Mask Adherence and Social Distancing in Houston, TX from January to April 2021

Shortly after the identification of COVID-19, public health experts recommended the use of face masks and social distancing to slow the spread of the virus. Early research indicates that there are associations between gender, age, and mask-wearing behavior. The primary aim of this paper was to explore how demographics, location, and mask mandates may affect COVID-19 mitigation strategies such as mask-wearing and social distancing. A prospective, cross-sectional observational study was conducted in Houston, TX from January to April 2021 at three outdoor locations: an urban park, an urban park with a trail, and a farmer's market. During each two-hour data collection period, trained observers recorded the total number of people in the designated spaces; people were categorized by approximate age, sex, race/ethnicity, physical activity level, social distancing, and mask adherence using the Systematic Observation of Mask Adherence and Distancing (SOMAD) protocol. Multivariable logistic regression was used to determine associations with gender, race, age, location, and the mask mandate. A total of 7778 observations were recorded after exclusion of inconclusive demographic data. Females had higher odds, reported as an odds ratio, of mask use than males (OR = 1.35, 95% CI 1.18-1.54). Compared to White individuals, Asian individuals had higher odds of mask use (OR = 1.84, 95% CI 1.48-2.30). The odds of mask use were higher while the Texas mask mandate was in effect (OR = 1.60, 95% CI 1.40-1.84). Regarding location, the odds of mask use were much higher in the urban park than in the urban park with a trail (OR = 13.33). Individuals had higher odds of social distancing at the urban park with a trail compared to the farmer's market (OR = 4.61, 95% CI 4.10-5.17). Mask wearing and social distancing behaviors differ by demographics, locality, and mask mandate. Thus, state policies can be effective tools to encourage mask wearing for disease mitigation.