To mask or not to mask – and which mask to use? With public health advice on masks in the United States confused by political coverage, clarity around the use of masks is increasingly important, especially as the western United States struggles with the double crisis of smoke from forest fires and COVID-19.
âThe CDC is the gold standard where we find advice to protect our health, but it is also very important that this information is disseminated in such a way that people can access and understand it,â said Francisca Santana, doctoral student. student at Stanford University and lead author of a perspective journal on mask use published in Environmental research letters October 28. “Unfortunately, a simple online website may not be effective in communicating this information.”
Researchers analyzed studies on large-scale responses to epidemics, drivers of human behavior, and responses to smoke exposure from forest fires. Based on what the scientists gleaned together, they came up with recommendations for communicating mask usage guidelines. For U.S. government agencies, their suggestions include:
- Reconcile factual messages from federal and local organizations,
- Clarify which masks effectively protect against COVID-19 compared to smoke from forest fires,
- Provide information on the quantities of masks and where they can be acquired,
- Create infographics or images on the differences in the use of masks, and
- Apply culturally appropriate formats and translate messages to reach vulnerable groups.
Even people who understand what they should be doing don’t. The message needs to be evidence-based and we need to offer people realistic options for behavior that they can actually do and afford. “
Gabrielle Wong-Parodi, lead author of the study and Assistant Professor of Earth System Sciences, School of Earth, Energy & Environmental Sciences (Stanford Earth), Stanford University
The researchers noted the importance of incorporating the social and psychological influences of mask use behavior – a critical and poorly understood topic that they urge scientists to explore further.
“We are social beings, we live in these social contexts and we do not make decisions in isolation, so it is very important to recognize this in all messages given to the public,” said Wong-Parodi.
“Just because we’re sending a good message doesn’t mean people are going to take it and do it – we have to be sensitive to what people are going through right now.”
One path to behavior change is through social norms – the beliefs shared within a social group. Common methods of establishing social norms include comparing the actions of people to those of others, providing positive feedback, and placing messages where they are most relevant. That could mean, for example, posting signage on wildfire masks outside and COVID-19 masks indoors.
Further investigation is needed to understand whether mask wearing may also affect other actions aimed at preventing the spread of infectious diseases, such as hand washing and social distancing, according to the co-authors.
To help fill the gap in research on the use of masks in forest fires, Santana, PhD. A student in the Emmett interdisciplinary program in environment and resources, interviewed residents affected by smoke from a wildfire during the 2018 camp fire that destroyed Paradise, Calif.
Discussions indicated that social norms are a powerful driver of mask use, but also revealed instances of inappropriate behavior, when action is taken is ineffective or even harmful. In an interview, Santana learned that during lingering smoke from a forest fire, a person with asthma wears a mask while sleeping – a practice that can further stress the breathing of people with pre-existing asthma.
âIt highlighted how some of the basic information about how to wear a mask – how to fit it, under what conditions should you wear it – did not permeate all of the communities we worked in,â Santana said. .
Unlike infectious disease-only situations, the dual threat of wildfire smoke and COVID-19 has presented a plethora of mask-wearing options with varying effectiveness, depending on the hazard.
While an N95 mask is snug and should be placed over the nose to protect against smoke from wildfires, cloth face covers are advised for COVID-19 protection indoors – and people sometimes wear less structured fabric masks under the nose, going against the CDC’s recommendation to wear them over the nose and mouth to reduce disease transmission.
The interviews also revealed a form of social support that is repeating itself now during COVID-19: offering masks to others. While it may or may not encourage mask use, this support may influence how people view the behaviors of close friends and family.
âYour perception of the behavior of the people you are in close contact with may count even more than what they actually do, in terms of influencing your own behavior,â said Wong-Parodi.
The review also included investigations in China and Japan, where wearing masks was associated with the perceived threat of pandemics like SARS and H1N1 and with strong perceived benefits of masks. More recent research in the United States reveals how masking use may indicate political affiliation or fear of racial profiling.
The researchers suggest several areas of study that would help public health communications take advantage of the social nature of mask use, such as how social norms influence individual health – such as smoke inhalation – versus to collective health such as the spread of COVID-19. Most importantly, they emphasize the importance of communications based on scientific evidence.
âIt’s really important that public health officials at the local or state level provide clearer advice to the public on the appropriate masks for which events and make recommendations for behavior change,â Santana said.
Stanford School of Earth, Energy and Environmental Sciences
Santana, FN, et al. (2020) Responding to Simultaneous Crises: Communications and Social Norms of Mask Behavior During Forest Fires and COVID-19. Environmental research letters. doi.org/10.1088/1748-9326/abba55.