Is low mask wearing in rural communities a sign of poor health messaging?

Is low mask wearing in rural areas due to poor health messaging? - STAT Mask wearing is less common in rural communities than elsewhere in the U.S. Changing that requires tailoring public health messaging. Patrick Skerrett STAT

As the U.S. heads toward a third peak in the pandemic, rural counties are among the areas most severely affected by Covid-19. While their absolute numbers of cases are still relatively small compared with large cities, case rates and death rates are growing fastest in rural counties.

This is especially worrisome because characteristics associated with poor Covid-19 outcomes, like older age, poorer general health, and fewer health care providers per capita, are more common in rural communities. In addition, many rural counties have been slowest to adopt key preventive public health measures such as social distancing and mask-wearing.

The Centers for Disease Control and Prevention recommends the use of face masks to limit the spread of Covid-19, and state mask mandates are generally associated with a decrease in case rates. Yet many individuals in rural communities eschew wearing masks.

This may be partly due to public health messaging that hasn’t been tailored to rural communities. Retention of health messaging is lower in rural areas than it is in urban or suburban areas, suggesting that there is no such thing as a one-size-fits-all approach when it comes to disseminating crucial health information to the public.

It is a challenge to create effective prevention-related messaging when the people it targets believe their risk is relatively low. In rural areas, low perceived risk of Covid-19 could spawn more widespread skepticism toward, and nonadherence to, government mask mandates. Reluctance to follow mask guidelines earlier in the pandemic in rural areas continues in spite of the current evidence indicating uncontrolled community spread in many rural states.

The current and projected increases in Covid-19 cases in rural areas may have resulted from people not following recommended preventive measures during the summer months when Covid-19 cases in these areas had not yet made headlines.

To explore that idea, we examined data from the New York Times’ mask-wearing survey and the Index of Relative Rurality, a widely used indicator that measures counties on a continuous scale from 0 to 1, with 1 being most rural, based on several geographic and population characteristics, including total population.

We found that intentions to wear a mask became significantly less likely as the level of rurality increased, even after adjusting for daily Covid-19 incidence during the two weeks before the mask survey.  ...