key: cord-1035174-kdzgbczq
authors: Kantor, Jonathan
title: Behavioral epidemiology: Vaccine hesitancy, sunscreen hesitancy, and smoking cessation
date: 2020-11-17
journal: JAAD Int
DOI: 10.1016/j.jdin.2020.10.008
sha: f44c85f31303acdcfe56d29e112405395c4b7025
doc_id: 1035174
cord_uid: kdzgbczq

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A s we approach the 1-year anniversary of the first detected case of COVID-19, it is helpful for dermatologists, the house of medicine, and the global and public health community to reflect on lessons learned from the pandemic. Of the many wake-up calls issued by the pandemic, the importance of considering behavioral factors when designing public health responses may be among the most important. Despite the investment of billions of dollars in vaccine development, the general public still has a largely tepid response to vaccine release, with approximately 75% of United States respondents willing to be vaccinateddand lower numbers in other countries. 1 While this phenomenon is multifactorial, even prior to the pandemic, the World Health Organization identified vaccine hesitancy as one of the 10 greatest threats to global health in 2019. 2 Similarly, mask-wearing, despite its lowtechnology, low-cost, and low-risk profiledin spite of a recent study suggesting its potential to save over 100,000 United States' lives in the next few months alonedremains anathema to many. 3, 4 As dermatologists, we have seen the same pattern emerge with sunscreen use, misuse, and usage hesitancy. Patients and the public fail to wear sunscreen for a range of reasons, from cost to irritation to outright forgetfulness. Yet, the model that we have largely adopted in the pastdthat education is the cornerstone of intervention strategies to increase sunscreen usedmay be necessary but is not sufficient to achieve behavioral change. Indeed, many people do not fail to use sunscreen because of lack of knowledge; instead, they often fail to use it in spite of understanding its benefits. 5 What do vaccines, sunscreen, and smoking have in common? All relate to behaviors that have well-known benefits (or risks), and in all the cases, the public is not necessarily suffering from an acute knowledge gap. Indeed, the deficit modeldthe argument that the attitudes of the public fail to align with those of professionals because of a knowledge deficitdhas been questioned vis-a-vis emerging scientific approaches, such as nanotechnology. 6 Instead, vaccine use, sunscreen use, and smoking cessation reflect situations wherein there is a significant temporal distance between the action and its putative benefit, and all may be framed by the public as protecting from an unlikely risk; that is, there is a perception that the undesired outcome (whether death due to COVID-19, skin cancer, or lung cancer) is both unlikely and not immediate.

We can no longer afford to divorce behavioral considerations from our public and global health planning. If we move beyond rational appeals and pivot to the emotional ones, focus on implementation intentions rather than on education alone, and treat public acceptance and uptake as necessary parts of the scientific process that need to be considered contemporaneously with underlying scientific advancesdrather than as rushed afterthoughtsdwe may have a chance to impact outcomes and make a real difference in the results that truly matter: improving and lengthening the lives of our patients, communities, and fellow human beings around the world.

A global survey of potential acceptance of a COVID-19 vaccine

From the Department of Dermatology, Center for Global Health, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine

Modeling COVID-19 scenarios for the United States

Behavioral considerations and impact on personal protective equipment use: early lessons from the coronavirus (COVID-19) pandemic

Compliance with sunscreen advice in a survey of adults engaged in outdoor winter recreation at high-elevation ski areas

Anticipating the perceived risk of nanotechnologies