Abstract
This cross-sectional study estimates the association of political party affiliation with physical distancing behaviors among young adults during the coronavirus disease 2019 pandemic.
Public messages about physical distancing during the coronavirus disease 2019 (COVID-19) pandemic in the US have diverged across government officials and news media outlets with different political leanings.1 Prior studies found that people with Republican (vs other) political party affiliations report less physical distancing.2,3 These studies used crowdsourced internet samples, inadequately adjusted for confounders, collected data before widespread public health messaging about physical distancing, or included few young adults.2,3
Adults aged 18 to 25 years might be inclined to contravene physical distancing guidelines and participate in high-risk social recreational activities that increase the risk of transmitting severe acute respiratory syndrome coronavirus 2.3 We estimated the associations of political party affiliation with physical distancing behaviors among young adults—a population with high rates of COVID-19.4
Methods
Ninth grade high school students (n = 3396) were originally recruited in Los Angeles, California, in 2013, provided informed written consent, and were surveyed (semi)annually about health behaviors.5 This cross-sectional study analyzed self-report data from the most recent (May 18-August 3, 2020) survey administered online. The University of Southern California institutional review board approved the study. Written informed consent was obtained and the survey responses were analyzed in a deidentified data set.
A political party affiliation survey item with 6 response options was collapsed into 4 categories (“Democrat,” “Republican,” “Independent,” “something else,” “don’t know” or “prefer not to answer”). Physical distancing (defined as staying ≥6 feet away from others) over the past 2 weeks with 5 response options was made a binary outcome (infrequent [“sometimes” or “rarely”] vs frequent [“usually,” “always,” or “not been in public places”]). Past 2-week frequency of engaging in 4 social recreational activities (listed in Table 1) was measured. Responses to the 4 items (“0,” “1,” “2-3” [recoded = 2.5], “4-6” [recoded = 5], or “≥7” [recoded = 7] times) were summed into a continuous outcome (range: 0-28) and examined individually as binary outcomes (≥1 vs 0 times).
Table 1. Prevalence and Frequency of Physical Distancing Behaviors in the Past 2 Weeks, by Political Party Affiliationa.
| Outcome | Descriptive statistics, No. (%), or mean (SD) | Association estimates, OR (95% CI) or B (95% CI) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall sample (n = 2065) | Democrat (n = 891) | Republican (n = 148) | Independent/other (n = 320) | Don’t know/decline answer (n = 706) | Republican vs Democrata | Republican vs Independent/othera | Republican vs don’t know/decline to answera | ||||
| Unadjusted | Adjustedb | Unadjusted | Adjustedb | Unadjusted | Adjustedb | ||||||
| Infrequent physical distancingc | 143 (6.9) | 46 (5.2) | 36 (24.3) | 21 (6.6) | 40 (5.7) | 5.9 (3.7-9.5) | 4.4 (2.6-7.6) | 4.6 (2.6-8.2) | 4.2 (2.2-7.9) | 5.4 (3.3-8.8) | 4.5 (2.5-8.1) |
| Total No. times engaged in social recreation activitiesd | 2.2 (3.1) | 1.9 (2.7) | 3.6 (4.2) | 2.2 (2.9) | 2.2 (3.2) | 1.8 (1.2-2.3) | 1.6 (1.0-2.1) | 1.4 (0.9-2.0) | 1.4 (0.8-2.0) | 1.4 (0.8-1.9) | 1.2 (0.7-1.8) |
| Engaged in activitye | |||||||||||
| Visit restaurant, bar, or club | 695 (33.9) | 257 (29.0) | 82 (56.6) | 120 (37.9) | 236 (33.6) | 3.2 (2.2-4.6) | 3.0 (2.1-4.5) | 2.1 (1.4-3.2) | 2.1 (1.4-3.3) | 2.6 (1.8-3.7) | 2.2 (1.5-3.3) |
| Host party with >10 people | 246 (12.0) | 100 (11.3) | 28 (19.2) | 29 (9.1) | 89 (12.6) | 1.9 (1.2-3.0) | 2.3 (1.4-3.9) | 2.4 (1.3-4.2) | 2.5 (1.4-4.6) | 1.6 (1.0-2.6) | 1.9 (1.2-3.2) |
| Attend party with >10 people | 650 (31.6) | 268 (30.1) | 68 (46.9) | 91 (28.8) | 223 (31.6) | 2.0 (1.4-2.9) | 2.1 (1.5-3.1) | 2.2 (1.5-3.3) | 2.4 (1.5-3.6) | 1.9 (1.3-2.8) | 2.0 (1.4-3.0) |
| Visit indoor public venue (eg, mall) | 671 (32.7) | 272 (30.6) | 64 (43.8) | 108 (34.1) | 227 (32.3) | 1.8 (1.2-2.5) | 2.1 (1.4-3.0) | 1.5 (1.0-2.3) | 1.7 (1.1-2.5) | 1.6 (1.1-2.4) | 2.0 (1.4-3.0) |
Abbreviations, B, mean difference; OR, odds ratio.
Self-identified political party affiliation (“Democrat,” “Republican,” “Independent” or “something else,” “don’t know” or “prefer not to answer”), 6 forced-choice response options collapsed into 4 categories.
Estimates from multivariable regression models including all covariates listed in Table 2 as simultaneous regressors and school fixed effects.
Self-reported frequency of practicing physical distancing (staying ≥6 feet away from other people) in the past 2 weeks (infrequent [“sometimes” or “rarely”] vs frequent [“usually,” “always,” or “not been in public places”]). Descriptive statistics are number (percentage). Association estimates are ORs from logistic regression models (n = 2065).
Self-reported total frequency of times engaged in 4 social recreational activities in the past 2 weeks (each activity rated “0,” “1,” “2-3” [recoded = 2.5], “4-6” [recoded = 5], or “≥7” [recoded = 7] times; responses summed [range: 0-28]). Descriptive statistics are mean (SD). Association estimates are B from linear regression models (n = 2062).
Engaged in respective activity 1 or more vs 0 times in the past 2 weeks. Descriptive statistics are number (percentage). Association estimates are ORs from logistic regression models for bar/restaurant (n = 2050), host party (n = 2057), attend party (n = 2056), indoor recreational venues (n = 2055).
Associations of political party with physical distancing were estimated in linear (continuous outcomes) or logistic (dichotomous outcomes) regression models, yielding regression weights (B; mean difference) or odds ratios (ORs) with 95% CIs, respectively. Planned pairwise tests compared Republicans with each other group. After unadjusted models, we adjusted for a priori confounders (eg, demographics, perceived COVID-19 vulnerability, and youth and adult risk-taking behaviors) (Table 2).1,2,3 Statistical significance was P < .05 (2-tailed).
Table 2. Covariate Descriptive Statistics and Associations With Physical Distancing in the Past 2 Weeksa.
| Covariates | No. (col %) or mean (SD) | Infrequent vs frequent physical distancing, OR (95% CI)b | Total No. social recreation activities, B (95% CI)c | OR (95% CI) | ||||
|---|---|---|---|---|---|---|---|---|
| Engaged in respective activity ≥1 vs 0 timesd | ||||||||
| Visit restaurant, bar, or club | Host party >10 people | Attend party >10 people | Visit indoor public venue | |||||
| Survey month | ||||||||
| May | 127 (6.2) | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| June | 1461 (70.8) | 0.9 (0.4 to 1.9) | 1.2 (0.7 to 1.7) | 4.7 (2.5 to 8.7) | 1.3 (0.7 to 2.4) | 2.1 (1.3 to 3.3) | 4.9 (2.6 to 9.4) | |
| July/August | 477 (23.1) | 0.7 (0.3 to 1.6) | 1.7 (1.1 to 2.2) | 6.7 (3.5 to 12.5) | 1.3 (0.6 to 2.5) | 1.8 (1.1 to 3.0) | 7.4 (3.8 to 14.3) | |
| Age, y | 21.2 (0.4)e | 0.7 (0.5 to 1.2) | 0.1 (–0.3 to 0.4) | 1.1 (0.8 to 1.4) | 1.2 (0.8 to 1.7) | 0.9 (0.7 to 1.2) | 1.2 (0.9 to 1.5) | |
| Female vs male sex | 1264 (61.2) | 1.3 (0.9 to 1.9) | 0.3 (0.0 to 0.6) | 1.2 (0.9 to 1.4) | 1.6 (1.1 to 2.2) | 1.1 (0.9 to 1.3) | 1.2 (1.0 to 1.5) | |
| Race/ethnicity | ||||||||
| Non-Hispanic White | 338 (16.7) | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| Non-Hispanic Black | 90 (4.4) | 1.1 (0.4 to 2.8) | –0.1 (–0.8 to 0.7) | 1.0 (0.6 to 1.8) | 1.1 (0.5 to 2.3) | 1.3 (0.7 to 2.2) | 1.6 (0.9 to 2.7) | |
| Hispanic | 950 (46.8) | 0.7 (0.4 to 1.3) | –0.2 (–0.6 to 0.2) | 0.9 (0.7 to 1.2) | 1.4 (0.9 to 2.2) | 1.3 (0.9 to 1.8) | 1.4 (1.0 to 1.9) | |
| Asian | 389 (19.2) | 0.5 (0.2 to 1.2) | –0.7 (–1.3 to 0.2) | 0.7 (0.5 to 1.1) | 0.4 (0.2 to 0.8) | 0.6 (0.4 to 0.9) | 0.7 (0.5 to 1.1) | |
| Other/multiracial | 263 (13.0) | 0.7 (0.4 to 1.4) | –0.2 (–0.7 to 0.3) | 0.9 (0.6 to 1.3) | 1.1 (0.6 to 1.9) | 1.1 (0.7 to 1.6) | 1.0 (0.7 to 1.5) | |
| Location | ||||||||
| Los Angeles County | 1737 (84.8) | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| Another CA county | 210 (10.3) | 0.9 (0.5 to 1.8) | –0.4 (–0.8 to 0.0) | 1.1 (0.8 to 1.6) | 0.8 (0.5 to 1.4) | 0.9 (0.6 to 1.2) | 0.9 (0.7 to 1.3) | |
| Outside CA | 101 (4.9) | 1.6 (0.8 to 3.2) | 0.7 (0.1 to 1.3) | 1.7 (1.1 to 2.7) | 0.4 (0.2 to 1.0) | 0.9 (0.6 to 1.5) | 1.6 (1.0 to 2.5) | |
| Health insurance | ||||||||
| Private | 948 (46.7) | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | 1 [Reference] | |
| Medicaid/VA/others | 888 (43.7) | 1.0 (0.7 to 1.5) | 0.1 (–0.2 to 0.4) | 0.9 (0.7 to 1.1) | 1.0 (0.7 to 1.4) | 1.2 (1.0 to 1.5) | 1.4 (1.1 to 1.7) | |
| No insurance | 196 (9.6) | 0.8 (0.4 to 1.8) | 0.4 (–0.1 to 0.9) | 1.1 (0.8 to 1.6) | 0.9 (0.5 to 1.5) | 1.0 (0.7 to 1.4) | 1.7 (1.2 to 2.4) | |
| In degree program | 1292 (62.6) | 0.6 (0.4 to 0.9) | 0.1 (–0.2 to 0.4) | 1.4 (1.1 to 1.7) | 1.2 (0.9 to 1.6) | 0.9 (0.8 to 1.2) | 1.0 (0.8 to 1.2) | |
| Lives with parent(s) | 1549 (75.3) | 0.8 (0.5 to 1.2) | 0.1 (–0.2 to 0.4) | 1.1 (0.9 to 1.4) | 1.2 (0.9 to 1.7) | 1.0 (0.8 to 1.3) | 1.1 (0.9 to 1.4) | |
| Financial situationf | 1137 (55.5) | 1.1 (0.7 to 1.6) | –0.2 (–0.4 to 0.1) | 1.2 (1.0 to 1.5) | 0.8 (0.6 to 1.1) | 0.9 (0.8 to 1.2) | 1.0 (0.8 to 1.2) | |
| Sexual orientationg | 461 (22.5) | 0.5 (0.3 to 0.9) | –0.6 (–0.9 to 0.3) | 1.0 (0.8 to 1.3) | 0.7 (0.5 to 1.1) | 0.9 (0.7 to 1.1) | 0.8 (0.6 to 1.0) | |
| Current | ||||||||
| Tobacco useh | 374 (18.1) | 2.1 (1.4 to 3.2) | 0.1 (–0.3 to 0.4) | 1.3 (1.0 to 1.7) | 1.0 (0.6 to 1.4) | 1.3 (1.0 to 1.7) | 1.0 (0.8 to 1.3) | |
| Alcohol useh | 1182 (57.3) | 1.3 (0.8 to 2.0) | 0.4 (0.1 to 0.7) | 1.5 (1.2 to 1.9) | 1.3 (1.0 to 1.8) | 1.6 (1.3 to 2.0) | 0.9 (0.8 to 1.2) | |
| Cannabis useh | 707 (34.3) | 0.9 (0.6 to 1.4) | 0.4 (0.0 to 0.7) | 1.3 (1.0 to 1.6) | 1.2 (0.8 to 1.6) | 1.2 (1.0 to 1.5) | 1.3 (1.0 to 1.7) | |
| Other drug useh | 117 (5.7) | 1.8 (0.9 to 3.5) | 1.1 (0.5 to 1.7) | 1.4 (0.9 to 2.1) | 1.0 (0.5 to 1.8) | 1.5 (1.0 to 2.2) | 1.6 (1.1 to 2.5) | |
| Perceived healthi | 393 (19.1)e | 1.7 (1.1 to 2.6) | 0.1 (–0.2 to 0.5) | 0.9 (0.7 to 1.1) | 1.0 (0.7 to 1.5) | 0.9 (0.7 to 1.2) | 1.1 (0.8 to 1.4) | |
| Possibly had COVID-19j | 120 (5.8) | 1.1 (0.5 to 2.3) | –0.1 (–0.6 to 0.5) | 0.8 (0.5 to 1.2) | 0.9 (0.5 to 1.7) | 1.1 (0.7 to 1.6) | 0.9 (0.6 to 1.4) | |
| Perceived chance of contracting COVID-19k,l | 36.1 (24.3)e | 1.1 (0.9 to 1.4) | 0.1 (0.0 to 0.3) | 1.0 (0.9 to 1.1) | 1.1 (0.9 to 1.3) | 1.0 (0.9 to 1.2) | 1.1 (0.9 to 1.2) | |
| Perceived chance of dying if got COVID-19l,m | 21.2 (24.3)e | 0.7 (0.6 to 0.9) | –0.1 (–0.2 to 0.0) | 1.0 (0.9 to 1.1) | 1.0 (0.9 to 1.2) | 1.0 (0.9 to 1.1) | 0.9 (0.8 to 1.0) | |
| Age 14 | ||||||||
| Substance usen | 749 (36.6) | 1.4 (0.9 to 2.1) | 0.1 (–0.2 to 0.5) | 1.1 (0.9 to 1.4) | 0.9 (0.6 to 1.2) | 1.2 (0.9 to 1.5) | 0.9 (0.7 to 1.1) | |
| Impulsivityl,o | 2.4 (1.5)e | 0.9 (0.7 to 1.1) | 0.1 (0.0 to 0.3) | 1.1 (1.0 to 1.2) | 1.1 (0.9 to 1.2) | 1.1 (1.0 to 1.3) | 1.0 (0.9 to 1.1) | |
| Delinquencyl,p | 15.2 (4.5)e | 1.2 (1.0 to 1.4) | 0.1 (0.0 to 0.3) | 1.0 (0.9 to 1.1) | 1.1 (1.0 to 1.3) | 1.0 (0.9 to 1.1) | 1.1 (1.0 to 1.2) | |
Abbreviations, B, mean difference; CA, California; col, column percent; OR, odds ratio; VA, Veterans Affairs.
Estimates from multivariable regression models including all covariates and political party affiliation as simultaneous regressors and high school fixed effects. Missing covariate data (missing range: 0-107) managed with multi-imputation using 20 multiply-imputed data sets.
Logistic regression model for infrequent physical distancing in past 2 weeks (n = 2065).
Linear regression model for total times engaged in 4 social recreational activities over the past 2 weeks (range: 0-28) (n = 2062).
Logistic regression models for bar/restaurant (n = 2050), host party (n = 2057), attend party (n = 2056), indoor recreational places (n = 2055).
Mean (SD)
“Meet needs,” “meet basic expenses,” or “don't meet basic expenses” vs “live comfortably.”
Lesbian, gay, bisexual, queer, questioning, or other sexual orientation vs straight.
Past 30-day use of any tobacco product (cigarettes, electronic cigarettes with nicotine, cigars, or hookah; yes/no), alcohol (yes/no), any cannabis product (cannabis vaping, concentrates, edibles, or blunts; yes/no), or any other drug (any illicit drug or nonmedical use of prescription drug; yes/no).
“In general, would you say your health is ‘fair,’ or ‘poor’ vs ‘good,’ ‘very good,’ or ‘excellent’?”
“Have you had COVID-19?” “Yes” or “maybe” vs “no.”
“How likely do you think it is that you will contract COVID-19?” (“no chance” to “will definitely get it”), range: 0-100.
Regression model estimates use rescaled variable into SD unit scores (M = 0, SD = 1).
“If you were to get COVID-19, how likely do you think it would be that you would die?” (“no chance” to “definitely”), range: 0-100.
Ever use of any psychoactive substance for fun or to get high in 9th grade (fall 2013) survey wave.
Temperament and Character Inventory impulsivity scale (5 items; eg, “I do things based on how I feel in the moment”) in 9th grade, range, 0-5.
Sum of past 6-month frequency of 11 behaviors (eg, stealing, lying to parents; 1 [never] to 6 [≥10 times]) in 9th grade, range: 11-66.
Results
Of 3134 cohort enrollees with valid contact information invited to take the survey, 2179 (69.5%) agreed. For the analytic sample with exposure and outcome data (n = 2065; mean [SD] age, 21.2 [0.4] years; 61.2% female), descriptive statistics for political party and physical distancing variables and covariates are reported in the left-hand portions of Table 1 and Table 2, respectively. In the analytic sample, 891 respondents identified themselves as Democrats (43.1%), 148 (7.2%) as Republicans, 320 as Independent/other (15.5%), and 706 (34.2%) as don’t know/decline to answer; 1737 (84.8%) reported living in Los Angeles County and 210 (10.3%) elsewhere in California.
Infrequent physical distancing was more common in Republican participants (36 [24.3%]) than Democrats (46 [5.2%]; OR, 5.9; 95% CI, 3.7-9.5; P < .001), Independent/other (21 [6.6%]; OR, 4.6; 95% CI, 2.6-8.2; P < .001), or don’t know/decline to answer (40 [5.7%]; OR, 5.4; 95% CI, 3.3-8.8; P < .001) groups. Total number of past 2-week social recreational activities was higher among Republican participants (mean [SD], 3.6 [4.2]) than Democrat participants (mean [SD], 1.9 [2.7]; B = 1.8; 95% CI, 1.2-2.3; P < .001), Independent/other (mean [SD], 2.2 [2.9]; B = 1.4; 95% CI, 0.9-2.0; P < .001), or don’t know/decline to answer (mean [SD], 2.2 [3.2]; B = 1.4; 95% CI, 0.8-1.9; P < .001) groups. Republicans vs other groups were more likely to visit public indoor venues (eg, malls), visit restaurants/bars/clubs, or attend or host parties with 10 people or more (Table 1). Associations of Republican party affiliation with all outcomes were consistent across unadjusted and covariate-adjusted models (Table 1). Table 2 presents covariate association estimates.
Discussion
In this study of young adults, predominantly living in Los Angeles County or elsewhere in California, self-reported Republican political party affiliation was associated with less frequent physical distancing and participating in social recreational activities that may perpetuate the COVID-19 pandemic. California recommends all residents practice physical distancing and requires mask wearing when outside the home. This study extends prior research2,3 by extensive adjustment for possible confounders, focusing on young adults, and data collection after widespread public health messaging about physical distancing.
Limitations of the study include a focus on young adults in 1 county in 1 state, possible reporting biases, and the small proportions of Republicans relative to their national prevalence in young adults, which is about 23%.6 These limitations notwithstanding, our findings suggest that efforts to promote physical distancing among young adults during the COVID-19 pandemic should consider the role of political affiliation.
References
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