Peer Reviewed Professional Journal Article on Vermont Public Health

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Peer-reviewed

Research Article

Survey of awareness, attitudes, and compliance with COVID-19 measures among Vermont residents

• John Hanley

Survey of awareness, attitudes, and compliance with COVID-nineteen measures among Vermont residents

• Christine Vatovec,
• John Hanley

10

• Published: March 14, 2022
• https://doi.org/ten.1371/periodical.pone.0265014

Figures

Abstract

The objective of this research was to examine residents' sensation, attitudes, and compliance with COVID-xix public health guidelines in Vermont, which emerged as an early leader in national pandemic response. Our methods included conducting an online survey of adult Vermont residents between January and Apr 2021. We analyzed demographics associated with awareness and compliance, and identified features associated with non-compliance. Our results show that of the ii,208 developed Vermont residents who completed the survey, 90% were extremely aware of the land'south COVID-19 guidelines, and 95% reported knowing exactly what to do to follow recommended deportment. Political affiliation emerged as a primary cistron related to attitudes and compliance. Self-identified Republicans were less likely to concord that public wellness measures keep people safe or assistance businesses stay open up, and were less likely to follow masking, quarantine, social distancing, and vaccine guidance than Independents, Progressives, and Democrats. The big differences in COVID-19 infection and death rates across the country, and recent shift toward a "pandemic of the unvaccinated," underscore the need for identifying public health strategies that work in some areas in order to adapt and use them to areas that have struggled with controlling the virus. Consistent with national surveys, our results bear witness that resistance to public wellness guidance is a partisan challenge even in states with high compliance. Identifying populations that are less supportive or hesitant to follow guidelines while understanding factors that motivate compliance can assistance inform strategies for developing targeted programs to encourage collective action on pandemic response. Developing advice strategies that accomplish people who do not believe COVID-19 guidelines keep them safe is necessary to reach universal compliance.

Citation: Vatovec C, Hanley J (2022) Survey of awareness, attitudes, and compliance with COVID-19 measures among Vermont residents. PLoS I 17(iii): e0265014. https://doi.org/10.1371/journal.pone.0265014

Editor: Jun Tanimoto, Kyushu Daigaku, Nihon

Received: November 12, 2021; Accepted: February 21, 2022; Published: March 14, 2022

Copyright: © 2022 Vatovec, Hanley. This is an open up admission article distributed nether the terms of the Creative Commons Attribution License, which permits unrestricted employ, distribution, and reproduction in whatsoever medium, provided the original writer and source are credited.

Information Availability: All information files are available from the Harvard Dataverse (https://doi.org/10.7910/DVN/BFTPZE).

Funding: CV: Grant number: None (internal university funding) Funders: Academy of Vermont Office of the Vice President for Research (https://world wide web.uvm.edu/ovpr); University of Vermont Rubenstein School of Environs and Natural Resources (https://www.uvm.edu/rsenr); Gund Institute for the Environment (https://www.uvm.edu/gund). JH received no specific funding for this piece of work. The funders had no role in study design, information collection and analysis, decision to publish, or training of the manuscript.

Competing interests: The authors take alleged that no competing interests exist.

Introduction

Betwixt January 2020 and Jan 2022, more than 57 million COVID-19 cases including over 829,000 COVID-19 deaths were reported in the Usa, with high levels of variation across the country in terms of infection and death rates [1]. Public wellness measures including masking, social distancing, quarantine, and vaccination acceptance have all proven useful tools for responding to the pandemic [two–five]. Still, wide variation in adoption and compliance with these measures has resulted in regional variation in infection rates, with higher rates in areas not following public health guidance [6]. Therefore, there is a critical demand to identify factors associated with people who exercise not adhere to recommended public health actions in order to develop targeted public health responses to regions where the pandemic continues to spread. In this paper, nosotros present findings from a land-wide survey of Vermont—which emerged as an early on leader in pandemic response in the U.S. by consistently reporting amid the lowest rates of infection and bloodshed during the early on pandemic—that highlight aspects associated with people who report not post-obit COVID-nineteen public wellness guidance.

In September 2020, six months into the COVID-nineteen pandemic, Dr. Anthony Fauci, Director of the U.S. National Constitute of Allergy and Infectious Illness and chief medical advisor to the president, chosen Vermont'south response to the pandemic a "model for the country" [vii]. Fauci praised Vermont residents for following the state'southward public health guidance for mask-wearing, social distancing, avoiding crowds, and other measures that lowered the adventure of SARS-CoV-2 transmission [8]. At that time, Vermont had both the lowest rate of new COVID-19 infections and examination positivity in the country [i], a trend that continued through tardily summertime 2021. On June 14, 2021, Vermont was the first state in the U.S. to reach an eighty% vaccination threshold among eligible residents anile 12 years and older, and Vermont's Republican Governor Phil Scott lifted all remaining pandemic restrictions at that time [9].

Public officials accept pointed to several reasons for Vermont's early success at curtailing the COVID-19 pandemic. Vermont's land Health Commissioner Dr. Marking Levine identified the state's relatively healthy population, early activeness to perform contact tracing and testing among the state's most vulnerable populations, fast activity to promote social distancing, consistent messaging and a coordinated approach from the state authorities as among the reasons for the state's successful handling of the early pandemic [7]. Governor Scott touted following the data and trusting science for the state'due south success [9]. Both Governor Scott and Commissioner Levine heralded Vermont's residents as the cardinal factor in allowing Vermont to emerging every bit an early leader in the public health response to the pandemic [seven, 10]. And all the same these early successes yielded as the Delta and Omicron variants of SARS-CoV-two created what Governor Scott referred to as a "pandemic of the unvaccinated" [xi], leading to the highest test positivity rate and case count in Vermont since the beginning of the pandemic.

Recent behavioral science inquiry related to the pandemic provides a framework for understanding factors that influence people'southward decisions regarding public wellness recommendations. In relation to following masking guidelines the cost of masks, agreement of infection risk, and social conformity all play a office in pandemic-related prosocial behavior [12]. The social dilemma of the trade-off between perceived short-term personal costs versus long-term societal benefits that upshot from following public wellness guidance can present a barrier to prosocial behaviors [xiii]. Importantly, social norms of mask-wearing, social distancing, and other prosocial behaviors within close peer groups can aid drive compliance with recommended deportment [fourteen, 15]. In addition, policies that back up social distancing have been identified every bit a strategy to help minimize infection rates amongst unvaccinated populations [xvi].

This commodity provides insight into behaviors among Vermont's residents in response to the land's COVID-19 guidelines, and highlights populations that report non-compliance with masking, social distancing, vaccination, and other recommended public health actions. Our promise is that this data will be useful for responding to the continuing challenges of COVID-19, along with future public health challenges across the state.

Materials and methods

This research project and all related procedures were approved by the University of Vermont Institutional Review Lath (CHRBSS 1363), and was open up January thirteen through Apr 7, 2021. Data were collected using an electronic questionnaire through Qualtrics® (Provo, UT). The landing page of the online survey musical instrument provided enquiry information and a consent statement; participants who chose to proceed with the anonymous survey acknowledged their consent by clicking a consent agreement button in order to go along to the survey instrument.

Nosotros obtained a convenience sample of Vermont residents past promoting the survey invitation on country agency websites (Section of Health, Department of Tourism & Marketing, Agency of Commerce and Community Evolution), neighborhood-based listservs, and college and academy listservs (Norwich University, St. Michael's Higher, University of Vermont).

Measures

We used 5-point Likert scales to measure out awareness (extremely aware to not at all aware) of Vermont's COVID-19 public health guidelines, and agreement (strongly agree to strongly disagree) with statements regarding respondents' perceptions of and response to the state'south guidelines (e.g., I accept the recommendations from Vermont'south regime government to prevent Covid-19 very seriously). We used a 5-point Likert calibration to mensurate compliance (e'er to never) with recommended deportment (e.yard., To what extent practice you lot follow each of these recommended deportment: Wear a mask in public). Nosotros asked respondents to rank the sources of information where they had learned the most nigh Vermont'southward COVID-19 guidelines (number ane rank corresponded to the most used source). We likewise collected standard demographic data (e.yard., age, gender, income, political affiliation), as well as whether the respondent had been personally affected by COVID-19 (eastward.one thousand., frontline worker, lost a job, lost a loved one) and whether they had always tested positive for COVID-xix.

Statistical analyses

Descriptive statistics were analyzed in Qualtrics. For all three of Vermont's major political parties (Democrats, Progressives, Republicans) and self-described Independents, nosotros brandish the percent of respondents who reported that they "Always" took an action, and the percent who reported understanding ("Agree" or "Strongly Agree") with COVID-xix sensation questions and we present these analyses as dumbbell plots.

We employed the Conjunctive Clause Evolutionary Algorithm (CCEA) to better understand factors associated with respondents who 1) never quarantine, ii) do not take guidelines seriously, or 3) practice not agree that guidelines go on them safe [17]. For each of the iii outputs, nosotros ran 5 seeded iterations of the CCEA and just the most-fit conjunctive clauses were selected for each output. Nosotros so extracted features from the virtually-fit conjunctive clauses for display in a Venn diagram to highlight which features and their associated values were shared and those that were unique to each of the 3 outputs.

Results

Characteristics of survey respondents

A total of two,208 Vermont residents aged xviii years or older completed the survey, which represents 0.43% of the state's adult population (Tables 1 and S1). Respondents were predominately white/Caucasian (94%), non-Hispanic (97%), female person (75%), educated (69% with Bachelor's caste or higher), and with annual income greater than $75,000 (53%). The survey sample was representative of the state's population with regard to race and ethnicity. The survey sample included four main political affiliations (Democrat 48%, Independent 21%, Progressive eight%, and Republican 7%), highlighting the state'southward political variety. The majority of respondents (60%) reported having been personally affected past COVID-nineteen in some way, and 3% had tested positive for the virus.

Awareness and attitudes toward Vermont COVID-nineteen guidelines

Among all survey respondents, 89% (95% CI: 90–91%) were extremely enlightened of Vermont's COVID-19 guidelines, 93% (95% CI: 94–96%) had received information from the state Section of Wellness, 90% (95% CI: 89–91%) agreed that the guidelines were easy to discover, 92% (95% CI: 91–93%) reported taking the recommendations very seriously, and 94% (95% CI: 93–95%) said that they understood what to do to follow the guidelines (Fig one). Party was strongly associated with several beliefs about state guidelines. A smaller per centum of people who cocky-identified as Republican reported understanding with statements that Vermont's COVID-xix guidelines are reliable, keeping me safe, keeping Vermonters safe, and helping keep businesses open up, as compared to Independents, Democrats, and Progressives. Similarly, beliefs effectually COVID-nineteen vaccine prophylactic and effectiveness varied by political political party affiliation with 52% (95% CI: 46–60%) of Republicans and 86% (95% CI: 84–88%) of Democrats in agreement that the vaccine is constructive. Understanding that the respondent would get the vaccine every bit presently equally it became bachelor to them ranged from 67% (95% CI: 59–75%) among Republicans to 93% (95% CI: 91–95%) among Democrats.

Fig one. Percent of Vermont residents who responded with sensation and agreement to survey questions, delineated by self-identified political party affiliation, January–Apr 2021.

(Note: The first line reports the percentages of respondents who reported existence "Extremely Aware" of VT guidelines; all other lines written report the per centum who responded "Agree" or "Strongly Agree" with survey statements).

https://doi.org/10.1371/journal.pone.0265014.g001

We found two instances where the partisan trend was reversed: i) 38% (95% CI: 30–46%) of Republicans agreed that Vermont's guidelines cripple the economy compared to 6% (95% CI: 4–8%) of Democrats and 1% (95% CI: 0–iii%) of Progressives, and two) 52% (95% CI: 44–60%) of Republicans reported awareness of Vermont'southward enforcement of COVID-19 guidelines compared to 41% (95% CI: 38–44%) of Democrats and 33% (95% CI: 26–39%) of Progressives. Interestingly, less than 20% of respondents from all four political parties agreed that visitors to the state follow quarantine guidelines.

Behaviors related to Vermont COVID-19 guidelines

Compliance with Vermont's COVID-19 public health guidance too announced to follow partisan lines. Republicans consistently had the lowest pct of respondents who always followed recommended actions to prevent COVID-nineteen transmission (Fig 2). For example, more Progressives (95%; 95% CI: 92–98%), Democrats (96%; 95% CI: 95–97%), and Independents (92%; 95% CI: 89–95%) reported always wearing a mask compared to 73% (95% CI: 66–80%) of Republicans. Always avoiding social gatherings had the largest difference in response rates, ranging from 31% (95% CI: 23–39%) of Republicans to 55% (95% CI: 50–60%) of Independents, 57% (95% CI: 54–sixty%) of Democrats, and 64% (95% CI: 56–72%) of Progressives.

Fig 2. Percent of Vermont respondents who reported always post-obit recommended actions to prevent COVID-19 infection, delineated by self-identified political party affiliations, January–April 2021.

https://doi.org/ten.1371/journal.pone.0265014.g002

Factors associated with responses to Vermont's public health guidance

News sources where Vermonters received information well-nigh Vermont's COVID-19 guidelines also varied by political affiliation. Online news was the top ranked source of data on Vermont'southward COVID-19 guidelines among Progressives (45%; 95% CI: 37–53%), Democrats (42%; 95% CI: 39–45%), and Independents (41%; 95% CI: 36–46%), and the second ranked source among Republicans (32%; 95% CI: 26–40%). Television was the number ane news source among Republicans (35%; 95% CI: 27–43%; S1 Fig).

Among all respondents, the principal motivating factors for following the state'south pandemic-related guidelines were "my own health" (41%; 95% CI: 39–43%), "the wellness of my friends/family" (40%; 95% CI: 38–42%), and "the health of other Vermonters" (17%; 95% CI: 15–nineteen%; S2 Fig). Political affiliation was not associated with a significant difference in motivation for following guidelines, just did propose some trends in altruism among Progressive of whom a greater percentage ranked health of family equally their primary motivation, equally compared to Democrats, Independents, and Republicans who had a higher percentage of respondents who gave the meridian rank to their own personal health (S3 Fig).

While the majority of survey participants responded positively to questions about Vermont'due south COVID-19 guidelines (Figs i and two), nosotros wanted to explore the features associated with the minority of people who reported that they 1) never quarantined, ii) did not take the guidelines seriously, and 3) did non think the guidelines kept them safe. Fig iii shows the overlap betwixt respondents in these groups; the center of the diagram highlights that the associations between all three of these minority groups were that they did not hold with Vermont's guidelines and did not agree that the guidelines continue businesses open. We also plant overlap between these three minority groups. For instance, respondents who practise not take the guidelines seriously are also associated with never quarantining and practice not agree that the guidelines go on them prophylactic. In addition, while the overwhelming majority of Vermont residents agreed that the state guidelines were clear, there is an clan between those who did not find guidelines to be articulate and those who practise not concord that the guidelines keep them condom.

Discussion

Our written report examined Vermont residents' behavior and response to the country's COVID-xix public health recommendations between January and April 2021 in an endeavour to provide some insight into the state's relative early success in responding to the pandemic. During that fourth dimension period, state officials held twice-weekly press briefings to provide updates on virus transmission and public health measures, including a phased curlicue-out of the COVID-19 vaccine for residents. Our results show that awareness and understanding of the land'due south pandemic response plan were high, as was the overall percentage of respondents who agreed that pandemic-related public health communications was both clear and reliable. These survey outcomes back up the thought that a clear, consequent, and coordinated public health entrada is likely to effect in a higher rate of compliance with public health recommendations and mandates [18–20].

During our survey catamenia, Vermont reported fewer than twenty new cases per 100,000 residents each day, and the governor'southward (Republican) management of the pandemic had a 71% blessing rating. Nationally, the proportion of Americans who approved of their local elected officials varied by political partisanship with 41% of Republicans approval, compared with 57% of Democrats [21], a tendency that was intensified in our results (55% Republican approval, 85% Democratic) [22]. Also consistent with national trends [21, 23], our findings indicate that political affiliation was a major factor in Vermonters' attitudes toward and compliance with the state'south COVID-nineteen public health guidelines. Respondents who identified as Republican reported the lowest rates of compliance with all COVID-xix guidelines including masking, quarantine, social distancing, and vaccination as compared with all other major political parties in the state of Vermont. Observed national trends in partisan-driven non-compliance with physical distancing has been associated with higher rates of COVID-xix infection and bloodshed [24], and is an area that may be worth pursuing for hereafter investigation in Vermont.

Since vaccination against COVID-19 is both a recommended public health action and a major determinant for many state governments to relax restrictions [25], it is important to note that our written report shows that Vermonters' intention to be vaccinated (86%) was slightly college than the national average (75%), and again differed by political affiliation (67% Republicans, 96% Democrats) [26]. The partisan gap in relation to Vermont'due south pandemic response may be partially explained by our findings that Republicans were more than probable to think guidelines would cripple the economy and more than pessimistic on whether the guidelines would help Vermont businesses to remain open up. Nationally, consumption of conservative media such equally Pull a fast one on News has been associated with reduced physical distancing and college COVID-19 infection and bloodshed rates [24] and our findings that television was the principal news source amongst Republicans may suggest another potential driver of the partisan response to Vermont'due south pandemic guidelines.

Despite political partisanship in attitudes and compliance, the majority of all respondents ranked their main motivations for following recommended public health actions as protecting their ain health, the health of family and friends, and the wellness of other Vermonters. This finding is consistent with a large international survey [27], and supports the idea that public health messaging targeting these motivating factors may be one component of strategies that can cutting across political divides.

While our results evidence that Vermont residents take high levels of awareness regarding COVID-xix guidelines and adherence to actions to limit manual, the emergence of the COVID-19 Delta variant showed that those who do non take the guidelines seriously or adhere to deportment that limit the transmission of COVID-19 are likely to be the most vulnerable to infection [eleven, 28]. Therefore, it is critical to increment understanding of those features that best depict people who practise not take seriously or comply with recommended COVID-19 public wellness measures. Our analysis indicates a number of features that help draw these populations (Fig 3). Respondents who practice not agree with Vermont's guidelines, practice not agree that the guidelines keep business organization open, do not agree that the guidelines proceed them safe, and exercise not take the guidelines seriously are common features across all three questions nosotros examined. Thus, for a minority of Vermont residents there is possibly a advice issue or mayhap a philosophical disagreement with Vermont'southward guidelines. The most apropos association is betwixt respondents who practise not believe that the guidelines keep them safe and practice non agree that the guidelines are clear. Unfortunately, there are no strong correlations in our demographic information that could help the state of Vermont better target this population. It would too be helpful to understand why this group does non feel that Vermont's guidelines are clear and how the messaging could be improved so that this group can fully sympathise the guidelines and hopefully adhere to them.

Respondents who do not feel that the guidelines go along them condom are also uniquely associated with the response that they do not plan to receive the vaccine. Although Vermont currently leads the nation in vaccinations [9], the state has not achieved universal total vaccination among eligible residents despite an abundance in vaccine availability. Again, this association between respondents not planning on getting vaccinated and not assertive that the guidelines go along them safe could relate to a advice effect, suggesting that more work is needed on communicating the science behind non-pharmaceutical interventions and vaccination in limiting COVID-nineteen transmission and deaths [20, 29, 30].

In terms of actions, perhaps it is not surprising that those who never quarantine are as well not probable to always adhere to other deportment such as masking, maintaining physical distance, staying at habitation, and avoiding gatherings. Such lack of enthusiasm to limit COVID-19 transmission through non-pharmaceutical interventions makes this group peculiarly vulnerable to infection. A farther agreement of whether lack of consistent adherence to deportment is driven by external factors such every bit the nature of employment or non believing in the science backside not-pharmaceutical interventions is needed to reach universal compliance.

Limitations

While our report offers insights on pandemic response from a state that has had overall positive outcomes, several limitations are worth noting. Outset, since the survey sample nether-represented males, low income earners, Republicans, and Vermonters with lower educational attainment as compared with Vermont's full general population, our results may not fully correspond the behavior and behaviors of these groups. However, the sample does include a representative sample of racially and ethnically various Vermonters which is important considering of the historical lack of representation of these communities. 2d, the survey tool was but provided online and in English, thereby limiting the sample to English-speaking Vermonters with internet access. Finally, the study relied on self-reporting and may reflect nether- or over-reporting of Vermonters' beliefs and behaviors. Despite these limitations, data regarding community response to pandemic-related guidelines is a necessary pace toward future public health communications.

Decision

The large differences in COVID-xix infection and death rates across the land underscore the demand for identifying public health strategies that work in some areas in club to accommodate and apply them to areas that have struggled with controlling the virus. Understanding differences in attitudes and compliance with public health measures such equally masking, social distancing, and vaccination are disquisitional for enhancing current and developing futurity pandemic response guidelines and communications. Identifying populations that are less supportive or hesitant to follow guidelines while agreement factors that motivate compliance can help inform strategies for developing targeted programs to encourage collective action on pandemic response.

Supporting information

S1 Fig. News sources where respondents take received data on Vermont'southward COVID-19 Guidelines, ranked from well-nigh used (1) to least used (vii); numbers inside cells represent percent of respondents (Notation: Each rank could be applied to multiple sources).

https://doi.org/10.1371/journal.pone.0265014.s002

(TIF)

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