National variability in Americans' COVID-19 protective behaviors: Implications for vaccine roll-out.

Qinyun Lin,Marynia Kolak,Russell Brewer,Jun Tanimoto,Bruce G. Taylor,John A. Schneider,Jade Pagkas-Bather,Jonathan Ozik,Phoebe A. Lamuda,Mai Tuyet Pho,Elizabeth Flanagan,Harold A. Pollack,Anna L. Hotton

doi:10.1371/journal.pone.0259257

Abstract

Protective behaviors such as mask wearing and physical distancing are critical to slow the spread of COVID-19, even in the context of vaccine scale-up. Understanding the variation in self-reported COVID-19 protective behaviors is critical to developing public health messaging. The purpose of the study is to provide nationally representative estimates of five self-reported COVID-19 protective behaviors and correlates of such behaviors. In this cross-sectional survey study of US adults, surveys were administered via internet and telephone. Adults were surveyed from April 30-May 4, 2020, a time of peaking COVID-19 incidence within the US. Participants were recruited from the probability-based AmeriSpeak® national panel. Brief surveys were completed by 994 adults, with 73.0% of respondents reported mask wearing, 82.7% reported physical distancing, 75.1% reported crowd avoidance, 89.8% reported increased hand-washing, and 7.7% reported having prior COVID-19 testing. Multivariate analysis (p critical value .05) indicates that women were more likely to report protective behaviors than men, as were those over age 60. Respondents who self-identified as having low incomes, histories of criminal justice involvement, and Republican Party affiliation, were less likely to report four protective behaviors, though Republicans and individuals with criminal justice histories were more likely to report having received COVID-19 testing. The majority of Americans engaged in COVID-19 protective behaviors, with low-income Americans, those with histories of criminal justice involvement, and self-identified Republicans less likely to engage in these preventive behaviors. Culturally competent public health messaging and interventions might focus on these latter groups to prevent future infections. These findings will remain highly relevant even with vaccines widely available, given the complementarities between vaccines and protective behaviors, as well as the many challenges in delivering vaccines.

Highlights

The United States is currently experiencing the largest COVID-19 epidemic in the world with 20% of the world’s cases and the most COVID-19 deaths [1]
Evidence suggests an association between COVID-19 rates and lower income likely associated with multiple factors including low income, criminal justice involvement (CJI), substance use disorders (SUD), opioid use disorder (OUD), overpopulated and poor housing conditions, dwelling in multigenerational homes, use of public transport, and higher rates of comorbidities [4,5,6,7,8]
The survey was completed by 994 of those invited from the larger AmeriSpeak panel (24%) with 17 respondents (2%) excluded from the analysis due to missing data, producing a final sample of 977 respondents

Summary

Introduction

The United States is currently experiencing the largest COVID-19 epidemic in the world with 20% of the world’s cases and the most COVID-19 deaths [1]. Clear disparities in COVID-19 infection and death rates exist within the US, with African Americans and Hispanic populations experiencing greater disease burden than other racial/ethnic groups [2]. COVID-19 data from several countries reflects a higher case fatality rate for elderly populations [3]. Various public health agencies including the WHO [9] and Centers for Disease Control and Prevention [10] have issued guidance on proven COVID-19 protective behaviors to complement vaccine implementation [11]. Recommended COVID-19 protective behaviors include physical distancing, use of face coverings, avoidance of large gatherings, and basic hand hygiene measures, among other measures to prevent transmission such as COVID-19 testing [9, 12]

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