School of Medicine, Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri.
Brown School at Washington University in St. Louis, St Louis, Missouri.
JAMA Netw Open. 2021 Jul 1;4(7):e2116113. doi: 10.1001/jamanetworkopen.2021.16113.
IMPORTANCE: Policies to promote social distancing can minimize COVID-19 transmission but come with substantial social and economic costs. Quantifying relative preferences among the public for such practices can inform locally relevant policy prioritization and optimize uptake. OBJECTIVE: To evaluate relative utilities (ie, preferences) for COVID-19 pandemic social distancing strategies against the hypothetical risk of acquiring COVID-19 and anticipated income loss. DESIGN, SETTING, AND PARTICIPANTS: This survey study recruited individuals living in the Missouri area from May to June 2020 via randomly distributed unincentivized social media advertisements and local recruitment platforms for members of minority racial and ethnic groups. Participants answered 6 questions that asked them to choose between 2 hypothetical counties where business closures, social distancing policy duration, COVID-19 infection risk, and income loss varied. MAIN OUTCOMES AND MEASURES: Reweighted population-level relative preferences (utilities) for social distancing policies, subgroups, and latent classes. RESULTS: The survey had a 3% response rate (3045 of 90 320). Of the 2428 respondents who completed the survey, 1669 (75%) were 35 years and older, 1536 (69%) were women, and 1973 (89%) were White. After reweighting to match Missouri population demographic characteristics, the strongest preference was for the prohibition of large gatherings (mean preference, -1.43; 95% CI, -1.67 to -1.18), with relative indifference to the closure of social and lifestyle venues (mean preference, 0.05; 95% CI, -0.08 to 0.17). There were weak preferences to keep outdoor venues (mean preference, 0.50; 95% CI, 0.39 to 0.61) and schools (mean preference, 0.18; 95% CI, 0.05 to 0.30) open. Latent class analysis revealed 4 distinct preference phenotypes in the population: risk averse (48.9%), conflicted (22.5%), prosocial (14.9%), and back to normal (13.7%), with men twice as likely as women to belong to the back to normal group than the risk averse group (relative risk ratio, 2.19; 95% CI, 1.54 to 3.12). CONCLUSIONS AND RELEVANCE: In this survey study using a discrete choice experiment, public health policies that prohibited large gatherings, as well as those that closed social and lifestyle venues, appeared to be acceptable to the public. During policy implementation, these activities should be prioritized for first-phase closures. These findings suggest that policy messages that address preference heterogeneity (eg, focusing on specific preference subgroups or targeting men) could improve adherence to social distancing measures for COVID-19 and future pandemics.
重要性:推行社会疏离政策可以最大程度地减少 COVID-19 的传播,但也会带来巨大的社会和经济成本。量化公众对这些做法的相对偏好,可以为当地的相关政策提供优先排序,并优化采用。
目的:评估 COVID-19 大流行期间社会隔离策略相对于获得 COVID-19 的假设风险和预期收入损失的相对效用(即偏好)。
设计、地点和参与者:这项调查研究于 2020 年 5 月至 6 月期间通过随机分发无激励性的社交媒体广告和当地少数族裔成员招募平台,从密苏里地区招募参与者。参与者回答了 6 个问题,要求他们在 2 个假设的县之间进行选择,这两个县的商业关闭、社会隔离政策持续时间、COVID-19 感染风险和收入损失各不相同。
主要结果和措施:重新加权的人口层面社会隔离政策、亚组和潜在类别相对偏好(效用)。
结果:调查的回复率为 3%(90320 人中的 3045 人)。在完成调查的 2428 名受访者中,1669 名(75%)年龄在 35 岁及以上,1536 名(69%)为女性,1973 名(89%)为白人。经过重新加权以匹配密苏里州人口特征后,最强烈的偏好是禁止大型集会(平均偏好,-1.43;95%CI,-1.67 至-1.18),对社交和生活方式场所的关闭相对漠不关心(平均偏好,0.05;95%CI,-0.08 至 0.17)。对保持户外场所(平均偏好,0.50;95%CI,0.39 至 0.61)和学校(平均偏好,0.18;95%CI,0.05 至 0.30)开放的偏好较弱。潜在类别分析显示,人群中有 4 种不同的偏好表型:风险厌恶(48.9%)、冲突(22.5%)、亲社会(14.9%)和恢复正常(13.7%),男性属于恢复正常组的可能性是风险厌恶组的两倍(相对风险比,2.19;95%CI,1.54 至 3.12)。
结论和相关性:在这项使用离散选择实验的调查研究中,禁止大型集会以及关闭社交和生活方式场所的公共卫生政策似乎得到了公众的认可。在政策实施过程中,这些活动应优先考虑第一阶段关闭。这些发现表明,针对偏好异质性(例如,关注特定的偏好亚组或针对男性)的政策信息可以提高公众对 COVID-19 和未来大流行期间社会隔离措施的依从性。
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