ABSTRACT
BACKGROUND: Wearing a protective face covering can reduce the spread of COVID-19, but Americans' compliance with wearing a mask is uneven. The purpose of this study is to examine the association between health determinants (Health Behaviors, Clinical Care, Social and Economic Conditions, and the Physical Environment) and mask wearing at the county level. METHODS: Data were collected from publicly available sources, including the County Health Rankings and the New York Times. The dependent variable was the percent of county residents who reported frequently or always wearing a mask when in public. County demographics and voting patterns served as controls. Two-levels random effects regression models were used to examine the study hypotheses. RESULTS: Results indicate that, after considering the effects of the controls, Health Behaviors were positively associated with mask wearing, the Physical Environment held a negative association, and Clinical Care and Social and Behavioral Factors were unrelated. CONCLUSIONS: Results indicate that patterns of healthy behaviors can help predict compliance with public health mandates that can help reduce the spread of COVID-19. From an instutitional theory perspective, the data suggest counties develop collective values and norms around health. Thus, public health officials can seek to alter governance structures and normative behaviors to improve healthy behaviors.