High rates of observed face mask use at Colorado universities align with students' opinions about masking and support the safety and viability of in-person higher education during the COVID-19 pandemic

Abstract

Background: Over the course of the COVID-19 pandemic, colleges and universities have focused on creating policies, such as mask mandates, to minimize COVID-19 transmission both on their campuses and in the surrounding community. Adherence to and opinions about these policies remain largely unknown.

Methods: The Centers for Disease Control and Prevention (CDC) developed a cross-sectional study, the Mask Adherence and Surveillance at Colleges and Universities Project (MASCUP!), to objectively and inconspicuously measure rates of mask use at institutes of higher education via direct observation. From February 15 through April 11, 2021 the University of Colorado Boulder (CU, n = 2,808 observations) and Colorado State University Fort Collins (CSU, n = 3,225 observations) participated in MASCUP! along with 52 other institutes of higher education (n = 100,353 observations) spanning 21 states and the District of Columbia. Mask use was mandatory at both Colorado universities and student surveys were administered to assess student beliefs and attitudes.

Results: We found that 91.7%, 93.4%, and 90.8% of persons observed at indoor locations on campus wore a mask correctly at University of Colorado, Colorado State University, and across the 52 other schools, respectively. Student responses to questions about masking were in line with these observed rates of mask use where 92.9% of respondents at CU and 89.8% at CSU believe that wearing masks can protect the health of others. Both Colorado universities saw their largest surges in COVID-19 cases in the fall of 2020, with markedly lower case counts during the mask observation window in the spring of 2021.

Conclusion: High levels of mask use at Colorado's two largest campuses aligned with rates observed at other institutes across the country. These high rates of use, coupled with positive student attitudes about mask use, demonstrate that masks were widely accepted and may have contributed to reduced COVID-19 case counts. This study supports an emerging body of literature substantiating masks as an effective, low-cost measure to reduce disease transmission and establishes masking (with proper education and promotion) as a viable tactic to reduce respiratory disease transmission on college campuses.

Keywords: COVID-19; Colleges; Institutes of higher education; MASCUP!; Mask Use; Mask adherence; Mask mandates; Prevention; SARS-CoV-2; Student Health; Student opinions; United States; Universities.

Fig. 1

Timeline of mask observation and student surveys at University of Colorado Boulder (CU) and Colorado State University Fort Collins (CSU). The National College Health Assessment survey at CU and the Social Norming Survey at CSU were temporally close during the Spring 2021 Semester and are used herein to compare opinions about mask use on each campus. The Surveillance Testing Survey at CU is unique in that it paired individual’s responses with their COVID-19 surveillance test results, giving insight into how different reported behaviors may associate with having tested positive for COVID-19 at any point during the 2020–2021 academic year.

Fig. 2

Comparing Masking Indoors between CU and CSU and Comparing Masking Off Campus between CU and CSU. A–B shows observations made indoors on campus at CU Boulder (CU; gold) and Colorado State (CSU; green). (A) Indicates the percentage of people wearing masks indoors on campus. (B) Indicates the percentage of people wearing masks correctly indoors on campus. C–D shows observations made outdoors off campus at CU and CSU. (C) Indicates the percentage of people wearing masks outdoors off campus. (D) Indicates the percentage of people wearing masks correctly outdoors off campus. Overall, there were no differences in masking behavior at CU compared to CSU as indicated by the p-value on each figure.

Fig. 3

Percentage of People Wearing Masks Correctly On Campus at CU. Figure shows the observed differences between masking indoors (left) and outdoors (right) on campus at CU (p < .001). A Bonferroni correction was used to compare masking behaviors indoors vs. outdoors on campus. The frequency of correct masking was higher indoors compared to outdoors (p < .001). Conversely, the frequency of incorrect and no mask usage was higher outdoors compared to indoors (p = .006 and p < .001, respectively).

Fig. 4

Percentage of People Wearing Masks Correctly Outdoors at CU. Figure shows the proportions of correct, incorrect, and no mask usage observed outdoors on campus (left) and outdoors off campus (right). At CU, there was a significant difference observed in masking behavior outdoors based on being on or off campus (p < .001). A Bonferroni post-hoc correction was used to compare masking behaviors on campus to off campus. The frequency of proper masking was higher on campus than off campus (80.7% vs. 58.4%, p < .001) and conversely the frequency of not wearing a mask was higher off campus than on campus (28.5% vs. 8.7%, p < .001). After correction there was no statistically significant difference between wearing a mask incorrectly on campus or off campus (10.6% vs. 13.1%, p = .754).

Fig. 5

CU Boulder (Gold) and CSU Fort Collins (Green) Confirmatory/Diagnostic PCR COVID-19 Cases (7-day rolling average). Figure shows the 7-day rolling average of PCR diagnostic test confirmed COVID-19 cases over the academic year at CU (Gold) and CSU (Green). 7-day rolling average is calculated using sum of prior 7-day case counts divided by 7. The red outline is used to represent the period in which observations were performed at the universities