Face Mask Use and Associated Factors Among Students: Mixed Methods Study.

BACKGROUND: COVID-19 has gravely affected the world, including students, due to the high level of contracting infections. OBJECTIVE: This study assessed the magnitude of mask use and associated factors among students. METHODS: A cross-sectional study using mixed methods was conducted among students at Gambella Teachers' Education and Health Science College, Gambella Region, Southwest Ethiopia, from March 5 to March 30, 2021. The stratified random sampling technique was used. Proportional allocation of samples was used to randomly select case teams, and a simple random sampling technique was used to recruit the students. The data were collected by trained and experienced enumerators. Data were entered into EpiData (version 3.1; EpiData Association) and exported to SPSS (version 22; IBM Corp) for analysis. Logistic regression was executed. The adjusted odds ratio (AOR) with the 95% CI was used to determine the association and strength with the outcome variable. The qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. Then, the themes were used to triangulate the quantitative study. RESULTS: The study included a total of 379 participants and yielded a response rate of 95.5% (379/397). The majority of study participants were older than 25 years, with the mean age being 26.34 (SD 5.8) years. This study found that the magnitude of mask use among students was 87% (330/379). The odds of mask use were higher among students who were female (AOR 3.32, 95% CI 1.191-9.248), younger (AOR 2.55, 95% CI 1.155-5.627), agreed that not all persons with COVID-19 develop severe disease (AOR 3.38, 95% CI 1.36-8.41), agreed that there is currently no effective cure (AOR 6.28, 95% CI 1.36-28.99), performed proper washing with soap and water (AOR 0.027, 95% CI 0.004-0.182), had started to stay home (AOR 0.168, 95% CI 0.054-0.52), agreed that COVID-19 is fatal (AOR 0.236, 95% CI 0.084-0.666), agreed that a flu vaccine is sufficient for COVID-19 prevention (AOR 3.874, 95% CI 1.540-9.749), and disinfected equipment and working areas at least once a day (AOR 0.222, 95% CI 0.086-0.575). CONCLUSIONS: This study found that the magnitude of mask use among students was relatively moderate in Ethiopia. Sex, age, agreeing that not all persons with COVID-19 develop severe disease, agreeing that there is currently no effective cure, performing proper washing with soap and water, starting to stay home, agreeing that COVID-19 is fatal, and agreeing that the flu vaccine is sufficient to prevent COVID-19 were independently associated with mask use among students. Therefore, colleges should aggressively encourage students to wear masks and monitor the implementation of COVID-19 prevention regulations along with the accessibility of masks.

Face Masks Use and Face Perception: Social Judgments and Emotion Recognition

An outbreak of the severe acute respiratory syndrome corona virus (SARS-CoV-2) made face masks use a norm in individuals' daily lives. The information individuals obtained with face perception is potentially affected by regular face mask use. This study investigated the effects of face masks, ethnicities, and sex on the social judgments including sex, age, trustworthiness, facial attractiveness, and approachability. Later, the effects of face masks, ethnicities, and sex, and facial expressions of happy, neutral, and sad faces on valence and arousal were studied. Likert-type scales and Self-Assessment Manikin were used in an online experiment by Psychopy to capture face perception. Only sex influences sex score in an apparent manner, and unmasked faces appear as more attractive. Face masks and ethnicities do not seem to have effects on sex, age, attractiveness, trustworthiness, and approachability. Faces with different expressions influence the scoring in valence and arousal scale. The results of the present study may be informative for the current pandemic for people to have fruitful social engagements. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Face Mask Use and Social Distancing Attitude of Healthcare Students: A Multi-Disciplinary Study.

This multi-disciplinary, cross-sectional, and descriptive study investigated health care students' face mask use knowledge, attitude, and practices (KAP) and social distancing attitudes. The study was carried out from October to December 2021 and surveyed 543 health care students selected via convenience sampling from the three Shaqra University campuses in Saudi Arabia. Standard multiple linear regressions were conducted on face mask use KAP and social distancing attitude to identify their significant associated factors. The students in this study had poor knowledge and a neutral attitude towards and modest use practices of face masks during the COVID-19 pandemic. Being female, being a nursing student, and having greater self-reported COVID-19-prevention knowledge were related to higher levels of face mask use knowledge. Having higher face mask use knowledge was linked to better attitude and practice. Knowledge of COVID-19 and its prevention and decreased COVID-19 risk perception were associated with better face mask use practices. The students had more positive than negative attitudes toward social distancing. Having known someone who was infected by the virus, lower risk perception, and better face mask use practices were associated with more positive social distancing attitudes. The findings imply the need to ensure that future health care practitioners are knowledgeable, have a positive attitude and good practices concerning face mask use, and have positive attitudes toward social distancing. The study implications are relevant for health care education in Saudi Arabia and elsewhere.

Collective health behavior and face mask utilization during the COVID-19 pandemic in Oklahoma, USA.

BACKGROUND: Face mask use offers an important public health tool for reducing the spread of coronavirus disease 2019 (COVID-19), yet the politicization of COVID-19 has resulted in uneven adherence. This study assesses the effects of setting characteristics and the sociodemographic composition of crowds on group-level masking rates. METHODS: We conducted 123 site observations of masking behavior at public locations across Oklahoma (USA) between June and September 2020. We used analyses of variance and t-tests to examine variation in masking and ordinary least squares regression to model the effect of setting and sociodemographic characteristics on site-level masking rates. RESULTS: The masking rate across all sites averaged 34% but varied widely. Site-level masking rates were higher at metropolitan sites and sites with a store or municipal masking mandate. The masking rate at sites where women or older adults (60+) were the predominant group did not differ significantly from other sites. Ethnically diverse sites exhibited significantly higher masking rates compared with predominantly white sites. Findings indicate that setting characteristics explained a greater amount of variation in collective masking rates than sociodemographic differences. CONCLUSIONS: This study underscores the importance of place and policy for mask adherence. In the absence of state-level mandates, masking policies at a more local level may be effective.

Understanding Physical Distancing and Face Mask Use Across High-Risk African American Subgroups During the COVID-19 Pandemic: Application of Health Belief Model.

Physical distancing and face masks remain frontline prevention strategies due to suboptimal vaccine uptake and the highly infectious COVID-19 variants. Communities of color are disproportionately impacted by a chronic disease burden that places them at higher risk of severe COVID-19 disease. Therefore, they can greatly benefit from face mask use and physical distancing, especially if the individual(s) have not received the vaccine. We applied the Health Belief Model to explore barriers and motivators influencing physical distancing and face mask use among high-risk, Black American subgroups during the early COVID-19 pandemic stages. We conducted 62 semi-structured interviews among four Black American subgroups: young adults, individuals with underlying medical conditions, essential workers, and parents. Thematic analysis, guided by the Health Belief Model, yielded six themes: (1) Knowledge on Face Mask Use and Physical Distancing, (2) Perceived Susceptibility and Severity Varies by Subgroup, (3) Experience with and Perceived Self-Efficacy to Engage in Preventive Behavior, (4) Perceived Benefits to engaging in preventive behaviors, (5) Perceived Barriers to engage in preventive behaviors, and (6) Cues to action to increase participation. Each subgroup's unique experience informed multilevel, tailored approaches that can be used by health promotion practitioners to improve face mask use and physical distancing among uniquely vulnerable Black American subgroups in the current and future pandemic.

Socioeconomic correlates of face mask use among pedestrians during the COVID-19 pandemic: An ecological study.

Background: Many countries have recommended using face masks for the general population in public places to reduce the risk of COVID-19 transmission. This study aimed to assess the effects of socioeconomic status on face mask use among pedestrians during the COVID-19 pandemic. Methods: This cross-sectional study was conducted in Ahvaz, southwest Iran in August 2020. A total of 10,440 pedestrians have been studied from 92 neighborhoods of the city. Three socioeconomic indicators including Land price, Literacy rate, and the Employment rate for each neighborhood were used in this study. Analysis of Covariance and partial correlation coefficients were applied to assess the relationship between prevalence rates of mask usage and SES indicators. Results: The mean ± SD age of the pedestrians was 32.2 ± 15.1 years. Of 10,440 observed participants, 67.9% were male. The overall prevalence of face mask usage was 45.6%. The prevalence of mask usage in older people and women was significantly higher than the others. The three assessed socioeconomic indicators were directly correlated to the prevalence of mask usage at individual and neighborhood levels. Conclusion: We found that literacy had the strongest correlation with the prevalence of mask usage compared to the land price and employment rate among the three assessed SES indicators. Hence, it can be concluded that the social component of socioeconomic status has a greater effect on mask usage by people than the economic component of socioeconomic status.

Development and initial validation of the attitudes toward face mask use scale (ATFMUS).

Despite availability of instruments for measuring attitudes towards mask use, the psychometric properties of many available instruments are not adequately established which limits their research usefulness across contexts. In three studies, we developed the Attitudes Towards Face Mask Use Scale (ATFMUS) in three phases: item generation, scale development, and scale evaluation. Phase one and two were addressed in study 1 while phase three was addressed in studies 2 and 3. In Study 1, a combined online and pen-and-paper sample of 174 (78% university students) completed a questionnaire with 19 items regarding attitudes towards face mask use derived from theory, previous research, and experience. Responses were subjected to item reduction analysis, exploratory factor analysis and reliability analysis. In Study 2, a student sample of 674 (70.5% high school) completed the new scale together with measures of COVID-19 related anxiety and obsession, personality, affect, social media use, and social desirability. Data from the ATFMUS were analyzed using confirmatory factor analysis and pertinent revisions done. The ATFMUS was then validated using correlation analyses, measurement invariance analyses, and known-group comparisons. In study 3, two samples of university students from Ghana (n = 242) and Kenya (n = 199) were involved in testing the cross-country invariance of the ATFMUS. The results reveal that the 5-item ATFMUS is a reliable and valid scale for assessing attitudes towards face mask use. Invariance analysis revealed that the ATFMUS is fair to use across participants of different age, level of education, and countries. The scale is also sensitive to participants' actual use of face masks as well as their beliefs about COVID-19 and efficacy of the facemasks. This study offers a foundation for further psychometric evaluation of the ATFMUS.

Impact of mask use on face recognition: an eye-tracking study.

We examined how mask use affects performance and eye movements in face recognition and whether strategy change reflected in eye movements is associated with performance change. Eighty-eight participants performed face recognition with masked faces either during learning only, during recognition only, or during both learning and recognition. As compared with the baseline condition where faces were unmasked during both learning and recognition, participants had impaired performance in all three scenarios, with larger impairment when mask conditions during learning and recognition did not match. When recognizing unmasked faces, whether the faces were learned with or without a mask on did not change eye movement behavior. Nevertheless, when recognizing unmasked faces that were learned with a mask on, participants who adopted more eyes-focused patterns had less performance impairment as compared with the baseline condition. When recognizing masked faces, participants had more eyes-focused patterns and more consistent gaze transition behavior than recognizing unmasked faces regardless of whether the faces were learned with or without a mask on. Nevertheless, when recognizing masked faces that were learned without a mask, participants whose gaze transition behavior was more consistent had less performance impairment as compared with the baseline condition. Thus, although eye movements during recognition were mainly driven by the mask condition during recognition but not that during learning, those who adjusted their strategy according to the mask condition difference between learning and recognition had better performance. This finding has important implications for identifying populations vulnerable to the impact of mask use and potential remedial strategies.

The association of face mask use with self-reported cardiovascular symptoms during the COVID-19 pandemic.

INTRODUCTION: Countries are mandating the use of face masks to stem the spread of COVID-19. Face mask use has been associated with discomfort due to its effects on thermoregulation, breathing and oxygenation. We evaluated the prevalence and severity of self-reported cardiovascular symptoms before and during face mask use. METHODS: This was a cross-sectional study of 1001 participants residing in Singapore, who participated in a self-administered questionnaire between 25th April 2020 to 4th May 2020. Symptom severity before and during mask use and health-seeking behaviour information were collected. The study outcome was the self-reported worsening of cardiovascular symptoms, and its association with the type of mask worn, duration of mask worn per day, and intensity of physical activities during mask use. RESULTS: The commonest symptom reported during mask use was dyspnoea. Independent predictors for self-reported cardiovascular symptoms during mask use were moderate-high physical activity during mask use (OR 1.634, 95% CI 1.176-2.270, p=0.003), duration of mask use ≥3 hours (OR 1.672, 95% CI 1.189-2.352, p=0.003) and the type of mask used, after adjusting for age, sex, healthcare-based worker status and presence of comorbidities. N95 mask was associated with worse symptoms when compared to surgical mask. Participants with ≥3 worsening symptoms, or worsening dyspnoea, palpitations, fatigue and dizziness were more likely to seek medical help. CONCLUSION: Face mask use is proven to be an effective way in curbing COVID-19 transmission. However, participants in this study had concerns regarding its use and these concerns should be urgently addressed to enable mask-use policies to be enacted.

Projected COVID-19 epidemic in the United States in the context of the effectiveness of a potential vaccine and implications for social distancing and face mask use.

BACKGROUND: Multiple candidates of COVID-19 vaccines have entered Phase III clinical trials in the United States (US). There is growing optimism that social distancing restrictions and face mask requirements could be eased with widespread vaccine adoption soon. METHODS: We developed a dynamic compartmental model of COVID-19 transmission for the four most severely affected states (New York, Texas, Florida, and California). We evaluated the vaccine effectiveness and coverage required to suppress the COVID-19 epidemic in scenarios when social contact was to return to pre-pandemic levels and face mask use was reduced. Daily and cumulative COVID-19 infection and death cases from 26th January to 15th September 2020 were obtained from the Johns Hopkins University Coronavirus resource center and used for model calibration. RESULTS: Without a vaccine (scenario 1), the spread of COVID-19 could be suppressed in these states by maintaining strict social distancing measures and face mask use levels. But relaxing social distancing restrictions to the pre-pandemic level without changing the current face mask use would lead to a new COVID-19 outbreak, resulting in 0.8-4 million infections and 15,000-240,000 deaths across these four states over the next 12 months. Under this circumstance, introducing a vaccine (scenario 2) would partially offset this negative impact even if the vaccine effectiveness and coverage are relatively low. However, if face mask use is reduced by 50% (scenario 3), a vaccine that is only 50% effective (weak vaccine) would require coverage of 55-94% to suppress the epidemic in these states. A vaccine that is 80% effective (moderate vaccine) would only require 32-57% coverage to suppress the epidemic. In contrast, if face mask usage stops completely (scenario 4), a weak vaccine would not suppress the epidemic, and further major outbreaks would occur. A moderate vaccine with coverage of 48-78% or a strong vaccine (100% effective) with coverage of 33-58% would be required to suppress the epidemic. Delaying vaccination rollout for 1-2 months would not substantially alter the epidemic trend if the current non-pharmaceutical interventions are maintained. CONCLUSIONS: The degree to which the US population can relax social distancing restrictions and face mask use will depend greatly on the effectiveness and coverage of a potential COVID-19 vaccine if future epidemics are to be prevented. Only a highly effective vaccine will enable the US population to return to life as it was before the pandemic.