Measuring Subjective Probabilities: The Effect of Response Mode on the Use of Focal Responses, Validity, and Respondents' Evaluations

Eliciting Risk Perceptions: Does Conditional Question Wording Have a Downside?

BACKGROUND

To assess the impact of risk perceptions on prevention efforts or behavior change, best practices involve conditional risk measures, which ask people to estimate their risk contingent on a course of action (e.g., "if not vaccinated").

PURPOSE

To determine whether the use of conditional wording-and its drawing of attention to one specific contingency-has an important downside that could lead researchers to overestimate the true relationship between perceptions of risk and intended prevention behavior.

METHODS

In an online experiment, US participants from Amazon's MTurk (N = 750) were presented with information about an unfamiliar fungal disease and then randomly assigned among 3 conditions. In all conditions, participants were asked to estimate their risk for the disease (i.e., subjective likelihood) and to decide whether they would get vaccinated. In 2 conditional-wording conditions (1 of which involved a delayed decision), participants were asked about their risk if they did not get vaccinated. For an unconditional/benchmark condition, this conditional was not explicitly stated but was still formally applicable because participants had not yet been informed that a vaccine was even available for this disease.

RESULTS

When people gave risk estimates to a conditionally worded risk question after making a decision, the observed relationship between perceived risk and prevention decisions was inflated (relative to in the unconditional/benchmark condition).

CONCLUSIONS

The use of conditionals in risk questions can lead to overestimates of the impact of perceived risk on prevention decisions but not necessarily to a degree that should call for their omission.

HIGHLIGHTS

Conditional wording, which is commonly recommended for eliciting risk perceptions, has a potential downside.It can produce overestimates of the true relationship between perceived risk and prevention behavior, as established in the current work.Though concerning, the biasing effect of conditional wording was small-relative to the measurement benefits that conditioning usually provides-and should not deter researchers from conditioning risk perceptions.More research is needed to determine when the biasing impact of conditional wording is strongest.

Behind closed doors: Protective social behavior during the COVID-19 pandemic

The success of personal non-pharmaceutical interventions as a public health strategy requires a high level of compliance from individuals in private social settings. Strategies to increase compliance in these hard-to-reach settings depend upon a comprehensive understanding of the patterns and predictors of protective social behavior. Social cognitive models of protective behavior emphasize the contribution of individual-level factors while social-ecological models emphasize the contribution of environmental factors. This study draws on 28 waves of survey data from the Understanding Coronavirus in America survey to measure patterns of adherence to two protective social behaviors-private social-distancing behavior and private masking behavior-during the COVID-19 pandemic and to assess the role individual and environmental factors play in predicting adherence. Results show that patterns of adherence fall into three categories marked by high, moderate, and low levels of adherence, with just under half of respondents exhibiting a high level of adherence. Health beliefs emerge as the single strongest predictor of adherence. All other environmental and individual-level predictors have relatively poor predictive power or primarily indirect effects.

Psychological health benefits of focusing on the 'here and now' versus a limited future during the COVID-19 pandemic

Objective: College students' psychological health has been negatively impacted by the COVID-19 pandemic (e.g., 1). We investigated whether students' psychological health was related to their orientation toward the future and mindfulness while considering previously-identified correlates of psychological health such as perceived risks of COVID-19. Participants: Participants were 278 college students at a mid-Atlantic US university in November and December 2020. Method: Using a self-report survey, we measured three aspects of psychological health (depression, anxiety, and stress) and future orientation, mindfulness, perceptions of risk, and the personal impact of COVID-19 on students' lives. Results: Multiple linear regression analyses showed that greater mindfulness and focusing less on a limited future were related to less depression, anxiety, and stress. Conclusions: Encouraging students to be mindful and focus on the present instead of focusing on a limited future may be beneficial for their psychological well-being during the COVID-19 pandemic.

Risk and protective factors for college students' psychological health during the COVID-19 pandemic

Objective: College students' psychological health may be compromised due to the COVID-19 pandemic. Here, we aimed to identify risk (eg, perceived risk of contracting COVID-19) and protective factors (ie, social support, mindfulness) for positive (ie, subjective happiness, satisfaction with life) and negative (ie, depression, anxiety, stress) aspects of psychological health. Participants: Participants were 251 college students at a mid-Atlantic university. Method: Self-report online survey data were collected between March and May 2020 using established measures of risk perception, mindfulness, social support, and psychological health. Results: Greater perceived risk of contracting COVID-19 was associated with greater depression, anxiety, and stress. Greater mindfulness was a protective factor for psychological health. Greater social support was associated with less depression, and greater happiness and life satisfaction. Conclusions: Programs that teach students how to cultivate mindfulness and supportive relationships and reduce their risk of contracting COVID-19 may help protect against depression, stress, and anxiety.

Tail and Center Rounding of Probabilistic Expectations in the Health and Retirement Study

We study rounding of numerical expectations in the Health and Retirement Study (HRS) between 2002 and 2014. We document that respondent-specific rounding patterns across questions in individual waves are quite stable across waves. We discover a tendency by about half of the respondents to provide more refined responses in the tails of the 0-100 scale than the center. In contrast, only about five percent of the respondents give more refined responses in the center than the tails. We find that respondents tend to report the values 25 and 75 more frequently than other values ending in 5. We also find that rounding practices vary somewhat across question domains and respondent characteristics. We propose an inferential approach that assumes stability of response tendencies across questions and waves to infer person-specific rounding in each question domain and scale segment and that replaces each point-response with an interval representing the range of possible values of the true latent belief. Using expectations from the 2016 wave of the HRS, we validate our approach. To demonstrate the consequences of rounding on inference, we compare best-predictor estimates from face-value expectations with those implied by our intervals.

Reciprocal relationships among influenza experiences, perceptions, and behavior: Results from a national, longitudinal survey of United States adults

OBJECTIVE

Our objective was to model the reciprocal relationships of perceived risk of contracting influenza with and without influenza vaccination, vaccination behavior, and reported influenza illness.

METHODS

We fit structural equation models to data from a longitudinal survey of adults in the United States collected through the RAND American Life Panel. Data come from fall and spring surveys fielded before and after each of 3 influenza seasons, 2016/2017, 2017/2018, and 2018/2019, for a total of 6 waves.

RESULTS

As expected, reported influenza experience was associated with increased perceived influenza risk in subsequent survey waves. Furthermore, perceived risk was associated with subsequent vaccination behavior, such that vaccination was more common for those with higher perceived unvaccinated influenza risk and lower perceived vaccinated influenza risk. Perhaps surprisingly, both elements of perceived risk were also associated with a greater likelihood of subsequent reported influenza illness. This malleability in illness reports may reflect uncertainty, as more respondents reported being sick but being unsure about whether they had influenza than reported certainty that they had influenza.

CONCLUSIONS

Interventions that influence perceptions about past experience with influenza, including increased testing and informational campaigns about influenza symptoms, could have unanticipated impacts on perceptions of influenza vaccination and vaccination behavior.

Black Americans demonstrate comparatively low levels of depression and anxiety during the COVID-19 pandemic

INTRODUCTION

During public health crises like the COVID-19 pandemic, populations can experience worsening mental health. Prior reports have suggested that Black Americans experienced lower rates of anxiety and depression than White Americans before the pandemic; however, during the pandemic, outcomes may be different as Black Americans have been disproportionately affected in terms of mortality, hospitalization, COVID-19 infection, and job loss. We documented the differential mental health impact of COVID-19 on Black and Non-Black Americans.

METHODS

We analyzed nationally representative longitudinal data from the Understanding America Study COVID-19 Tracking Survey spanning March through November of 2020 to assess differences over time in prevalence of anxiety and depression between Black and non-Black Americans.

RESULTS

We found that Black Americans were significantly less likely to report symptoms for anxiety, depression, or both during the pandemic. In a given month between March through November of 2020, the odds of Black Americans reporting such symptoms was on average about half that of Non-Black Americans. We also found that in September 2020, the gap in reporting symptoms for depression began to widen gradually. Specifically, since that time, prevalence of depression remained stable among non-Black Americans while it declined gradually among Black Americans. Our main results were robust to adjusting for demographics, risk perceptions, and baseline pre-pandemic mental health status.

CONCLUSIONS

Black Americans maintained significantly better mental health than Non-Black Americans despite their struggle against economic, health, and racial inequalities during the pandemic. We discuss the significance and implications of our results and identify opportunities for future research.

How do the UK public interpret COVID-19 test results? Comparing the impact of official information about results and reliability used in the UK, USA and New Zealand: a randomised controlled trial

OBJECTIVES

To assess the effects of different official information on public interpretation of a personal COVID-19 PCR test result.

DESIGN

A 5×2 factorial, randomised, between-subjects experiment, comparing four wordings of information about the test result and a control arm of no additional information; for both positive and negative test results.

SETTING

Online experiment using recruitment platform Respondi.

PARTICIPANTS

UK participants (n=1744, after a pilot of n=1657) quota-sampled to be proportional to the UK national population on age and sex.

INTERVENTIONS

Participants were given a hypothetical COVID-19 PCR test result for 'John' who was presented as having a 50% chance of having COVID-19 based on symptoms alone. Participants were randomised to receive either a positive or negative result for 'John', then randomised again to receive either no more information, or text information on the interpretation of COVID-19 test results copied in September 2020 from the public websites of the UK's National Health Service, the USA's Centers for Disease Control, New Zealand's Ministry of Health or a modified version of the UK's wording. Information identifying the source of the wording was removed.

MAIN OUTCOME MEASURES

Participants were asked 'What is your best guess as to the percent chance that John actually had COVID-19 at the time of his test, given his result?'; questions about their feelings of trustworthiness in the result, their perceptions of the quality of the underlying evidence and what action they felt 'John' should take in the light of his result.

RESULTS

Of those presented with a positive COVID-19 test result for 'John', the mean estimate of the probability that he had the virus was 73% (71.5%-74.5%); for those presented with a negative result, 38% (36.7%-40.0%). There was no main effect of information (wording) on these means. However, those participants given the official information from the UK website, which did not mention the possibility of false negatives or false positives, were more likely to give a categorical (100% or 0%) answer (UK: 68/343, 19.8% (15.9%-24.4%); control group: 42/356, 11.8% (8.8%-15.6%)); the reverse was true for those viewing the New Zealand (NZ) wording, which highlighted the uncertainties most explicitly (20/345: 5.8% (3.7%-8.8%)). Aggregated across test result (positive/negative), there was a main effect of wording (p<0.001) on beliefs about how 'John' should behave, with those seeing the NZ wording marginally more likely to agree that 'John' should continue to self-isolate than those viewing the control or the UK wording. The proportion of participants who felt that a symptomatic individual who tests negative definitely should not self-isolate was highest among those viewing the UK wording (31/178, 17.4% (12.5%-23.7%)), and lowest among those viewing the NZ wording (6/159, 3.8% (1.6%-8.2%)). Although the NZ wording was rated harder to understand, participants reacted to the uncertainties given in the text in the expected direction: there was a small main effect of wording on trust in the result (p=0.048), with people perceiving the test result as marginally less trustworthy after having read the NZ wording compared with the UK wording. Positive results were generally viewed as more trustworthy and as having higher quality of evidence than negative results (both p<0.001).

CONCLUSIONS

The public's default assessment of the face value of both the positive and negative test results (control group) indicate an awareness that test results are not perfectly accurate. Compared with other messaging tested, participants shown the UK's 2020 wording about the interpretation of the test results appeared to interpret the results as more definitive than is warranted. Wording that acknowledges uncertainty can help people to have a more nuanced and realistic understanding of what a COVID-19 test result means, which supports decision making and behavioural response.

PREREGISTRATION AND DATA REPOSITORY

Preregistration of pilot at osf.io/8n62f, preregistration of main experiment at osf.io/7rcj4, data and code available online (osf.io/pvhba).

Communicating personalized risks from COVID-19: guidelines from an empirical study

As increasing amounts of data accumulate on the effects of the novel coronavirus SARS-CoV-2 and the risk factors that lead to poor outcomes, it is possible to produce personalized estimates of the risks faced by groups of people with different characteristics. The challenge of how to communicate these then becomes apparent. Based on empirical work (total n = 5520, UK) supported by in-person interviews with the public and physicians, we make recommendations on the presentation of such information. These include: using predominantly percentages when communicating the absolute risk, but also providing, for balance, a format which conveys a contrasting (higher) perception of risk (expected frequency out of 10 000); using a visual linear scale cut at an appropriate point to illustrate the maximum risk, explained through an illustrative 'persona' who might face that highest level of risk; and providing context to the absolute risk through presenting a range of other 'personas' illustrating people who would face risks of a wide range of different levels. These 'personas' should have their major risk factors (age, existing health conditions) described. By contrast, giving people absolute likelihoods of other risks they face in an attempt to add context was considered less helpful. We note that observed effect sizes generally were small. However, even small effects are meaningful and relevant when scaled up to population levels.

Capturing Subjective Age, Subjective Life Expectancy, and Their Links With Older Adults' Health: The Dutch Longitudinal Aging Study Amsterdam

Objectives: This study compares the associations of two subjective lifetime perspectives, subjective age (SA) and subjective life expectancy (SLE), with physical performance, self-rated health, and depressive symptoms. Methods: 64 91-year-old participants were selected from three waves of the Longitudinal Aging Study Amsterdam (2008/09, 2011/12, 2015/16; n = 1822 participants, n = 3500 observations) that included graphical and numerical measures of SA and SLE. We used generalized estimating equations to examine their associations with health. Results: Associations of SA/SLE with health were weaker for physical performance than for self-rated health and depressive symptoms. The associations of SA and SLE with physical performance were of similar magnitude but with self-rated health depended on the type of measure. Depressive symptoms, instead, showed a stronger association with SA than with SLE. Graphical measures showed weaker associations than numerical measures. Discussion: The way in which subjective lifetime perspectives and health are conceptualized and measured influences the strength of their associations.

Mental associations with COVID-19 and how they relate with self-reported protective behaviors: A national survey in the United States

RATIONALE

To understand novel diseases, patients may draw comparisons to other diseases.

OBJECTIVE

We examined whether mentally associating specific diseases with COVID-19 was related to self-reported protective behaviors early in the pandemic.

METHODS

In March 2020, a national sample of 6534 U.S. adults listed diseases that came to mind when thinking of COVID-19. They self-reported protective behaviors, demographics, and COVID-19 risk perceptions.

RESULTS

Participants associated COVID-19 with common infectious diseases like seasonal influenza (59%), common cold (11%), and pneumonia (10%), or emergent infectious diseases like pandemic influenza (28%), SARS/MERS (27%), and Ebola (14%). Seasonal influenza was most commonly mentioned, in all demographic groups. Participants mentioning seasonal influenza or common cold reported fewer protective behaviors. Those mentioning pneumonia or emergent infectious diseases reported more protective behaviors. Mentioning pneumonia, SARS/MERS, and Ebola was associated with the most protective behaviors, after accounting for other generated diseases, demographics, and risk perceptions (e.g., for avoiding crowds, OR = 1.52, 95% CI = 1.26, 1.83; OR = 1.28, 95% CI = 1.13, 1.46; OR = 1.30, 95% CI = 1.11, 1.52, respectively).

CONCLUSIONS

Early in the pandemic, most participants mentally associated COVID-19 with seasonal flu, which may have undermined willingness to protect themselves. To motivate behavior change, COVID-19 risk communications may need to mention diseases that resonate with people while retaining accuracy.

Association Between Risk Factors for Complications From COVID-19, Perceived Chances of Infection and Complications, and Protective Behavior in the US

Importance

It is unknown whether adults who are susceptible to severe complications from COVID-19 recognize their susceptibility and modify behavior to reduce exposure.

Objective

To determine whether adults with risk factors for COVID-19 complications perceive an elevated chance of complications and undertake fewer higher infection risk behaviors.

Design, Setting, and Participants

This cross-sectional analysis, adjusted for sociodemographic characteristics, included civilian noninstitutionalized US adults of wave 18 of the Understanding America Study collected from November 11 to December 9, 2020.

Exposures

US Centers for Disease Control and Prevention-identified medical risk factors for COVID-19 complications and older age.

Main Outcomes and Measures

Primary outcomes were perceived percentage chance of infection and hospitalization and death if infected; whether 9 potentially higher infection risk activities were undertaken in the past week and, if so, whether a mask was worn; whether a mask was worn anywhere in the past week; and attitudes toward 12 aspects of mask wearing.

Results

In Understanding America Study wave 18 (n = 5910 participants with nonmissing data), the mean age was 48 years, and 52% were women. The response rate was 77%. Adults with 7 of 9 medical risk factors and aged 70 years and older reported a higher perceived chance of complications if infected. Adjusted mean perceived chance of hospitalization if infected ranged from 23.9% (95% CI, 22.2%-25.5%) for those with high blood pressure to 40.4% (95% CI, 34.6%-46.2%) for those with chronic lung disease and was associated with number of medical risk factors: 17.6% (95% CI, 16.4%-18.8%) and 41.8% (95% CI, 38.7%-45.0%) for adults with 0 vs 3 or more medical risk factors, respectively. Fewer potentially higher infection risk activities were undertaken by adults with 3 or more vs 0 risk factors: 2.83 (95% CI, 2.66-2.99) vs 3.12 (95% CI, 3.02-3.22). Wearing a mask sometime last week was nearly universal (90.1%). But during only 1 specific activity (visiting a grocery store or pharmacy) did more than half always wear a mask, and for only 1 activity (visiting a grocery store or pharmacy) was mask wearing more common among adults with 3 or more vs 0 conditions.

Conclusions and Relevance

In this cross-sectional survey study, adults with risk factors for COVID-19 complications reported higher perceived susceptibility to complications. During common activities, including visiting with friends, the majority of adults, including the highly susceptible, did not consistently wear masks.

Age Differences in COVID-19 Risk Perceptions and Mental Health: Evidence From a National U.S. Survey Conducted in March 2020

OBJECTIVES

Theories of aging posit that older adult age is associated with less negative emotions, but few studies have examined age differences at times of novel challenges. As COVID-19 spread in the United States, this study therefore aimed to examine age differences in risk perceptions, anxiety, and depression.

METHOD

In March 2020, a nationally representative address-based sample of 6,666 U.S. adults assessed their perceived risk of getting COVID-19, dying if getting it, getting quarantined, losing their job (if currently working), and running out of money. They completed a mental health assessment for anxiety and depression. Demographic variables and precrisis depression diagnosis had previously been reported.

RESULTS

In regression analyses controlling for demographic variables and survey date, older adult age was associated with perceiving larger risks of dying if getting COVID-19, but with perceiving less risk of getting COVID-19, getting quarantined, or running out of money, as well as less depression and anxiety. Findings held after additionally controlling for precrisis reports of depression diagnosis.

DISCUSSION

With the exception of perceived infection-fatality risk, U.S. adults who were relatively older appeared to have a more optimistic outlook and better mental health during the early stages of the pandemic. Interventions may be needed to help people of all ages maintain realistic perceptions of the risks, while also managing depression and anxiety during the COVID-19 crisis. Implications for risk communication and mental health interventions are discussed.

Political polarization in US residents' COVID-19 risk perceptions, policy preferences, and protective behaviors

When the novel coronavirus entered the US, most US states implemented lockdown measures. In April-May 2020, state governments started political discussions about whether it would be worth the risk to reduce protective measures. In a highly politicized environment, risk perceptions and preferences for risk mitigation may vary by political inclinations. In April-May 2020, we surveyed a nationally representative sample of 5517 members of the University of Southern California's Understanding America Study. Of those, 37% identified as Democrats, 32% as Republican, and 31% as Third Party/Independent. Overall, Democrats perceived more risk associated with COVID-19 than Republicans, including for getting infected, being hospitalized and dying if infected, as well as running out of money as a result of the pandemic. Democrats were also more likely than Republicans to express concerns that states would lift economic restrictions too quickly, and to report mask use and social distancing. Generally, participants who identified as Third Party/Independent fell in between. Democrats were more likely to report watching MSNBC or CNN (vs. not), while Republicans were more likely to report watching Fox News (vs. not), and Third Party/Independents tended to watch neither. However, political inclinations predicted reported policy preferences, mask use, and social distancing, in analyses that accounted for differences in use of media sources, risk perceptions, and demographic background. In these analyses, participants' reported media use added to the partisan divide in preferences for the timing of lifting economic restrictions and reported protective behaviors. Implications for risk communication are discussed.

SUPPLEMENTARY INFORMATION

The online version of this article (10.1007/s11166-020-09336-3) contains supplementary material, which is available to authorized users.

Predictors of mental health during the Covid-19 pandemic in the US: Role of economic concerns, health worries and social distancing

Despite the profound health and economic implications of Covid-19, there is only limited knowledge to date about the role of economic concerns, health worries and social distancing for mental health outcomes during the pandemic. We analyze online survey data from the nationally representative "Understanding America Study" (UAS) covering the period of March 10-31st 2020 (sample size: 6,585). Mental health is assessed by the validated PHQ-4 instrument for measuring symptoms of depression and anxiety. About 29% (CI:27.4-.30.4%) of the US adult population reported some depression/anxiety symptoms over the study period, with symptoms deteriorating over the month of March. Worsening mental health was most strongly associated with concerns about the economic consequences of the pandemic, while concerns about the potential implications of the virus for respondents' own health and social distancing also predicted increases in symptoms of depression and anxiety during the early stages of the pandemic in the US, albeit less strongly. Our findings point towards the possibility of a major mental health crisis unfolding simultaneously with the pandemic, with economic concerns being a key driving force of this crisis. These results highlight the likely importance of economic countermeasures and social policy for mitigating the impact of Covid-19 on adult mental health in the US over and above an effective public health response.

Access and Use Experience of Personal Protective Equipment Among Frontline Healthcare Workers in Pakistan During the COVID-19 Emergency: A Cross-Sectional Study

Healthcare workers are at the highest risk of contracting novel coronavirus disease 2019 (COVID-19) and, therefore, require constant protection. This study assesses access to personal protective equipment (PPE), availability of adequate information about PPE use, self-reported ability to correctly wear and remove (donning and doffing) PPE, and risk perceptions associated with COVID-19 among frontline healthcare workers in Pakistan. Using a structured and validated questionnaire, an online survey was conducted from May 9 to June 5, 2020. Responses were received from 453 healthcare workers. Of these, 218 (48.12%) were doctors, 183 (40.40%) were nurses, and 52 (11.48%) were paramedical staff. Only 129 (28.48%) healthcare workers reported having adequate access to PPE at all times, whereas 156 (34.44%) never had access to PPE and 168 (37.09%) had access to PPE occasionally. Lack of access to PPE led the majority (71.74%) of healthcare workers to use coping strategies such as reuse of N95 and surgical masks. A total of 312 (68.87%) respondents believed that the risk of contracting COVID-19 in the work environment was high and the majority (62.69%) adopted precautionary measures at home to keep their families safe. A significantly high (n = 233, 51.43%, P = .03) number of respondents reported self-medicating. Of all the respondents, only 136 (30.02%) were tested for COVID-19 at least once, of which 32 (23.53%) ever tested positive. These findings suggest that healthcare workers in Pakistan had limited access to PPE. Adequate provision and training is vital to protect the healthcare workforce during the COVID-19 pandemic.

Relationships Between Initial COVID-19 Risk Perceptions and Protective Health Behaviors: A National Survey

INTRODUCTION

Perceptions of health risks inform decisions about protective behaviors, but COVID-19 was an unfamiliar risk as it began to spread across the U.S. In the initial stage of the epidemic, authors examined perceived risks for COVID-19 infection and infection fatality and whether these risk perceptions were associated with protective behaviors. They also examined whether findings differed between later versus earlier responders.

METHODS

Between March 10 and March 31, 2020, a cross-sectional online survey was conducted with a nationally representative U.S. sample (n=6,684). Half responded before March 13, 2020 (versus later). Participants assessed their risks of COVID-19 infection and infection fatality (0%-100%) which were transformed into quartiles (1-4). They reported their implementation of protective behaviors like handwashing and social distancing (yes/no). Analyses were conducted in April‒May 2020.

RESULTS

Median perceived risk was 10.00% for COVID-19 infection and 5.00% for infection fatality, but respondents showed large disagreement. An increase of 1 quartile in perceived infection risk was associated with being 1.45 times (95% CI=1.33, 1.58) more likely to report handwashing, with perceived infection fatality risk showing no significant association. When predicting social distancing behaviors such as avoiding crowds, both quartile-based risk perceptions were significant (OR=1.24, 95% CI=1.17, 1.30 for infection and OR=1.19, 95% CI=1.13, 1.26 for infection fatality). Perceived COVID-19 infection risk, protective behaviors, and their relationship increased among later (versus earlier) responders.

CONCLUSIONS

Despite disagreements about the risks, people perceiving greater risks were more likely to implement protective behaviors-especially later (versus earlier) in March 2020. These findings have implications for risk communication.

Reports of social circles' and own vaccination behavior: A national longitudinal survey

OBJECTIVE

Flu vaccinations are recommended for almost everyone, but uptake may vary because of perceived social norms. We aimed to examine the relationship between perceived social circle vaccine coverage (including family, friends, and acquaintances) and own vaccination behavior as well as potential mediators.

METHODS

In 2011, 357 participants from RAND's American Life Panel reported perceived social circle vaccine coverage for the 2010-2011 flu season, own vaccination behavior for the 2009-2010 and 2010-2011 flu seasons, perceived flu risk without and with vaccination, and perceived vaccine safety. In 2012 and 2016, respectively, participants returned to report their own vaccination behavior for the 2011-2012 flu season (N = 338) and 2015-2016 flu season (N = 216).

RESULTS

Perceiving greater percentage of 2010-2011 social circle vaccine coverage was associated with a greater likelihood of getting vaccinated in the 2010-2011 flu season (odds ratio [OR] = 1.03, 95% confidence interval [CI] = 1.01, 1.04) and the subsequent 2011-2012 flu season (OR = 1.02, 95% CI = 1.01, 1.03) but not the 2015-2016 flu season (OR = 1.00, 95% CI = .99, 1.01), as seen in logistic regressions that controlled for demographics and 2009-2010 vaccination behavior. All significant relationships between social circle vaccine coverage and own vaccination behavior were mediated by perceived flu risk without vaccination.

CONCLUSIONS

Perceived social circle vaccine coverage is associated with own vaccination behavior in the current and subsequent flu season, establishing behavior patterns that may persist into the future. People's vaccination decisions may be informed by their perceptions of their peers' beliefs and behaviors. We discuss intervention strategies for promoting vaccine uptake by counteracting negative and promoting positive perceived social norms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).