Widespread misinformation about the COVID-19 pandemic has presented challenges for communicating public health recommendations. Should campaigns to promote protective behaviors focus on debunking misinformation or targeting behavior-specific beliefs? To address this question, we examine whether belief in COVID-19 misinformation is directly associated with two behaviors (face mask wearing and social distancing), and whether behavior-specific beliefs can account for this association and better predict behavior, consistent with behavior-change theory. We conducted a nationally representative two-wave survey of U.S. adults from 5/26/20-6/12/20 (n = 1074) and 7/15/20-7/21//20 (n = 889; follow-up response 83%). Scales were developed and validated for COVID-19 related misinformation beliefs, social distancing and face mask wearing, and beliefs about the consequences of both behaviors. Cross-lagged panel linear regression models assessed relationships among the variables. While belief in misinformation was negatively associated with both face mask wearing (B = −.27, SE =.06) and social-distancing behaviors (B = −.46, SE =.08) measured at the same time, misinformation did not predict concurrent or lagged behavior when the behavior-specific beliefs were incorporated in the models. Beliefs about behavioral outcomes accounted for face mask wearing and social distancing, both cross-sectionally (B =.43, SE =.05; B =.63, SE =.09) and lagged over time (B =.20, SE = 04; B =.30, SE =.08). In conclusion, belief in COVID-19related misinformation is less relevant to protective behaviors, but beliefs about the consequences of these behaviors are important predictors. With regard to misinformation, we recommend health campaigns aimed at promoting protective behaviors emphasize the benefits of these behaviors, rather than debunking unrelated false claims. Past studies Concern about misinformation predates the COVID-19 pandemic. Much attention has been paid to the proliferation of political misinformation, particularly in the wake of the 2016 U.S. presidential election (Guess et al., 2020), and how to effectively counter it (Cook et al., 2015). Misinformation is comparatively understudied in the health domain (Kreps & Kriner, 2020; Southwell et al., 2019). There is some evidence that belief in specific false health information is associated with undesirable outcomes, including lowered vaccination rates (Jolley & Douglas, 2014; Oliver & Wood, 2014), reduced contraceptive use (Thorburn & Bogart, 2005), and nonadherence to antiretroviral treatment (Bogart et al., 2010), although overall, the research is limited and the findings mixed (Nan et al., in press).

Wide-spread misinformation about the COVID-19 pandemic has presented challenges for communicating public health recommendations. Should campaigns to promote protective behaviors focus on debunking misinformation or targeting behavior-specific beliefs? To address this question, we examine whether belief in COVID-19 misinformation is directly associated with two behaviors (face mask wearing and social distancing), and whether behavior-specific beliefs can account for this association and better predict behavior, consistent with behavior-change theory. We conducted a nationally representative two-wave survey of U.S. adults from 5/26/20-6/12/20 (n=1074) and 7/15/20-7/21//20 (n=889; follow up response 83%). Scales were developed and validated for COVID-19 related misinformation beliefs, social distancing and face mask wearing, and beliefs about the consequences of both behaviors. Cross-lagged panel linear regression models assessed relationships among the variables. While belief in misinformation was negatively associated with both face mask wearing (B= -.27, SE=.06) and social distancing behaviors (B= -.46, SE=.08) measured at the same time, misinformation did not predict concurrent or lagged behavior when the behavior-specific beliefs were incorporated in the models. Beliefs about behavioral outcomes accounted for face mask wearing and social distancing, both cross-sectionally (B= .43, SE=.05; B= .63, SE=.09) and lagged over time (B= .20, SE=04; B= .30, SE=.08). In conclusion, belief in COVID-19-related misinformation is less relevant to protective behaviors, but beliefs about the consequences of these behaviors are important predictors. With regard to misinformation, we recommend health campaigns aimed at promoting protective behaviors emphasize the benefits of these behaviors, rather than debunking unrelated false claims

Political advertising can influence which issues are public policy priorities. Population health–relevant issues were frequently referenced in televised political advertising in the 2011‐2012 and 2015‐2016 US election cycles, with about one‐fourth of all ads aired mentioning traditional public health and health policy topics and more than half referencing broader determinants of population health. The volume of population health–relevant issues referenced in political ads varied by geography, political office, political party, and election cycle. Ads referencing broader determinants of population health (such as employment, education, or gender equality) rarely tied these determinants directly to health outcomes. Context Political discourse is one way that policymakers and candidates for public office discuss societal problems, propose solutions, and articulate actionable policies that might improve population health. Yet we know little about how politicians define and discuss issues relevant to population health in their major source of electoral communication, campaign advertisements. This study examined the prevalence of references to population health–relevant issues conveyed in campaign advertising for political office at all levels of government in the United States in 2011‐2012 and 2015‐2016. Understanding advertising as part of the political discourse on topics of relevance to population health yields insights about political agenda‐setting and can inform efforts to shape opinion. Methods We conducted a content analysis of all English‐language, candidate‐related campaign advertisements aired on local broadcast, national network, and national cable television in the 2011‐2012 and 2015‐2016 election cycles (3,980,457 and 3,767,477 airings, respectively). We analyzed the volume of coverage in these ads about issues relevant to population health, including narrowly defined public health issues as well as a broad range of other social, economic, and environmental factors that affect population health. Findings Across both election cycles and all electoral races, 26% of campaign advertising discussed issues relevant for the narrowly defined conceptualization of public health and 57% discussed issues pertinent to topics within the more expansive population health conceptualization. There was substantial variation in population health–related content in ads across election cycles, by level of political office, political party, and geographic area. Geographic variation indicates that where a person lives affects their potential exposure to political communication about various health‐related topics. Conclusions Political campaign ads in the United States frequently referenced population health–relevant content at all levels of government, although the ads rarely connected population health–relevant issues to health. Variation in volume and content of these references likely shaped public opinion and the public will to address population health–related policy.

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