COVID-19 risk perceptions of social interaction and essential activities and inequity in the United States: Results from a nationally representative survey

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related diagnoses, hospitalizations, and deaths have disproportionately affected disadvantaged communities across the United States. Few studies have sought to understand how risk perceptions related to social interaction and essential activities during the COVID-19 pandemic vary by sociodemographic factors, information that could inform targeted interventions to reduce inequities in access to care and information. Methods: We conducted a nationally representative online survey of 1,592 adults in the United States to understand risk perceptions related to transmission of COVID-19 for various social and essential activities. We assessed relationships for each activity, after weighting to adjust for the survey design, using bivariate comparisons and multivariable logistic regression modeling, between responses of safe and unsafe, and participant characteristics, including age, gender, race, education, income, and political affiliation. Results: Half of participants were younger than 45 years (n=844, 53.0%), female (n=800, 50.3%), and White/Caucasian (n=685, 43.0%), Black/African American (n=410, 25.8%), or Hispanic/Latino (n=382, 24.0%). Risk perceptions of unsafe for 13 activities ranged from 29.2% to 73.5%. Large gatherings, indoor dining, and visits with elderly relatives had the highest proportion of unsafe responses (>58%) while activities outdoor, visiting the doctor or dentist, and going to the grocery store had the lowest (<36%). Older respondents were more likely to view social gatherings and indoor activities as unsafe, yet more likely to view activities such as going to the grocery store, participating in outdoor activities, visiting elderly relatives, and visiting the doctor or emergency room as safe. Compared to White/Caucasian respondents, Black/African American and Hispanic/Latino respondents were more likely to view activities such as dining and visiting friends outdoor as unsafe. Generally, men vs. women, Republicans vs. Democrats and independents, and individuals with higher vs. lower income were more likely to view activities as safe. Conclusions: These findings suggest the importance of sociodemographic differences in risk perception, health behaviors, and access to information and health care when implementing efforts to control the COVID-19 pandemic. Further research should address how evidence-based interventions can be tailored considering these differences with a goal of increased health equity in the pandemic response.