We found that a clear majority of the adolescents in Oslo who responded to the survey reported to comply with the infection control rules to a large extent or always during the COVID-19 pandemic. However, it was only to the question of hand washing that a majority of the adolescents answered that they always complied with the rules. Adolescents from immigrant backgrounds and those living in the outer eastern suburbs reported higher compliance with the rules. Girls reported compliance with the rules more frequently than boys. A large majority trusted the authorities' handling of the pandemic. On the other hand, fewer respondents trusted people in general to comply with the infection control rules. Nine out of ten believed that the rules were appropriately strict or could be even stricter. Trust in the authorities and in people in general and acceptance of the infection control rules were related to reported compliance.
The high level of trust in the health authorities indicates that they have communicated well with young people during the pandemic. Other Norwegian studies have shown that this also applies to adults (12). However, adolescents had less trust in people in general to comply with the infection control rules. This may have led to poorer compliance on their own part.
In line with previous research, girls reported to comply with the infection control rules to a higher extent than boys (4, 6). Reported compliance was lowest in the youngest age groups. This may be linked to the fact that the media and authorities have presented infection as less of a problem in young age groups. It is a new observation that adolescents from immigrant backgrounds in the outer eastern suburbs report higher compliance than others. The excess incidence of infection in these districts may be related to structural factors, such as residential crowding, the fact that many have jobs with high exposure to infection, and perhaps closer contact across generations. It is also conceivable that adolescents in the outer eastern suburbs were less careful about protective behaviour at the early stage of the pandemic, when the infection was less prevalent in these districts, and that they changed their behaviour when the spread of the infection intensified.
It is worth noting that those few (9 %) who felt that the infection control rules were too strict reported lower compliance. The causal relationship has not been identified, and it is conceivable that these respondents legitimise violations of the rules by toning down their importance. The findings nevertheless indicate that acceptance of restrictions is important for protective behaviour.
The strength of the study lies in being population-based, with a large sample. It was conducted at a time when strict restrictions were in force and when the pandemic defined the lives of these young people and their families. However, it also has some limitations. We used self-reporting, and the answers may have been tainted by the social desirability of compliance with the infection control rules (17). The estimate of compliance rates may thus be too high.
The advantage of our measure is that it was tested by both students and teachers and that we asked the adolescents to report how they complied with the infection control rules over a defined period of 6–8 weeks (from the time when the restrictions were introduced until the time when they participated in the study). This can be assumed to enhance reliability, compared to questions that measure longer time intervals retrospectively (17). We measured the degree of compliance with the rules, not the frequency of various types of behaviour. We thus do not know how often adolescents have been exposed to situations involving risk of infection. Such knowledge would have been useful for estimating the risk of actual infection. Furthermore, factors that are not included in the study, such as concerns of becoming infected (6), may have a bearing on infection control behaviour among adolescents.
The response rate is lower than in similar studies, such as the Ungdata and Young in Oslo surveys (16). Most likely, many teachers were unable to implement the survey at short notice. Moreover, the situation was less structured than when students respond to a questionnaire in the classroom. The data have a selection bias in relation to sociodemographic background variables. This attrition may be linked to compliance with the infection control rules, which could have an effect on the estimates.
The findings may also reflect the timing of the data collection. It was conducted 6–8 weeks after the strict restrictions were introduced. The news media and everyday life were dominated by the pandemic. Later studies may report other findings, because the authorities loosen the restrictions, because fatigue may set in among the population if the restrictions remain in place over a prolonged period, and because the focus on the heightened risk of infection in the eastern suburbs of Oslo may shift. Future studies will show whether the findings from Oslo can be generalised to other parts of Norway.
We conclude that a clear majority of the adolescents in Oslo who participated in the study reported to have complied with the infection control rules to a large extent. Most of them accepted that the rules were necessary, and they have high trust in the handling of the COVID-19 pandemic by the authorities. Some will be surprised that adolescents from immigrant backgrounds and those resident in the outer eastern suburbs of Oslo appear to comply with the rules to a larger extent than others. Later studies should elucidate such differences and their possible causes. More knowledge about this and other issues that we shed light on may contribute to even more effective measures to prevent the spread of infection.