Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 1

Mask Wearing is Associated with Local COVID-19

Prevalence, Perceived Risk of Infection, Stress, and
Future Orientation
Diego Guevara Beltran1, Calvin Isch2, Jessica D. Ayers1, Joe Alcock3, Jessica F. Brinkworth4,5,
Lee Cronk6, Hector Hurmuz-Sklias, Keith Tidball7, Andrew Van Horn6, Peter M. Todd2✝ & Athena
Aktipis1✝

1
Department of Psychology, Arizona State University
2
Cognitive Science Program and Department of Psychological and Brain Sciences, Indiana
University Bloomington
3
Department of Emergency Medicine, University of New Mexico
4
Department of Anthropology, University of Illinois Urbana-Champaign
5
Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana-Champaign
6
Department of Anthropology, Rutgers University - New Brunswick
7
Department of Natural Resources, Cornell University

This working paper has not yet been peer-reviewed

✝These authors share senior authorship

Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 2

Abstract
Since the beginning of the COVID-19 pandemic, wearing protective facial masks has become a
divisive issue, yet little is known about what drives differences in mask wearing across individuals.
We surveyed 711 people around the world, asking about mask wearing and several other
variables. We found that people who reported greater perceived risk of infection, stress, and those
with greater consideration of future consequences reported wearing masks more often during in-
person interactions. Participants who knew more people who had been infected and those who
lived in postal codes with higher prevalence of COVID-19 perceived their risk of infection to be
higher and reported greater pandemic-related stress. Perceived risk of infection and pandemic-
related stress were higher overall in women and those reporting greater future-orientedness.
Finally, participants who were more politically conservative reported lower perceived risk of
becoming infected and lower stress than those who were more liberal, but there was no reliable
difference in mask wearing between these groups. This is the first of four papers investigating
mask wearing using this data set; the forthcoming papers will focus on predicting attitudes and
motivations about mask wearing, the situations in which people do and do not report wearing
masks, and the extent to which people report mask wearing in their communities. This is part of
a broader study to understand the psychological and social influences on mask wearing and,
more broadly, the impacts of the pandemic on human behavior and social interactions.
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 3

Mask wearing is associated with Local COVID-19

Prevalence, Perceived Risk of Infection, Stress, and
Future Orientation
Introduction
On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a global
pandemic (World Health Organization, 2020). Since then cases have risen around the world,
with a global total of more than 60 million cases and nearly 1.5 million deaths as of November
30, 2020 (Dong et al., 2020). The COVID-19 pandemic has also led to adverse economic
consequences, increasing both labor market inequalities and the unemployment rate in the US
(Béland et al., 2020). In response to these grave threats to human life and economic
productivity, governments imposed quarantines and took other measures to slow the spread of
the disease (Desai & Patel, 2020; Parmet & Sinha, 2020). The airborne spread of COVID-19
has been documented in asymptomatic and presymptomatic individuals (Riediker & Tsai, 2020;
Santarpia et al., 2020), increasing the difficulty of identifying infected individuals who may
transmit the disease and making the practice of wearing protective masks important to
preventing the spread of disease.

Protective mask wearing is associated with a reduction in infection risk (Chu et al., 2020) and
transmission (Cheng et al., 2020; Liu & Zhang, 2020) of the SARS-CoV-2 virus. Surgical masks
and cloth face coverings (hereafter “masks”) have been recommended by the U.S. Centers for
Disease Control and Prevention (Centers for Disease Control and Prevention, 2020), the WHO,
and governments around the world (Centers for Disease Control and Prevention, 2020;
Greenhalgh et al., 2020) to reduce the airborne spread of COVID-19. Depending on the fabric
worn and the size of human-produced droplets that carry the SARS-CoV-2 virus, masks can
block the spread of 67-95% of virus-carrying droplets (Peeples, 2020). This protects others if the
wearer is infected, and also protects the wearer of the mask (Centers for Disease Control and
Prevention, 2020). Not only is mask wearing effective, it is a relatively low cost and convenient
measure to reduce the high costs of community transmission of the disease (Greenhalgh et al.,
2020), making it a precaution worth taking according to experts (MacIntyre & Chughtai, 2020).

Despite recommendations from healthcare officials to wear masks and engage in social
distancing to reduce the spread of SARS-CoV-2, the virus that causes COVID-19, there is a
great deal of heterogeneity in people’s adherence to social distancing recommendations,
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 4

compliance with mask wearing recommendations, and engagement in other protective

behaviors. We are interested in the question of why some individuals wear masks more often
and in a broader array of contexts than others. Among the protective behaviors that can help
prevent the spread of SARS-CoV-2, mask wearing is readily observable and interpretable, and it
is under the direct control of the individual (in contrast to social distancing, which requires the
cooperation of others). Mask-wearing behavior, like other protective behaviors, is likely
influenced by many factors, such as the prevalence of COVID-19 in one’s local community,
perceived risk of infection, stress caused by the disease, demographics, and individual
differences in attitudes and motivations towards mask wearing. In this paper, we explore the
effect of these and other factors, described next, on mask wearing during the COVID-19
pandemic.

Perceived risk and stress can promote protective behaviors

People often attempt to protect themselves from disease by engaging in protective behaviors
such as mask wearing, hand washing, social distancing, and getting vaccinated. When people
perceive the risk of disease to be higher, they are more likely to engage in protective behaviors.
For example, a meta-analysis showed that people are more likely to get vaccinated against
diseases like influenza if they think it is more likely that they will contract the disease, if they
think the disease will be more severe, and if they feel more susceptible to the disease (Brewer
et al., 2007). During previous Severe Acute Respiratory Syndrome (SARS) outbreaks, people
perceived the likelihood of becoming infected and the severity of disease if infected to be higher
when mortality was higher, when there was a lack of preventive measures, when cases
increased rapidly, when they were not aware of effective treatments, and when they felt that
their susceptibility to the disease was not under their control (Smith, 2006).

People often experience stress associated with disease outbreaks. For example, a 2003 survey
of Hong Kong adults about their perceptions of SARS outbreak showed that over a third of their
sample reported increased work, family, and financial stress (Lau et al., 2005). Emerging work
form the current COVID-19 crisis similarly shows that people all over the world experienced
pandemic-induced stress. For example, a large, nationally representative survey of Chinese
adults (N > 52,000) conducted in January, 2020 showed that 35% of respondents reported
moderate signs of psychological distress (Qiu et al., 2020). Pandemic-induced stress has also
been reported in Bangladeshi adults (Islam et al., 2020) and a meta-analysis that included
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 5

participants from Iran, China, Japan, Nepal, India, Iraq, Spain, the UK, Nigeria, and Italy showed
that 29% of the population surveyed exhibited signs of pandemic-induced stress (Salari et al.,
2020).

Moderate levels of perceived risk and stress can sometimes be a positive force, motivating
people to reduce their exposure to threats and to engage in protective behaviors (Brewer et al.,
2007; Schneiderman et al., 2005). For example, stress can induce sickness behaviors such as
loss of appetite and low energy, which can reduce the likelihood of encountering threats
(Schneiderman et al., 2005; Eisenberger et al., 2017). Stress also motivates people to avoid
others whom they find threatening, while increasing the motivation to seek support from close
others (Eisenberger et al., 2017). In the case of COVID-19, individuals who perceive their risk of
COVID-19 to be higher engage in more protective behaviors such as physical distancing and
hand washing (Yıldırım & Güler, 2020). However, individuals who perceive their risk to be lower
are more likely to engage in these protective behaviors if they believe they will have a large
effect (i.e., high perceived self-efficacy of these protective behaviors), indicating that efficacy
can make up for a lack of perceived risk of infection in terms of motivating protective behaviors
(Jørgensen et al., 2020).

COVID-19 is not like other diseases when it comes to predictors of protective behaviors
and stress
Pre-COVID-19 research has shown that demographic factors influence general compliance with
protective behaviors, with older and more educated people engaging in protective behaviors to
a greater extent than younger and less educated people (Bish & Michie, 2010; Qiu et al., 2020).
Work on protective behaviors such as mask wearing during the COVID-19 pandemic is still
relatively early, and some results are not consistent with previous patterns. For example, a
recent study found that women are more likely to wear masks than men, though this was only
the case in countries where mask wearing was not mandated (Capraro & Barcelo, 2020).
Furthermore, while women and more educated people report greater psychological distress as a
result of the COVID-19 pandemic (Qiu et al., 2020; Yıldırım & Güler, 2020), younger people
(i.e., 20-30 year-olds) report more stress than older people (Qiu et al., 2020; Masters et al.,
2020). This relationship is somewhat puzzling, given that older people experience higher
mortality from COVID-19 (Jordan et al., 2020). However, previous work has speculated that this
age difference in pandemic-induced stress is in part due to younger people being exposed to
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 6

more negative content about the pandemic on social media than their older counterparts (Qiu et
al., 2020).

Future orientation is associated with protective behaviors and COVID-19 stress

Future orientation is the extent to which individuals value the future compared to the present.
There is reason to think that future orientation should be associated with protective behaviors.
Engaging in protective behaviors like mask wearing and social distancing requires a willingness
to incur present costs to avoid exposure and potential infection. Some of these costs include
giving up close interactions with friends, not attending events, and possibly experiencing
adverse psychological consequences as a result. Thus, individual differences in how much
people consider the immediate and future consequences of their actions could influence their
engagement with protective behaviors and consequently their wellbeing during the current
pandemic. Previous work has shown that greater concern for future consequences is positively
correlated with other types of protective health behaviors such as limiting exposure to sunlight
(Heckman et al., 2009) and using condoms (Appleby et al., 2005). Subsequent work has also
found that concern about the future consequences of one’s actions is positively associated with
health-oriented behavior (Joireman et al., 2012). For example, one study that used a food-
specific time-perspective questionnaire found that reported healthy eating was correlated with
more concern about future consequences (Dassen et al., 2015). While there has been some
work exploring how a present-hedonistic time perspective interacts with pandemic-induced
stress (Bodecka et al., 2021), little work has been conducted on consideration of future
consequences. We address this gap with the present study.

The present work

This paper is part of a set of four related papers in which we explore various aspects of mask
wearing using our longitudinal dataset. First, in this paper, we look at the individual differences
and demographic factors that are associated with mask wearing during in-person interactions. In
a second paper, we will look at the attitudes and motivations underlying mask wearing and what
predicts them. The third paper will examine the different contexts (e.g., routine/recreational) in
which people may wear masks and what predicts mask wearing in these situations. The fourth
paper will explore variation in reports of mask-wearing behavior in people’s communities.
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 7

Here we focus on environmental factors (related to COVID-19 prevalence), demographic

variables (age, sex, education, subjective socioeconomic status, and political orientation), and
individual difference factors (perceived COVID-19 infection risk, COVID-19-related stress, and
future orientation) that are associated with mask wearing behavior. We also investigate which of
these factors are themselves associated with perceived infection risk and related stress, as
expected primary motivators of mask wearing behavior.

Method
We recruited an international sample of participants through Prolific academic, a platform for
online participant recruitment, for an ongoing study on COVID-19 and behavior. We report data
from three timepoints: June 27 (N = 711, Mage = 29.3, SDage = 10.8, 51% male), July 25 (N =
695, Mage = 29.7, SDage = 10.8, 52.6% male), and August 8 (N = 634, Mage = 29.6, SDage = 11,
50.7% male). On June 27, participants came from 36 countries, including continental Europe (N
= 400), North America (N = 97), the UK/Ireland (N = 190), and various other countries (N = 23).
Participant demographics included age, sex, education (1 = Less than high school, 8 = Doctoral
or professional degree), subjective socioeconomic status (1 = Much worse off than others, 10 =
Much better off than others; Adler et al., 2000), and political orientation (1 = Extremely to the
left, 7 = Extremely to the right). Participants then completed the Consideration of Future
Consequences Scale (Joireman et al., 2012; Strathman et al., 1994), a 14-item questionnaire
that captures concern for the immediate consequences (e.g., “I only act to satisfy immediate
concerns, figuring the future will take care of itself.”; this sample’s Cronbach’s 𝛼 = .80), and
future consequences (e.g., “I consider how things might be in the future, and try to influence
those things with my day to day behavior.”; this sample’s Cronbach’s 𝛼 = .80) of one’s behavior
measured on a 7-point scale (1 = Strongly disagree, 7 = Strongly agree).

Across all three time points, participants reported their perceived risk of COVID-19 infection
(How likely do you think it is that you will become infected with COVID-19?; 1 = not at all, 7 =
extremely), their COVID-19 related stress (How stressed do you currently feel dealing with
changes caused by COVID-19?; 1 = not at all, 7 = extremely), and the number of people they
personally know who have been diagnosed with COVID-19 by a physician or have tested
positive for COVID-19. On July 25 and August 8, participants also reported whether they had
worn a mask and/or socially distanced during in-person interactions they had over the past
week (During these in-person interactions did you wear a mask and/or stay 6 feet (2 meters)
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 8

away from the other person(s)?; 1 = Never, 3 = Half the time, 5 = Always). Participants'
responses to this item are heretofore referred to as ‘mask wearing.’ Participants also answered
questions related to the larger study which are not part of the present paper. For a list of all the
questions that participants were asked, see OSF (https://osf.io/acjrh/wiki/Survey%20items/).

Lastly, to determine the local prevalence of COVID-19, we matched participants’ postal codes to
the COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at
Johns Hopkins University (Dong et al., 2020). With this database, we linked cumulative
incidence rates (i.e., confirmed cases per 100,000 individuals), death rates (per 100,000), and
deaths per cases to the postal codes of 586 of our participants on June 27, for 567 participants
on July 25, and for 520 participants on August 8, 2020. We were not able to match the
prevalence of COVID-19 for participants who did not provide postal codes or who provided
postal codes that were unidentifiable.

Results

Prevalence of COVID-19, contacts infected, perceived risk of infection, and stress are
correlated with higher reported mask wearing
We were interested in whether the local prevalence of COVID-19, perceived risk of infection,
stress, demographics, and time orientation are associated with mask wearing behavior. We did
not collect mask wearing information on June 27. Because the primary focus for this paper is on
mask wearing, and the factors that are associated with mask wearing, we report on data
collected on July 25 and August 8 before reporting on data collected on June 27. We test for
correlations between mask-wearing behavior in July and August with the prevalence of COVID-
19, the number of contacts people know to have been infected with COVID-19, perceived risk of
infection, stress, time orientation, and demographics (Table 1). We conduct zero order
correlations with listwise deletion for missing data to understand how variables are associated
within the same subset of participants within each respective time point. Listwise deletion omits
participants who are missing responses from one or more of the variables shown on Table 1.
Correlations with pairwise deletion method that yield statistically different conclusions within
each timepoint are reported below1. Pairwise deletion omits observations between two variables
when one variable is missing a response, but does not omit other observations from the same
participant for which participants do report information on.

We find that people report greater mask wearing when they were from communities that had a
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 9

higher incidence rate (Figure 1), death rate, and deaths per case on both July 25 and August 8.
The number of contacts infected with COVID-19 is also positively correlated with mask wearing;
however, this correlation was significant only in August and not in July (Figure 1). We also find
that mask wearing is associated with greater perceived risk of COVID-19 infection and
pandemic-induced stress at both time points (Figure 1). In terms of demographics, we find that
women report wearing masks more often than men in August but not in July. However, the
correlation between sex and mask wearing when we apply the pairwise deletion method is
positive1.

Although we do not observe a significant correlation between mask wearing and political
orientation when we apply listwise deletion, pairwise deletion shows that people politically
inclined to the right report less mask wearing in July1. Lastly, we find that consideration for
future consequences is positively associated with mask wearing in both July and August, while
consideration for immediate consequences is negatively correlated with mask wearing in July
but not in August. When we apply pairwise deletion method, we observe that consideration for
immediate consequences is negatively correlated with mask wearing in August, but not in July1.
We find that the statistical significance of some correlations depend on the type of deletion
method. To account for the number of comparisons while maintaining reasonable analytical
power, we adjusted significance using the false discovery rate (FDR) procedure (Benjamini &
Hochberg, 1995). For application of FDR, correlation analyses were separated by outcome
variable (mask wearing, perceived risk of infection and stress), but not time point, with false
discovery rate set to 5%. After adjusting the FDR, we find that consideration of immediate
consequences is no longer correlated with mask wearing in July, and sex is no longer correlated
with mask wearing in August.

1
Pairwise zero-order correlations between age and mask wearing in July (r(685) = .09, p = .01), and
August (r(627) = .12, p = .002) show positive associations. A pairwise zero-order correlation shows
women reported greater mask wearing than men in July (τ(681) = .09, p = .007). Pairwise zero-order
correlations show a positive association between education and mask wearing in July (τ(681) = .08, p =
.01), and August (τ(624) = .08, p = .008). A pairwise zero-order correlation shows people politically
inclined to the right report less mask wearing in July (τ(602) = -.07, p = .037). Pairwise zero-order
correlations show no association between mask wearing and immediate consequences in July (r(547) = -
.06, p = .065), and a negative association with mask wearing in August (r(509) = -.09, p = .004).
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 10

Table 1. Correlations between COVID-19 prevalence, demographics, perceived risk of infection,

stress, and mask wearing/social distance during in-person interactions.

JUNE (N = 477) JULY (N = 429) AUGUST (N = 406)

COVID-19 COVID-19 COVID-19
COVID-19 Mask/ COVID-19 Mask/ COVID-19
perceived perceived perceived
Stress distance Stress distance Stress
Risk Risk Risk

Mask/distance - - - - - - - -

COVID-19 perceived risk - - .19**τ - - .17**τ - -

COVID-19 stress .31**τ - .20**τ .36**τ - .18**τ .26**τ -

COVID-19 incidence rate .14**⍴ .18**⍴ .21**⍴ .14**⍴ .16**⍴ .16**⍴ .10*⍴ .09⍴

COVID-19 death rate .12*⍴ .15**⍴ .22**⍴ .16**⍴ .17**⍴ .18**⍴ .13*⍴ .12*⍴

COVID-19 deaths/cases .12*⍴ .12*⍴ .14**⍴ .11*⍴ .13*⍴ .14**⍴ .11*⍴ .12*⍴

Contacts infected .11*⍴ .17**⍴ .08⍴ .21**⍴ .17**⍴ .12*⍴ .20**⍴ .16**⍴

Age -.01 -.06 .04 .01 -.07 .09 .005 -.01

Sex .10*τ .14**τ .08τ .12*τ .10* .09*τ .12*τ .16**τ

Education .10*τ -.01τ .03τ .14τ .02τ .03τ .11**τ .05τ

Subjective SES -.01τ -.06τ -.05τ .002τ -.04τ .006τ .02τ -.03τ

Political Orientation -.11**τ -.11**τ -.05τ -.06τ -.06τ -.05τ -.08*τ -.11*τ

Future consequences .21* .19** .17** .22** .22** .15** .13** .24**

Immediate
-.04 -.08 -.10* -.03 -.06 -.09 -.07 -.13*
consequences

Note. * = p < .05, ** = p < .01, ⍴ indicates Spearman’s Rho, and τ indicates Kendall’s Tau-b,
correlations. All others show Pearson’s r. Sample sizes reflect correlations with listwise deletion
for each respective time-point. Correlations shaded in gray are robust to False Discovery Rate
adjustments applying the Benjamini-Hochberg procedure.
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 11
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 12

Figure 1. Heatmaps showing the relationships between mask wearing (y axis) and local COVID-
19 prevalence, perceived risk of infection, pandemic-induced stress, and personal contacts
infected (x axis). The left heatmap reports data collected on July 25 and the right one reports
data collected on August 8. An interactive online version of Figure 1 can be found here:
https://public.tableau.com/profile/cooperationandconflictlab#!/vizhome/Maskwearingassociatedw
ithCOVID-19PrevalenceRiskStressandFutureOrientation/dash-mask

People reported higher mask wearing on August 8, than on July 25, 2020
How consistent is people’s mask wearing behavior over time? To understand the temporal
stability of participants’ mask wearing behavior we test whether participants report different
amounts of mask wearing on July 25 compared to August 8. A paired samples t-test shows that
participants reported greater mask wearing in August (M = 3.67, SD = 1.22) than in July (M =
3.51, SD = 1.25, t(574) = 3.33, p = .001, 95%CIdiff [.065, .252]).

Prevalence of COVID-19, sex (women), education, political orientation (left), and future
orientation are correlated with greater perceived risk of infection and stress
What factors are associated with perceived risk of infection and COVID-19 related stress? We
find that perceived risk of infection and stress are reliably associated with greater mask wearing
during in-person interactions. Previous research has shown that factors such as the prevalence
of disease, demographics, and time orientation are associated with perceived risk of infection
and pandemic related stress (e.g., Jørgensen et al., 2020; Yıldırım & Güler, 2020). Variation in
perceived risk of infection and stress that is determined by factors such as demographics and
time orientation could ultimately have an influence on mask wearing behavior. In light of
previous findings, we examine perceived risk of COVID-19 infection and stress. We test for
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 13

associations between demographic variables, consideration of immediate consequences, and

consideration of future consequences with perceived risk of COVID-19 infection and stress. We
conduct zero order correlations with listwise deletion for missing data to observe associations
within the same subset of participants for each respective time point (Table 1). Correlations with
pairwise deletion that yield statistically different conclusions within each timepoint are reported
below2.

Across all three timepoints, we find that people who were from communities that had a higher
incidence rate, death rate, deaths per cases; knew a greater number of personal contacts who
have been infected, women, people politically inclined to the left, and people with a greater
consideration of future consequences report greater perceived risk of infection (Figure 2) and
COVID-19 related stress (Figure 3). Although the correlation between the incidence rate and
stress on August 8 does not reach statistical significance when we apply listwise deletion, the
correlation between the incidence rate and stress on August 8 when we apply pairwise deletion
is statistically significant, albeit small2. Similarly, while the correlations between perceived risk
and stress with political orientation are not statistically significant in July, applying pairwise
deletion, we observe small negative correlations indicating that people politically inclined to the
right reported lower perceived risk and stress in July2.

We also find that more educated people report greater perceived risk of infection on June 27,
and August 8, but not on July 25. While we do not observe correlations between education and
stress when we apply listwise deletion, when we apply pairwise deletion we observe small
positive correlations between education and stress on July 25, and August 8. We observe a
negative correlation between consideration for immediate consequences and stress on August
8 only. Lastly, neither age nor subjective socioeconomic status are associated with perceived
risk of infection or stress. Lastly, to account for running multiple exploratory tests, we again
adjust p-values by applying the Benjamini-Hochberg False Discovery Rate procedure. All
correlations remain statistically significant after adjusting for multiple comparisons.

2
Pairwise Kendall Tau-b correlations show that education is positively associated with stress in July
(τ(688) = .06, p = .047), and August (τ(631) = .06, p = .043). Pairwise Kendall Tau-b correlations show
that people politically inclined to the right report lower perceived risk of infection ( τ(609) = -.07, p = .031),
and stress (τ(609) = -.08, p = .011) in July. A pairwise Spearman’s Rho correlation shows a positive
association between the prevalence of COVID-19 and stress in August (⍴(521) = .09, p = .042).
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 14
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 15

Figure 2. Heatmaps showing the relationships between perceived risk of infection (y axis) and
local COVID-19 prevalence, sex, education, political orientation, and future orientation (x axis).
The heatmaps from left to right report data collected on June 27, July 25 and August 8. An
interactive online version of Figure 2 can be found here:
https://public.tableau.com/profile/cooperationandconflictlab#!/vizhome/Maskwearingassociatedw
ithCOVID-19PrevalenceRiskStressandFutureOrientation/dash-risk

Political orientation (right) is associated with lower perceived risk of infection and stress
after adjusting for population density
Higher population densities were associated with a higher rate of COVID-19 transmission (Kadi
& Khelfaoui, 2020; Sun et al., 2020; Sy et al., 2020). Because in the United Kingdom (and its
former colonies), the US, and parts of Western Europe people who reside in places with lower
population densities tend to be more politically inclined to the right than people living in places
with higher population densities (De Vries, 2018; Gallego et al., 2016; Pew Research Center,
2018; Rodden, 2010), we tested whether political orientation has an effect on the perceived risk
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 16

of COVID-19 infection and stress after controlling for population density.

Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 17

Figure 3. Heatmaps showing the relationships between pandemic-induced stress (y axis), and
local COVID-19 prevalence, sex, education, political orientation, and future orientation (x axis).
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 18

The heatmaps from left to right report data collected on June 27, July 25 and August 8. An
interactive online version of Figure 3 can be found here:
https://public.tableau.com/profile/cooperationandconflictlab#!/vizhome/Maskwearingassociatedw
ithCOVID-19PrevalenceRiskStressandFutureOrientation/dash-stress

To test whether political orientation would have an effect on perceived risk of infection and
pandemic related stress after adjusting for population density, we matched participant location
data with the UN WPP-Adjusted population density map, which maintains 2020 estimates for
population density at 2.5 arc minutes or ~5 kilometers at the equator (CIESIN, 2018). Due to
high skewness, we take the common logarithm of population density and conduct an ordinal
linear regression with probit link function with population density (logged) and political
orientation as independent variables and perceived risk of infection and stress on June 27 as
the dependent variables. We found that political orientation had a small but statistically
significant effect on stress after adjusting for population density (𝜒(2)2 = 8.22, p = .016, Cox and
Snell R2 = .014, McFadden R2 = .004). Population density had no impact on stress (b = .064, SE
= .05, W = 1.71, 95%CI [-.03, .16]), but people politically inclined to the right reported lower
COVID-19 related stress (b = -.08, SE = .03, W = 6.15, 95%CI [-.15, -.02]). Similarly, political
orientation remained a significant predictor of perceived risk of infection after controlling for
population density (𝜒(2)2 = 10.69, p = .005, Cox and Snell R2 = .019, McFadden R2 = .005),
which has no effect on perceived risk (b = .07, SE = .05, W = 2.13, 95%CI [-.02, .17]), with
people politically inclined to the right reporting lower perceived risk of infection (b = -.09, SE =
.03, W = 8.16, 95%CI [-.16, -.03]).

Discussion

Being female and being older were weakly but significantly correlated with mask
wearing
We find that several indicators are associated with mask wearing. Participants who report mask
wearing in July also reported high levels of mask wearing in August. However, we also saw an
increase in mask wearing on August 8 compared to July 25. Somewhat consistent with previous
research (Capraro & Barcelo, 2020), we find that women reported greater mask wearing during
in-person interactions than men. However, we observe only a small correlation between
participant’s sex and mask wearing, and this correlation was not robust after adjusting for
conducting multiple tests.
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 19

Even though the mortality rate of COVID-19 is much higher for older people (Jordan et al.,
2020), we observe only a small correlation between age and mask wearing. One possible
explanation for this lack of association is that our sample does not include enough older
participants (i.e., 60 years or older) to capture what might be a stronger positive association
between mask wearing and age. Another possibility is that most older people are less active
and therefore less likely to be exposed to people who could carry the disease, therefore leading
them to take fewer precautions.

Political orientation was only weakly correlated with mask wearing

Unlike previous work (Kachanoff et al., 2020), we find a small negative association between
mask wearing and people who report being politically inclined to the right in July, but not in
August. One possible reason why we did not observe a more reliable negative association
between mask wearing and political orientation is that previous studies relied solely on US
participants, whereas our participants are from around the world, primarily Europe. Mask
wearing may be more politicized in the US than in other countries. Also, while previous work
asked people about their intentions to wear masks (Kachanoff et al., 2020), we asked people
about their actual mask-wearing behavior.

Further, it is possible that political orientation may have a different effect on mask wearing
depending on the social context. For example, it may be that people politically inclined to the
right are less likely to wear masks than people politically inclined to the left only when their
reputation or identity as a conservative might be at stake. Thus, we may have observed a weak
and inconsistent relationship between political orientation and mask wearing in our sample
simply because some of the activities people engaged in required wearing masks (e.g., while
shopping indoors in places with mask-wearing mandates).

Future orientation is associated with mask wearing

We observed that people with greater consideration of future consequences report greater mask
wearing during in-person interactions. People with a greater consideration for future
consequences may weigh the potential risks of infection more heavily, which may, in turn, lead
them to perceive a greater risk of contracting COVID-19 and to engage in preventative
behaviors more often as a result. This is consistent with previous work showing that people with
greater future orientation engage in more protective behaviors (Appleby et al., 2005; Heckman
et al., 2009).
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 20

When COVID-19 is more prevalent, people report higher perceived risk of infection to
be higher and more pandemic-related stress
We found that participants from communities with a greater prevalence of COVID-19 reported
increased stress concerning the disease and higher perceived risk of infection. This suggests
that people’s perceived risk of infection and stress are influenced by objective measures of
disease prevalence, or at least things that are correlated with these objective measures. We
also find that individuals from communities with greater rates of COVID-19 report knowing a
larger number of personal contacts who have been infected with the disease, which, in turn, was
positively correlated with perceived risk of infection and stress. These findings are rather
intuitive: as the number of COVID-19 cases increases in a community, the probability is higher
that people living there will become infected, which, in turn, increases the probability that
participants in that community will know infected people. This prevalence of the disease is then
likely to increase people’s perceived risk of infection and pandemic-related stress.

Education, consideration of future consequences, and being female were associated

with greater perceived risk of COVID-19 infection and stress
Beyond the local prevalence of COVID-19, perceived risk of infection and stress were also
influenced by education, sex, and future orientation. Women, people with higher education, and
people with a greater consideration of future consequences reported greater perceived risk of
COVID-19 infection and stress. These findings replicate previous studies showing that these
groups experience greater perceived risk of infection and pandemic-induced stress (Qiu et al.,
2020; Yıldırım & Güler, 2020). They are also in line with previous work showing that women are
generally more risk averse than men (Byrnes et al., 1999; Sapienza et al., 2009; but see Flesia
et al., 2020 for a discussion on the size of the magnitude of this sex difference), that more
educated people have higher COVID-19 health literacy (Okan et al., 2020), and that people with
greater consideration of future consequences assign greater weight to future potential risks
(Appleby et al., 2005; Flesia et al., 2020; Heckman et al., 2009; Joireman et al., 2012).
Moreover, consistent with previous findings (Kachanoff et al., 2020), we find that people
politically inclined to the right report lower perceived risk of infection and pandemic-induced
stress even after we control for population density. Unlike previous studies (Masters et al., 2020;
Qiu et al., 2020), we do not observe an association between age and pandemic-induced stress.
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 21

Limitations and Future Directions

We cannot make causal inferences based on our current analyses

Although we observed reliable associations between the prevalence of COVID-19, stress,

perceived risk of infection, and mask wearing, it is unclear how the prevalence of COVID-19
increases perceived risk of infection and stress, and, in turn, causally influences adherence to
mask-wearing. A longitudinal mediational analysis testing the pathways between these variables
could reveal the extent to which the effect of the local prevalence of COVID-19 on people’s
mask-wearing behavior is explained by changes in the perceived risk of infection and/or
pandemic-induced stress over time. In future work, experimental manipulations could make it
possible to draw causal inferences among some of these variables, but it might not be ethically
advisable to manipulate things like people’s perception of the incidence of COVID-19, as this
could potentially interfere with their information/knowledge of the disease. Nevertheless, future
work, could perhaps ask participants to make decisions about mask wearing in the case of a
future respiratory disease pandemic with different fictional scenarios. By manipulating the
perceived incidence of disease, it would be possible to see how these factors affect perceived
risk of infection, pandemic-induced stress, and mask wearing.

Along similar lines, one of the limitations of our study is that our measures of local COVID-19
prevalence were taken from the dates on which data were collected (i.e., June 27, July 25, and
August 8, 2020). This is a limitation because people’s perceived risk of COVID-19 and stress at
these time points are likely a result of past and repeated exposure to information about disease
prevalence, not just the incidence rate on the day of data collection.

Pandemic-related stress has many diverse sources

Future work could also focus on identifying the diverse sources of pandemic-related stress and
how they differently contribute to mask wearing and other protective behaviors. Stress that
stems from economic concerns, social isolation, or experience with infection could influence
mask wearing in qualitatively different ways. For example, stress related to economic or
isolation concerns may not predict mask-wearing behavior, whereas stress relating to becoming
infected or infecting others with COVID-19 should more reliably predict mask wearing. Future
work could investigate these possibilities both longitudinally and experimentally.
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 22

Stress can influence susceptibility to COVID-19

Understanding variation in people’s pandemic-related stress over time is important for

assessing COVID-19 infection risk and managing the pandemic not only because they can
affect behavior, but also because immune responses to infection are readily altered by social
stress. Chronic social stress and loneliness can modify white blood cell behavior, lowering
antiviral gene expression and lessening antibody responses, which affects infection and even
the success of vaccinations (Miller et al., 2008; Thames et al., 2019; Cole et al., 2015; Vedhara
et al., 1999; Pressman et al., 2005; Wong et al., 2012). Significant, continued pandemic induced
stress could, therefore, contribute to increased biological susceptibility to SARS-CoV-2
infections and compound the vulnerability of groups already under the greatest strain including
essential workers and people of color (CDC, 2020; Williams and Cooper, 2020; Wadhera et al.,
2020).

Mask wearing has symbolic meaning to some subgroups

When it comes to understanding why some people and groups do not adhere to mask wearing
recommendations, one potential explanation is that mask wearing can have different meanings
to different people. As Witte recently said in the Washington Post (Witte et al., 2020) “at the
heart of the dismal U.S. coronavirus response” is a “fraught relationship with masks.”
Anthropologist Graham Jones noted that masks are “one of the most important human artifacts”
(MIT SHASS Communications, 2020) and that “today's cloth masks have come to figure into
everyday interaction rituals in ways that reflect central functions that anthropologists have long
associated with masking: subsuming individual identities within culturally constructed personae
and differentiating groups of people based on power and privilege. Like all masks, they are a
medium of communication.”3

Given the many interpretations people can make based on their own and others’ mask wearing,
it would be valuable to explore whether people associate mask wearing behavior (or lack
thereof) with attributes such as status, group membership, warmth, likeability, or intelligence. In
turn, future work could also investigate whether people’s mental associations with mask wearing
influence their willingness to wear protective masks.

3
For a deeper discussion on meanings of mask wearing in the COVID-19 context, see
https://news.mit.edu/2020/meanings-of-masks-shass-series-0924.
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 23

Conclusion
Our primary goal in conducting this research was to understand variation in adherence to mask
wearing recommendations and the factors that are associated with this variation. Participants
reported more mask wearing when the prevalence of COVID-19 was higher, when they
perceived risk of infection to be higher, when they had higher levels of stress, and when they
were more future-oriented. Women, more educated people, and people politically inclined to the
left reported greater mask wearing during in-person interactions. Despite the continued
transmission of COVID-19 around the world, some people remain reluctant and/or indifferent to
mask wearing recommendations. In our future papers we examine variation in mask-wearing
attitudes (e.g., whether people believe wearing a mask is the right thing to do) and motivations
(e.g., whether people wear masks to protect themselves or others) as well as how the
prevalence of COVID-19, demographics, future orientation, perceived risk of infection, and
stress contribute to mask-wearing attitudes and motivations. We also investigate how these
factors contribute to mask-wearing behavior in various settings (e.g., during recreational and
routine activities). In our future papers we also report on analyses of community mask wearing -
- the extent to which individuals observe others wearing masks -- and examine what predicts
and is predicted by community mask wearing. Understanding the environmental, demographic,
and psychological sources that predict mask wearing behavior could help design interventions
to limit the spread of disease.
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 24

References

Adler, N. E., Epel, E. S., Castellazzo, G., & Ickovics, J. R. (2000). Relationship of subjective and

objective social status with psychological and physiological functioning: preliminary data in

healthy white women. Health Psychology: Official Journal of the Division of Health

Psychology, American Psychological Association, 19(6), 586–592.

https://doi.org/10.1037//0278-6133.19.6.586

Appleby, P. R., Marks, G., Ayala, A., Miller, L. C., Murphy, S., & Mansergh, G. (2005).

Consideration of future consequences and unprotected anal intercourse among men who

have sex with men. Journal of Homosexuality, 50(1), 119–133.

https://doi.org/10.1300/J082v50n01_06

Béland, L. P., Brodeur, A., & Wright, T. (2020). The short-term economic consequences of

Covid-19: exposure to disease, remote work and government response.

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3584922

Benjamini, Y., & Hochberg, Y. (1995). Controlling the False Discovery Rate: A Practical and

Powerful Approach to Multiple Testing. Journal of the Royal Statistical Society. Series B,

Statistical Methodology, 57(1), 289–300. http://www.jstor.org/stable/2346101

Bish, A., & Michie, S. (2010). Demographic and attitudinal determinants of protective behaviours

during a pandemic: a review. British Journal of Health Psychology, 15(Pt 4), 797–824.

https://doi.org/10.1348/135910710X485826

Bodecka, M., Nowakowska, I., Zajenkowska, A., Rajchert, J., Kaźmierczak, I., & Jelonkiewicz, I.

(2021). Gender as a moderator between Present-Hedonistic time perspective and

depressive symptoms or stress during COVID-19 lock-down. Personality and Individual

Differences, 168, 110395. https://doi.org/10.1016/j.paid.2020.110395

Brewer, N. T., Chapman, G. B., Gibbons, F. X., Gerrard, M., McCaul, K. D., & Weinstein, N. D.

(2007). Meta-analysis of the relationship between risk perception and health behavior: the
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 25

example of vaccination. Health Psychology: Official Journal of the Division of Health

Psychology, American Psychological Association, 26(2), 136–145.

https://doi.org/10.1037/0278-6133.26.2.136

Byrnes, J. P., Miller, D. C., & Schafer, W. D. (1999). Gender differences in risk taking: A meta-

analysis. Psychological Bulletin, 125(3), 367–383. https://doi.org/10.1037/0033-

2909.125.3.367

Capraro, V., & Barcelo, H. (2020). The effect of messaging and gender on intentions to wear a

face covering to slow down COVID-19 transmission. https://doi.org/10.31234/osf.io/tg7vz

Centers for Disease Control and Prevention. (2020, August 6). About Cloth Face Coverings.

CDC.gov. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-

coverings.html

Cheng, V. C.-C., Wong, S.-C., Chuang, V. W.-M., So, S. Y.-C., Chen, J. H.-K., Sridhar, S., To,

K. K.-W., Chan, J. F.-W., Hung, I. F.-N., Ho, P.-L., & Yuen, K.-Y. (2020). The role of

community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19)

epidemic due to SARS-CoV-2. The Journal of Infection, 81(1), 107–114.

https://doi.org/10.1016/j.jinf.2020.04.024

Dassen, F. C. M., Houben, K., & Jansen, A. (2015). Time orientation and eating behavior:

Unhealthy eaters consider immediate consequences, while healthy eaters focus on future

health. Appetite, 91, 13–19. https://doi.org/10.1016/j.appet.2015.03.020

Desai, A. N., & Patel, P. (2020). Stopping the Spread of COVID-19. JAMA: The Journal of the

American Medical Association. https://doi.org/10.1001/jama.2020.4269

De Vries, C. E. (2018). The cosmopolitan-parochial divide: changing patterns of party and

electoral competition in the Netherlands and beyond. Journal of European Public Policy,

25(11), 1541–1565. https://doi.org/10.1080/13501763.2017.1339730

Dong, E., Du, H., & Gardner, L. (2020). An interactive web-based dashboard to track COVID-19

in real time. The Lancet Infectious Diseases.https://doi.org/10.1016/S1473-3099(20)301201

Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 26

Eisenberger, N. I., Moieni, M., Inagaki, T. K., Muscatell, K. A., & Irwin, M. R. (2017). In Sickness

and in Health: The Co-Regulation of Inflammation and Social Behavior.

Neuropsychopharmacology: Official Publication of the American College of

Neuropsychopharmacology, 42(1), 242–253. https://doi.org/10.1038/npp.2016.141

Flesia, L., Monaro, M., Mazza, C., Fietta, V., Colicino, E., Segatto, B., & Roma, P. (2020).

Predicting Perceived Stress Related to the Covid-19 Outbreak through Stable

Psychological Traits and Machine Learning Models. https://doi.org/10.3390/jcm9103350

Gallego, A., Buscha, F., Sturgis, P., & Oberski, D. (2016). Places and preferences: a

longitudinal analysis of self-selection and contextual effects. British Journal of Political

Science, 46(3), 22. https://doi.org/10.1017/S0007123414000337

Greenhalgh, T., Schmid, M. B., Czypionka, T., Bassler, D., & Gruer, L. (2020). Face masks for

the public during the covid-19 crisis. BMJ , 369, m1435. https://doi.org/10.1136/bmj.m1435

Griff Witte, Ariana Eunjung Cha, Josh Dawsey. (2020, July 28). At the heart of dismal U.S.

coronavirus response, a fraught relationship with masks. The Washington Post.

https://www.washingtonpost.com/national/at-the-heart-of-dismal-us-coronavirus-response-

a-fraught-relationship-with-masks/2020/07/28/f47eccd0-cde4-11ea-bc6a-

6841b28d9093_story.html

Heckman, C. J., Wilson, D. B., & Ingersoll, K. S. (2009). The influence of appearance, health,

and future orientations on tanning behavior. American Journal of Health Behavior, 33(3),

238–243. https://doi.org/10.5993/ajhb.33.3.2

Islam, S. M. D.-U., Bodrud-Doza, M., Khan, R. M., Haque, M. A., & Mamun, M. A. (2020).

Exploring COVID-19 stress and its factors in Bangladesh: A perception-based study.

Heliyon, 6(7), e04399. https://doi.org/10.1016/j.heliyon.2020.e04399

Joireman, J., Shaffer, M. J., Balliet, D., & Strathman, A. (2012). Promotion orientation explains

why future-oriented people exercise and eat healthy: evidence from the two-factor

consideration of future consequences-14 scale. Personality & Social Psychology Bulletin,

Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 27

38(10), 1272–1287. https://doi.org/10.1177/0146167212449362

Jordan, R. E., Adab, P., & Cheng, K. K. (2020). Covid-19: risk factors for severe disease and

death [Review of Covid-19: risk factors for severe disease and death]. BMJ , 368, m1198.

https://doi.org/10.1136/bmj.m1198

Jørgensen, F. J., Bor, A., & Petersen, M. B. (2020). Compliance Without Fear: Predictors of

Protective Behavior During the First Wave of the COVID-19 Pandemic. PsyArXiv. May, 19.

https://slack-files.com/files-pri-safe/TBY1XTCCR-

F014JMR8N73/compliance_without_fear.pdf?c=1597765636-f25ab85dc72655bc

Kachanoff, F. J., Bigman, Y. E., Kapsaskis, K., & Gray, K. (2020). Measuring Two Distinct

Psychological Threats of COVID-19 and their Unique Impacts on Wellbeing and Adherence

to Public Health Behaviors. In PsyArXiv Preprints. The University of North Carolina at

Chapel Hill . https://doi.org/10.31234/osf.io/5zr3w

Kadi, N., & Khelfaoui, M. (2020). Population density, a factor in the spread of COVID-19 in

Algeria: statistic study. Bulletin of the National Salmon Resources Center , 44(1), 138.

https://doi.org/10.1186/s42269-020-00393-x

Lau, J. T. F., Yang, X., Pang, E., Tsui, H. Y., Wong, E., & Wing, Y. K. (2005). SARS-related

perceptions in Hong Kong. Emerging Infectious Diseases, 11(3), 417–424.

https://doi.org/10.3201/eid1103.040675

Liu, X., & Zhang, S. (2020). COVID‐19: Face masks and human‐to‐human transmission.

Influenza and Other Respiratory Viruses, 14(4), 472–473. https://doi.org/10.1111/irv.12740

MacIntyre, C. R., & Chughtai, A. A. (2020). A rapid systematic review of the efficacy of face

masks and respirators against coronaviruses and other respiratory transmissible viruses for

the community, healthcare workers and sick patients. International Journal of Nursing

Studies, 103629. https://www.sciencedirect.com/science/article/pii/S0020748920301139

Masters, N. B., Shih, S.-F., Bukoff, A., Akel, K. B., Kobayashi, L. C., Miller, A. L., Harapan, H.,

Lu, Y., & Wagner, A. L. (2020). Social distancing in response to the novel coronavirus
Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 28

(COVID-19) in the United States. PloS One, 15(9), e0239025.

https://doi.org/10.1371/journal.pone.0239025

MIT SHASS Communications. (2020, July 2). MIT SHASS: News - 2020 - Pandemic - Masks -

Anthropology - Graham Jones. https://shass.mit.edu/news/news-2020-pandemic-masks-

anthropology-graham-jones

Okan, O., Bollweg, T. M., Berens, E.-M., Hurrelmann, K., Bauer, U., & Schaeffer, D. (2020).

Coronavirus-Related Health Literacy: A Cross-Sectional Study in Adults during the COVID-

19 Infodemic in Germany. International Journal of Environmental Research and Public

Health, 17(15). https://doi.org/10.3390/ijerph17155503

Parmet, W. E., & Sinha, M. S. (2020). Covid-19—the law and limits of quarantine. The New

England Journal of Medicine, 382(15), e28.

https://www.nejm.org/doi/full/10.1056/NEJMp2004211

Peeples, L. (2020). Face masks: what the data say [Review of Face masks: what the data say].

Nature, 586(7828), 186–189. https://doi.org/10.1038/d41586-020-02801-8

Pew Research Center. (2018, May 22). How urban, suburban and rural residents’ view social

and political issues. https://www.pewsocialtrends.org/2018/05/22/urban-suburban-and-

rural-residents-views-on-key-social-and-political-issues/

Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of

psychological distress among Chinese people in the COVID-19 epidemic: implications and

policy recommendations. General Psychiatry, 33(2), e100213.

https://doi.org/10.1136/gpsych-2020-100213

Riediker, M., & Tsai, D.-H. (2020). Estimation of Viral Aerosol Emissions From Simulated

Individuals With Asymptomatic to Moderate Coronavirus Disease 2019. JAMA Network

Open, 3(7), e2013807. https://doi.org/10.1001/jamanetworkopen.2020.13807

Rodden, J. (2010). The Geographic Distribution of Political Preferences. Annual Review of

Political Science, 13(1), 321–340.

Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 29

https://doi.org/10.1146/annurev.polisci.12.031607.092945

Salari, N., Hosseinian-Far, A., Jalali, R., Vaisi-Raygani, A., Rasoulpoor, S., Mohammadi, M.,

Rasoulpoor, S., & Khaledi-Paveh, B. (2020). Prevalence of stress, anxiety, depression

among the general population during the COVID-19 pandemic: a systematic review and

meta-analysis. Globalization and Health, 16(1), 57. https://doi.org/10.1186/s12992-020-

00589-w

Santarpia, J. L., Rivera, D. N., Herrera, V. L., Morwitzer, M. J., Creager, H. M., Santarpia, G. W.,

Crown, K. K., Brett-Major, D. M., Schnaubelt, E. R., Broadhurst, M. J., Lawler, J. V., Reid,

S. P., & Lowe, J. J. (2020). Author Correction: Aerosol and surface contamination of SARS-

CoV-2 observed in quarantine and isolation care. Scientific Reports, 10(1), 13892.

https://doi.org/10.1038/s41598-020-70939-6

Sapienza, P., Zingales, L., & Maestripieri, D. (2009). Gender differences in financial risk

aversion and career choices are affected by testosterone. Proceedings of the National

Academy of Sciences of the United States of America, 106(36), 15268–15273.

https://doi.org/10.1073/pnas.0907352106

Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). Stress and health: psychological,

behavioral, and biological determinants. Annual Review of Clinical Psychology, 1, 607–628.

https://doi.org/10.1146/annurev.clinpsy.1.102803.144141

School of Humanities, Arts, and Social Sciences. (n.d.). The meanings of masks. Retrieved

November 19, 2020, from https://news.mit.edu/2020/meanings-of-masks-shass-series-0924

Smith, R. D. (2006). Responding to global infectious disease outbreaks: lessons from SARS on

the role of risk perception, communication and management. Social Science & Medicine,

63(12), 3113–3123. https://doi.org/10.1016/j.socscimed.2006.08.004

Strathman, A., Gleicher, F., Boninger, D. S., & Edwards, C. S. (1994). The consideration of

future consequences: Weighing immediate and distant outcomes of behavior. Journal of

Personality and Social Psychology, 66(4), 742–752. https://doi.org/10.1037/0022-

Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 30

3514.66.4.742

Sun, Z., Zhang, H., Yang, Y., Wan, H., & Wang, Y. (2020). Impacts of geographic factors and

population density on the COVID-19 spreading under the lockdown policies of China. The

Science of the Total Environment, 746, 141347.

https://doi.org/10.1016/j.scitotenv.2020.141347

Sy, K. T. L., White, L. F., & Nichols, B. E. (2020). Population density and basic reproductive

number of COVID-19 across United States counties. medRxiv : The Preprint Server for

Health Sciences. https://doi.org/10.1101/2020.06.12.20130021

World Health Organization. (2020, March 11). WHO Director-General’s opening remarks at the

media briefing on COVID-19-11 March 2020. World Health Organization.

https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-

media-briefing-on-covid-19---11-march-2020

Yıldırım, M., & Güler, A. (2020). Factor analysis of the COVID-19 Perceived Risk Scale: A

preliminary study. Death Studies, 1–8. https://doi.org/10.1080/07481187.2020.1784311

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html

Center for International Earth Science Information Network - CIESIN - Columbia University.

(2018). Gridded Population of the World, Version 4 (GPWv4): Population Density Adjusted

to Match 2015 Revision UN WPP Country Totals, Revision 11. Palisades, NY: NASA

Socioeconomic Data and Applications Center (SEDAC). https://doi.org/10.7927/H4F47M65.

Accessed 27 March 2020.

Cole, S.W. & Levine, M.E., Arevalo, J.M.G., Ma., J., Weir, D.R., Crimmins, E.M.. 2015.

Loneliness, eudaimonia, and the human conserved transcriptional response to adversity.

Psychoneuroendocrinology. 62:11-17. DOI: 10.1016/j.psyneuen.2015.07.001

Miller, G.E. & Chen, E., Sze, J., Marin, T., Arevalo, J.M.G., Doll, R., Ma, R., Cole, S.W..2008. A

Functional Genomic Fingerprint of Chronic Stress in Humans: Blunted Glucocorticoid and

Mask wearing associated with COVID-19 Prevalence, Risk, Stress, and Future Orientation 31

Increased NF-kB Signaling. Biological Psychiatry. 64(4):P266-272.

DOI:https://doi.org/10.1016/j.biopsych.2008.03.017

Pressman, S.D. & Cohen, S., Miller, G.E., Barkin, A., Rabin, B.S., Treanor, J.J..2005.

Loneliness, social network size, and immune response to influenza vaccination in college

freshman. Health Psychology. 24(3):297-306 https://doi.org/10.1037/0278-6133.24.3.297

Thames, A.D., & Irwin, M.R., Breen, E.C., Cole, S.W.. 2019. Experienced discrimination an

racial differences in leukocyte gene expression. Psychoneuroendocrinology. 106:277-283

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589103/

Vedhara, K. & Cox, N.K., Wilcock, G.K., Perks, P., Hunt, M., Anderson, S., Lightman, S.L.,

Shanks, N.M.. 1999. Chronic stress in elderly carers of dementia patients and antibody

response to influenza vaccination. Lancet. 353(9153):627-31.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)06098-X/fulltext

Wadhera, R.K. & Wadhera, P., Gaba, P., Figueroa, J.F., Maddox, K.E.J., Yeh, R. W., Shen, C..

2020. Variation in COVID-19 hospitalizations and deaths across New York City boroughs.

JAMA. 323(21): 2192-2195 doi: 10.1001/jama.2020.7197

Williams, D. R. and L. Cooper. 2020. COVID-19 and health equity - A new kind of “herd

immunity”. JAMA. 323(24):2487-2480 doi:10.1001/jama.2020.8051

Wong, S.Y.S. & Wong, C.K., Chan, F.W.K., Chan, P.K.S., Ngai, K., Mercer, S., Woo, J.. 2013.

Chronic psychosocial stress: does it modulate immunity to the influenza vaccine in Hong

Kong Chinese elderly caregivers? Age (Dordr). 35(4):1479-93. DOI: 10.1007/s11357-012-

9449-z