Public stigma against fentanyl overdose decedents in the United States: A conjoint vignette experiment

The United States is facing a drug overdose crisis, and stigma against people who use drugs is a major roadblock to implementing solutions. Despite the public health importance of understanding and mitigating substance use stigma, prior research has focused mainly on perceptions of individuals with substance use disorders and a limited set of demographic traits. This leaves critical gaps in our understanding of stigma against fentanyl overdose decedents, who represent a much broader group, including people who use substances recreationally. This study develops a more robust understanding of these attitudes through an experimental vignette survey fielded to a national sample of American adults (n = 1432). Respondents were shown two fictional fentanyl overdose obituaries where a complex suite of decedent characteristics-including demographic traits and contexts of substance use-were randomly varied in a conjoint design. Respondents then endorsed one of the two decedents for each of several attitudinal outcomes, including blameworthiness and support for various interventions, and justified their choices in an open-ended format. Results indicate that the public assesses victims of fentanyl overdose meritocratically, making judgments based on personal history and life experience rather than traditional race, class, and gender status beliefs. While certainly a signal of progress on some fronts, this meritocratic lens conflicts with the public health model of addressing the overdose crisis and exposes the alarming persistence of explicit stigma against people who use drugs.

Politics matters for individual attitudes toward vaccine donation: cross-national evidence from the United States and Taiwan

BACKGROUND

Vaccine equity has been a major concern during the COVID-19 pandemic. According to the principle of vaccine equity, donor countries should apply the criterion of needs to make decisions about vaccine donation instead of considering recipient countries' economic status. We examine whether people follow the same criterion or consider other factors to decide which country to donate vaccines and how many vaccines should be delivered.

METHODS

We conducted online surveys with the design of conjoint experiment in the United States and Taiwan in 2021. 1,532 American citizens and 1,587 Taiwanese citizens were interviewed. The respondents were broadly quota-matched to their respective demographic proportions on the dimensions of age, gender, and education. We estimated the average marginal component effects (AMCEs) of the conjoint attributes by using the OLS regression models with standard errors clustered at the respondent level.

RESULTS

15,320 and 15,870 decisions on vaccine donation generated by conjoint experiment respectively in the United States and Taiwan were included in the analysis. Both American and Taiwanese people tend to donate vaccines to countries that suffer severe consequences of COVID-19 and democracies compared to authoritarian countries. However, they are less willing to donate vaccines to those with higher levels of capability in response to COVID-19. Taiwanese people tend to donate vaccines to countries having formal diplomatic relations with Taiwan (AMCE 13.4%, 95% CI 11.8%-15.1%). Nonetheless, American people would rather donate vaccines to countries without formal diplomatic relations with the United States (AMCE - 4.0%, 95% CI -5.6%--2.4%).

CONCLUSIONS

The findings reveal that politics plays a significant role in people's decisions about vaccine donation. Under electoral pressure, political leaders must think about how to respond to the public's preferences over vaccine donation to achieve vaccine equity and address the global health crisis.

The relative impact of health communication conveyed via quick response codes: A conjoint experiment among young thai consumers doing grocery shopping

This paper explores the impact of health communication using smartphones and the outcome of healthier purchases when young Thai consumers shop for groceries. A conjoint experiment was arranged whereby participants (n = 214) purchased grocery using information conveyed via quick response (QR) codes. Results show that a healthy food label, and a good consumer rating on the food's health, evoked the consumers' tendencies towards interacting with a smartphone in the purchasing situation. In addition, likelihood of buying increased. Further simulations revealed that health communication conveyed via QR codes can be a good investment for brands to increase healthier purchases.

COVID-19 booster uptake among US adults: Assessing the impact of vaccine attributes, incentives, and context in a choice-based experiment

OBJECTIVE

Evidence shows that booster shots offer strong protection against the Omicron variant of COVID-19. However, we know little about why individuals would receive a booster compared to the initial decision to vaccinate. We investigate and assess the factors that affect individuals' reported willingness to receive the COVID-19 vaccine booster. This information can aid in tailoring public health messaging to communicate attributes that are associated with individuals' attitudes toward the COVID-19 booster.

RATIONALE

Existing research provides little insight into whether the same factors that affect Americans' likelihood of accepting initial vaccination against COVID-19 also affect booster uptake. Our experiment also examines the influence of contextual information about a novel variant on willingness to receive a booster.

METHODS

We administered a conjoint experiment (N = 2740 trials) in a survey of fully vaccinated US adults that had not yet received a COVID-19 booster (N = 548) to assess the impact of varied vaccine attributes on willingness to receive a booster.

RESULTS

The most important factors associated with higher willingness to receive a booster were efficacy, manufacturer, and the size of a financial incentive. Protection duration and protection against future variants vs. only current variants had modest influence. A contextual prime reporting that some public health experts believe the Omicron variant is more contagious, but less lethal than those previously seen, significantly increased favorability toward boosters. This provides potential motivation and guidance for vaccination campaigns to emphasize these variant-specific traits.

CONCLUSION

With several vaccines with varying degrees of efficacy available to consumers, emphasizing boosters with a high efficacy would likely improve attitudes toward boosters. Financial incentives and predispositions toward manufacturers also matter. Concerns about more contagious variants may spur uptake, even if such variants are less lethal.

Vaccine nationalism among the public: A cross-country experimental evidence of own-country bias towards COVID-19 vaccination

What types of vaccines are citizens most likely to accept? We argue that citizens' identification with their nation may lead them to prefer vaccines developed and produced within their national borders, to the exclusion and/or detriment of vaccines from other nations. We administered a conjoint experiment requesting 15,000 adult citizens across 14 individual countries from around the world to assess 450,000 profiles of vaccines that randomly varied on seven attributes. Beyond vaccine fundamentals such as efficacy rate, number of doses, and duration of the protection, we find that citizens systematically favor vaccines developed and produced in their own country of residence. The extent of preference in favor of vaccines developed and produced within the national borders is particularly large among citizens who identify more strongly with their nation, suggesting nationalism plays a role in explaining the bias in favor of vaccines developed and produced locally. This public opinion bias on vaccine preferences has significant theoretical and practical implications.

Vaccine alliance building blocks: a conjoint experiment on popular support for international COVID-19 cooperation formats

The design principles of institutions that visibly and significantly affect citizens' lives are likely to be politically salient. Popular support for these principles is in turn crucial for institutional viability and effectiveness. Transboundary pandemics are a case in point. Understanding citizens' preferences regarding the design of international alliances set up to mass-produce and distribute vaccines is likely to determine citizens' subsequent cooperation with vaccination campaigns. This study explores Germans' preferences for international COVID-19 vaccine alliance design principles. We conducted a conjoint experiment at a recurring cognitive moment in many pandemics' cycles, between the initial outbreak and a more devastating but still-unknown second wave, when infection rates were very low, yet no policy solutions had been developed. We analyzed preferences regarding four building blocks: (1) alliance composition (size; EU-centrism), (2) alliance distribution rules (joining cost; vaccine allocation), (3) vaccine nationalism (cost per German household; coverage in Germany) and (4) vaccine producer confidence (origin; type). Distribution rules, political ideology and personal perceptions of pandemic threat matter little. But a larger alliance size and dominant EU-country composition increase alliance support. And vaccine nationalism is key: support increases with both lower costs and larger coverage for own-nation citizens. Moreover, support goes down for Chinese and American producers and increases for Swiss and especially own-nation producers. In sum, a realist and technocratic outlook is warranted at the cognitive stage in pandemic cycles when no solutions have been found, yet the worst already seems to be over, as national self-interest reigns supreme in popular attitudes.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s11077-021-09435-1.

Public attitudes toward pandemic triage: Evidence from conjoint survey experiments in Switzerland

The question of how to implement medical triages has become highly salient during the COVID-19 pandemic and continues to be actively discussed. It is important to know how members of the general public think about this issue. For one, knowledge about the public's standpoint can help resolve important questions where ethical considerations are by themselves not sufficient, for instance whether the patient's age should matter. It can also help identify if more communication with the public about medical ethics is needed. We study how members of the Swiss public would allocate intensive medical care among COVID-19 patients using data from two original conjoint survey experiments conducted in Switzerland in the context of the first and second pandemic waves in 2020 (N = 1457 & N = 1450). We find that our participants would not base triage decisions on the patient's age. However, they do give much importance to the patient's behavior prior and during illness, discriminate against non-nationals, and assign only a relatively small and inconsistent role to medical considerations. Our findings suggest that there is a need for more communication with the public about the ethics of medical triage.

Risk perceptions and DUI decisions of drivers in different legal environments: New evidence on differential deterrence from a Chinese sample

OBJECTIVES

Research on the deterrent effects of driving-under-the-influence (DUI) laws has been limited in China, which has criminalized drunk driving since May 2011 yet the effectiveness of this legislation remains unclear. Primary studies are needed to confirm whether government reports of reductions in DUI rates since then can indeed match changes in driver perceptions of DUI risk, and if so, be attributed to what specific components of the DUI legal environments. Based on the classical theory of deterrence and recent advances in differential deterrence, this study adopted a conjoint experiment from a previous US study that simulated the decision-making process of potential drinking drivers, and evaluated how DUI sanctions and enforcement practices contributed differentially to the three components of deterrence (i.e., certainty, swiftness, and severity of punishment). Key individual characteristics and nonlegal factors, as suggested by differential deterrence research to moderate the impact of DUI laws, were also considered.

METHODS

A Web-based conjoint experiment was conducted on a sample of 109 college students from two major universities in Shenzhen, China. Participants were randomly assigned to blocks of hypothetical scenarios composed of different levels of DUI enforcement and penalties, and asked to choose from a pair of scenarios each time, in which they were more likely to drink and drive. They also answered questions adapted from previous studies that measured key individual factors in relation to differential deterrence, such as informal sanction threat, moral inhibition, and personal and vicarious experiences with punishment. Such individual differences were accounted for in both a conventional two-level mixed logit aggregate model and a Hierarchical Bayes model.

RESULTS

Consistent with prior findings in Western countries, DUI enforcement intensity, was found to be the strongest deterrent to potential drinking drivers in China. License suspension, as an administrative punishment that can be swiftly implemented, was also effective in deterring the Chinese drivers, who however were much more likely to fear the revocation of their licenses rather than a 6-month suspension only. Meanwhile, they were notably deterred by the possibility of being in jail for 1-3 days, let alone for 1-2 months. Altogether, enforcement, license suspension and jail penalties accounted for more than 75 percent of attribute impact on drivers' decision to drink and drive, whereas fine penalty and license points had almost no effect. On the other hand, nonlegal factors such as informal sanction threat and vicarious experiences were found to have significantly moderated the deterrent effects of DUI laws.

CONCLUSIONS

Overall, this study quantified the unique effects of perceived certainty, swiftness, and severity of DUI punishment in the Chinese context, and supported the usefulness of conjoint experiments for examining risk perceptions and DUI decisions in different legal environments. It also provided new empirical evidence on differential deterrence and pointed out the need of determining for which subsets of individuals and under what conditions can legal sanctions successfully deter potential offenders. Such research will help researchers and policy makers better understand the role of deterrence, for more effective policy development related to DUI as well as other important traffic safety issues.

Factors influencing Covid-19 vaccine acceptance across subgroups in the United States: Evidence from a conjoint experiment

Public health officials warn that the greatest barrier to widespread vaccination against Covid-19 will not be scientific or technical, but the considerable public hesitancy to take a novel vaccine. Understanding the factors that influence vaccine acceptance is critical to informing public health campaigns aiming to combat public fears and ensure broad uptake. Employing a conjoint experiment embedded on an online survey of almost 2,000 adult Americans, we show that the effects of seven vaccine attributes on subjects’ willingness to vaccinate vary significantly across subgroups. Vaccine efficacy was significantly more influential on vaccine acceptance among whites than among Blacks, while bringing a vaccine to market under a Food and Drug Administration Emergency Use Authorization had a stronger adverse effect on willingness to vaccinate among older Americans and women. Democrats were more sensitive to vaccine efficacy than Republicans, and both groups responded differently to various endorsements of the vaccine. We also explored whether past flu vaccination history, attitudes toward general vaccine safety, and personal contact with severe cases of Covid-19 can explain variation in group vaccination hesitancy. Many subgroups that exhibit the greatest Covid-19 vaccine hesitancy did not report significantly lower frequencies of flu vaccination. Several groups that exhibited greater Covid-19 vaccine hesitancy also reported greater concerns about vaccine safety generally, but others did not. Finally, subgroup variation in reported personal contact with severe cases of Covid-19 did not strongly match subgroup variation in vaccine acceptance.

The perceived deservingness of COVID-19 healthcare in the Netherlands: a conjoint experiment on priority access to intensive care and vaccination

BACKGROUND

Amidst the COVID-19 pandemic, governments, health experts, and ethicists have proposed guidelines about ICU triage and priority access to a vaccine. To increase political legitimacy and accountability, public support is important. This study examines what criteria beyond medical need are deemed important to be perceived of priority COVID-19 healthcare access.

METHOD

Two conjoint experiments about priority over ICU treatment and early COVID-19 vaccination were implemented in a probability-based sample of 1461 respondents representative of the Netherlands. Respondents were asked who should receive treatment out of two fictitious healthcare claimants that differed in in age, weight, complying with corona policy measures, and occupation, all randomly assigned. Average marginal coefficient effects are estimated to assess the relative importance of the attributes; attributes were interacted with relevant respondent characteristics to find whether consensus exists in this relative ranking.

RESULTS

The Dutch penalize those not complying with coronavirus policy measures, and the obese, but prioritize those employed in 'crucial' sectors. For these conditions, there is consensus among the population. For age, young people are prioritized for ICU treatment, while the middle-aged are given priority over a vaccine, with younger respondents favoring healthcare for elderly claimants, while older respondents favor support for young cohorts.

CONCLUSION

People who have no control over their social risk and are able to reciprocate to society are considered as more deserving of priority of COVID-19 healthcare. Our findings provide fair support for the implemented ethical guidelines about ICU-treatment and COVID-19 vaccines.