Association of Political Party Affiliation With Physical Distancing Among Young Adults During the COVID-19 Pandemic

Public messages about physical distancing during the coronavirus disease 2019 (COVID-19) pandemic in the US have diverged across government officials and news media outlets with different political leanings.¹ Prior studies found that people with Republican (vs other) political party affiliations report less physical distancing.^2,3 These studies used crowdsourced internet samples, inadequately adjusted for confounders, collected data before widespread public health messaging about physical distancing, or included few young adults.^2,3

Adults aged 18 to 25 years might be inclined to contravene physical distancing guidelines and participate in high-risk social recreational activities that increase the risk of transmitting severe acute respiratory syndrome coronavirus 2.³ We estimated the associations of political party affiliation with physical distancing behaviors among young adults—a population with high rates of COVID-19.⁴

Ninth grade high school students (n = 3396) were originally recruited in Los Angeles, California, in 2013, provided informed written consent, and were surveyed (semi)annually about health behaviors.⁵ This cross-sectional study analyzed self-report data from the most recent (May 18-August 3, 2020) survey administered online. The University of Southern California institutional review board approved the study. Written informed consent was obtained and the survey responses were analyzed in a deidentified data set.

A political party affiliation survey item with 6 response options was collapsed into 4 categories (“Democrat,” “Republican,” “Independent,” “something else,” “don’t know” or “prefer not to answer”). Physical distancing (defined as staying ≥6 feet away from others) over the past 2 weeks with 5 response options was made a binary outcome (infrequent [“sometimes” or “rarely”] vs frequent [“usually,” “always,” or “not been in public places”]). Past 2-week frequency of engaging in 4 social recreational activities (listed in Table 1) was measured. Responses to the 4 items (“0,” “1,” “2-3” [recoded = 2.5], “4-6” [recoded = 5], or “≥7” [recoded = 7] times) were summed into a continuous outcome (range: 0-28) and examined individually as binary outcomes (≥1 vs 0 times).

Associations of political party with physical distancing were estimated in linear (continuous outcomes) or logistic (dichotomous outcomes) regression models, yielding regression weights (B; mean difference) or odds ratios (ORs) with 95% CIs, respectively. Planned pairwise tests compared Republicans with each other group. After unadjusted models, we adjusted for a priori confounders (eg, demographics, perceived COVID-19 vulnerability, and youth and adult risk-taking behaviors) (Table 2).^1-3 Statistical significance was P < .05 (2-tailed).

Of 3134 cohort enrollees with valid contact information invited to take the survey, 2179 (69.5%) agreed. For the analytic sample with exposure and outcome data (n = 2065; mean [SD] age, 21.2 [0.4] years; 61.2% female), descriptive statistics for political party and physical distancing variables and covariates are reported in the left-hand portions of Table 1 and Table 2, respectively. In the analytic sample, 891 respondents identified themselves as Democrats (43.1%), 148 (7.2%) as Republicans, 320 as Independent/other (15.5%), and 706 (34.2%) as don’t know/decline to answer; 1737 (84.8%) reported living in Los Angeles County and 210 (10.3%) elsewhere in California.

Infrequent physical distancing was more common in Republican participants (36 [24.3%]) than Democrats (46 [5.2%]; OR, 5.9; 95% CI, 3.7-9.5; P < .001), Independent/other (21 [6.6%]; OR, 4.6; 95% CI, 2.6-8.2; P < .001), or don’t know/decline to answer (40 [5.7%]; OR, 5.4; 95% CI, 3.3-8.8; P < .001) groups. Total number of past 2-week social recreational activities was higher among Republican participants (mean [SD], 3.6 [4.2]) than Democrat participants (mean [SD], 1.9 [2.7]; B = 1.8; 95% CI, 1.2-2.3; P < .001), Independent/other (mean [SD], 2.2 [2.9]; B = 1.4; 95% CI, 0.9-2.0; P < .001), or don’t know/decline to answer (mean [SD], 2.2 [3.2]; B = 1.4; 95% CI, 0.8-1.9; P < .001) groups. Republicans vs other groups were more likely to visit public indoor venues (eg, malls), visit restaurants/bars/clubs, or attend or host parties with 10 people or more (Table 1). Associations of Republican party affiliation with all outcomes were consistent across unadjusted and covariate-adjusted models (Table 1). Table 2 presents covariate association estimates.

In this study of young adults, predominantly living in Los Angeles County or elsewhere in California, self-reported Republican political party affiliation was associated with less frequent physical distancing and participating in social recreational activities that may perpetuate the COVID-19 pandemic. California recommends all residents practice physical distancing and requires mask wearing when outside the home. This study extends prior research^2,3 by extensive adjustment for possible confounders, focusing on young adults, and data collection after widespread public health messaging about physical distancing.

Limitations of the study include a focus on young adults in 1 county in 1 state, possible reporting biases, and the small proportions of Republicans relative to their national prevalence in young adults, which is about 23%.⁶ These limitations notwithstanding, our findings suggest that efforts to promote physical distancing among young adults during the COVID-19 pandemic should consider the role of political affiliation.

Accepted for Publication: October 3, 2020.

Published Online: December 14, 2020. doi:10.1001/jamainternmed.2020.6898

Corresponding Author: Adam M. Leventhal, PhD, Institute for Addiction Science, 2250 Alcazar St, CSC 240, Los Angeles, CA 90033 (adam.leventhal@usc.edu).

Author Contributions: Dr Dai had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Leventhal, Dai, Unger.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Leventhal, Dai, Unger, Cho.

Critical revision of the manuscript for important intellectual content: Leventhal, Dai, Barrington-Trimis, McConnell, Unger, Sussman.

Statistical analysis: Leventhal, Dai, Cho.

Obtained funding: Leventhal, Barrington-Trimis, McConnell, Unger.

Administrative, technical, or material support: Leventhal, Sussman, Cho.

Supervision: Leventhal, McConnell, Unger.

Conflict of Interest Disclosures: None reported.

Funding/Support: Research reported in this publication was supported by the National Cancer Institute under Award Number R01CA229617 (Barrington-Trimis/Leventhal) and by the National Institute on Drug Abuse Award Number K24DA048160. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Role of the Funder/Sponsor: The National Cancer Institute and the National Institute on Drug Abuse had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.