COVID-19 Response-Related Discrimination Scale

1. Abstract

The COVID-19 Response-Related Discrimination Scale is a specialized, brief four-item psychometric measurement tool developed by Algarin et al. (2023) designed to capture acute interpersonal and structural experiences of mistreatment, harassment, and stigmatization precipitated by public health mitigation mandates and social disruptions during the COVID-19 pandemic. Specifically conceptualized and validated among highly vulnerable populations—principally people who inject drugs (PWID)—the instrument addresses a critical void in public health psychometrics where traditional, generalized measures of marginalization fail to account for epidemic-specific systemic dynamics. Grounded theoretically in intersectionality theory and adapted conceptually from the well-established Everyday Discrimination Scale (Forman et al., 1997; Thurber et al., 2021), the measure examines both anticipatory apprehension regarding harassment due to environmental modifications (e.g., depopulated public spaces, mask-wearing mandates) and direct exposure to heightened verbal victimization and physical endangerment.

The scale employs a dual-stage administration architecture: respondents first complete a dichotomous screening protocol (Yes = 1, No = 0) for four focal experiences, yielding a primary composite burden index spanning 0 to 4. For any affirmative endorsement, an evaluative attributional probe is deployed, asking respondents to rate the perceived role of status-based attributes (such as substance use, socioeconomic status, or racialized identity) on a 5-point Likert-type intensity metric ranging from 1 (not at all related to the discrimination experience) to 5 (a lot to do with the discrimination experience). Psychometric evaluation via Principal Component Analysis (PCA) establishes an unambiguous unidimensional factor structure characterized by an eigenvalue of 2.59, accounting for an impressive 85% of the total cumulative variance. Reliability investigations demonstrate acceptable internal consistency across parameter estimates (Cronbach’s α = 0.66; McDonald’s ω = 0.66), reflecting robust measurement efficacy for an ultra-brief screening scale. Construct and convergent validity analyses corroborate meaningful theoretical links, demonstrating statistically significant positive correlations with COVID-19 disinformation endorsement, clinical anxiety, physical assault exposures, and viral testing frequency, alongside an inverse relationship with psychological resilience.

2. Keywords

COVID-19, COVID-19 Response-Related Discrimination, Discrimination Experiences, People Who Inject Drugs, Self-Report, Interpersonal Discrimination, Public Health Policy, Health Inequities, Psychometrics, Stigma

3. Authors

The COVID-19 Response-Related Discrimination Scale was designed and validated by an interdisciplinary consortium of clinical, psychiatric, epidemiological, and harm-reduction scholars:

• Angel B. Algarin, Ph.D., MPH: Arizona State University – Downtown Campus Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Phoenix, Arizona, United States.
• Samantha Yeager, MPH: Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States (ORCID: 0000-0002-0533-1875).
• Thomas L. Patterson, Ph.D.: Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, California, United States.
• Steffanie A. Strathdee, Ph.D.: Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States (ORCID: 0000-0002-7724-691X).
• Alicia Harvey-Vera, Ph.D.: Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States.
• Carlos F. Vera, M.S.: Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States.
• Tara Stamos-Buesig: Harm Reduction Coalition of San Diego, San Diego, California, United States.
• Irina Artamanova, M.S.: Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States.
• Daniela Abramovitz, M.S.: Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States.
• Laramie R. Smith, Ph.D. (Corresponding Author): Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, San Diego, CA 92093-0507, United States. Email: [email protected].

4. Purpose

The fundamental purpose of the COVID-19 Response-Related Discrimination Scale is to systematically identify, quantify, and track discrimination directly linked to the societal, structural, and behavioral consequences of the COVID-19 pandemic response. Historically, major global respiratory pandemics have elicited profound social friction, frequently crystallizing preexisting systemic biases against marginalized populations. When broad public health mandates—such as stay-at-home orders, strict spatial distancing guidelines, commercial closures, and compulsory universal masking protocols—were enacted, they disrupted natural social ecologies. For individuals existing on the social periphery, particularly people who inject drugs (PWID), unhoused persons, and street-based communities, these containment measures introduced unprecedented hazards. As commercial corridors and public transit hubs emptied, individuals lacking private domestic sanctuaries experienced amplified hyper-surveillance, intensified police scrutiny, and escalated public hostility.

In clinical and public health paradigms, having a brief, psychometrically sound instrument allows investigators to differentiate baseline, lifetime marginalization from acute, crisis-driven surges in victimization. Prior to the creation of this instrument, behavioral scientists predominantly relied on generic instruments such as the Everyday Discrimination Scale (EDS). While invaluable for evaluating longitudinal, chronic insults, generic measures lack semantic and operational sensitivity toward context-bound triggers—such as the threat of arrest or vigilante harassment attributable solely to public masking non-compliance or being visibly present in depopulated public zones. The scale fulfills a pressing epidemiological need by isolating the specific pathways through which pandemic response interventions inadvertently compounded the vulnerability of structurally marginalized groups.

From a research and public policy perspective, data collected through this scale illuminate how state-level health countermeasures can yield unequal burdens across demographic strata. Quantifying response-related discrimination is vital for establishing health equity frameworks, identifying risk factors for treatment attrition, explaining disparities in COVID-19 vaccine uptake, and formulating harm-reduction interventions. By examining the cognitive link between experiencing elevated response-related marginalization and subsequently endorsing pandemic disinformation, the instrument serves as an explanatory bridge within crisis health communications and social epidemiology.

5. Psychological Construct

The construct assessed by this scale—termed COVID-19 Response-Related Discrimination—is operationalized as the subjective perception, anticipatory apprehension, and objective experience of unfair, hostile, or punitive interpersonal and institutional treatment that stems directly from societal adaptations to the SARS-CoV-2 pandemic. Unlike general discrimination, which is typically measured as ongoing, diffuse interpersonal bias, this construct explicitly reflects the collision between structural epidemic control measures and socially marginalized status.

The construct encompasses two primary conceptual facets:

• Anticipatory Harassment Concerns Driven by Structural Shifts: This dimension evaluates psychological vigilance and perceived threat originating from transformed public landscapes. The sudden depopulation of public spaces stripped individuals who rely on open community spaces of the protective cover of normative pedestrian crowds, increasing their conspicuousness to law enforcement and intolerant citizens. Similarly, the implementation of masking mandates created an ambiguous regulatory environment where marginalized people faced a double jeopardy: wearing a facial covering could trigger criminalized profiling (stereotyping them as dangerous or suspicious), whereas failing to wear a mask could provoke immediate moralized policing and aggressive exclusion from essential services.
• Acute Escalations in Direct Victimization: This facet captures the observed escalation in both verbal harassment (such as derogatory insults, slurs, scapegoating, or verbal accusations of spreading viral contagion) and severe physical threats or battery relative to pre-pandemic baselines. Because crises frequently intensify social scapegoating, marginalized individuals often become physical targets for societal anxiety, frustration, and disease-related terror.

Underpinning this construct is an essential attributional mechanism. Recognizing that discriminatory acts are rarely unidimensional, the construct posits that individuals interpret pandemic-specific maltreatment through the prism of their intersecting stigmatized attributes. Consequently, the operationalized construct captures both the occurrence of the event (the presence of harassment linked to COVID-19 environmental shifts) and the degree to which respondents attribute this hostility to their underlying social positions (such as their identity as a person who uses drugs, racial identity, or unhoused status).

6. Theoretical Framework

The theoretical framework undergirding the COVID-19 Response-Related Discrimination Scale is grounded at the nexus of Minority Stress Theory (Meyer, 2003), Intersectionality Theory (Crenshaw, 1989), and Social Stigma Theory (Goffman, 1963). Minority Stress Theory postulates that individuals belonging to socially stigmatized demographics experience chronic, additive physiological and psychological strain over and above the routine stressors encountered by dominant populations. This framework distinguishes between distal minority stressors (external objective events such as physical assault, rejection, and verbal harassment) and proximal minority stressors (internalized subjective appraisals such as hypervigilance, anticipation of mistreatment, and fear of institutional violence). The scale directly encapsulates these dynamics: Items 1 and 2 capture proximal, anticipatory stress responses evoked by institutional policies (empty streets and masking requirements), while Items 3 and 4 index distal, manifest victimizations occurring within the pandemic landscape.

Simultaneously, the scale is informed by intersectional frameworks within public health crises. As described by theorists like Collins (2000) and Bowleg (2012), structural oppressions do not operate as isolated, additive variables; rather, they intersect to create distinct structural realities. For people who inject drugs, preexisting stigmas—grounded in criminalization, clinical marginalization, and moral condemnation—became violently entangled with public health containment efforts. When municipal authorities issued mandates commanding citizens to stay indoors, individuals experiencing homelessness or housing instability were rendered instantly non-compliant, transforming standard public health mandates into tools of regulatory oppression and street-level harassment.

Finally, the scale draws upon adaptation paradigms established by the Everyday Discrimination Scale (Williams et al., 1997; Forman et al., 1997). The EDS fundamentally reconceptualized discrimination research by proving that mundane, recurrent slights and chronic micro-insults often inflict equal or greater psychological damage than isolated major legal civil rights violations. Algarin and colleagues (2023) adapted this legacy to crisis circumstances, identifying that unprecedented emergencies generate entirely new categories of everyday structural friction, requiring dedicated measurement protocols to track their behavioral and mental health sequelae.

7. Validity

The psychometric evaluation performed by Algarin et al. (2023) demonstrates strong empirical evidence supporting the scale’s construct, convergent, and concurrent validity within a cohort of community-recruited individuals who inject drugs in the United States.

Construct and Convergent Validity

Construct validity was confirmed through correlation analyses testing hypothesized relationships with theoretically interconnected psychosocial, behavioral, and clinical markers:

• COVID-19 Disinformation Endorsement: Demonstrating construct validity, higher scores on the scale significantly correlated with an increased tendency to endorse COVID-19 disinformation (r = 0.18; p = 0.007). This finding substantiates the behavioral theory that individuals experiencing discriminatory abuse from public health mandates and state agents develop deep epistemic mistrust, making them significantly more receptive to non-mainstream or conspiratorial health narratives.
• Clinical Anxiety: The instrument demonstrated a strong, statistically significant positive correlation with elevated symptoms of general anxiety (r = 0.33; p < 0.001). This large effect size confirms that pandemic-induced social harassment functions as a salient psychological stressor exacerbating mental health distress.
• Physical Assault History: A positive correlation was observed between the scale and experiences of physical assault within the preceding 6 months (r = 0.14; p = 0.006), validating the tool’s capacity to reflect genuine environmental vulnerability and violent victimization.
• Testing Engagement: Discriminatory experiences positively correlated with having undergone a COVID-19 diagnostic test (r = 0.17; p = 0.001), reflecting increased scrutiny, mandated workplace/shelter screenings, or heightened symptomatic presentations.

Discriminant and Divergent Patterns

Divergent validity was substantiated through an inverse correlation with psychological resilience. Scores on the COVID-19 Response-Related Discrimination Scale were negatively associated with validated resilience inventories (r = -0.18; p < 0.001), indicating that psychological fortitude and adaptive resources buffer against subjective perceptions of marginalization, or conversely, that systemic discrimination degrades individual coping reserves.

8. Reliability

The internal consistency of the COVID-19 Response-Related Discrimination Scale was assessed within a vulnerable field-based sample, producing psychometric indicators appropriate for brief four-item screening instruments. Standard classical test theory estimates revealed:

• Cronbach’s Alpha (α): 0.66
• McDonald’s Omega (ω): 0.66

In psychometric methodology, while comprehensive diagnostic batteries typically aim for internal consistency thresholds of α ≥ 0.80, ultra-brief scales consisting of four or fewer items mathematically depress raw coefficient alpha values due to alpha’s known sensitivity to test length. In applied psychometrics, a reliability coefficient between 0.65 and 0.70 for an ultra-brief instrument operating in highly heterogeneous, marginalized community settings is recognized as acceptable and structurally stable, particularly when capturing multifaceted experiential dimensions (anticipatory anxiety versus past physical battery).

Furthermore, the exact equivalence between Cronbach’s alpha and McDonald’s omega (α = ω = 0.66) indicates tau-equivalence among items, demonstrating that the four questions contribute essentially equal weight to the latent construct without substantial violation of essential parallel measurement assumptions.

9. Factor Analysis

The structural dimensionality of the COVID-19 Response-Related Discrimination Scale was systematically explored using Principal Component Analysis (PCA) conducted on the primary dichotomous indicator matrix.

Eigenvalue and Variance Extraction

The PCA extracted a single primary component, decisively confirming the unidimensional nature of the instrument. The extracted component demonstrated an Eigenvalue of 2.59, substantially exceeding the classic Kaiser-Guttman criterion threshold of 1.0. This single dominant dimension accounted for an extraordinary 85% of the total cumulative variance across the scale items. The remaining residual eigenvalues failed to surpass 0.50, and scree plot inspections displayed an unmistakable elbow following the first component, verifying that a unidimensional construct adequately accounts for the observed inter-item variance.

Item Loadings and Component Architecture

All four items exhibited high, positive structural loadings onto the solitary component, with factor saturation values confirming that both anticipatory institutional concerns (worries over police/harasser presence due to deserted streets and masking behaviors) and manifest behavioral victimization (escalated verbal abuse and physical threats) measure the identical underlying continuum of response-related discrimination burden. The extraordinary magnitude of the extracted variance (85%) supports the use of a simple, unweighted summative score across the four items.

10. Instrument / Measurement Tool

• Test Type: Original Psychometric Questionnaire / Brief Screening Instrument.
• Target Population: Human adults (aged 18 years and older), validated specifically with marginalized vulnerable groups including people who inject drugs (PWID).
• Administration Format: Self-report questionnaire or interviewer-administered survey protocol (suitable for digital, paper-and-pencil, or street-intercept administration).
• Item Count: 4 core behavioral/experiential items, each followed by conditional status-attribution follow-up queries.
• Primary Response Metric: Dichotomous classification: Yes (= 1) and No (= 0).
• Secondary Attribution Metric: For each item answered affirmatively (Yes), respondents complete a 5-point Likert-type intensity scale evaluating attributional factors: 1 = “not at all related to the discrimination experience” to 5 = “a lot to do with the discrimination experience.”
• Scoring Protocols:
  • Primary Composite Burden Score: Sum the dichotomous scores across Items 1 through 4. The resulting score ranges from 0 to 4, where 0 indicates no endorsed response-related discrimination and 4 denotes maximal, multidimensional discrimination exposure.
  • Attribution Sub-scores: The secondary continuous ratings are analyzed descriptively or continuously to discern whether discrimination was perceived as being driven by substance use stigma, racial/ethnic bias, poverty, or other socio-demographic indicators.
• Administration Time: Approximately 2 to 3 minutes.

11. Permissions & Fee and Test Year

• Year of Development: 2023.
• Academic Copyright & Permissions: The scale was established as an open-access academic measure for clinical, educational, and empirical investigation. It may be utilized freely without financial royalties for non-commercial research, academic inquiry, and public health surveillance purposes.
• Commercial Exploitation: Strictly prohibited without express authorization from the primary authors and copyright holders.
• Usage Fee: Free ($0.00). No licensing or administration fees are charged for academic or non-profit evaluation.
• Primary Contact / Inquiries: Dr. Laramie R. Smith, Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, San Diego, CA 92093-0507, USA. Email: [email protected].

12. References

Algarin, A. B., Yeager, S., Patterson, T. L., Strathdee, S. A., Harvey-Vera, A., Vera, C. F., Stamos-Buesig, T., Artamanova, I., Abramovitz, D., & Smith, L. R. (2023). The moderating role of resilience in the relationship between experiences of Covid-19 response-related discrimination and disinformation among people who inject drugs. Drug and Alcohol Dependence, 246, Article 109831. https://doi.org/10.1016/j.drugalcdep.2023.109831

Bowleg, L. (2012). The problem with the phrase women and minorities: Intersectionality—an important theoretical framework for public health. American Journal of Public Health, 102(7), 1267–1273. https://doi.org/10.2105/AJPH.2012.300750

Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment (2nd ed.). Routledge.

Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1989(1), 139–167.

Forman, T. A., Williams, D. R., & Jackson, J. S. (1997). Race, place, and discrimination. In C. Gardner (Ed.), Perspectives on Social Problems (Vol. 9, pp. 231–261). JAI Press.

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.

Gonzales, G., & Blewett, L. A. (2014). National and state trends in health insurance coverage for same-sex partner households, 2008–2012. Medical Care, 52(9), 834–840.

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674

Thurber, K. A., Colonna, E., Jones, R., Gee, G. C., Priest, N., Cohen, R., Williams, D. R., & Lovett, R. (2021). Call to action: A need for greater vigilance, transparency, and accountability in the measurement of racism in health research. Social Science & Medicine, 272, Article 113661. https://doi.org/10.1016/j.socscimed.2020.113661

Williams, D. R., Yu, Y., Jackson, J. S., & Anderson, N. B. (1997). Racial differences in physical and mental health: Socio-economic status, stress and bias. Journal of Health Psychology, 2(3), 335–351. https://doi.org/10.1177/135910539700200305

13. Items of the Scale