Factors influencing mask-wearing behavior in the context of COVID-19 severity risks in the post-COVID-19 era: a Japanese Nationwide Epidemiological Survey in 2023.

Shingo NOGUCHI; Tomohiro ISHIMARU; Kazuhiro YATERA; Yoshihisa FUJINO; Masayoshi ZAITSU; Takahiro TABUCHI

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Factors influencing mask-wearing behavior in the context of COVID-19 severity risks in the post-COVID-19 era: a Japanese Nationwide Epidemiological Survey in 2023.

Author: Shingo NOGUCHI ¹ ; Tomohiro ISHIMARU ² ; Kazuhiro YATERA ¹ ; Yoshihisa FUJINO ³ ; Masayoshi ZAITSU ⁴ ; Takahiro TABUCHI ⁵
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1. Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan.
2. Department of Medical Humanities, School of Medicine, University of Occupational and Environmental Health, Japan.
3. Department of Environmental Epidemiology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan.
4. Center for Research of the Aging Workforce, University of Occupational and Environmental Health, Japan.
5. Division of Epidemiology, School of Public Health, Tohoku University Graduate School of Medicine.
Publication Type:Journal Article
Keywords: Mask; Risk factors; Severe COVID-19
MeSH: Adolescent; Adult; Aged; Aged, 80 and over; Female; Humans; Male; Middle Aged; Young Adult; COVID-19/psychology*; Japan/epidemiology*; Masks/statistics & numerical data*; Risk Factors; Surveys and Questionnaires; East Asian People
From:Environmental Health and Preventive Medicine 2025;30():41-41
CountryJapan
Language:English
Abstract: BACKGROUND:Although the global COVID-19 mortality rate is decreasing, COVID-19 remains an infectious disease with a high mortality rate, especially in older adults and individuals with comorbidities. In Japan, mask-wearing has been left to individual discretion since March 13, 2023, but remains a key protective measure. This study aimed to identify factors influencing individual mask-wearing behavior in post COVID-19 era, with a focus on risk factors for severe COVID-19.
METHODS:Data from 33,000 participants, obtained from the Japan COVID-19 and Society Internet Survey 2023, were used, which was conducted from September 25 to November 17, 2023. Participants were randomly selected from approximately 2.2 million panelists from a nationwide Japanese Internet research company, with sampling adjusted by age, sex, and living area to match the population distribution in Japan. The association between wearing a mask and risk factors for severe COVID-19 (age, sex, smoking, COVID-19 vaccination, history of COVID-19, body mass index (BMI), and comorbid conditions) was evaluated using univariate and multivariate analyses.
RESULTS:In total, 28,481 individuals were included, of whom 18,371 (64.5%) answered that they wore masks. After adjusting for confounders, older age (adjusted relative risk [RR], 1.50; 95% confidence interval [CI], 1.45-1.55 for "75-83" years), no history of COVID-19 (adjusted RR, 1.06; 95% CI, 1.04-1.08), low BMI (adjusted RR, 1.04; 95% CI, 1.02-1.07), and increased number of comorbid conditions (adjusted RR, 1.11; 95% CI, 1.05-1.18 for three or more) were significant positive factors for wearing a mask. In contrast, men (adjusted RR, 0.89; 95% CI, 0.87-0.90), no COVID-19 vaccination (adjusted RR, 0.78; 95% CI, 0.76-0.81), and current smoking history (adjusted RR, 0.96; 95% CI, 0.93-0.99) were significant negative factors.
CONCLUSION:We demonstrated that mask-wearing behavior differed based on individual risk factors for severe COVID-19, with some risk factors negatively influencing mask use in Japan. It may be necessary to recommend mask-wearing for these individuals, especially during situations such as COVID-19 epidemic season or the onset of epidemics, considering individual mask-wearing behavior.