Physician Trust in the News Media and Attitudes toward COVID-19.

CONTEXT: Previous research has established the importance of primary care physicians in communicating public health directives. The implicit assumption is that, because of their expertise, doctors provide accurate and up-to-date information to their patients, independent of partisan affiliation or media trust. METHODS: Using an online survey of 625 primary care physicians, this paper tests (1) whether physicians trust media outlets consistent with their partisanship and (2) whether trust in media outlets influences (a) personal concern someone in their family will get sick; (b) perceptions about the seriousness of the pandemic as portrayed in the media; and (c) trust in federal government agencies and scientists. FINDINGS: While physicians are better positioned to critically evaluate health-related news, they are subject to the same biases that influence public opinion. Physicians' partisan commitments influence media trust and media trust influences concern a family member will get sick, perceptions regarding the seriousness of the pandemic, and trust in federal government agencies and scientists. CONCLUSIONS: Physician trust in specific media outlets shapes their understanding of the pandemic and- to the extent that they trust conservative media outlets-may limit their effectiveness as health policy messengers.

Vaccinating across the aisle: using co-partisan source cues to encourage COVID-19 vaccine uptake in the ideological right.

Overcoming the COVID-19 pandemic in the United States will require most Americans to vaccinate against the disease. However, considerable research suggests that a significant proportion of Americans intend to forego vaccination, putting pandemic recovery at risk. Republicans are one of the largest groups of COVID-19 vaccine hesitant individuals. Therefore, identifying strategies to reduce vaccine hesitancy within this group is vital to ending the pandemic. In this study, we investigate the effectiveness of messages from co-partisan sources in reducing vaccine hesitancy. In a large (N = 3000) and demographically representative survey, we find that exposing "Middle-of-the-Road" partisans to pro-vaccine messages from co-partisan source cues reduces vaccine hesitancy. However, for those who identify as "Strong" or "Weak" partisans, we find no statistically significant differences in vaccination intentions when exposed to pro-vaccine messages from co-partisan sources. We conclude by discussing how our findings are helpful for vaccine communication efforts.

Erroneous Consonance. How inaccurate beliefs about physician opinion influence COVID-19 vaccine hesitancy.

Throughout the COVID-19 pandemic, researchers have studied how Americans' attitudes toward health experts influence their health behaviors and policy opinions. Fewer, however, consider the potential gap between individual and expert opinion about COVID-19, and how that might shape health attitudes and behavior. This omission is notable, as discrepancies between individual and expert opinion could help explain why some Americans fail to take action to protect themselves and others from the virus. In novel demographically representative surveys of the US adult population (N = 5,482) and primary care physician subpopulations (PCPs; N = 625), we contrast the relationship between: (1) Americans' and (2) PCPs' preferences regarding who ought to be responsible for taking action to combat the spread of COVID-19, as well as (3) Americans' perceptions of PCP preferences ("PCP meta-opinion"). In the aggregate, we find that Americans are far less likely than PCPs to see a role for both private and state actors in taking action to combat COVID-19. Interestingly, though, this disjuncture is not reflected in individual-level PCP meta-opinion; as most Americans think that PCPs share their views on state and private intervention (τb = 0.44-0.49). However, this consonance is often erroneous, which we show can have problematic health consequences. Multivariate models suggest that Americans who both see little place for individual responsibility in taking action to stop viral spread and who think that PCPs share those views are significantly less likely to vaccinate against COVID-19. We conclude by discussing the public health benefits of efforts to bring public opinion in line with expert opinion.

The Changing Nature of Telehealth Use by Primary Care Physicians in the United States.

INTRODUCTION: Prior to the COVID-19 pandemic, telehealth utilization was growing slowly and steadily, although differentially across medical specialties in the United States. The pandemic dramatically expanded physician use of telehealth, but our understanding of how much telehealth use has changed in primary care in the United States, the correlates of physician telehealth uptake, and the frequency with which primary care physicians intend to use telehealth after the pandemic are unknown. This paper is designed to assess these important questions. METHODS: Using data from an original national survey of 625 primary care physicians conducted from May 14 to May 25, 2021, we investigate the frequency of physician telehealth use before and during the pandemic and intended use after the pandemic. We also assess the correlates of changes in telehealth use by physicians, comparing telehealth use before the pandemic to use during and after the pandemic. RESULTS: The proportion of primary care physicians using telehealth often, jumped from 5.3% (95% CI 3.5, 7.0) before the pandemic to 46.2% (95% CI 42.3, 50.2) during the pandemic. More importantly, over 70% of physicians intended to use telehealth at least occasionally after the pandemic compared to just 18.7% before, with younger physicians, physicians without telehealth training in medical school, and Asian physicians most likely to increase their telehealth use long-term. DISCUSSION: The COVID-19 pandemic has spurred expansion in telehealth use by primary care physicians that will continue to shape care delivery well beyond the pandemic. Policy change could be needed to facilitate this growth of telehealth long-term.

Past experiences with surprise medical bills drive issue knowledge, concern and attitudes toward federal policy intervention.

Scholars and journalists have devoted considerable attention to understanding the circumstances in which Americans receive surprise medical bills. Previous research on this issue has focused on the scope of the problem, including the conditions that are most likely to lead to surprise bills. However, the existing literature has almost exclusively relied on claims data, limiting our understanding of consumer experiences and attitudes toward policy changes to address surprise billing. Using a survey administered to a nationally representative sample of 4998 Americans, we analyze consumer experiences with surprise billing, knowledge of the issue, how concerned Americans are about receiving surprise bills and how past experiences influence policy preferences toward federal action on surprise billing. Our analysis demonstrates that knowledge and concern about surprise billing are the highest among the educated and those who have previously received a surprise bill. These factors also predict support for federal policy action, with high levels of support for federal policy action across the population, including among both liberals and conservatives. However, more detailed federal policy proposals receive significantly less support among Americans, suggesting that stand-alone policy action may not be viable. Our results show bipartisan support among American consumers for federal action on surprise billing in the abstract but no consistent views on specific policy proposals.

Imperfect messengers? An analysis of vaccine confidence among primary care physicians.

BACKGROUND: Growing narratives emphasize using primary care physicians as leaders in efforts to promote COVID-19 vaccination among the vaccine hesitant. Critically however, little is known about vaccine confidence among primary care physicians themselves. The objective of this study was to assess both physician confidence that in general, vaccines are safe, effective, and important, as well as physician confidence in each COVID-19 vaccine in the United States. METHODS: We rely on data from a national survey of primary care physicians conducted from May 14-May 25, 2021. We assess the influence of demographic, social, and political factors on physician beliefs that in general, vaccines are safe, effective, and important, as well as physician confidence in the safety of the Moderna, Pfizer, and Johnson & Johnson COVID-19 vaccines. RESULTS: 10.1% of primary care physicians do not agree that, in general, vaccines are safe, 9.3% do not agree they are effective, and 8.3% do not agree they are important. While 68.7% of physicians were 'very confident' in the safety of the Moderna vaccine and 72.7% were 'very confident' in the safety of the Pfizer vaccine, only 32.1% of physicians were 'very confident' in the safety of the Johnson & Johnson COVID-19 vaccine. CONCLUSION: A troubling proportion of primary care physicians lack high levels of vaccine confidence. These physicians may not be well positioned to actively promote COVID-19 vaccination even as political and media narratives push physicians to lead this effort. Interventions aimed at improving vaccine confidence among some physicians may be needed so that all physicians can fulfill needed roles as trusted vaccine communicators.

Inside the 'black box' of COVID-19 vaccination beliefs: Revealing the relative importance of public confidence and news consumption habits.

RATIONALE: President Biden's goal for 70% of U.S. adults to have received at least one vaccine by July 4, 2021 was not achieved. OBJECTIVE: The aim of this research was to assess the 'black box' of positive COVID-19 vaccination beliefs to determine the relative importance of each factor and thus inform well-targeted and tailored health promotion efforts. METHODS: A cross-sectional survey was conducted in a sample of U.S. adults (N = 1656), assessing the influence of demographic characteristics, cognitive effects, public confidence, and news source variety and evaluation on positive COVID-19 vaccination beliefs. RESULTS: Overall, the strongest predictor of positive beliefs was high confidence in public health officials and political institutions to handle the COVID-19 pandemic effectively, yet negative sentiments toward COVID-19 research and science and COVID-19 vaccine ambivalence reduced the likelihood that beliefs were positive. Cognitive effects and public confidence were identified as key predictors of positive COVID-19 vaccination beliefs over and above party identification. Importantly, high levels of confidence in science and government were mostly driven by positive evaluations of liberal news sources. High levels of COVID-19 science backlash were mostly driven by positive evaluations of conservative news sources. CONCLUSIONS: To motivate COVID-19 vaccination among hesitant or resistant groups in the population, health promotion efforts should seek to reinforce positive COVID-19 vaccination beliefs by increasing public confidence and by reducing COVID-19 science backlash, largely by choosing specific news media and social media platforms (e.g., Breitbart, Fox News, and Facebook) as channels for health promotion and health information dissemination.

Suicidal Ideation During the COVID-19 Pandemic: Investigating Mental Health, COVID-19 Health Beliefs, and News Media Consumption in the United States Population in the Year 2020.

This study examines the role of general news media consumption during COVID-19 in aggravating mental health and suicide risk in the US population. In a sample of U.S. adults (N = 5,010), we investigated how mental health, COVID-19 health beliefs, and general news consumption influenced the odds of suicidal ideation using hierarchical logistic regression models. Both worsening mental health overall and specifically in regard to COVID-19 increased suicidal ideation. Perceived susceptibility to COVID-19 infection did not increase suicidal ideation, yet higher levels of COVID-19 self-efficacy reduced suicidal ideation. Overall news consumption did not affect suicidal ideation, but media-specific post-hoc analyses revealed that TV news watching decreased suicidal ideation as much as high levels of COVID-19 self-efficacy decreased suicidal ideation. Furthermore, online news consumption increased suicidal ideation as much as worsening mental health overall increased suicidal ideation. Further implications are discussed.

Promoting COVID-19 vaccine acceptance: recommendations from the Lancet Commission on Vaccine Refusal, Acceptance, and Demand in the USA.

Since the first case of COVID-19 was identified in the USA in January, 2020, over 46 million people in the country have tested positive for SARS-CoV-2 infection. Several COVID-19 vaccines have received emergency use authorisations from the US Food and Drug Administration, with the Pfizer-BioNTech vaccine receiving full approval on Aug 23, 2021. When paired with masking, physical distancing, and ventilation, COVID-19 vaccines are the best intervention to sustainably control the pandemic. However, surveys have consistently found that a sizeable minority of US residents do not plan to get a COVID-19 vaccine. The most severe consequence of an inadequate uptake of COVID-19 vaccines has been sustained community transmission (including of the delta [B.1.617.2] variant, a surge of which began in July, 2021). Exacerbating the direct impact of the virus, a low uptake of COVID-19 vaccines will prolong the social and economic repercussions of the pandemic on families and communities, especially low-income and minority ethnic groups, into 2022, or even longer. The scale and challenges of the COVID-19 vaccination campaign are unprecedented. Therefore, through a series of recommendations, we present a coordinated, evidence-based education, communication, and behavioural intervention strategy that is likely to improve the success of COVID-19 vaccine programmes across the USA.

Childhood immunization during the COVID-19 pandemic in Texas.

In 2020, the state of Texas implemented coronavirus disease 2019 (COVID-19) social distancing guidelines in order to prevent surges at Texas hospital emergency rooms and in intensive care units. As noted in other states, an unintended consequence of these activities was significant declines in childhood immunizations. After analyzing state-wide immunization register data for Texas, we observed a 47% relative decline in immunization rates between 2019 and 2020 among 5-month-olds and a 58% decline among 16-month-olds. We observed a small decline (5%) among 24-month-olds, and no decline in vaccines received at birth (Hepatitis B). Declines were larger in rural counties compared to urban. These declines are superimposed on increases in state vaccine exemptions over the last five years due to an aggressive anti-vaccine movement in Texas. There are concerns that continued declines in childhood immunization coverage due to COVID-19 could lead to co-endemics of measles and other vaccine preventable diseases.

Rural and Urban Differences in COVID-19 Prevention Behaviors.

PURPOSE: To examine whether the adoption of COVID-19-related preventive health behaviors vary in rural versus urban communities of the United States while accounting for the influence of political ideology, demographic factors, and COVID-19 experiences. METHODS: We rely on a representative survey of 5009 American adults collected from May 28 to June 8, 2020. We analyze the influence of rural status, political ideology, demographic factors, and COVID-19 experiences on self-reported adoption of 8 COVID-19-related preventive health behaviors. FINDINGS: Rural residents are significantly less likely to have worn a mask in public, sanitized their home or workplace with disinfectant, avoided dining at restaurants or bars, or worked from home. These findings, with the exception of dining out, are robust to the inclusion of measures accounting for political ideology, demographic factors, and COVID-19 experiences. CONCLUSIONS: Rural residents are significantly less likely to participate in several COVID-19-related preventive health behaviors. This reality could exacerbate existing disparities in health access and outcomes for rural Americans. Health messaging targeted at improving COVID-19 preventive behavior adoption in rural America is warranted.

COVID-19 vaccine decisions: considering the choices and opportunities.

In the coming months, most American adults will have the opportunity to receive at least one of up to five different COVID-19 vaccines produced by Operation Warp Speed and released through emergency use authorization by the U.S. Food and Drug Administration (FDA). A similar group of vaccines will also be released in Europe by the European Medicines Agency (EMA) and in the United Kingdom by the Medicines & Healthcare products Regulatory Agency (MHRA). Those living outside of North America and Europe may not have access to those particular vaccines, but they will benefit from receiving vaccines produced in Brazil, China, India, or Russia. These vaccines and some of their major features based on clinical trials and testing are listed in Table 1 [1-25]. As vaccine scientists and policy experts working in the area of coronavirus disease 2019 (COVID-19), we are frequently asked about potential choices regarding the available vaccines, both in the U.S. and globally. Provided here is a summary and informal decision-making tool kit for considering the different vaccine options at this time.