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ImportanceEfforts to understand the complex association between social media use and mental health have focused on depression, with little investigation of other forms of negative affect, such as irritability and anxiety. ObjectiveTo characterize the association between self-reported use of individual social media platforms and irritability among US adults. Design, Setting, and ParticipantsThis survey study analyzed data from 2 waves of the COVID States Project, a nonprobability web-based survey conducted between November 2, 2023, and January 8, 2024, and applied multiple linear regression models to estimate associations with irritability. Survey respondents were aged 18 years and older. ExposureSelf-reported social media use. Main Outcomes and MeasuresThe primary outcome was score on the Brief Irritability Test (range, 5-30), with higher scores indicating greater irritability. ResultsAcross the 2 survey waves, there were 42 597 unique participants, with mean (SD) age 46.0 (17.0) years; 24 919 (58.5%) identified as women, 17 222 (40.4%) as men, and 456 (1.1%) as nonbinary. In the full sample, 1216 (2.9%) identified as Asian American, 5939 (13.9%) as Black, 5322 (12.5%) as Hispanic, 624 (1.5%) as Native American, 515 (1.2%) as Pacific Islander, 28 354 (66.6%) as White, and 627 (1.5%) as other (ie, selecting the other option prompted the opportunity to provide a free-text self-description). In total, 33 325 (78.2%) of the survey respondents reported daily use of at least 1 social media platform, including 6037 (14.2%) using once a day, 16 678 (39.2%) using multiple times a day, and 10 610 (24.9%) using most of the day. Frequent use of social media was associated with significantly greater irritability in univariate regression models (for more than once a day vs never, 1.43 points [95% CI, 1.22-1.63 points]; for most of the day vs never, 3.37 points [95% CI, 3.15-3.60 points]) and adjusted models (for more than once a day, 0.38 points [95% CI, 0.18-0.58 points]; for most of the day, 1.55 points [95% CI, 1.32-1.78 points]). These associations persisted after incorporating measures of political engagement. Conclusions and RelevanceIn this survey study of 42 597 US adults, irritability represented another correlate of social media use that merits further characterization, in light of known associations with depression and suicidality. 

ImportanceTrust in physicians and hospitals has been associated with achieving public health goals, but the increasing politicization of public health policies during the COVID-19 pandemic may have adversely affected such trust. ObjectiveTo characterize changes in US adults’ trust in physicians and hospitals over the course of the COVID-19 pandemic and the association between this trust and health-related behaviors. Design, Setting, and ParticipantsThis survey study uses data from 24 waves of a nonprobability internet survey conducted between April 1, 2020, and January 31, 2024, among 443 455 unique respondents aged 18 years or older residing in the US, with state-level representative quotas for race and ethnicity, age, and gender. Main Outcome and MeasureSelf-report of trust in physicians and hospitals; self-report of SARS-CoV-2 and influenza vaccination and booster status. Survey-weighted regression models were applied to examine associations between sociodemographic features and trust and between trust and health behaviors. ResultsThe combined data included 582 634 responses across 24 survey waves, reflecting 443 455 unique respondents. The unweighted mean (SD) age was 43.3 (16.6) years; 288 186 respondents (65.0%) reported female gender; 21 957 (5.0%) identified as Asian American, 49 428 (11.1%) as Black, 38 423 (8.7%) as Hispanic, 3138 (0.7%) as Native American, 5598 (1.3%) as Pacific Islander, 315 278 (71.1%) as White, and 9633 (2.2%) as other race and ethnicity (those who selected “Other” from a checklist). Overall, the proportion of adults reporting a lot of trust for physicians and hospitals decreased from 71.5% (95% CI, 70.7%-72.2%) in April 2020 to 40.1% (95% CI, 39.4%-40.7%) in January 2024. In regression models, features associated with lower trust as of spring and summer 2023 included being 25 to 64 years of age, female gender, lower educational level, lower income, Black race, and living in a rural setting. These associations persisted even after controlling for partisanship. In turn, greater trust was associated with greater likelihood of vaccination for SARS-CoV-2 (adjusted odds ratio [OR], 4.94; 95 CI, 4.21-5.80) or influenza (adjusted OR, 5.09; 95 CI, 3.93-6.59) and receiving a SARS-CoV-2 booster (adjusted OR, 3.62; 95 CI, 2.99-4.38). Conclusions and RelevanceThis survey study of US adults suggests that trust in physicians and hospitals decreased during the COVID-19 pandemic. As lower levels of trust were associated with lesser likelihood of pursuing vaccination, restoring trust may represent a public health imperative. 

Abstract Critical Race Theory (CRT) has become a flashpoint of elite political discord, yet how Americans actually perceive CRT is unclear. We theorize that Republican elites utilized a strong framing strategy to re-define CRT as an “empty signifier” representing broader racial and cultural grievances. Using a survey and a pre-registered experiment among U.S. adults (N = 19,060), we find that this strategy worked. Republicans exhibit more familiarity with CRT and hold more negatively valenced (and wide ranging) sentiments toward CRT, relative to Democrats. Moreover, compared to teaching the legacy of racism in schools, Republicans are significantly more opposed to teaching CRT while Democrats express greater uncertainty. Our findings suggest that by framing CRT as a broad term that envelopes many grievances (including those beyond the scope of CRT), Republican elites have shaped a subset of Americans’ understanding of and attitudes toward CRT. 

Abstract Depression can affect individuals’ attitudes by enhancing cognitive biases and altering perceptions of control. We investigate the relationship between depressive symptoms and Americans’ attitudes regarding domestic extremist violence. We develop a theory that suggests the association between depression and support for political violence depends on conspiracy beliefs, participatory inclinations, and their combination. We test our theory using a two‐wave national survey panel from November 2020 and January 2021. We find that among those who hold conspiracy beliefs and/or have participatory inclinations, depression is positively associated with support for election violence and the January 6 Capitol riots. The participatory inclination dynamic is particularly strong for men. Our findings reveal how the intersection of two concerning features of American society—poor mental health and conspiratorial beliefs—strongly relate to another feature: support for political violence. The results also make clear that interventions aimed at addressing depression can potentially have substantial political consequences. 

Gun ownership is a highly consequential political behavior. It often signifies a belief about the inadequacy of state-provided security and leads to membership in a powerful political constituency. As a result, it is important to understand why people buy guns and how shifting purchasing patterns affect the composition of the broader gun-owning community. We address these topics by exploring the dynamics of the gun-buying spike that took place during the COVID-19 pandemic, which was one of the largest in American history. We find that feelings of diffuse threat prompted many individuals to buy guns. Moreover, we show that new gun owners, even more than buyers who already owned guns, exhibit strong conspiracy and anti-system beliefs. These findings have substantial consequences for the subsequent population of gun owners and provide insight into how social disruptions can alter the nature of political groups.