Investigating Seasonal Changes in Factors Associated With COVID-19 Concerns: Results From a Serial Cross-Sectional Survey Study in Germany Between 2020 and 2023

allemand. Objective: COVID-19 risk perceptions are discussed to be volatile and have been shown to be connected to the adoption of preventive public health behaviors. This study aimed to investigate changes in COVID-19 concerns and influencing factors as a function of season among the German public. Methods: Sixty-three waves of cross-sectional telephone surveys with German participants aged 14 years and older conducted at least monthly between June 2020 and April 2023 provided the data basis (N = 63,471). After pooling participants of different waves by season (spring, summer, fall, winter), data were analyzed with regard to changes in physical health, mental health, economic, and social COVID-19 concerns. Individual characteristics (e.g., age), COVID-19 behavior (e.g., hygiene practices), and related perceptions (e.g., controllability of risk) were considered as predictors of composite concerns in different seasons. Results: Results showed a higher between-seasons than within-seasons variability in concerns, with rises in physical and mental health and social concerns during fall. Multivariate regressions revealed being female, lower education, adopting protective measures, and higher perceived probability of infection in both public and private settings to be consistent predictors of higher COVID-19 concerns. Coefficients of these predictors remained comparatively stable over seasons and years. Conclusion: Results indicate re-occurring changes in concerns during a prolonged crisis, with distinct characteristics being consistently associated with higher reported concerns. To ensure the application of protective measures, communicators should consider that risk perceptions are subject to fluctuations, but that certain groups of individuals tend to develop them and therefore deserve particular focus.