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. 2025 Aug;95(8):597-603.
doi: 10.1111/josh.70026. Epub 2025 Jun 5.

After Mandates End: Complex Decision Making Regarding COVID-19 Masking in San Diego Elementary Schools Through the Social Ecological Model

Ashkan Hassani  1 , Marlene Flores  2 , Sam Streuli  2 , Yan Jiang  2 , Alison Wishard Guerra  2 , Rebecca Fielding-Miller  2
Affiliations

After Mandates End: Complex Decision Making Regarding COVID-19 Masking in San Diego Elementary Schools Through the Social Ecological Model

Ashkan Hassani et al. J Sch Health. 2025 Aug.

Abstract

Background: While mask mandates are unlikely to return in the event of a major resurgence in COVID-19 or another major respiratory disease surge, voluntary masking still shows promise. This ethnographic study seeks to understand the masking decision-making processes of parents and children in the diverse San Diego region, including US-Mexico Border school districts and military housing school communities.

Methods: We conducted 19 interviews with parents and their young children focused on COVID-19 efforts at their child's school in English and Spanish and collected detailed field notes on masking culture from over 60 systematic observations from elementary schools across San Diego County from December 2021 to May 2022. We conducted analysis using Dedoose, including multiple rounds of coding and ongoing consensus meetings between researchers.

Results: Guided by the social ecological model (SEM), we categorized the results into the following categories: Children's Attitudes and Behaviors, Parent Belief and Influence, School Culture, and District/School Mask Mandates. Each level of the SEM influenced individual and family masking behavior. In our data, School Culture in particular differentiated schools in mask adherence and encouraged masking after state mandates ended.

Implications for school health policy, practice and equity: Masking does not need to end with mandates. Masking has been proven to reduce COVID-19 transmission, and school health policies should consider encouraging masking beyond mandates.

Conclusions: Adapting health messaging to the local context, partnering with trusted community champions, and building trust across governmental, school, and public health entities can improve the effectiveness of public health messaging.

Keywords: COVID‐19; health behavior; masking; school communities.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Children's attitudes and behaviors (individual).
FIGURE 2
FIGURE 2
Two examples of child drawings.
See this image and copyright information in PMC

References

    1. Jamison J. C., Bundy D., Jamison D. T., Spitz J., and Verguet S., “Comparing the Impact on COVID ‐19 Mortality of Self‐Imposed Behavior Change and of Government Regulations Across 13 Countries,” Health Services Research 56, no. 5 (2021): 874–884, 10.1111/1475-6773.13688. - DOI - PMC - PubMed
    1. Ritter A. and Cameron J., “A Review of the Efficacy and Effectiveness of Harm Reduction Strategies for Alcohol, Tobacco and Illicit Drugs,” Drug and Alcohol Review 25, no. 6 (2006): 611–624, 10.1080/09595230600944529. - DOI - PubMed
    1. Omaleki V., Gonzalez A. F., Hassani A., et al., “‘They Protect Us as if They Were Our Mom’ Masking Attitudes From Freelist Survey Data and Qualitative Interviews in San Diego School Communities,” Journal of Community Health 49, no. 1 (2023): 17–25, 10.1007/s10900-023-01245-1. - DOI - PMC - PubMed
    1. Ai T., Adams G., and Zhao X., “Obligation or Desire: Variation in Motivation for Compliance With COVID‐19 Public Health Guidance,” Frontiers in Psychology 12 (2021): 647830, 10.3389/fpsyg.2021.647830. - DOI - PMC - PubMed
    1. Asri A., Asri V., Renerte B., et al., “Wearing a Mask—For Yourself or for Others? Behavioral Correlates of Mask Wearing Among COVID‐19 Frontline Workers,” PLoS One 16, no. 7 (2021): e0253621, 10.1371/journal.pone.0253621. - DOI - PMC - PubMed

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