Precautionary behaviors have demonstrated efficacy at containing the spread of COVID-1956–58. Similarly, COVID-19 vaccines have been found to reduce the risk of infection, hospitalization, and death59–61. Thus, to slow the spread of the Coronavirus and limit its negative health consequences it is crucial to understand the factors associated with individuals’ adoption of precautionary behaviors and acceptance of COVID-19 vaccines. Our study focuses on the role of kin ties among older people, which the general (pre-COVID) literature on health behaviors found to be crucial for the adoption of healthy behaviors42–44,47−49,51−52.
Our results show that having close kin is overall positively associated with older individuals’ likelihood of adopting precautionary behaviors and of being vaccinated or willing to get a COVID-19 vaccine. In particular, we find individuals in a partnership to be more likely to accept vaccine and to adopt (almost all) precautionary behaviors considered in this analysis. Results are robust to controlling for several other drivers of precautionary behaviors and vaccine acceptance (such as health and education), as well as to accounting for co-residence with kin. In addition, results are not specific for age, gender, or country groups. Most statistically significant associations are also substantially important. We find an adjusted difference in the probability of adoption of certain precautionary behavior (washing hand, using hand sanitizer, covering coughs and sneezes, reduced shopping) and of accepting COVID-19 vaccines of about 5 percentage points between partnered and unpartnered older adults, which is similar to the effect found in previous research for gender, health perception and chronic conditions11,15,18,30−31.
Although our data do not include direct measures of social control, the positive effect of kin on older people’s adoption of precautionary behaviors and vaccine acceptance in the context of the COVID-19 pandemic is in line with predictions from the pre-COVID literature which finds ample evidence of positive effects of family social control on health behaviors, such as avoidance of alcohol and cigarette consumption38,62−64. Thus, it can be speculated that during a pandemic partners and children have an important role in encouraging and controlling the respect of public health measures and recommendations to reduce the risk of contagion and its negative health effects. Evidence in our study is also consistent with social support mechanisms identified in pre-COVID studies, showing that motivational and practical help from close kin may positively influence health behaviors38,54,65. In the context of a pandemic, partners and children may provide assistance and useful information to understand the importance of precautionary behaviors and vaccination. Practical help may also be a mechanism at work. Indeed, among the health behaviors analyzed, we find that having children is especially important for a specific outcome, i.e., limiting in-person shopping. Children, in this case, might take the burden to go shop or order groceries online for their parents in order to reduce their risk of meeting strangers in a crowded indoor space, and therefore their risk of infection66–68.
The generally stronger role that we find for partners compared to children in influencing precautionary behaviors and vaccine acceptance also fits with the predominant evidence in the general literature on family and health behaviors that reports larger associations with health behaviors of being in a partnership than of having children48,52−53. This is in part explained by the stronger and more effective social control received by partners38,63, and by their usually greater provision of emotional and practical support41,52,69. In addition, partners have been found to bilaterally influence each other’s behaviors, thus reinforcing the social support and control function of being in a partnership70. In addition, previous studies found that concerns about the possible consequences of COVID-19 for family members influences precautionary behavior and vaccine acceptance30. This mechanism might also contribute explaining the stronger effect we find for partnership than for parenthood: older individuals might be more concerned about reducing the risk of infecting their partner than their children, because partners are more likely to be older individuals with health pre-conditions.
Our findings should be considered in light of some limitations. Our data could not account for the quality of relationships with partner and children for those individuals who have these ties. Previous research found that in case of conflicting relationships, family ties may also lead to health-compromising behaviors as coping mechanisms to deal with stress71. Also, the effectiveness of social control may vary with the type of behavior of the agent of the control72. Future research could examine more in detail possible heterogeneity in the role of kin ties in the context of the COVID-19 pandemic related to these and other factors (e.g., geographical distance to children and availability of friends). Also, an interesting avenue for future research is to examine the role of kin’s characteristics such as education and health. Finally, our results might be affected by differential response rates by family status during the pandemic. However, data quality controls showed that response rates remained satisfactory73.
Despite these limitations, our findings shed some light on the complex role of kin ties during the COVID-19 pandemic. It has been argued that family relationships (measured, for example, in terms of co-residence, frequent face-to-face contacts, etc.) may increase the chances of getting in contact with an infected person, thus constituting a risk to contract the virus. While it has been shown that conditional on having a (co-resident) family member infected the risk of getting the Coronavirus substantially increases74–75, the evidence on the (unconditional) risk of Coronavirus infection due to family ties per se is still scarce and, with few exceptions, is based on macro-level data. Also such macro-level analyses show mixed results76–82. A recent study83 based on part of the same individual-level data we used (SCS1) found that living with children was associated with a lower risk of Coronavirus infection for older women. Although it was not the focus on their study, the authors also found a similar effect for living with a partner for both men and women. These results are consistent with our findings of a positive association of close kin ties with precautionary behaviors and vaccine acceptance.
As Ross and colleagues52 wrote well before the onset of the COVID-19 pandemic, “a family is more than just a collection of people who might expose each other to infections and pollutants.” Thus, on the one hand, as all types of in-person contact, family contact can constitute a risk factor for Coronavirus infection. On the other hand, our study shows that partners, and to a lesser extent, children can also positively influence precautionary behaviors and vaccination. The overall effect of kin on risk of contagion and death is not easy to predict and it may vary with several factors, including extra-family (horizontal) relationships84 working status85 and age86 of family members. Our findings point to a potential positive role of kin in helping public health institutions to fight the pandemic and suggest that when analyzing the role of social relationships on COVID-19 outcomes rather than social network size per se one should account for (precautionary) behaviors and all types of contact (not limited to a specific type of ties, e.g., family) a person has. Understanding under which conditions social relationships may play a positive role in the context of a pandemic is of paramount importance and our study offers a new perspective and empirical evidence on this matter. Our findings that kin can have a positive influence on precautionary behaviors and vaccine acceptance suggest that policy makers and practitioners should focus especially on kinless individuals, especially those who are unpartnered, when designing measures to encourage the uptake and adherence to public health measures for COVID-19 prevention or in future pandemics.