Social and behavioral consequences of mask policies during the COVID-19 pandemic

Abstract

Mandatory and voluntary mask policies may have yet unknown social and behavioral consequences related to the effectiveness of the measure, stigmatization, and perceived fairness. Serial cross-sectional data (April 14 to May 26, 2020) from nearly 7,000 German participants demonstrate that implementing a mandatory policy increased actual compliance despite moderate acceptance; mask wearing correlated positively with other protective behaviors. A preregistered experiment (n = 925) further indicates that a voluntary policy would likely lead to insufficient compliance, would be perceived as less fair, and could intensify stigmatization. A mandatory policy appears to be an effective, fair, and socially responsible solution to curb transmissions of airborne viruses.

Keywords: COVID-19; face masks; pandemic; policy.

Fig. 1.

Behavior, knowledge and attitudes related to wearing masks in Germany during the COVID-19 pandemic. Mask wearing became mandatory in public transport and shops starting on April 27, 2020 and increased steeply (A). For people wearing masks, the probability of hand washing was between 2.71 and 7.73 times greater than for people not wearing masks; for handshakes, the probability was between 2.37 and 20.50 times greater; and, for physical distancing, odds were between 2.32 and 13.13 times greater (B). Despite increasing compliance with mask-wearing requirements and widespread agreement that wearing masks is effective, support for mandatory policies remained at a moderate level throughout and largely differed between people who fully agreed with all measures and those who rejected them (C). Finally, knowledge that fabric masks do not protect the wearer but do protect others became common among the public (D). Perceived exaggeration of policy measures based on median-split at each data collection is shown by red vs. blue lines. B displays odds ratios from binary logistic regressions, in which mask wearing predicted other behaviors. n_04/14 = 1032, n_04/21 = 1006, n_04/28 = 1018, n_05/05 = 1007, n_05/12 = 1013, n_05/19 = 972, n_05/26 = 925.

Fig. 2.

Experimental evidence shows that, independent from policies, mask wearing signals prosocial concerns (A), and is a social contract where noncompliant others are negatively evaluated (B); voluntary policies can increase stigma (C and D) and are perceived as less fair (E). Note that n_05/26 = 925 (9). Points represent mean values, and error bars represent 95% CIs. The colored areas represent rotated kernel density distributions of individual responses. All dependent variables were normalized to a range from 0 to 100.