• Chandini Raina MacIntyre, Phi-Yen Nguyen, Abrar Ahmad Chughtai, Mallory Trent, Brian Gerber, Kathleen Steinhofel, and Holly Seale.
• Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, United States. Electronic address: r.macintyre@unsw.edu.au.
• Int. J. Infect. Dis. 2021 May 1; 106: 199-207.

ObjectivesTo determine patterns of mask wearing and other infection prevention behaviours, over two time periods of the COVID-19 pandemic, in cities where mask wearing was not a cultural norm.MethodsA cross-sectional survey of masks and other preventive behaviours in adults aged ≥18 years was conducted in five cities: Sydney and Melbourne, Australia; London, UK; and Phoenix and New York, USA. Data were analysed according to the epidemiology of COVID-19, mask mandates and a range of predictors of mask wearing.ResultsThe most common measures used were avoiding public areas (80.4%), hand hygiene (76.4%), wearing masks (71.8%) and distancing (67.6%). Over 40% of people avoided medical facilities. These measures decreased from March-July 2020. Pandemic fatigue was associated with younger age, low perceived severity of COVID-19 and declining COVID-19 prevalence. Predictors of mask wearing were location (US, UK), mandates, age <50 years, education, having symptoms and knowing someone with COVID-19. Negative experiences with mask wearing and low perceived severity of COVID-19 reduced mask wearing. Most respondents (98%) believed that hand washing and distancing were necessary, and 80% reported no change or stricter adherence to these measures when wearing masks.ConclusionPandemic mitigation measures were widely reported across all cities, but decreased between March and July 2020. Pandemic fatigue was more common in younger people. Cities with mandates had higher rates of mask wearing. Promotion of mask use for older people may be useful. Masks did not result in a reduction of other hygiene measures.Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.

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