National variability in Americans' COVID-19 protective behaviors: Implications for vaccine roll-out

PLoS One. 2021 Nov 5;16(11):e0259257. doi: 10.1371/journal.pone.0259257. eCollection 2021.


Protective behaviors such as mask wearing and physical distancing are critical to slow the spread of COVID-19, even in the context of vaccine scale-up. Understanding the variation in self-reported COVID-19 protective behaviors is critical to developing public health messaging. The purpose of the study is to provide nationally representative estimates of five self-reported COVID-19 protective behaviors and correlates of such behaviors. In this cross-sectional survey study of US adults, surveys were administered via internet and telephone. Adults were surveyed from April 30-May 4, 2020, a time of peaking COVID-19 incidence within the US. Participants were recruited from the probability-based AmeriSpeak® national panel. Brief surveys were completed by 994 adults, with 73.0% of respondents reported mask wearing, 82.7% reported physical distancing, 75.1% reported crowd avoidance, 89.8% reported increased hand-washing, and 7.7% reported having prior COVID-19 testing. Multivariate analysis (p critical value .05) indicates that women were more likely to report protective behaviors than men, as were those over age 60. Respondents who self-identified as having low incomes, histories of criminal justice involvement, and Republican Party affiliation, were less likely to report four protective behaviors, though Republicans and individuals with criminal justice histories were more likely to report having received COVID-19 testing. The majority of Americans engaged in COVID-19 protective behaviors, with low-income Americans, those with histories of criminal justice involvement, and self-identified Republicans less likely to engage in these preventive behaviors. Culturally competent public health messaging and interventions might focus on these latter groups to prevent future infections. These findings will remain highly relevant even with vaccines widely available, given the complementarities between vaccines and protective behaviors, as well as the many challenges in delivering vaccines.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • COVID-19 / epidemiology*
  • COVID-19 / prevention & control*
  • COVID-19 Testing*
  • COVID-19 Vaccines*
  • Communicable Disease Control
  • Cross-Sectional Studies
  • Female
  • Geography
  • Hand Disinfection*
  • Health Behavior
  • Humans
  • Infectious Disease Medicine / methods
  • Internet
  • Male
  • Masks*
  • Middle Aged
  • Multivariate Analysis
  • Poverty
  • Probability
  • SARS-CoV-2
  • Surveys and Questionnaires
  • United States / epidemiology
  • Young Adult


  • COVID-19 Vaccines