key: cord-0933045-ozusqmld authors: Seehuus, Martin; Stanton, Amelia M.; Handy, Ariel B.; Haik, Amanda K.; Gorman, Rebecca; Clifton, Jessica title: Impact of COVID-19 predicts perceived risk more strongly than known demographic risk factors date: 2020-11-15 journal: J Psychosom Res DOI: 10.1016/j.jpsychores.2020.110299 sha: af19c7407ceff03f1eb4dbdbe92111c4304d9428 doc_id: 933045 cord_uid: ozusqmld Objective To identify the factors associated with perceived COVID-19 risk among people living in the US. Methods A cross-sectional representative sample of 485 US residents was collected in mid-April 2020. Participants were asked about (a) perceptions of COVID-19 risk, (b) demographic factors known to be associated with increased COVID-19 risk, and (c) the impact of COVID-19 on different life domains. We used a three-step hierarchical linear regression model to assess the differential contribution of the factors listed above on perceived COVID-19 risk. Results The final model accounted for 16% of variability in perceived risk, F(18,458) = 4.8, p < .001. Participants who were White reported twice as much perceived risk as participants of color (B = −2.1, 95% CI[−3.4,-0.8]. Higher perceived risk was observed among those who reported a negative impact of the pandemic on their sleep (B = 1.5, 95% CI[0.8,2.1]) or work (B = 0.7, 95%CI[0.1,1.3]). The number of cases per capita in their state of residence, age, or proximity to someone with a COVID-19 diagnosis were not found to meaningfully predict perceived risk. Conclusions Perceived risk was not found to be associated with known demographic risk factors, except that the effect of race/ethnicity was in the opposite direction of existing evidence. Perception of COVID-19 risk was associated with the perceived personal impact of the pandemic. By April 16, 2020, COVID-19-related deaths reached 130,885 worldwide. Instated preventive measures (e.g., face masks) represent significant behavior changes. 1 Protection motivation theory 2 suggests these measures are more likely to be adopted if they are perceived as necessary. Thus, perceived risk of COVID-19 likely predicts adoption of risk-minimization behaviors. 3 We examined demographic factors theorized to predict perceived risk of COVID-19, household. 4 We anticipated that participant's reports of personal impact of COVID-19 (e.g., effect of the pandemic on work) would also predict perceived risk. 5 The scope of the pandemic makes understanding perceived COVID-19 risk challenging and pressing. A nationally representative sample of participants was recruited through Prolific (prolific.co); 501 participants completed the online survey between April 14 and April 16, 2020. Most respondents (n = 348, 71.8%) were White, with smaller proportions of Black/African American (n = 62, 12.8%), Asian (n = 33, 6.8%), Hispanic (n = 28, 5.8%), and Native American/Native Hawaiian (n = 4, 0.8%) participants. This study was approved by the Institutional Review Board at the first author's home institution. Participants provided informed consent through Qualtrics, completed the survey, and were paid $2.64 for their time. Perceived risk of COVID-19 was assessed with the 8-item Perceived Risk of HIV Scale, 9 which was adapted by replacing -HIV‖ with -COVID-19‖ for all items. For example, the item -I J o u r n a l P r e -p r o o f worry about getting infected with HIV‖ was modified to -I worry about getting infected with COVID-19.‖ Higher scores indicate greater risk perception. Participants rated how COVID-19 had impacted several aspects of their lives on a 1 (very positive impact) to 5 (very negative impact) scale. Questions assessed the impact of COVID-19 on social relationships, romantic relationships, sleep, physical activity, and work. Financial status, as distinct from subjective SES, 6 was measured by asking -without giving exact dollars, how would you describe your household's financial situation right now?‖, This single-item, plain language approach to assessing financial status is intended to capture variability associated with regional differences in cost of living and family size, 10 has been demonstrated to have a higher response rate than direct income assessment, 11 and has seen wide use. 12-16 Participants reported if they had been diagnosed with COVID-19 and if others in their family or social circle had been diagnosed. Six yes or no questions probed if they, a significant other, immediate family member, extended family member, friend, or coworker had been diagnosed. Participants provided the first three digits of their ZIP code to connect responses to data on the pandemic. A three-step hierarchical linear regression predicting perceived risk was estimated (see Table 2 ). In the first step, demographic and geographic risk factors were added. In the second step, proximity to people diagnosed with COVID-19 was added. In the third step, perceived impact of COVID-19 and/or preventative measures were added. The final model predicted 16% of the variability in perceived risk; race/ethnicity, work, and sleep were statistically significant. White participants reported higher levels of perceived risk, and greater perceived negative impact on sleep and work predicted higher perceived risk. Demographic risk factors for COVID-19 may not be predictive of perceived COVID-19 risk. In this sample, age, gender, cases per capita, household size, and knowing someone diagnosed with COVID-19factors associated with actual risk 1,4,19-21did not predict perceived risk. It is particularly noteworthy that age was not associated with perceived risk, given that older individuals who are more likely to have comorbid conditions that exacerbate the likelihood of COVID acquisition are at greatest risk for severe COVID-19 illness. 22 It is possible that this null effect and the other null effects reflect an optimism bias 23 for comparison with other studies that used the same categories. In addition, subjective socioeconomic status was measured using a single three-point question that has not yet been validated, so demographic data from that measure should be interpreted cautiously, particularly given findings that suggest that more people in the USA identify as middle class than would be J o u r n a l P r e -p r o o f placed there by objective measurement of their income, net worth, or educational attainment. 27, 28 Finally, the aphorism that absence of evidence is not evidence of absence applies here. Although the effect sizes suggest no large, general connection between demographic risk factors and perceived risk, it remains to be seen if that connection exists for some populations and not others. Since COVID-19 preventive measures represent a significant burden borne largely by individuals who are not yet sick, reduced risk perception may be a barrier to the initiation and maintenance of these behaviors. We identified three factors that predicted perceived riskself- Contact Tracing, Testing, and Control of COVID-19-Learning From Taiwan A Protection Motivation Theory of Fear Appeals and Attitude Change Demographic and attitudinal determinants of protective behaviours during a pandemic: A review Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) -United States Emotion regulation and decision making under risk and uncertainty Best Practices in Conceptualizing and Measuring Social Class in Psychological Research Emotional intelligence, belongingness, and mental health in college students Gender effects on mental health symptoms and treatment in college students Development of the Perceived Risk of HIV Scale Methods for measuring financial toxicity after cancer diagnosis and treatment: a systematic review and its implications Informal costs of dementia care: estimates from the National Longitudinal Caregiver Study Burden and Well-Being Among a Diverse Sample of Cancer, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease Caregivers Reasons for quitting smoking among low-income African American smokers Women's Interest in Gene Expression Analysis for Breast Cancer Recurrence Risk Oncologist patient-centered communication with patients with advanced cancer: Exploring whether race or socioeconomic status matter The New York Times. Coronavirus (COVID-19) Data in the United States Presumed Asymptomatic Carrier Transmission of COVID-19 Covid-19: Black people and other minorities are hardest hit in US Covid-19: risk factors for severe disease and death COVID-19) The optimism bias Note: GenderM coded as 0=women and 1=men, GenderTGD as men or women=0, TGD=1. Cases/Cap = cases per capita; Fin. Status = financial status = romantic relationships SO = significant other; Ext. Family = extended family The authors have no competing interests to report. Journal Pre-proof