How do the general population behave with facemasks to prevent COVID-19 in the community?

IMPORTANCEThe appropriate use of facemasks, recommended or mandated by authorities, is critical to protect the community and prevent the spread of COVID-19.OBJECTIVETo evaluate the frequency and quality of facemask use in general populations of different socio-spatial backgrounds.DESIGNA multi-site observational study carried out from 25 June 2020 to 21 July 2020.SETTINGThe observations were carried out in 43 different locations in a region in the west of France, representing various areas: rural and urban, indoor and outdoor, and in areas where masks were mandated or not. An observer was positioned at a predetermined place, facing a landmark, and collected information about the use of facemasks and socio-demographic data.PARTICIPANTSAll individual passing between the observer and the landmark were included.EXPOSUREThe observer collected information on whether a mask was worn, the type of mask used, the quality of the positioning, gender, and the age category of each individual.MAIN OUTCOMES AND MEASURESThe main outcomes were the use of a facemask and the quality of the positioning. Factors associated with these outcomes were identified.RESULTSA total of 3354 observations were recorded. A facemask was worn by 56.4% (n=1892) of individuals, varying from 49% (n=1359) in non-mandatory areas and 91.7% (n=533) in mandatory areas, including surgical facemasks (56.8%, n=1075) and cloth masks (43.2%, n=817). The facemask was correctly positioned in 75.2% (n=1422) of cases. The factors independently associated with wearing a facemask were being indoors (adjusted odds ratio [aOR], 0.37; 95% confidence interval [CI], 0.31-0.44), being in a mandatory area (aOR, 0.14; 95%CI, 0.10-0.20), female gender (aOR, 0.57; 95%CI, 0.49-0.66), and age >40 years (aOR, 0.54; 95%CI, 0.46-0.63). The factors independently associated with correct mask position were rural location (aOR, 0.76; 95%CI, 0.97-0.98), being in an indoor area (aOR, 0.49; 95%CI, 0.38-0.65), use of a cloth mask (aOR, 0.65; 95%CI, 0.52-0.81), and age >40 years (aOR, 0.61; 95%CI 0.49-0.76).CONCLUSIONS AND RELEVANCEInformation campaigns should promote the use of cloth masks. Young people in general and men in particular are the priority targets. Simplifying the rules to require universal mandatory masking seems to be the best approach for health authorities.Key PointsQuestionWhat is the frequency and quality, and their associated factors, of the use of facemasks in general populations of different socio-spatial backgrounds?FindingsAmong 3354 observations, 56.4% of individuals wore a facemask, either a surgical mask (56.8%) or a cloth mask (43.2%), and the mask was correctly positioned in 75.2% of cases. Correct use of facemasks was more common in rural and indoors areas, individuals wearing cloth masks, and among those aged >40 years.MeaningHealth authorities should promote the use of cloth masks, engage young people in this process, and consider the mandatory universal masking.