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Who is Most Likely to Voluntarily Comply with COVID-19 Public Health Recommendations?

washing hands
Photo credit: Center for Disease Control

Note: This is the first article in The Blue Review’s Coronavirus Conversations, a special series on the 2020 COVID-19 pandemic.


Luke Fowler

Luke Fowler is an Associate Professor of Public Policy and Administration and Director of the MPA and Nonprofit Administration programs in the School of Public Service at Boise State University. He completed his Ph.D. at Mississippi State University in 2013. His research interests include policy implementation, energy and environmental policy, state and local government, public management, public budgeting and finance, and organizational theory. He has written articles for American Review of Public Administration, Review of Policy Research, State and Local Government Review, Journal of Public Budgeting, Accounting, & Financial Management, Environmental Politics, Social Science Journal, and Electricity Journal. He has also presented papers at numerous conferences including the annual meetings of the Southeastern Conference on Public Administration and American Association of Public Administration.


Steve Utych

Steve Utych is an assistant professor of political science at Boise State University. His research focuses on political psychology, specifically the role of language and emotions in politics.

 


COVID-19 has caught the world off-guard.  Since December, it has spread as an unexplained respiratory illness originating in Wuhan, China, to affecting more than 700,000 people worldwide in more than 170 countries, at the time of this writing.  In the US, national, state, and local officials are developing policy responses in hopes of constraining the spread of the virus, which will give way to policies that mitigate its impacts and aid in recovery (both in terms of public health and economics) in the coming weeks.  Since early March, the coronavirus pandemic, as it is also referred to, has become the leading news story on nearly every TV network and internet site, as phrases such as “flattening the curve,” “public health emergency,” “social distancing,” and “stay-at-home orders” are now part of the American lexicon and social reality.  Much of the political commentary litigates whether these steps are astute policy choices or overreactions, as we balance public health against social and economic disruptions.

Recent news stories of outbreaks resulting from Spring Breakers crowding beaches in Florida and young people throwing a “coronavirus party” in Kentucky highlight the tragedies that can occur when public health recommendations are ignored.  Of course, bad behavior is multi-generational and it appears that older Americans are also not taking coronavirus or the risks it poses as seriously as they should.  This highlights that not all Americans are willing to voluntarily comply with public health recommendations designed to contain the virus and reduce the probability of exposure for everyone.  While countries like China and India have implemented more draconian policies to forcibly limit citizen movement and interactions, the U.S. has yet to take steps that dramatic.  Given that the government’s strategy hinges on voluntarily compliance, this begs the question of how likely Americans are to follow public health recommendations, such as hand washing, social distancing, and avoiding public gatherings.

Recent polling data has uncovered both good news and bad.  In one poll, conducted March 10-12, 85% of respondents reported washing hands or using hand sanitizer frequently, 61% reported social distancing, and 45% reported avoiding high-risk people.  Another poll indicated that nearly two-thirds of respondents have taken at least one type of precaution in response to coronavirus.  However, important differences may be emerging in what type of person is more compliant with public health recommendations.

Americans are increasingly polarized along partisan lines, and the response to COVID-19 is no different. In one poll, conducted March 13-14, respondents reported large partisan gaps in whether they changed travel plans (38% of Democrats compared to 26% of Republicans), cancelled plans to avoid crowds (59% of Democrats, 40% of Republicans), or decided to eat at home more often (60% of Democrats, 36% of Republicans).  Additionally, the same poll shows that 76% of Democrats believe the coronavirus is a real threat while only 40% of Republicans do.  In sum, while Americans are likely to be taking precautions, certain types of people are more willing to comply with voluntary public health recommendations than others.  Given this, we think it is worthwhile to investigate whether differences also exist across demographic or socio-economic groups.

Survey

In order to examine this, we used Amazon’s Mechanical Turk to survey 1,015 people on March 23.  Since we used a convenience sample, our respondents tend to be more educated (58% have a Bachelor’s degree), more white (72%), and more likely to identify as Democrats (59%), compared to the general population.  On the other hand, our sample is more comparable to the general population for gender (45% female) and age (mean age is 38.14).  Given that the situation has evolved rapidly over the last few weeks, for context, on March 23, there were a total of 42,152 positive COVID-19 cases in the U.S., with 3,325 hospitalization, and 471 confirmed deaths.  Additionally, governors of all 50 states and the president had declared states of emergencies and every state had at least 16 cases, so it is reasonable to believe that all respondents were well aware of the coronavirus as a public health emergency.  Respondents were asked how likely (on a 0-6 scale, ranging from “extremely unlikely” to “extremely likely”) they were to do the following (over the next month):

  • wash hands for at least 20 seconds after using the bathroom
  • wash hands for at least 20 seconds after leaving home
  • cover mouth with the inside of elbow when sneezing or coughing
  • work from home
  • stay home from work, even without pay
  • only leave your house to obtain necessary medical treatment/supplies or groceries
  • not dine in a restaurant
  • not go to the gym
  • follow federal government recommendations about staying home
  • follow state government recommendations about staying home.

Table 1 shows results for the entire sample.  The good news is that two-thirds of respondents were extremely likely to comply with public health recommendations for washing hands, covering mouth while coughing or sneezing, not eating out at restaurants, and not going to the gym.  Additionally, the majority of respondents were extremely likely to work from home, not leave their house, and follow federal/state regulations.  Unsurprisingly, respondents were least likely to stay at home from work without pay, but a majority were still likely to do so.  This would generally suggest that average Americans are voluntarily complying with COVID-19 public health recommendations.

Table 1. Willingness to Comply with Recommendations

 Extremely likelyModerately likelySlightly likelyNeither likely nor unlikelySlightly unlikelyModerately unlikelyExtremely unlikely
Wash Hands – Bathroom69.34%16.22%6.13%2.37%1.88%1.98%2.08%
Wash Hands – Leaving home66.00%16.65%6.42%3.91%2.11%1.91%3.01%
Cover Cough74.80%13.69%4.56%2.58%1.29%1.39%1.69%
Work from Home55.66%13.47%6.44%7.87%2.50%4.05%10.01%
Stay home from work with no pay34.93%15.62%10.33%11.81%7.26%7.26%12.79%
Not leave house except for emergency54.53%23.38%9.65%3.68%2.99%2.29%3.58%
Not eat out76.55%9.99%4.02%3.26%2.17%2.28%1.74%
Not go to gym81.81%6.14%3.01%3.49%2.41%1.57%1.57%
Follow federal regulation56.55%24.80%9.03%3.87%2.18%1.49%2.08%
Follow state regulation59.96%23.79%7.23%3.77%1.88%1.78%1.59%

The not-so-good news is that there are some disparities across socio-economic and political groups.  Table 2 shows the numerical average for responses across age, political party, and political ideology; table 3, for gender, race, and education.  Given that age and politics have been on the forefront of discussion about COVID-19, let’s start there.

First, respondents over the age of 40 are more likely to comply with almost every public health recommendation (except work from home) than respondents under 40, with the largest disparities for washing hands after leaving the bathroom (interestingly, there are only minimal differences on washing hands after leaving home) and staying home from work without pay.  Given the vulnerability of older adults to COVID-19 as compared to younger adults, this finding may reflect a threat response where those most at risk are also most likely to comply with public health recommendations to minimize that risk.

Table 2. Willingness to Comply with Recommendations, by Gender, Race, and Education

 MenWomenWhiteNon-WhiteCollege DegreeNo College degree
Wash Hands – Bathroom5.215.515.315.425.285.43
Wash Hands – Leaving home5.155.325.195.335.165.33
Cover Cough5.345.625.485.465.375.61
Work from Home4.574.624.554.724.774.33
Stay home from work with no pay3.664.143.893.83.883.83
Not leave house except for emergency4.855.24.935.234.955.1
Not eat out5.345.515.465.35.385.46
Not go to gym5.45.635.535.445.455.59
Follow federal regulation5.035.335.125.295.125.24
Follow state regulation5.115.45.235.295.195.32

Second, Democrats are far more likely to comply with recommendations than Republicans across the board, with the largest disparities for not eating out, not leaving the house, not going to the gym, and following federal/state regulations, and the smallest disparities for washing hands and staying/working at home.  This would indicate that Democrats are more likely to comply with public health recommendations when it causes social disruption in their lives, compared to Republicans, who may be less willing to allow the government to tell them what to do.  Unsurprisingly, liberals are also more likely to comply with public health recommendations compared to conservatives, which mimics the findings for partisanship.  This is largely consistent with other surveys from the last few weeks.

Third, women are more likely to comply with public health recommendations than men, with the largest disparities for staying home from work without pay and not leaving the house except for emergency, and the smallest disparities for working from home.  Interestingly, the differences between females and males are strongest for any group.  Fourth, it appears there are no consistent trends across racial groups, with whites being more likely to follow some recommendations (e.g., not eat out, not go to gym, stay home from work) compared to non-whites, and non-whites being more likely to follow other recommendations (wash hands, work from home, follow federal/state regulations).  Finally, respondents without a college degree were more likely to comply with every public health recommendation, except working from home and staying home from work without pay, which may reflect occupational differences between these groups.

Table 3. Willingness to Comply with Recommendations, by Age, Political Party, and Ideology

 40 or youngerOver 40DemocratsRepublicansLiberalsConservatives
Wash Hands – Bathroom5.275.495.395.235.425.29
Wash Hands – Leaving home5.215.255.275.075.45.1
Cover Cough5.435.555.55.295.565.41
Work from Home4.624.544.654.54.844.61
Stay home from work with no pay3.794.023.863.764.013.83
Not leave house except for emergency4.995.065.114.795.174.87
Not eat out5.365.525.555.065.575.32
Not go to gym5.465.615.585.275.595.41
Follow federal regulation5.125.255.265.025.355.07
Follow state regulation5.25.335.385.065.445.12

Why This Matters?

Although other countries have adopted draconian measures to constrain and mitigate the impact of COVID-19, the U.S. strategy is grounded in voluntary compliance at the individual-level with public health recommendations; if people do voluntarily comply and it is successful in containing the pandemic, it means that both our communities are at less risk and the government will not need to pursue more aggressive strategies that create more social and economic disruption. Cooperation with these guidelines is important not only to stem the spread of the disease, but for larger questions of democratic governance – the harshest restrictions seem to occur in authoritarian or semi-authoritarian states, such as the two-month lockdown of the Hubei Provence in China. Voluntary compliance with restrictions may shorten the duration of the pandemic in the United States, likely serving to somewhat mitigate problematic economic and political consequences.

While the majority of respondents are likely to voluntarily comply with public health recommendations for COVID-19, there are important differences that stretch across socio-economic and political groups.  In sum, those over 40, Democrats, liberals, women, and those without college degrees are more likely to voluntarily comply as compared to those under 40, Republicans, males, and those with college degrees, respectively.  Given that public health recommendations are designed to limit the spread of the virus and people tend to congregate with those that are socio-economically or political similar, this likely means that people falling into those groups are at higher risk of exposure to COVID-19.  It also means that some communities are going to experience more acute impacts from this pandemic than others.

Evidence from South Korea suggests that compliance with these measures can limit the spread of COVID-19 without a nationwide lockdown. So it is important to understand who is more likely to comply with these measures, and why. For now, we can only speculate as to why – perhaps certain groups view their health as more at risk, or partisan polarization around the virus causes some to take it less seriously than others. However, an important first step is determining that these differences in compliance exist; now, we need to figure out how to encourage less compliant groups to take action.