Social Cognitive Theory and Willingness to Perform Recommended Health Behavior: The Moderating Role of Misperceptions

More than 6 million people have died due to the COVID-19 pandemic. In order to slow down the spread of COVID-19, health authorities have created numerous guidelines. In the current study, we use survey data from the U.S. and social cognitive theory (SCT) to examine the associations among self-efficacy, outcome expectancies, and willingness to perform recommended COVID-19 related health behavior. Considering the misinformation-filled information ecology during the pandemic, we also examine the moderating role of misperceptions in these relationships. Our findings show that in general the SCT hypotheses hold for COVID-19 related behavior willingness. The interaction effects with COVID-19 misperceptions show that self-efficacy is not enough to understand people's health behavior. Higher outcome expectancies are important and may be able to overcome even if people held high misperceptions. Our findings have direct implications for communication theory and for health organizations in the contemporary information ecology.

Openness to change among COVID misinformation endorsers: Associations with social demographic characteristics and information source usage

RATIONALE

Misinformation is a major concern for public health, with its presence and impact strongly felt in the COVID-19 pandemic. Misinformation correction has drawn strong research interest. In contrast, relatively little attention has been given to the likelihood of favorable behavioral change post correction (i.e., openness to change).

OBJECTIVE

This study seeks to identify the characteristics of COVID misinformation endorsers who are open to adopt more self-protective behaviors after misinformation correction.

METHODS

COVID misinformation endorsers (N = 1991) in a large, nationally representative survey (fielded in October and November 2021) were asked how likely they would adopt self-protective behaviors if a source they trusted debunked their prior misperceptions. Multiple linear regression estimated the relationships between openness to change and socio-demographics, health-related factors, and health information source usage patterns.

RESULTS

Less than half of the misinformation endorsers in the sample (41.3%) indicated any openness to change. Openness to change was positively associated with minority status and negatively associated with leaning Republican in political affiliation, higher income, being currently unvaccinated or unsure about vaccination status, better health, and a greater number of misinformation items endorsed. Past-month use of government, community, and personal sources for health information positively predicted openness. The use of online media was negatively associated with openness.

CONCLUSIONS

Openness to change is not guaranteed after misinformation correction. Targeted interventions based on openness to change are needed to enhance the public health impact of misinformation correction efforts.

The role of perceived minority-group status in the conspiracy beliefs of factual majority groups

Research suggests that minority-group members sometimes are more susceptible to misinformation. Two complementary studies examined the influence of perceived minority status on susceptibility to misinformation and conspiracy beliefs. In study 1 (n = 2140), the perception of belonging to a minority group, rather than factually belonging to it, was most consistently related with an increased susceptibility to COVID-19 misinformation across national samples from the USA, the UK, Germany and Poland. Specifically, perceiving that one belongs to a gender minority group particularly predicted susceptibility to misinformation when participants factually did not belong to it. In pre-registered study 2 (n = 1823), an experiment aiming to manipulate the minority perceptions of men failed to influence conspiracy beliefs in the predicted direction. However, pre-registered correlational analyses showed that men who view themselves as a gender minority were more prone to gender conspiracy beliefs and exhibited a heightened conspiracy mentality. This effect was correlationally mediated by increased feelings of system identity threat, collective narcissism, group relative deprivation and actively open-minded thinking. Especially, the perception of being a minority in terms of power and influence (as compared to numerically) was linked to these outcomes. We discuss limitations and practical implications for countering misinformation.

Misinformation, Trust, and Use of Ivermectin and Hydroxychloroquine for COVID-19

Importance

The COVID-19 pandemic has been notable for the widespread dissemination of misinformation regarding the virus and appropriate treatment.

Objective

To quantify the prevalence of non-evidence-based treatment for COVID-19 in the US and the association between such treatment and endorsement of misinformation as well as lack of trust in physicians and scientists.

Design, Setting, and Participants

This single-wave, population-based, nonprobability internet survey study was conducted between December 22, 2022, and January 16, 2023, in US residents 18 years or older who reported prior COVID-19 infection.

Main Outcome and Measure

Self-reported use of ivermectin or hydroxychloroquine, endorsing false statements related to COVID-19 vaccination, self-reported trust in various institutions, conspiratorial thinking measured by the American Conspiracy Thinking Scale, and news sources.

Results

A total of 13 438 individuals (mean [SD] age, 42.7 [16.1] years; 9150 [68.1%] female and 4288 [31.9%] male) who reported prior COVID-19 infection were included in this study. In this cohort, 799 (5.9%) reported prior use of hydroxychloroquine (527 [3.9%]) or ivermectin (440 [3.3%]). In regression models including sociodemographic features as well as political affiliation, those who endorsed at least 1 item of COVID-19 vaccine misinformation were more likely to receive non-evidence-based medication (adjusted odds ratio [OR], 2.86; 95% CI, 2.28-3.58). Those reporting trust in physicians and hospitals (adjusted OR, 0.74; 95% CI, 0.56-0.98) and in scientists (adjusted OR, 0.63; 95% CI, 0.51-0.79) were less likely to receive non-evidence-based medication. Respondents reporting trust in social media (adjusted OR, 2.39; 95% CI, 2.00-2.87) and in Donald Trump (adjusted OR, 2.97; 95% CI, 2.34-3.78) were more likely to have taken non-evidence-based medication. Individuals with greater scores on the American Conspiracy Thinking Scale were more likely to have received non-evidence-based medications (unadjusted OR, 1.09; 95% CI, 1.06-1.11; adjusted OR, 1.10; 95% CI, 1.07-1.13).

Conclusions and Relevance

In this survey study of US adults, endorsement of misinformation about the COVID-19 pandemic, lack of trust in physicians or scientists, conspiracy-mindedness, and the nature of news sources were associated with receiving non-evidence-based treatment for COVID-19. These results suggest that the potential harms of misinformation may extend to the use of ineffective and potentially toxic treatments in addition to avoidance of health-promoting behaviors.

Assessing Brigada Digital de Salud Audience Reach and Engagement: A Digital Community Health Worker Model to Address COVID-19 Misinformation in Spanish on Social Media

U.S. Spanish-speaking populations experienced gaps in timely COVID-19 information during the pandemic and disproportionate misinformation exposure. Brigada Digital de Salud was established to address these gaps with culturally tailored, Spanish-language COVID-19 information on social media. From 1 May 2021 to 30 April 2023, 495 Twitter, 275 Facebook, and 254 Instagram posts were published and amplified by 10 trained community health workers. A qualitative content analysis was performed to characterize the topics and formats of 251 posts. To assess reach and engagement, page analytics and advertising metrics for 287 posts were examined. Posts predominantly addressed vaccination (49.45%), infection risks (19.12%), and COVID-related scientific concepts (12.84%). Posts were educational (48.14%) and aimed to engage audiences (23.67%), promote resources (12.76%), and debunk misinformation (9.04%). Formats included images/text (55.40%), carousels (27.50%), and videos (17.10%). By 9 June 2023, 394 Facebook, 419 Instagram, and 228 Twitter followers included mainly women ages 24-54. Brigada Digital reached 386,910 people with 552,037 impressions and 96,868 engagements, including 11,292 likes, 15,240 comments/replies, 9718 shares/retweets, and 45,381 video play-throughs. The most engaging posts included videos with audio narration, healthcare providers, influencers, or music artists. This community-based model to engage Spanish-speaking audiences on social media with culturally aligned content to counter misinformation shows promise for addressing public health threats.

Distractions, analytical thinking and falling for fake news: A survey of psychological factors

Analytical thinking safeguards us against believing or spreading fake news. In various forms, this common assumption has been reported, investigated, or implemented in fake news education programs. Some have associated this assumption with the inverse claim, that distractions from analytical thinking may render us vulnerable to believing or spreading fake news. This paper surveys the research done between 2016 and 2022 on psychological factors influencing one's susceptibility to believing or spreading fake news, considers which of the psychological factors are plausible distractors to one's exercise of analytical thinking, and discusses some implications of considering them as distractors to analytical thinking. From these, the paper draws five conclusions: (1) It is not analytical thinking per se, but analytical thinking directed to evaluating the truth that safeguards us from believing or spreading fake news. (2) While psychological factors can distract us from exercising analytical thinking and they can also distract us in exercising analytical thinking. (3) Whether a psychological factor functions as a distractor from analytical thinking or in analytical thinking may depend on contextual factors. (4) Measurements of analytical thinking may not indicate vulnerability to believing or spreading fake news. (5) The relevance of motivated reasoning to our tendency to believe fake news should not yet be dismissed. These findings may be useful to guide future research in the intersection of analytical thinking and susceptibility to believing or spreading fake news.

Fear God, Not COVID-19: Is Conservative Protestantism Associated with Risky Pandemic Lifestyles?

Previous research has established attitudinal and behavioral health variations in relation to the COVID-19 pandemic, but scholarship on the religious antecedents associated with these outcomes has only recently gained momentum. Rhetoric from some leading conservative Protestants in the U.S. has underplayed the threat of the pandemic and may have contributed to unhealthy pandemic behaviors within this faith tradition. Moreover, previous inquiries have revealed that conservative Protestantism's otherworldly focus can thwart personal and community health. We use nationally representative data to test the hypotheses that, compared with other religious groups and the non-religious, conservative Protestants will tend to (1) perceive the pandemic as less threatening and (2) engage in riskier pandemic lifestyles. These hypotheses are generally supported net of confounding factors. We conclude that affiliation with a conservative Protestant denomination can undermine public health among this faith tradition's adherents and may therefore compromise general health and well-being during a pandemic. We discuss the implications of these findings, offer recommendations for pandemic health promotion among conservative Protestants, and delineate promising avenues for future research on this important topic.

Intention to Vaccinate against COVID-19 among Young Adults: The Role of Conspiratorial Thinking

The anti-scientific and anti-vaccine movements gained momentum amidst the health and socio-economic crisis brought about by the COVID-19 pandemic. These widespread pseudoscientific beliefs and the endorsement of conspiracy theories likely contributed to the COVID-19 vaccine hesitancy. The aim of this study was to explore which variables best differentiated between groups of vaccinated (n = 289), vaccine-hesitant (n = 106), and vaccine-refusing (n = 146) young adults. The study was conducted online at the beginning of the mass vaccination campaign in Croatia when the vaccine just became available for younger and non-vulnerable members of the general population. The demographic variables, COVID-19 anxiety, and conspiratorial thinking regarding COVID-19 were entered into the discriminant analysis. The function explaining 89.2% of the group differences, mostly between the vaccinated and vaccine-refusing, was largely defined by conspiratorial thinking regarding COVID-19 (0.852), followed by variables with substantially less discriminative power, including COVID-19 anxiety (0.423; lower in the vaccine-refusing group), political orientation (0.486; vaccine-refusing leaning less to the left), financial and educational status (0.435 and 0.304, respectively; both lower in the vaccine-refusing group), and religiosity (0.301; higher in the vaccine-refusing group). These results confirm that among young adults, the decision to vaccinate against COVID-19 might be heavily influenced by one's proclivity to engage in conspiratorial thinking.

Understanding healthcare workers' knowledge and attitudes regarding the coronavirus disease 2019 (COVID-19) vaccine: Overcoming gaps to improve public health response

Vaccines serve as a major tool against the coronavirus disease 2019 (COVID-19) pandemic, but vaccine hesitancy remains a major concern in the United States. Healthcare workers (HCWs) strongly influence a patient's decision to get vaccinated. We evaluated HCW knowledge and attitudes regarding the COVID-19 vaccine.

Investigating the Heterogeneity of Misperceptions: A Latent Profile Analysis of COVID-19 Beliefs and Their Consequences for Information-Seeking

This panel study in Austria in 2020 (NW1 = 912, NW2 = 511) explores distinct audience segments regarding beliefs in misinformation, conspiracy, and evidence statements on COVID-19. I find that citizens fall into seven segments, three of which endorse unsupported claims: The threat skeptics selectively accept misinformation and evidence; the approvers tend to accept all types of information; and the misinformed believe in misinformation and conspiracy statements while rejecting evidence. Further analyses suggest that the misinformed increasingly sought out COVID-19 threat-negating information from scientific sources, while also overall attending to threat-confirming information. These patterns have practical implications for correcting misperceptions.

"They're trying to bribe you and taking away your freedoms": COVID-19 vaccine hesitancy in communities with traditionally low vaccination rates

Vaccination is an essential public health intervention to control the COVID-19 pandemic. A minority of Canadians, however, remain hesitant about COVID-19 vaccines, while others outright refuse them. We conducted focus groups to gauge perceptions and attitudes towards COVID-19 vaccines in people who live in a region with historically low rates of childhood vaccination. Participants discussed their perception of COVID-19 vaccines and their intention to get vaccinated, and the low rate of COVID-19 vaccine uptake in Manitoba's Southern Health Region compared to other regions in Canada. We identified three drivers of vaccine hesitancy: (1) risk perceptions about COVID-19 and the vaccines developed to protect against it, (2) religious and conservative views; and (3) distrust in government and science. Participant proposed recommendations for improving communication and uptake of the COVID-19 vaccines included: public health messages emphasising the benefits of vaccination; addressing the community's specific concerns and dispelling misinformation; highlighting vaccine safety; and emphasising vaccination as a desirable behaviour from a religious perspective. Understanding the specific anxieties elicited by COVID-19 vaccines in areas with low childhood immunization rates can inform risk communication strategies tailored to increase vaccination in these specific regions. This study adds important information on potential reasons for vaccine hesitancy in areas with historically low rates of childhood vaccination, and provides important lessons learned for future emergencies in terms of vaccine hesitancy drivers and effective risk communication to increase vaccine uptake.

Unpacking COVID ‐19 and conspiracy theories in the UK black community

OBJECTIVES

Conspiracy theories are associated with significant COVID-19 health consequences including lower engagement with protective behaviours. This study uses sensemaking theory, a process of constructing meanings through interpersonal exchanges that enable people to interpret their world to explain the theoretical process underlying the development of conspiratorial beliefs around COVID-19 within Black African and Caribbean communities in the UK.

DESIGN

Qualitative, in-depth interviews were used.

METHODS

Twenty-eight members of the communities were recruited: semi-structured interviews were analysed using grounded theory.

RESULTS

Our findings provide an explanation of how an environment of crisis combined with current and historical mistrust, perceived injustice and inequality provided a context in which alternative conspiracy narratives could thrive. The nature of these conspiratorial beliefs made more sense to many of our respondent's than institutional sources (such as the UK Government). Critically, these alternative beliefs helped respondents shape their decision-making, leading to non-engagement with COVID protective behaviours.

CONCLUSIONS

We conclude that the uncertainty of the pandemic, combined with historical and contemporary perceived injustice and mistrust, and a lack of specific identity-aligned messaging, created a perfect environment for conspiratorial sense-making to thrive. This alternative sensemaking was inconsistent with the health-protection messaging espoused by the Government. To ensure all groups in society are protected, and for health promotion messages to take purchase, the experiences of different target audiences must be taken into account, with sensemaking anchored in lived experience.

“I Did My Own Research”: Overconfidence, (Dis)trust in Science, and Endorsement of Conspiracy Theories

Epistemically suspect beliefs, such as endorsement of conspiracy theories or pseudoscientific claims, are widespread even among highly educated individuals. The phenomenon of conspiratorial thinking is not new, yet the COVID-19 pandemic, causing a global health crisis of an unprecedented scale, facilitated the emergence and rapid spread of some rather radical health-related pseudoscientific fallacies. Numerous correlates of the tendency to endorse conspiracy theories have already been addressed. However, many of them are not subject to an intervention. In this study, we have tested a model that includes predictors ranging from stable characteristics such as demographics (gender, age, education, and size of the place of residence), less stable general traits such as conservatism and overconfidence in one’s own reasoning abilities, to relatively changeable worldviews such as trust in science. A hierarchical regression analysis (N = 859 participants) showed that included predictors explained a total of 46% of the variance of believing in COVID-19 conspiracy theories, with only gender, overconfidence, and trust in science yielding significance. Trust in science was the strongest predictor, implying that campaigns aimed at enhancing public trust in both science as a process, and scientists as individuals conducting it, might contribute to the reduction in susceptibility to pseudoscientific claims. Furthermore, overconfidence in one’s own reasoning abilities was negatively correlated with an objective measure of reasoning (syllogisms test) and positively correlated with the endorsement of conspiracy theories, indicating that the so-called Dunning-Kruger effect plays a role in pseudoscientific conspiratorial thinking regarding COVID-19.

Comparative analysis of social bots and humans during the COVID-19 pandemic

Using more than 4 billion tweets and labels on more than 5 million users, this paper compares the behavior of humans and bots politically and semantically during the pandemic. Results reveal liberal bots are more central than humans in general, but less important than institutional humans as the elite circle grows smaller. Conservative bots are surprisingly absent when compared to prior work on political discourse, but are better than liberal bots at eliciting replies from humans, which suggest they may be perceived as human more frequently. In terms of topic and framing, conservative humans and bots disproportionately tweet about the Bill Gates and bio-weapons conspiracy, whereas the 5G conspiracy is bipartisan. Conservative humans selectively ignore mask-wearing and we observe prevalent out-group tweeting when discussing policy. We discuss and contrast how humans appear more centralized in health-related discourse as compared to political events, which suggests the importance of credibility and authenticity for public health in online information diffusion.

Sentinel node approach to monitoring online COVID-19 misinformation

Understanding how different online communities engage with COVID-19 misinformation is critical for public health response. For example, misinformation confined to a small, isolated community of users poses a different public health risk than misinformation being consumed by a large population spanning many diverse communities. Here we take a longitudinal approach that leverages tools from network science to study COVID-19 misinformation on Twitter. Our approach provides a means to examine the breadth of misinformation engagement using modest data needs and computational resources. We identify a subset of accounts from different Twitter communities discussing COVID-19, and follow these ‘sentinel nodes’ longitudinally from July 2020 to January 2021. We characterize sentinel nodes in terms of a linked domain preference score, and use a standardized similarity score to examine alignment of tweets within and between communities. We find that media preference is strongly correlated with the amount of misinformation propagated by sentinel nodes. Engagement with sensationalist misinformation topics is largely confined to a cluster of sentinel nodes that includes influential conspiracy theorist accounts. By contrast, misinformation relating to COVID-19 severity generated widespread engagement across multiple communities. Our findings indicate that misinformation downplaying COVID-19 severity is of particular concern for public health response. We conclude that the sentinel node approach can be an effective way to assess breadth and depth of online misinformation penetration.

Determinants of COVID-19 skepticism and SARS-CoV-2 vaccine hesitancy: findings from a national population survey of U.S. adults

BACKGROUND

The enduring presence of COVID-19 skepticism and SARS-CoV-2 vaccine hesitancy is an ongoing impediment to the global response effort to the current pandemic. This study seeks to identify determinants of skepticism and vaccine hesitancy in U.S. adults.

METHODS

Data are from the Values and Beliefs of the American Public Survey, conducted in 2021 by the Gallup Organization in conjunction with Baylor University. The survey used stratified random probability sampling of the U.S. adult population (N = 1222). Outcome measures were respective single items assessing COVID-19 skepticism and SARS-CoV-2 vaccine hesitancy. Exposure variables included political, religious, and sociodemographic indicators, and moderators assessed personal history of COVID-19 and losing a relative or close friend to COVID-19.

RESULTS

Skepticism and vaccine hesitancy were strongly associated with conservative and Republican political preference and conservative religious beliefs, and less so with socioeconomic status. Personal experience with COVID-19 did not mitigate the effect of politics on skepticism and barely reduced the odds for hesitancy. Results confirm that attitudes toward COVID-19 are politically and religiously conditioned, and are especially a product of conservative political preference.

CONCLUSION

Skepticism about COVID-19 and hesitancy regarding SARS-CoV-2 vaccination are highest among the political and religious right. Efforts to increase immunization through public education may be inadequate; resistance appears ideological. Other solutions may need to be considered, which risk widespread pushback both politically and religiously motivated.

Politicization and COVID-19 vaccine resistance in the U.S

Science is frequently used and distorted to advance political, economic, or cultural agendas. The politicization of science can limit the positive impacts that scientific advances can offer when people reject sound and beneficial scientific advice. Politicization has undoubtedly contributed to hesitancy toward uptake of the COVID-19 vaccine. It is urgent for scientists and clinicians to better understand: (1) the roots of politicization as related to COVID-19 vaccines; (2) the factors that influence people's receptivity to scientific misinformation in politicized contexts; and (3) how to combat the politicization of science to increase the use of life-saving vaccines. This chapter explores these issues in the context of COVID-19 vaccine resistance in the United States. After briefly describing the development of the vaccines, we describe the ways in which the disease itself became politicized because of statements by political leaders and also by media accounts including social media. We then review the politicization of the vaccine at both national and international scales, variability in public acceptance of the vaccines in the United States, and response to the emergence of variants. The next section summarizes social science findings on overcoming vaccine resistance, and the concluding section outlines some of the lessons of the politicization of the disease and the vaccine for health practitioners and life scientists.

The ephemeral effects of fact-checks on COVID-19 misperceptions in the United States, Great Britain and Canada

Widespread misperceptions about COVID-19 and the novel coronavirus threaten to exacerbate the severity of the pandemic. We conducted preregistered survey experiments in the United States, Great Britain and Canada examining the effectiveness of fact-checks that seek to correct these false or unsupported beliefs. Across three countries with differing levels of political conflict over the pandemic response, we demonstrate that fact-checks reduce targeted misperceptions, especially among the groups who are most vulnerable to these claims, and have minimal spillover effects on the accuracy of related beliefs. However, these reductions in COVID-19 misperception beliefs do not persist over time in panel data even after repeated exposure. These results suggest that fact-checks can successfully change the COVID-19 beliefs of the people who would benefit from them most but that their effects are ephemeral.

Association of Major Depressive Symptoms With Endorsement of COVID-19 Vaccine Misinformation Among US Adults

IMPORTANCE

Misinformation about COVID-19 vaccination may contribute substantially to vaccine hesitancy and resistance.

OBJECTIVE

To determine if depressive symptoms are associated with greater likelihood of believing vaccine-related misinformation.

DESIGN, SETTING, AND PARTICIPANTS

This survey study analyzed responses from 2 waves of a 50-state nonprobability internet survey conducted between May and July 2021, in which depressive symptoms were measured using the Patient Health Questionnaire 9-item (PHQ-9). Survey respondents were aged 18 and older. Population-reweighted multiple logistic regression was used to examine the association between moderate or greater depressive symptoms and endorsement of at least 1 item of vaccine misinformation, adjusted for sociodemographic features. The association between depressive symptoms in May and June, and new support for misinformation in the following wave was also examined.

EXPOSURES

Depressive symptoms.

MAIN OUTCOMES AND MEASURES

The main outcome was endorsing any of 4 common vaccine-related statements of misinformation.

RESULTS

Among 15 464 survey respondents (9834 [63.6%] women and 5630 [36.4%] men; 722 Asian respondents [4.7%], 1494 Black respondents [9.7%], 1015 Hispanic respondents [6.6%], and 11 863 White respondents [76.7%]; mean [SD] age, 47.9 [17.5] years), 4164 respondents (26.9%) identified moderate or greater depressive symptoms on the PHQ-9, and 2964 respondents (19.2%) endorsed at least 1 vaccine-related statement of misinformation. Presence of depression was associated with increased likelihood of endorsing misinformation (crude odds ratio [OR], 2.33; 95% CI, 2.09-2.61; adjusted OR, 2.15; 95% CI, 1.91-2.43). Respondents endorsing at least 1 misinformation item were significantly less likely to be vaccinated (crude OR, 0.40; 95% CI, 0.36-0.45; adjusted OR, 0.45; 95% CI, 0.40-0.51) and more likely to report vaccine resistance (crude OR, 2.54; 95% CI, 2.21-2.91; adjusted OR, 2.68; 95% CI, 2.89-3.13). Among 2809 respondents who answered a subsequent survey in July, presence of depression in the first survey was associated with greater likelihood of endorsing more misinformation compared with the prior survey (crude OR, 1.98; 95% CI, 1.42-2.75; adjusted OR, 1.63; 95% CI, 1.14-2.33).

CONCLUSIONS AND RELEVANCE

This survey study found that individuals with moderate or greater depressive symptoms were more likely to endorse vaccine-related misinformation, cross-sectionally and at a subsequent survey wave. While this study design cannot address causation, the association between depression and spread and impact of misinformation merits further investigation.

When Motivated Responses to Threat Backfire: Risky Socializing During the COVID-19 Health Crisis

This research examined the relationship between psychological processes that help individuals cope with challenging circumstances and their failure to act to reduce the likelihood and severity of the challenge itself. In two cross-sectional studies of U.S. residents ( N = 621) conducted during the COVID-19 pandemic, individuals’ motivated responses to threat predicted their noncompliance with directives prohibiting risky socializing: Those who perceived the disease to be a threat to their health were more likely to engage in risky socializing if they avoided information about the pandemic or they exhibited a dispositional tendency to join with other people when stressed. Several alternative causal sequences can account for these findings, but one suggests that the risky socializing during the COVID-19 pandemic was due, in part, to people’s psychological reaction to threat; as people responded to minimize their distress, they inadvertently increased their risk of contracting the illness.