Lifting State-Issued COVID-19 Mask Mandates Associated with Decline in Mask Wearing Among Rural and Unvaccinated Americans

Posted on October 10, 2024 by Solape Ajiboye

This entry is part 4 of 4 in the series Nov 2024

Americans not yet vaccinated against COVID-19 and those living in rural areas altered their masking behaviors after statewide COVID-19 masking policies were relaxed. Public health messaging that emphasizes the benefits of behavioral prevention methods is crucial to helping to slow the spread of COVID-19 and other respiratory viruses.

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Observational studies conducted early in the COVID-19 pandemic found that multi-layered cloth facemasks, respirators, and face coverings reduce the transmission of SARS-CoV-2 by 70-79%, after exposure to an infected person. In April 2020, the US Centers for Disease Control and Prevention issued a recommendation to wear cloth face coverings in public settings. Cloth face coverings were recommended in public spaces that restricted social distancing (ie, grocery stores, elevators, etc.) and in areas experiencing high community transmission. In the following months, 39 US states and the District of Colombia issued statewide mask mandates, requiring residents to either 1) wear masks anywhere outside the home or 2) wear masks in retail businesses or restaurants¹. Immediately after implementation, state-issued mask mandates were associated with declines in COVID-19 case counts, hospitalizations, and deaths. One study noted a decline of up to 5.0 percentage points in hospitalizations, just three weeks after state-wide policies went into effect². Despite CDC recommendations and evidence that face masks slow the spread of COVID-19, between January to June 2021, 20 US states lifted their statewide mask mandates for all individuals. In our article, “Changes in Self-reported Mask Use After the Lifting of State-Issued Mask Mandates in 20 US States, January-June 2021,” we compare individual mask wearing behaviors before and after US states lifted their masking policies.

From January to June 2021, we collected self-reported data on engagement in COVID-19 prevention behaviors (masking, social distancing, etc.) from US residents in all 50 states. Data on state-issued COVID-19 masking policies was gathered from the CDC COVID-19 Data tracker.

Of the 37 US states with an existing mask mandate in February 2021, 20 of these states lifted their mandate by June 2021. Self-reported mask use varied between survey months, with 90% of respondents stating that they wore a mask outside of the home in March 2021, and only 78% indicating such by June of that year.

Overall, lifting state-wide masking mandates was not associated with changes in an individual’s likelihood to wear a mask outside of the home. However, stratifying the policy change by the urbanicity of the region that a respondent lived, and by their COVID-19 vaccination status, showed a differential effect of the policy change on masking wearing behavior. Residents of rural US counties were 11-percentage points less likely to report wearing a mask outside the home after mandates were lifted than those living in urban areas. Those unsure if they would get a COVID-19 vaccine were 12-percentage points less likely to report wearing a mask outside the home after changes to statewide policy were made. Changes to statewide policy was not significantly associated with changes in reported mask use for those already vaccinated or not planning to vaccinate.

Our results highlight a population within the United States who may be considered the “movable middle” as it relates to COVID-19 behavioral prevention. To prepare for future pandemics, education on the importance of behavioral disease prevention is critical, especially in populations whose prevention behavior may be influenced by external factors, such as state-wide policies.

For further information, read our article here: “Changes in Self-reported Mask Use After the Lifting of State-Issued Mask Mandates in 20 US States, February-June 2021.“

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About the Author

Solape Ajiboye: Solape Ajiboye is an Epidemiologist in the Global Health Center at the U.S. Centers for Disease Control and Prevention. She recently served on the CDC COVID-19 Response, provided monitoring and evaluation expertise. Solape’s background and expertise is in program monitoring and evaluation, population-based disease surveillance, mixed-methods research. She holds a Master of Public Health degree from The George Washington University and a Bachelor of Science in Psychology from the University of North Carolina at Chapel Hill.