Social Distancing as a Health Behavior: County-Level Movement in the United States During the COVID-19 Pandemic Is Associated with Conventional Health Behaviors

Abstract

Background: Social distancing-when people limit close contact with others outside their household-is a primary intervention available to combat the COVID-19 pandemic. The importance of social distancing is unlikely to change until effective treatments or vaccines become widely available. However, relatively little is known about how best to promote social distancing. Applying knowledge from social and behavioral research on conventional health behaviors (e.g., smoking, physical activity) to support public health efforts and research on social distancing is promising, but empirical evidence supporting this approach is needed.

Purpose: We examined whether one type of social distancing behavior-reduced movement outside the home-was associated with conventional health behaviors.

Method: We examined the association between GPS-derived movement behavior in 2,858 counties in USA from March 1 to April 7, 2020 and the prevalence of county-level indicators influenced by residents' conventional health behaviors.

Results: Changes in movement were associated with conventional health behaviors, and the magnitude of these associations were similar to the associations among the conventional health behaviors. Counties with healthier behaviors-particularly less obesity and greater physical activity-evidenced greater reduction in movement outside the home during the initial phases of the pandemic in the USA.

Conclusions: Social distancing, in the form of reduced movement outside the home, is associated with conventional health behaviors. Existing scientific literature on health behavior and health behavior change can be more confidently used to promote social distancing behaviors during the COVID-19 pandemic.

Keywords: COVID-19; Counties; Health behaviors; Physical activity; Smoking; Social distancing.

Fig. 1.

Change in movement behavior from the first week of March to the first week of April. Counties were categorized by the health behavior composite, which was z-scored. Best were 1.0 SD or more above the mean (n = 473, 16.6%), Very good = between 0.5 and 1 SD (n = 398, 13.9%), Good = between the mean and 0.5 SD (n = 532, 18.6%), Fair = the mean and −0.5 SD (n = 544, 19.0%), Poor = between −0.5 and −1 SD below the mean (n = 486, 17.0%), Very poor <1 SD below the mean (n = 425, 14.9%). Error bars represent 95% confidence intervals.