Stay-at-home orders, social distancing, and trust

Religiosity, attitudes toward science, and public health: Evidence from Finland

We explore how religiosity influences perceptions and the adoption of protective health behaviours, as reflected in COVID-19 infection and vaccination rates. In the first part of our analysis, we use Finnish data from four nationally representative surveys, we find that individuals with higher self-reported religiosity and those from more conservative religious groups tend to hold less favourable attitudes towards science, technology and medicine, compared to non-religious individuals. In the second part, we observe that municipalities with higher shares of conservative religious groups experienced greater COVID-19 spread and lower vaccination rates, with these trends persisting throughout the pandemic. Our findings underscore the importance of accounting for religiosity when crafting public health policies, as it may contribute to the existence of non-compliance hotspots.

Social capital and vaccination compliance: Evidence from Italy

Exploiting high-frequency vaccination data for COVID-19 and social capital measures at the municipal level in Italy between January and October 2021, this paper estimates the effect of social capital on vaccination compliance. We find that weekly vaccination coverage increased up to 1.60 percentage points more in municipalities with higher social capital. Results do not differ by gender and the effect is mainly driven by younger generations. Our findings shed light on the role of social capital as a driver of health protective behavior.

Refueling a Quiet Fire: Old Truthers and New Discontent in the Wake of COVID-19

This article investigates the factors that contributed to the proliferation of online COVID skepticism on Twitter across Italian municipalities in 2020. We demonstrate that sociodemographic factors were likely to mitigate the emergence of skepticism, whereas populist political leanings were more likely to foster it. Furthermore, pre-COVID anti-vaccine sentiment, represented by "old truthers" on Twitter, amplified online COVID skepticism in local communities. Additionally, exploiting the spatial variation in restrictive economic policies with severe implications for suspended workers in nonessential economic sectors, we find that COVID skepticism spreads more in municipalities significantly affected by the economic lockdown. Finally, the diffusion of COVID skepticism is positively associated with COVID vaccine hesitancy.

Trust predicts compliance with COVID-19 containment policies: Evidence from ten countries using big data

We use Twitter, Google mobility, and Oxford policy data to study the relationship between trust and compliance over the period March 2020 to January 2021 in ten, mostly European, countries. Trust has been shown to be an important correlate of compliance with COVID-19 containment policies. However, the previous findings depend upon two assumptions: first, that compliance is time invariant, and second, that compliance can be measured using self reports or mobility measures alone. We relax these assumptions by calculating a new time-varying measure of compliance as the association between containment policies and people's mobility behavior. Additionally, we develop measures of trust in others and national institutions by applying emotion analysis to Twitter data. Results from various panel estimation techniques demonstrate that compliance changes over time and that increasing (decreasing) trust in others predicts increasing (decreasing) compliance. This evidence indicates that compliance changes over time, and further confirms the importance of cultivating trust in others.

COVID-19 and influenza vaccine-hesitancy subgroups

Health communicators are faced with the challenge that people can hesitate vaccines for different reasons. Our aim was to identify and describe the qualities of distinct COVID-19 and influenza vaccine-hesitancy subgroups to facilitate the development of tailored vaccine-hesitancy communication. In two studies, we used agglomerative hierarchical cluster analysis to identify COVID-19 (N = 554) and influenza (N = 539) vaccine-hesitancy subgroups in the general population based on nine vaccine hesitancy-related variables (intent to get vaccinated, perceived vaccine safety, perceived vaccine efficacy, perceived disease threat, perceived vaccination responsibility, perceived vaccination convenience, distrust in authorities, conspiracy mentality, and reliance on anecdotal testimonies). We identified and described six distinct COVID-19 vaccine-hesitancy subgroups (the Vaccination Positive, the Ambivalent, the Fearing Skeptic, the Unconvinced, the Constrained Skeptic, and the Vaccination Opponent), and three influenza vaccine-hesitancy subgroups (the Vaccination Positive, the Complacent, and the Vaccination Opponent), with different levels of hesitancy. We discuss the implications of the results for health communicators. Our results shed light on the (dis)similarities between people who hesitate COVID-19 and influenza vaccines and suggest that there is greater variety in hesitancy concerning COVID-19 vaccinations than influenza vaccinations. These findings can be used to design and test tailored vaccination messages.

Changes in Obesity Prevalence Among U.S. Adults After the COVID-19 Pandemic by State and Territorial Stay-at-Home Order Level and Sociodemographic Characteristics

PURPOSE

To examine changes in obesity prevalence among US adults after the COVID-19 pandemic by level of stay-at-home order and sociodemographic characteristics.

DESIGN

Quasi-experimental study using repeated cross-sectional data.

SETTING

Behavioral Risk Factor Surveillance System (BRFSS).

SAMPLE

Pooled data for US adults ages ≥26 years (n = 1,107,673) from BRFSS (2018-2021).

MEASURES

States/territories were classified into three levels of stay-at-home order: none, advisory/only for persons at risk, or mandatory for all. Individual-level sociodemographic characteristics were self-reported.

ANALYSIS

The difference-in-differences method was conducted with weighted multiple logistic regression analysis to examine obesity (body mass index ≥30 kg/m2) prevalence by stay-at-home order level and sociodemographic characteristics before/after the COVID-19 pandemic (January 2018-February 2020 vs March 2020-February 2022).

RESULTS

After adjusting for a secular trend and multiple covariates, adults in states/territories with mandatory stay-at-home orders experienced a larger increase in obesity prevalence (adjusted odds ratio: 1.05; 95% confidence interval: 1.01, 1.11) than adults in states/territories with no stay-at-home order. Younger adults (vs ≥65 years) and individuals with

CONCLUSION

Increases in obesity prevalence were perpetuated 2 years after implementation of stay-at-home orders, indicating that longer-term health implications are co-occurring during the pandemic recovery period. Future research should focus on successful methods for staying active and healthy during social distancing and beyond.

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Key Words

• COVID-19
• age
• education
• health policy
• obesity
• sociodemographic characteristic
• stay-at-home order

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MESH Headings

• Humans
• COVID-19/epidemiology
• Obesity/epidemiology
• Male
• United States/epidemiology
• Female
• Prevalence
• Adult
• Middle Aged
• Cross-Sectional Studies
• Behavioral Risk Factor Surveillance System
• Sociodemographic Factors
• Aged
• SARS-CoV-2
• Socioeconomic Factors
• Pandemics
• Young Adult

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Affiliation(s)

Beomyoung Cho Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
Yining Pan Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
McKinley Chapman Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA
Aaron Spaulding Division of Health Care Delivery Research, College of Medicine, Mayo Clinic, Jacksonville, FL, USA
Sericea Stallings-Smith Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, FL, USA

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Community responses to corona virus disease (COVID-19) in Africa in the face of "Infodemic": A scoping review

Globally, Corona Virus Disease (COVID-19) has significantly affected communities in various aspects. The World Health Organization proposed different measures to prevent the pandemic. However, these measures in some instances have not effectively minimized the impacts of COVID-19, due to innumerable factors, inter alia, considerable "infodemic" related to myths, misinformation, and misconceptions. Knowledge of the "infodemic" on COVID -19 can lead to effective interventions to rid societies of COVID-19, hence reduction of COVID-19-related risks and outcomes. This article explores the "COVID-19 infodemic" that affected community responses to COVID-19 in Africa. The study employed a scoping review approach involving peer-reviewed articles from numerous search engines and databases. The keywords involved in the search query were: "COVID-19 infodemic, COVID-19 false news, COVID-19 in Africa, 'knowledge of COVID-19, 'myths, misinformation, and misconceptions on COVID-19, 'history of COVID-19', 'community responses to COVID-19 in Africa". Findings show that 5G technology transferred coronavirus, high temperature and alcohol can kill coronavirus, blacks are immune to COVID-19, COVID-19 vaccine development has been rushed hence not very effective and safe and also causes infertility. Diverse community responses have been registered which in some ways frustrated efforts in combating the pandemic. Therefore, the "infodemic" consisting of myths, misconceptions, and misinformation have been resulting from the history of COVID-19 which first affected white people more than blacks. Also, low knowledge of how the virus is transmitted and affect human being; and the notion that COVID-19 affects richer than poor people, hence since white people are richer than black people then they were the first to be affected by the pandemic. Obviously in presence of such myths, misconceptions, and misinformation; community responses in combating COVID-19 have not been very effective in Africa. For these interventions to be effective, collective efforts involving various stakeholders to raise awareness of COVID-19 are needed.

The Politicization of the COVID-19 Pandemic

Political actors and institutions are largely responsible for effectively implementing the latest scientific and medical information in the form of public health measures. However, when politicians' judgments and decision-making are not founded on scientific facts or when scientific findings are misrepresented to further political goals, global crises such as pandemics may be even more galvanized. Like other scientific topics that entered public debate before 2020 (e.g., the debate on climate change), the COVID-19 pandemic has been heavily politicized worldwide. Consequently, COVID-19-related outcomes were strongly affected by politicization-a process of making a non-political issue political, i.e., debating it in the public sphere as an issue of public contestation. The present chapter presents a condensed overview and synthesis of the literature on the politicization of the COVID-19 pandemic in high- and low-income countries. In addition, we discuss several mechanisms explaining why, to some extent universally, conservatives (the right-wing oriented public) were less likely to follow public health recommendations, were more COVID-19 vaccine-hesitant, and had increased infection rates, poor health outcomes, and increased mortality compared to left-wing oriented public. The mechanisms explaining the links include the media, trust, cognitions, and values. We conclude the chapter with lessons learned during the COVID-19 pandemic and future research directions on the pandemics' politicization.

Love thy neighbor? The role of trust in neighbors during the COVID-19 crisis

During a pandemic, trust can either promote cooperative behavior, as people pay attention to their actions toward other people's health, or hinder cooperative behavior by decreasing risk perception. By linking South Korea's Community Health Survey data with district-level statistics of the number of confirmed cases, I examine the effect of trust during the pre-pandemic period on district-level infection rates. I find that trust in neighbors is negatively associated with infection rates during the period when people are well aware of social distancing measures. Results of the individual-level analysis demonstrate that trust in neighbors is positively associated with the probability of implementing social distancing measures, particularly, those that are difficult to enforce. This finding implies that trust in neighbors increases people's motivation to cooperate voluntarily with public precautionary measures that can reduce the probability of infection.

Online health information seeking and Covid-19 vaccine hesitancy: Evidence from 50+ Europeans

We use recently released data from the Survey of Health Ageing and Retirement in Europe (SHARE) to investigate the role of online health information seeking on Covid-19 vaccine hesitancy, which is defined as the reluctance or refusal to receive vaccinations despite the availability of vaccines. We adopt an instrumental variable strategy that exploits the computerization of workplaces occurred in the last century to deal with endogeneity. We find that searching for health information strongly reduces vaccine hesitancy. Results also show that individuals whose social networks suffered more during the outbreak, in terms of hospitalisations and deaths, are less likely to be hesitant. Improving individuals' technological skills might have positive spill-over effects for public health.

The Relationship Between Communicative Actions, Behavioral Intentions, and Corporate Reputation in the Framework of Situational Theory of Problem Solving in a Public Health Crisis

Objectives: This study aims to determine the individuals' communicative actions based on the basic assumptions of the situational theory of problem solving (STOPS) and the effect of these actions on people's willingness to follow WHO's instructions in the event of an epidemic. It also seeks to determine the impact of corporate reputation on people's communicative actions and intention to follow instructions. Methods: Data were collected digitally from 261 graduate students enrolled at a state university in the Eastern Anatolia Region of Turkey. A structural equation model (SEM) was employed for data analysis. Results: Perceptual antecedents affected situational motivation, and situational motivation affected communicative actions. Communicative actions were a determining factor in individuals' willingness to follow instructions. The perception of corporate reputation influenced both communicative actions and people's willingness to follow instructions. Conclusion: The study revealed that STOPS can provide an important theoretical framework for more effective risk communication practices in public health crises such as epidemics. It also displayed the relationship between the individuals' communicative actions and their willingness to follow instructions and the determining effect of corporate reputation on both of these factors.

Gimme shelter. Social distancing and income support in times of pandemic

Stay-at-home orders feature high in the set of policies used to curb the spread of epidemics such as COVID-19, but are potentially less efficient among poor people who must continue to work during pandemics. We examine how income support programs help poor people comply with stay-at-home order and thereby generate positive health externalities. We use data on work-related mobility in 2020 and on poverty rates for 729 subnational regions of Africa, Latin America and Asia. We focus on within-country differential mobility changes between higher- and lower-poverty regions. Accounting for all time-variant country-level factors, we show that lockdowns have decreased mobility significantly less in poorer regions. In turn, emergency income support programs have helped reduce this difference, mitigating the regional poverty gap in virus exposure through work mobility.

The impact of COVID-19 on the value of coastal recreational resource from the perspective of recreational behaviour change: Evident from China

The Corona Virus Disease 2019 (COVID-19) outbreak took a heavy toll on the global tourism industry in 2020, and affected the value realization of coastal recreational ecosystem service. From the micro perspective, this paper combines travel cost method with contingent behaviour method to obtain residents' actual behaviour and contingent behaviour data, and discusses the impact of the outbreak of COVID-19 on the value realization of coastal recreational resources from the perspective of the change in residents' recreational behaviour in Qingdao, China. Residents are observed to significantly reduce their outdoor activities in response to the COVID-19. The number of visits to the beach decreases by 25.2% when there is an outbreak, and decreases by 0.064% for every 1% increase in the number of confirmed cases, which is used to represent the severity of the epidemic. The asymmetries effects of epidemic situation on residents' recreational behaviour show that the improvements lead to larger and more significant impacts than the deteriorations. The disappearance of the pandemic crisis will provide considerable welfare for the citizens in Qingdao, which reaches to 1.9323 billion CNY/year. If the number of confirmed cases deteriorates to 900, the environmental welfare loss will be 0.3366 billion CNY/year. Additionally, we test the effects of residents' cognitive variables, and find that risk perception can strengthen the negative impacts of COVID-19 cases. Furthermore, the deteriorations in the environmental attributes are found to have stronger impacts on the number of visits than the improvements. This paper provides empirical-support results about the change of coastal recreational value through the evaluation of recreational behaviours in the post-epidemic period, which will give important implications for government's marine ecosystem restoration and coastal management work.

Perceptions of the impact of COVID-19 in Tennessee, USA: a retrospective study

Background

Despite high incidence and mortality risks associated with COVID-19 during the pandemic, stay-at-home orders and vaccination recommendations were met with varying levels of acceptance in Tennessee. Understanding perceptions of individuals regarding the health and economic impacts of COVID-19 is necessary to address public concerns while ensuring appropriate public health response. Therefore, the objectives of this study were to (a) investigate differences in opinions among residents of Tennessee regarding the impacts of COVID-19; and (b) identify socioeconomic and demographic predictors/determinants of these opinions.

Methods

This retrospective cross-sectional study was conducted using survey data collected in nine waves during 2020. Distributions of survey-weighted sociodemographic characteristics and respondent perceptions of the impact of COVID-19 were computed. Weighted logistic models were used to investigate predictors of a number of perceptions: whether the health or economic impact was greater, concern for respondent's health, concern for family's health, and willingness to accept COVID-19 vaccine.

Results

The study included a total of 9,754 survey respondents. Approximately equal percentages considered COVID-19 to have a greater economic (48.4%) versus health impact (51.6%). Just 40.1% of the respondents reported that they would definitely accept a COVID-19 vaccine. Age group, race, educational attainment, and household composition were significant (p < 0.05) predictors of all investigated perceptions regarding COVID-19. Lack of prior infection was the strongest predictor of the perception of COVID-19 having a greater impact on health (OR = 2.40, p < 0.001), concern for respondent's health (OR = 1.86, p = 0.002), and concern for family members' health (OR = 1.90, p = 0.001). Compared to males, females had higher odds of identifying the health impact of COVID-19 as greater (OR = 1.09, p = 0.041) and reporting concern for family health (OR = 1.14, p = 0.003). However, they had lower odds (OR = 0.63, p < 0.001) of willingness to accept vaccine than males.

Conclusion

These findings improve our understanding of the drivers of health behaviors, including vaccine hesitancy, and are useful for guiding public health outreach/education programs.

Socioeconomic determinants of stay-at-home policies during the first COVID-19 wave

Introduction

The COVID-19 pandemic has had a significant impact on public health and social systems worldwide. This study aims to evaluate the efficacy of various policies and restrictions implemented by different countries to control the spread of the virus.

Methods

To achieve this objective, a compartmental model is used to quantify the "social permeability" of a population, which reflects the inability of individuals to remain in confinement and continue social mixing allowing the spread of the virus. The model is calibrated to fit and recreate the dynamics of the epidemic spreading of 42 countries, mainly taking into account reported deaths and mobility across the populations.

Results

The results indicate that low-income countries have a harder time slowing the advance of the pandemic, even if the virus did not initially propagate as fast as in wealthier countries, showing the disparities between countries in their ability to mitigate the spread of the disease and its impact on vulnerable populations.

Discussion

This research contributes to a better understanding of the socioeconomic and environmental factors that affect the spread of the virus and the need for equitable policy measures to address the disparities in the global response to the pandemic.

The Effects of Non-Pharmaceutical Interventions on COVID-19 Cases, Hospitalizations, and Mortality: A Systematic Literature Review and Meta-Analysis

Introduction

To assess the effects of various non-pharmaceutical interventions (NPI) on cases, hospitalizations, and mortality during the first wave of the COVID-19 pandemic.

Methods

To empirically investigate the impacts of different NPIs on COVID-19-related health outcomes, a systematic literature review was conducted. We studied the effects of 10 NPIs on cases, hospitalizations, and mortality across three periodic lags (2, 3, and 4 weeks-or-more following implementation). Articles measuring the impact of NPIs were sourced from three databases by May 10, 2022, and risk of bias was assessed using the Newcastle-Ottawa scale.

Results

Across the 44 papers, we found that mask wearing corresponded to decreased per capita cases across all lags (up to -2.71 per 100,000). All NPIs studied except business and bar/restaurant closures corresponded to reduced case growth rates in the two weeks following implementation, while policy stringency and travelling restrictions were most effective after four. While we did not find evidence of reduced deaths in our per capita estimates, policy stringency, masks, SIPOs, limited gatherings, school and business closures were associated with decreased mortality growth rates. Moreover, the two NPIs studied in hospitalizations (SIPOs and mask wearing) showed negative estimates.

Conclusions

When assessing the impact of NPIs, considering the duration of effectiveness following implementation has paramount significance. While some NPIs may reduce the COVID-19 impact, others can disrupt the mitigative progression of containing the virus. Policymakers should be aware of both the scale of their effectiveness and duration of impact when adopting these measures for future COVID-19 waves.

Patient-reported distress at a cancer center during the COVID-19 pandemic

Assessments of health-related quality of life (HRQOL) are conducted by health systems to improve patient-centered care. Studies have shown that the COVID-19 pandemic poses unique stressors for patients with cancer. This study investigates change in self-reported global health scores in patients with cancer before and during the COVID-19 pandemic. In this single-institution retrospective cohort study, patients who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) at a comprehensive cancer center before and during the COVID-19 pandemic were identified. Surveys were analyzed to assess change in the global mental health (GMH) and global physical health (GPH) scores at different time periods (pre-COVID: 3/1/5/2019-3/15/2020, surge1: 6/17/2020-9/7/2020, valley1: 9/8/2020-11/16/2020, surge2: 11/17/2020-3/2/2021, and valley2: 3/3/2021-6/15/2021). A total of 25,192 surveys among 7209 patients were included in the study. Mean GMH score for patients before the COVID-19 pandemic (50.57) was similar to those during various periods during the pandemic: surge1 (48.82), valley1 (48.93), surge2 (48.68), valley2 (49.19). Mean GPH score was significantly higher pre-COVID (42.46) than during surge1 (36.88), valley1 (36.90), surge2 (37.33) and valley2 (37.14). During the pandemic, mean GMH (49.00) and GPH (37.37) scores obtained through in-person were similar to mean GMH (48.53) and GPH (36.94) scores obtained through telehealth. At this comprehensive cancer center, patients with cancer reported stable mental health and deteriorating physical health during the COVID-19 pandemic as indicated by the PROMIS survey. Modality of the survey (in-person versus telehealth) did not affect scores.

Does expert information affect citizens' attitudes toward Corona policies? Evidence from Germany

Information provided by experts is believed to play a key role in shaping attitudes towards policy responses to the COVID-19 pandemic. This paper uses a survey experiment to assess whether providing citizens with expert information about the health risk of COVID-19 and the economic costs of lockdown measures affects their attitudes towards these policies. Our findings show that providing respondents with information about COVID-19 fatalities among the elderly raises support for lockdown measures, while information about their economic costs decreases support. However, different population subgroups react differently. Men and younger respondents react more sensitively to information about lockdown costs, while women and older respondents are more susceptible towards information regarding fatality rates. Strikingly, our results are entirely driven by respondents who underestimate the fatality of COVID-19, who represent a majority.

Do more stringent policies reduce daily COVID-19 case counts? Evidence from Canadian provinces

The enactment of COVID-19 policies in Canada falls under provincial jurisdiction. This study exploits time-series variation across four Canadian provinces to evaluate the effects of stricter COVID-19 policies on daily case counts. Employing data from this time-period allows an evaluation of the efficacy of policies independent of vaccine impacts. While both OLS and IV results offer evidence that more stringent Non-Pharmaceutical Interventions (NPIs) can reduce daily case counts within a short time-period, IV estimates are larger in magnitude. Hence, studies that fail to control for simultaneity bias might produce confounded estimates of the efficacy of NPIs. However, IV estimates should be treated as correlations given the possibility of other unobserved determinants of COVID-19 spread and mismeasurement of daily cases. With respect to specific policies, mandatory mask usage in indoor spaces and restrictions on business operations are significantly associated with lower daily cases. We also test the efficacy of different forecasting models. Our results suggest that Gradient Boosted Regression Trees (GBRT) and Seasonal Autoregressive-Integrated Moving Average (SARIMA) models produce more accurate short-run forecasts relative to Vector Auto Regressive (VAR), and Susceptible-Infected-Removed (SIR) epidemiology models. Forecasts from SIR models are also inferior to results from basic OLS regressions. However, predictions from models that are unable to correct for endogeneity bias should be treated with caution.

Causal effects of mobility intervention policies on intracity flows during the COVID-19 pandemic: The moderating role of zonal locations in the transportation networks

Many studies have investigated the impact of mobility restriction policies on the change of intercity flows during the outbreak of COVID-19, whereas only a few have highlighted intracity flows. By using the mobile phone trajectory data of approximately three months, we develop an interrupted time series quasi-experimental design to estimate the abrupt and gradual effects of mobility intervention policies during the pandemic on intracity flows of 491 neighborhoods in Shenzhen, China, with a focus on the role of urban transport networks. The results show that the highest level of public health emergency response caused an abrupt decline by 4567 trips and a gradually increasing effect by 34 trips per day. The effectiveness of the second return-to-work order (RtW2) was found to be clearly larger than that of the first return-to-work order (RtW1) as a mobility restoration strategy. The causal effects of mobility intervention policies are heterogenous across zonal locations in varying urban transport networks. The declining effect of health emergency response and rebounding effect of RtW2 are considerably large in better-connected neighborhoods with metro transit, as well as in those close to the airport. These findings provide new insights into the identification of pandemic-vulnerable hotspots in the transport network inside the city, as well as of crucial neighborhoods with increased adaptability to mobility interventions during the onset and decline of COVID-19.

Happiness predicts compliance with preventive health behaviours during Covid-19 lockdowns

To combat the public health crisis of Covid-19, governments and public health officials have been asking individuals to substantially change their behaviours for prolonged periods of time. Are happier people more willing to comply with such measures? Using independent, large-scale surveys covering about 79,000 adult respondents across 29 countries, including longitudinal data from the UK, we find that life satisfaction predicts compliance with preventive health behaviours during Covid-19 lockdowns, especially the number of weekdays stood at home (β = 0.02, p < 0.01). The association is stronger for higher levels of life satisfaction (e.g. β = 0.19, p < 0.01, 7 on a 0-to-10 scale). Lower life satisfaction, on the contrary, predicts lower compliance (e.g. β = 0.02, p > 0.10, 2 on a 0-to-10 scale). We explore risk-avoidance and pro-social motivations for this relationship, and find suggestive evidence that people who are older or have certain medical preconditions seem to be behave in line with risk-avoidance, whereas motivations of people who are less at risk of Covid-19 seem more mixed. While it is difficult to estimate the relationship between life satisfaction and compliance behaviour due to potential confounders and unobserved heterogeneity, our findings suggest that life satisfaction is important, both for complying with preventive health measures and as a policy end in itself.

How consumer behaviours changed in response to COVID-19 lockdown stringency measures: A case study of Walmart

Walmart is a major player in the US retail sector and was one of the grocery corporations that bucked the trend of declining retail sales at the start of the COVID-19 pandemic in 2020. Particularly in the initial stages of the pandemic, governance priorities focussed on restricting the movement of people and closing non-essential retailers and service providers to slow the spread of the virus and keep people safe. This paper investigates the impact of non-pharmaceutical interventions, in the form of lockdown stringency measures, on consumer purchasing behaviours for essential goods over the onset of the pandemic. Focussing on both instore and online sales outcomes for Walmart in the US, we examine changes between pre-pandemic trends in two different sales outcomes, sales transactions and total spend, and trends in 2020. We then employ a series of multi-level regression models to estimate the impact that imposed stringency measures had on these sales outcomes, at both national and state level. Results indicate that nationally consumers were making fewer, larger physical shopping trips and huge increases in online sales was seen ubiquitously across the country. Novel and expansive insights from such a wide-spread retailer, such as Walmart, can help retailers, stakeholders and policy makers understand changing consumption trends to inform business strategies and resilience planning for the future. Furthermore, this study highlighted the value of examining spatial trends in sales outcomes and hopes to influence greater consideration of this in future research.

The effect of a nighttime curfew on the spread of COVID-19

While nighttime curfews are less severe restrictions compared to around-the-clock curfews in mitigating the spread of Covid-19, they are nevertheless highly controversial, with the scarce literature on their effectiveness providing mixed evidence. We study the effectiveness of the nighttime curfew in Hamburg, Germany's second largest city, in mitigating the spread of Covid-19. This curfew forbid people from leaving their home between 9 p.m. and 5 a.m. for non-essential businesses. Applying both difference-in-differences and synthetic control methods, we find that the curfew was effective in reducing the number of Covid-19 cases. As it is unclear whether and how the virus will mutate in the next time, policy-makers might have to resort to non-pharmaceutical interventions again. Nighttime curfews should be kept in the toolbox of policy-makers to fight Covid-19.

Neo-humanism and COVID-19: Opportunities for a socially and environmentally sustainable world

A series of crises, culminating with COVID-19, shows that going "Beyond GDP" is urgently necessary. Social and environmental degradation are consequences of emphasizing GDP as a measure of progress. This degradation created the conditions for the COVID-19 pandemic and limited the efficacy of counter-measures. Additionally, rich countries did not fare much better during the pandemic than poor ones. COVID-19 thrived on inequalities and lack of cooperation. In this article, we leverage on defensive growth theory to explain the relationships between these factors, and we put forward the idea of neo-humanism, a cultural movement grounded on evidence from quality-of-life studies. The movement proposes a new culture leading towards a socially and environmentally sustainable future. Specifically, neo-humanism suggests that prioritizing well-being by, for instance promoting social relations, would benefit the environment, and enable collective action to address public issues. This, in turn, would positively affect productivity and health - among other behavioral outcomes - and thereby instill a virtuous cycle. Such a society would have been better endowed to cope with COVID-19, and possibly even prevented the pandemic. Neo-humanism proposes a world in which the well-being of people comes before the well-being of markets, in which promoting cooperation and social relations represents the starting point for better lives, and a peaceful and respectful coexistence with other species on Earth.

Economic analysis through alternative data and big data techniques: what do they tell about Brazil?

Alternative data are now widely used in economic analyses worldwide but still infrequent in studies on the Brazilian economy. This research demonstrates how alternative data extracted from Google Trends and Google Mobility contribute to innovative economic analysis. First, it demonstrates that the search for the future on the internet is correlated (R = 0.62) with the average household income in Brazilian states. The three Brazilian states with the most people looking for the future on the internet have an average household income 1.6 times higher than people from states that do not have this behavior. The search for the future represents 10.9% of the economic development potential of the states, while the proportion of people with university degrees, scientific publications, and researchers represents another 60.4%. The reduction in mobility in retail/recreation locations averaged 34.28% in Brazil, Ecuador, Paraguay, and Uruguay. This group of countries had COVID-19 infection and death rates 1.25 and 1.74 times higher than in countries that reduced their mobility in retail/recreation locations by 45.03%. The impact of reduced mobility in retail/recreation locations on the unemployment rate, gross domestic product degrowth, and inflation in countries such as Brazil was 1.1, 2.2, and 2.6 times lower than in countries that reduced mobility more of people. The research contributions are associated with identifying new indicators extracted from alternative data and their application to carry out innovative economic analyses.

Education and COVID-19 excess mortality

We study the role of education during the COVID-19 epidemic in Italy. We compare excess mortality in 2020 and 2021 compared to the pre-pandemic mortality between municipalities with different shares of educated residents. We find that education initially played a strong protective role, which however quickly faded out. After pondering several alternative explanations, we tentatively interpret this finding as the outcome of the interplay between education, information and public health communication, whose availability and coherence varied along the epidemic.

Spreading the disease: Protest in times of pandemics

This study analyzes the impact of large anti-lockdown protests on the spread of SARS-CoV-2 in Germany. Since protesters at such large gatherings are very mobile and largely neglect SARS-CoV-2 containment strategies, they may contribute to the regional transmission of the coronavirus. Employing novel data on bus connections of travel companies specialized in driving protesters to these gatherings, and exploiting the timing of two large-scale demonstrations in November 2020, we estimate the causal impact of these protests on the spread of SARS-CoV-2 using an event study framework. Our findings imply sizable increases in infection rates in protesters' origin regions after these demonstrations. A month after the protests, treated areas face a relative increase in infection rates up to 35% compared to non-treated areas. Our results shed light on public health consequences of behavior that ignores potential externalities for the society during a pandemic.

Modelling optimal lockdowns with waning immunity

This paper studies continuing optimal lockdowns (can also be interpreted as quarantines or self-isolation) in the long run if a disease (Covid-19) is endemic and immunity can fail, that is, the disease has SIRS dynamics. We model how disease related mortality affects the optimal choices in a dynamic general equilibrium neoclassical growth framework. An extended welfare function that incorporates loss from mortality is used. In a disease endemic steady state, without this welfare loss even if there is continuing mortality, it is not optimal to impose even a partial lockdown. We characterize how the optimal restriction and equilibrium outcomes vary with the effectiveness of the lockdown, the productivity of working from home, the rate of mortality from the disease, and failure of immunity. We provide the sufficiency conditions for economic models with SIRS dynamics with disease related mortality-a class of models which are non-convex and have endogenous discounting so that no existing results are applicable.

Trust and vaccination intentions: Evidence from Lithuania during the COVID-19 pandemic

In this paper, we study the relationship between trust and COVID-19 vaccination intentions. Vaccinating a large share of the population is essential for containing the COVID-19 pandemic. However, many individuals refuse to get vaccinated, which might be related to a lack of trust. Using unique survey data from Lithuania during the COVID-19 pandemic, we show that trust in government authorities, science, and pharmaceutical companies are important predictors of individual vaccination intentions. We do not find evidence that trust in strangers, the healthcare system, or the media predict intentions to get vaccinated against COVID-19.

Does pro-sociality or trust better predict staying home behavior during the Covid-19?

Voluntary compliance of preventive and mitigation measures due to social concerns can play a crucial role in slowing down the spread of the Covid-19. The existing economic models for disease spread however do not direct a lot of focus on the possible role of pro-social behavior and general trust in predicting preventive behaviors amid the Covid-19. Therefore, this study analyzes whether pro-sociality and general trust measured in the short run (2020 and 2019) and in the long run (2015 and 2010) predict attitudes towards the stay home behavior and the intended stay home behavior in case the government mandates it due to the Covid-19 in the Netherlands. The results suggest that these preferences positively influence attitudes towards staying home behavior. However, trust in comparison to pro-sociality is a stable and robust predictor of stay home attitudes both in the short as well as long run. On the other hand, neither trust nor pro-sociality influences the intended stay home behavior in case the government mandates the lockdown, and it is most likely due to the timing of the survey coinciding with a significant drop in the Covid-19 infections and easing out of the lockdown restrictions by the Dutch government.

Variation in Public Trust, Perceived Societal Fairness, and Well-Being before and after COVID-19 Onset-Evidence from the China Family Panel Studies

The sudden onset of the COVID-19 pandemic had a significant impact on all aspects of people's lives, including their attitudes toward society and psychological well-being. This study aimed to analyze the variation in public trust, perceived societal fairness, and well-being before and after the outbreak of the coronavirus disease 2019 (COVID-19). This study used two-wave longitudinal data of 15,487 residents (2018, T1; 2020, T2) derived from the Chinese Family Panel Studies (CFPS). A repeated measures analysis of variance showed that (a) public trust, perceived societal fairness, and subjective well-being significantly improved and (b) depression significantly increased. Linear regression analysis showed that education and socioeconomic status had a significant predictive effect on public trust, perceived societal fairness, and depression; socioeconomic status had a significant predictive effect on subjective well-being. This study provides evidence and direction for current social governance, namely, policy implementation and pandemic response.

Using Pandemic Behavior to Test the External Validity of Laboratory Measurements of Risk Aversion and Guilt

We test whether laboratory measures of individual preferences for risk and guilt relate to risk-connected behaviors in a pandemic, such as socializing, dining in at restaurants, and hand washing. We utilize a survey administrated to a nationally representative subject pool in the United States in April, 2020 - the month following the declaration of a national state of emergency in response to the global outbreak of COVID-19. We find that higher levels of risk aversion are associated with risk-reducing behaviors during the COVID-19 pandemic. Meanwhile, we do not find strong evidence that guilt relates to the same behavior.

Pandemic knowledge and regulation effectiveness: Evidence from COVID-19

The spread of COVID-19 led countries around the world to adopt lockdown measures of varying stringency, with the purpose of restricting the movement of people. However, the effectiveness of these measures on mobility has been markedly different. Employing a difference-in-differences design, we analyse the effectiveness of movement restrictions across different countries. We disentangle the role of regulation (stringency measures) from the role of people's knowledge about the spread of COVID-19. We proxy COVID-19 knowledge by using Google Trends data on the term "Covid". We find that lockdown measures have a higher impact on mobility the more people learn about COVID-19. This finding is driven by countries with low levels of trust in institutions and low levels of education.

COVID-19 infection induces higher trust in strangers

How does the COVID-19 pandemic affect interpersonal trust? Most evidence shows that natural disasters reinforce trust and cooperation, but the COVID-19 virus differs from other calamities, since it spreads through contact with people, potentially increasing suspicion and distrust, as, according to contemporaneous writers' accounts, seems to have been the case with the Black Death, the London plague, and the Spanish influenza. We investigate the link between interpersonal trust and individuals exposed to COVID-19, either vicariously through their community or networks or directly by becoming infected. We rely on an original panel survey, including a survey experiment, with a representative sample of adults in Italy, one of the countries hardest struck by the pandemic. Our experimental findings reveal that priming people about the risk that the pandemic poses to their health leads to a substantial increase in their trust in strangers. Our panel data analysis of within-individual effects shows that those who become infected trust strangers more than those who are not infected. Our findings could be explained by people observing higher than expected altruistic behavior or becoming more dependent on other people's support, consistent with the "emancipation theory of trust." When people recover from COVID-19, however, they drop to trusting strangers as much as those who were not directly exposed to the virus, an indication that the positive effects on trust during the pandemic have an emotional source. Nonetheless, the evidence suggests that, in the aggregate, there has been a small but significant increase in trust among the general population relative to prepandemic levels.

Individualism Versus Collectivism and the Early-Stage Transmission of COVID-19

We propose a perspective based on the individualism versus collectivism (IC) cultural distinction to understand the diverging early-stage transmission outcomes of COVID-19 between countries. Since individualism values personal freedom, people in such cultures would be less likely to make the collective action of staying at home and less likely to support compulsory measures. As a reaction to the public will, governments of individualistic societies would be more hesitant to take compulsory measures, leading to the delay of necessary responses. With processed COVID-19 data that can provide a fair comparison, we find that COVID-19 spread much faster in more individualistic societies than in more collectivistic societies. We further use pronoun drop and absolute latitude as the instruments for IC to address reverse causality and omitted variable bias. The results are robust to different measures. We propose to consider the role of IC not only for understanding the current pandemic but also for thinking about future trends in the world.

A Culturally and Linguistically Appropriate Telephone Support Intervention for Diverse Family Caregivers of Persons With Dementia During the COVID-19 Pandemic

Caregivers of persons with dementia (PWDs) were socially isolated with little support during the COVID-19 pandemic "Stay-At-Home" order in the United States. To enhance social and emotional connection for diverse caregivers, a culturally/linguistically appropriate telephone intervention provided compassionate listening, mindful breathing, and COVID-19 safety education. The study purpose was to understand caregiving challenges and to evaluate the intervention for caregivers during the early pandemic using a qualitative approach. Twenty-three caregivers participated in the intervention provided by bilingual research assistants for 3 months. Call logs were used to describe the caregivers' dialogue. Thematic analysis identified (a) the challenges, including fear of coronavirus disease, providing around-the-clock care, and forced isolation and negative emotions; and (b) caregivers' experience with the intervention, including connecting with the outside, relief from emotional stress, reliable COVID-19 information, and reinformed caregiving skills. Results suggest that the telephone support was of benefit to diverse caregivers of PWDs during the pandemic by promoting social connection and reducing emotional distress.

Motivations and Limits for COVID-19 Policy Compliance in Germany and Switzerland

BACKGROUND

In contrast to neighboring countries, German and Swiss authorities refrained from general curfews during the first pandemic wave in spring 2020, calling for solidarity and personal responsibility instead. Using a qualitative methodology, this study aims to explore why people in Germany and Switzerland were motivated to comply with policy measures during the first wave of the coronavirus disease 2019 (COVID-19) pandemic, and what factors hindered or limited their motivation. While quantitative surveys can measure the level of compliance, or broadly ask what motives people had for compliance, we here strive to explain why and how these motives lead to compliance.

METHODS

This publication has been made possible by the joint work of the members of the "Solidarity in times of pandemics" (SolPan) research commons. Seventy-seven semi-structured qualitative interviews were conducted with members of the general public in Germany (n = 46) and the German-speaking part of Switzerland (n = 31) in April 2020. Interviews were transcribed and analyzed following a grounded theory approach.

RESULTS

Three themes were identified that summarize factors contributing to compliant or noncompliant behavior. (1) Social cohesion was, on the one hand, an important motivator for compliance, but at the same time related to conflicting needs, illustrating the limits of compliance. (2) Consequences were considered on both the individual level (eg, consequences of individual infection) and societal level (eg, the societal and economic consequences of restrictions). (3) While for some participants following the rules was perceived as a matter of principle, others stressed the importance of making their own risk assessment, which was often associated with with a need for evidence on the effectiveness and reasons behind measures.

CONCLUSION

A variety of motives contribute to COVID-19 related compliance. Authorities should seek to address these multi-faceted aspects to support motivation for compliance in a large proportion of the population.

Mobile health technology as a solution to self-control problems: The behavioral impact of COVID-19 contact tracing apps in Japan

RATIONALE

Mobile technology has been widely utilized as an effective healthcare tool during the COVID-19 pandemic. Notably, over 50 countries have released contact-tracing apps to trace and contain infection chains. While earlier studies have examined obstacles to app uptake and usage, whether and how this uptake affects users' behavioral patterns is not well understood. This is crucial because uptake can theoretically increase or decrease behavior that carries infection risks.

OBJECTIVE

The goal of this study is to evaluate the impact of app uptake on the time spent out of home in Japan. It tests four potential underlying mechanisms that drive the uptake effect: compliance with stay-at-home requirements, learning about infection risk, reminders, and commitment device.

METHOD

We use unique nationwide survey data collected from 4,379 individuals aged between 20 and 69 in December 2020 and February 2021 in Japan. Japan has features suitable for this exercise. The Japanese government released a contact tracing app in June 2020, which sends a warning message to users who have been in close contact with an infected person. We conduct a difference-in-differences estimation strategy combined with the entropy balancing method.

RESULTS

App uptake reduces the time spent out of home. Sensitivity analysis shows that it cannot be explained by unobserved confounders. Importantly, the impact is large even among users who have not received a warning message from the app, and even larger for those with poor self-control ability. Furthermore, individuals' self-control ability is negatively associated with the uptake decision, supporting our hypothesis that the apps serve as a commitment device.

CONCLUSIONS

It may be beneficial to encourage citizens to uptake contact tracing apps and other forms of commitment devices. This study also contributes to the literature on mobile health (mHealth) by demonstrating its efficacy as a commitment device.

COVID-19 information and self-protective behaviors among rural communities in tropical forests

BACKGROUND

Health risk communication plays a key role in promoting self-protective measures, which are critical in suppressing COVID-19 contagion. Relatively little is known about the communication channels used by rural poor populations to learn novel measures and their effectiveness in promoting self-protective behaviors. Behavioral change can be shaped by people's trust in government institutions which may be differentiated by social identity, including indigeneity.

METHODS

During an early phase of the pandemic, we conducted two telephone surveys with over 460 communities - both Indigenous and mestizo - without road access and limited communication access in the Peruvian Amazon. This is the first report on the association of information sources about self-protective measures against COVID-19 with the adoption of self-protective behaviors in remote rural areas in developing countries.

RESULTS

People mainly relied on mass media (radio, television, newspapers) and interpersonal sources (local authorities, health workers, neighbors/relatives) for information and adopted handwashing, mask-wearing, social distancing, and social restrictions to varying degrees. Overall, self-protective behaviors were largely positively and negatively associated with mass media and interpersonal sources, respectively, depending on the source-measure combination. Mistrust of the government seems to have shaped how Indigenous and mestizo peoples distinctively responded to interpersonal information sources and relied on mass media.

CONCLUSIONS

Our findings call for improved media access to better manage pandemics in rural areas, especially among remote Indigenous communities.

Did States With More Social Capital Pre-pandemic Offer Mental Health Protection During the COVID-19 Pandemic? A Cross-Sectional View

Background

Social capital is a well-known health determinant with both relational and geographic aspects. It can help mitigate adverse events and has been shown to impact behaviors and responses during the COVID-19 pandemic. Mental health has declined during the COVID-19 pandemic, and social capital, may serve to buffer those declines.

Methods

Building from this, we assessed whether pre-pandemic social capital and contemporaneous social policy, which included indicators of social trust, civic participation, and presence of mask mandates, affected pandemic mental health, measured as the percent of the population experiencing symptoms of depression and anxiety at the state level.

Results

Generalized social trust and state mask mandates were significantly associated with lower levels of depression and anxiety. Conversely, states with greater civic engagement prior to the pandemic experienced more anxiety and depression.

Conclusions

Findings suggest that existing social capital, particularly social trust, may protect against anxiety and depression and contribute to community resilience during times of adversity. States should invest in policies and programs that increase social trust.

COVID-19, information management by local governments, and food consumption

Federal and state governments in developing countries have tasked local governments with managing COVID-19 on the ground. The bottom-up approach is critical to ensuring household food security, especially in rural areas. We have utilized data from a panel of Indian households that participated in two rounds of a livelihoods survey. While the first round was fielded before COVID-19, the second round was conducted telephonically after the COVID-19-lockdown. We developed an Information Management Response Index (IMRI) to measure the strength of local governments' information management initiatives. The difference-in-difference estimates show that local governments could partially mitigate the pandemic's adverse effects on (a) level and distribution (adult-equivalent per-capita) of food and nutrition expenditure and (b) household vulnerability to food and nutrition poverty. For landless households, IMRI led to statistically significant and additional welfare effects. Three channels explain our empirical findings: (a) maintenance of essential commodities through fair-price shops, (b) access to paid employment and cash (income effect), and (c) disease management (substitution effect). The estimates have been adjusted for sample attrition and multiple-hypothesis correction. We conducted robustness checks with respect to index construction, instrumental variable estimation, and sub-group analysis.

Lockdown Policies, Economic Support, and Mental Health: Evidence From the COVID-19 Pandemic in United States

During the COVID-19 pandemic, various lockdown policies were put in place by the governments in different countries and different levels, which effectively curbed the spread of the virus, but also cause substantial damage to the mental health of local residents. We use statistics provided by the Household Pulse Survey and OxCGRT between 23 April 2020 and 30 August 2021 to analyze the impact of lockdown on overall mental health levels in US states during the COVID-19 pandemic at the macro level. The results show that the lockdown policies implemented by the state governments lead to a deterioration in psychological conditions, and this relationship varies to some extent depending on the level of high-quality economic support, that the state governments implement to alleviate the symptoms of depression and anxiety associated with the lockdown. Therefore, we argue that although lockdown policies are necessary during the COVID-19 pandemic, further government efforts are needed to give high-quality economic and mental health support to mitigate the negative effects of lockdown on mental health.

How did consumers react to the COVID-19 pandemic over time?

Non-pharmaceutical interventions (NPIs) have been the key policy instrument utilized to contain the impact of the COVID-19 pandemic. This paper disentangles the effects of NPIs from that of the virus and looks at the specific channels through which the virus impacts consumption. Using geo-located transaction data, we find that consumers' behaviour towards the virus has explanatory power for the drop in consumption in the early stages of the pandemic. This effect disappears in the later stages of the pandemic, suggesting that consumers have adapted their behaviour. As the COVID-19 pandemic progressed, consumers tended to make 'safer' consumption decisions, by avoiding crowded places.

Impact of Social Media, Extended Parallel Process Model (EPPM) on the Intention to Stay at Home during the COVID-19 Pandemic

Considering how communities perceive the threat and risks of COVID-19, it is essential to examine how emotional regulation stimulated through intrinsic and extrinsic incentive mechanisms via social media can reinforce ‘Stay at home’ intentions. The conceptual framework was developed using the elements of the Extended Parallel Process Model (EPPM). A self-reported questionnaire was used to measure individuals’ intention to stay at home during the pandemic based on the perceived locus of causality as a part of self-determination theory. The empirical research was conducted on a sample of 306 USA respondents. The study results indicate that both components of the EPPM—efficacy and threat—positively affect ‘stay at home’ intentions. Moreover, a positive effect of efficacy on threats was found, as was a moderating effect of threats on the relationship between efficacy and the intention to stay at home. Meanwhile, the influence of social media exposure on threats and behavioral intentions was not significant. People are likely to stay at home as a preventive measure during COVID-19 if there is enough threats and efficacy. However, the abundance of information and opinions in social media can lead to a decreased perceived threat and might disrupt the acceptance of preventive actions.

COVID-19 social distancing measures and economic growth: Distinguishing short- and long-term effects

Social distancing policies have been criticized for their adverse effect on economies. However, we evidence that while they have a short-run adverse effect, they also have a long-run recovery effect on economic growth. Utilizing quarterly gross domestic product (GDP) growth rate data from OECD member states, we find that the medium-term recovery effect of stringent social distancing policies on economic growth is three times higher the short-term adverse effect. We additionally investigate social distancing measures with sub-components of GDP, as well as the conditioning roles of institutional factors.

How does the impact of the COVID-19 state of emergency change? An analysis of preventive behaviors and mental health using panel data in Japan

This study applies the difference-in-difference method on panel data collected from internet surveys to investigate changes in the preventive behaviors and mental health of individuals as influenced by the COVID-19 state of emergency declaration between March and June 2020. The key findings are: (1) The declaration led people to exhibit preventive behaviors but also generated negative emotions; (2) Such behaviors persisted even after deregulation of the state of emergency; (3) Making the declaration early (vs. late) had a larger effect on preventive behavior, with the gap between residents' behaviors for areas that made early vs. late declarations persisting after the deregulation; and (4) The effects on mental health diminished during the state of emergency and disappeared after its deregulation.

Communities and testing for COVID-19

The response to the COVID-19 epidemic requires people to undertake actions such as mask-wearing or vaccination that also confer benefits to the whole community, and therefore, are akin to public good contributions. This is the case also for participation to the mass testing that took place between November 18th and 25th, 2020 in the South Tyrol region of Italy, where 361,781 out of 500,607 (72.3%) eligible residents volunteered to take a COVID-19 rapid antigen test. We examine the community characteristics that are associated with higher testing rates. Our findings point to a number of key community determinants of people's willingness to volunteer. Convenience and social capital were important factors. Beyond that, socioeconomic status and religiosity were also both positively related to greater testing, while childhood vaccinations refusal rates show a negative relationship.

Effects of trust, risk perception, and health behavior on COVID-19 disease burden: Evidence from a multi-state US survey

Early public health strategies to prevent the spread of COVID-19 in the United States relied on non-pharmaceutical interventions (NPIs) as vaccines and therapeutic treatments were not yet available. Implementation of NPIs, primarily social distancing and mask wearing, varied widely between communities within the US due to variable government mandates, as well as differences in attitudes and opinions. To understand the interplay of trust, risk perception, behavioral intention, and disease burden, we developed a survey instrument to study attitudes concerning COVID-19 and pandemic behavioral change in three states: Idaho, Texas, and Vermont. We designed our survey (n = 1034) to detect whether these relationships were significantly different in rural populations. The best fitting structural equation models show that trust indirectly affects protective pandemic behaviors via health and economic risk perception. We explore two different variations of this social cognitive model: the first assumes behavioral intention affects future disease burden while the second assumes that observed disease burden affects behavioral intention. In our models we include several exogenous variables to control for demographic and geographic effects. Notably, political ideology is the only exogenous variable which significantly affects all aspects of the social cognitive model (trust, risk perception, and behavioral intention). While there is a direct negative effect associated with rurality on disease burden, likely due to the protective effect of low population density in the early pandemic waves, we found a marginally significant, positive, indirect effect of rurality on disease burden via decreased trust (p = 0.095). This trust deficit creates additional vulnerabilities to COVID-19 in rural communities which also have reduced healthcare capacity. Increasing trust by methods such as in-group messaging could potentially remove some of the disparities inferred by our models and increase NPI effectiveness.

Pandemic responsiveness: Evidence from social distancing and lockdown policy during COVID-19

We study changes in social distancing and government policy in response to local outbreaks during the COVID-19 pandemic. Using aggregated county-level data from approximately 20 million smartphones in the United States, we show that social distancing behaviors have responded to local outbreaks: a 1% increase in new cases (deaths) is associated with a 3% (11%) increase in social distancing intensity. Responsiveness is reinforced by the presence of public measures restricting movements, but remains significant in their absence. Responsiveness is higher in high-income, more educated, or Democrat-leaning counties, and in counties with low health insurance coverage. By contrast, social capital and vulnerability to infection are strongly associated with more social distancing but not with more responsiveness. Our results point to the importance of politics, trust and reciprocity for compliance with social distancing, while material constraints are more critical for being responsive to new risks such as the emergence of variants.