. 2022 Sep;50(9):969-974.

doi: 10.1016/j.ajic.2022.04.010. Epub 2022 May 8.

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

Eric J Puttock¹, Jose Marquez², Deborah R Young¹, Abraelle M Shirley¹, Bing Han¹, Thomas L McKenzie³, Nicole J Smith⁴, Kathleen Manuel⁵, Deanna Hoelscher⁵, Suzanne Spear⁶, Monica Ruiz⁷, Charlotte Smith⁸, Kimberly Krytus⁹, Iveris Martinez¹⁰, Hosung So¹¹, Marian Levy¹², Vikki Nolan¹², Erika Bagley¹³, Amber Mehmood¹⁴, Joy Goens Thomas¹⁵, Lily Apedaile¹⁶, Shelby Ison¹⁷, Daheia J Barr-Anderson¹⁸, John G Heller¹⁹, Deborah A Cohen²⁰

Affiliations

¹ Kaiser Permanente, Southern California, Research and Evaluation, Pasadena, CA, USA.
² California State University, Long Beach, CA USA.
³ San Diego State University, San Diego, CA, USA.
⁴ Department of Kinesiology, California State University, Fresno, CA, USA.
⁵ 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.
⁶ Department of Health Sciences, California State University, Northridge, CA, USA.
⁷ Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
⁸ Environmental Health Sciences, School of Public Health, University of California, Berkeley.
⁹ University at Buffalo, Buffalo, NY, USA.
¹⁰ Center for Successful Aging, College of Health and Human Services, California State University, Long Beach, CA, USA.
¹¹ Department of Kinesiology, California State University, San Bernardino, CA, USA.
¹² The University of Memphis, School of Public Health, Memphis, TN, USA.
¹³ Muhlenberg College, Allentown, PA, USA.
¹⁴ Lead Global Disaster Management, Humanitarian Relief and Homeland Security Concentration, University of South Florida College of Public Health, Tampa, FL, USA.
¹⁵ Department of Public Health, College of Health Professions, Mercer University, Atlanta, GA, USA.
¹⁶ University of Montana Health & Medicine, Missoula, MT, USA.
¹⁷ University of Illinois, Urbana Champaign, IL, USA.
¹⁸ School of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
¹⁹ Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Norman, OK, USA.
²⁰ Kaiser Permanente, Southern California, Research and Evaluation, Pasadena, CA, USA. Electronic address: Deborah.a.cohen@kp.org.

PMID: 35545151
PMCID: PMC9080722
DOI: 10.1016/j.ajic.2022.04.010

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

Eric J Puttock et al. Am J Infect Control. 2022 Sep.

. 2022 Sep;50(9):969-974.

doi: 10.1016/j.ajic.2022.04.010. Epub 2022 May 8.

Authors

Affiliations

¹ Kaiser Permanente, Southern California, Research and Evaluation, Pasadena, CA, USA.
² California State University, Long Beach, CA USA.
³ San Diego State University, San Diego, CA, USA.
⁴ Department of Kinesiology, California State University, Fresno, CA, USA.
⁵ 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.
⁶ Department of Health Sciences, California State University, Northridge, CA, USA.
⁷ Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
⁸ Environmental Health Sciences, School of Public Health, University of California, Berkeley.
⁹ University at Buffalo, Buffalo, NY, USA.
¹⁰ Center for Successful Aging, College of Health and Human Services, California State University, Long Beach, CA, USA.
¹¹ Department of Kinesiology, California State University, San Bernardino, CA, USA.
¹² The University of Memphis, School of Public Health, Memphis, TN, USA.
¹³ Muhlenberg College, Allentown, PA, USA.
¹⁴ Lead Global Disaster Management, Humanitarian Relief and Homeland Security Concentration, University of South Florida College of Public Health, Tampa, FL, USA.
¹⁵ Department of Public Health, College of Health Professions, Mercer University, Atlanta, GA, USA.
¹⁶ University of Montana Health & Medicine, Missoula, MT, USA.
¹⁷ University of Illinois, Urbana Champaign, IL, USA.
¹⁸ School of Kinesiology, University of Minnesota, Minneapolis, MN, USA.
¹⁹ Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Norman, OK, USA.
²⁰ Kaiser Permanente, Southern California, Research and Evaluation, Pasadena, CA, USA. Electronic address: Deborah.a.cohen@kp.org.

PMID: 35545151
PMCID: PMC9080722
DOI: 10.1016/j.ajic.2022.04.010

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.

Keywords: Mask mandates; Policy; Surveillance.

PubMed Disclaimer

Figures

**Fig 1**
Map of locations of observations of mask adherence and distancing.

See this image and copyright information in PMC

Cited by

Maintaining Adherence to COVID-19 Preventive Practices and Policies Pertaining to Masking and Distancing in the District of Columbia and Other US States: Systematic Observational Study.
Ruiz MS, McMahon MV, Latif H, Vyas A. Ruiz MS, et al. JMIR Public Health Surveill. 2023 Apr 25;9:e40138. doi: 10.2196/40138. JMIR Public Health Surveill. 2023. PMID: 36888910 Free PMC article.
Effect of face-covering use on adherence to other COVID-19 protective behaviours: A systematic review.
Millest A, Saeed S, Symons C, Carter H. Millest A, et al. PLoS One. 2024 Apr 11;19(4):e0284629. doi: 10.1371/journal.pone.0284629. eCollection 2024. PLoS One. 2024. PMID: 38603671 Free PMC article.
Masks and respirators for prevention of respiratory infections: a state of the science review.
Greenhalgh T, MacIntyre CR, Baker MG, Bhattacharjee S, Chughtai AA, Fisman D, Kunasekaran M, Kvalsvig A, Lupton D, Oliver M, Tawfiq E, Ungrin M, Vipond J. Greenhalgh T, et al. Clin Microbiol Rev. 2024 Jun 13;37(2):e0012423. doi: 10.1128/cmr.00124-23. Epub 2024 May 22. Clin Microbiol Rev. 2024. PMID: 38775460 Free PMC article. Review.
Masking Behaviors in the Absence of Local Mandate-An Observational Study from Hillsborough County, Florida.
Pecoraro J, Bakour C, Oberne A, Mehmood A. Pecoraro J, et al. Int J Environ Res Public Health. 2022 Nov 30;19(23):15982. doi: 10.3390/ijerph192315982. Int J Environ Res Public Health. 2022. PMID: 36498054 Free PMC article.
Epidemiological impact of revoking mask-wearing recommendation on COVID-19 transmission in Tokyo, Japan.
Nagata M, Okada Y, Nishiura H. Nagata M, et al. Infect Dis Model. 2024 Aug 10;9(4):1289-1300. doi: 10.1016/j.idm.2024.08.002. eCollection 2024 Dec. Infect Dis Model. 2024. PMID: 39252817 Free PMC article.

See all "Cited by" articles

References

1. CDC. Delta Variant: What We Know About the Science. 2021. Accessed December 28, 2021. https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html
1. CDC. How to Protect Yourself & Others. 2021. Accessed December 28, 2021. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/preventio...
1. Cohen DA, Talarowski M, Awomolo O, Han B, Williamson S, McKenzie TL. Systematic observation of mask adherence and distancing (SOMAD): findings from Philadelphia. Prev Med Rep. 2021;23 - PMC - PubMed
1. Haischer MH, Beilfuss R, Hart MR, et al. Who is wearing a mask? Gender-, age-, and location-related differences during the COVID-19 pandemic. PLoS One. 2020;15 - PMC - PubMed
1. Clark C, Davila A, Regis M, Kraus S. Predictors of COVID-19 voluntary compliance behaviors: an international investigation. Glob Transit. 2020;2:76–82. - PMC - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

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

Affiliations

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

Authors

Affiliations

Abstract

Figures

Similar articles

Cited by

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous