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Who follows mask guidelines but is still unvaccinated? A new COVID-19 survey explores the answers

October 19, 2021 Category: FeaturedLongPurpose

This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

A recent survey of more than 20,000 adults shows that 66% of the respondents who had not been vaccinated against COVID-19 said that they wore masks while 11% of vaccinated respondents said they didn’t, highlighting the nuances in the two behaviors that have been central to public health guidelines amid the COVID-19 pandemic.

The findings are detailed in “Who Are the Masked Unvaccinated and the Unmasked Vaccinated?” — a report produced by The COVID States Project and published Oct. 15 on a preprint website operated by the Center for Open Science.

“This report is unique because there has previously not been a huge amount of investigation into the masked-unvaccinated groups in the U.S. and the unmasked-vaccinated groups,” said two of the report authors, Anjuli Shere, a researcher at Harvard University and the University of Oxford, and Kristin Lunz Trujillo, a postdoctoral researcher at Harvard University and Northeastern University, in a joint emailed response to questions from The Journalist’s Resource. “Understanding this complexity seems relevant in the drive to get people both vaccinated and masked up.”

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A few other reports have attempted to explore the association between vaccination status and mask wearing behavior.

For example, a July 2021 survey by the Kaiser Family Foundation found that the vaccinated and unvaccinated adults reacted differently to the spread of new coronavirus delta variant: 62% of vaccinated adults said the delta variant made them more likely to wear a mask in public, compared with 37% of unvaccinated adults.

Some people have been confused by the evolving messaging about whether vaccinated adults should wear masks.

Some people have been confused by the evolving messaging about whether vaccinated adults should wear masks. In May, before the delta variant surge, the U.S. Centers for Disease Control and Prevention said that vaccinated adults didn’t have to wear a mask in most places. But two months later, the agency changed its position in response to another wave of COVID-19 infections and advised vaccinated people to wear masks in public indoor spaces.

The agency currently says that vaccinated adults don’t need to wear a mask in outdoor settings unless it’s in crowded outdoor areas where the number of COVID-19 infections are high and when there’s close contact with others who aren’t fully vaccinated. It also recommends masks for vaccinated adults in public indoor spaces if there’s a high risk of coronavirus transmission.

The project’s report is based on a survey of 21,079 U.S. adults, conducted between Aug. 26 and Sept. 27, across 50 states and the District of Columbia.

One of its noteworthy findings is that respondents were more concerned about a family member getting infected with the new coronavirus than they did about getting infected themselves (74% v. 62%).

Respondents were more concerned about a family member getting infected with the new coronavirus than they (were) about getting infected themselves.

“We took this to mean that messages that emphasize the risk of transmission of the virus to loved ones could potentially be more effective at encouraging vaccination and mask use than messages that emphasize threats to personal safety,” Shere and Lunz Trujillo said.

This is The COVID States Project’s 67th report since April 2020, when the regularly-occurring survey was launched as a collaboration between Harvard Medical School; Harvard Kennedy School’s Shorenstein Center on Media, Politics and Public Policy; Northeastern University Network Science Institute; Northwestern University and Rutgers University. (The Shorenstein Center is also home to The Journalist’s Resource.)

The surveys, the results of which are typically published monthly, have tackled a wide range of COVID-related topics, depending on current issues or what’s around the corner. The team’s goal with the surveys is to identify links between social behaviors and virus transmission. In addition, researchers study the impact of public health messaging and government regulation on individual and community outcomes during the pandemic.

The team — a multi-university group of researchers with expertise in computational social science, network science, public opinion polling, epidemiology, public health, communication and political science — plans to collect survey data through Fall 2022.

None of the survey-based reports have been peer-reviewed or published in an academic journal so far. They’ve been posted on the Center for Open Science’s preprint website. A preprint is a research paper that has not been published in an academic journal.

Shere and Lunz Trujillo said the large team cross-checks the data, the code, and the report itself, including text and figures, before the reports are released.

In their latest report, the team focuses on two behaviors: vaccination and mask wearing. They divide the respondents into four categories — the masked unvaccinated, the masked vaccinated, the unmasked unvaccinated and the unmasked vaccinated — and explore their characteristics. The team also seeks to understand each group’s level of trust in public officials and institutions like hospitals.

Adults who said they have received at least one dose of COVID-19 vaccine are considered “vaccinated” in this report. Adults were considered “masked” if they said they had “very closely” or “somewhat closely” followed mask wearing recommendations in the past week. They were considered “unmasked” if they said responded “not very closely” or “not at all closely” to the question of following mask wearing recommendations.

1 in 10 respondents (of the survey) say they are unvaccinated and unmasked.

Overall, 60% of the respondents report being vaccinated and masked, while 19% are unvaccinated and masked. Eleven percent say they are vaccinated but unmasked. And 1 in 10 respondents say they are unvaccinated and unmasked, according to the report.

The report states the “masked unvaccinated are, perhaps, the most interesting slice of the population. They are sufficiently concerned about COVID-19 to regularly wear a mask but are unwilling to take the more powerful step to avoid serious infection by getting vaccinated.”

African Americans make up 20% of the masked unvaccinated group.

Nearly half of the masked unvaccinated report identified as Independent politically, more than any of the other three groups. They are also less likely to be Democrats compared to the overall sample. African Americans make up 20% of the masked unvaccinated group, being substantially overrepresented compared to the general population, while whites are underrepresented at 55%.

The group also skews younger, lives disproportionately in the southern U.S. and less likely to attend college compared to the overall sample.

The unmasked vaccinated group is more likely to be Republican, compared to the overall sample and disproportionately live in the Northeast and Midwest.

Meanwhile, the unmasked vaccinated group is more likely to be Republican, compared to the overall sample and disproportionately live in the Northeast and Midwest. Most — It’s 83% white. Members of this group are more likely to have bachelor’s or graduate degrees compared to the overall sample.

In this report, researchers also asked the respondents about their trust in the ability of 22 individuals and organizations to handle the pandemic. The options ranged from general entities like hospitals and doctors to specific individuals like Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and renowned infectious disease physicians, President Joe Biden and former President Donald Trump as well as media outlets like CNN and Fox News and social media platforms like Facebook and Twitter.

“The unmasked unvaccinated consistently registered the lowest levels of trust that these individuals and organizations are ‘doing the right thing’ to address the pandemic,” the authors write in the report. “The sole exception is Donald Trump, in whom this group expressed the highest level of trust of all the groups (although the share reporting trust in Trump is still marginally lower than their trust in hospitals and doctors).”

In stark contrast, the masked vaccinated show the highest levels of trust in all but three subjects: Donald Trump, Fox News and the police.

The unmasked vaccinated and the masked unvaccinated average somewhere in the middle in terms of overall levels of trust in the various entities, the report shows.

Across the sample, average trust regarding COVID-19 was highest for hospitals and doctors at 91%. Scientists and researchers received the second-highest rating at 85%. The lowest levels were reported for social media companies, including Twitter at 31% and Facebook at 36%.

However, Shere and Lunz Trujillo pointed out a caveat: “It would be disingenuous to say that the seemingly high levels of trust in hospitals and doctors are indicative of trust in all hospitals and doctors,” they said. “It is entirely possible that respondents were only thinking of the specific medical professionals that they know they trust when they answered the question.”

Shere and Lunz Trujillo stressed that no individual report from the team can be taken as conclusive evidence of overarching trends throughout the last two years.

“The reasons why people might choose to wear masks and get vaccinated are far too complex to be boiled down to either trust or concern,” they said in their e-mail to JR. “This study is intended to be an exploratory snapshot and not comprehensive. There are likely other factors that play into these decisions, with obvious ones including mask mandates and employee vaccination requirements!”

One of the team’s upcoming reports will focus on parental concerns about COVID-19 vaccinations for their children.

Although this report summarizes the data nationally, the team has state-level data, and will make it available upon request.

Map from the State Behavior Dashboard. (The COVID States Project)

For more reports, see the project’s State Behavior Dashboard, which explores behaviors such as “avoiding contact with other people” by state, and the COVID Tweet Dashboard, which shows trends in most-shared news sites on Twitter.

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