Trust as a hidden driver of epidemic-relevant behavior: Institution- and behavior-specific associations across 20 national survey waves.

Institutional trust in US public health agencies, physicians, and hospitals is a dominant predictor of protective behavior adoption during COVID-19, explaining more mask-wearing differences across groups than age, income, education, or partisan affiliation combined.

• Why it matters: Epidemic transmission models often rely on demographic contact stratification, but they may miss social and psychological drivers of protective behaviors that vary across population groups.
• What they did: Using 20 waves of a US national survey during the COVID-19 pandemic, the study tested how institutional trust predicts protective behaviors, including mask wearing during periods of strongest activity, and compared it to age, income, education, and partisan affiliation.
• The result: In unadjusted analyses, CDC trust differences (highest vs lowest) were four- to six-fold larger than differences by age, income, or education and exceeded Democratic–Republican differences; the association was institution- and behavior-specific, supporting trust as a candidate stratifier and surveillance target.

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