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Comparison of Face-Touching Behaviors Before and During the Coronavirus Disease 2019 Pandemic.
JAMA Netw Open. 2020 07 01; 3(7):e2016924.JN

Abstract

Importance

There is insufficient evidence on the efficacy of masks in the general population for the prevention of coronavirus disease 2019 (COVID-19) in public areas. Therefore, it is imperative to investigate the association of mandatory mask-wearing policies with behaviors associated with the transmission of COVID-19.

Objective

To assess the association of mask wearing with face-touching behavior among the general population in public areas.

Design, Setting, and Participants

This cross-sectional study used videos recorded in public transportation stations, streets, and parks among the general population in China, Japan, South Korea, Western Europe (ie, England, France, Germany, Spain, and Italy), and the US to analyze mask-wearing and face-touching behavior in public areas. Videos before the COVID-19 pandemic were defined as those recorded from January 2018 to October 2019, and those during the COVID-19 pandemic were defined as those recorded during February 2020 to March 2020 in China, Japan, and South Korea and during March 2020 in Western Europe and the US. Individuals who clearly displayed their face and face-touching behavior were included, and those whose behaviors were influenced by filming or public events were excluded.

Exposures

Mandatory mask-wearing policies enacted at various time points in China, Japan, South Korea, Western Europe, and the US.

Main Outcomes and Measures

Proportion of individuals wearing masks and incidence of face touching.

Results

This study included 4699 individuals before the COVID-19 pandemic and 2887 individuals during the pandemic. During the periods studied, mask wearing increased in all regions except the US, from 20 of 1745 individuals (1.1%) to 1090 of 1097 individuals (99.4%) in mainland China (P < .001), 44 of 1422 individuals (3.1%) to 346 of 893 individuals (38.7%) in Japan (P < .001), 6 of 717 individuals (0.8%) to 277 of 324 individuals (85.5% ) in South Korea (P < .001), 1 of 546 individuals (0.2%) to 6 of 379 individuals (1.6%) in Western Europe (P = .02), and 1 of 269 individuals (0.4%) to 4 of 194 individuals (2.1%) in the US (P = .17). Surgical masks were predominant in China (989 masks [89.1%]), and fabric masks were predominant in the other regions (Japan: 371 masks [95.1%]; South Korea: 240 masks [84.8%]; Western Europe: 6 masks [85.7%]; US: 5 masks [100%]). Face-touching behaviors decreased from before COVID-19 to during COVID-19 among individuals in China (72 incidences of 1745 observations [4.1%] to 12 incidences of 1097 observations [1.1%]; P < .001), South Korea (80 incidences of 717 observations [11.2%] to 7 incidences of 324 observations [2.2%]; P < .001), and Europe (62 incidences of 546 observations [11.4%] to 23 incidences of 379 observations [6.1%]; P = .01). Logistic regression found that mask wearing was associated with a reduction in face touching in China (odds ratio [OR], 3.91; 95% CI, 2.11-7.24) and South Korea (OR, 6.69; 95% CI, 2.69-16.69) and of touching the nose, mouth, and eyes (China: OR, 8.60; 95% CI, 2.65-27.86; South Korea: OR, 29.27; 95% CI, 1.79-478.22).

Conclusions and Relevance

The findings of this cross-sectional study suggest that mandatory mask-wearing policies were associated with increased mask wearing during the COVID-19 pandemic. Mask wearing was associated with reduced face-touching behavior, especially touching of the eyes, nose, and mouth, which may prevent contact transmission of COVID-19 among the general population in public areas.

Authors+Show Affiliations

Guangdong Key Laboratory of Liver Disease Research, Department of Medical Oncology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.Guangdong Key Laboratory of Liver Disease Research, Department of Medical Oncology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Grade 2015, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.Guangdong Key Laboratory of Liver Disease Research, Department of Medical Oncology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.Department of Hepatobiliary Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.Department of Pulmonary and Critical Care Medicine, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.Guangdong Key Laboratory of Liver Disease Research, Department of Medical Oncology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.Guangdong Key Laboratory of Liver Disease Research, Department of Medical Oncology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32725247

Citation

Chen, Yong-Jian, et al. "Comparison of Face-Touching Behaviors Before and During the Coronavirus Disease 2019 Pandemic." JAMA Network Open, vol. 3, no. 7, 2020, pp. e2016924.
Chen YJ, Qin G, Chen J, et al. Comparison of Face-Touching Behaviors Before and During the Coronavirus Disease 2019 Pandemic. JAMA Netw Open. 2020;3(7):e2016924.
Chen, Y. J., Qin, G., Chen, J., Xu, J. L., Feng, D. Y., Wu, X. Y., & Li, X. (2020). Comparison of Face-Touching Behaviors Before and During the Coronavirus Disease 2019 Pandemic. JAMA Network Open, 3(7), e2016924. https://doi.org/10.1001/jamanetworkopen.2020.16924
Chen YJ, et al. Comparison of Face-Touching Behaviors Before and During the Coronavirus Disease 2019 Pandemic. JAMA Netw Open. 2020 07 1;3(7):e2016924. PubMed PMID: 32725247.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Face-Touching Behaviors Before and During the Coronavirus Disease 2019 Pandemic. AU - Chen,Yong-Jian, AU - Qin,Gang, AU - Chen,Jie, AU - Xu,Jian-Liang, AU - Feng,Ding-Yun, AU - Wu,Xiang-Yuan, AU - Li,Xing, Y1 - 2020/07/01/ PY - 2020/7/30/entrez PY - 2020/7/30/pubmed PY - 2020/8/11/medline SP - e2016924 EP - e2016924 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 7 N2 - Importance: There is insufficient evidence on the efficacy of masks in the general population for the prevention of coronavirus disease 2019 (COVID-19) in public areas. Therefore, it is imperative to investigate the association of mandatory mask-wearing policies with behaviors associated with the transmission of COVID-19. Objective: To assess the association of mask wearing with face-touching behavior among the general population in public areas. Design, Setting, and Participants: This cross-sectional study used videos recorded in public transportation stations, streets, and parks among the general population in China, Japan, South Korea, Western Europe (ie, England, France, Germany, Spain, and Italy), and the US to analyze mask-wearing and face-touching behavior in public areas. Videos before the COVID-19 pandemic were defined as those recorded from January 2018 to October 2019, and those during the COVID-19 pandemic were defined as those recorded during February 2020 to March 2020 in China, Japan, and South Korea and during March 2020 in Western Europe and the US. Individuals who clearly displayed their face and face-touching behavior were included, and those whose behaviors were influenced by filming or public events were excluded. Exposures: Mandatory mask-wearing policies enacted at various time points in China, Japan, South Korea, Western Europe, and the US. Main Outcomes and Measures: Proportion of individuals wearing masks and incidence of face touching. Results: This study included 4699 individuals before the COVID-19 pandemic and 2887 individuals during the pandemic. During the periods studied, mask wearing increased in all regions except the US, from 20 of 1745 individuals (1.1%) to 1090 of 1097 individuals (99.4%) in mainland China (P < .001), 44 of 1422 individuals (3.1%) to 346 of 893 individuals (38.7%) in Japan (P < .001), 6 of 717 individuals (0.8%) to 277 of 324 individuals (85.5% ) in South Korea (P < .001), 1 of 546 individuals (0.2%) to 6 of 379 individuals (1.6%) in Western Europe (P = .02), and 1 of 269 individuals (0.4%) to 4 of 194 individuals (2.1%) in the US (P = .17). Surgical masks were predominant in China (989 masks [89.1%]), and fabric masks were predominant in the other regions (Japan: 371 masks [95.1%]; South Korea: 240 masks [84.8%]; Western Europe: 6 masks [85.7%]; US: 5 masks [100%]). Face-touching behaviors decreased from before COVID-19 to during COVID-19 among individuals in China (72 incidences of 1745 observations [4.1%] to 12 incidences of 1097 observations [1.1%]; P < .001), South Korea (80 incidences of 717 observations [11.2%] to 7 incidences of 324 observations [2.2%]; P < .001), and Europe (62 incidences of 546 observations [11.4%] to 23 incidences of 379 observations [6.1%]; P = .01). Logistic regression found that mask wearing was associated with a reduction in face touching in China (odds ratio [OR], 3.91; 95% CI, 2.11-7.24) and South Korea (OR, 6.69; 95% CI, 2.69-16.69) and of touching the nose, mouth, and eyes (China: OR, 8.60; 95% CI, 2.65-27.86; South Korea: OR, 29.27; 95% CI, 1.79-478.22). Conclusions and Relevance: The findings of this cross-sectional study suggest that mandatory mask-wearing policies were associated with increased mask wearing during the COVID-19 pandemic. Mask wearing was associated with reduced face-touching behavior, especially touching of the eyes, nose, and mouth, which may prevent contact transmission of COVID-19 among the general population in public areas. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32725247/Comparison_of_Face_Touching_Behaviors_Before_and_During_the_Coronavirus_Disease_2019_Pandemic_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.16924 DB - PRIME DP - Unbound Medicine ER -