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Association of Child Masking With COVID-19–Related Closures in US Childcare Programs

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Is child masking associated with reduced COVID-19–related childcare program closures?

Findings  In this survey study of 6654 childcare professionals from all 50 states, child masking at baseline (May 22 to June 8, 2020) was associated with a 13% reduction in program closure within the following year, and continued child masking throughout the 1-year study period was associated with a 14% reduction in program closure.

Meaning  These results suggest that masking of children in childcare programs is associated with reduced program closures, supporting current masking recommendation in younger children provided by the Centers for Disease Control and Prevention.

Abstract

Importance  It is not known how effective child masking is in childcare settings in preventing the transmission of SARS-CoV-2. This question is critical to inform health policy and safe childcare practices.

Objective  To assess the association between masking children 2 years and older and subsequent childcare closure because of COVID-19.

Design, Setting, and Participants  A prospective, 1-year, longitudinal electronic survey study of 6654 childcare professionals at home- and center-based childcare programs in all 50 states was conducted at baseline (May 22 to June 8, 2020) and follow-up (May 26 to June 23, 2021). Using a generalized linear model (log-binomial model) with robust SEs, this study evaluated the association between childcare program closure because of a confirmed or suspected COVID-19 case in either children or staff during the study period and child masking in both early adoption (endorsed at baseline) and continued masking (endorsed at baseline and follow-up), while controlling for physical distancing, other risk mitigation strategies, and program and community characteristics.

Exposures  Child masking in childcare programs as reported by childcare professionals at baseline and both baseline and follow-up.

Main Outcomes and Measures  Childcare program closure because of a suspected or confirmed COVID-19 case in either children or staff as reported in the May 26 to June 23, 2021, end survey.

Results  This survey study of 6654 childcare professionals (mean [SD] age, 46.9 [11.3] years; 750 [11.3%] were African American, 57 [0.9%] American Indian/Alaska Native, 158 [2.4%] Asian, 860 [12.9%] Hispanic, 135 [2.0%] multiracial [anyone who selected >1 race on the survey], 18 [0.3%] Native Hawaiian/Pacific Islander, and 5020 [75.4%] White) found that early adoption (baseline) of child masking was associated with a 13% lower risk of childcare program closure because of a COVID-19 case (adjusted relative risk, 0.87; 95% CI, 0.77-0.99), and continued masking for 1 year was associated with a 14% lower risk (adjusted relative risk, 0.86; 95% CI, 0.74-1.00).

Conclusions and Relevance  This survey study of childcare professionals suggests that masking young children is associated with fewer childcare program closures, enabling in-person education. This finding has important public health policy implications for families that rely on childcare to sustain employment.

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Article Information

Accepted for Publication: November 3, 2021.

Published: January 27, 2022. doi:10.1001/jamanetworkopen.2021.41227

Correction: This article was corrected on February 25, 2022, to fix a typographic error in the Discussion.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Murray TS et al. JAMA Network Open.

Corresponding Author: Thomas S. Murray, MD, PhD, Department of Pediatrics, Yale School of Medicine, 333 Cedar St, New Haven, CT 06520-8064 (thomas.s.murray@yale.edu).

Author Contributions: Drs Malik and Gilliam had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Murray and Malik contributed equally to this work.

Concept and design: Murray, Malik, Humphries, Wilkinson, Diaz, Reyes, Omer, Gilliam.

Acquisition, analysis, or interpretation of data: Murray, Malik, Shafiq, Lee, Harris, Klotz, Humphries, Patel, Wilkinson, Yildirim, Elharake, Reyes, Omer, Gilliam.

Drafting of the manuscript: Murray, Malik, Gilliam.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Malik, Shafiq, Lee, Harris, Klotz, Reyes, Gilliam.

Obtained funding: Gilliam.

Administrative, technical, or material support: Klotz, Humphries, Patel, Wilkinson, Elharake, Diaz, Omer, Gilliam.

Supervision: Humphries, Yildirim, Gilliam.

Conflict of Interest Disclosures: Dr Gilliam reported receiving grants from the Andrew & Julie Klingenstein Family Fund, Esther A. & Joseph Klingenstein Fund, Heising-Simons Foundation, W.K. Kellogg Foundation, Foundation for Child Development, Early Educator Investment Collaborative, and Scholastic Inc during the conduct of the study. No other disclosures were reported.

Funding/Support: All phases of this study were supported by the Andrew & Julie Klingenstein Family Fund, Esther A. & Joseph Klingenstein Fund, Heising-Simons Foundation, W.K. Kellogg Foundation, Foundation for Child Development, Early Educator Investment Collaborative, and Scholastic Inc. The study was partially funded by the Yale Institute for Global Health (Drs Malik, Shafike, Elharake, and Omer).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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