Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 152 No. 1516 (2022)

Perceptions towards mask use in school children during the SARS-CoV-2 pandemic: descriptive results from the longitudinal Ciao Corona cohort study

  • Priska Ammann
  • Agne Ulyte
  • Sarah R. Haile
  • Milo A. Puhan
  • Susi Kriemler
  • Thomas Radtke
Cite this as:
Swiss Med Wkly. 2022;152:w30165


BACKGROUND: Mask wearing contributes to the reduction of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In Switzerland, compulsory use of masks was introduced in indoor public spaces and later in schools. This study explored perceptions of the usefulness of masks in school and public in a cohort of children and adolescents in the canton of Zurich, Switzerland, in January to May 2021.

METHODS: School children aged 10 to 17 years enrolled in Ciao Corona, a prospective school-based cohort study, responded to nested online surveys between 12 January and 24 March 2021 (Q1) and 10 March and 16 May 2021 (Q2). Secondary school children were surveyed at Q1 and Q2, and primary school children at Q2 only. Surveys for parents and their children included questions on the children’s perception of the usefulness of masks and mask wearing behaviour by applying a non-validated questionnaire. Associations between perceived usefulness of masks and child’s school level and gender, and parents’ educational attainment were analysed with Pearson’s and McNemar’s chi-square tests. Free-text comments provided by children were classified into categories of expressed attitude towards mask wearing.

RESULTS: A total of 595 (54% girls) and 1118 (52% girls) school children with predominantly Swiss nationality and a high socioeconomic status responded to online questionnaires at Q1 and Q2, respectively. More than half of the school children perceived masks to be useful at school (Q1: 60% and Q2: 57%) and in public (Q1: 69% and Q2 :60%). Girls perceived masks as useful more often than boys (at Q2 at school: 61% versus 53%, in public: 64% versus 57%), and children of parents with high educational attainment more often than those of parents with lower educational attainment (at Q2 at school: 61% versus 49%, in public: 63% versus 54%). At Q1 and Q2 each, about 20% of children provided individual statements about masks, of which 36% at Q1 and 16% at Q2 reported side effects and discomfort such as skin irritations, headache or difficulties breathing during physical education.

CONCLUSIONS: Approximately 60% of school children perceived masks at school and in public places as useful. A small but non-negligible proportion of children reported discomfort and side effects that should be considered to ensure high adherence to mask wearing among school children. A validation of the questionnaire is needed.


  1. Goldstein E, Lipsitch M, Cevik M. On the Effect of Age on the Transmission of SARS-CoV-2 in Households, Schools, and the Community. J Infect Dis. 2021 Feb;223(3):362–9.
  2. Viner RM, Russell SJ, Croker H, Packer J, Ward J, Stansfield C, et al. School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review. Lancet Child Adolesc Health. 2020 May;4(5):397–404.
  3. Hoang A, Chorath K, Moreira A, Evans M, Burmeister-Morton F, Burmeister F, et al. COVID-19 in 7780 pediatric patients: A systematic review. EClinicalMedicine. 2020 Jun;24:100433.
  4. Levin AT, Hanage WP, Owusu-Boaitey N, Cochran KB, Walsh SP, Meyerowitz-Katz G. Assessing the age specificity of infection fatality rates for COVID-19: systematic review, meta-analysis, and public policy implications. Eur J Epidemiol. 2020 Dec;35(12):1123–38.
  5. Shekerdemian LS, Mahmood NR, Wolfe KK, Riggs BJ, Ross CE, McKiernan CA, et al.; International COVID-19 PICU Collaborative. Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units. JAMA Pediatr. 2020 Sep;174(9):868–73.
  6. Stringhini S, Wisniak A, Piumatti G, Azman AS, Lauer SA, Baysson H, et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet. 2020 Aug;396(10247):313–9.
  7. Ulyte A, Radtke T, Abela IA, Haile SR, Berger C, Huber M, et al. Clustering and longitudinal change in SARS-CoV-2 seroprevalence in school children in the canton of Zurich, Switzerland: prospective cohort study of 55 schools. BMJ. 2021 Mar;372(616):n616.
  8. Armann JP, Kirsten C, Galow L, Kahre E, Haag L, Dalpke A, et al. SARS-CoV-2 transmissions in students and teachers: seroprevalence follow-up study in a German secondary school in November and December 2020. BMJ Paediatr Open. 2021 Mar;5(1):e001036.
  9. Li X, Xu W, Dozier M, He Y, Kirolos A, Theodoratou E ; UNCOVER. The role of children in transmission of SARS-CoV-2: A rapid review. J Glob Health. 2020 Jun;10(1):011101.
  10. Davies NG, Klepac P, Liu Y, Prem K, Jit M, Eggo RM ; CMMID COVID-19 working group. Age-dependent effects in the transmission and control of COVID-19 epidemics. Nat Med. 2020 Aug;26(8):1205–11.
  11. Lee B, Raszka WV Jr. COVID-19 in Children: Looking Forward, Not Back. Pediatrics. 2021 Jan;147(1):e2020029736.
  12. Zimmerman KO, Akinboyo IC, Brookhart MA, Boutzoukas AE, McGann KA, Smith MJ, et al.; ABC SCIENCE COLLABORATIVE. Incidence and Secondary Transmission of SARS-CoV-2 Infections in Schools. Pediatrics. 2021 Apr;147(4):e2020048090.
  13. Chernozhukov V, Kasahara H, Schrimpf P. The association of opening K-12 schools with the spread of COVID-19 in the United States: county-level panel data analysis. Proc Natl Acad Sci USA. 2021 Oct;118(42):e2103420118.
  14. Jehn M, McCullough JM, Dale AP, Gue M, Eller B, Cullen T, et al. Association Between K-12 School Mask Policies and School-Associated COVID-19 Outbreaks - Maricopa and Pima Counties, Arizona, July-August 2021. MMWR Morb Mortal Wkly Rep. 2021 Oct;70(39):1372–3.
  15. Ulyte A, Radtke T, Abela IA, Haile SR, Ammann P, Berger C, et al. Evolution of SARS-CoV-2 seroprevalence and clusters in school children from June 2020 to April 2021 reflect community transmission: prospective cohort study Ciao Corona. Swiss Med Weekly 2021: 2021;151:w30092.
  16. Walsh S, Chowdhury A, Braithwaite V, Russell S, Birch JM, Ward JL, et al. Do school closures and school reopenings affect community transmission of COVID-19? A systematic review of observational studies. BMJ Open. 2021 Aug;11(8):e053371.
  17. UNICEF. COVID-19 and School Closures. One year of education disruption n.d. (accessed 4 July 2021).
  18. Buonsenso D, Roland D, De Rose C, Vásquez-Hoyos P, Ramly B, Chakakala-Chaziya JN, et al. Schools Closures During the COVID-19 Pandemic: A Catastrophic Global Situation. Pediatr Infect Dis J. 2021 Apr;40(4):e146–50.
  19. Engzell P, Frey A, Verhagen MD. Learning loss due to school closures during the COVID-19 pandemic. Proc Natl Acad Sci USA. 2021 Apr;118(17):e2022376118.
  20. Brooks JT, Butler JC. Effectiveness of Mask Wearing to Control Community Spread of SARS-CoV-2. JAMA. 2021 Mar;325(10):998–9.
  21. Rader B, White LF, Burns MR, Chen J, Brilliant J, Cohen J, et al. Mask-wearing and control of SARS-CoV-2 transmission in the USA: a cross-sectional study. Lancet Digit Health. 2021 Mar;3(3):e148–57.
  22. Lopes H, Middleton J, De Guchtenaere A, Hadjipanayis A ; Statement From the Association of Schools of Public Health in the European Region and the European Academy of Paediatrics. COVID-19 and the Use of Masks by Children. Front Pediatr. 2021 Jan;9:580150.
  23. Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, Westhuizen H-M van der, et al. An evidence review of face masks against COVID-19. Proc Natl Acad Sci 2021;118.
  24. Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, et al.; COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet. 2020 Jun;395(10242):1973–87.
  25. Lazzarino AI, Steptoe A, Hamer M, Michie S. Covid-19: important potential side effects of wearing face masks that we should bear in mind. BMJ. 2020 May;369:m2003.
  26. Rosner E. Adverse Effects of Prolonged Mask Use among Healthcare Professionals during COVID-19. J Infect Dis Epidemiol. 2020;6(3):130.
  27. Irfan M, Akhtar N, Ahmad M, Shahzad F, Elavarasan RM, Wu H, et al. Assessing Public Willingness to Wear Face Masks during the COVID-19 Pandemic: Fresh Insights from the Theory of Planned Behavior. Int J Environ Res Public Health. 2021 Apr;18(9):4577.
  28. Taylor S, Asmundson GJ. Negative attitudes about facemasks during the COVID-19 pandemic: the dual importance of perceived ineffectiveness and psychological reactance. PLoS One. 2021 Feb;16(2):e0246317.
  29. Haischer MH, Beilfuss R, Hart MR, Opielinski L, Wrucke D, Zirgaitis G, et al. Who is wearing a mask? Gender-, age-, and location-related differences during the COVID-19 pandemic. PLoS One. 2020 Oct;15(10):e0240785.
  30. Ulyte A, Radtke T, Abela IA, Haile SR, Braun J, Jung R, et al. Seroprevalence and immunity of SARS-CoV-2 infection in children and adolescents in schools in Switzerland: design for a longitudinal, school-based prospective cohort study. Int J Public Health. 2020 Dec;65(9):1549–57.
  31. Migration im Kanton Zürich. 2020. Kanton Zür Migr 2021. (accessed 2 December 2021).
  32. Statistisches Amt des Kantons Zürich. Statistisches Jahrbuch des Kantons Zürich 2018 2018. (accessed 2 December 2021).
  33. West EA, Anker D, Amati R, Richard A, Wisniak A, Butty A, et al.; Corona Immunitas Research Group. Corona Immunitas: study protocol of a nationwide program of SARS-CoV-2 seroprevalence and seroepidemiologic studies in Switzerland. Int J Public Health. 2020 Dec;65(9):1529–48.
  34. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria: 2020.
  35. Wickham H, Averick M, Bryan J, Chang W, McGowan LD, François R, et al. Welcome to the Tidyverse. J Open Source Softw. 2019;4(43):1686.
  36. Sjoberg DD, Whiting K, Curry M, Lavery JA, Larmarange J. Reproducible Summary Tables with the gtsummary Package. R J. 2021;13(1):570–80.
  37. World Health Organization (WHO) and United Nations Children’s Fund. Advice on the use of masks for children in the community in the context of COVID-19: annex to the advice on the use of masks in the context of COVID-19 2021.
  38. Goh DY, Mun MW, Lee WL, Teoh OH, Rajgor DD. A randomised clinical trial to evaluate the safety, fit, comfort of a novel N95 mask in children. Sci Rep. 2019 Dec;9(1):18952.
  39. Smart NR, Horwell CJ, Smart TS, Galea KS. Assessment of the Wearability of Facemasks against Air Pollution in Primary School-Aged Children in London. Int J Environ Res Public Health. 2020 Jun;17(11):3935.
  40. Eberhart M, Orthaber S, Kerbl R. The impact of face masks on children-A mini review. Acta Paediatr. 2021 Jun;110(6):1778–83.
  41. Chuang Y, Liu JC. Who wears a mask? Gender differences in risk behaviors in the COVID-19 early days in Taiwan. Econ Bull. 2020;40:2619–27.
  42. Rieger MO. To wear or not to wear? Factors influencing wearing face masks in Germany during the COVID-19 pandemic. Soc Health Behav. 2020;3(2):50.
  43. Shelus VS, Frank SC, Lazard AJ, Higgins IC, Pulido M, Richter AP, et al. Motivations and Barriers for the Use of Face Coverings during the COVID-19 Pandemic: Messaging Insights from Focus Groups. Int J Environ Res Public Health. 2020 Dec;17(24):9298.
  44. Wilson RF, Sharma AJ, Schluechtermann S, Currie DW, Mangan J, Kaplan B, et al. Factors Influencing Risk for COVID-19 Exposure Among Young Adults Aged 18-23 Years - Winnebago County, Wisconsin, March-July 2020. MMWR Morb Mortal Wkly Rep. 2020 Oct;69(41):1497–502.
  45. Zhang B, Li Z, Jiang L. The Intentions to Wear Face Masks and the Differences in Preventive Behaviors between Urban and Rural Areas during COVID-19: An Analysis Based on the Technology Acceptance Model. Int J Environ Res Public Health. 2021 Sep;18(19):9988.
  46. Statista Research Department. Bildungsstand der Wohnbevölkerung im Kanton Zürich nach höchster abgeschlossener Ausbildung im Jahr 2019. Bild Wohnbevölk Im Kanton Zür Nach Höchster Abgeschloss Ausbild Im Jahr 2019 2021. (accessed July 15, 2021).

Most read articles by the same author(s)

<< < 1 2