Assessing effective mask use by the public in two countries: An observational study

Clare L. Atzema; Ivona Mostarac; Dana Button; Peter C. Austin; Arshia P. Javidan; Lauren Wintraub; Allen Li; Raumil V. Patel; Daniel Dongjoo Lee; Nathaniel P. Latham; Eric A. Latham; Patrick C.M. Brown; Rita D. Somogyi; Alex Chang; Huong Nguyen; Sara Buerk; Bin Chen; Tristen Zimmerman; Trevor Funari; Cameron Colbert; Bory Kea

doi:10.1136/bmjopen-2021-049389

Assessing effective mask use by the public in two countries: An observational study

Clare L. Atzema, Ivona Mostarac, Dana Button, Peter C. Austin, Arshia P. Javidan, Lauren Wintraub, Allen Li, Raumil V. Patel, Daniel Dongjoo Lee, Nathaniel P. Latham, Eric A. Latham, Patrick C.M. Brown, Rita D. Somogyi, Alex Chang, Huong Nguyen, Sara Buerk, Bin Chen, Tristen Zimmerman, Trevor Funari, Cameron ColbertBory Kea

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

Objectives During the COVID-19 pandemic wearing a mask in public has been recommended in some settings and mandated in others. How often this advice is followed, how well, and whether it inadvertently leads to more disease transmission opportunities due to a combination of improper use and physical distancing lapses is unknown. Design Cross-sectional observational study performed in June-August 2020. Setting Eleven outdoor and indoor public settings (some with mandated mask use, some without) each in Toronto, Ontario, and in Portland, Oregon. Participants All passers-by in the study settings. Outcome measures Mask use, incorrect mask use, and number of breaches (ie, coming within 2 m of someone else where both parties were not properly masked). Results We observed 36 808 persons, the majority of whom were estimated to be aged 31-65 years (49%). Two-thirds (66.7%) were wearing a mask and 13.6% of mask-wearers wore them incorrectly. Mandatory mask-use settings were overwhelmingly associated with mask use (adjusted OR 79.2; 95% CI 47.4 to 135.1). Younger age, male sex, Torontonians, and public transit or airport settings (vs in a store) were associated with lower adjusted odds of wearing a mask. Mandatory mask-use settings were associated with lower adjusted odds of mask error (OR 0.30; 95% CI 0.14 to 0.73), along with female sex and Portland subjects. Subjects aged 81+ years (vs 31-65 years) and those on public transit and at the airport (vs stores) had higher odds of mask errors. Mask-wearers had a large reduction in adjusted mean number of breaches (rate ratio (RR) 0.19; 95% CI 0.17 to 0.20). The 81+ age group had the largest association with breaches (RR 7.77; 95% CI 5.32 to 11.34). Conclusions Mandatory mask use was associated with a large increase in mask-wearing. Despite 14% of them wearing their masks incorrectly, mask users had a large reduction in the mean number of breaches (disease transmission opportunities). The elderly and transit users may warrant public health interventions aimed at improving mask use.

Original language	English (US)
Article number	e049389
Journal	BMJ open
Volume	11
Issue number	12
DOIs	https://doi.org/10.1136/bmjopen-2021-049389
State	Published - Dec 1 2021

Keywords

COVID-19
Health policy
Public health

ASJC Scopus subject areas

General Medicine

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10.1136/bmjopen-2021-049389

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Atzema, C. L., Mostarac, I., Button, D., Austin, P. C., Javidan, A. P., Wintraub, L., Li, A., Patel, R. V., Lee, D. D., Latham, N. P., Latham, E. A., Brown, P. C. M., Somogyi, R. D., Chang, A., Nguyen, H., Buerk, S., Chen, B., Zimmerman, T., Funari, T., ... Kea, B. (2021). Assessing effective mask use by the public in two countries: An observational study. BMJ open, 11(12), Article e049389. https://doi.org/10.1136/bmjopen-2021-049389

Atzema, CL, Mostarac, I, Button, D, Austin, PC, Javidan, AP, Wintraub, L, Li, A, Patel, RV, Lee, DD, Latham, NP, Latham, EA, Brown, PCM, Somogyi, RD, Chang, A, Nguyen, H, Buerk, S, Chen, B, Zimmerman, T, Funari, T, Colbert, C & Kea, B 2021, 'Assessing effective mask use by the public in two countries: An observational study', BMJ open, vol. 11, no. 12, e049389. https://doi.org/10.1136/bmjopen-2021-049389

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title = "Assessing effective mask use by the public in two countries: An observational study",

abstract = "Objectives During the COVID-19 pandemic wearing a mask in public has been recommended in some settings and mandated in others. How often this advice is followed, how well, and whether it inadvertently leads to more disease transmission opportunities due to a combination of improper use and physical distancing lapses is unknown. Design Cross-sectional observational study performed in June-August 2020. Setting Eleven outdoor and indoor public settings (some with mandated mask use, some without) each in Toronto, Ontario, and in Portland, Oregon. Participants All passers-by in the study settings. Outcome measures Mask use, incorrect mask use, and number of breaches (ie, coming within 2 m of someone else where both parties were not properly masked). Results We observed 36 808 persons, the majority of whom were estimated to be aged 31-65 years (49%). Two-thirds (66.7%) were wearing a mask and 13.6% of mask-wearers wore them incorrectly. Mandatory mask-use settings were overwhelmingly associated with mask use (adjusted OR 79.2; 95% CI 47.4 to 135.1). Younger age, male sex, Torontonians, and public transit or airport settings (vs in a store) were associated with lower adjusted odds of wearing a mask. Mandatory mask-use settings were associated with lower adjusted odds of mask error (OR 0.30; 95% CI 0.14 to 0.73), along with female sex and Portland subjects. Subjects aged 81+ years (vs 31-65 years) and those on public transit and at the airport (vs stores) had higher odds of mask errors. Mask-wearers had a large reduction in adjusted mean number of breaches (rate ratio (RR) 0.19; 95% CI 0.17 to 0.20). The 81+ age group had the largest association with breaches (RR 7.77; 95% CI 5.32 to 11.34). Conclusions Mandatory mask use was associated with a large increase in mask-wearing. Despite 14% of them wearing their masks incorrectly, mask users had a large reduction in the mean number of breaches (disease transmission opportunities). The elderly and transit users may warrant public health interventions aimed at improving mask use.",

keywords = "COVID-19, Health policy, Public health",

author = "Atzema, {Clare L.} and Ivona Mostarac and Dana Button and Austin, {Peter C.} and Javidan, {Arshia P.} and Lauren Wintraub and Allen Li and Patel, {Raumil V.} and Lee, {Daniel Dongjoo} and Latham, {Nathaniel P.} and Latham, {Eric A.} and Brown, {Patrick C.M.} and Somogyi, {Rita D.} and Alex Chang and Huong Nguyen and Sara Buerk and Bin Chen and Tristen Zimmerman and Trevor Funari and Cameron Colbert and Bory Kea",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2021",

month = dec,

day = "1",

doi = "10.1136/bmjopen-2021-049389",

language = "English (US)",

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T2 - An observational study

AU - Atzema, Clare L.

AU - Mostarac, Ivona

AU - Button, Dana

AU - Austin, Peter C.

AU - Javidan, Arshia P.

AU - Wintraub, Lauren

AU - Li, Allen

AU - Patel, Raumil V.

AU - Lee, Daniel Dongjoo

AU - Latham, Nathaniel P.

AU - Latham, Eric A.

AU - Brown, Patrick C.M.

AU - Somogyi, Rita D.

AU - Chang, Alex

AU - Nguyen, Huong

AU - Buerk, Sara

AU - Chen, Bin

AU - Zimmerman, Tristen

AU - Funari, Trevor

AU - Colbert, Cameron

AU - Kea, Bory

PY - 2021/12/1

Y1 - 2021/12/1

N2 - Objectives During the COVID-19 pandemic wearing a mask in public has been recommended in some settings and mandated in others. How often this advice is followed, how well, and whether it inadvertently leads to more disease transmission opportunities due to a combination of improper use and physical distancing lapses is unknown. Design Cross-sectional observational study performed in June-August 2020. Setting Eleven outdoor and indoor public settings (some with mandated mask use, some without) each in Toronto, Ontario, and in Portland, Oregon. Participants All passers-by in the study settings. Outcome measures Mask use, incorrect mask use, and number of breaches (ie, coming within 2 m of someone else where both parties were not properly masked). Results We observed 36 808 persons, the majority of whom were estimated to be aged 31-65 years (49%). Two-thirds (66.7%) were wearing a mask and 13.6% of mask-wearers wore them incorrectly. Mandatory mask-use settings were overwhelmingly associated with mask use (adjusted OR 79.2; 95% CI 47.4 to 135.1). Younger age, male sex, Torontonians, and public transit or airport settings (vs in a store) were associated with lower adjusted odds of wearing a mask. Mandatory mask-use settings were associated with lower adjusted odds of mask error (OR 0.30; 95% CI 0.14 to 0.73), along with female sex and Portland subjects. Subjects aged 81+ years (vs 31-65 years) and those on public transit and at the airport (vs stores) had higher odds of mask errors. Mask-wearers had a large reduction in adjusted mean number of breaches (rate ratio (RR) 0.19; 95% CI 0.17 to 0.20). The 81+ age group had the largest association with breaches (RR 7.77; 95% CI 5.32 to 11.34). Conclusions Mandatory mask use was associated with a large increase in mask-wearing. Despite 14% of them wearing their masks incorrectly, mask users had a large reduction in the mean number of breaches (disease transmission opportunities). The elderly and transit users may warrant public health interventions aimed at improving mask use.

AB - Objectives During the COVID-19 pandemic wearing a mask in public has been recommended in some settings and mandated in others. How often this advice is followed, how well, and whether it inadvertently leads to more disease transmission opportunities due to a combination of improper use and physical distancing lapses is unknown. Design Cross-sectional observational study performed in June-August 2020. Setting Eleven outdoor and indoor public settings (some with mandated mask use, some without) each in Toronto, Ontario, and in Portland, Oregon. Participants All passers-by in the study settings. Outcome measures Mask use, incorrect mask use, and number of breaches (ie, coming within 2 m of someone else where both parties were not properly masked). Results We observed 36 808 persons, the majority of whom were estimated to be aged 31-65 years (49%). Two-thirds (66.7%) were wearing a mask and 13.6% of mask-wearers wore them incorrectly. Mandatory mask-use settings were overwhelmingly associated with mask use (adjusted OR 79.2; 95% CI 47.4 to 135.1). Younger age, male sex, Torontonians, and public transit or airport settings (vs in a store) were associated with lower adjusted odds of wearing a mask. Mandatory mask-use settings were associated with lower adjusted odds of mask error (OR 0.30; 95% CI 0.14 to 0.73), along with female sex and Portland subjects. Subjects aged 81+ years (vs 31-65 years) and those on public transit and at the airport (vs stores) had higher odds of mask errors. Mask-wearers had a large reduction in adjusted mean number of breaches (rate ratio (RR) 0.19; 95% CI 0.17 to 0.20). The 81+ age group had the largest association with breaches (RR 7.77; 95% CI 5.32 to 11.34). Conclusions Mandatory mask use was associated with a large increase in mask-wearing. Despite 14% of them wearing their masks incorrectly, mask users had a large reduction in the mean number of breaches (disease transmission opportunities). The elderly and transit users may warrant public health interventions aimed at improving mask use.

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KW - Health policy

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Assessing effective mask use by the public in two countries: An observational study

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