By Carol A. Kemper, MD, FACP

Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases, Santa Clara Valley Medical Center

SOURCE: Leventhal AM, Dai H, Barrington-Trimis JL, et al. Association of political party affiliation with physical distancing among young adults during the COVID-19 pandemic. JAMA Intern Med 2021;181:399-403.

Disparate public health messaging from political officials, news media, and online outlets has occurred throughout the COVID-19 pandemic in the United States. Some have wanted to ascribe lower rates of compliance with public health guidance to political affiliation.

Leventhal et al examined the political affiliation of a group of young adults age 18 to 25 years, mostly residing in Los Angeles County, with their compliance with physical distancing guidelines and risk activities for COVID-19 infection between May 18 and Aug. 3, 2020. The cohort (n = 3,396) was recruited originally in high school in 2013 as part of an existing health behavior survey. Of those with currently valid contact information, 2,179 agreed to participate in this study. The mean age of the participants was 21.2 years, 61% were women, and 84.8% lived in Los Angeles County. Political party affiliation was collapsed into four categories: Democrat (43.1%), Republican (7.2%), Independent/other (15.8%), or don’t know/declined to answer (34%). Questions regarding physical distancing (sometimes/rarely vs. always/usually/have not been in public places) were given a binary outcome (0 or 1). Engaging in four different kinds of social/recreational activities (visiting a public venue, such as a mall, attending or hosting a party with more than 10 people, or going to a restaurant) also were given binary scores (1 or 0), which were summed as continuous outcomes.

Those who identified as Republican were twice as likely to engage in social/recreational activities as Democrats (mean standard deviation [SD] 3.6 vs. 1.9; P < 0.001), and somewhat more likely than either Independents/other (mean SD, 2.2) or those who don’t know/declined to state (mean SD, 2.2; both P < 0.001). Participants identifying as Republicans also were significantly more likely to engage in infrequent physical distancing (24.3%) compared with any of the other three groups: Democrats (5.2%), Independent/other (6.6%), or don’t know/decline to state (5.7%). For each comparison, P < 0.001). The proportion of participants who perceived a risk of contracting COVID-19 or a chance of dying of COVID-19 was no different between any of the groups. Further, substance use, impulsivity, and delinquency scores (as measured by inventory impulsivity scales or a sum of generally bad behavior in 9th grade) also had no apparent relationship with a willingness to disregard social distancing and to engage in social/recreational activities.

The psychology of behavior is difficult to pin down. We once participated in a study of safer sex behavior involving five medical centers on the West Coast. I was struck that none of our ongoing, repetitive, safe sex messaging, T-shirts, posters, and free condoms made much difference in either the frequency of safer sex or the number of partners. But one fundamental finding was that outcomes differed depending on where people fell on the pessimism vs. optimism personality scales. Only those people classified as “pessimists” actually believed that bad things could happen to them and were willing to modify their behavior. People who scored higher on the “optimism” scale only saw the future as getting better, regardless. During the COVID-19 pandemic, perhaps mask-wearers are simply more pessimistic about the future?