Facemasks: Perceptions and use in an ED population during COVID-19

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.

研究目的：口罩佩戴与新型冠状病毒（SARS-CoV-2）的传播抑制密切相关。当前多数评估口罩使用认知与实践行为的调查，往往遗漏了最易受影响的种族、族裔及社会经济弱势群体，而这些群体在新冠疫情中承受了不成比例的冲击。本研究旨在针对全美15个城市急诊科（emergency department, ED）人群，评估其口罩佩戴的认知观念、获取途径与行为习惯。

研究方法：本研究为一项横断面研究的二次分析，数据采集自2020年12月至2021年3月期间，美国15个地域分布广泛的安全网急诊科（safety net EDs）的急诊科患者。本研究的主要结局指标为外出及与他人共处时的口罩佩戴频率；其他结局指标包括是否拥有充足口罩以及获取口罩的困难程度。

研究结果：本次共接洽2575名患者，其中2301名（89%）同意参与研究；另有9名患者的主要结局数据存在缺失，最终纳入2292名患者完成最终分析。结果显示，总计79%的受访者表示“始终”佩戴口罩，96%的受访者表示超过半数时间佩戴口罩。拥有初级保健医生（primary care physicians, PCPs）的受试者，其报告超过半数时间佩戴口罩的比例高于无初级保健医生的受试者（97% vs 92%）。无固定居所的无家可归者，其报告超过半数时间佩戴口罩的比例低于有固定居所者（81% vs 96%）。

研究结论：本研究参与者的口罩佩戴率整体较高。无初级保健医生及无固定居所的受访者，报告超过半数时间佩戴口罩的比例更低，且更易反馈存在口罩获取障碍。急诊科可在为弱势人群开展口罩相关教育及提供口罩资源方面发挥关键作用。