Effects of trust, risk perception, and health behavior on COVID-19 disease burden: Evidence from a multi-state US survey
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Abstract
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.
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SciScore for 10.1101/2021.11.17.21266481: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Our survey questionnaire (Appendix S1) was approved by the University of Idaho Institutional Review Board (IRB #20-119).
Consent: Informed consent was obtained from all survey participants.Sex as a biological variable The remaining measures are recorded as Boolean variables measuring race (white = 1), gender (female = 1), age (over 64 years = 1), and geography (rural = 1). Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources We used ArcGIS software from Environmental Systems Research Institute, Inc. (ESRI; West Redlands, CA, USA) to perform this spatial association. ArcGISsuggested: (ArcGIS for Desktop Basic, …SciScore for 10.1101/2021.11.17.21266481: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: Our survey questionnaire (Appendix S1) was approved by the University of Idaho Institutional Review Board (IRB #20-119).
Consent: Informed consent was obtained from all survey participants.Sex as a biological variable The remaining measures are recorded as Boolean variables measuring race (white = 1), gender (female = 1), age (over 64 years = 1), and geography (rural = 1). Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources We used ArcGIS software from Environmental Systems Research Institute, Inc. (ESRI; West Redlands, CA, USA) to perform this spatial association. ArcGISsuggested: (ArcGIS for Desktop Basic, RRID:SCR_011081)Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Our study has several limitations. First, survey instruments are subject to response bias. Our respondents tend to be older, wealthier, more-educated individuals compared to the population as a whole. This is typical of many survey-based studies [33]. We interpret our findings in light of this limitation. Second, we received fewer responses from Texas (144) than from Idaho and Vermont. However, we received a substantial fraction of rural responses from each state, resulting in a multifaceted picture of rural attitudes; therefore, the effect of a lack of respondents from Texas may have been minimal. Third, with respect to disease data, we are limited by the shortcomings of the disease surveillance and reporting mechanisms. Because of limitations in testing for COVID-19, reported case counts are an underestimate of the true number of cases. This should have little effect on the outcome of our study so long as there are no heterogeneous biases in under-reporting of cases. Fourth, we are limited by the fact that COVID-19 cases are reported at the county level within the US. We may have been able to achieve greater resolution in our study had we been able to associate case counts with census tracts, the geographic level at which the geographic analysis was conducted. Related to this, in determining whether a zip code is rural or urban, we use the RUCA classification system. This system offers a finer level of granularity of which locations are urban and which are rural than the MS...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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