Educational Disparities in COVID-19 Prevention in China: The Role of Contextual Danger, Perceived Risk, and Interventional Context

Despite the social disparities in COVID-19 infection, little is known about factors influencing social disparities in preventive behaviors during the pandemic. This study examined how educational disparities in mask-wearing, handwashing, and limiting public outings might be contingent upon three factors: contextual cue of danger, perceived risk of local outbreak, and interventional context with different levels of intensity (i.e, Wuhan vs. other areas). Data were obtained from a telephone survey of 3327 adults, who were recruited through a random-digit-dial method to be representative of all cell phone users in China. Interviews were conducted from 28 April to 26 May 2020. Stratified multiple regression models showed that educational disparities in all three behaviors were only consistently observed among people exposed to context cues of danger, with an enhanced sense of risk of a local outbreak, or in areas other than Wuhan. College education seems to make a difference in handwashing regardless of contextual cues of danger or perception of risk. The findings suggested that, in the process of an epidemic, emerging threats in one’s immediate environment or raised awareness of risks are important conditions triggering educational disparities in prevention. However, effective public health interventions could potentially reduce such disparities.