Mask-wearing Behavior Research Articles

Mask wearing impacts skin barrier function and microbiome profile in sensitive skin

Mask-wearing behavior, common in the post-COVID-19 era, raises concerns for sensitive skin. This split-face study investigated mask-related changes in skin barrier function and microbiome composition among 30 female volunteers with sensitive skin and assessed the mitigating effects of a moisturizer containing biological lipids and probiotics. Skin physiological indicators (transepidermal water loss, erythema index, stratum corneum hydration, pH, temperature) of masked and unmasked areas were collected at baseline, after three hours of mask-wearing, post-tape stripping, and after 24 h, respectively. Microbiome samples collected from the masked areas before and after wearing a medical mask were analyzed with bioinformatics methods. Mask-wearing significantly weakened barrier function in both masked and adjacent unmasked areas, while reducing bacterial diversity. It was also associated with an increase in Cutibacterium (P = 0.110) and decreases in Streptococcus (P = 0.032) and Prevotella (P = 0.026) abundance. Moisturizer application prior to mask-wearing significantly reduced transepidermal water loss and erythema (both P < 0.001) and further improved erythema after 24 h (P = 0.048). These findings demonstrate that mask-wearing can disrupt the skin barrier and microbiome in individuals with sensitive skin and applying a moisturizer beforehand can mitigate mask-related discomforts by aiding barrier repair and reducing sensitivity.

Longitudinal assessment of the impact of COVID-19 infection on mask-wearing behaviors

BackgroundWearing a mask was a crucial component in slowing the COVID-19 pandemic. However, little is known about the intersectionality between mask usage, risk perception, and infection. The purpose of this study was to investigate whether risk perceptions and masking behaviors are associated with contracting SARS-CoV-2 and how contracting SARS-CoV-2 subsequently changes masking behaviors in specific situations.MethodsThis cohort study utilized survey data from the UC San Diego ZAP COVID-19 study (n = 1,230) to evaluate the risk of contracting SARS-CoV-2 in relation to baseline risk perceptions and masking behaviors in various situations and how contracting SARS-CoV-2 affects subsequent masking behavior.ResultsWe found that more consistent self-reported mask use in indoor public spaces (p = 0.03) and in other people’s houses (p = 0.002) was associated with remaining free of SARS-CoV-2 infection. We also found that contracting SARS-CoV-2 was associated with a subsequent increase in mask use in other people’s houses (p = 0.01).ConclusionsOur findings suggest that consistent mask use is correlated with decreased infection and that contracting SARS-CoV-2 may modify mask use behaviors in high-risk situations. These findings may help inform future public health messaging for infectious disease prevention.Trial registrationThis study has not been previously registered as it is an observational study. There was no pre-registration of the analytic plan for the present study.

Real-Time Detection of Face Mask Usage Using Convolutional Neural Networks

The widespread adoption of face masks has been a crucial strategy in mitigating the spread of infectious diseases, particularly in communal settings. However, ensuring compliance with mask-wearing directives remains a significant challenge due to inconsistencies in usage and the difficulty in monitoring adherence in real time. This paper addresses these challenges by leveraging advanced deep learning techniques within computer vision to develop a real-time mask detection system. We have designed a sophisticated convolutional neural network (CNN) model, trained on a diverse and comprehensive dataset that includes various environmental conditions and mask-wearing behaviors. Our model demonstrates a high degree of accuracy in detecting proper mask usage, thereby significantly enhancing the ability of organizations and public health authorities to enforce mask-wearing rules effectively. The key contributions of this research include the development of a robust real-time monitoring system that can be integrated into existing surveillance infrastructures to improve public health safety measures during ongoing and future health crises. Furthermore, this study lays the groundwork for future advancements in automated compliance monitoring systems, extending their applicability to other areas of public health and safety.

The role of the environment: how mask wearing varies across different activities

BackgroundPeople’s decisions to engage in protective health behaviors, such as mask wearing during the COVID-19 pandemic, are influenced by environmental and social contexts. Previous research on mask wearing used a single question about general mask usage in public, which may not reflect actual behavior in every setting. The likelihood of wearing a mask during one activity is also related to the likelihood of wearing a mask in another or avoiding an activity entirely. This analysis compared responses between a general question and activity-specific questions and identified patterns of mask-wearing behavior across activities.MethodsOnline, opt-in, cross-sectional surveys were conducted every 2 months from November 2020 to May 2021 (n = 2508), with quota sampling and weighting to achieve a representative sample of the U.S.population. Respondents were asked how frequently they wore a mask in public and during 12 specific activities including: on public transportation, while shopping, and attending social gatherings indoors and outdoors. Spearman’s rank order correlation was used to compare the frequency of mask wearing reported using a general question versus an activity specific question. Additionally, a latent class analysis was conducted to identify patterns of mask wearing behavior across activities.ResultsThere was little to no correlation (r = .16–0.33) between respondents’ general attitudes towards mask wearing and their reported frequency of mask wearing in different activities. Latent class analysis identified six distinct groups based on their mask wearing behaviors and avoidance of certain activities. The largest group (29%) avoided ten of the twelve activities and always wore a mask during activities that could not be avoided. Additional groups included those who avoided most activities but made exceptions when around friends or family (20%), part time mask wearers (18%), and never mask wearers (6%).ConclusionsThe findings suggest that activity-specific questions provide more accurate and useful information than a single general question. Specific, context based, questions allow for analyses that consider the nuances of people’s decision-making regarding engaging in protective health behaviors, such as mask wearing, thus enabling public health professionals to create targeted guidelines and messages.

Mask-Wearing Behavior Among Individuals Newly Diagnosed With Type 2 Diabetes: Insights From Community Health Screenings During the COVID-19 Pandemic in Indonesia

The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on people with type 2 diabete (T2D) and their health behaviors. This study investigated the associations between T2D status and mask-wearing behaviors in public settings during the first wave of COVID-19 among community residents in Yogyakarta, Indonesia. Outreach health checkups and self-report questionnaires were cross-sectionally conducted to measure for mask-wearing behavior, T2D status, and sociodemographic characteristics. Chi-square tests, bivariate, and multivariate logistic regression were performed for data analysis. Out of 254 total participants, nearly one forth (24%) of them were newly diagnosed with T2D, while 15% of them reported that they had ever been diagnosed as T2D before. There were no statistically significant associations between mask-wearing behavior and T2D status in bivariate and multivariate logistic regression models. However, Chi-square test results showed significant differences (P=0.02) in percentages of inconsistent mask-wearing behavior among those who were newly diagnosed as T2D (19.4%), those who had known as T2D (7.9%), and those who had no T2D (7.1%). This discrepancy in the results suggests the need for further investigations using larger sample size and more representative community samples to examine the associations between mask-wearing behaviors and T2D. Early diagnostic services and the awareness education for T2D is imperative to reduce the disease severity and mortality for future pandemic particularly among undiagnosed individuals who are unaware of their T2D status,

Impact of Perceived and Collective Norms on COVID-19 Preventive Behaviors in 23 Countries: A Multi-Level Approach

ABSTRACT Social norms can be studied at both the individual and societal levels. While the influence of individual perceived norms on health behaviors has been well-documented, the role of societal-level factors in social normative influence remains unclear. We adopted a multilevel approach to investigate the impact of individual-level perceived norms, country-level collective norms, and individualistic culture on mask-wearing behavior during the COVID-19 pandemic. A secondary analysis of cross-sectional data collected from 23 countries (N = 450,223) was conducted. The findings reveal that perceived descriptive norms, perceived injunctive norms, and collective norms conjointly influenced mask-wearing behavior. Positive relationships between perceived descriptive and injunctive norms and mask wearing were stronger in countries with a higher collective norm. Furthermore, positive relationships between norms (i.e., perceived descriptive norms, perceived injunctive norms, and collective norms) and mask wearing were stronger in countries with a more individualistic culture. The study provides evidence for theorizing social normative influence beyond the individual level and underscores the importance of incorporating multilevel factors in social norm research.

Towards prevention of new COVID-19 infections in institutions of higher education: factors influencing compliance with mask-wearing among public university students in Ghana.

Ghana's mask-wearing compliance with COVID-19 prevention protocols has not been as impressive among the general population. In this study, we examined factors influencing compliance with mask-wearing among public university students in Ghana to make recommendations for the prevention of new COVID-19 infections in public universities. We conducted this Census in a public university in Ghana between January and December 2022. The study design was an exploratory-cross-sectional and online survey. Structured questionnaires developed by the authors were used to collect data from 3,272 students. Data were analyzed with Jeffreys's Amazing Statistics Program (JASP). Frequency distributions were used to summarize the data into tables and graphs whilst logistic regression analysis was done to examine the factors influencing compliance with mask-wearing among participants as well as their mask-wearing behaviors in school. Compliance with mask-wearing measures was high with 85.9% of the students wearing a nose mask always or often. Agreeing that the reusable masks do not last long was associated with a reduced chance of non-compliance (OR = 0.70, 95% CI = 0.57, 0.86). However, agreeing with some challenges was associated with increased chances of non-compliance. These included concerns that it is boring to mask after wearing makeup or having a haircut (OR = 1.71, 95% CI = 1.37, 2.14), and that masking is burdensome because it has to be removed when talking (OR = 1.26, 95% CI 1.01, 1.57), and that it is difficult to hear while masked (OR = 1.36, 95% CI = 1.04, 1.79). Cost-benefit analyses, opinions about one's look, and communication difficulties are the key factors influencing students' non-compliance with mask-wearing regulations. To encourage student compliance with mask-wearing regulations at Ghana's public universities, we recommend innovation in nose mask manufacture.

Motivational Typology and Characteristics of Adolescents" Mask-Wearing Behavior After the Conclusion of the COVID-19 Emergency

Motivational Typology and Characteristics of Adolescents" Mask-Wearing Behavior After the Conclusion of the COVID-19 Emergency

The Underlying Structure of Preventive Behaviors and Related Factors During the COVID-19 Pandemic: A Comprehensive Network Analysis.

Various strategies against COVID-19 have been adopted in different countries, with vaccination and mask-wearing being widely used as self-preventive interventions. However, the underlying structure of these behaviors and related factors remain unclear. In this study, we aimed to explore the network structure of preventive behaviors during the COVID-19 pandemic and their underlying factors, incorporating age and sex in the network. We used a multi-center sample of 20,863 adults who were vaccinated against COVID-19 in China between April 1, 2021, and June 1, 2021. Networks were estimated using unregularized partial correlation models. We also estimated the accuracy and stability of the network. The preventive behaviors related to network factors revealed that self-initiated vaccination was more connected with cognition factors, and mask-wearing was more connected with personal profiles. The two clusters were linked through information-seeking and political beliefs. Moreover, self-initiated vaccination was negatively connected with vaccine hesitancy and concerns about COVID-19 vaccines and positively connected with trust in the vaccines, pandemic-related altruism, political beliefs, and being married. Mask-wearing was negatively connected with being a professional/white collar worker and higher education level and positively connected with regular physical examination, self-rated health, migration, being married, and better family relationships. Incorporation of age and sex into the network revealed relevant associations between age and mask-wearing and age and self-initiated vaccination. The network was highly accurately estimated. The subset bootstrap showed that the order of node strength centrality, betweenness, and closeness were all stable. The correlation stability coefficient (CS-coefficient) also showed the stability of this estimate, with 0.75 for node strength, 0.75 for betweenness, and 0.67 for closeness. The internal structures of vaccination and mask-wearing behaviors were quite different, the latter of which were mainly affected by socioeconomic status and health-related behaviors and the former by knowledge about vaccines and political beliefs. Information-seeking and family relationships were the bridge factors connecting these two self-preventive behavior clusters, suggesting the direction of future efforts.

Political Party Collective Norms, Perceived Norms, and Mask Wearing Behavior: A Test of the Theory of Normative Social Behavior

ABSTRACT The theory of normative social behavior (TNSB) postulates that people are influenced by others’ behaviors, which they observe from messages and experience. In addition to focusing on perceived (i.e., descriptive and injunctive) norms, the TNSB was expanded to include collective norms, which represent what people actually do. Testing this expanded theoretical model, the current study examined whether two types of collective norms – collective political norms and collective regional norms – interacted with descriptive norms to influence pandemic mask wearing behavior expectations among U.S. adults (N = 444). The interaction was statistically significant for collective political norms (β = -.74, p = .009) but not collective regional norms (β = -.16, p = .85). Specifically, descriptive norms were related to increased mask wearing expectation for all values of political party collective norms, but the effects were stronger when political party collective norms were low (i.e., low mask wearing behavior was normative). The findings support the inclusion of collective norms in the TNSB, clarify the relationships among different types of norms, and provide insights for norms-based interventions.

Association Between Risk Perceptions of COVID-19, Political Ideology, and Mask-Wearing Behavior After the Outbreak: A Cross-Sectional Survey in South Korea.

After the declaration by the World Health Organization signaling the conclusion of the COVID-19 pandemic, most countries lifted mandatory mask-wearing regulations. This study aimed to investigate factors such as risk perception and political ideology associated with continued adherence to mask-wearing among specific populations, particularly when it is no longer deemed necessary. We conducted a cross-sectional study including a sample of 1001 respondents stratified by sex, age (≥ 18 years), and region from January 31 to February 2, 2023, after the mandatory mask regulation was lifted in South Korea. Multivariate logistic regression models were applied to estimate the relationships between risk perceptions, political ideology, and mask-wearing maintenance, adjusting for factors such as sex, age, occupation, and trust in the government. Our results indicated significant associations between age, self-reported household economic status, political ideology, affective risk perception, and perceived effectiveness of the government's COVID-related measures with indoor mask-wearing. Specifically, liberals were more likely to keep mask-wearing indoors than conservatives (adjusted odds ratio [aOR]: 2.19; 95% confidence interval [CI]: 1.33-3.59); and those who perceived a greater affective risk of COVID-19 (aOR: 2.47; 95% CI: 1.96-3.10), along with those who perceived the government's countermeasures as inadequate, were more inclined to maintain the habit of wearing masks indoors (aOR: 1.90; 95% CI: 1.19-3.03). Our study highlighted the multifaceted factors influencing mask-wearing behavior in the post-COVID-19 era. Even after adjusting for various confounding factors, such as age, sex, and trust in the government, an association remained between affective risk perception, political ideology, and mask-wearing behavior. However, further research for psychological mechanisms is needed to foster a culture of preventive behaviors proportional to the risk of infection.

Exploring the Barriers and Facilitators of Mask-Wearing Behavior During the COVID-19 Pandemic in Taiwan, the United States, the Netherlands, and Haiti: A Qualitative Study.

This study explored the barriers and facilitators of mask-wearing behaviors during the pandemic in Taiwan, the United States, the Netherlands, and Haiti. Face-to-face interviews were conducted in Taiwan and online interviews were conducted with participants in the United States, the Netherlands, and Haiti. In general, the habit of wearing a mask before coronavirus disease 2019 (COVID-19) was reported by Taiwanese participants. Additionally, Taiwanese participants perceived that wearing a mask was a social responsibility during the pandemic, suggesting that the collectivistic context might influence mask-wearing behavior. Unlike the Taiwanese population, some people in the United States and the Netherlands were reluctant to wear masks due to perceived restrictions on their freedom. Participants from Haiti mentioned that people who wore masks encountered violence, bullying, and discrimination. The results of this study suggest that political leadership and mask mandates have a strong impact on people's mask-wearing behavior. These findings have valuable implications for the design of diverse behavioral interventions to enhance mask-wearing as part of infectious disease preparedness. Additionally, the findings from these countries offer valuable insights for the development of effective public health interventions to enhance society's resilience during the current pandemic and future infectious disease outbreaks.

COVID-19 Impact on Refugees Mask-Wearing Behaviors and Intentions.

COVID-19 challenged countries in addressing population and raising awareness about mask-wearing during pandemic; Lebanon is a refugee hotspot, with humanitarian responsibility for their protection. The goal of this study is to emphasize the need of raising awareness among vulnerable populations and studying their mask-wearing behavior and intentions. This research draws on findings from a survey characterized by refugees' representatives from NGO, focusing on the behaviors and implications of refugees' mask-wearing. To address the study question, a customized survey based on Theory of Interpersonal Behavior was undertaken, in which the behavior of refugees was impacted by their desire to engage in an activity. The findings show that refugees are influenced by other people's mask-wearing behavior; they view masks as providing protection and aim to use them in the future provided all enabling conditions are met. Artificial intelligence might be a better monitor for this behavior in the future.

The effect of activity-supported hand-hygiene and mask-using education on behavior of secondary school students: Wash your hands, wear your mask, do not get COVID-19!

Objective: COVID-19 still poses a global threat. Children may develop infections (COVID-19) as they dislike using masks, touch their faces more frequently while using masks, and often take off/on their masks. This quasi-experimental study aimed to examine the effect of education for secondary school students on hand hygiene and mask use. Method: A total of 273 secondary school students were included in the study and were provided with two weeks of education on hand hygiene and mask use, including presentations and practical activities. A Descriptive Information Form, the Hand Hygiene Behavior Form, and the Mask-Wearing Behavior Form were used. The data collection forms were applied before (T1) and one month after (T2) the education. Results: Of the students, 57.5% had previously received education on hand hygiene and 44.3% on correct mask use. The students’ hand hygiene behavior (T1=31.46±5.25, T2=32.90±5.43; t=98.861) and mask-wearing behavior (T1=20.10±4.48, T2=21.38±5.71; t=74.113) total mean score significantly increased after the education. Conclusion: Correct hand hygiene and mask use education, which uses simple and easy-to-use educational materials to appeal to students and allows them to participate in interactive applications, effectively makes students acquire correct hand hygiene and mask use behaviors.

Understanding consumer face mask consumption: a MaxDiff-based cluster analysis

This study aims to develop a consumer typology based on the importance of product attributes in consumer face mask consumption during the COVID-19 pandemic. An online survey with a MaxDiff experiment was employed to measure the importance of eight face mask attributes. Data were collected from 563 U.S. consumers during April 2022. Hierarchical Bayes analysis, K-means clustering, Chi-square tests, and ANOVA were used for data analysis. Results suggested that protection and comfort were the most important attributes, while appearance and brand were the least important. Based on the tradeoffs made in their purchase decision-making process, three distinct groups of face mask consumers were identified, named protection-focused, utilitarian-driven, and eco-conscious consumers. A consumer profile was established for each group, reflecting their mask-wearing behaviors, mask type preferences, and demographics. This study provides implications for face mask manufacturers and retailers to develop effective production and target marketing strategies for future respiratory pandemics.

What Sustains Mask-Wearing Behavior among Elders in a Rural Community in the Post-COVID-19 Era: An Exploratory Mixed-Methods Study.

The current study investigates the factors influencing face-mask-wearing practices among elderly individuals in rural Thailand. A mixed-methods approach was employed, involving qualitative interviews with 15 elderly participants and a subsequent survey of 201 elders. Seven subthemes were identified, including the perceived benefits of mask-wearing, the perceived threat of COVID-19, mask-wearing enhancing attractiveness and self-confidence, social norms, misconceptions about COVID-19 prevention tools, perceived barriers to mask-wearing, and resources to afford face masks. The developed themes, codes, and quotes were utilized for creating a questionnaire. The survey revealed the adherence of 81.1% of the participants to mask-wearing. Structural equation modeling (SEM) analysis demonstrated that motivation, comprising (1) the perceived threat of COVID-19, (2) alternative threats aside from COVID-19, and (3) the perceived benefits of a face mask strongly affected mask-wearing practices (β = 0.68, p < 0.001) and the willingness to wear a face mask (β = 0.61, p < 0.001). Social norms had a negative direct effect on the perceived barrier (β = -0.48, p < 0.001) and a positive direct effect on mask-wearing practices (β = 0.25, p = 0.001). This study highlights that motivation and social norms play pivotal roles in sustaining mask-wearing behavior among rural elderly populations. Encouraging local cooperative actions through community rules could initiate behavioral changes within the community. These findings contribute to the understanding of factors influencing mask-wearing and provide insights into designing effective interventions to promote mask-wearing among elderly individuals in rural areas.

Bridging online and offline dynamics of the face mask infodemic

BackgroundOnline infodemics have represented a major obstacle to the offline success of public health interventions during the COVID-19 pandemic. Offline contexts have likewise fueled public susceptibility to online infodemics. We combine a large-scale dataset of Twitter conversations about face masks with high-performance machine learning tools to detect low-credibility information, bot activity, and stance toward face masks in online conversations. We match these digital analytics with offline data regarding mask-wearing and COVID-19 cases to investigate the bidirectional online-offline dynamics of the face mask infodemic in the United States.ResultsOnline prevalence of anti-mask over pro-mask stance predicts decreased offline mask-wearing behavior and subsequently increased COVID-19 infections. These effects are partially influenced by low-credibility information and automated bot activity, which consistently feature greater anti-mask stance online. Despite their purported controversy, mask mandates generally decrease anti-mask stance online and increase mask-wearing offline, thus reducing future COVID-19 infections. Notable asymmetries are observed, however, between states run by Democratic and Republican governors: the latter tend to see higher levels of low-credibility information and anti-mask stance online, and thus lower mask-wearing and higher infection rates offline.ConclusionsThese findings contribute new insights around collective vulnerabilities to online infodemics and their links to evolving offline crises. We highlight the need to synergize and sustain targeted online campaigns from legitimate information sources alongside offline interventions in and beyond the pandemic.

The importance of attitudes on mask wearing behavior: The moderating role of trust in science

Understanding the variables and processes that predict mask wearing has implications for reducing the likelihood of viral spread during pandemics. Research has shown that trust in science and mask-wearing attitudes predict mask-wearing behavior; however, no research has investigated the interaction between these two variables across different time points of the COVID-19 pandemic. The current project presents programmatic research to address these gaps in the literature. The aim of Study 1 (N = 229; average age is 38.30 years) was to create and examine the psychometric properties of a new multi-dimensional measure of mask attitudes in a sample of US adults, and results showed that three independent factors (positive attitudes, negative attitudes, and negative comfort-related attitudes) were observed. Using this measure, the aim of Study 2 (N = 869; average age is 37.81 years) was to test the interaction between trust in science and mask attitudes across four cohorts of US adults sampled six months apart during the COVID-19 pandemic. Results showed drastic shifts in the strength of the interaction between trust in science and positive mask attitudes at predicting mask wearing between the cohorts. Implications are discussed.

Predictors and motives for mask-wearing behavior and vaccination intention

Containing a pandemic requires that individuals adhere to measures such as wearing face-masks and getting vaccinated. Therefore, identifying predictors and motives for both behaviors is of importance. Here, we study the decisions made by a cross-national sample in randomized hypothetical scenarios during the COVID-19 pandemic. Our results show that mask-wearing was predicted by empathic tendencies, germ aversion, and higher age, whilst belief in misinformation and presentation of an interaction partner as a family member lowered the safety standards. The main motives associated with taking the mask off included: rationalization, facilitating interaction, and comfort. Vaccination intention was positively predicted by empathy, and negatively predicted by belief in misinformation and higher costs of the vaccine. We found no effect of immunization status of the surrounding social group. The most common motive for vaccination was protection of oneself and others, whereas undecided and anti-vaccine groups reported doubts about the effectiveness and fear of side effects. Together, we identify social and psychological predictors and motives of mask-wearing behavior and vaccination intention. The results highlight the importance of social context for mask-wearing, easy access to vaccines, empathy, and trust in publicly distributed information.

Fostering mask-wearing with virality metrics and social media literacy: evidence from the U.S. and Korea.

Although social media can pose threats to the public health by spreading misinformation and causing confusion, they can also provide wider access to health information and opportunities for health surveillance. The current study investigates the ways in which preventive health behaviors and norms can be promoted on social media by analyzing data from surveys and experiments conducted in the U.S. and South Korea. Survey results suggest that the pathway from social media use for COVID-19 information to mask-wearing behavior through mask-wearing norms emerges only among individuals with strong perceived social media literacy in the U.S. Experimental findings show that wear-a-mask campaign posts on social media foster mask-wearing norms and behavioral intention when they come with large (vs. small) virality metrics (e.g., Likes, shares) in both the U.S. and South Korea. Additionally, American users are more willing to engage with posts that come with supportive (vs. mixed) comments by Liking, sharing and commenting. The results highlight the need to cultivate social media literacy and opportunities for exploiting social media virality metrics for promoting public health norms and behaviors.