PONE-D-21-14147

Politicization of COVID-19 Health-Protective Behaviors in the United States: Longitudinal and Cross-National Evidence

PLOS ONE

Dear Dr. vanDellen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jul 20 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Amitava Mukherjee, ME, Ph.D.

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Review of : Politicization of COVID-19 Health-Protective Behaviors in the United States: Longitudinal and Cross-National Evidence

This manuscript present two studies, the first examines the associations between political ideology, perceived COVID-19 risk and engagement in three protective behaviors in a series of US surveys. The second study expands to include mask wearing and vaccine intentions as further outcomes and compares the US against an international non-US sample.

Although the samples in these studies are large, the conclusions that can be drawn from the data are limited due to the nature of the survey roll out and structure of the data. The authors are keenly aware of this and, for the most part, clearly acknowledge these limitations.

The sample sizes are impressive and the overall statistical approach (examining correlations and mediation) is reasonable.

The basic premise of the manuscript is clear and worthwhile, essentially examining how political ideology in the US plays into the Health Belief Model (HBM) in the context of COVID-19 protective behaviors. The HBM posits that engagement in a given health behavior is the product of perceived susceptibility and severity of a disease and perceived efficacy of the behavior in preventing it (among other factors). The authors sensibly investigate the extent to which several HBM predictors mediate the established relationship between ideology and protective behavior in the US.

Below I outline my major and minor concerns with specific revisions indicated as numbered points.

Major concerns/revisions:

The biggest challenge for the studies appears to arise from the fact that political orientation was only measured at one point, and often at a different time point than the other variables in analyses. If I am incorrect about this, then a wholly different set of analyses would be more appropriate and far more informative (e.g. Random Intercepts Cross-Lagged models).

Thus the conclusions drawn are based on the assumption that political orientation is a stable individual factor that did not change throughout the survey period. I not sure how well this assumption holds, and would like to see some more discussion and justification of this. Ultimately, the authors are limited by the data they have and have made choices about how to best analyze it given those limitations.

In Study 1 the authors examine the correlations between (March baseline) political orientation and health behaviors, and identify perceived health risk of COVID-19 as significant mediator explaining the association between political orientation intended protective behvaiour across the five waves of the survey.

1) Please make clear in table 3 and 4 that is associations with ‘*baseline* political orientation’ that are presented.

In Study 2 The authors analyze the results of a large international convenience/snowball sample. After several readings I’m still not sure of the nature of surveys. A key question I have is when were people recruited? My immediate assumption was that large a sample was recruited in March and then administered follow up surveys. However, the results suggest that new participants were recruited throughout the survey period. At any given time point in Table 4, to what extent were participants returning (who had provided their political orientation in a previous wave) vs new participants (who provided their political orientation concurrently)?

2) Supplementary tables outlining the distribution of participants recruited in each wave, and their subsequent participation in following waves should be included (i.e. cross tabulating wave participation x wave recruited). The authors should also ensure that this is adequately captured in the raw data to eventually be made available with the article.

This becomes even more complicated in Table 6 where perceived risk and mask-wearing behavior were measured at different time points. This leads to a ‘cross-sectional’ mediation analysis where the effect of political orientation (as I understand it) measured at either W1,W2,W3,W4, or W5 on mask wearing at W6 is mediated by perceived risk at W5. Furthermore it is unclear how many participants are captured in such an analysis as we don’t know how many people completed both W5 and W6. It is entirely possible that I am misunderstanding this but, if so, the authors need to be clearer about *when* each construct, including political orientation was measured.

The ‘baseline’ analyses are also troublesome, in that (I assume) they cover all people who completed the baseline survey at some point between March and July. This covers a period where peoples’ perceptions and understanding of the virus would have been changing dramatically.

3) The authors should either break up the baseline analyses into separate time points, or clearly outline, both in their results and limitations, the possible problems with covering such a long time period .

Lastly the comparison between the US and non-US is a little foolhardy. Based on such an analysis, you cannot draw that conclusion that the US is somehow different to the rest of the world. It is possible that many countries are like the US in terms of politicization, and in other countries the reverse pattern plays out (i.e. liberals perceive less risk/engage in less behavior). As there is no information on the composition of the sample in terms of country (and across waves also), the reader is unable to judge.

4) Provide some indication of the extent to which other countries were represented in the data. This would not have to be a frequency table of all countries but perhaps the top 20 or so.

5) I feel it would be useful to offer some specific country comparisons (perhaps in a supplement, perhaps those where the authors have the largest sample sizes) this would offer some weight to their claim that US is different to *other countries*, rather than only comparing it to the lumped together ‘rest of the world’

6) Refrain from referring to comparing “across countries” or “between countries” or “country of residence” – non-US is not a country.

Overall, my main concerns regarding Study 2 stem from a lack of clarity about who was asked about WHAT, WHEN.

The analyses not ideal for answering the questions that the authors pose (for example HBM predictors are only considered as single mediators rather than a more comprehensive application of the full model). But I believe that they are trying to make the most of the large dataset available, covering multiple constructs in different waves. No study is perfect, and I can personally appreciate the difficulty in getting a large-scale survey off the ground in right in the middle of the first wave of an international pandemic. Given the specific time frame examined, I believe this study can make a useful contribution to the literature if appropriately revised.

Minor revisions:

Abstract

1) Remove the term ‘cross-cultural’. This was definitely not a cross-cultural analysis.

Introduction

2) P7 Capitalize protection motivation theory (for consistency with HBM)

3) P8 “…within the context of COVID-19, the group deemphasized the public health threat…” who is the group here? Conservatives? I feel like this might be referring more to conservative elites (e.g. Trump).

4) P9 there are number of citations of news articles here, which is fine. Are there any more systematic, peer-reviewed analyses of media/elite statements that could be cited to as evidence of the claim?

Study 1 Methods

5) I would be clear here, and throughout the rest of the manuscript, that what was measured was *intended* behaviors (‘I would…’) not reported behaviors (‘I have…’).

6) P15 Please report the results of your analyses controlling for demographics in a supplement.

Study 2 Methods

7) P19 “March 27th to July 13th, 2020.” Inconsistent superscripting

8) P19 “The study was approved by the Ethics…” unnecessary quote marks

9) Measuring political orientation with a 400pt scale is odd - rescaling (e.g. to -1+1) would not change the results but might make the mediation results a little more interpretable and save a few zeros.

10) P20 “Perceived Severity of Infection.” I’m pretty sure this paragraph repeats itself.

Study 2 Results

11) P23 it is great that the authors conducted multilevel analyses as a robustness checks, and I’m fine with them including the simpler analyses in the main text. But they should provide at least a summary of the results of these additional analyses in the supplementary material.

12) Again I would reiterate in this section just what is referred to when discussing ‘political orientation’ – i.e. at which point(s) it was measured.

13) Table 4, do the month rows (e.g. Late April/Early May) correspond to waves?

General Discussion

14) P31 In discussing mask use, the authors should acknowledge that the primary reason for wearing masks is to prevent the spread of the virus *to others* rather than self-protection.

15) P31 “…happening under other political leadership” – I would be specific here and note that it was democratic leadership.

16) P31 “Our studies, however, go beyond merely demonstrating that political communication has consequences that may be life-threatening.” This sentence is overstating the results, study did not investigate political communication.

17) “…allowing us to examine the stability of associations over…Ten waves in study 2” This should be rephrased – no associations were examined over all ten waves, and given political orientation was only measured once, I don’t think you can make strong claims about stability.

18) P34 “Our studies show that messages from leaders and media outlets…” again this is overstates the results. The studies did not examine media messages. ‘Indicate’ or ‘suggests’ would be more appropriate and tentative verb to use.

19) In light of the many limitations of this study, it would be good to outline a more perfect version that could be undertaken in future (e.g. examining all HBM predictors as parallel mediators of the association between politics and behavior; conducting a truly longitudinal panel study with all measures repeated at all waves, allowing statistical tests of stability and stronger casual inferences…).

Reviewer #2: In this manuscript, the [impressively large] collaboration of coauthors use two longitudinal studies of U.S. residents to show that political conservatism was

inversely associated with perceived health risk and adoption of health-protective COVID-19 behaviors over time. They also found the effects of political orientation on health-protective behaviors were mediated by perceived risk of infection, perceived severity of infection, and perceived effectiveness of the health-protective behaviors. The manuscript also includes crossnational analyses to show effects were stronger in the U.S. (N=10,923) than in an international sample (total N=51,986), highlighting the increased and overt politicization of health behaviors in the U.S.

This is an interesting study that examines aspects and implications of the relationship between political orientation and health behaviors in the case of COVID-19. It adds to a growing number of studies that have made similar observations. Although the study does not advance this literature much theoretically, it does include some additional mediating variables that contribute to our understanding of these relationships. Overall, I find the study to be generally well-written and analyzed, although I have some concerns. If these can be addressed, the study may be publishables.

First and foremost, as the authors acknowledge, the nature of the MTurk sample is problematic. The authors recognize this but dismiss the implications too readily. Why should we believe these differences did not affect results? Also, the authors should show differences between their samples (every wave) and the general US population and probe attrition in the sample further to assure readers there were no imbalances that affect results. More needs to be dine here.

The authors could also make a more compelling case by 1) presenting key patterns and findings visually in figures and 2) reporting uncertainty measures and other methodological details more clearly.

The authors also mention differences between partisanship and ideology but could do more here to distinguish and consider implications.

Finally, lots of recent work (including studies by Sander van der Linden and colleagues) on this topic is overlooked and should be integrated.

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Reviewer #1: Yes: John Kerr

Reviewer #2: No

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PONE-D-21-14147R1

Politicization of COVID-19 Health-Protective Behaviors in the United States: Longitudinal and Cross-National Evidence

PLOS ONE

Dear Dr. vanDellen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Sep 06 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Amitava Mukherjee, ME, Ph.D.

Academic Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I would like to first acknowledge the authors efforts to address my many points and their attempt to simplify the results.

Their revised analyses are now much more streamlined, but they have sacrificed some nuance in the process. I am relatively sceptical of their approach of averaging responses across waves. I’m willing to accept the proposed stability of political orientation over time. But there are inherent assumptions in averaging outcomes and mediators across waves. Fortunately the authors mitigate this to some extent by retaining the original analyses in the supplementary material, so the motivated reader can examine the effects by wave more closely and see they are relatively consistent over time. This is not the approach I would have taken, but the authors are clear about the choices they have made, and I believe their conclusions can be drawn from the results they report, so I’m willing to (begrudgingly) accept this approach.

I believe the manuscript to be publishable but note the following minor points for further revision.

I made a previous recommendation that the authors outline how future research might circumvent some of the limitations of the current study. Although their response states that they have added this to the discussion I was not able to spot it (apologies if I have missed it).

I think there may be an error in the column labels of Table S4. It currently appears that the waves were alternatingly conducted in US and non-US samples, with the table values being separated by location by row as well. I would guess that the US/Non-Us labelling in the columns is an error?

Other than that point of confusion, I found this table to be very informative for understanding the structure of dataset. I would recommend that this be included in the main text – especially as the average column represents the final variables used in the main text analyses. It would help the reader to understand what is going on a bit better. If the authors are hesitant about the size of the table then perhaps a very simple table or diagram outlining which variables were included in which waves could suffice?

I would also clarify in the main text that averages were calculated for any participant that provided a response for a given variable at least one relevant wave. That is, a given participants average score on, say, perceived efficacy of face coverings could be the average of between 1 and 4 responses, depending on how many of the relevant waves they participated in. At least that is how I interpret the revised approach – if I’m wrong then then the nature of how averages were calculated should still be clarified.

A refence on page 10 (Franz and Dhanani (2021)) is incorrectly formatted.

Table 4 – clarify the nature of the comparison column, I assume this is the F result and effect size for the PO*location interaction term in the GLM. But it is not clear in the table or text.

In Table 5 I assume the indirect effect CI is based on bootstrapping, please note in the table note or text the number of samples. I would also recommend reiterating that the PO variable was standardised in the table note.

Reviewer #2: The revisions have strengthened the manuscript and addressed my major concerns and those of the other reviewer. I leave it to the editors to render a decision about the availability of the data and any lingering concerns this may pose with respect to journal policy. In any case, the revised manuscript is theoretically and technically sound and makes a valuable contribution to the burgeoning literature onnthis topic. I support publication in its current form.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: John R Kerr

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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Politicization of COVID-19 Health-Protective Behaviors in the United States: Longitudinal and Cross-National Evidence

PONE-D-21-14147R2

Dear Dr. vanDellen,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Amitava Mukherjee, ME, Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: