Prevalence of COVID-19 Mitigation Behaviors in US Adults (August-December 2020): Nationwide Household Probability Survey

• Authors: Travis Sanchez, Emory University; Eric Hall, Emory University; Aaron J Siegler, Emory University; Radhika Prakash Asrani, Emory University; Heather Bradley, Georgia State University; Mansour Fahimi, Marketing Systems Group; Ben Lopman, Emory University; Nicole Luisi, Emory University; Kristin Nelson, Emory University; Charles Sailey, Molecular Testing Labs; Kayoko Mori, Emory University; Mariah Valentine-Graves, Emory University; Patrick S Sullivan, Emory University
• Journal Title: JMIR Public Health and Surveillance
• Volume: Volume 9
• Publisher: JMIR Publications | 2023-12-06, Pages e37102-None
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.2196/37102
• Subjects: Health Sciences, Public Health; Health Sciences, Epidemiology
• Keywords: COVID-19; mask; social distancing; handwashing; hand sanitizer; public health; pandemic; mitigation behavior; risk factor; disease prevention; health policy; latent class analysis; hygiene

Abstract

Background COVID-19 mitigation behaviors, such as wearing masks, maintaining social distancing, and practicing hand hygiene, have been and will remain vital to slowing the pandemic. Objective This study aims to describe the period prevalence of consistent mask-wearing, social distancing, and hand hygiene practices during the peak of COVID-19 incidence (August-December 2020) and just before COVID-19 vaccine availability, overall and in demographic subgroups. Methods We used baseline survey data from a nationwide household probability sample to generate weighted estimates of mitigation behaviors: wearing masks, maintaining social distancing, and practicing hand hygiene. Weighted logistic regression explored differences in mitigation behaviors by demographics. Latent class analysis (LCA) identified patterns in mitigation behaviors. Results Among 4654 participants, most (n=2727, 58.6%) were female, were non-Hispanic White (n=3063, 65.8%), were aged 55 years or older (n=2099, 45.1%), lived in the South (n=2275, 48.9%), lived in metropolitan areas (n=4186, 89.9%), had at least a bachelor’s degree (n=2547, 54.7%), had an income of US $50,000-$99,000 (n=1445, 31%), and were privately insured (n=2734, 58.7%). The period prevalence of consistent mask wearing was 71.1% (sample-weighted 95% CI 68.8-73.3); consistent social distancing, 42.9% (95% CI 40.5-45.3); frequent handwashing, 55.0% (95% CI 52.3-57.7); and frequent hand sanitizing, 21.5% (95% CI 19.4-23.8). Mitigation behaviors were more prevalent among women, older persons, Black or Hispanic persons, those who were not college graduates, and service-oriented workers. LCA identified an optimal-mitigation class that consistently practiced all behaviors (n=2656, 67% of US adults), a low-mitigation class that inconsistently practiced all behaviors (n=771, 20.6%), and a class that had optimal masking and social distancing but a high frequency of hand hygiene (n=463, 12.4%). Conclusions Despite a high prevalence of COVID-19 mitigation behaviors, there were likely millions who did not consistently practice these behaviors during the time of the highest COVID-19 incidence. In future infectious disease outbreak responses, public health authorities should also consider addressing disparities in mitigation practices through more targeted prevention messaging.