Differential COVID-19 preventive behaviors among Asian subgroups in the United States

ABSTRACTBackground Given the observed within-Asian disparity in Covid-19 incidence, we aimed to explore the differential preventive behaviors among Asian subgroups in the United States.Methods Based on data from the Asian subsample (N = 982) of the 2020 Health, Ethnicity and Pandemic survey, we estimated the weighted proportion of noncompliance with Center for Disease Control and Prevention (CDC) guidelines on preventive behaviors and Covid-19 testing by Asian subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian). We examined these subgroup differences after adjusting for demographic factors and state-level clustering.Results Filipinos demonstrated the lowest rate of noncompliance for mask-wearing, social distancing and handwashing. As compared with the Filipinos, our logistic models showed that the Chinese and the 'other Asians' subgroup had significantly higher risk of noncompliance with mask-wearing, while the Japanese, the Vietnamese, and other Asians were significantly more likely to report noncompliance with social distancing.Conclusions The significant variation of preventive behavior across Asian subgroups signals the necessity of data disaggregation when it comes to understanding the health behavior of Asian Americans, which is critical for future pandemic preparedness. The excess behavioral risk among certain Asian subgroups (especially those 'other Asians') warrants further investigation and interventions about the driving forces behind these disparities.KEYWORDS: Asian AmericansCovid-19hand-washingmask-wearingmortalitysocial distancingDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Author contributionsAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Dejun Su, Ahan Shi, YuJing Wu and Laite Chen. The first draft of the manuscript was written by Ahan Shi, YuJing Wu and Laite Chen. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.Declaration of interestThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to discloseAmong those who had not had Covid at time of surveyWFH: work from home; CI, confidence interval; CDC, Center for Disease Control and Prevention;Additional informationFundingThe "Health, Ethnicity, and Pandemic" study was funded by the Center for Reducing Health Disparities at the University of Nebraska Medical Center, The Chinese Economists Society, and the Calvin J. Li Memorial Foundation.