Family Ties: Are Hawaii's Multigenerational Households More At Risk?
This is part of a series of posts highlighting results from the Hawaii COVID Contact Tracking Survey conducted by the National Disaster Preparedness Training Center (NDPTC) and the Pacific Urban Resilience Lab (PURL) at the University of Hawaii at Manoa. The Hawaii Data Collaborative has partnered with this group to share regular analyses and updates from this survey in the coming weeks. If you have not done so already, we encourage you to participate in the survey here.
It’s no secret that a large percentage of Hawaii’s population is made up of multigenerational households—three or more generations living under one roof. But it might surprise some that we lead the nation, at around 7.7 percent of all households, according to the US Census Bureau (2018 American Community Survey, 1-year Estimates). Of the 5 largest ethnic groups in Hawaii, they are led by Filipinos at 17.1 percent, followed by Native Hawaiians at 13.6 percent and Chinese at 11.9 percent (2017 American Community Survey, 5-year PUMS).
The reasons are fairly well known: our high cost of living, our chronic housing shortage, a large immigrant population and, of course, our cultural sensibilities. While some may find that generational makeup heartwarming and reassuring, it can also invite domestic environments and social interactions that may encourage the spread of Coronavirus—with more adult members under one roof than single generation households and with working adults traveling daily between the office and home, or serving the general public then returning to a home with seniors and children sheltering in place.
In Hawaii, nearly 250,000 people live in multigenerational households (about 1 in 5 people), according to the American Community Survey. These households are found in all communities across the islands, but at greater density in urban areas (Map 1). Italy and Spain also have a large number of individuals in multigenerational households, a fact that some believe helped spur the spread of the virus in those countries.
In addition, Hawaii also has a large number of extended families who live in close proximity to each other—within easy driving distance—unlike many extended families on the mainland separated by hundreds of miles (the exception here being those separated by islands). Some families have to balance social distancing with the need to look in on fragile seniors living on their own, which is stressful and wrenching. But it’s a choice many families are being forced to make during this pandemic. The desire to be with family members to celebrate and share life’s special and ordinary moments is just as compelling.
Could those familial situations and pressures lend themselves to potentially more clusters of outbreaks centered around extended families, especially as we begin to relax pandemic restrictions? When we are around family, either under one roof or otherwise, do we tend to let our guard down with distancing, hygiene and protective clothing? As we begin to open up the state, our offices and our homes, do our behaviors change because it’s grandma and not the postman; because it’s a present from Auntie Sue and not from Walmart; or because it’s a party with cousins and not co-workers?
Despite the abundance of multigenerational households, the state has bucked the odds and has maintained one of the lowest rates of exposure to the Coronavirus in the nation. This new phase of the pandemic will test our resolve. Where do we need to keep our guard up? While all eyes are on the growing influx of visitors, who is watching our own back yards?
According to data collected from our surveys, the risk of exposure to COVID-19 decreases as age increases for both multigenerational and non-multigenerational households. However, after age 40, respondents in multigenerational households are more likely to report being exposed to COVID-19 (Figure 1). To be clear, it is not that multigenerational households are inherently more at risk. Rather they are, on average, simply larger in size. And increased household size often means increased risk of exposure. Thus, the risk of exposure does not differ between multigenerational and non-multigenerational households of the same size.
There is a positive relationship between the number of people in the household and risk of exposure in households with more than 9 people. Further, there is an interesting curved pattern in the risk of exposure, which increases as household size tends toward 6 and decreases until it reaches 9 (Figure 2). One theory is that these midsized households (between 4 and 8 people) tend to have younger individuals who are more likely be exposed to the virus (see Underlying Health Conditions and How They Impact Our Vulnerability in Hawaii).
In the same way that multigenerational households are not inherently more risky; larger households are not in and of themselves at greater risk of exposure—size alone does explain degree of risk. Rather, it is the multiplier effect when households interact with their communities (e.g., work, shopping, school, etc.) that increases the risk of exposure for individuals in larger households. This can be seen in early models built from our survey data that show the risk of exposure greatly increases among respondents who recently traveled, as well as respondents who reported working within the past week.
In other words, when you live with other people or live in large households, the risk for everyone increases the more we go out into the community. While that fact may seem self-evident, there is a compelling need for all of us to keep reflecting on it.
Related Posts in this Series
Insights From the Hawaii COVID Contact Tracking Survey
The Good, The Bad, and Social Distancing in Hawaii
Ongoing and Comprehensive Information Key to Reopening Hawaii
Our Kupuna: Understanding Their Risks
Contact Tracing versus Contact Tracking
How Vulnerable is Hawaii in the Face of a Coronavirus Pandemic?
Small Business May Play A Not-So-Small Part In Restarting Hawaii's Economy
Underlying Health Conditions and How they Impact Our Vulnerability in Hawaii
