Direct Observation, Estimates, and Correlates of Public Mask-Wearing During the COVID-19 Pandemic

Abstract

Objectives To estimate the prevalence of public mask-wearing in various settings through direct observation. Self-report mask-wearing is susceptible to recall bias and a desire by respondents to appear socially responsible. Direct observation of public behavior does not face such limitations and can provide differentiation between correct and incorrect mask-wearing. Methods Trained observers recorded public behavior between 11/01/2020-12/31/2020 at 37 sites across Marion County, Indiana. For each individual observed, data collection staff recorded a status of “masked,” “non-masked” or “partial mask.” “Masked” was defined as the presence of any cloth face covering or surgical mask that covered the mouth and nose, including the nostrils, and extended below the chin. “Non-masked” was defined as the complete absence of a face covering, a face covering that was worn only below the chin, a face covering held in a hand, a face covering hanging off an ear, or a face shield only. “Partial mask” was defined as the face covering only over the mouth or over the nose, but not both, or the nose being partially covered with the nostrils somewhat or fully visible. Results 80% of adults wore face masks correctly and an additional 9% were partially masked. The prevalence of mask-wearing was lowest in outdoor spaces (54%) as well as in small retail stores (58%). Higher rates of mask usage were observed at large organizations like grocery stores and “big box” retailers (84%), shopping malls (85%), civic and government sites (86%), or higher education settings (88%). Mask-wearing was more common among females (84%) than males (76%); males had a higher percentage of partial mask-wearing. Conclusions While public health professionals and agencies encourage universal mask-wearing in public settings, observed levels may still be sufficient to reduce the spread of COVID-19.