Association of masking policies with mask adherence and distancing during the SARS-COV-2 pandemic

Eric J. Puttock, Kaiser Permanente, Southern California, Research and Evaluation, Pasadena, CA, USA.
Jose Marquez, California State University, Long Beach, CA USA.
Deborah R. Young, Kaiser Permanente, Southern California, Research and Evaluation, Pasadena, CA, USA.
Abraelle M. Shirley, Kaiser Permanente, Southern California, Research and Evaluation, Pasadena, CA, USA.
Bing Han, Kaiser Permanente, Southern California, Research and Evaluation, Pasadena, CA, USA.
Thomas L. McKenzie, San Diego State University, San Diego, CA, USA.
Nicole J. Smith, Department of Kinesiology, California State University, Fresno, CA, USA.
Kathleen Manuel, Michael and Susan Dell Center for Healthy Living at The University of Texas Health Science Center (UTHealth), School of Public Health in Austin, Houston, TX, USA.
Deanna Hoelscher, Michael and Susan Dell Center for Healthy Living at The University of Texas Health Science Center (UTHealth), School of Public Health in Austin, Houston, TX, USA.
Suzanne Spear, Department of Health Sciences, California State University, Northridge, CA, USA.
Monica Ruiz, Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
Charlotte Smith, Environmental Health Sciences, School of Public Health, University of California, Berkeley.
Kimberly Krytus, University at Buffalo, Buffalo, NY, USA.
Iveris Martinez, Center for Successful Aging, College of Health and Human Services, California State University, Long Beach, CA, USA.
Hosung So, Department of Kinesiology, California State University, San Bernardino, CA, USA.
Marian Levy, The University of Memphis, School of Public Health, Memphis, TN, USA.
Vikki Nolan, The University of Memphis, School of Public Health, Memphis, TN, USA.
Erika Bagley, Muhlenberg College, Allentown, PA, USA.
Amber Mehmood, Lead Global Disaster Management, Humanitarian Relief and Homeland Security Concentration, University of South Florida College of Public Health, Tampa, FL, USA.
Joy Goens Thomas, Department of Public Health, College of Health Professions, Mercer University, Atlanta, GA, USA.
Lily Apedaile, University of Montana Health & Medicine, Missoula, MT, USA.
Shelby Ison, University of Illinois, Urbana Champaign, IL, USA.
Daheia J. Barr-Anderson, School of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
John G. Heller, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Norman, OK, USA.
Deborah A. Cohen, Kaiser Permanente, Southern California, Research and Evaluation, Pasadena, CA, USA. Electronic address: Deborah.a.cohen@kp.org.

Abstract

BACKGROUND: Quantification of the impact of local masking policies may help guide future policy interventions to reduce SARS-COV-2 disease transmission. This study's objective was to identify factors associated with adherence to masking and social distancing guidelines. METHODS: Faculty from 16 U.S. colleges and universities trained 231 students in systematic direct observation. They assessed correct mask use and distancing in public settings in 126 US cities from September 2020 through August 2021. RESULTS: Of 109,999 individuals observed in 126 US cities, 48% wore masks correctly with highest adherence among females, teens and seniors and lowest among non-Hispanic whites, those in vigorous physical activity, and in larger groups (P < .0001). Having a local mask mandate increased the odds of wearing a mask by nearly 3-fold (OR = 2.99, P = .0003) compared to no recommendation. People observed in non-commercial areas were least likely to wear masks. Correct mask use was greatest in December 2020 and remained high until June 2021 (P < .0001). Masking policy requirements were not associated with distancing. DISCUSSION: The strong association between mask mandates and correct mask use suggests that public policy has a powerful influence on individual behavior. CONCLUSIONS: Mask mandates should be considered in future pandemics to increase adherence.

Publication Title

American journal of infection control

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