Disparities in Adherence to COVID-19 Public Health Recommendations

As the coronavirus 2019 (COVID-19) pandemic continues, there has been much discussion about the need for, and the public’s adherence to, public health recommendations for minimizing spread of the infection. Although infectious disease experts recommend social distancing and wearing masks in public, many people do not wear masks and some politicians even want to ban mask requirements (Bogel-Burroughs & Robertson, 2020). Thus, it is timely that HLRP: Health Literacy Research and Practice contains reports of two national surveys about the public’s awareness of and intent to comply with those public health recommendations. The surveys used different methods, studied different populations, and have specific methodological limitations. Nonetheless, they have important findings—notably marked differences among respondents to the two surveys in their awareness of and intent to comply with those public health recommendations. One survey, by Lennon et al. (2020), collected data from more than 5,000 largely White respondents in communities across the United States and found that 86% to 90% of respondents most certainly intended to comply with recommendations about hand washing and social distancing. The other survey, by Block et al. (2020), was focused exclusively on African Americans and found that only 67% to 72% of respondents reported always following those recommendations. Readers could easily make the mistake of concluding that the differences in reported compliance with public health recommendations between the two studies are due to the racial/ethnic differences in the two surveyed populations, one largely White and the other exclusively African American. In reality, however, the different levels of compliance with public health recommendations are far more likely due to differences in education and income levels between the respondents in the two surveys. In the Lennon et al. (2020) study of largely White people, 81% of respondents had attained a college or graduate/professional degree. In the Block et al. (2020) study of African Americans, only 27% had attained a college or graduate/professional degree. A recent report from the Pew Research Center (2020) confirms that higher levels of education are associated with higher rates of compliance with public health recommendations among people of all racial/ethnic groups. In addition, their data show that overall, African American adults are more likely to wear masks than White respondents (Igielnik, 2020). Higher education levels are also strongly associated with higher income levels (Wolla & Sullivan, 2017), and income is another major factor in whether people comply