Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis.

BACKGROUND: The COVID-19 pandemic has created a global health crisis, leading to stigmatization and discriminatory behaviors against people who have contracted or are suspected of having contracted the virus. Yet the causes of stigmatization in the context of COVID-19 remain only partially understood. Using attribution theory, we examine to what extent attributes of a fictitious person affect the formation of stigmatizing attitudes towards this person, and whether suspected COVID-19 infection (vs. flu) intensifies such attitudes. We also use the familiarity hypothesis to explore whether familiarity with COVID-19 reduces stigma and whether it moderates the effect of a COVID-19 infection on stigmatization. METHODS: We conducted a multifactorial vignette survey experiment (28-design, i.e., NVignettes = 256) in Germany (NRespondents = 4,059) in which we experimentally varied signals and signaling events (i.e., information that may trigger stigma) concerning a fictitious person in the context of COVID-19. We assessed respondents' cognitive (e.g., blameworthiness) and affective (e.g., anger) responses as well as their discriminatory inclinations (e.g., avoidance) towards the character. Furthermore, we measured different indicators of respondents' familiarity with COVID-19. RESULTS: Results revealed higher levels of stigma towards people who were diagnosed with COVID-19 versus a regular flu. In addition, stigma was higher towards those who were considered responsible for their infection due to irresponsible behavior. Knowing someone who died from a COVID infection increased stigma. While higher self-reported knowledge about COVID-19 was associated with more stigma, higher factual knowledge was associated with less. CONCLUSION: Attribution theory and to a lesser extent the familiarity hypothesis can help better understand stigma in the context of COVID-19. This study provides insights about who is at risk of stigmatization and stigmatizing others in this context. It thereby allows identifying the groups that require more support in accessing healthcare services and suggests that basic, factually oriented public health interventions would be promising for reducing stigma.

The effect of COVID-19 confinement and economic support measures on the mental health of older population in Europe and Israel.

This study focuses on the impact of confinement and economic support measures on the mental health of the older population (aged 50 and above) across twenty-five European countries and Israel. While studies evaluating the effect of confinement measures on mental health exist, they largely ignore the potentially offsetting effects of economic support measures. Moreover, previous findings on the effect of confinement measures are inconsistent, and many studies are based solely on cross-sectional designs. Using data from the Corona Survey wave (2020) of the Survey on Health, Ageing and Retirement in Europe (SHARE), we leverage the date of interview information to vary individual exposure to different policy contexts within countries. Overall, we do not find support for the negative effect of confinement measures on older adults' mental health. If anything, both confinement and support measures worked in tandem to soothe mental distress, resulting from the pandemic. The confinement effects, however, are contingent on age, potentially indicating that younger people are more likely to be negatively affected by lockdowns.

The effect of non-pharmaceutical policy interventions on COVID-19 transmission across three cities in Colombia.

Governments across the globe have implemented different strategies to handle the COVID-19 pandemic. A national mandatory quarantine was the most applied policy tool. While there are studies that tested the effectiveness of a national mandatory quarantine, the question about the effectiveness of additional quarantine policies is not yet answered. In this study we focus on three large cities in Colombia (Bogota, Medellin and Cali) with similar socio-economic conditions but made use of different COVID-19 prevention measures. We examine whether different non-pharmaceutical policy interventions (NPIs) conducted in these three cities are effective against the spread of the COVID-19 pandemic. We inspect the effect of the quarantine policies restricting exit from home by sex, ID number, whereby only Bogota implemented the restriction to leave the home according to sex followed by a restriction according to ID number, and Medellin and Cali implemented a restriction by ID number only. Data for the analysis are obtained from the National Administrative Department of Statistics of Colombia [Departamento Administrativo Nacional de Estadística (DANE)]. The data on pandemic severity is measured by the number of confirmed COVID-19 cases per city. We conduct single-group interrupted time series analysis (ITSA) to examine differences in the extent of the pandemic severity in Bogota, Medellin and Cali. We found that NPIs in all three Colombian cities had a positive effect on slowing the spread of the pandemic.

Vaccination against COVID-19 reduces virus-related fears: Findings from a German longitudinal study.

During the recent pandemic, fear of COVID-19 has been widespread and is considered to deteriorate mental health. We assessed whether vaccination can effectively reduce the fear of COVID-19 and, thus, contribute to improving people's mental health status. We used two-wave panel data from a German online study collected in April 2021 (t1) and August/September 2021 (t2) and estimated differences-in-differences to determine whether those who were vaccinated against COVID-19 experienced a reduction of fear of COVID-19, and whether the reduction was more evident as compared to people who were not vaccinated for various reasons. Fear of COVID-19 generally decreased between t1 and t2 for all respondents. Moreover, reduction of fear for people who were unvaccinated at t1 but received the vaccine between t1 and t2 was strongest as compared to people who did not get vaccinated during that period, even after we controlled for factors associated with fear (e.g., age, gender). Vaccination reduced fear of COVID-19 beyond some seasonal fluctuation and, therefore, we argue that vaccination partially reduces the psychological distress caused by the pandemic. We recommend that scientists, practitioners, and politicians highlight this additional positive effect of vaccination in health communication.

Correlates of COVID-19 vaccination intentions: Attitudes, institutional trust, fear, conspiracy beliefs, and vaccine skepticism.

Successful campaigns to combat the COVID-19 pandemic depend, in part, on people's willingness to be vaccinated. It is therefore critical to understand the factors that determine people's vaccination intentions. We applied a reasoned action approach - the theory of planned behavior - to explore these factors. We used data from an online survey of adults (18-74 years; n = 5044) conducted in Germany between April 9 and April 28, 2021 and found that attitudes toward getting vaccinated predicted vaccination intentions, while normative and control beliefs did not. In turn, positive attitudes toward getting vaccinated were supported by trust in science and fear of COVID-19 whereas negative attitudes were associated with acceptance of conspiracy theories and skepticism regarding vaccines in general. We advise policymakers, physicians, and health care providers to address vaccination hesitancy by emphasizing factors that support positive attitudes toward getting vaccinated, such as prevention of serious illness, death, and long-term health detriments, as opposed to exerting social pressure or pointing to the ease of getting vaccinated.

Unhealthy Immigrants: Sources for Health Gaps Between Immigrants and Natives in Israel.

The study focuses on sources for health gaps between Jewish immigrants and native-born Israelis. Unlike traditional immigrant societies where immigration is viewed as economically motivated, immigrants returning to Israel are viewed as the "returning diaspora". Because immigrants in Israel are entitled to the same health benefits and medical services as native-born, we expect Israel to attract unhealthy immigrants in disproportionate numbers. The data for the analysis are obtained from the Israeli National Health Interview Survey (2013-2015). The data set provides detailed information on health status and illness, sociodemographic attributes and origin of immigrants. Three major origin groups of immigrants are distinguished: the former Soviet Union, Western Europeans or the Americans (mostly Ashkenazim), and Asians or North Africans (mostly Sephardim). Our findings lend support to the expectations that the health status of all immigrant groups is poorer than that of native-born Israelis. The nativity-illness gap is most pronounced in the case of male immigrants (from Europe or the Americas or South Africa or Australia) and for female immigrants (from countries in the Middle East or North Africa) and least pronounced in the case of immigrants arriving from the former Soviet Union for both gender groups. Decomposition of the gaps into components reveals that some portion of the illness gap can be attributed to nativity status, but the largest portion of the gap is attributed to demographic characteristics. Neither socioeconomic status nor health-related behavior accounts for a substantial portion of the nativity-illness gap for all subgroups of immigrants.

The Comparability of Perceived Physical and Mental Health Measures Across Immigrants and Natives in the United States.

The comparative study of perceived physical and mental health in general-and the comparative study of health between the native-born and immigrants, in particular-requires that the groups understand survey questions inquiring about their health in the same way and display similar response patterns. After all, observed differences in perceived health may not reflect true differences but rather cultural bias in the health measures. Research on cross-country measurement equivalence between immigrants and natives on self-reported health measures has received very limited attention to date, resulting in a growing demand for the validation of existing perceived health measures using samples of natives and immigrants and establishing measurement equivalence of health-related assessment tools. This study, therefore, aims to examine measurement equivalence of self-reported physical and mental health indicators between immigrants and natives in the United States. Using pooled data from the 2015-2017 IPUMS Health Surveys, we examine the cross-group measurement equivalence properties of five concepts that are measured by multiple indicators: (1) perceived limitations in activities of daily life; (2) self-reported disability; (3) perceived functional limitations; (4) perceived financial stress; and (5) nonspecific psychological distress. Furthermore, we examine the comparability of these data among respondents of different ethnoracial origins and from different regions of birth, who report few versus many years since migration, their age, gender, and the language used to respond to the interview (e.g., English vs. Spanish). We test for measurement equivalence using multigroup confirmatory factor analysis. The results reveal that health scales are comparable across the examined groups. This finding allows drawing meaningful conclusions about similarities and differences among natives and immigrants on measures of perceived health in these data.

Health trajectories of immigrants in the United States: Does income inequality of country of origin matter?

This study aims to investigate whether and to what extent income inequality of country of origin modifies the health trajectories of immigrants to the United States (U.S.). Much previous research has found a negative association between income inequality and health across nations. A separate, large literature shows that characteristics of immigrants' countries of origin affect their health status after migration. However, there is no evidence about whether income inequality of countries of origin affects postmigration health trajectories. Merging individual data from the Current Population's Annual Social and Economic Supplement (ASEC CPS) (2013) with macro-level data, I find that income inequality exerts a statistically significant negative effect on immigrants' health trajectories. While immigrants arriving from countries with greater income inequality tend to be healthier than immigrants arriving from countries that are more egalitarian, their health tends to decline at a faster rate over time. The results are consistent with at least two mechanisms. Immigrants from higher-inequality countries may arrive in the U.S. with fewer transferable skills and take up low-paid jobs, with negative consequences for their long-term health. Alternatively, the harmful consequences of early exposure to high-income inequality in home countries before immigration may persist over the life course, damaging individuals' health even after they have left their home nations.

Healthcare system and the wealth-health gradient: a comparative study of older populations in six countries.

The present study provides a comparative analysis of the association between wealth and health in six healthcare systems (Sweden, the United Kingdom, Germany, the Czech Republic, Israel, the United States). National samples of individuals fifty years and over reveal considerable cross-country variations in health outcomes. In all six countries wealth and health are positively associated. The findings also show that state-based healthcare systems produce better population health outcomes than private-based healthcare systems. The results indicate that in five out of the six countries studied, the wealth-health gradients were remarkably similar, despite significant variations in healthcare system type. Only in the United States was the association between wealth and health substantially different from, and much greater than that in the other five countries. The findings suggest that private-based healthcare system in the U.S. is likely to promote stronger positive associations between wealth and health.

Where wealth matters more for health: the wealth-health gradient in 16 countries.

Researchers have long demonstrated that persons of high economic status are likely to be healthier than persons of low socioeconomic standing. Cross-national studies have also demonstrated that health of the population tends to increase with country's level of economic development and to decline with level of economic inequality. The present research utilizes data for 16 national samples (of populations fifty years of age and over) to examine whether the relationship between wealth and health at the individual-level is systematically associated with country's level of economic development and country's level of income inequality. The analysis reveals that in all countries rich persons tend to be healthier than poor persons. Furthermore, in all countries the positive association between wealth and health holds even after controlling for socio-demographic attributes and household income. Hierarchical regression analysis leads to two major conclusions: first, country's economic resources increase average health of the population but do not weaken the tie between wealth and health; second, a more equal distribution of economic resources (greater egalitarianism) does not raise health levels of the population but weakens the tie between wealth and health. The latter findings can be mostly attributed to the uniqueness of the US case. The findings and their significance are discussed in light of previous research and theory.