The Relationship Between Face Mask Use and Face-Touching Frequency in Public Areas: Naturalistic Study

Background: Throughout the COVID-19 pandemic in the United States, a major public health goal has been reducing the spread of the virus, with particular emphasis on reducing transmission from person to person. Frequent face touching can transmit viral particles from one infected person and subsequently infect others in a public area. This raises an important concern about the use of face masks and their relationship with face-touching behaviors. One concern discussed during the pandemic is that wearing a mask, and different types of masks, could increase face touching because there is a need to remove the mask to smoke, drink, eat, etc. To date, there have been few studies that have assessed this relationship between mask wearing and the frequency of face touching relative to face-touching behaviors.Objective: This study aimed to compare the frequency of face touching in people wearing a mask versus not wearing a mask in high-foot traffic urban outdoor areas. The purpose of this study was to assess if mask wearing was associated with increased face touching.Methods: Public webcam videos from 4 different cities in New York, New Jersey, Louisiana, and Florida were used to collect data. Face touches were recorded as pedestrians passed under the webcam. Adult pedestrians wearing masks were compared to those not wearing masks. Quantitative measures of frequency, duration, site of touch, and oral activities were recorded. Linear regression analysis was used to assess the association between mask use and face touching.Results: Of the 490 observed subjects, 241 (49.2%) were wearing a mask properly and 249 (50.8%) were not. In the unmasked group, 33.7% (84/249) were wearing it improperly, covering the mouth only. Face touching occurred in 11.4% (56/490) of the masked group and 17.6% (88/490) in the unmasked group. Of those who touched their face, 61.1% (88/144) of people were not wearing a mask. The most common site of face touching was the perioral region in both groups. Both the masked and unmasked group had a frequency of face touching for 0.03 touches/s. Oral activities such as eating or smoking increased face touching in the unmasked group.Conclusions: Contrary to expectations, non-mask-wearing subjects touched their face more frequently than those who were wearing a mask. This finding is substantial because wearing a face mask had a negative association with face touching. When wearing a mask, individuals are less likely to be spreading and ingesting viral particles. Therefore, wearing a mask is more effective in preventing the spread of viral particles.