In the first step, a survey experiment, we find the timing of vaccine rollout  has a significant impact on public decision-making. Not only is there a higher level of acceptance when the vaccine becomes available at a later time, but delayed availability is correlated with both lower levels of ‘desire to wait’ and ‘total rejection’ of the vaccine. In a second step, we explore associated qualitative data, finding that temporal expressions  can serve as a proxy for underlying non-temporal rationales, like concerns around safety, efficacy, personal situations, or altruism. By identifying these patterns, as well as the complexities of underlying factors, through a mixed-methods investigation, we can inform better vaccine-related policy and public messaging, as well as enhance our understanding of how individuals make decisions about vaccines in the context of COVID-19.Managing the COVID-19 pandemic—and other communicable diseases—involves broad societal uptake of vaccines. As has been demonstrated, however, vaccine uptake is often uneven and incomplete across populations. This is a substantial challenge that must be addressed by public health efforts. To this point, significant research has focused on demographic and attitudinal correlates with vaccine hesitancy to understand uptake patterns. In this study, however, we advance understandings of individual decision-making processes involved in vaccine uptake through a mixed-methods investigation of the role of  While there are different ways to mitigate the spread and impacts of COVID-19 using non-pharmaceutical interventions , vaccination campaigns around the world are essential to recovery. Their successful deployment is, however, a challenging operation. Development, approval by national health agencies, and distribution present important difficulties including logistical and ethical challenges ,3. Even Given the important role of vaccines in ameliorating the COVID-19 pandemic, tremendous attention is currently being given to documenting and improving levels of vaccine uptake. Much of this work focuses on reducing “vaccine hesitancy”, understood broadly as a “delay in acceptance or refusal of vaccination despite availability of vaccination services” . While sWhile these demographic features, risk perceptions, and interventions via media and other campaigns can help to explain broad patterns of uptake, work remains to be done in terms of understanding the complexity of individual-level decision-making on vaccines and the unique features of the COVID-19 vaccine rollout that might affect those decisions. For example, COVID-19 vaccine decisions are complicated by a context where those living in many locations did not—or even still do not—have immediate or readily available access to COVID-19 vaccines and must think about their vaccine decisions in terms of future possibilities and uncertainties regarding access. In many jurisdictions, for example, vaccine access was prioritized by vulnerability to the disease, exposure via healthcare or other frontline roles, or other factors. Moreover, different countries have had widely variable access to dose availability. In other words, when a vaccine becomes available to an individual may vary widely and has the potential to be a causal factor in their decisions about whether or not to get vaccinated.In this paper, we investigate the way that public acceptance of vaccines  varies based on scenarios of personal vaccine availability . We used a mixed-methods approach that blends analysis of a quantitative experiment with a qualitative investigation of respondents’ open-ended perspectives. In the first, quantitative step, we experimentally manipulated the scenario facing respondents to isolate our variable of interest: the proximity of vaccine availability for the individual  and its impact on vaccine intentions. In addition to increasing overall pro-vaccine intentions, we find that delaying vaccine availability not only reduces the proportion of respondents wishing to wait before getting vaccinated, but also the proportion of respondents who outright reject vaccination in more proximate scenarios.time are actually proxy expressions for a desire to wait for something in particular . In the second, qualitative step, we asked those participants who wished to wait for the vaccine to explain their reasons, which allows in-depth analysis of these perspectives. Alongside a wide variety of reasons for delaying vaccination, we find that often expressions of a desire to wait for a period of Even prior to the COVID-19 pandemic, significant research attention was given to the issue of ‘vaccine hesitancy’ or ‘vaccine decision-making’ from various disciplines. Within public health and psychological research, significant work has highlighted the different roles of sociodemographic, attitudinal, and knowledge-based factors in vaccine decisions in general ,18,19, aAs might be expected, this massive body of literature has revealed a wide variety of factors that affect vaccine decision-making. Beyond the sociodemographic, attitudinal factors like beliefs, risk perceptions, and the behaviors of oneself and others play a critical and interconnected role in vaccine decision-making ,5,28,29.The influence of these factors—aspects like political affiliation, partisanship, information quality, and trust in government decisions—reveals a landscape wherein individual perceptions of risk, safety, and efficacy are critical to vaccine decision-making. This is supported by earlier research , as well as appreciating a spectrum of different kinds of concern (from outright rejection to the desire to ‘wait and see’) can offer a more holistic perspective that avoids assuming ‘deficits’ amongst those with concerns .In the case of COVID-19, this is made even more complicated by concerns among members of the public that the vaccine may have been ‘rushed’, which has been documented to impact vaccine intentions and vaccine trust ,49. ThisIn the Canadian context, there has been a comparatively high degree of professed vaccine acceptance—and actual vaccine uptake. Public opinion polling firms initially showed just under 80% of respondents intending to get vaccinated, with increases to near 90% of respondents affirming that intention by May 2021 . Even thTo address these questions—and to advance the understanding of determinants of waiting behaviors—we integrated a series of questions into a mixed-methods, nationally representative survey of Canadians. We first investigate the impact of different timing scenarios  using an experimental design, and we then explore the qualitative explanations provided about these decisions. We detail our mixed-methods approach in the next section.To investigate the influence of vaccine availability on vaccine intentions, we designed a scenario-based survey experiment to isolate the issue of personal availability of the vaccine, followed by a qualitative investigation into open-ended rationales offered by participants. This experiment was administered as part of a national Canadian survey on COVID-19 risk perceptions, impacts, adaptations, and preferences . All parIn this paper, we consider a subset of 2602 respondents recruited from the Leger polling firm online panel between 9–22 December 2020, a timing selected to be just prior to broad vaccine availability, but while there was already a great deal of anticipation, information, and public discourse surrounding the eventual rollout. These participants were recruited using nested quotas factoring in provincial populations, gender, age, and visible minority status. All recruitment and responses occurred during the aforementioned period, in multiple waves to ensure completion of each quota category. Once quota was met, no further respondents were recruited within those demographic criteria. Overall, the sample closely mimics the Census data on variables like age, gender, provinces . Each respondent had a probability of 0.25 to receive any of the four treatments. Randomization is key as it allows us to be very confident that all potential cofounders are equally distributed across the different groups. The use of a between-subjects experimental design was essential in order the estimate the average causal effect of different timelines of the vaccine offers. For instance, we would not expect that participants could, necessarily, explicitly articulate the factors affecting a complex decision; nor would we be sure that the factors they did articulate were actually those that would drive the behavior. If participants had been presented with all four scenarios , for example, participants might have felt pressure to maintain consistency across answers. For instance, if a participant selected “wait until some time passes” during an early scenario, they might be more likely to acquiesce during a later scenario. Similarly, if they selected “no, I would not” for an early question, they might be tempted to answer the same way for all future questions , they were then presented with a follow-up question and open-ended text box asking them to describe “how long they might wait” or “what they planned to wait for”, respectively.As is the case with many survey questions, these questions are subject to the possibility of social desirability bias, wherein respondents might believe that there is a social norm in favor of vaccination. While the literature is mixed on the presence of a social desirability bias in the COVID-19 literature ,55, the Once the responses were gathered, data cleaning involved three verification questions. First, participants were asked to provide their age range as well as the year of birth at different points in the survey. Instances where answers were in conflict were identified. Second, participants were asked to provide both their province of residence and their postal code (which was used to deduce province of residence). Respondents who provided contradictory information were identified. Third, an explicit attention-checking question was embedded in the survey. All participants who were identified in these three steps were manually checked for having provided cogent text responses to at least one open-ended question. Those who did not were removed from the dataset. n = 892 respondents provided answers to these open-ended questions, which were then coded inductively by three members of the research team, allowing multiple codes to be applied per piece of data. After developing an inductive codebook based on an initial review of the data, we used an intercoder consensus approach  to alloGiven the clean design of our survey experiment in isolating the variable of interest, we directly focus on the bivariate relationship, that is, vaccine intention across the treatments. It also allows us to include every respondent in our sample (as they are not missing on other variables that we would include), with the only exception of 149 participants that we excluded due to the fact that they were not Canadians. The four groups were composed of 622, 661, 670 and 615 respondents, respectively. chi2 option) when cross-tabulating vaccine intention across the four treatments. As expected, we find a difference that is statistically significant, whereas X2 = 27.466, p = 0.001. In a second, we unpacked the differences among the answer choices and the treatments. To do so, we conducted multinomial logistic regression shown in In a first step, we conducted a Pearson’s Chi-square test , especially when we consider the implications of vaccination on the number of hospitalized citizens and deaths [The effect is very much linear, although we should note that the biggest impact comes from the six-month treatment (compared to any of the other conditions). Overall, the total effect (from “today” to “in one year”) is about 10 percentage points, which is very substantial and statistically significant at d deaths  and the both those who mention that they would take the vaccine but would wait, as well as from those who would have otherwise stated an intention not to take the vaccine at all. In both cases , the decrease is about 7%, which is especially important when comparing the proportion of 18% who said “no” to 11% of these across the treatments (from “today” to “in one year”). We should note that the “yes, but would wait for something else” category is remarkably stable and always included less than 5% of the sample. The percentage increase in those intending to receive the vaccine as soon as possible across treatments is accompanied by a decrease in other answer choices. Importantly, this decrease comes from While we believe that Overall, there is strong evidence that timing affects citizens’ willingness to take the vaccine: the longer until a vaccine becomes available, the more respondents become willing to take it immediately, and the fewer state a desire to wait—or to not take the vaccine at all. This research, therefore, illustrates an additional factor to add to the many already within the literature reviewed in n = 892 qualitative responses were given to these questions, ranging from a few words  to more detailed responses .Building upon the quantitative experimental design of the vignettes, our research design also allowed us to dive into more fine-grained analyses of respondents’ vaccine intention using open-ended questions. Open-ended questions varied across answer choices. Respondents who selected “Yes, but would wait until some time passes first” were presented with the question “How long do you think you might wait?” For respondents that selected “Yes, but would wait for something else first”, they were asked, “What do you plan to wait for?” In total, some Using the inductive coding scheme with consensus-based coding described above, researchers sorted the responses into a series of codes that fit within three broad categories: temporal, substantive, and other. Temporal codes identified a specific period of time, either from a milestone within vaccine development  or from point of availability  For future researchers working on this topic, we highly recommend careful design of these temporal questions. In particular, because of the brevity of many of the qualitative responses , it was very difficult to assess whether respondents were answering the question based on their date of response  or based on their scenario’s timing . This lack of confidence that all respondents interpreted the prompt the same way led to the inability to confidently analyze the variation in temporal responses, which is why we treat them as a single category within this article.Safety Efficacy Ambiguous safety/efficacy Health conditions Priority Purpose Leaders Other (a reason that did not fit into the above)Unsure Substantive codes were those that identified specific issues or concerns, which fell into the following clusters:Finally, some responses (n = 120) were deemed to be unable to be coded, either because of insufficient information to make any judgment about the subject matter or because of irrelevance to the question asked. Note that each response could contain more than one code .Among the coded responses, there was a very clear pattern: there was a dramatic difference between respondents who said they were waiting for some time to pass versus those who said they were waiting for something else see . For thoPerhaps the more striking difference, however, comes from comparing the substantive and uncertain rationales between these two groups of respondents see . For resBy contrast, not a single respondent who said they were waiting not “until some time passes first” but “for something else” expressed uncertainty about what they were waiting for. Rather, this group overwhelmingly expressed concerns about safety (41%), ambiguous forms of safety and/or efficacy , and efficacy (15%). Again, these were not closed-ended prompts that primed the respondents (nor were any of these factors introduced in the survey prior to this question): these were open-ended expressions by the respondents about what they believed would move them from the category of ‘waiting’ into actually obtaining the vaccine.In addition to coding these responses into the themes discussed above, we were also able to explore the open-ended data for more nuanced expressions of individual attitudes, beliefs, and opinions. This allows for richer insights into the motivations driving these behaviors, as well as an opportunity to understand the heterogeneity of concerns present among those who self-identified as wishing to wait to receive the COVID vaccine. It also provides the groundwork for future qualitative inquiry into the perspectives of those who choose to delay their vaccination.As indicated in the coding, the single most common specific answer (excluding uncertainty) was to raise concerns about the safety of the vaccine. This, unsurprisingly, includes significant discussion about ‘side effects’, which cut across a wide range of time horizons and cases. For example, some respondents seemed to be concerned with side effects at the time of injection , while others articulated much more explicitly long-term time horizons . These concerns with side effects were often explicitly connected to perceptions of rushed development, such as one respondent who stated “Side effects. It’s too early to say that a vaccine is ready for use and 99.9% safe”, or another respondent who said, “I think it takes about 2 years for a vaccination to be made and tested as safe”. This perception of rush leading to a lack of safety was, at times, connected explicitly to perceptions of the trustworthiness of the pharmaceutical industry, such as by the respondent who said, “The vaccine was developed and marketed quickly, there are no data on efficacy and long-term side effects yet”.others get the vaccine first, such as the statement “To see what side effects it has on others who want to be the Guinea pigs”. Sometimes this was delivered in a hyper-local fashion, like a respondent who wanted to wait “A couple months… Until other people in my province have had it and there seem to be no side effects” rather than relying on trials from elsewhere. Still, others called out specific kinds of knowledge that they thought were lacking, such as long-term trials  or from more specific subpopulations .These concerns about safety were often cast in an explicitly epistemic nature: individuals grappling with how they could personally know and trust that the vaccine was safe. For instance, some respondents referenced the need to see By contrast, other respondents articulated concerns with efficacy: uncertainty about whether the vaccine was actually as efficacious as claimed. Often, this was articulated as a divergence between ‘lab’ and ‘real-world’ demonstrations of effectiveness, such as waiting “long enough to see that it works” or “until data is available proving the vaccine works well” became available.Relatedly, some responses referred to more ambiguous concerns about the safety and/or efficacy of a COVID-19 vaccine, without explicitly mentioning “safety” or “efficacy”. These responses were coded as “ambiguous safety/efficacy”. Some responses made mention of waiting until the vaccine could be deemed trustworthy , whereas other responses referred to waiting to observe vaccine “effects” without specifying which effects were of interest .Some of the most interesting and nuanced answers arose from those who respondent by citing concerns about individual health conditions, such as referencing personal ailments or physiological characteristics that might influence their decisions. For example, one respondent cited waiting “Until I’ve received some reassurance that the vaccination is more on the safe side for me to take with my current health issues”, while another suggested holding off “until I talk it through with my doctor to make sure I do not have a medical reason that I should not take it”. Pregnancy—specifically, concerns about a lack of thorough trials, or sufficient safety data—was an oft-cited personal situation here, including respondents who gave responses like “Until after I give birth since I am expecting and I am unsure if they did a clinical test for pregnant people” or “When there is enough research to show its efficacy and when I am no longer breastfeeding, as there is not enough research data on the vaccine’s impact on breastfed infants”. Likewise, allergies were another common issue mentioned, such as waiting “until info about allergies were available and a safe setting with EpiPen on hand”, as well as responses that included the desire to wait for condition-specific data  and nuts and leaves”). For some participants, the decision to wait was not about any form of hesitation, but rather either a ‘reality-check’ that they were unlikely to get access soon because of government priorities or pro-social altruism, believing that they owed it to others to allow those at higher risk to get their shots first. An example of a ‘reality-check’ response would be the participant who articulated planning to wait “due to my age, I would have to wait a few months before it is our turn to get the vaccine. The priority is frontline medical workers and seniors”). By contrast, an example of pro-social altruism would be the respondent who suggested that they would wait “Not very long, but I am not a high-risk group so while supplies are limited I would let the doses go to others first”. A small number of respondents mentioned waiting until vaccination was necessary for some other area of life . Such responses were coded as “purpose”. Only three responses made any sort of mention of waiting until leaders, like politicians (“to see if the damn politicians get it first”), social influencers, or cultural leaders. These responses were coded as “leaders”.Some responses included meaningful information about how long participants might wait to vaccinate, although the reasons provided did not fit into one of the aforementioned themes and were coded as “other”. This included a wide range of one-off answers, such as crowds (“Until the big rush is over. I remember the crowds and the long line-ups for the H1N1 vaccine and would not want to repeat that experience.”), general knowledge , or more ambiguous forces .Finally, some respondents made explicit mention of not knowing what or how long they wanted to wait for . Such responses were coded as “unsure”.In this investigation, we used a mixed-methods design intended to assess the impact of vaccine availability and timing on individual decision-making. Through the design of the study, we were able not only to isolate the effect of the timing element but also to investigate the rationales that these individuals give for wanting to delay their vaccinations. In doing so, this work contributes to the existing literature by providing a clearer understanding of the factors that go into vaccine decision-making , and also presents a rich and nuanced portrait of some of the factors being considered that can often be lumped under the heading of ‘hesitancy’.people who would have otherwise stated no desire to get the vaccine becoming more open to receiving it.Through the experimental design, we found that there was a strong and influential effect from the timing component. The more temporally distant the availability of COVID vaccines, the more likely individuals were to want to get the shot immediately. Perhaps most saliently, however, this increase in vaccine uptake does not just come from converting those who would state a desire to “wait” in a more proximate scenario. Rather, it results from This has important implications for policymakers. As the COVID vaccine rollout is underway around the world, it is important to remember that differing individual preferences can be a ‘feature rather than bug’. In other words, the fact that some individuals want to be first movers, while others want to delay their vaccination slightly, can actually serve as an advantage in rolling out a supply-constrained vaccination campaign. Moreover, our evidence shows that these late adopters may actually not be an impossible group to reach while they express hesitations, questions, and concerns, they also show a proclivity to increase in willingness to get vaccinated as time passes—even if they might otherwise have said ‘no’ in an earlier offering of the vaccine. Combing these two approaches  may be key in transitioning vaccination campaigns from initial victories to broad population coverage. wait for vaccines, rather than those who rejected them entirely, where it might be expected that a significant portion of the conspiratorial sentiment may be represented. In any event, the deployment of effective communication strategies [The insight of this mixed-method design, therefore, is also useful. As we found, there are a wide variety of reasons for waiting. Some of these might be wanting time to pass, but even amongst those who identify as wanting to “wait some time”, a portion actually identify non-temporal concerns as motivating their delay. Indeed, almost no answers in the entire survey embody conspiratorial or wildly off-base concerns. Instead, respondents generally seem to raise highly salient, well-informed, specific, and appropriate questions when given the chance. This paucity of conspiratorial attitudes with respect to the vaccine question is striking, as these sorts of attitudes were well represented among respondents throughout other questions in the survey. However, it is important to note that the qualitative component of this particular study solicited only responses from those who intended to rategies  that helrategies ,62,63. Srategies . Another important finding of this work is the fact that nearly one-in-ten respondents who said they were waiting for some time to pass were unsure about what they were waiting for . This group of respondents represents an important group for further investigation—and for empathetic outreach. While some folks waiting may have specific concerns  that can be addressed through listening, dialogue, and caring engagement, others—at least on the surface—seem more uncertain about their reasons for waiting and may require different engagement strategies to help work through considerations that are less articulated.and quantitative investigation on these topics. For instance, there are many more correlates that could be explored related to vaccine delay . Likewise, the qualitative data calls out for further data collection in richer qualitative ways .There are, of course, limitations to this work. As we are investigating in the context of COVID-19 via another portion of the overall project, the degree to which online panels truly represent broader populations is subject to significant debate. Likewise, it is critical to recognize that measures of ‘intention’ capture only professions of anticipated behavior, not the actual behavior itself . As such, we can speak to the influence of time on respondents’ anticipations of their own behavior but cannot confirm whether their real-world actions matched these stated intentions. Moreover, we use Canadian data exclusively given that, unfortunately, this original survey was not conducted anywhere else. While we believe that is it reasonable to expect a similar effect of timing on individuals’ vaccines behavior elsewhere, more data from other countries is needed to establish the external validity of our findings. It is also challenging to know whether our findings would apply to different vaccines , as the broad societal discourses around the ‘novelty’ and ‘speed of development’ of the COVID-19 vaccine reflect the unique priority and context of its development ,66. In oRegardless of these limitations, however, this work challenges traditional notions of vaccine hesitancy. It is easy to label those who want to ‘wait’ as simply being “vaccine hesitant”. While this may be fitting if “hesitant” is taken in its literal form, “to hesitate”, the label of “vaccine hesitancy” can pathologize and dismiss this group, reducing complex, nuanced, and insightful questions into a binary of ‘those who accept science’ and ‘those who don’t.’ Our study adds to the literature that questions this traditional framing, thereby reinforcing the need to move beyond deficit-based, strictly educational techniques of public outreach to those that take questions seriously, empathetically, and kindly, and work to provide actual and individualized answers that validate the thoughtfulness of the person making decisions about vaccination.Finally, this work has important methodological implications as well. Studies of vaccination intentions need to abandon attempts to measure intended or actual behavior as a dichotomy. Not only do those ‘waiting’ provide an interesting middle-ground case worthy of understanding, but there are many different forms of waiting. While those who identified “waiting for something else” other than time were less common in our sample, a non-trivial portion of those who identified as waiting for a period of time actually articulated waiting for something else entirely. It is important to use methods that can capture this granularity and diversity, as appreciating these heterogeneous underlying reasons allow for more robust work to support pro-vaccine decision-making.In this study, we used an experimental design in a large-scale Canadian COVID tracking study to better understand individual decision-making. We found that the timing presented to respondents  has a significant and substantial effect on intended behaviors. Indeed, this study suggests there may even be, as time passes, possibilities to convert those who would have described themselves as entirely unwilling to receive a vaccine in a more proximate scenario. Moreover, we found a wide variety of reasons for ‘waiting’ among those who self-identify in that category, including a non-trivial proportion of respondents who articulate wanting to wait until time passes, but actually use that as a proxy for waiting for something else . By paying attention to this variety of responses, we can better tailor outreach efforts and engagement strategies. Through this mixed-methods investigation, we enhance the understanding of vaccine decision-making and provide tools for supporting the COVID-19 (and other) vaccine roll-outs worldwide.


The aim of this preliminary study is to identify how ban zhu ren perceive the mental health of their students, and how they have acted on these perceptions. Content analysis was used to organize the data and distinguish categories or themes derived from in-depth semi-structured interviews conducted with 27 ban zhu ren from Zhejiang and Anhui provinces. Frequencies of informant responses were used to identify the areas of agreement and disagreement across identified categories and themes among the informants. The results illustrate that the informants consider issues, such as not paying attention in class (n = 14), not getting along well with classmates (n = 12), and excessive gaming (n = 11) to be indicative of mental illness, although these would commonly be considered normal adolescent behaviors. Fifteen informants admitted that they found it difficult to work with student mental health issues, and 18 felt they had inadequate or non-existent training. However, all informants stated that they had intervened with what they perceived to be students’ mental health issues, although only 9 informants had referred students for professional help. The informants reported that they were reluctant to provide referrals, due to the stigmatization they believed students would experience if given a diagnosis of mental illness. We conclude that among our informants there is a lack of agreement on what behavioral and mental health issues are, and that informants may be confusing what are, in actuality, non-conformist or non-compliant , adolescent behaviors with mental illness due to insufficient mental health training.In China, primary and secondary school teachers, known as  In 2019, there were 1.2 billion adolescents, aged 10–19 years, representing 16% of the world’s population . Mental In China, there are growing concerns about increasing mental health problems in adolescents. A recent nationwide study among Chinese adolescents aged 12 to 18 years estimated that the prevalence of mild, moderate, or severe symptoms of anxiety and depression was 43.7% and 37.4%, respectively ,10. HencBan zhu ren are primary and secondary school teachers who are responsible for all aspects of student education in China. Their role is closest to what are called “class teachers”, “homeroom teachers” or “classroom tutors” in other countries, although they teach in areas that range from mathematics to English and Chinese [Ban zhu ren are put through a selective process that seeks “qualified” teachers who can take on additional responsibilities [ban zhu ren, they must also receive initial training that aims to improve their ability to manage the classroom. Chinese . Ban zhubilities . They arban zhu ren are expected to: (i) have a comprehensive understanding of each student in their class, including their capacity to learn, their daily life, and their mental well-being, in order to help students reach their “full potential”; (ii) manage the class and create a good study environment for students; (iii) organize class activities, such as class meetings, field trips, and other off-campus activities; and (iv) communicate frequently with other teachers and parents about a student’s progress [ban zhu ren are supposed to be the leader, the organizer, and the educator of a class, who are in charge of facilitating students’ academic study, implementing classroom discipline, organizing extracurricular activities, and maintaining contact with subject teachers and parents involved in their class” [According to the Ministry of Education’s 2009 report, “Regarding the Responsibilities of Ban zhu ren in Primary and Middle Schools”, progress . In gener class” .ban zhu ren are expected to take responsibility for mental health education, by offering classes that improve mental health awareness, identifying mental health problems in students [In 2012, the Chinese Ministry of Education declared a need for psychological services in primary and secondary schools, due to a reported worsening of student mental health . As a restudents ,17, and students ,19,20. ban zhu ren in China.China is not unusual in this regard. Schools have been identified globally as an important environment for the support of adolescent mental health ,22,23. FMuch of the literature reviewed, broadly identifies how teachers in China can impact student mental health. For example, according to Luo et al., (2011), ”The positively nurturing interpersonal relationships between teachers and students play an important role in student success and found that emotionally warm relationships between teachers and students provide students with a sense of security within school” . Other eban zhu ren have the responsibility to refer students to mental health professionals [The specific role of teachers as providers of student mental health support varies across countries and settings ,33. For ssionals , in somessionals . Severalssionals ,37. Ren ssionals . In genessionals ,40. Thusban zhu ren assume an important role in supporting student mental health, few, if any, studies examine the perceptions, knowledge, and/or activities of ban zhu ren concerning student mental health. The aim of this research is to identify how a group of ban zhu ren perceive the mental health of their students, and how they have acted on these perceptions. Specifically, this study seeks to identify patterns of meaning across the data, including: (i) how ban zhu ren differentiate between behavioral and mental health issues; (ii) what ban zhu ren do when they believe a student has mental health issues; and (iii) the perception ban zhu ren have of their ability to effectively manage these issues. Even though the ban zhu ren, and content analysis was employed to organize and interpret the data.This qualitative study employed in-depth semi-structured interviews with a convenience sample of 27 ban zhu ren from middle schools (ages 12 to 15) in Zhejiang and Anhui provinces, which represent relatively wealthier and poorer provinces, respectively. Anhui is an inland eastern province with a population of 63.7 million and is ranked at 13 out of 31 provinces for GDP per capita, whereas Zhejiang is an eastern coastal province with a population of 58.5 million and ranked fifth in the nation for GDP per capita [This study was conducted with r capita ,42. Usinban zhu ren from each grade cohort, or 3 informants from each of the 9 schools, were recruited. Inclusion criteria were being the ban zhu ren of the class and having more than one year of work experience. In total, 27 ban zhu ren from 9 middle schools were eligible for inclusion. In one school in Zhejiang province, 2 ban zhu ren from the eighth-grade class, and 1 ban zhu ren from the seventh-grade class were included, because the ban zhu ren from the ninth-grade class were not available. Ban zhu ren were recruited with the help of the teacher intermediaries, who introduced the researcher (YM) to the ban zhu ren at their school. Ban zhu ren were then invited to participate in the research and those who agreed were included in the study.A convenience sample of 1 ban zhu ren. Following an iterative review of the initial interview schedule with members of the team , modifications were then made to the final interview guide, with several questions combined and with two questions about interventions for student mental health added, and one question, that was unclear to initial pilot informants, was removed.A topic guide based on a review of the literature served to generate the original interview schedule, containing a broad range of questions, for an initial pilot study of semi-structured interviews conducted with 6 The final interview schedule had 24 open-ended questions see . In-deptban zhu ren, the number of students in their class, and subject taught  identification of mental health issues in students; (ii) differentiation of behavioral issues from mental health issues; (iii) support of students with mental health issues; and (iv) perceived ability to provide appropriate support. All interviews were recorded and transcribed prior to data analysis.The data collected for this research were the informants’ responses to open-ended questions in semi-structured interviews. In order to organize informant responses in a way that provided meaning, content analysis was employed to analyze the data. Since we were interested in identifying and grouping responses according to content that shares a commonality, and according to their frequencies among informants, both conventional and summative content analyses were used. Summative content analysis facilitates both the creation of categories and the quantification of qualitative data ,44. ConvContent analysis is a nonlinear, iterative process of analysis. In this analysis, data were grouped using an iterative and (predominantly) inductive process, closely linked to the semantic data content. Specifically, the data-based meaning was attributed using an inductive approach, while theory-based meaning  employed a deductive approach.The researchers conducting data analysis  pursued the following steps in this summative and conventional content analysis ,44. (1) All aspects of data analysis were conducted without software and after agreement regarding the interpretation of the data by the contributing authors. A summary of the final categories and sub-categories is detailed in Ethical approval was obtained from the Ethics Review Committee of Zhejiang University (ZGL201909-6), and oral informed consent was obtained prior to each interview. All informants were informed that their participation was completely voluntary and that they could cease or withdraw from participating in the research at any time without any consequence. All identifying informant information was anonymized to protect informant confidentiality. The confidentiality of informants was further protected by storing all data on an external hard drive that was secured in a locked drawer to which only the researcher, YM, had access.ban zhu ren in Anhui province and 9 in Zhejiang province were recruited. The informants consisted of 12 females and 15 males. 21 informants worked in public schools and 6 in private schools. The size of the schools varied from 500 students to 3500. The informants’ ages ranged between 20–60 years of age. 7 informants had worked as ban zhu ren for more than ten years. All informants were responsible for classes of 30 or more students. The socio-demographic background of informants is detailed in A total of 18 ban zhu ren, are also detailed within the results of each theme.Using an iterative content analysis approach “I think mental health problems are common in adolescents. In my experience, I have encountered students with mental health issues in every class.”When asked how common they thought mental health issues were among adolescents, 19 informants stated that mental illness was common among adolescents, and that there had been an increase in the number of students with mental health issues over time. However, all informants agreed that it was necessary to pay attention to student mental health issues in school.ban zhu ren were more likely to perceive mental illness among adolescents as being common. Given the perceived prevalence of mental illness, it is important to identify exactly what informants consider to be student mental health issues.Both of these informants voice a common perception among the informants of an increasing prevalence of mental health issues. In general, informants in the 30–39-year-old age group, females, and those with 10 or fewer years of experience as a “Psychological problems are common problems for students, especially those who do not like to learn. When they don’t like to learn, they pursue other activities a little more. For example: falling in love at a young age, surfing the internet and fighting, all of these are psychological problems.”When asked to list what they consider to be mental health issues, informants report that students who: are “tired of learning”; display “interpersonal problems”; are “addicted” to the internet; are “rebellious”; “fall in love” at a young age; and physically “fight with classmates”, all reflect signs of mental illness, even though in and of themselves, none of these would be considered to be a symptom of mental illness by mental health professionals. Specifically, 14 informants consider that a student who does not want to attend school or does not pay attention in the classroom is “tired of learning”; 12 informants believe that students who do not get along with most of their classmates have “interpersonal problems”; 11 informants state that students who enjoy playing video games online or who stay up late to play games are “addicted to the internet”, which is a mental health issue; 9 informants report that students who argue with their parents or teachers are “rebellious” and have mental health issues; 5 informants believe that adolescents who are in love display signs of mental illness; and 4 believe that students who physically fight with their classmates display mental illness.ban zhu ren, agreed that “being tired of learning”; “having interpersonal problems”; and being “addicted to the internet” were all mental health issues. However, informants also identified signs of mental illness that may be more commonly agreed upon by mental health professionals.“I believe that reasons for one student’s self-harm are a lack of parents’ love and care, imitating others, and because she broke up with her boyfriend.”This informant’s perception of what many mental health professionals would consider to be normal adolescent behavior, as “psychological problems”, was repeated by other informants. In general, a majority of informants from all age groups, both males and females, and informants of any number of years as a n = 3), to ease emotions (n = 2), for attention (n = 2), due to a lack of parental love and care (n = 1), and to escape punishment (n = 1). Although few informants addressed causality, several informants agreed with established signs of mental illness. For example, 8 informants identified students with mental health issues who demonstrated suicidal ideation or had attempted suicide; 13 informants stated that students who demonstrate a decreased interest in life or appeared sad for long periods would be considered to be depressed; and 12 informants identify scratching parts of one’s body with a knife or sharp object as “self-harm”, a mental health issue. Among these 12 informants, 11 specifically witnessed girls and 2 witnessed boys who had engaged in self-harm. A few informants did question causality and explained that informants committed self-harm to imitate someone else , sex, and the number of years as However, some established signs of mental illness appeared to be normalized by some informants. For example, only 5 informants considered anxiety to be a mental health problem for students; most informants regarded anxiety as a normal response to the stress of studying and the pressure of assessments in schools in China. Overall, few informants identified actual mental health issues in those students who had already been diagnosed by a professional. For example, only 3 informants identified students that were professionally diagnosed with mania, and only a single informant mentioned students professionally diagnosed with ADHD, bipolar disorder, social phobia, or schizophrenia. n = 14) stated that students who do not prepare homework carefully or who do not obey school rules display behavioral problems. Physically fighting with classmates (n = 11), interpersonal problems  (n = 10), rebelliousness (demonstrated by arguing with parents or teachers) (n = 5), inability to control one’s behavior (n = 5), using foul language (n = 4), bullying (n = 2), lying (n = 2), stealing (n = 2), demonstrating violent tendencies (n = 1), demonstrating immature thoughts and behaviors (n = 1), and lack of hygiene (n = 1), were all identified as reflecting a behavioral, rather than a mental illness, issue. Furthermore, not obeying school rules, physically fighting with classmates, and interpersonal problems were identified as behavioral issues by informants, regardless of their age group, sex, or years as a ban zhu ren.Informants were asked what they would classify specifically as a behavioral issue, rather than as a sign of mental illness. Nearly half of informants , eating paper (n = 1), showing no enthusiasm for life (n = 1), and having suicidal ideation (n = 1) were all behavioral issues.“As for behavioral problems I would include: fighting, always getting into arguments with people, not communicating, cutting wrists, and there are lots of others.”However, 8 informants perceived self-harm as a behavioral problem, and 5 of these also labeled self-harm as a mental health issue. Furthermore, whereas 5 informants believed that falling in love during adolescence was a mental health issue, 4 other informants identified this as a behavioral issue. Self-harm and falling in love during adolescence were also identified as behavioral issues by informants regardless of their age group, sex, or years as a n = 9), that mental health problems can be identified by students’ behavior (n = 6), and that behavioral problems will lead to mental illness (n = 1).“I think behavioral problems are related to mental health problems, some behavioral problems are caused by mental health problems, some behavioral problems are the external manifestations of psychological problems.”As with the informant above, several informants conflated what might normatively be agreed upon as behavioral issues with signs of mental illness. The challenges of differentiating between mental health and behavior are further exemplified by the belief of almost all informants (25/27) that behavioral problems are related to mental health, that psychological problems will always lead to behavioral problems (n = 25) reported that they identified student mental health issues by observing students or by speaking with them. Informants also reported that they would identify mental health issues based on parental reports of students’ behavior at home (n = 17), feedback from classmates (n = 13), feedback from other teachers (n = 5), and when students came to them with their problems (n = 4). Observing and speaking with students, and feedback from parents and from other students, were used to identify mental health issues by informants, regardless of their age group, sex, or years as a ban zhu ren.“I think this girl may have mental health issues because of her strange performance. I observed that the girl had pulled out her hair and she had a bald patch. I learned more about her by talking with her mother, for example, she locks herself in her room, so I believe she has mental health issues.”Almost all informants All informants claimed that they had intervened with what they perceive to be issues of students’ mental health. They report having talked with students and having tried to encourage them to overcome their issues, in addition to trying to put students at ease. One informant reported meeting with a student, whom she believed to have mental health issues, every 2 days to encourage her to overcome her issues .n = 23), classmates (n = 14), their teaching colleagues (n = 12), and with school psychological counselors (n = 11) to address the mental health issues they believe their students have. In fact, a majority of informants, regardless of their age group, sex, or years as a ban zhu ren, report informing parents.“When I think that a student has mental health problems, I chat with them to get their trust. I help them to work through their feelings so that their situation improves.”Informants report having intervened with students’ parents Given the amount of time that n = 20), and by taking students out to the playground, or showing movies in the classroom, especially when students seemed to be stressed (n = 17). However, informants report that these activities were not very effective.“Occasionally, I will take students to the playground in the evening, and they lie on the ground to see the evening sky. But I don’t know if this helps. I don’t know enough about psychology. So, I tend to talk to the students about my own experience.”Informants report that they have also intervened by educating their students about mental illness Few informants reported intervening by referring students for a professional assessment. Although 12 informants stated that students should be sent to a hospital or clinic if they exhibit “extreme behaviors”, such as self-harm, only 9 informants reported that they had referred students they believed to have mental health issues for professional help.ban zhu ren. Specifically, informants identified that they: (i) do not have access to effective ways to intervene (n = 7); (ii) lack mental health expertise and the ability to intervene with student issues (n = 6); and (iii) have no time or energy to intervene with student mental health issues (n = 4).“Our curriculum is tight and the school pays more attention to student learning, so we dedicate most of our time to teaching.”“I don’t know how to work with students’ mental health problems and I believe that I need to improve my ability to work with such problems.”Overall, informants reported having considerable difficulty working with student mental health issues, regardless of the informant’s age group, sex, or years working as a Furthermore, 7 informants felt that students were generally unwilling to communicate with them about their problems, and 8 reported that parents could not cooperate with them when their child was having problems. ban zhu ren who received training, compared to those who worked as a ban zhu ren for a longer period. Of the 19 informants who reported having mental health training, only 11 received training that was specifically focused on mental health, whereas the remaining 8 received teacher training that included limited mental health instruction. Furthermore, 10 of the 19 informants thought their training was of little or no help, including those who participated in the full mental health training program.“I don’t think training helps much, because the content is theoretical and it doesn’t teach us how to work with specific mental health issues, and the training is not all about adolescent mental health. It is useless when we have problems with students.”The final category examines the actual training that informants completed in mental health. Mental health training was not uniform among informants. Although 8 informants reported not having had any mental health training, 19 informants reported they had attended some form of teacher training that included mental health . For exa“The mental health certificate training was 7–8 days. During the training, different people gave lectures related to mental health. I thought some lectures were useful, but many were not.”Another informant, who completed the full mental health certificate training in Zhejiang province, stated:ban zhu ren believe that mental health issues are common among their students. Although one of the responsibilities of ban zhu ren is to identify and manage students’ mental health, and all informants report having intervened with student mental health, 8 of the 27 informants claimed to have no mental health training at all, and 10 of the 19 informants who did receive training felt that the training was of little to no value. Hence, 18 of the 27 informants felt they either had inadequate mental health training or no training at all, which may explain why more than half of the informants (n = 15) found it difficult to work with student mental health issues. This research identifies that the majority of n = 9) referred students for professional help, which may, in part, be due to their lack of training, in addition to the strong stigmatization of mental illness in China [ban zhu ren informants, “half of the participants rated listening or talking with the patient more highly” than accompanying them for professional help or encouraging the person to visit a psychiatrist or psychologist [Yet, even though the majority of informants believed they were inadequately trained and were challenged by working with student mental health, only one-third of informants  ,56, are n = 25), who believe that behavioral problems are related to mental illness, because, according to some informants, mental health issues cause students to have many of the behavioral problems discussed. Furthermore, several informants regard students’ behavior alone as the standard by which to identify mental illness. The informant’s quote: “Psychological problems are common problems for students, especially those who do not like to learn. When they don’t like to learn, they pursue other activities a little more. For example: falling in love at a young age, surfing the internet and fighting, all of these are psychological problems”  is illustrative. A student may, of course, be “tired of learning” for reasons that range from students having different learning styles to lack of motivation and interest in the subject matter—all normal responses, particularly among adolescents. What is also interesting about this statement is how one behavior that is perceived to be pathological (“tired of learning”) becomes the precursor for other “psychological problems”, which, again, are actually considered normal adolescent behaviors elsewhere.This confusion between mental illness and behavioral issues is also reflected by the majority of informants ” . Hence, n = 13), evidence of self-harm (n = 12), and suicidal ideation (n = 6)) that are corroborated by psychological reference manuals, such as the DSM-5. Similarly, some informants identified behaviors that are normatively considered to be behavioral issues, such as disobeying school rules (n = 14), physically fighting with classmates (n = 11), and interpersonal problems (n = 10) [On the other hand, it should be acknowledged that some informants did identify symptoms of mental health issues  ,56.ban zhu ren or any middle-school staff member in any context should be responsible for the mental health of their students, but rather whether they have been given the skill sets and tools whereby they can effectively intervene and know when to refer students to mental health professionals. However, the informants of this study are by no means outliers. The management of student mental health is a challenge for teachers in many countries. Studies in the UK and Germany emphasize how teachers feel unqualified to support students with mental health issues [Thus, the issue is not whether h issues ,70,71. Fh issues . The literature has frequently championed the impact of proper mental health training . In a stHowever, this is not to imply that training and responsibilities should be an individual matter. Several studies emphasize the importance of collaborative teamwork among colleagues, both in schools and across the community, to address student mental health. A Norwegian study identified the positive outcomes when teachers and mental health professionals work together to support student mental health . SimilarYet, even if all of these factors were rectified, challenges may persist due to the social stigma of mental illness in China, as well as in myriad contexts around the world. Redressing social stigma is a long process, although a global review of the literature identifies that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes, at least in the short term .ban zhu ren concerning the mental health of their students. This study identifies that our sample of ban zhu ren commonly rely on their own perceptions, which are often independent of what is accepted and practiced by mental health professionals, for their determinations of student mental health issues. This is one of the first studies concerning the perceptions and actions of ban zhu ren regarding student mental health in China, though there are a number of limitations to this preliminary study. Given the small sample of informants from a small number of schools, the findings are not and cannot be generalized to different educational systems, educational settings, or other cultural frameworks, nor even to different schools within the two provinces studied, much less throughout China. Furthermore, the size of the sample does not engender meaningful analysis of the impact of various demographic factors on responses, such as age, sex, and years working as a ban zhu ren, which all yielded similar results in this sample. The methodology for the study was also a limitation, particularly in terms of protecting against bias. For example, the convenience sample did not strive for representativeness. The data collection instrument was piloted, but not validated, and, although content analysis is a structured process, it is very much a subjective process in which “excessive interpretation” can threaten validity [In summary, this research was a preliminary attempt to investigate the perceptions and actions of a group of validity . Lastly,ban zhu ren in China will not only benefit student mental health, but may also help to reduce the long-standing social stigma of mental illness in China.Given the importance of adolescent mental health and the dearth of research on the influence of those who are most likely to intervene with adolescents, more research in this area is necessary to better understand the issues identified in this research. Future studies in this important area will benefit from mixed-methods research of higher internal and external validity and significantly larger and representative samples. Prioritizing the mental health training of


Although the positive outcomes of human–environment interactions have been established, research examining the motivation between engagement in pro-environmental activities and psychological well-being is limited. In this mixed-methods study, the relationship between pro-environmental engagement, meaning in life, and well-being, including loneliness and depression, were investigated in a sample of 112 young adults in Canada. It was found that engaging in pro-environmental activities was negatively associated with loneliness. This association was mediated by meaning in life . In addition, qualitative analyses explored how engaging in pro-environmental activities has a meaningful impact on meaning in life, and on well-being. A thematic analysis generated three unique themes: (1) responsibility to teach the next generation about the environment, (2) deep appreciation for and connection to nature, and (3) renewed agency through self-directed learning. Overall, findings suggest that meaning in life is a core motive that underlies the association between environmental engagement and loneliness. The present study enriched the relationship between pro-environmentalism and well-being with a mixed-methods perspective. The synergies of human–nature interaction and psychological well-being have gained considerable attention in the fields of Psychology and Public Health. Recent studies indicate that the interaction between humans and nature promotes increased well-being, physical activity, improved quality of life, and may reduce levels of depression and loneliness, e.g., ,3,4,5,6.Pro-environmental activities can be perceived as meaningful and intrinsic experiences with nature ,9. For ePast studies have also shown that people who engage in more environmentally friendly eco-behaviors experienced heightened well-being in general ,3,4,5,6.However, no study has explored a potential mechanism underlying the association between pro-environmental actions and psychological well-being such as loneliness and depression. One possible factor that we propose may help to explain this potential link is meaning in life such as generativity . GeneratMoreover, researchers have also indicated a positive relationship between generativity and well-being and meaning in life . AckermaThe present study used a mixed-methods approach  to invesn = 112) included young adults in Canada (71% women); Mage = 31.59 years, SD = 0.87 years. Of these, 51% of the participants reported that they have at least one child; 83% were full-time employed, 68% had completed a college degree. While the majority participants were European Canadians (91.1%), ten participants identified themselves as members of underrepresented communities . Portions of these data were analyzed in other studies that had different foci [The present study was part of a larger longitudinal project examining the transition to adulthood in Canadian youth (“The Future’s Study”) . In the ent foci .This study was approved by the Review Ethics Board at Wilfrid Laurier University, Canada. Participants were contacted either by email or phone and invited to participate in Round 5 of the Future’s Study. The study was conducted in-person in participants’ homes or at a private research space on a university campus in Southwestern Ontario, and involved a narrative interview followed by a brief survey instrument that included the following measures.Pro-Environmental Activities: Engaging in pro-environmental activities was measured by the Environmental Inventory of Involvement Scale . It consLoneliness: Loneliness  consisteDepression: Depression was measured in the Center for Epidemiological Studies Depression Scale (CES-D) . It has Generative concern: Generative concern was measured with the Loyola Generativity Scale (LGS) . ParticiAs part of a longer interview that captured domains of participants’ life stories , particiWe utilized a convergent-parallel mixed method design which involves collecting, analyzing, and integrating both quantitative and qualitative data in a single study . We gaveBoth univariate and multivariate statistical procedures were used to analyze the quantitative data using SPSS version 25. We first computed descriptive statistics and assessed the data for any violations of assumptions of the general linear model (GLM). All dependent variables were normally distributed via visual inspection of the histograms and normal-probability-plots. A z-score cut off criteria of ±3.29 was used to detect outliers. No outliers were present in the dataset, and skewness and kurtosis values were also in acceptable ranges, with values falling between −2 to +2 for skew, and −3 to +3 for kurtosis. No multivariate outliers or influential observations were detected, using a Cook’s distance value of 1.0, and all relationships were linear, were homoscedastic, and normally distributed via inspections of the scatterplots and residual histograms. Descriptive statistics  and mediation analysis (PROCESS Macro Model 4)  were conTo further unpack these associations, we identified 20 individuals as a high on environmental engagement . This targeted identification procedure has been used in previous studies  to furthWith this framework in mind, Braun and Clarke  recommenb = −0.23, p = 0.02) after controlling gender and the number of children . Unexpectedly, there was no significantly direct relationship between pro-environmental engagement and depression . Thus, the mediation analysis was conducted only on the relationship between pro-environmental engagement and loneliness.Descriptive statistics and correlation coefficients can be found in To examine whether generative concern mediated the association between pro-environmental activities and loneliness, we used Hayes’s PROCESS Macro v3.1 , model 4Using the Braun and Clarke’s  qualitatResponsibility to teach the next generation about the environment. Several pro-environmental participants expressed the importance of teaching pro-environmental activities to their children, so that these activities will not only carry forward to their children’s lives, but also create a sustainable world for future generations.“I try to teach my kids about not just the recycling but the composting and the green bin and the importance of how it all fits together and to make the world a better place for them, and when they have kids and their kids.”(Participant #62) These stories connected environmental events and activities  via teaching and learning with their children. These pro-environmental stories increased expectations regarding the quality of the bond and the sense of belonginess with one’s children in later life. These intergenerational responsibilities may promote well-being, as expressed by the following participants:“I do what I can do so that I can have a better life in this world… my offspring and my offsprings’ offspring, so I do my part.”(Participant #4)“I’m committed to do something about climate change, and I hope that I don’t have to apologize too much to my grandkids about it.”(Participant #458)“I think more not for myself but sort of looking at my kids and wondering how things will be as they grow up and then their children and sort of more in a long-term scale. Like what can I be doing now to ensure that things aren’t incredibly messed up for them as they get older. So just started to do research into clean energy, climate, like pollution control, looking at alternative energies, things like that.”(Participant # 186)Deep appreciation for and connection to nature. Another mechanism that connected pro-environmental engagement and well-being, through generative concern, is a connection to nature.“I enjoy going out there and my brothers and I would ride our bikes out there... part of that is monitoring for areas of high amounts of road kill so that we can provide passage for those creatures so that there isn’t that road kill, that we don’t lose them and that there’s no more frog pavement. So, it was a different time and now people care about the frogs, so it’s part of everything we do now.”(Participants #633)“We spent a lot of time on site at xxx in the tailings ponds, which are these big… So we’re spending a lot of time sampling those and it was just the smell combined with just the scene of desolation… if you ever see wildlife that’s struggling, you have to help it. You have to call someone and they have to come and help because sometimes birds will land there. It’s an important migratory route and so they get confused and they land in these ponds and they can get, well, they can die.”(Participant #672)“It wasn’t until after I got back from Guatemala, a hurricane hit the community where I had been, and there were mudslides and people died. I had never been, so closely impacted by climate change, because it’s kind of an abstract kind of environmental issue, it was a moment of clarity where I thought that is the environmental issue that I want to work on… the earth is hurting, there’s no lack of environmental tragedies. But it wasn’t until I knew people that had been impacted by it, that I thought, my God, if I can, if I have the luxury to pick what I work on”.(Participant #833)“For me, the impact has just been again, to try and appreciate every day what we have, and the fact that for so many people they didn’t, I mean one day they had everything and the next day they had nothing, so just sort of appreciating day to day… everything that I have and, I haven’t had to go through such devastating sort of environmental disaster like that.”(Participant #765)These stories illustrated connectedness with nature via outdoor activities in the natural world and personal experiences during natural disasters. Their experiences impacted participants’ views about nature in terms of concern for wild species and gaining a feeling of appreciation.Renewed agency through self-directed learning. Another mechanism between engaging in pro-environmental activities and well-being may be conveyed via learning about the environment. For example, participants described learning activities that were directed toward the natural environment and how it impacted their personal views about nature.“I am learning a way of sort of promoting new technologies that are gonna help to move us into a carbon-free society.”(Participant #600)“I’m very engaged in reading about different environmental issues, politically, socially, green political theory… ecological philosophy and environmentalism and I started to read all this stuff…it’s actually very much integrated into my life and who I am and what I find important and I’ve changed everything from the toiletries I use to the cleaning products, to how I spend my free time to the issues I care about.”(Participant #648)“I ended up going back to studying water quality and what I do now as my current job as an educator is to discuss natural resources like the oil sands, talk about their environmental impacts and try and help students understand that maybe there are other ways we can get our energy without having such a big environmental footprint.”(Participant #672)“I wrote poetry about animal rights and got in an animal rights book and it was just kind of a pivotal moment because I realized what effect humans had in the bigger picture, not just a human centric world but a complete environmental landscape. And I realized our impact and what we took for granted and really the interplay of the environment on humans’ lives and how we used it and abuse it and what we can change.”(Participant # 714)Other participants started with a negative belief such as helplessness and changed their attitude to searching for positive solutions as well as making contributions toward environmental issues.“The negative sides of it, but here’s all the positive sides of it. And trying to say, okay here’s the problem but here are a few ideas of a solution. Or looking at climate change and saying okay, here’s the problem, but here are some ideas of solutions that could help. They may not fix everything, but help. So that’s more the issue, is his take on the environmental issues was only from the negative…Trying to find the positive things rather than just the negatives… understand the negative but then move forward with it.”(Participant # 678)“I was just happy that we were actually cause sometimes you feel like you don’t have a voice and you can’t impact things because the company that produced bottle water have so much more money than the companies that are advertising against bottled water and talking about how ridiculous it is and so I was feeling a little bit of obviously like satisfaction and redemption at being able to make an impact.”(Participant # 706)The topic of human-nature connection and aspects of psychological health and well-being have been studied in the field of environmental psychology, e.g., ,3,4,5,6.Our findings that pro-environmental activities were directly associated with well-being  support past literature. However, the mechanism underlying this association has yet to be ascertained. Past research has indicated that generative concern is a motive of pro-environmental behavior ,32,35,36Our thematic analysis revealed three themes that specified the unique impact that participants’ environmental scenes had on meaning in life: (1) teaching pro-environmental activities to children (2) a deep appreciation for and connection to nature, (3) renewed agency through self-directed learning. Even though participants did not directly say their generative concerns from pro-environmental activities reduced their loneliness, they all mentioned that the importance of passing on a sustainable environment for their children and for future generations. This sense of intergenerational responsibility has been found to promote greater life satisfaction, eudaimonic happiness, purpose, autonomy, identity, personal growth, and self-acceptance ,40. In aThe extensive literature on nature and well-being supports this relationship ,2,3,4,5.Past research has predominantly used quantitative analysis (such as survey) to establish the relationship between pro-environmentalism and well-being. The present study utilized a convergent-parallel mixed method design to investigate motivations and mechanisms of the relationship. Specifically, we first analyzed the quantitative data to explore possible links among pro-environmental engagement, generative concern, and loneliness/depression. Then, we collected qualitative interviews to support the link and to further explore the process and motivation on how engaging in pro-environmental activities promote well-being via meaning in life. This mixed-methods design can promote a greater understanding of our quantitative analyses and enrich with compressive narratives.While the current study integrated qualitative and quantitative data to unpack these associations, it has several limitations. First, this study was part of a longitudinal project that examined positive development during the transition to adulthood . MeasureEven though the current study revealed that engaging pro-environmental activities is related to loneliness via meaning in life, future studies need to investigate other aspects of psychological well-being such as life satisfaction, positive emotions, and eduaimonic well-being ,39,42. IIn summary, we demonstrated that generative concern underlies the association between environmental engagement and well-being. Engaging in environmental activities predicted higher levels of generativity which, in turn, protected against loneliness. Qualitative analysis revealed environmental actions led to passages that speak directly to the importance of meaning in life such as intergenerational connection, i.e., imparting lessons to children about nature, a deep respect and appreciation for the natural world that extends beyond the self, and an intrinsic drive to continue to learn more about the environment. Environmental involvement is thus one avenue for the expression of meaning in life in adulthood.


Tracing explanatory narratives of mask-wearing throughout COVID-19, we argue that multiple narratives contribute to the global experience of COVID-19, making it as much a social and political object as it is a scientific one. This assumption drives our commitment to take seriously alternative narratives that do not conform to dominant ones in order to examine how structures of power might privilege particular types of ‘truths’ and with what consequences. We see this reflective piece as a re-articulation of social work’s historic call to interrogate dominant ways of knowing, particularly the ways in which science obscures its own power and politics and sidelines other narratives in the process. We might be tempted to view COVID-19 in dramaturgical terms: It “start[s] at a moment in time, proceed[s] on a stage limited in space and duration, following a plot line of increasing and revelatory tension, move to a crisis of individual and collective character, then drift toward closure” : 279. AnDespite the cacophony of voices that uniformly suggests the pandemic may evade a single, or even a few, plotlines, what is remarkable about this moment in time is our insistence to find a single explanatory narrative to make sense of it. Yet, because the temptation to retell its dominant narratives swells as the story of COVID-19 seemingly “drift[s] to closure,” our call is to take seriously the putatively irrational, peripheral, or nonscientific narratives that crop up. Social work has long been aware that narratives are political because they are imbricated in structures of power that produce hierarchically-stratified truths in given moments . We therTo illustrate the stakes involved in the production and transmission of narratives, we trace explanatory narratives of mask wearing – that thin, often-pleated, material we lay on top of our mouths and noses – throughout COVID-19 to examine which narratives appear to glide to the top more smoothly than others as well as those which tend to get sidelined.In the months following WHO’s declaration that COVID-19 is a pandemic, the CDC and U.S. public health experts advised the public against wearing face masks unless they have COVID-19 or care for people who do. Denouncing the masks’ ability to protect, the U.S. Surgeon General, Dr. Jerome Adams, demanded the American public to “STOP BUYING MASKS!” See .rd. The CDC refurbished its website with a dedicated section on cloth coverings, declaring in the text: “In light of this new evidence, CDC recommends wearing cloth face coverings in public settings.” The text is accompanied by a 45-second video of Dr. Adams, who previously tweeted “STOP BUYING MASKS,” refashioning a black t-shirt harkening back to another epidemic, “got naloxone?”, into a face covering .Yet, with the scientific discovery of the virus’ potential for airborne flight from people without symptoms (“asymptomatic”) or at the cusp of developing symptoms (“pre-symptomatic”) to unknowing bystanders, the CDC reversed its recommendation on April 3Insulated by an ideology of scientific progress, there is rarely culpability in science for the provision of suspect advice. Instead, there is simply scientific uncertainty caused by the wily of a virus whose chaos evades scientific capture. Consider, for example, But could the experts really not anticipate the importance of face masks and coverings? After all, since September 11 and Hurricane Katrina, institutions of “Emergency Preparedness” have proliferated in American bureaucratic life, readying workers for anticipatory action through the arcane and mundane practices of safety drills and online trainings . As earlNew Yorker, In an interview in mid-June, Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases and America’s poster child for ‘sticking to the scientific facts’ amid COVID-19, conceded the public was not advised to wear masks due to the national shortage in personal protective equipment . WritingYet the shortage of personal protective equipment does not change the fact that masks were deemed non-essential for months. Skirting the limits of truth through the play of words, the CDC, Dr. Fauci, among others drew a line between “masks” and “coverings”. They reminded their adherents that coverings are distinct from surgical masks and N-95 respirators, and that masks ought to be conserved for healthcare workers. Furthermore, they assured the public that their previous guidance was offered when the facts of airborne spread were not yet determined, however now “we know that you don’t need an N95 if you’re an ordinary person in the street,” and “simple cloth coverings that many people have can work as well as masks in many cases” .On the same day that the CDC revised its recommendations, the U.S. Health and Human Services Secretary, Alex Azar, declared his allegiance to face coverings. Appealing to “the science” which “suggests it will help prevent you from spreading it to others,” he cajoled, “face coverings are a new, voluntary opportunity for a unified national effort […]. Taking this step will protect our loved ones, our communities, and our country from the invisible enemy we’re fighting together” . ThroughPlandemic on the causes of COVID-19, donning masks carries serious health concerns. She warned that flu vaccines implant a dormant form of coronavirus into peoples’ bodies, which will “literally activate” upon wearing masks. Despite Plandemic’s expulsion from social media platforms such as YouTube, Facebook, Vimeo and Twitter, it remained one of the most widely circulated repositories of conspiracy theories on COVID-19  concept of As we have shown, even narratives concerning face masks, including shortages in personal protective equipment, semantic quibbles over masks versus coverings, conspiracy theories, police shootings and protests, run alongside, interweave and intersect with COVID-19. The multitude of narratives and voices in many ways capture the essence of COVID-19 that would otherwise be glossed over in neat timelines and stylized histories. These narratives, along with many more, accrete and interact to contribute to the global experience of COVID-19, making it as much a social and political object as it is a scientific one . The exp