Early COVID-19 Attitudes and Behaviors and Their Associations With Later Infection: A Local Perspective From One U.S. City : Medical Care

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Original Article

Early COVID-19 Attitudes and Behaviors and Their Associations With Later Infection

A Local Perspective From One U.S. City

Light, Sophia W. MS*; Opsasnick, Lauren MS*; Bailey, Stacy C. PhD, MPH*; Yoshino Benavente, Julia MPH*; Eifler, Morgan BS*; Lovett, Rebecca M. PhD*; Russell, Andrea PhD*; Yoon, Esther MS, MPH*; McCaffery, Kirsten PhD; Wolf, Michael S. PhD, MPH, MA, PhD*

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Medical Care 61(6):p 409-414, June 2023. | DOI: 10.1097/MLR.0000000000001855



At the onset of the pandemic, there was poor public awareness and inaction in response to COVID-19; it is less known whether this translated to subsequent infections.


To explore whether adults who perceived COVID-19 as less of a threat and who were not taking early actions were more likely to become infected over the following year.

Research Design: 

Survey data from the ongoing (COVID-19 & Chronic Conditions (C3) anonymized for review) cohort study.


Six hundred forty-two adults with a mean age of 63 and ≥1 chronic condition.


Self-reported attitudes and behaviors regarding COVID-19 were assessed from March 13 to April 3, 2020, and COVID-19 infection status was captured between May 2020 and January 2021. Bivariate and multivariable analyses examined associations between early perceptions and behaviors with later infection.


Approximately 7% reported infection with COVID-19 (N = 46). Adults who perceived the threat of COVID-19 less seriously at the initial outbreak were more likely to test positive over the following year [odds ratio (OR): 0.81, CI: 0.70–0.94; P = 0.006]. Those who were less likely to believe their actions would affect whether they would become infected were more likely to test positive (OR: 0.87, CI: 0.77–0.99; P = 0.03), as were adults who reported not changing their routines (OR: 0.45; CI: 0.24–0.85; P = 0.01).


Adults with delayed responses in acknowledging the threat of COVID-19 and in changing behaviors were more likely to contract the virus. This investigation provides insight into the consequences of inadequate public understanding and response to COVID-19, and it highlights the importance of promoting early awareness among high-risk groups during public health crises.

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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