Southwestern College Students  Attitudes and Behaviors towards Face Mask wearing on Campus.

doi:10.21203/rs.3.rs-5306087/v1

The emergence of respiratory viral infections has necessitated the use of face masks worldwide. Although several studies have examined the uses of the face and attested to its efficacy in preventing airborne diseases. In the United States, wearing face masks is a divisive and politicized topic. College students on campus have their own reservations on mask wearing and are influenced by a myriad of factors that determine compliance to mask mandate. The aim of this study is to examine the perception, attitudes, and behavior of college students toward facemask wearing on campus. To achieve that, we recruited 217 participants. 117 (53.9%) participants identified as females, 97 (44.7%) identified as males while the remaining three (1.4%) participants identified as non-binary, with an average age of 19.89. Participants were recruited using convenience sampling through the distribution of flyers both in class and online course pages or website. With an online survey, we measured participants’ attitude, behavior, perceived benefit, and perceived risk of wearing facemasks. We conducted, one-way ANOVA, correlation, and regression analysis. The result indicated that there is no relationship between perceived benefit and attitude towards wearing face masks among US college students. From the analysis, as perceived benefit increases, students' attitude also decreases moderately. This means that perceived benefits do not necessarily correlate with the attitude of students in wearing face masks. Therefore, it might be due to other factors such as the mandatory rule instituted for all to wear face mask on campus. Additionally, there is a positive low relationship between students’ perceived risk of face mask wearing and their face mask wearing behavior, the relationship, therefore, is not significant. This suggests that college students who are at a high perceived risk of COVID-19 are less likely to engage in high face mask wearing behavior. Implications and future directions are discussed.

Until recently, face masks were typically worn in clinical settings by medical professionals (1). However, the outbreak of respiratory viral infections (RVIs) that predates the COVID-19 pandemic such as severe acute respiratory syndrome (SARS), the H1N1 influenza (bird flu), the Middle East respiratory syndrome (MERS), and Ebola introduced the use of face mask in the affected areas. The declaration of the life-threatening COVID-19 outbreaks worldwide, broadened the use of face masks as a prophylactic tactic against the deadly airborne infection. Several studies have examined the uses of the face mask and their efficacy in preventing airborne diseases (2) (3), (4), (5) (6). Evidently, wearing a face mask helps prevent some infections from spreading through droplets(5). In a study by Cheng et al., (7) public mask-wearing is effective in reducing COVID-19 transmission in the community, thus curbing the spread of the pandemic.

The protocol of wearing face masks has been controversial and politicized in many countries including the U.S.(8, 9, 10). Mask wearing is hardly seen as a norm in the US (11, 12). Despite media claims that more people are donning masks in public places, many people disagree over whether this behavior is healthy and effective (13, 14). The motivation of individuals to adhere to these preventative measures is crucial for the effectiveness of preventive behaviors (15, 16). Positive attitudes towards COVID-19 preventive measures such as using masks can improve mask-wearing behavior, though, concerns about mask impact on health may influence negative attitudes and behaviors.

Zhang et al. (17) examined four major constructs viz perceived usefulness, perceived risk, social pressure, and social image as motivations for mask use when they investigated mask-wearing behavior among Chinese urban and rural residents. Results on perceived usefulness indicated a signiﬁcant relationship between attitude and behavioral intention to wear a mask, meaning that individuals with positive attitudes towards mask use or who perceived that wearing a mask will benefit them, were more likely to wear one. Meanwhile, the hypothesis testing on the variables perceived risk, social image, and social pressure did not indicate any association with mask use behavioral intention, the test yielded signiﬁcant relationships with attitudes. An indication of that attitude was a predictor of intentions to use a mask. The study further observed that social image and social pressure also had a strong influence on attitudes but not on the behavioral intention to wear masks. In other words, individuals develop positive attitudes towards mask-wearing when they perceive that the behavior could improve their social status.

Similarly, Aboagye et al., (18) found that the perceived usefulness of masks improved students’ attitudes towards wearing one because they believe that wearing masks would protect them against COVID-19. However, the health challenges of wearing masks — especially for students with respiratory problems including asthma— and for an extended period impacted attitudes towards mask use on campus. Instead, alternative prevention strategies such as physical distancing and remote learning were put forward to limit the use of masks for students while on campus. Both studies demonstrate the influence of perceptions of mask use on attitudes which by extension, determines the behavioral action or intention toward using it. Also, they reiterate the need to sustain positive attitudes to inform mask-wearing behaviors and considerations for alternative measures to prevent COVID-19. Risk perceptions are very necessary for taking preventive measures, but they are frequently biased(19). Brug and Richardus (15) also asserted that most health behavior theories include risk perception as a critical component. The pandemic risk perceptions significantly influence individuals’ intention to wear face masks (20, 21, 22).The perceived benefits of face masks refer to people's understanding and awareness of the benefits that face masks provide in controlling and preventing the transmission of infectious viral diseases (23). The perceived benefits of face masks have a significant influence on individuals’ intention to wear face masks (24, 25, 26).

Apart from levels of perceived benefits and risk, other studies have shown that demographic factors such as age, gender, marital status, and living situation influenced preventative health behaviors (27).When Rawlings et al.(27), explore students’ perceptions of COVID-19 risks and preventive measures in Uganda, they found that many students obeyed the face mask guidelines, students believed that COVID-19 is a health risk, and this perspective favorably influenced their attitudes and behaviors regarding the intention to wear the face masks, their intentions differ by their age, gender and level or year. This adds to the argument that age, gender, and academic level of students determine people or students’ attitudes which influences their behavior to follow preventive measures or guidelines towards face mask wearing. Situating this to gender, prior studies have suggested generally that women are more likely to have positive attitudes and behavior towards face mask wearing than men since men are more likely to perceive face mask wearing negatively with reasons such as being a weakness sign, shameful, a threat to their independence and masculine identity. (28, 29, 30, 31).This was clearly demonstrated in research conducted by Dattel et al., (32)that examined divergent attitudes regarding the benefits of face masks in aviation colleges and universities. Females reported greater benefits to wearing a face mask and fewer inconveniences. A similar finding was reported by Soltan et al. (33), female senior students have higher percentages regarding related knowledge and practicing preventive behaviors as well among their population. In relation to age, older people are more susceptible to covid 19 infection than younger ones in terms of immune system defense, morbidity, and mortality rates. This explains the reason older students and even females wear face masks more than younger males. Additionally, it was observed that younger people feel they are invincible to the coronavirus which, helps explain their lower perceptions of the benefits of face masks. These attitudes may also have arisen from reports of fewer COVID-19 infections among youth(34, 35). However, this reasoning is flawed because many younger people who become exposed to or ill with COVID-19 are like the rest of the population indisposed or must quarantine for a considerable period (32).

Limna et al. (19) investigated the main factors affecting the general public’s intention to wear a face mask during the COVID-19 pandemic in Thailand. The work indicated that the predictors of intention to wear face masks included attitude, face mask cost, pandemic risk perceptions, perceived benefits, and face mask availability. The findings revealed that attitude had the most significant influence on the intention to wear a face mask, and then the perceived benefit of a face mask, the next was pandemic risk perceptions, followed by the availability of face masks, and face mask cost. It was indicated that the respondents’ pandemic risk perceptions greatly influenced attitudes. Also, their attitude significantly influenced their pandemic risk perceptions and their intention to wear face masks. Furthermore, Soltan et al. (33) in their evaluation of knowledge, risk perception, and preventive behaviors among undergraduate medical students disclosed that about 86.9% of the students perceived a COVID-19-infected person as a serious threat to society and as a result, about 92% of the students were practicing the COVID-19 preventive behaviors. Several studies have supported the claim of students' positive attitude and adherence to the wearing of face masks (36). Conversely, few of the studies have accounted that some students resisted wearing face masks despite the growing trends in the COVID-19 pandemic (37, 38). Dattel et al, (32), revealed polarized opinions on the advantages of face masks and described that those who even disagreed with the benefit of face masks claimed that they complied with it when on their college campuses.

It is well-established that many factors influence the correlation between attitudes and behaviors, but it is generally accepted that specific attitudes will predict specific behaviors (39). Age, gender, and academic level of student’s factors may explain attitudes and behaviors regarding wearing face masks.

Overall, practicing preventive behaviors of mask-wearing is dependent on the assessment of risk perception by college students on COVID-19 disease as a serious threat to the academic environment. Even though many students experience face mask wearing as discomforting, and sometimes inconvenient as a result of difficulty in breathing. Studies show that risk perception assessment done by college students on COVID-19 infection on the benefits of wearing face masks outweigh the discomforts and see wearing face masks as potentially lifesaving(40)

Research Question and Hypotheses 

RQ1: What is the level of perceived risk of wearing face mask among US college students?

RQ2: What is the level of perceived benefit of wearing face masks among US college students?

Hypotheses

H1: There is no statistically significant difference in perceived risk of wearing face masks due to gender and undergraduate student classification level among US college students.

H2: There is no statistically significant difference in the perceived benefit of wearing face masks due to gender and undergraduate student classification level among US college students.

H3: There is no relationship between perceived benefit and attitude towards wearing face masks among US college students.

H4: There is no relationship between perceived risk and attitude towards wearing face masks among US college students.

H5: There is a positive relationship between perceived risk and behavior toward wearing face masks among US college students.  

H6: There is a positive relationship between perceived benefit and behavior towards wearing face masks among US college students. 

H7: Perceived benefit and perceived risk will significantly predict the attitude of students towards face mask wearing.

H8: Perceived benefit and perceived risk will significantly predict the behavior of students towards face mask wearing.

Procedures for Data Collection

Participants were recruited using convenience sampling through the distribution of flyers both in class and online course pages or websites. Both recruitment methods directed participants to scan a QR code on the flyer posted on their course pages to be directed to the online survey on Qualtrics. The flyer's advertisement was done by the researcher and course instructors. Participants were offered a small amount of extra course credit for participation. The inclusion criteria for participation were that respondents must be enrolled in the university where the study was conducted. Again, students taking various undergraduate courses must be 18 years old or above. To protect participation identities and to get the extra credit, a unique code was generated on the last page of the survey and students were instructed to take a picture of the code and upload it onto canvas. The study began with a consent form that detailed the study procedures and a review of the rights, anonymous nature of participation and potential risks of participation. Contact information for both the IRB (Institutional Review Board) and the study’s primary investigator was provided to participants.

Socio-Demographic Characteristics

Demographic questions such as age, gender, year of school, living condition, COVID-19 status as well as COVID-19 vaccination status.

Measures

We measured participants’ attitudes, behavior, perceived benefits and perceived risks, the researcher used an adapted version of the scale by different researchers as described below:

Attitudes variable.Attitudes of student scale (41)originally used to assess attitudes towards mask use in preventing and controlling the COVID-19 outbreak was used in the present study. Cronbach’s alpha was good at 0.78. Participants s indicated on a scale from 1 = strongly disagree to 5 = strongly agree to measure the extent to which they agree with a 10 - item question on attitude, for example, “Wearing facemasks cause outer ear pain”. The attitude items were further summed (SD and Mean), and reverse coded such that higher scores indicated more positive attitudes towards face mask-wearing”.

Behavior variable. In the current study, the behavior of students toward face mask wearing was s to assess the behavior students exhibit toward how they use and dispose of their face masks on campus. Larebo et al. (42) developed the original version of the scale with a reliability coefficient of 0.84 to evaluate the practices of face mask utilization and associated factors during the COVID-19 pandemic among Wachemo University Students. Participants completed a 14-item behavior scale which was measured on varied levels such as 1= Yes, 2 = Maybe to 3 = No, 1 = never to 4 = always. For instance, there were questions such as “Did you keep a used facemask in your pocket/ bag for later use?”

Perceived benefits variable. This scale was developed by Davis (43) for predicting user acceptance of computers but has been adapted by several researchers (e.g.,) in different contexts. A 7-item perceived benefits scale with a reliability coefficient of 0.90 was used to measure whether students’ attitudes and behavior are predicted by knowing and perceiving that using face masks is useful. Participants indicated on a Likert scale from 1 = strongly disagree to 5 = strongly agree.

Perceived risks variable. The current study adapted the COVID-19 perceived risks scale (CPRS) (44, 45) to assess the responses to COVID-19. The researcher mainly added the phrase “while wearing face masks” to each of the statements to situate it in the present context of face mask wearing. Participants responded using a 5-point Likert scale with a reliability coefficient of 0.88, ranging from 1 =very unlikely to 5 = very likely to measure whether the effects of COVID-19 while wearing a face mask are likely to predict the attitudes and behavior of students or not. To do this, a 5-item scale was used. All items were reverse-recoded so that higher scores indicate higher perceived risks of COVID-19.

Data Analysis

After the survey was closed, the first author checked and cleaned the data so participants exhibiting large amounts of missing data were excluded. For instance, those who provided only demographic information and failed to answer items related to study aims were deleted. We utilized SPSS version 27 to conduct the data analysis and a p-value of less than 0.05 was considered significant. Frequencies, mean, and standard deviation were used to analyze the demographic data. We used a variety of statistical techniques, such as one-way ANOVA, correlation, and regression to help us address the research questions and hypotheses.

The total sample size comprised of (N = 217) participants. The data showed that 117 representing 53.9% of the students were females, 97 representing 44.7% were males and the remaining three representing 1.4% were non-binary with the age being (M_age = 19.89 SD = 1.53). Additionally, demographics such as year of school, living conditions as well as COVID-19 vaccination status were also provided. For the information on year of school, Freshmen (first-year students) formed the majority (41.5%), followed by juniors (26.3%), sophomores (22.1%), seniors (6.9%) and super seniors (3.2%). In describing their living condition, those who lived with friends/roommates was the highest (68.2), then those living with family (21.2%), those staying alone (8.8%) and the other options apart from the ones provided (1.8%). In addition, the large number of participants have been fully vaccinated (46.5%), not vaccinated (25.3%), vaccinated and boosted (22.1%) and others who have received only one shot (6.0%). Participants were asked whether they have ever tested positive for COVID-19 before, those who responded Yes (54.4%) while the No (45.6%). All results are shown in Table I

Table I: Participants’ characteristics (N=271)

Characteristic	n	%	M	SD
Age (range 18-25)	217		19.89	1.53
Gender
Female	117	53.9
Male	97	44.7
Nonbinary	3	1.4
Year in College
Freshmen	90	41.5
Sophomore	48	22.1
Junior	57	26.3
Senior	15	6.9
Super senior (5+ years)	7	3.2
Living Condition
Alone	19	8.8
Family	46	21.2
Friends/Roommates	148	68.2
Others	4	1.8
COVID-19 Vaccination Status
Fully vaccinated.	101	46.5
Vaccinated and boosted.	13	6.0
One shot	48	22.1
Not vaccinated	55	25.3
Previous COVID-19 diagnosis
Yes	118	54.4
No	99	45.6

Level of perceived risk

The purpose of the research question was to find out the perceived risk of students wearing a face mask. The cut-off points on the five-point Likert scale for the set of data are 1.00-1.60 = low, 1.61-2.20 = weak, 2.21-2.80 = moderate, 2.81-3.40 = strong and 3.41-4.00 = perfect. The results of the descriptive statistics for the perceived risk of face mask wearing as expressed by the students is presented in Table II.

Table II- Descriptive statistics of students’ perceived risk of face mask wearing.

Statements	N	Mean	Std. Dev	Skewness	Kurtosis
How likely is it that you might become infected with COVID-19 when wearing a face mask?	217	2.89	.906	.191	-.167
How likely is it that people in your family and friends might become infected with COVID-19 when wearing a face mask?	217	2.89	.899	-.021	-.099
How likely are you from dying of COVID-19 when wearing face mask?	217	2.38	1.003	.202	-.450
Do I worry about myself contracting COVID-19 while wearing a face mask?	217	2.49	1.137	.424	-.632
Do I worry about a family member contracting COVID-19 while wearing a face mask?	217	2.71	1.128	.162	-.799
Do I worry about COVID-19 becoming severe in the school because of our attitude and behavior toward face mask wearing?	217	2.88	1.277	.070	-1.034
Do I worry about COVID-19 causing a shutdown in schools because of our attitude and behavior toward face mask wearing?	217	2.99	1.253	.069	-.970
Mean of Means Mean of Std. Dev. Overall skewness Overall kurtosis		2.75	1.086	.000	.349

The result shows that the distribution of students’ perceived risk of wearing mask is normal (Sk = 0.000) and platykurtic (kp <3). The results show that, the students expressed that they have moderate level of risk of face mask wearing. This is because the means of means (2.75) lies within the range of moderate level of risk in wearing face mask.

Perceived benefit

The purpose of the research question was to find out the perceived benefit of students in wearing face mask. The cut-off points on the five-point Likert scale for the set of data are 1.00-1.60 = low, 1.61-2.20 = weak, 2.21-2.80 = moderate, 2.81-3.40 = strong and 3.41-4.00 = perfect. The results of the descriptive statistics for perceived of benefit face mask wearing as expressed by the students are presented in Table III.

Table III: Descriptive statistics of students’ perceived benefit of face mask wearing.

Statement	N	Mean	Std. Dev	Skewness	Kurtosis
I believe that wearing a face mask is an effective precautionary measure	217	3.55	1.306	-.638	-.702
I believe that wearing a face mask will protect my health	217	3.36	1.313	-.364	-1.027
I believe that wearing a face mask reduces the chances of getting infected	217	3.55	1.294	-.545	-.816
I believe that wearing a face mask reduces the chances of inhaling unhealthy air	217	3.57	1.223	-.608	-.544
I believe that wearing a face mask will reduce my exposure to novel SARS-CoV-2 virus	217	3.46	1.305	-.427	-.969
I do not fear going out after wearing a face mask	217	3.76	1.087	-.504	-.366
I believe that society will get protected from viral diseases if people wear face masks	217	3.14	1.327	-.169	-1.124
Mean of Means Mean of std. dev Overall skewness Overall kurtosis		3.49	1.27	-.391	-.68

The result shows the distribution of students on the perceived benefit is negatively skewed (overall Sk = -.391) and platykurtic (overall kp <3). The results show that, the students expressed perfect level of benefit of face mask wearing. This is because the means of means (3.49) lies within the range of perfect level of benefit in wearing face mask.

There is no significant difference in perceived risk due to gender and level.

The purpose of the hypothesis was to find if students have different risk level in wearing face mask as result of their gender and undergraduate student classification level. The result of the descriptive statistics is presented in Table IV.

Table IV: Descriptive statistics of students perceived risk of face mask wearing by gender and level

Gender	Levels	Mean	Std. Deviation	N
Female	Freshmen	19.58	5.08	53
	Sophomore	19.88	3.80	25
	Juniors	20.19	4.54	32
	Seniors	19.57	3.26	7
Male	Freshmen	19.41	5.38	37
	Sophomore	18.09	5.35	23
	Juniors	17.28	4.74	25
	Seniors	19.00	4.69	7
	Super seniors (5 + years)	18.00	3.00	5
Nonbinary	Seniors	18.00	.	1
Nonbinary	Super seniors (5 + years)	24.50	3.54	2

The results showed that among females, the juniors (M = 20.19; SD = 4.54; N = 32) have the highest risks of wearing face masks. The seniors (M = 19.57; SD = 3.26; N = 7) however, have the least risks in wearing face masks. The result also shows that among males, the freshmen (M = 19.41; SD = 5.38; N = 37) have the highest risks in wearing face mask. Conversely, the juniors (M = 17.28; SD = 4.74; N = 25) have the least risks in wearing face masks. Within the Non-binary, it was found that the super seniors (M = 24.50; SD = 3.54; N = 2) have higher risks in wearing face masks than the seniors (M = 18.00; N = 1). To find out whether the differences in the means are significant, a two-way ANOVA was used to test the hypothesis. The result of the two-way ANOVA is presented in Table V.

Table V: Results of the two-way ANOVA on perceived risk due to gender and level

Source	Type III Sum of Squares	df	Mean Square	F	Sig.
Gender	114.502	2	57.251	2.466	.087
Level	38.837	4	9.709	.418	.795
Gender * Level	96.898	4	24.224	1.043	.386
Error	4782.382	206	23.215
Total	85308.000	217

The results show that there is no statistically significant gender difference in the perceived risk of the students in wearing face masks, (F_2,206 = 2.466, p= 0.087, p>0.05). This means male and female students have the same level of risk in wearing face masks. Also, the result shows that there is no statistically significant level difference in the perceived risk of the students wearing face masks (F_4,206 = 0.418, p= 0.795, p>0.05). This means that students irrespective of their level have the same risks in wearing face masks. Finally, the result shows that there is no significant difference in students’ risk of wearing face by the interaction of gender and level (F_4,206 = 1.043, p= 0.386, p>0.05). This means that female and male students of a particular level have the same risks in wearing face masks.

There is no significant difference in perceived benefit due to gender and level.

The purpose of the hypothesis was to find if students have perceived benefits in wearing face mask as result of their gender and level. The result of the descriptive statistics is presented in Table VI.

Table VI: Descriptive statistics of students’ perceived benefit of face mask wearing by gender and level

Gender	Levels	Mean	Std. Deviation	N
Female	Freshmen	24.19	7.16	53
	Sophomore	25.44	6.65	25
	Juniors	24.41	7.09	32
	Seniors	29.00	4.73	7
Male	Freshmen	25.05	7.31	37
	Sophomore	24.57	6.24	23
	Juniors	22.88	6.98	25
	Seniors	23.29	9.69	7
	Super seniors (5 + years)	24.00	6.40	5
Nonbinary	Seniors	22.00	.	1
Nonbinary	Super seniors (5 + years)	13.00	8.49	2

The results showed that among females, the seniors (M = 29.00; SD = 4.73; N = 7) have the highest risks of wearing face masks. The freshmen (M = 24.19; SD = 7.16; N = 53) have the least benefit from wearing face masks. The result also shows that among the males, the freshmen (M = 25.05; SD = 7.31; N = 37) have the highest benefit in wearing face masks. The juniors (M = 22.88; SD = 6.98; N = 25) have the least benefit from wearing face masks. Among the non-binary, it was found that the seniors (M = 22.00; N = 1) have higher benefits in wearing face masks than the super seniors (M = 13.00; SD = 8.49; N = 2). To find out whether the differences in the means are significant, a two-way ANOVA was used to test the hypothesis. The result of the two-way ANOVA is presented in Table VII.

Table VII: Results of the two-way ANOVA on the perceived benefit due to gender and level

Source	Type III Sum of Squares	df	Mean Square	F	Sig.
Gender	130.481	2	65.241	1.322	.269
Level	145.906	4	36.477	.739	.566
Gender * Level	180.195	4	45.049	.913	.458
Error	10169.605	206	49.367
Total	139997.000	217

The results indicate that there is no statistically significant gender difference in perceived benefit of the students in wearing face masks, (F_2,206 = 1.322, p= 0.269, p>0.05). This means male and female students have the same perceived benefit in wearing face masks. Also, the result shows that there is no statistically significant level difference in the perceived benefit of the students in wearing face masks (F_4,206 = 0.739, p= 0.566, p>0.05). This means that students irrespective of their level have the same perceived benefit in wearing face masks. Finally, the result shows that there is no significant difference in students’ benefit of wearing face masks by the interaction of gender and level (F_4,206 = .913, p= 0.458, p>0.05). This means that female and male students of a particular level have the same benefit in wearing face masks.

There is no positive relationship between perceived benefit and attitude.

The purpose of the hypothesis is to find out if there is a positive relationship between students’ perceived benefit of face mask wearing and their attitude towards face mask wearing. The Pearson Moment Correlation Coefficient was used to test the hypothesis. The result of the Pearson Moment Correlation Coefficient is presented in Table VIII.

Table VIII: Pearson Moment Correlation Coefficient of the relationship between students’ perceived benefit and attitude

Variable	N	R	R²	p
Attitude	217	-.502	.252	0.000
Perceived benefit	217	-.502	.252	0.000

The result as indicated in table IX shows that there is a significant negative moderate relationship between students’ perceived benefit of face mask wearing and their attitude towards face mask wearing (r_p= -.502; p = 0.000, p<0.05). This indicates that students with high perceived benefits have moderately low attitudes toward face mask wearing. All things being equal, students with high attitudes have a 25.2% chance of exhibiting low attitudes toward mask wearing.

There is no positive relationship between perceived risk and attitude.

The purpose of the hypothesis is to find out if there is a positive relationship between students’ perceived risk of face mask wearing and their attitude towards face mask wearing. The Pearson Moment Correlation Coefficient was used to test the hypothesis. The result is presented in Table IX.

Table IX: Pearson Moment Correlation Coefficient of the relationship between students’ perceived benefit and attitude

Variable	N	r	R²	p
Attitude	217	-.053	0.003	0.433
Perceived risk	217	-.053	0.003	0.433

The result showed that there is a negative low relationship between students’ perceived risk of face mask wearing and their attitude towards face mask wearing (r_p= -.053; p = 0.433, p>0.05). The relationship is not significant. This indicates that students with high perceived risk have a low attitude toward face mask wearing. All things being equal, students with high attitudes have a 0.3% chance of exhibiting low attitudes toward mask wearing. That is students’ perceived risk of wearing face does not significantly explain their attitude towards face mask wearing. Students’ attitudes towards face wearing are explained by other factors other than their perceived risk of wearing face masks.

There is a positive relationship between perceived risk and behavior.

The purpose of the hypothesis is to find out if there is a positive relationship between students’ perceived risk of face mask wearing and their face mask wearing behavior. The Pearson Moment Correlation Coefficient was used to test the hypothesis. The result is presented in Table X.

Table X: Pearson Moment Correlation Coefficient of the relationship between students’ perceived risk and behavior

Variables	N	r	R²	p
Perceived risk	217	.087	.008	0.243
Behavior	217	.087	.008

The result shows that there is a positive low relationship between students’ perceived risk of face mask wearing and their face mask wearing behaviour (r_p= .087; p = 0.243, p>0.05). The relationship is not significant. The relationship is due to chance. This indicates that students with high risk have low chance of exhibiting a high face mask wearing behaviour. All things considered, students with high risk have 0.8% chance of exhibiting high face mask wearing behaviour. This means that students’ risk of wearing face does not significantly explain their behaviour of face mask wearing. Rather students’ behaviour of face mask wearing is explained by other factors other than their risk of wearing face mask.

There is a significant relationship between perceived benefits and behavior

The purpose of the hypothesis is to find out if there is a significant positive relationship between students’ perceived benefit and behavior of wearing face masks. The Pearson Moment Correlation Coefficient was used to test the hypothesis. The result of the Pearson Moment Correlation Coefficient is presented in Table XI.

Table XI: Pearson Moment Correlation Coefficient of the relationship between students’ perceived benefit and behavior

Variable	N	r	R²	p
Behavior	217	.233	.054	0.002
Perceived benefit	217	.233	.054	0.002

The result shows a significant positive relationship between students’ perceived benefit of face mask wearing and their face mask wearing behaviour (r_p= .233; p = 0.002, p<0.05). This indicates that students with high benefit have slim chance of exhibiting a high face mask wearing behaviour. All things being equal, students who expressed high benefit have 5.4% chance of exhibiting high face mask wearing behaviour. That is even though students’ benefits of wearing face significantly explain their behaviour of face mask wearing, it explains a small portion of their behaviour. Students’ behaviour of face mask wearing is explained by other factors other than their benefit of wearing face mask.

Data on hypothesis seven was analysed with regression. The hypothesis seeks to check the effect of perceived benefits and perceived risks on attitude towards face mask wearing. The regression would be used because all variables of interest were recoded into continuous variables. are continuous in nature.

The analysis shows a significant fit of the model, F (₂, _{214) =} 41.12, p = <0.001 with an R² of 0.278. The result shows that only perceived benefit had a significant effect on students’ attitude towards face mask wearing, t (216) = 9.04, r = 0.06, p = <0.001; perceived risk did not make any significant effect to students’ attitude towards face mask wearing, t (216) = -0.12, r = -0.001, p = 0.91. This is because only students’ perceived benefit of wearing face mask predicts students’ attitude towards face mask wearing, which accounts for 52.8% of students’ attitude toward face mask wearing. However, perceived risk is 0.7% of students' attitude towards face mask wearing. Hence, the regression model can be defined by the equation:

ATFW_i= 1.419 + 0.058PB_i– 0.001PR_i

The regression result demonstrated a significant fit of the model, F (₂, _{178) =} 5.570, p = 0.005 with an R² of 0.059. The result also shows that only perceived benefit had a significant effect on students’ behavior towards face mask wearing, t (180) = 3.12, r = 0.11, p = 0.002; but the perceived risk did not make any significant effect on students’ behavior towards face mask wearing, t (180) = 0.917, r = 0.05, p = 0.36. This means only students’ perceived benefit of wearing face mask predicts students’ behavior towards face mask wearing, which accounts for 22.7% of students’ behavior face mask wearing. However, perceived risk accounts for 6.7% of students’ behavior towards face mask wearing. Hence, the regression model can be defined by the equation:

BTFW_i= 26.972 + 0.110PB_i+ 0.048PR_i

This study aims to examine the perception, attitudes, and behavior of college students towards facemask wearing on campus. Perceived risk is conceptualized as the sense of the seriousness of a specific public health risk and the probability that the threat will lead to harm. Specifically, in this study perceived risk is defined as the student's perception of the severity and probability of contracting COVID-19. The perceived risk will however compel students to engage in self-protective behaviors (i.e., wearing of mask) to fight the disease. Several research findings indicated that perceived risk positively and significantly influenced the use of self-protective measures (17, 46, 47). This led us to hypothesize that there will be a positive relationship between perceived risk and behavior toward wearing face masks among US college students.

This is consistent with the health belief model (HBM) which posits that peoples’ perceived risk is positively and directly related to protective behavior (48). However, the results from this study indicated that there is a positive low relationship between students’ perceived risk of face mask wearing and their face mask wearing behavior, the relationship therefore is not significant. This suggests that college students who are at a high perceived risk of COVID-19 are less likely to engage in high face mask wearing behavior. This could be due to myriad of factors, it could be lack of education of the potential benefit of mask wearing (36). It could also be that the efficacy of vaccines is making vaccination a better option than mask wearing (49).

The result also shows that there is a positive weak relationship between the perceived benefit of mask wearing and their face mask wearing behavior. This indicates that students with high benefits have a slim chance of exhibiting a high face mask wearing behavior. Therefore, their perceived benefits of wearing face mask predicted their behavior towards face masks wearing. This finding is consistent with Li et al. (50)’s study which examined predictors of adopting preventive health behavior of handwashing, facemask wearing and maintaining social distance among student pharmacists. Their finding also disclosed that perceived benefit is one of the determinants of facemask wearing and supported the negative association we had on perceived risk.

Results further indicated that there was no significant difference in perceived risk and perceived benefit towards face mask wearing by gender and level among US college students respectively. This means male and female students have the same perceived risk and perceived benefit in wearing face masks. This result is inconsistent with a study done in Uganda by Rawlings et al.(51) to explore students’ perceptions of COVID-19 risks and preventive measures. Their findings showed that students agreed on COVID-19 as a health risk, and their preventive behaviors were influenced by age, gender, marital status, and living situation. These studies results are inconsistent with this study. Their findings show a significant difference in perceived risk and perceived benefit towards face mask wearing by gender. It was observed that younger people feel they are invincible to the coronavirus which, helps explain their lower perceptions of the benefits of facemask. These attitudes may also have arisen from reports of fewer COVID-19 infections among youth (34, 35). However, this assertion is defective because many younger people who become exposed to or ill with COVID-19 are the same as the rest of the population who are indisposed or quarantined for a certain period (52). Shifting to the level of students in college, Interestingly, only one of the studies captured the year of school the same way it was used in the present study but did not include it in the analysis (36).

Most of the other studies categorized it as educational level. As a result, they used labels such as undergraduates/graduate or bachelors/masters for their university participants (27, 53) while the others focused on participants in grade level (10th grade, 11th grade, 12th grade etc.) or primary / elementary / secondary school (54). Thus, analysing this variable is unique to this study. Therefore, for this study, the result showed that seniors had the highest behavior towards facemask wearing than the freshmen. This may be due to the notion that seniors will be more knowledgeable about the policies in the school as well as the consequences so do not want to bear the punishment if any. Also, seniors are known to be preparing for graduation so would not leave anything to chance to get COVID-19 due to negligence which can affect their academic performance and graduation plans. This is supported by studies and reports that analyzed undergraduates’ and graduates’ students’ behavior towards certain health prevention measures and disclosed that graduate students are more likely to have positive attitudes and behavior than undergraduates, given the reasons of age, being knowledgeable and responsibility (55). Therefore, since the seniors can be compared to the status of graduate students the same can be said about them.

We found a relationship between perceived benefits and attitudes towards wearing face masks among US college students. The result shows that there is a negative moderate relationship between students’ perceived benefit of face mask wearing and their attitude towards face mask wearing. From the analysis, as perceived benefit increases students' attitude decreases moderately. This means that perceived benefits do not necessarily correlate with the attitude of students in wearing face mask. Therefore, it might be due to other factors such as the mandatory rule instituted for all to wear face mask on campus which support a study conducted by Dattel et al (32) examining divergent attitudes regarding the benefits of face masks in aviation colleges and universities. Their findings indicated that aviation colleges and universities located in states which had face mask mandates, exhibited a higher likelihood of community compliance, lower rates of COVID-19 in their state, and reports of less inconvenience predicted attitudes of greater benefits of wearing face masks. Additional comments were provided by 28% of the respondents, showing strongly polarized attitudes about the benefits of face masks. Respondents who had negative attitudes about the benefits of wearing face masks, nevertheless reported compliance on a college campus.

However, Aboagye et al. (18), findings were not consistent. They reported that perceived usefulness of masks similarly improved students’ attitudes towards wearing face mask because they believe that wearing masks would protect them against COVID-19. However, the health challenges of wearing masks — especially, for students with respiratory problems including asthma and for an extended period impacted attitudes towards mask use on campus. Instead, alternative prevention strategies such as physical distancing and remote learning were put forward to limit the use of masks for students while on campus. The perceived benefits of face masks have even been found to have a significant influence on individuals’ intention to wear face masks (24, 25, 26).

There is also a negative low relationship between students’ perceived risk of face mask wearing and their attitude towards face mask wearing. This therefore means that the relationship found here is quite weak although some relationship exists. Moreover, as perceived risk increases students’ attitude toward face mask wearing decreases. Thus, the students were not afraid of the virus as they might have been when it began where lots of people were dying almost every day in different countries. It is understandable for the earlier studies to have revealed that the pandemic risk perceptions significantly influence individuals’ attitudes or intention to wear face masks (20, 21, 22) during the period when the pandemic was at its peak. No wonder Limna et al., (19) found that attitude had the most significant impact on the intention to wear a face mask, followed by the perceived benefit of a face mask and pandemic risk perception. Nonetheless, it was indicated that the respondents’ pandemic risk perceptions greatly influenced attitudes. On the other hand, in a longitudinal study conducted by Isch et al. (56) on potential predictors of attitudes about mask wearing during COVID-19 pandemic, perceived risk (local incident rate of COVID-19 and stress about COVID-19) predicted the attitude among their respondents. This is likely because currently, the rate of infection and death has not been as rapid as it was in 2021 when their study was conducted. Again, the introduction of the COVID-19 vaccine might have also played a role in the present finding since people now have some hope of protection.

We also found that the perceived benefit of wearing a face mask influenced students’ attitudes and behaviors toward face mask use which was also consistent with Limna et al., (19). However, against our expectations, perceived risk of COVID-19 infection did not significantly impact students’ attitudes or behaviors toward face mask wearing in this study. This result has not been described elsewhere but is similar to Isch et al. (56) where perceived risk of COVID-19 infection was weakly associated with the length of time people were willing to wear a face mask. Our report is also closely related to that of Wismans et al. (57) who found that only risk perception of COVID-19 for self- predicted face mask use among students, while perceived risk of COVID-19 for family and friends was not associated with face mask use. In contrast to our findings, previous research (19, 58) reported that risk perceptions of COVID-19 transmission highly influenced attitudes and face mask wearing behaviours. A possible explanation for our findings could be the underestimation of COVID-19 prevalence and its negative impact on younger people, as older people have demonstrated to be more susceptible to the negative effects of the virus (59). Moreover, studies e.g.,(60) suggest that sociodemographic factors such as age (i.e., being older) and other factors including the prevalence of the COVID-19 pandemic were important predictors of COVID-19 risk perception. For example, when compared to older students (ages), younger college students were seen to demonstrate lower risk perceptions of COVID-19 (61, 62). Consequently, young people may perceive they are less likely to be infected by COVID-19 which, may manifest in poorer attitudes toward preventive measures and in high-risk behaviors including non-compliance with wearing face masks.

This present study has limitations, and it is noteworthy. One of these is that the results might not be generalizable because they draw conclusions from a single undergraduate institution and again due to the small sample size used for the analysis. Further studies will be needed to expand the scope and the sample size to provide a broader perspective that can represent most students and make it more generalizable. With the sample, it is recommended that more studies could recruit all stakeholders in the institutions such as students, professors, and non-teaching staff to add up to the diversity of the sample which can provide richer data. Moreover, the perception of benefits and risks, as the attitudes and behaviors towards facemask wearing vary from a different person, gender, level of education, and culture, so might have influenced the quality of the responses for data analysis. A step further can be for future longitudinal research to investigate the association among variables such as COVID-19 status, COVID-19 vaccine status, race, and the status of a student as to whether domestic or international to attitude and behavior as well as adding adherence to the variable because attitude and behavior could predict adherence. Another research conducted to qualitatively explore the experiences of attitude and behavior of students towards facemask wearing using semi-structured interviews will be beneficial since it will afford the researchers the opportunity to investigate experiences unique to participants in wearing a face mask.

Ethics approval and consent to participate

This study was reviewed and deemed exempt by Arizona State University Institutional Review Board (IRB) with the approval number STUDY00015710. This study complies with all regulations.

Informed consent was obtained from all individual participants included in the study

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

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No competing interests reported.

Southwestern College Students Attitudes and Behaviors towards Face Mask wearing on Campus.

Status:

Version 1

Abstract

Introduction

Materials and Methods

Results

Discussion

Limitations and Future Directions

Declarations

References

Additional Declarations

Status:

Version 1