The Perfect Enemy | Prevention is political: political party affiliation predicts perceived risk and prevention behaviors for COVID-19 - BMC Public Health - BMC Public Health
June 30, 2022

Prevention is political: political party affiliation predicts perceived risk and prevention behaviors for COVID-19 – BMC Public Health – BMC Public Health

Prevention is political: political party affiliation predicts perceived risk and prevention behaviors for COVID-19 – BMC Public Health  BMC Public Health

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As of November 23, 2021, there were over 43.6 million SARS-CoV-2 infections in the US [1, 2] and more than 700,000 COVID-19 deaths [1, 3]. Both the infection and the death rates likely substantially underestimate the true population impact given that there are nearly 300,000 excess deaths in the US since the start of the pandemic [4, 5]. In addition to the mortality burden, there are long-term cardiac, respiratory, and other health consequences for COVID-19 patients [6, 7]. In many areas of the US, infection rates have shifted over time with changes in policy-mandated preventive strategies, decreasing when prevention-oriented policies were in place and then increasing again as prevention strategies were eased [8].

A centerpiece of public health strategies to control infectious disease spread is either recommending or mandating that members of the public engage in protective behavior to prevent disease transmission. In the case of COVID-19, staying 6 ft apart, wearing masks, working remotely when possible, avoiding public gatherings, and other strategies have been endorsed and communicated to the public by CDC, FEMA, WHO, and other national and international public health agencies [9,10,11]. These preventive strategies are effective at slowing the rate of COVID-19 infection [12,13,14]. However, for infectious disease prevention behaviors to be effective, they must be undertaken consistently by a sufficient proportion of the population to slow transmission [15,16,17].

Social and Cultural Influences on Construction of Risk Perceptions and Preventive Behaviors.

Most theoretical and empirical treatments of risk perception focus on individual cognitive and reasoning processes as the key determinant of a person’s risk perceptions [18, 19]. In contrast, the social amplification of risk framework [20, 21] describes the process by which scientific evidence, the ways in which people obtain information (e.g., news media), and political and cultural forces shape how individuals interpret and prioritize health risk information. According to this framework, perceptions of risk can be amplified or attenuated through social processes that influence: 1) the availability of risk information (e.g., via media and political sources) and 2) society’s response to the information (e.g., discourse about the veracity of the risk information in the media and interactions with cultural and peer groups [20]).

Influential communicators such as social/activist organizations and opinion leaders among social groups or organizations are key sources of information and can influence discourse surrounding risk information [21]. For example, political groups, parties, and leaders are prominent examples of influential communicators who may shape how their members and affiliates interpret risk information. These amplification and attenuation processes through influential communicators likely contribute to an alignment between, on one hand, people’s political affiliation and their underlying values and, on the other hand, their perceived risk.

During the pandemic, politicians in multiple countries have sought to control the amount and kind of information the public received about COVID-19 risk as well as actively disputing scientific discourse about the risk. Residents of several countries received messages from political leaders that minimized risk and raised doubt about preventive strategies. For example, the Prime Minister of Great Britain, Boris Johnson, publicly announced that he would not engage in social distancing and, specifically, would continue to shake hands [22] less than a week before the British government began to plan policy strategies to prevent transmission [23]. In Brazil, President Jair Bolsonaro made public statements that minimized the perception that the virus posed a risk, comparing it to the flu [24] and actively arguing against preventive policy strategies that were being put in place in Brazilian cities [25, 26]. Similar minimizing and contradictory statements can be found from the leaders of other countries [27].

In the United States, the country of focus in the current study, then President Donald Trump regularly made public statements that downplayed the threat posed by the virus [28, 29] in terms of both severity, comparing it to the flu [30], and the number of cases and deaths [31]. President Trump also downplayed the importance of preventive actions to protect against transmission, including arguing against mask mandates [32], pushing for early easing of stay at home and business closure orders [33], and holding public gatherings in spite of social distancing policies in place [34]. The President admitted to being motivated to downplay the risk despite receiving clear warnings about the severity and seriousness of the spread of COVID-19 ([35] p. xviii).

In addition to risk perception, individuals’ decision making about COVID-19 prevention behaviors has taken place in the context of a complex, saturated, fast-moving information environment, with multiple and sometimes contradictory messages from traditional media, social media, and government messaging [36]. There is evidence that political messaging has an influence on behavior for individuals who support the politician conveying the messaging. Specifically, a study of the impact of President Trump’s anti-vaccination messaging found that the exposure to the messages negatively impact vaccination engagement intentions, but only on the part of voters who voted for him [37].

Based on the social amplification of risk framework, one would expect that the selective communication of risk information by politicians and the conflating of politics and public health in media messaging would influence the public’s perceptions of risk and their decision making about behavioral strategies to mitigate risk. Moreover, given the current US phenomenon where some news media outlets provide partisan lenses on issues, one would expect this effect to be exacerbated as news media “amplify” the messaging about risk perception [38]. Thus, one would predict that political affiliation would, by affecting exposure, attention, processing, and response to SARS-CoV-2/COVID-19 messages, influence risk perception and behavior.

Given the empirical evidence and plausible, theory-derived mechanisms for the role of social amplification in risk perception and decision making about risk reduction messages, we hypothesize that political party affiliation will relate to engagement in preventive measures for SARS-CoV-2/COVID-19, such that – given the predominant minimization themes in President Trump’s statements, those who identify more strongly as Republicans will be less likely to engage in preventive measures and will perceive less risk relative to those who identify more strongly as Democrats.

We examined whether Americans’ political party identification is related to perceived risk of SARS-CoV-2 infection, the severity of COVID-19 illness, and engagement in a range of preventive behaviors. Although there have been examinations of how political affiliation relates to support for preventive measures against COVID-19 (e.g., policy measures to restrict gatherings, mask wearing), our approach adds to this literature in two ways. First, we utilize a nuanced, quasi-continuous assessment of strength of party affiliation, allowing for an understanding of how strength of political beliefs affect responses to COVID-19. Second, we examine the effects of political partisanship on risk perceptions for COVID-19 infection in addition to support for preventive measures, adding to the understanding of how politicians’ risk minimizing messages might affect individuals’ perceptions of the risks posed by COVID-19.