Contrasting Objective and Perceived Risk: Predicting COVID-19 Health Behaviors in a Nationally Representative U.S. Sample.

BACKGROUND: Individuals confronting health threats may display an optimistic bias such that judgments of their risk for illness or death are unrealistically positive given their objective circumstances. PURPOSE: We explored optimistic bias for health risks using k-means clustering in the context of COVID-19. We identified risk profiles using subjective and objective indicators of severity and susceptibility risk for COVID-19. METHODS: Between 3/18/2020-4/18/2020, a national probability sample of 6,514 U.S. residents reported both their subjective risk perceptions (e.g., perceived likelihood of illness or death) and objective risk indices (e.g., age, weight, pre-existing conditions) of COVID-19-related susceptibility and severity, alongside other pandemic-related experiences. Six months later, a subsample (N = 5,661) completed a follow-up survey with questions about their frequency of engagement in recommended health protective behaviors (social distancing, mask wearing, risk behaviors, vaccination intentions). RESULTS: The k-means clustering procedure identified five risk profiles in the Wave 1 sample; two of these demonstrated aspects of optimistic bias, representing almost 44% of the sample. In OLS regression models predicting health protective behavior adoption at Wave 2, clusters representing individuals with high perceived severity risk were most likely to report engagement in social distancing, but many individuals who were objectively at high risk for illness and death did not report engaging in self-protective behaviors. CONCLUSIONS: Objective risk of disease severity only inconsistently predicted health protective behavior. Risk profiles may help identify groups that need more targeted interventions to increase their support for public health policy and health enhancing recommendations more broadly.

As we move into an endemic stage of the COVID-19 pandemic, understanding engagement in health behaviors to curb the spread of disease remains critically important to manage COVID-19 and other health threats. However, peoples' perceptions about their risk of getting sick and having severe outcomes if they do fall ill are subject to bias. We studied a nationally representative probability sample of over 6,500 U.S. residents who completed surveys immediately after the COVID-19 pandemic began and approximately 6 months later. We used a computer processing (i.e., machine learning) approach to categorize participants based on both their actual risk factors for COVID-19 and their subjective understanding of that risk. Our analysis identified groups of individuals whose subjective perceptions of risk did not align with their actual risk characteristics. Specifically, almost 44% of our sample demonstrated an optimistic bias: they did not report higher risk of death from COVID-19 despite having one or more well-known risk factors for poor disease outcomes (e.g., older age, obesity). Six months later, membership in these risk groups prospectively predicted engagement in health protective and risky behaviors, as well as vaccine intentions, demonstrating how early risk perceptions may influence health behaviors over time.

Idiosyncratic media exposures during a pandemic and their link to well-being, cognition, and behavior over time.

Over the past two decades of research, increased media consumption in the context of collective traumas has been cross-sectionally and longitudinally linked to negative psychological outcomes. However, little is known about the specific information channels that may drive these patterns of response. The current longitudinal investigation uses a probability-based sample of 5,661 Americans measured at the onset of the COVID-19 pandemic to identify a) distinct patterns of information-channel use (i.e., dimensions) for COVID-related information, b) demographic correlates of these patterns, and c) prospective associations of these information channel dimensions with distress (i.e., worry, global distress, and emotional exhaustion), cognition (e.g., beliefs about the seriousness of COVID-19, response efficacy, and dismissive attitudes), and behavior (e.g., engaging in health-protective behaviors and risk-taking behaviors) 6 mo later. Four distinct information-channel dimensions emerged: journalistic complexity; ideologically focused news; domestically focused news; and nonnews. Results indicate that journalistic complexity was prospectively associated with more emotional exhaustion, belief in the seriousness of the coronavirus, response efficacy, engaging in health-protective behaviors, and less dismissiveness of the pandemic. A reliance on conservative-leaning media was prospectively associated with less psychological distress, taking the pandemic less seriously, and engaging in more risk-taking behaviors. We discuss the implications of this work for the public, policy makers, and future research.

Psychological responses to U.S. statewide restrictions and COVID-19 exposures: A longitudinal study.

OBJECTIVE: The COVID-19 pandemic has generated debate as to whether community-level behavioral restrictions are worth the emotional costs of such restrictions. Using a longitudinal design, we juxtaposed the relative impacts of state-level restrictions and case counts with person-level direct and media-based exposures on distress, loneliness, and traumatic stress symptoms (TSS) during the COVID-19 pandemic in the United States. METHOD: From March 18, 2020 to April 18, 2020 and September 9, 2020 to October 16, 2020, a representative probability sample of U.S. adults (N = 5,594) completed surveys of their psychological responses and personal direct and media-based exposures to the COVID-19 pandemic. Survey data were merged with publicly available data on the stringency of state-level mitigation policies (e.g., school/business closures) during this period and longitudinal case/death counts for each state. RESULTS: Three multilevel models (outcomes: distress, loneliness, TSS) were constructed. Measurements of dependent variables (Level 1) were nested within respondents (Level 2) who were nested within states (Level 3). State-level mitigation, cases, or deaths were not associated with any dependent variables (all p's > .05). However, person-level exposures, including having contracted COVID-19 oneself (distress b = .22, p < .001; loneliness b = .13, p = .03; TSS b = .18, p = .001), knowing others who were sick (distress b = .04, p < .001; loneliness b = .02, p < .001; TSS b = .05, p < .001) or died (distress b = .10, p = .001; loneliness b = .10, p = .003; TSS b = .16, p < .001), and exposure to pandemic-related media (distress b = .12, p < .001; loneliness b = .09, p < .001; TSS b = .16, p < .001), were positively associated with outcomes. CONCLUSIONS: Personal exposures to COVID-19 are more strongly associated with psychological outcomes than statewide mitigations levied to stop disease spread. Results may inform public health response planning for future disease outbreaks. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Media exposure, threat processing, and mitigation behaviors in Gulf Coast residents facing the co-occurring threats of COVID-19 and hurricanes.

The 2020 hurricane season threatened millions of Americans concurrently grappling with COVID-19. Processes guiding individual-level mitigation for these conceptually distinct threats, one novel and chronic (COVID-19), the other familiar and episodic (hurricanes), are unknown. Theories of health protective behaviors suggest that inputs from external stimuli (e.g., traditional and social media) lead to threat processing, including perceived efficacy (self- and response) and perceived threat (susceptibility and severity), guiding mitigation behavior. We surveyed a representative sample of Florida and Texas residents (N = 1846) between April 14, 2020 and April 27, 2020; many had previous hurricane exposure; all were previously assessed between September 8, 2017 and September 11, 2017. Using preregistered analyses, two generalized structural equation models tested direct and indirect effects of media exposure (traditional media, social media) on self-reported (1) COVID-19 mitigation (handwashing, mask-wearing, social distancing) and (2) hurricane mitigation (preparation behaviors), as mediated through perceived efficacy (self- and response) and perceived threat (susceptibility and severity). Self-efficacy and response efficacy were associated with social distancing (p = .002), handwashing, mask-wearing, and hurricane preparation (ps < 0.001). Perceived susceptibility was positively associated with social distancing (p = 0.017) and hurricane preparation (p < 0.001). Perceived severity was positively associated with social distancing (p < 0.001). Traditional media exhibited indirect effects on COVID-19 mitigation through increased response efficacy (ps < 0.05), and to a lesser extent self-efficacy (p < 0.05), and on hurricane preparation through increased self-efficacy and response efficacy and perceived susceptibility (ps < 0.05). Social media did not exhibit indirect effects on COVID-19 or hurricane mitigation. Communications targeting efficacy and susceptibility may encourage mitigation behavior; research should explore how social media campaigns can more effectively target threat processing, guiding protective actions.

Association Between Repeated Exposure to Hurricanes and Mental Health in a Representative Sample of Florida Residents.

Importance: During the past century, more than 100 catastrophic hurricanes have impacted the Florida coast; climate change will likely be associated with increases in the intensity of future storms. Despite these annual threats to residents, to our knowledge, no longitudinal studies of representative samples at risk of hurricane exposure have examined psychological outcomes associated with repeated exposure. Objective: To assess psychosocial and mental health outcomes and functional impairment associated with repeated hurricane exposure. Design, Setting, and Participants: In this survey study, a demographically representative sample of Florida residents was assessed in the 60 hours prior to Hurricane Irma (wave 1: September 8-11, 2017). A second survey was administered 1 month after Hurricane Irma (wave 2: October 12-29, 2017), and a third survey was administered after Hurricane Michael (wave 3: October 22 to November 6, 2018). Data were analyzed from July 19 to 23, 2021. Exposure: Hurricanes Irma and Michael. Main Outcomes and Measures: The main outcomes were posttraumatic stress symptoms (PTSS), global distress, worry about future events (generalized worries), and functional impairment. Path models were used to assess associations of individual-level factors (prior mental health, recent adversity), prior storm exposures (loss and/or injury, evacuation), and direct, indirect, and media-based exposures to hurricanes Irma and Michael with those outcomes. Poststratification weights were applied to facilitate population-based inferences. Results: Of 2873 individuals administered the survey in wave 1, 1637 responded (57.0% completion rate) (894 [54.6%, weighted] women; mean [SD] age, 51.31 [17.50] years); 1478 in wave 2 (90.3% retention from wave 1) and 1113 in wave 3 (75.3% retention from wave 2) responded. Prior mental health ailments (b, 0.18; 95% CI, 0.07-0.28), prior hurricane-related loss and/or injury (b, 0.09; 95% CI, 0.02-0.17), hours of Hurricane Irma-related media exposure (b, 0.03; 95% CI, 0.02-0.04), being in an evacuation zone during Hurricane Irma and not evacuating (b, 0.14; 95% CI, 0.02-0.27), and loss and/or injury in Hurricane Irma (b, 0.35; 95% CI, 0.25-0.44) were positively associated with PTSS after Hurricane Irma; most associations persisted and were associated with responses to Hurricane Michael. Prior mental health ailments (b, 0.10; 95% CI, 0.03-0.17), hours of Hurricane Michael-related media exposure (b, 0.01; 95% CI, 0.003-0.02), hurricane Irma-related PTSS (b, 0.42; 95% CI, 0.34-0.50), recent individual-level adversity (b, 0.03; 95% CI, 0.005-0.05), being in an evacuation zone during Hurricane Irma and evacuating (b, 0.10; 95% CI, 0.002-0.19), and direct (b, 0.36; 95% CI, 0.16-0.55) and indirect (b, 0.12; 95% CI, 0.05-0.18) Hurricane Michael-related exposures were directly associated with Hurricane Michael-related PTSS. After Hurricane Michael, prior mental health ailments (b, 0.17; 95% CI, 0.06-0.28), and PTSS related to hurricanes Irma (b, 0.11; 95% CI, 0.001-0.22) and Michael (b, 0.58; 95% CI, 0.47-0.69) were associated with respondents' functional impairment. Analogous analyses using global distress and generalized worries as mediators of functional impairment yielded a similar pattern of results. Conclusions and Relevance: In this survey study, repeated direct, indirect, and media-based exposures to hurricanes were associated with increased mental health symptoms among Florida residents who experienced hurricanes Irma and Michael, suggesting that people were sensitized to respond with more psychological symptoms over time. These results may inform targeted public health intervention efforts for natural disasters.

The unfolding COVID-19 pandemic: A probability-based, nationally representative study of mental health in the United States.

The COVID-19 (coronavirus disease 2019) pandemic is a collective stressor unfolding over time; yet, rigorous empirical studies addressing its mental health consequences among large probability-based national samples are rare. Between 18 March and 18 April 2020, as illness and death escalated in the United States, we assessed acute stress, depressive symptoms, and direct, community, and media-based exposures to COVID-19 in three consecutive representative samples from the U.S. probability-based nationally representative NORC AmeriSpeak panel across three 10-day periods (total N = 6514). Acute stress and depressive symptoms increased significantly over time as COVID-19 deaths increased across the United States. Preexisting mental and physical health diagnoses, daily COVID-19-related media exposure, conflicting COVID-19 information in media, and secondary stressors were all associated with acute stress and depressive symptoms. Results have implications for targeting public health interventions and risk communication efforts to promote community resilience as the pandemic waxes and wanes over time.

Preparing for the aftermath of COVID-19: Shifting risk and downstream health consequences.

Due to the COVID-19 pandemic, the public is currently living through a collective continuous traumatic stressor. Objective risk levels shift with each new piece of data regarding the coronavirus. These data points are communicated through public health officials and the media, easily accessible through modern advanced technology including online news and push notifications. When objective risk changes, individuals must reappraise their subject risk levels. Updating subjective risk levels several times per week is linked to ambiguity of the situation and uncertainty in daily life. The uncertainty and potential feelings of uncontrollability is linked to heightened anxiety. The continuous stress, anxiety, and uncertainty may have several negative downstream mental and physical health effects nationwide. The health care sector must begin preparing for the long-term consequences of the pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Worst Life Events and Media Exposure to Terrorism in a Nationally Representative U.S. Sample.

Indirectly experienced negative life events are not considered Criterion A traumatic events per DSM-5 posttraumatic stress disorder diagnostic criteria, yet individuals indirectly exposed to trauma via the media may report these events as peak traumatic experiences. We studied which events people considered to be the "worst" in their lifetimes to gain a better understanding of the types of events individuals consider to be distressing. This longitudinal study included a nationally representative sample of U.S. residents living outside New York (N = 1,606) who were exposed to the September 11th, 2001 (9/11) terror attacks exclusively via the media. Bereavement was the most frequently cited "worst" life event (42.0%); violent events were cited by 11.4% of the sample. However, 22.0% of respondents reported 9/11 as their worst life event even though they did not directly experience the attacks. More lifetime exposure to violent events and bereavement, odds ratios (ORs) = 0.79 and 0.72, respectively, and a college education, OR = 0.61, were associated with decreased odds of naming 9/11 as one's worst life event. Watching 4 or more hours of 9/11-related television coverage in the week after the attacks, OR = 1.67, and identifying as African American, OR = 2.01, were associated with increased odds of naming 9/11 as one's worst life event 1 year after the attacks. Events experienced indirectly through the media may be considered the worst of people's lives, with important implications for assessing stressful life event history and understanding indirect exposure to negative life events.

National Opinions on Death Penalty Punishment for the Boston Marathon Bomber Before vs. After Sentencing.

Humans seek consistency between their internal thoughts and the outside world. Thus, when legal authorities make decisions, people are likely to accept and obey these decisions in order to remain consistent with the societies in which they live. Few studies have explored these biases in an applied context. We examined the relationship between the sentencing of Dzhokhar Tsarnaev (the Boston Marathon bomber) and Americans' opinions about his punishment in a natural quasi-experiment. We expected that Tsarnaev's sentencing would be associated with increased support for his death penalty sentence, in a manner consistent with the legitimization literature. A survey of a representative U.S. national sample (N=3,341; 78.13% total response rate) was conducted between April 29 and June 26, 2015. We assessed views about Tsarnaev's sentencing (i.e., whether he should receive the death penalty), political party, demographics, and psychological indicators; 81.77% of our sample completed the survey prior to Tsarnaev's sentencing and 18.23% completed the survey afterwards. Multiple logistic regression analyses indicated that those who completed the survey after Tsarnaev was sentenced to death were more likely to support a death penalty sentence than were those who took the survey prior to the sentencing (OR=1.48, p=.007; 95% confidence [1.11, 1.96]). These results remained significant after adjusting for significant covariates, including male gender, White race, Protestant-Christian religious affiliation, Boston residency, beliefs in a just world, and Republican political party identification. Results of this quasi-experiment suggest that people adjust their opinions to be consistent with the fait accompli, particularly once the outcome is widely known.

Media exposure to mass violence events can fuel a cycle of distress.

The established link between trauma-related media exposure and distress may be cyclical: Distress can increase subsequent trauma-related media consumption that promotes increased distress to later events. We tested this hypothesis in a 3-year longitudinal study following the 2013 Boston Marathon bombings and the 2016 Orlando Pulse nightclub massacre using a national U.S. sample (N = 4165). Data were collected shortly after the bombings, 6 and 24 months post-bombings, and beginning 5 days after the Pulse nightclub massacre (approximately 1 year later; 36 months post-bombings). Bombing-related media exposure predicted posttraumatic stress symptoms (PTS) 6 months later; PTS predicted worry about future negative events 2 years after the bombings, which predicted increased media consumption and acute stress following the Pulse nightclub massacre 1 year later. Trauma-related media exposure perpetuates a cycle of high distress and media use.

Media Coverage, Forecasted Posttraumatic Stress Symptoms, and Psychological Responses Before and After an Approaching Hurricane.

Importance: Exposure to disaster-related media coverage is associated with negative mental health outcomes. However, risk factors that render individuals vulnerable to this exposure are unknown. Hurricane-associated media exposure was expected to explain the association between forecasted posttraumatic stress (PTS) and adjustment after the hurricane. Objective: To examine forecasted PTS responses and media coverage as risk factors for negative mental health outcomes in the context of media coverage of an approaching disaster (Hurricane Irma). Design, Setting, and Participants: In a representative probability community sample of 1637 adults from Florida, respondents completed 2 online surveys: the first during the 60 hours before Hurricane Irma's landfall (wave 1; September 8-11, 2017) and the second approximately 1 month later (wave 2; October 12-29, 2017). Poststratification weights were applied to facilitate population-based inferences. Data were analyzed from October 19 through 31, 2018. Main Outcomes and Measures: Posttraumatic stress responses, psychological distress, functional impairment, and worry about future events. Results: The wave 1 survey included 1637 participants (57.0% response rate); 1478 participants were retained at the wave 2 follow-up (90.3% retention) (weighted proportion of women, 62.2%; mean [SD] age, 59.1 [15.2] years). The final weighted sample closely approximated US Census benchmarks for the state of Florida. Data analyses using structural equation modeling revealed that exposure to media coverage of the hurricane (ß = 0.21; 95% CI, 0.11-0.31; P < .001) and forecasted PTS (ß = 0.44; 95% CI, 0.35-0.52; P < .001) were significantly associated with adjustment after the hurricane. In addition, a significant indirect path from forecasted PTS to adjustment after the storm occurred through exposure to hurricane-related media coverage (ß = 0.07; 95% CI, 0.05-0.08; P < .001). Covariates included demographics, mental health diagnoses before the storm, perceived evacuation zone status, and degree of hurricane exposure. Conclusions and Relevance: Results of this study provide a more thorough understanding of how psychological factors before hurricanes are associated with adjustment after hurricanes via media consumption. The findings may also demonstrate the importance of considering prestorm psychological factors when assessing poststorm outcomes, with implications for the media and public health efforts.

Acute stress and subsequent health outcomes: A systematic review.

OBJECTIVE: To systematically review the relationship between acute posttraumatic stress symptoms (<1 month) and subsequent physical and mental health outcomes other than posttraumatic stress disorder (PTSD). METHODS: A systematic search of electronic databases (PubMed, PsycINFO, CINAHL, and Web of Science) was conducted to identify longitudinal studies examining the link between acute posttraumatic stress and physical and mental health. Inclusion criteria required assessment of acute posttraumatic stress (<1 month post-event) and at least one follow-up assessment of a physical or mental health outcome (not PTSD). RESULTS: 1,051 articles were screened; 22 met inclusion criteria. Fourteen studies examined physical health outcomes and 12 examined non-PTSD mental health outcomes. Early psychological responses to trauma were associated with a variety of short- (<1 year) and long- (≥1 year) term physical and mental health outcomes. Physical health outcomes included poor general physical health, increased pain and disability, lower quality of life, and higher risk of all-cause mortality. Significant psychological outcomes included more cumulative psychiatric disorders, depression, and anxiety. Significant psychosocial outcomes included increased family conflict. CONCLUSIONS: Methodologically rigorous longitudinal studies support the utility of measuring acute psychological responses to traumatic events as they may be an important marker of preventable trauma-related morbidity and mortality that warrants long-term monitoring and/or early intervention.

Distress and rumor exposure on social media during a campus lockdown.

During crisis events, people often seek out event-related information to stay informed of what is happening. However, when information from official channels is lacking or disseminated irregularly, people may be at risk for exposure to rumors that fill the information void. We studied information-seeking during a university lockdown following an active-shooter event. In study 1, students in the lockdown (n = 3,890) completed anonymous surveys 1 week later. Those who indicated receiving conflicting information about the lockdown reported greater acute stress [standardized regression coefficient (b) = 0.07; SE = 0.01; 95% confidence interval (CI), 0.04, 0.10]. Additionally, those who reported direct contact with close others via text message (or phone) and used Twitter for critical updates during the lockdown were exposed to more conflicting information. Higher acute stress was reported by heavy social media users who trusted social media for critical updates (b = 0.06, SE = 0.01; 95% CI, 0.03, 0.10). In study 2, we employed a big data approach to explore the time course of rumor transmission across 5 hours surrounding the lockdown within a subset of the university's Twitter followers. We also examined the patterning of distress in the hours during the lockdown as rumors about what was happening (e.g., presence of multiple shooters) spread among Twitter users. During periods without updates from official channels, rumors and distress increased. Results highlight the importance of releasing substantive updates at regular intervals during a crisis event and monitoring social media for rumors to mitigate rumor exposure and distress.

Evacuation from Natural Disasters: A Systematic Review of the Literature.

Research on evacuation from natural disasters has been published across the peer-reviewed literature among several disparate disciplinary outlets and has suggested a wide variety of predictors of evacuation behavior. We conducted a systematic review to summarize and evaluate the current literature on demographic, storm-related, and psychosocial correlates of natural disaster evacuation behavior. Eighty-three eligible papers utilizing 83 independent samples were identified. Risk perception was a consistent positive predictor of evacuation, as were several demographic indicators, prior evacuation behavior, and having an evacuation plan. The influence of prior experiences, self-efficacy, personality, and links between expected and actual behavior were examined less frequently. Prospective, longitudinal designs are relatively uncommon. Although difficult to conduct in postdisaster settings, more prospective, methodologically rigorous studies would bolster inferences. Results synthesize the current body of literature on evacuation behavior and can help inform the design of more effective predisaster evacuation warnings and procedures.