Masks, Mental Health, and Disparity: Kansas City, MO Resident Perceptions of the COVID-19 Pandemic in the Second Wave

Since mid-March, ETC Institute has assisted the City of Kansas City, Missouri in administering four surveys to better understand the varied impacts of the COVID-19 pandemic for our residents. The latest survey, conducted from July 12–16 online to a random sample of 302 KCMO residents (margin of error +/- 5.9% at 95% confidence interval) captured the perspectives of residents as a second wave of COVID-19 cases within the City was becoming a heightened concern.

In the March survey, 2% of residents said that they knew someone personally who had tested positive for COVID-19. This number increased to 29% in April and May/June. In the July survey, 49% of residents said that they knew someone personally who had tested positive for COVID-19.

As the impact of the pandemic has grown, our policymakers in KCMO have used this survey data to better understand how residents are reacting to public health directions, as well as to get a picture of the needs of our residents who have been disparately impacted by the pandemic, based on race/ethnicity and income. (For more information on previous surveys, see past posts on the March survey and the April survey).

Mask-wearing

Mayor Quinton Lucas announced a mask requirement for Kansas Citians while indoors in a place of public accommodation beginning June 29. The survey administered in late May/early June (May 28-June 2) asked residents about mask-wearing as an action to prevent against COVID-19 spread, but the July 12–16 survey additionally asked whether residents supported the mask order.

Overall, 78% of residents support orders that require masks to be worn in public places and 20% do not support mask orders. Support is higher among lower-income residents (85–87% support), Black residents (85% support) and residents aged 65+ (87% support). Opposition is higher among higher-income residents (25–29% do not support), white residents (24% do not support), residents aged 18–34 (25% do not support), and residents aged 55–64 (24% do not support).

Despite some opposition to a mask order, wearing a mask is the only self-reported action from KCMO residents that saw an increase from the May 28-June 2 survey (76% of residents reporting that they wore a mask in public) to the July 12–16 survey (91% of residents reporting that they wore a mask in public).

Self-reported mask-wearing varies somewhat across demographic groups, but is greater than 90% for most age groups, racial/ethnicity groups, and income levels.

Mental Health

The April COVID-19 survey was the first to ask residents how they would rate their level of stress, anxiety, and/or depression during this time, and results revealed that 44% of residents considered themselves extremely or moderately stressed, anxious, or depressed. These numbers dropped slightly in the May/June survey, but in July, as the second wave of cases came to bear, 51% of residents rated themselves as extremely or moderately stressed, anxious or depressed. Even more alarming is that the percent increase is due to an increase in the “extremely” stressed, anxious, or depressed rating, from 12% in May/June to 19% in July.

Self-reported use of mental health services also increased consistently across this time frame, to 15% in July; however, this number still lags the self-ratings of stress, anxiety and depression by a considerable amount.

Higher ratings of stress/anxiety/depression were negatively correlated with age in the July survey. One contributing factor may have been the start of public conversations about decisions for the 2020–2021 academic school year for K-12 students.

Racial and Income-based Disparities in Financial Impact

As discussed in the April survey post, the disparate impacts of the pandemic that have been seen on a national basis are also seen in Kansas City. In particular, financial impacts are more likely to be experienced by Black and Hispanic residents (59% of Black residents and 52% of Hispanic residents say that their financial situation has gotten worse as a result of COVID-19, compared to 37% of white residents). Specific impacts such as job loss and reduction in work hours are also more concentrated for Black and Hispanic residents.

The same analysis by income shows that in particular, members of the lowest income group on the survey (less than $30,000 annual household income last year) have experienced a greater financial impact than higher income groups.

Conclusion

The COVID-19 Resident Survey has provided the City of Kansas City with invaluable feedback during a time of near constant change and disruption. A better understanding of how residents are reacting to the mask order provides context for future public health communications, and also reassurance of a high level of current compliance. Data about self-reported mental health concerns is crucial for leadership to keep in mind in designing future interventions and communications. And finally, the clear disparities in financial and health impact for people of color and low-income people cannot be overstated or overemphasized.

Kansas City, Missouri’s leadership, including the Health Department and Mayor’s Office, have both embraced this data as we continue to develop a path forward for the community. If you are interested in seeing this data at a national level, or wondering if your community has been represented in surveying to date, survey results from around the country are available on ETC’s coronavirus dashboard.