A newly published review, by a trio of researchers from the University of Cambridge and King’s College London, has concluded there is no evidence to suggest wearing a face mask leads to lower levels of compliance with other hygiene measures such as social distancing and hand washing.
Face masks have arguably become the most divisive issue in this ongoing COVID-19 pandemic. Despite more than 100 countries bringing in some kind of mandatory mask wearing policy there is still vociferous debate on the topic.
One of the fundamental concerns often raised over broad compulsory mask orders is that they can instill a false sense of security in the wearer. This hypothetically could lead to individuals feeling over-protected and subsequently they may wash their hands less or become less vigilant in social distancing practices.
Even the World Health Organization’s current COVID-19 advice warns mask wearing can result in a, “false sense of security, leading to potentially less adherence to well recognized preventive measures such as physical distancing and hand hygiene.”
While there seems to be an intuitive appeal to the idea that a face mask can lead to relaxation in other important protective behaviors, is there any actual scientific evidence this is true? According to a systematic review of the current research, the answer is no, there isn’t any evidence to show one precautionary behavior reduces adherence to other related behaviors.
The new study begins by investigating the foundations of a common psychological theory called risk compensation. This is the idea that people tend to increase risky behaviors relative to safety measures that are imposed. For example, making bicycle helmets compulsory could be considered counter-productive if people intrinsically respond by subsequently cycling at higher speeds.
From a public health perspective, risk compensation is certainly something to consider when mandating new safety measures. However, the new study examines the history of several major public health interventions (including compulsory bicycle and ski helmets, HIV prevention measures, and HPV vaccinations) and finds evidence lacking to suggest any of these cases resulted in compensating behavior that led to worse outcomes.
“In each case, the benefit to the population tremendously outweighed the additional and very modest risk compensation that occurred in some individuals,” says the University of Exeter’s David Strain , who did not work on this new study. “Indeed, in alpine skiing and snowboarding, wearing a helmet was generally associated with risk reduction oriented-behavior, suggesting safety devices are both compatible with and perhaps encourage safety-oriented behavior, reducing head injuries more than can be accounted for by the helmet alone.”
Looking more closely at the research conducted on the impact of mask-wearing in relation to respiratory virus transmission, 22 systematic reviews were analyzed and none showed evidence that wearing a face mask reduced a person’s frequency of hand-washing. In fact, the researchers note two particular experimental studies found self-reported rates of hand-washing were higher in mask-wearing groups.
No prior research exists looking at mask-wearing in relation to social distancing behaviors. However, the researchers do reference three observational, albeit currently unpublished and not yet peer-reviewed, studies finding people tend to move away from others wearing face masks. This of course does not offer evidence to suggest people wearing masks will socially distance less, but it does affirm a lack of evidence showing how mask-wearing could result in people physically coming closer together.
“We do not rule out the possibility that for some people, engaging in one behavior can influence other behaviors in ways that might attenuate their beneficial effects,” the trio of researchers write in the study. “But based on the evidence we review here, any attenuation is unlikely to be sufficient to counter, or even reverse, these beneficial effects and lead to a worse outcome for a population.”
In the end, the new study goes so far as to claim the concept of risk compensation is a greater threat to public health. This long-held idea is not backed up by any evidence yet it seems to constantly appear as a justification for pushing back on public health and safety interventions. In this case, it has underpinned an argument, based on no evidence, suggesting mask-wearing could do more harm than good by making individuals relax other preventative behaviors.
The trio of researchers conclude their analysis by citing a 2016 commentary piece from McGill University epidemiologist Barry Pless, who adamantly says pushing the risk compensation theory is akin to flogging a dead horse.
“We would add that this dead horse now needs burying to try to prevent the continued threat it poses through slowing the adoption of effective public health interventions,” the new study concludes.
The new study was published in the journal BMJ.
Source: University of Cambridge
