0.2% Descriptive data and outcome data In Sect. 1, Transmission Routes, the majority of participants believed that “COVID-19 virus transmits via respiratory droplets of infected patients” (99.2%) and most (94.3%) believed that uncovered sneezing or cough could spread COVID-19 virus. 75.6% believed that virous may be transmitted by patients’ feces, urine and excrements. Additionally, only 853 participants (69.8%) believed that COVID-19 virus may spread by eating contaminated food. In Sect. 2, regarding the personal preventive measures, the majority of participants (95.7%) strongly agreed or agreed with the statement “a good handwashing should last for at least 10 seconds”. Additionally, most (92.2%) strongly agreed or agreed with the statement “people should cover their moth while sneezing and coughing by hands”. Unfortunately, based on the WHO and CDC recommendations to people for the prevention of COIVD-19, these responses were incorrect (Table 2 ). Table 2 Distributions of Participants’ Awareness (number/ percentage, N = 1222) Questions Strongly/ agree Unsure Strongly /Disagree Section 1: How is COVID-19 transmitted? Q1. Respiratory Droplets of Patients Mean: 4.78, SD:0.435 1212/ 99.2% 10/ 0.8% 0/0 Q2. Feces, Urine and Excrement Mean:4.13, SD: 0.954 924/75.6% 231/ 18.9% 67/ 5.5% Q3. Eye Discharge of Patients Mean:4.13, SD: 0.959 930/ 76.3% 206/ 16.9% 83/ 6.8% Q4. Uncovered Sneeze, or Cough Mean:4.55, SD:0.71 1153/ 94.3% 42/3.4% 27/ 2.2% Q5. Direct Hand Contact with an Infected Person’s Respiratory Droplets Mean:4.24, SD:0.925 1005/ 82.3% 137/ 11.2% 80/ 6.5% Q6. Eating Contaminated Food Mean: 3.98, SD:1.028 853/ 69.8% 254/ 20.8% 115/ 9.4% Q7. Touching Other’s Clothes and Shoes; Mean: 4.02, SD:1.00 880/ 72% 234/ 19.1% 108/ 8.8% Section 2: Knowledge of COVID-19 Preventive Measures Q8. I understand how to properly wear and remove masks. Mean: 4.64, SD:0.528 1201/98.3% 18/1.5% 3/ 0.3% Q9. A good handwashing should last for at least 10 seconds; Mean: 4.58, SD: 0.683 (Reverse question) 1190/ 95.7% 25/ 2% 27/ 2.2% Q10. I separate outdoor clothes and indoor clothes. Mean: 4.59, SD: 0.564 1185/96.9% 34/ 2.8% 3/0.3% Q11. In order to prevent spreading the virus, we should cover our mouth with our hands when coughing or sneezing. Mean: 4.47, SD:0814 (Reverse question) 1126/ 92.2% 33/ 2.7% 63/ 5.1% Q12, Sect. 3: What are the symptoms of COVID-19 in children? (Number/Percentage of “Yes”) S1. Fever: 1196/ 97.9%; S2. Stuffy Nose & Cough: 746/ 61%; S3. Sneezing: 594/ 48.6% S4. Nausea & Vomiting : 611/ 50%; S5. Diarrhea: 426/ 34.9%; S6. Myalgia: 323/ 26.4% S7. Fatigue: 354/ 28.7%; S8. Itchy Eyes & Watery Eyes: 204/ 16.7%; S9. Itchy & Red Rash: 141/11.5% S10. Loss of smell or taste: 163/13.3%; S11. Swollen Joints:81/6.6%; S12.Flushed Face, Sweaty: 227/ 18.6%; S13. Chapped lips:143/ 11.7%; S14. Stomatitis: 273/ 22.3% In Sect. 3, Symptoms of COVID-19 In Children, the majority of participants (97.9%) responded that fever was one of the symptoms of COVID-19 in children, and 61% believed that stuffy nose and coughing were also symptoms. Few participants believed that the symptoms of “nausea & vomit” (50%) and “diarrhea” (34%) were related to pediatric COVID-19. Literature did not suggest that swollen joints, flushed face, sweaty, chapped lips may not relate to COVID-19, and indeed few participants considered those symptoms related to COVID-19. Table 2 displays distribution and comparison of participants’ awareness levels. Factors associated with awareness score toward COVID-19 prevention Awareness scores significantly differed by parental relationship (mother or father), educational attainment, and social - economic Status ( p < 0.05; Table 3 ), after adjusting for the age effect. More specially, the results of multiple liner regression analysis exhibited that mothers had, on average, 0.779 units significantly lower score of awareness regarding pediatric COIVD-19 than did fathers (estimate= -0.779; p = 0.026; Table 3 ), after adjusting for other factors. Participants with higher academic attainment had higher awareness scores. After adjusting of other factors’ effects, those participants with a high school diploma (estimate: 1.588, p = 0.007; Table 3 ), an undergraduate degree (estimate: 2.224, p < 0.001; Table 3 ), or a graduated degree (estimate: 2.554, p = 0.046; Table 3 ) had higher awareness score than those with the lowest educational attainment (primary school or less). Participants in the highest socio-economic class had higher awareness scores than those in the lowest class (estimate: 1.504, p = 0.031). Table 3 Multiple Linear Regression Models of Significant Impact Factors on Awareness (N = 1222) Variables Estimate SE 95% CI P Intercept 62.962 1.589 59.846,66.077 < 0.001* Parental Role Mother versus Father a -0.779 0.349 -1.465, -0.093 0.026* Educational Attainment Postgraduate 2.554 1.282 0.04, 5.068 0.046* Undergraduate 2.224 0.584 1.079, 3.37 < 0.001* High School 1.588 0.589 0.432, 2.743 0.007* Junior High School 0.721 0.424 -0.11, 1.552 0.089 Primary school or Under 0 a Socio-Economic Status Rich 1.885 3.843 -5.648, 9.417 0.624 Well-off 1.504 0.696 0.139,2.869 0.031* Middle-class 0.905 0.612 -0.296, 2.106 0.140 Poor 0 a Age -0.059 0.032 -0.123, 0.006 0.074 Note: Dependent variable: Total Score of Awareness; Model: (Intercept), Parental Role, Educational Attainment, Socio-Economic Status. a. Set to zero because this parameter is redundant. * p < 0.05 Discussion To our Knowledge, this is the first investigation of Chinese parents’ awareness regarding pediatric COVID-19. Research was conducted as most schools reopened after the COVID-19 outbreak, while China was no longer at the epidemic stage but still a dangerously affected area, especially with many imported confirmed cases. In contrast to a previous study in Wuhan city [ 10 ], most participants in this study were farmers with low educational attainment (55% junior high school). In Fujian province, almost 50% residents are farmers. To this point, Fujian has recorded 367 COVID-19 patients including 71 patients recently came from abroad or from other provinces, and no confirmed infections in children. Therefore, this research data may be considered and accurate picture of the Fujian population. In our research, although most participating parents knew that respiratory transmission (patients’ droplets) was the main transmitted route of COVID-19; few recognized contact transmission as another transmitted rout for the virus (Question 4, 5, & 7; Table 2 ). In this study, 69.8% of participants believed that contaminated food may be a transmission route, but 20.8% participants doubted this theory. Although one hypothesis proposes that the COVID-19 virus may be transmitted via respiratory droplets on the surface of food or food package, currently no evidence proves this hypothesis. Good handwashing, personal hygiene practices, and choice of grocery stores are more important [ 18 ]. Personal preventive measures towards COVID-19, including proper handwashing, appropriate facemask use, and respiratory hygiene practices (cough etiquette), are particularly important [ 18 – 19 ]. Clinical experts recommend that proper handwashing technique involve 7 steps and last at 20 seconds [ 23 – 25 ], and it is recommended to cover nose and mouth with tissue or and an elbow rather than hands when coughing or sneezing [ 17 , 21 – 26 ]. However, our research revealed that the majority of participants had incorrect information on handwashing technique and respiratory hygiene practice (Table 2 , q11 and q12). These parents urgently need accurate and appropriate information to correct these misunderstandings. Additionally, evidence has found differences between the COVID-19 symptoms of children and those of adults [ 8 – 9 ]. In this research, most participants knew that fever and cough are symptoms of COVID-19 in children, but few knew that sneezing is also a symptom. Unlikely adult patients, children with COVID-19 have digestive symptoms (nausea, vomiting, diarrhea) [ 6 – 8 , 20 ]. Our research found that participants lack knowledge regarding the symptoms of COVID-19 in children (Table 2 ). Parental role, educational attainment and socio-economic condition were significant factors affecting COVID-19 awareness scores. Research participants who were fathers, more highly educated, and of a higher socio-economic status showed better awareness than did others. We assure that more educated, and prosperous parents may possess more resources and access to information on COVID-19, and accordingly better hygiene practices, than parents of lower education and income. These results are likely consisted with a previous study [ 10 , 16 ]. Investigations in other countries have also revealed that educational attainment, poverty level on awareness regarding COVID-19 [ 19 , 29 ]. Limitation One important limitation of this study was that it is not representativeness of the Chinese population as a whole due to use of a snowball sampling method to recruited participants. Additionally, since research setting was limited to two provinces in China, data may not represent the conditions in other provinces which suffered many COVID-19 cases during the outbreak. Conclusion Because the COVID-19 is a new disease which infected only few children in China during outbreak, and due to the prevalence of myths and misinformation about this virus, parents lacked clear protective information on protecting children during the critical outbreak in China. However, evidence has found that children of all age can be infected and develop COVID-19. Our research results suggest an urgent need to improve parental knowledge regarding the transmission routes, symptoms in children, and preventive measures for children, especially handwashing techniques. cough etiquette and recognition of children’s COVID-19 symptoms. Moreover, we also suggest an urgent push to develop educational outreaches to parents and schoolchildren to promote personal hygiene knowledge and practice to protect both children and their families. Further studies are needed to develop and evaluate the effectiveness of these programs. Abbreviations WHO: World Health Organization; COVID-19: Novel Coronavirus Disease; SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2 ACE‐2 : Angiotensin‐Converting Enzyme 2 CDC: Centers for Disease Control and Prevention Declarations - Ethics approval and consent to participate: The study was reviewed and approved by the Institutional Review Board of Putain University (approval number: 2020-33). Written informed consent was posted on web-based questionnaire and all participants had to log into web-based questionnaire and answer a yes or no question to voluntarily confirm their willingness to participate before data were collected. - Consent to publish: Not applicable. - Availability of data and materials: This research datasets generated and analyzed during this study are not publicly available due to the sensitive nature of the data and ethics restrictions on data sharing. Respondents did not consent to have their data publicly shared. - Competing interests: The authors declare that they have no competing interests. -Funding: This research has no foundation and no financial support. - Authors' Contributions: N-H Peng, JF Zhou conceived and designed the study. H Meng, ZZ Li, BR Wei, MX Huang contributed research data collection, Y‐C Chang was responsible for data analysis. All authors have read and approved the manuscript. - Acknowledgements: The authors thank all research participants for their attending and many contributions. References World Health Organization (WHO), The Coronavirus disease (COVID-19) pandemic. 2019, https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=EAIaIQobChMI24jsrsHE6gIV06mWCh1oTgIuEAAYASAAEgIQGfD_BwE World Health Organization (WHO). 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Annals of Internal Medicine, 9 April 2020. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151355/pdf/aim-olf-M201239.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-89502","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research article","associatedPublications":[],"authors":[{"id":3326269,"identity":"f50cd4f5-3e01-423f-8c5e-c56f6c8387f5","order_by":0,"name":"Niang-Huei Peng","email":"","orcid":"","institution":"Putian University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Niang-Huei","middleName":"","lastName":"Peng","suffix":""},{"id":3326270,"identity":"593cd334-e3aa-4835-9268-1a06f1ea642f","order_by":1,"name":"Hongyan Meng","email":"","orcid":"","institution":"Soochow University Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hongyan","middleName":"","lastName":"Meng","suffix":""},{"id":3326271,"identity":"4f384154-0811-471b-8b3d-617e9e83d5c2","order_by":2,"name":"ZhenZhen Li","email":"","orcid":"","institution":"Putian University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"ZhenZhen","middleName":"","lastName":"Li","suffix":""},{"id":3326272,"identity":"1a6cf224-010a-4c64-ac8c-b7b1c2054538","order_by":3,"name":"BiRong Wei","email":"","orcid":"","institution":"Putian University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"BiRong","middleName":"","lastName":"Wei","suffix":""},{"id":3326273,"identity":"ae1dcef2-9371-45fd-bd96-b72a799d6092","order_by":4,"name":"Yue‐Cune Chang","email":"","orcid":"","institution":"Tamkang University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yue‐Cune","middleName":"","lastName":"Chang","suffix":""},{"id":3326274,"identity":"e5d193fc-39bd-44b9-b78a-b179c0cf306f","order_by":5,"name":"MaoXin Huang","email":"","orcid":"","institution":"Putian University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"MaoXin","middleName":"","lastName":"Huang","suffix":""},{"id":3326275,"identity":"65cc2168-a6ed-4cac-83d7-2224f05fd1d4","order_by":6,"name":"JianFu Zhou","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYDACZijNL//4AANjA3FaIOokG9ISiNTCAFVncCDHgDgtBseZnz/4uOewPcOBM98kfu6wkWNgP3x0A14th9kMG2c8O8zM2Ni7TbL3TJoxA09a2g18WiSbeRibeQ4cZmNm5t0mwdt2OLFBgseMKC08bGw8zyT/EqOFnxmiRYKHh4dNmihb+JnZDGfOOJBuICHBZmwt25ZmzEbIL2z8hx98+HDA2t7+BvPDm2/bbOT42Q8fw6sFCppBBIsE2BAilINAHYhg/kCk6lEwCkbBKBhhAADFlkarUFxtrAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-5322-3238","institution":"Putian University School of Medicine","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"JianFu","middleName":"","lastName":"Zhou","suffix":""}],"badges":[],"createdAt":"2020-10-08 00:50:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-89502/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-89502/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":13603577,"identity":"9e18340d-933f-4821-bfd8-61e03b39ba63","added_by":"auto","created_at":"2021-09-17 05:56:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":418951,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-89502/v1/c375b196-a39c-4026-8530-255630eef82e.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eExploration of Chinese Parental Awareness About COVID-19 Outbreaks\u003c/p\u003e","fulltext":[{"header":"Background","content":" \u003cp\u003eThe recent novel coronavirus outbreak was first detected in Wuhan, China in late December 2019. By July. 2020, it has spread to 216 countries and territories, resulting in over 12\u0026nbsp;million confirmed cases and fifty-five thousand deaths [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. This new pandemic was officially determined by World Health Organization (WHO) to be an novel coronavirus disease (abbreviated as COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Where infection rate is concerned, young children seem to be less susceptible to COVID-19 infection than adults; additionally, children with COIVD-19 became less ill and demonstrated less obvious symptom and classic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Current investigations have confirmed that SARS- CoV‐2 enters cells by binding to the angiotensin‐converting enzyme 2 (ACE‐2) cell receptor and facilitate internalization of the virus into human cells. That may explain this different infection rate between adults and children because of low ACE2 expression in children [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, evidence has proved children can get COVID-19 like adults, and pediatric COVID-19 cases are now gradually increasing in different countries.\u003csup\u003e6\u0026ndash;9\u003c/sup\u003e The most common clinical manifestations of pediatric cases are fever, cough, or shortness of breath (over 60%) followed by headache (15% in 0\u0026ndash;9\u0026nbsp;year old pediatric patients, 42% in 10\u0026ndash;19\u0026nbsp;year old pediatric patients) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. According to clinical characteristics of existing pediatric cases, children with COVID-19 can be divided into five clinical types: asymptomatic infection, mild, common, severe, and critically severe [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In comparison adult patients, most children diagnosed with the disease experience mild symptoms, faster recovery, shorter detoxification time, and good prognosis [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, a rare new serious multisystem inflammatory syndrome, related to COVID-19 and apparently caused by overactive immune responses in old children and adolescents, can occur, and the number of these atypical cases in pediatric patients has been increasing since the middle of April. 2020 in Europe, Canada, and the United States [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCOVID-19 is highly contagious and transmits mainly from person-to-person contact with respiratory droplets of an infected person and usually through coughing and sneezing [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Currently, experts believe that SARS-CoV‐2 can be transmitted through direct, indirect, or close contact with infected secretions (saliva, respiratory droplets, eye discharge, feces or urine) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Infection can occur by multiple routes including contact and droplet transmission, touch contaminated surfaces and objects (Fomite transmission), aerosols transmission, fecal-oral, and waterborne routes [\u003cspan additionalcitationids=\"CR15 CR16\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. WHO has acknowledged that the coronavirus can be spread by tiny particles suspended in the air [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A South Korea\u0026rsquo;s study found that children, younger than 10, transmit COVID-19 to others much less often than adults do; however, children, between 10\u0026ndash;19\u0026nbsp;years old seemed to transmit the virus as well as adults do [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This research, conducted during school closure, also found that the highest COVID-19 rate in school-aged children and the lowest for household contacts of children 0\u0026ndash;9\u0026nbsp;years [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In contract, an investigation in Wuhan and Shanghai, China, found that school closures and social distancing significantly reduced COVID-19 rates among school-age children [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBased on above research, personal protective measures, personal hygiene, and appropriate social distance remain the most viable options for prevention among children [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In recent months schools around the world have gradually begun to reopen, including in most provinces in China, causing many parents to fear for their children\u0026rsquo;s safety in the midst of a pandemic. To keep students safe, self-protection measures and educational facilities and outreach are particularly important, and parental awareness regarding COVID-19 must first be evaluated. As schools reopen in China and around the world, such studies will be essential to a safe reopening process. The aim of this research was to investigate the awareness of parents regarding pediatric COVID-19 in relation to protecting their children.\u003c/p\u003e "},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eStudy design and setting\u003c/h2\u003e\n\u003cp\u003eA cross-sectional research was conducted in Fujian province provinces from 25th. May. through 25th. June. 2020, as most schools in China reopened after COVID-19 outbreak.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2\u003eStudy population and participant selection\u003c/h2\u003e\n\u003cp\u003eBecause literature found that school-age children may transmit the COVID-19 virus more easily than younger children or adults [\u003cspan class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e], the criteria of inclusive sampling for this study were parents of children aged 6 to 16\u0026nbsp;years old who could read Chinese. The criteria of exclusive sampling were the parents of younger (\u0026lt;\u0026thinsp;6 y/o) or older (\u0026gt;\u0026thinsp;16 y/o), or parents unable to read Chinese.\u003c/p\u003e\n\u003ch2\u003eSample size calculation\u003c/h2\u003e\n\u003cp\u003eTo estimate the sample size needed for this study, we used the \u0026ldquo;Multiple Linear Regression: Fixed model, R\u003csup\u003e2\u003c/sup\u003e deviation from zero\u0026rdquo; in the G-Power 3.1 [\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e28\u003c/span\u003e] with small effect size (0.01), power\u0026thinsp;=\u0026thinsp;0.8, type I error\u0026thinsp;=\u0026thinsp;0.05, and number of predictors\u0026thinsp;=\u0026thinsp;5. The total sample size was 1289. The estimated incomplete data was 10%, the final sample sized we needed were 1428.\u003c/p\u003e\n\u003ch2\u003eInstrument and measurement\u003c/h2\u003e\n\u003cp\u003eThe questionnaire was constructed and developed based on literature [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e]. It comprised 8 demographic questions and 25 questions assess parental awareness regarding COVID-19 in children, with Sect.\u0026nbsp;1 (7 questions) covering transmission routes, Sect.\u0026nbsp;2 (4 questions) covering preventive measures, and Sect.\u0026nbsp;3 (14 questions) covering symptoms of COVID-19 in children. For each question of Sect.\u0026nbsp;1 and 2, the response options were on a 5- point Likert-type scale (1\u0026thinsp;=\u0026thinsp;strong disagreement, 2\u0026thinsp;=\u0026thinsp;disagreement, 3\u0026thinsp;=\u0026thinsp;unsure, 4\u0026thinsp;=\u0026thinsp;agreement, 5\u0026thinsp;=\u0026thinsp;strong agreement). For each question of in Sect.\u0026nbsp;3, the response options were no (1) and yes (2). Two questions in Sect.\u0026nbsp;2 were negatively worded (Question 9 and Question 11). In Sect.\u0026nbsp;3, the correct answer to five questions was false (yes) (S9, S11-S14). In this research, dependent variable was total score of awareness and independent variables were parental role, educational attainment, and socio-economic status.\u003c/p\u003e\n\u003ch2\u003eReliability and Validity\u003c/h2\u003e\n\u003cp\u003eThe content validity Index (CVI) of research questionnaire was 0.85 to evaluate by a panel of five experts including three clinical experts (two doctors and one nursing manager) and two pediatric scholars. Internal consistency reliability evaluated with overall Cronbach\u0026rsquo;s alpha coefficient was 0.8, 0.858 for questions of transmission routes (Sect.\u0026nbsp;1), 0.794 for questions on preventive measurements (Sect.\u0026nbsp;2), and 0.746 for questions on symptoms of COVID-19 (Sect.\u0026nbsp;3).\u003c/p\u003e\n\u003ch2\u003eData Collection\u003c/h2\u003e\n\u003cp\u003eThe study was reviewed and approved by the Institutional Review Board of Putain University (approval number: 2020-33). Research data was collected via an online survey. Participants were recruited via the snowball sampling techniques and a consent form was including a link to the web survey platform. All participants had to answer a yes or no question to voluntarily confirm their willingness to participate before data were collected.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n\u003cp\u003eData were analyzed using the Statistical Package for Social Sciences (SPSS) software version 26. The research data were described by number and frequency for categorical data and mean, standard deviations and range were used for continuous variables. Multiple linear regression models were used to explore the possible factors affecting participants\u0026rsquo; awareness regarding children COVID-19. A \u003cem\u003ep\u003c/em\u003e value of less than 0.05 was considered as statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Research Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eParticipants\u0026rsquo; demographic data\u003c/h2\u003e\n\u003cp\u003eA total of 1360 participants completed the online questionnaire. After detailed review of the responses 138 questionnaires were excluded to missing data or duplications, for the final total of 1222 responses from Fujian province. The average age of participants was 39.3 y/o (range: 23\u0026ndash;58, standard deviation: 5.161). The educational attainment of the majority of participants was junior high school (55.6%) and 53.3% were farmers. Most reported middle-class household social-economic status. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e summarizes the demographic profile of participants in this study.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eCharacteristics of Participants (N\u0026thinsp;=\u0026thinsp;1222)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCharacteristic\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eNumbers of Participants\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003ePercentage\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e419\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e803\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eParental Role\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFather\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e419\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMother\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e803\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e65.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1168\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e95.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumbers of Children\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOne\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e142\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eTwo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e683\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThree or more\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e397\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eCivil Servant, Teacher\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eFarmer\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e651\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e53.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eLabor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e259\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eBusinessman\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e124\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eClinician\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e72\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOther\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducational Attainment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary School or Under\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e245\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJunior High School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e679\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e55.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e140\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUndergraduate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e139\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e11.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePostgraduate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eResidential Status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHouseowner\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1081\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e87.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRenter\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e155\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-Economic Status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePoor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMiddle-class\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e908\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e74.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWell-off\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e227\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRich\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003ch2\u003eDescriptive data and outcome data\u003c/h2\u003e\n\u003cp\u003eIn Sect.\u0026nbsp;1, Transmission Routes, the majority of participants believed that \u0026ldquo;COVID-19 virus transmits via respiratory droplets of infected patients\u0026rdquo; (99.2%) and most (94.3%) believed that uncovered sneezing or cough could spread COVID-19 virus. 75.6% believed that virous may be transmitted by patients\u0026rsquo; feces, urine and excrements. Additionally, only 853 participants (69.8%) believed that COVID-19 virus may spread by eating contaminated food.\u003c/p\u003e\n\u003cp\u003eIn Sect.\u0026nbsp;2, regarding the personal preventive measures, the majority of participants (95.7%) strongly agreed or agreed with the statement \u0026ldquo;a good handwashing should last for at least 10 seconds\u0026rdquo;. Additionally, most (92.2%) strongly agreed or agreed with the statement \u0026ldquo;people should cover their moth while sneezing and coughing by hands\u0026rdquo;. Unfortunately, based on the WHO and CDC recommendations to people for the prevention of COIVD-19, these responses were incorrect (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDistributions of Participants\u0026rsquo; Awareness (number/ percentage, N\u0026thinsp;=\u0026thinsp;1222)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eQuestions\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStrongly/ agree\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eUnsure\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eStrongly /Disagree\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSection 1: How is COVID-19 transmitted?\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ1. Respiratory Droplets of Patients\u003c/p\u003e\n\u003cp\u003eMean: 4.78, SD:0.435\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1212/ 99.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10/ 0.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0/0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ2. Feces, Urine and Excrement\u003c/p\u003e\n\u003cp\u003eMean:4.13, SD: 0.954\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e924/75.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e231/ 18.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e67/ 5.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ3. Eye Discharge of Patients\u003c/p\u003e\n\u003cp\u003eMean:4.13, SD: 0.959\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e930/ 76.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e206/ 16.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83/ 6.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ4. Uncovered Sneeze, or Cough\u003c/p\u003e\n\u003cp\u003eMean:4.55, SD:0.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1153/ 94.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42/3.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27/ 2.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ5. Direct Hand Contact with an\u003c/p\u003e\n\u003cp\u003eInfected Person\u0026rsquo;s Respiratory Droplets\u003c/p\u003e\n\u003cp\u003eMean:4.24, SD:0.925\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1005/ 82.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e137/ 11.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e80/ 6.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ6. Eating Contaminated Food\u003c/p\u003e\n\u003cp\u003eMean: 3.98, SD:1.028\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e853/ 69.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e254/ 20.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e115/ 9.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ7. Touching Other\u0026rsquo;s Clothes and Shoes; Mean: 4.02, SD:1.00\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e880/ 72%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e234/ 19.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e108/ 8.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSection 2: Knowledge of COVID-19 Preventive Measures\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ8. I understand how to properly wear and remove masks. Mean: 4.64, SD:0.528\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1201/98.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e18/1.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3/ 0.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ9. A good handwashing should last for at least 10 seconds; Mean: 4.58, SD: 0.683 (Reverse question)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1190/ 95.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e25/ 2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e27/ 2.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ10. I separate outdoor clothes and indoor clothes. Mean: 4.59, SD: 0.564\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1185/96.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e34/ 2.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3/0.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eQ11. In order to prevent spreading the virus, we should cover our mouth with our hands when coughing or sneezing. Mean: 4.47, SD:0814 (Reverse question)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1126/ 92.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e33/ 2.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e63/ 5.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eQ12, Sect.\u0026nbsp;3: What are the symptoms of COVID-19 in children? (Number/Percentage of \u0026ldquo;Yes\u0026rdquo;)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eS1. Fever: 1196/ 97.9%; S2. Stuffy Nose \u0026amp; Cough: 746/ 61%; S3. Sneezing: 594/ 48.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eS4. Nausea \u0026amp; Vomiting : 611/ 50%; S5. Diarrhea: 426/ 34.9%; S6. Myalgia: 323/ 26.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eS7. Fatigue: 354/ 28.7%; S8. Itchy Eyes \u0026amp; Watery Eyes: 204/ 16.7%; S9. Itchy \u0026amp; Red Rash: 141/11.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eS10. Loss of smell or taste: 163/13.3%; S11. Swollen Joints:81/6.6%;\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eS12.Flushed Face, Sweaty: 227/ 18.6%; S13. Chapped lips:143/ 11.7%; S14. Stomatitis: 273/ 22.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Sect.\u0026nbsp;3, Symptoms of COVID-19 In Children, the majority of participants (97.9%) responded that fever was one of the symptoms of COVID-19 in children, and 61% believed that stuffy nose and coughing were also symptoms. Few participants believed that the symptoms of \u0026ldquo;nausea \u0026amp; vomit\u0026rdquo; (50%) and \u0026ldquo;diarrhea\u0026rdquo; (34%) were related to pediatric COVID-19. Literature did not suggest that swollen joints, flushed face, sweaty, chapped lips may not relate to COVID-19, and indeed few participants considered those symptoms related to COVID-19. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e displays distribution and comparison of participants\u0026rsquo; awareness levels.\u003c/p\u003e\n\u003ch2\u003eFactors associated with awareness score toward COVID-19 prevention\u003c/h2\u003e\n\u003cp\u003eAwareness scores significantly differed by parental relationship (mother or father), educational attainment, and social - economic Status (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e), after adjusting for the age effect. More specially, the results of multiple liner regression analysis exhibited that mothers had, on average, 0.779 units significantly lower score of awareness regarding pediatric COIVD-19 than did fathers (estimate= -0.779; p\u0026thinsp;=\u0026thinsp;0.026; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e ), after adjusting for other factors. Participants with higher academic attainment had higher awareness scores. After adjusting of other factors\u0026rsquo; effects, those participants with a high school diploma (estimate: 1.588, p\u0026thinsp;=\u0026thinsp;0.007; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e), an undergraduate degree (estimate: 2.224, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e), or a graduated degree (estimate: 2.554, p\u0026thinsp;=\u0026thinsp;0.046; Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) had higher awareness score than those with the lowest educational attainment (primary school or less). Participants in the highest socio-economic class had higher awareness scores than those in the lowest class (estimate: 1.504, p\u0026thinsp;=\u0026thinsp;0.031).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eMultiple Linear Regression Models of Significant Impact Factors on Awareness (N\u0026thinsp;=\u0026thinsp;1222)\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eEstimate\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eSE\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e95% CI\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntercept\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62.962\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.589\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e59.846,66.077\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eParental Role\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMother versus Father \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.779\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.349\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-1.465, -0.093\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.026*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducational Attainment\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePostgraduate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.554\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.282\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.04, 5.068\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.046*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUndergraduate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.224\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.584\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.079, 3.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026lt;\u0026thinsp;0.001*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHigh School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.588\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.589\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.432, 2.743\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.007*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eJunior High School\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.721\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.424\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.11, 1.552\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.089\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePrimary school or Under\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-Economic Status\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eRich\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.885\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.843\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-5.648, 9.417\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.624\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWell-off\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.504\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.696\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.139,2.869\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.031*\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMiddle-class\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.905\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.612\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.296, 2.106\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.140\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePoor\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.059\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.032\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-0.123, 0.006\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.074\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003ctfoot\u003e\n\u003ctr\u003e\n\u003ctd colspan=\"5\"\u003eNote: Dependent variable: Total Score of Awareness; Model: (Intercept), Parental Role, Educational Attainment, Socio-Economic Status. a. Set to zero because this parameter is redundant. * p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tfoot\u003e\n\u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":" \u003cp\u003eTo our Knowledge, this is the first investigation of Chinese parents\u0026rsquo; awareness regarding pediatric COVID-19. Research was conducted as most schools reopened after the COVID-19 outbreak, while China was no longer at the epidemic stage but still a dangerously affected area, especially with many imported confirmed cases. In contrast to a previous study in Wuhan city [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], most participants in this study were farmers with low educational attainment (55% junior high school). In Fujian province, almost 50% residents are farmers. To this point, Fujian has recorded 367 COVID-19 patients including 71 patients recently came from abroad or from other provinces, and no confirmed infections in children. Therefore, this research data may be considered and accurate picture of the Fujian population.\u003c/p\u003e \u003cp\u003eIn our research, although most participating parents knew that respiratory transmission (patients\u0026rsquo; droplets) was the main transmitted route of COVID-19; few recognized contact transmission as another transmitted rout for the virus (Question 4, 5, \u0026amp; 7; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In this study, 69.8% of participants believed that contaminated food may be a transmission route, but 20.8% participants doubted this theory. Although one hypothesis proposes that the COVID-19 virus may be transmitted via respiratory droplets on the surface of food or food package, currently no evidence proves this hypothesis. Good handwashing, personal hygiene practices, and choice of grocery stores are more important [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePersonal preventive measures towards COVID-19, including proper handwashing, appropriate facemask use, and respiratory hygiene practices (cough etiquette), are particularly important [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Clinical experts recommend that proper handwashing technique involve 7 steps and last at 20 seconds [\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], and it is recommended to cover nose and mouth with tissue or and an elbow rather than hands when coughing or sneezing [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR22 CR23 CR24 CR25\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, our research revealed that the majority of participants had incorrect information on handwashing technique and respiratory hygiene practice (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, q11 and q12). These parents urgently need accurate and appropriate information to correct these misunderstandings.\u003c/p\u003e \u003cp\u003eAdditionally, evidence has found differences between the COVID-19 symptoms of children and those of adults [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In this research, most participants knew that fever and cough are symptoms of COVID-19 in children, but few knew that sneezing is also a symptom. Unlikely adult patients, children with COVID-19 have digestive symptoms (nausea, vomiting, diarrhea) [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Our research found that participants lack knowledge regarding the symptoms of COVID-19 in children (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParental role, educational attainment and socio-economic condition were significant factors affecting COVID-19 awareness scores. Research participants who were fathers, more highly educated, and of a higher socio-economic status showed better awareness than did others. We assure that more educated, and prosperous parents may possess more resources and access to information on COVID-19, and accordingly better hygiene practices, than parents of lower education and income. These results are likely consisted with a previous study [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Investigations in other countries have also revealed that educational attainment, poverty level on awareness regarding COVID-19 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e "},{"header":"Limitation","content":" \u003cp\u003eOne important limitation of this study was that it is not representativeness of the Chinese population as a whole due to use of a snowball sampling method to recruited participants. Additionally, since research setting was limited to two provinces in China, data may not represent the conditions in other provinces which suffered many COVID-19 cases during the outbreak.\u003c/p\u003e "},{"header":"Conclusion","content":" \u003cp\u003eBecause the COVID-19 is a new disease which infected only few children in China during outbreak, and due to the prevalence of myths and misinformation about this virus, parents lacked clear protective information on protecting children during the critical outbreak in China. However, evidence has found that children of all age can be infected and develop COVID-19. Our research results suggest an urgent need to improve parental knowledge regarding the transmission routes, symptoms in children, and preventive measures for children, especially handwashing techniques. cough etiquette and recognition of children\u0026rsquo;s COVID-19 symptoms. Moreover, we also suggest an urgent push to develop educational outreaches to parents and schoolchildren to promote personal hygiene knowledge and practice to protect both children and their families. Further studies are needed to develop and evaluate the effectiveness of these programs.\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eWHO: World Health Organization;\u003c/p\u003e\n\u003cp\u003eCOVID-19: Novel Coronavirus Disease;\u003c/p\u003e\n\u003cp\u003eSARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2\u003c/p\u003e\n\u003cp\u003eACE‐2 : Angiotensin‐Converting Enzyme 2\u003c/p\u003e\n\u003cp\u003eCDC: Centers for Disease Control and Prevention\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e- Ethics approval and consent to participate:\u003c/p\u003e\n\u003cp\u003eThe study was reviewed and approved by the Institutional Review Board of Putain University (approval number: 2020-33). Written informed consent was posted on web-based questionnaire and all participants had to log into web-based questionnaire and answer a yes or no question to voluntarily confirm their willingness to participate before data were collected.\u003c/p\u003e\n\u003cp\u003e- Consent to publish:\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp;Availability of data and materials:\u003c/p\u003e\n\u003cp\u003eThis research datasets generated and analyzed during this study are not publicly available due to the sensitive nature of the data and ethics restrictions on data sharing. Respondents did not consent to have their data publicly shared.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp;Competing interests:\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e-Funding:\u003c/p\u003e\n\u003cp\u003eThis research has no foundation and no financial support.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp;Authors' Contributions:\u003c/p\u003e\n\u003cp\u003eN-H Peng, JF Zhou conceived and designed the study. H\u0026nbsp;Meng, ZZ Li, BR Wei, MX Huang contributed research data collection, Y‐C Chang was responsible for data analysis. All authors have read and approved the manuscript.\u003c/p\u003e\n\u003cp\u003e-\u0026nbsp;Acknowledgements:\u003c/p\u003e\n\u003cp\u003eThe authors thank all research participants for their attending and many contributions.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization (WHO), The Coronavirus disease (COVID-19) pandemic. 2019, \u003ca href=\"https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=EAIaIQobChMI24jsrsHE6gIV06mWCh1oTgIuEAAYASAAEgIQGfD_BwE\"\u003ehttps://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=EAIaIQobChMI24jsrsHE6gIV06mWCh1oTgIuEAAYASAAEgIQGfD_BwE\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO). 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UpToDate\u0026nbsp;(Jun 24, 2020)\u0026nbsp;\u003ca href=\"https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-multisystem-inflammatory-syndrome-in-children\"\u003ehttps://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-multisystem-inflammatory-syndrome-in-children\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003eKumar J, Katto M, Siddiqui A A, et al. Knowledge, attitude, and practices of healthcare workers regarding the use of face mask to limit the spread of the new coronavirus disease (COVID19). Cureus 2020; 12(4): e7737.\u0026nbsp; DOI 10.7759/cureus.7737\u003c/li\u003e\n\u003cli\u003eZhang, R., Lib,Y. Zhang, A.L., Wang, Y., \u0026amp; Molina, M.J. Identifying airborne transmission as the dominant route for the spread of COVID-19. PNAS, 2020; 117\u0026nbsp;(26)\u0026nbsp;14857-14863.\u003c/li\u003e\n\u003cli\u003eAmirian, E.S. Potential fecal transmission of SARS-CoV-2: Current evidence and implications for public health. International Journal of Infectious Diseases. 2020; 95, 363\u0026ndash;370.\u003c/li\u003e\n\u003cli\u003eZhang\u0026nbsp;J,\u0026nbsp;Litvinova\u0026nbsp;\u0026nbsp;M,\u0026nbsp;Liang\u0026nbsp;\u0026nbsp;Y,\u0026nbsp;Wang\u0026nbsp;Y,\u0026nbsp;Wang\u0026nbsp;\u0026nbsp;W,\u0026nbsp;Zhao\u0026nbsp;\u0026nbsp;S,\u0026nbsp;et al.\u0026nbsp;Changes in contact patterns shape the dynamics of the COVID-19 outbreak in China. Science.\u0026nbsp;2020; 368:1481\u0026ndash;6.\u0026nbsp;\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Transmission of SARS-CoV-2: implications for infection prevention precautions. (9. July. 2020) file:///C:/Users/user/Desktop/new%20research%202020/WHO-COVID19.pdf\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. COVID-19 and food safety: guidance for food businesses. Published at 7\u003csup\u003eth\u003c/sup\u003e. (April.2020) \u003cbr /\u003efile:///C:/Users/user/Downloads/WHO-2019-nCoV-Food_Safety-2020.1-eng.pdf\u003c/li\u003e\n\u003cli\u003ePark, Y-J, Choe, Y-J., Park, O., Park, S-Y., Kim, Y-M, et al. Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020. Emerging Infectious Diseases, 2020; 26(10). \u003ca href=\"https://wwwnc.cdc.gov/eid/article/26/10/20-1315_article\"\u003ehttps://wwwnc.cdc.gov/eid/article/26/10/20-1315_article\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003eDavies, N.G., Klepac, P., Liu,Y., Prem ,K. et al. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nature Medicine, Published online (2020). \u003ca href=\"https://www.nature.com/articles/s41591-020-0962-9.pdf\"\u003ehttps://www.nature.com/articles/s41591-020-0962-9.pdf\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003eBender, L. UNICEF Key Messages and Actions for COVID-19 Prevention and Control in Schools. 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(2020). file:///C:/Users/user/Desktop/new%20research%202020/PIIS2352464220301772.pdf\u003c/li\u003e\n\u003cli\u003eVivas, A., Gelayea,B., Aboset, N., Kumie, A., Berhane, Y., \u0026amp; Williams M.A. Knowledge, attitudes, and practices (KAP) of hygiene among school children in Angolela, Ethiopia. J Prev Med Hyg. 2010; 51(2): 73\u0026ndash;79.\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention, When and how to wash your hands.\u0026nbsp;\u003cbr /\u003e\u003ca href=\"https://www.cdc.gov/handwashing/when-how-handwashing.html\"\u003ehttps://www.cdc.gov/handwashing/when-how-handwashing.html\u003c/a\u003e\u003c/li\u003e\n\u003cli\u003ePradhan,D., Biswasroy, P., Naik,PK., Ghosh,G., \u0026amp; Rath, G. A Review of current interventions for COVID-19 prevention. Archives of Medical Research. 2020; 51, 363-374.\u003c/li\u003e\n\u003cli\u003eFaul, F., Erdfelder, E., Buchner, A., \u0026amp; Lang, A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses.\u0026nbsp;\u003cem\u003eBehavior Research Methods, 41\u003c/em\u003e, 1149-1160.\u003c/li\u003e\n\u003cli\u003eFaul, F., Erdfelder, E., Lang, A.-G., \u0026amp; Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences.\u0026nbsp;\u003cem\u003eBehavior Research Methods, 39\u003c/em\u003e, 175-191.\u003c/li\u003e\n\u003cli\u003eWolf, M.S., Serper, M., Opsasnick, L., O\u0026rsquo;Conor, RM. et al. Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the U.S. outbreak a cross-sectional survey. Annals of Internal Medicine, 9 April 2020. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151355/pdf/aim-olf-M201239.pdf\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7151355/pdf/aim-olf-M201239.pdf\u003c/a\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Parental Awareness, COVID-19 Prevention, Schoolchildren, Outbreak","lastPublishedDoi":"10.21203/rs.3.rs-89502/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-89502/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Currently children’s COVID-19 case numbers are gradually increased in various countries, and many parents fear for their children’ safety after schools reopen. The aim of this research was to investigate Chinese parents’ awareness of pediatric COVID-19 in relation to protecting their children. \u003c/p\u003e\u003cp\u003eMethods: A cross-sectional study was conducted in Fujian and Jiangsu provinces in China using a web-based research questionnaire to investigate parents with children aged 6 to 16 years old. \u003c/p\u003e\u003cp\u003eResults: Research samples included 1222 participants. 99.2% of participants were aware of respiratory transmission of COVID-19, and 75.6% also believed fecal-oral transmission to be possible. Although 98.3% of participants reported knowing how to properly wear and remove masks, most parents were unaware of good handwashing technique and answered incorrectly regarding cough etiquette. Research participants seemed uncertain of children’s symptoms. Awareness scores of participants significantly differed across parental role, educational attainment levels, and social-economic levels (P\u0026lt;0.005), with fathers, the better educated, and those of higher income showing higher levels of awareness. \u003c/p\u003e\u003cp\u003eConclusion: Research results suggest an urgent need for parental education regarding COVID-19 in children, especially regarding handwashing techniques and cough etiquette; educational facilities and outreach to parents and schoolchildren are particularly important.\u0026nbsp;\u0026nbsp;\u003c/p\u003e","manuscriptTitle":"Exploration of Chinese Parental Awareness About COVID-19 Outbreaks","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2020-10-14 15:38:57","doi":"10.21203/rs.3.rs-89502/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c8c421af-2ca6-400b-b37d-499662db643d","owner":[],"postedDate":"October 14th, 2020","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":775105,"name":"Health Economics \u0026 Outcomes Research"},{"id":775106,"name":"Infectious Diseases"},{"id":775107,"name":"Health Policy"}],"tags":[],"updatedAt":"2020-10-25T14:50:33+00:00","versionOfRecord":[],"versionCreatedAt":"2020-10-14 15:38:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-89502","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-89502","identity":"rs-89502","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}