DOI: 10.7272/q68050vn
title: Facemasks: Perceptions and use in an ED population during COVID-19

description: Study Objective: Facemask use is associated with reduced
 transmission of SARS-CoV-2. Most surveys assessing perceptions
 and practices of mask use miss the most vulnerable racial, ethnic, and
 socio-economic populations. These same populations have suffered
 disproportionate impacts from the pandemic. The purpose of this study was
 to assess beliefs, access, and practices of mask wearing across 15 urban
 emergency department (ED) populations.  Methods: This
 was a secondary analysis of a cross-sectional study of ED patients from
 December 2020 to March 2021 at 15 geographically diverse, safety net EDs
 across the US. The primary outcome was frequency of mask use outside the
 home and around others. Other outcome measures included having enough
 masks and difficulty obtaining them. Results: Of 2,575 patients
 approached, 2,301 (89%) agreed to participate; nine had missing data
 pertaining to the primary outcome, leaving 2,292 included in the final
 analysis. A total of 79% of respondents reported wearing masks “all of the
 time” and 96% reported wearing masks over half the time. Subjects with
 PCPs were more likely to report wearing masks over half the time compared
 to those without PCPs (97% vs 92%). Individuals experiencing homelessness
 were less likely to wear a mask over half the time compared to those who
 were housed (81% vs 96%). Conclusions: Study participants
 reported high rates of facemask use. Respondents who did not have PCPs and
 those who were homeless were less likely to report wearing a mask over
 half the time and more likely to report barriers in obtaining masks. The
 ED may serve a critical role in education regarding, and provision of,
 masks for vulnerable populations. 
description: <strong>Study Design and Setting</strong>
 We conducted this secondary analysis of a previously published
 study regarding ED patients perceptions’ of COVID-19 vaccination.[13] The
 parent study was a prospective, cross-sectional survey of ED patients at
 15 safety net EDs in 14 US cities. The University of California
 Institutional Review Board approved this study. Verbal consent was
 obtained.  <strong>Data
 Processing</strong> Participant ethnicity
 (Latinx/non-Latinx) and race were self-reported. We categorized those who
 self-identified as any race other than Latinx as ‘reported race’,
 non-Latinx (i.e. Black, non-Latinx and White, non-Latinx). If the patient
 identified themselves as Latinx, they were placed in that category and not
 in that of any other race. If an individual identified as more than one
 non-Latinx race, they were categorized as multiracial.
 Individuals who reported that they were currently applying for
 health insurance, were unsure if they were insured, or if their response
 to the question was missing (18 respondents) were categorized as uninsured
 in a binary variable, and separate analysis was done based on type of
 insurance reported. The survey submitted in our supplement (S1) is the
 version used at the lead site. Each of the remaining sites revised their
 survey to include wording applicable to their community (i.e., the site in
 Los Angeles changed Healthy San Francisco to Healthy Los Angeles), and
 these local community health plans were coded together.
 We identified individuals who reported English and Spanish as
 their primary language, and grouped those who reported Arabic, Bengali,
 Cantonese, Tagalog, or Other as “Other” primary language. With regards to
 gender, we categorized those who identified as gender queer, nonbinary,
 trans man and trans woman as “other”.
 <strong>Study Outcomes and Key
 Variables</strong> Our primary outcome was
 subjects’ response to the question, “Do you wear a mask when you are
 outside of your home when you are around other people?” with answer
 choices a) always, b) most of the time (more than 50%), c) sometimes, but
 less than half of the time (less than 50%), and d) I never wear a mask.
 Respondents were provided with these percentages to help quantify their
 responses. We stratified respondents into two groups: those who responded
 always or most of the time as “wears masks over half the time” and those
 who responded sometimes or never as “wears masks less than half the
 time. We sorted each of the 15 sites into four
 geographic regions within the United States. There were 3 sites located in
 New Jersey, Massachusetts, and Pennsylvania which we categorized in the
 Northeast region. We categorized 3 sites in Michigan and Iowa as Midwest,
 and 3 sites in North Carolina, Louisiana, and Maryland as the South. There
 were 6 sites located on the West Coast from California and Washington
 State.