Beyond the beauty of occlusion: medical masks increase ...

... thus result in lower ratings of facial attractiveness of the wearer. ... The results show that faces were considered as most attractive ... Skiptomaincontent Advertisement SearchallSpringerOpenarticles Search DownloadPDF Originalarticle OpenAccess Published:10January2022 Beyondthebeautyofocclusion:medicalmasksincreasefacialattractivenessmorethanotherfacecoverings OliverHies1&MichaelB.Lewis  ORCID:orcid.org/0000-0002-5735-53181  CognitiveResearch:PrinciplesandImplications volume 7,Article number: 1(2022) Citethisarticle 25kAccesses 2211Altmetric Metricsdetails AbstractThesanitary-maskeffect(MiyazakiandKawaharainJpnPsycholRes58(3):261–272,2016)isthefindingthatmedicalfacemaskspromptanimageofdiseaseandthusresultinlowerratingsoffacialattractivenessofthewearer.However,duringtheCOVID-19pandemic,medicalmaskshavebeenfoundtoincreaseattractiveness(Pateletal.inPlastReconstructSurgGlobOpen8(8),2020)althoughthiscouldhavebeenageneraleffectofocclusion.Tofurtherexplorethisissue,femaleparticipantswerepresentedwithaseriesofmalefacesofloworhighattractivenessthatwereoccludedwithamedicalmask,clothmask,bookornotoccludedandaskedtoratethemonattractiveness.Theresultsshowthatfaceswereconsideredasmostattractivewhencoveredbymedicalmasksandsignificantlymoreattractivewhenoccludedwithclothmasksthanwhennotoccluded.Contrarytoexpectation,baseattractivenessdidnotinteractwiththetypeofocclusion,suggestingthatthisisnotsimplyduetoocclusionofnegativefeatures.Thepresentfindingsarecontrarytothesanitary-maskeffectandexplanationsintermsofsocialdesirability,andtheassociationofmedicalmaskswithcaregivingprofessionsisexplored. IntroductionAsaresultoftheoutbreakoftheCoronavirusdisease2019(COVID-19)pandemic,therehasbeenasharpincreaseindemandforprotectivefacemasksgloballytopreventthespreadofthevirus.SinceJuly2020(Rabetal.,2020),itwasmandatorytowearmaskscoveringthemouthandnoseintheUKinanumberofdifferentplaces,forexamplesupermarketsandonpublictransport—although,ruleschangedafterJune2021.Despiteconcernsaboutmaskselicitingafalse-senseofsecurity(Javidetal.,2020),researchshowstheyareofparamountimportanceinhelpingtoreducethespreadofCOVID-19(Howardetal.,2021),whichisreflectedingovernmentpolicyworldwide.Notwithstandingthemedicalbenefits,theuseofmaskscarriescosts.Evidencesuggestswearingmasksinducesperceiveddiscomfort,impairsvocalcommunication(Ribeiroetal.,2020),andmaybeabarriertosocialinteraction(Hung,2018).Furthermore,maskspreventcrucialface-to-faceinteractionsbetweennewbornsandtheirprimaryattachmentfigures,whichcouldimpedeearlybonding(Greenetal.,2020).Finally,researchshowsmasksimpairrecognitionofemotions(Carbon,2020),withparticipantsreportinglowerconfidenceandgreaterpatternsofconfusion.Overall,researchonsideeffectsofmaskshassignificantimplicationsforday-to-daylife,inwhichrecognisingemotionsandclearcommunicationarekeytointerpersonalinteraction.WhilefacecoveringswereasomewhatraresightinWesternnations,suchastheUK,priorto2020,theyhavebeencommoninsomecultureslongbeforetheCOVID-19pandemic.ManyMuslimwomenwearniqābsorburqas,whichcoverlargepartsoftheface.Medicalmasks(sometimesreferredtoassurgicalorsanitarymasks)areroutinelyusedforhealthreasonsincollectivistcountriessuchasJapan,wherepeoplehaveenhancedpersonalhygienepractices(Wadaetal.,2012).MasksarealsocustomaryinChinaasaprotectionfromairpollution,despiteconcernsabouttheirefficacy(Cherrieetal.,2018).FacemasksandattractivenessIncontrasttotheproblemsassociatedwithmasksdiscussedabove,thereisacommonbeliefamongJapanesewomenthatwearingamaskincreasesone’sattractiveness,asitoccludespotentiallyundesirablefacialfeaturessuchasacne(Miyazaki&Kawahara,2016).WearingmasksinJapanwascommonlongbeforetheCOVID-19pandemic,asmanybelieveitreducestransmissionofinfluenzaviruses(Burgess&Horii,2012).MiyazakiandKawahara(2016)thusinvestigatedtheeffectofwearingamedicalmaskonperceivedfacialattractivenessinaJapanesesample.Theyconductedaseriesofexperimentsinwhichtheypresentedparticipantswithimagesoffemalefacespreviouslyratedashigh,lowormediuminattractiveness.Somefaceswerewearingmedicalmasks,whileothershadthelowerhalfoccludedbyacardornotebook(controloccluders)andfurtherfaceswerenotoccluded.Participants’taskwastoratethefacesonattractiveness.Theauthorsfoundthatfacesoccludedbyamedicalmaskwereperceivedaslessattractivethanthosethatwerenot(regardlessofbaseattractiveness),whichtheytermedthesanitary-maskeffect(Miyazaki&Kawahara,2016,p.262).Incontrast,thiseffectwasnotfoundforfacescoveredbycontroloccluders.Instead,theauthorsfoundanocclusioneffect,whichisaregressiontothemean,withattractivenessratingsincreasingforfaceslowinbaseattractivenessanddecreasingforfaceshighinbaseattractiveness.Thelatterfindingisplausible,ascoveringthelowerhalfofthefaceislikelytoobstructundesirableordesirablefacialfeatures(Miyazaki&Kawahara,2016);however,occlusionoffacialfeatureshasbeenfoundtoincreasefacialattractivenessregardlessofwhichfeaturesareoccludedandthebaseattractivenessoftheface(Sadr&Krowicki,2019).MiyazakiandKawahara(2016)explainthesanitary-maskeffectintermsofmedicalmasksactingasaprimeofdisease,whichissupportedbydataobtainedinasurvey,whichshowedthatpeopleassociatedmedicalmaskswithdisease.Moreover,theauthorsfoundthatmaskedfaceswereconsistentlyperceivedaslesshealthythanunmaskedfaces.Overall,thesefindingssuggestmedicalmasksarelinkedtopoorhealth,andindividualswearingthemareseenaslessattractive.Thisisconsistentwiththeideaofabehaviouralimmunesystemwheredisease-relatedstimuliareautomaticallyassociatedwithunattractiveness(e.g.Klebletal.,2021).WiththeoutbreakoftheCOVID-19pandemic,moreresearchhasbeenconductedinthisarea.Pateletal.(2020)investigatedtheinfluenceoffacialocclusionwithmedicalmasksonjudgmentsoffacialattractivenessintheUnitedStates.WithoutreferencetoMiyazakiandKawahara’s(2016)research,andcontrarytowhatthesanitary-maskeffectwouldpredict,theauthorshypothesisedthatfaceswearingmedicalmaskswouldberatedasmoreattractivethanunmaskedfacesduetotheimportanceoflowerfaceinformation,particularlyfromtheperioralarea,indeterminingfacialattractiveness.Pateletal.(2020)foundthatunattractiveandaveragelyattractivefaceswereratedassignificantlymoreattractivewheninthemaskedcomparedtounmaskedcondition.Thiseffectwasgreatestforfacesintheunattractiveconditionacrossbothmalesandfemales.Attractivefaceswereratedaslessattractiveinthemaskedcondition.ThesefindingsreflecttheocclusioneffectfoundbyMiyazakiandKawahara(2016)intheircontroloccludercondition.Pateletal.(2020)didnotincludeanocclusioncontrolconditionandsoitisnotpossibletodistinguishbetweentheeffectofocclusionandtheeffectofthemedicalmaskintheirstudyandsoitispossiblethatthesanitary-maskeffectisstillpresentbutswampedbytheocclusioneffect.Inrelatedresearch,Olivera-LaRosaetal.(2020)lookedattheeffectofmultipleindividualdifferenceson,amongothervariables,illnessandsocialdesirabilityperceptionsoffaceswithorwithoutmedicalmasks.ThistookplaceinSpanish-speakingcountriesinEuropeandSouthAmerica.Theyfoundthatpeopleshownasmaskedfacesweregenerallyconsideredmoresociallydesirablethanunmaskedfaces.Furthermore,theyfoundthatmaskedfaceswerealsoratedasmorelikelytobeillthanunmaskedfaces,whichsupportsMiyazakiandKawahara’s(2016)findings.Aspreviousresearchhasshown,socialdesirabilityandphysicalattractivenessarecloselylinked(Huston,1973);thesefindingsraisethequestionastowhetherfacialattractivenessandhealthcanbedissociated.Onepossibleexplanationforthesecounterintuitiveresultsisthatparticipantsformedamoreimplicitassociationbetweenmedicalmasksandillness,butadeliberativelinkbetweenmedicalmasksandsocialdesirability,whichmayreflecttheroleofsocialnormsinattractivenessjudgments(Olivera-LaRosaetal.,2020).Alinkbetweenmedical-relatedattireandattractivenesshaspreviouslybeenshownbyBraiseandRichmond(2004)whofoundthatmaledoctorsinwhitecoatswerejudgedasmoreattractivethanthosenotinwhitecoats.Themedicalfacemaskhas,infact,becomeaniconofthemedicalprofessionals’fightagainsttheCOVID-19pandemicasillustratedbytheartworkofNathanWyburn(Wyburn,2020).Thus,thesocialdesirabilityofmedicalmaskwearerscouldpotentiallyoff-settheassociationwithdiseaseintheassessmentoftheattractivenessoffaceswithmedicalmaskson.Finally,theoriginalMiyazakiandKawahara(2016)experimentwasrepeatedduringthepandemicinJapan(Kamatanietal.,2021).Inthisstudy,thesanitary-maskeffectdisappearedandtherewasonlyaregressiontothemeansuchthatthemaskmadeunattractivefacesmoreattractiveandattractivefaceslessattractive.Thisstudyusedeitherblackorwhitemasksratherthanthemoretypicalbluemedicalmasks.Also,andasinPateletal.(2020),therewasnoocclusion-onlycontrolcondition.Therewasadecreaseintheassociationofmaskwearingandperceivedunhealthinessbetweenthepre-pandemicandpandemicversionsoftheexperiments,indicatingthatCOVID-19couldbeunderpinningthisshiftintheperceptionofattractivenessoffaceswithmasks.ThepresentstudyThepresentstudysetouttoansweranumberofquestionsrelatedtofacialattractivenessandocclusionthathavearisenfrompreviousresearch,inparticularfromMiyazakiandKawahara’s(2016)findings.Firstly,howuniversalandrobustisthesanitary-maskeffect?DoesitgeneralisetotheUKpopulationduringaglobalpandemic?Secondly,howdoclothfacemasksaffectjudgmentsoffacialattractiveness?ReusableclothmasksareamuchmorecommonsightintheUKatthemomentandsodoesthisincreasedfamiliarityhaveanimpactonassessmentofthewearer?Finally,acceptanceofmaskwearingisnotuniversalanditwasexploredwhetherattitudestowardsmaskwearingimpactpeoples’assessmentofthemask-wearer.Toinvestigatethesequestions,thepresentstudyemployeda2 × 4within-subjectsdesignwiththeindependentvariables(IVs)baseattractivenessandtypeofocclusionandthedependentvariable(DV)facialattractiveness.Participantswereaskedtoratetheattractivenessoffacespreviouslyratedasunattractiveorattractive(lowvshighbaseattractiveness)whenoccludedwithamedicalmask,occludedwithaclothfacemask,occludedwithacontrolobject,ornotoccluded.MethodParticipantsAnaprioripoweranalysisusedanappropriateeffectsizeobtainedfromMiyazakiandKawahara(2016).Givenaneta-squaredscoreof0.22(medicalmaskeffect)andanalphalevelof0.05,awithin-participantstudywithjust10participantswouldgiveapowerof0.8.Giventhatthereweremorecomparisonsbeingmadeherethanthesimplemask/no-maskcomparison,thenumberofparticipantswasincreasedto43.Thus,43CardiffUniversityundergraduatePsychologystudentswererecruitedontheSchoolofPsychology’sExperimentalManagementSystem.Thestudywasonlyavailabletofemaleparticipants.Oneparticipantwasexcludedduetoarbitraryresponding.Inthefinalpoolofparticipants,most(40)indicatedtheirageasbeingbetween18and24 years.Themajorityofparticipants(40)identifiedaswhite.MaterialsThestimuliweregeneratedfromimagesof40differentmalefaces(2444 × 1718pixels)fromtheChicagoFaceDatabase(CFD)Version2.0.3—July2016(Maetal.,2015).Allimageswerefrontalportraits.Thefacesvariedinraceandphysicalattractiveness.The20mostattractiveand20leastattractivefaces,basedonpreviousratingsincludedintheCFD,wereselected.Themeanpreviousratingforthehighattractivenessfaceswas4.26(SD = 0.32)onaseven-pointLikertscale(1 = Notatall,7 = Extremely),andthemeanforthelowattractivenessfaceswas2.06(SD = 0.19)(Maetal.,2015).Theperceivedageofthefaceswasbetween18and30 years(M = 24.94,SD = 2.96).Onlyneutralfacialexpressionswerechosen.Whilethefacesdifferedinhairstyle,nonehadpiercings,glasses,beards,orotherpotentiallyoccludingfeaturesorconfoundingfactors.Occludingstimuliweremadefromfrontalportraitsofamodelwearingthreedifferentclothfacemasksandamedicalmask.Themodelwasalsophotographedholdingaplain,blackbookcoveringacomparableareaofthefaceasmasksdo.Theclothmasksweremadeofcottonandcharacterisedbyabstractpatterns.Thefinalstimuliwereconstructedfromthe40CFDfaceswitheachofthethreetypesofoccludingstimuli.(Onlyoneclothmaskwasusedforeachface.)Thefacialoccluderswereadjustedusingeditingsoftwaretomakesurethedigitallycreatedstimuliappearedasnaturalandconsistentaspossibleandcoveredthesamefacialproportionsacrossdifferentfaces.Theedgesoftheoccluderswereeditedtomakesuretheyblendedinwellwiththerestoftheface.Thus,therewere160differentstimuli,i.e.40differentfaceswithnofacialoccluder,amedicalmask,aclothmaskandabookoccluder,asdepictedinFig. 1.Fig.1Examplesofthefourtypesofstimuliused.Topleft:Fullface.Topright:Notebook.Bottomleft:Clothmask.Bottomright:Medicalmask. TheoriginalCFDimageisreproducedwithpermissionFullsizeimageProcedureTheexperimentwassetuponPsychoPyandruninFebruary2021,i.e.sevenmonthsafterwearingmasksbecamemandatoryintheUK.DuetoCOVID-19restrictions,itwasconductedonlineviaPavlovia.organdthuscompletedonparticipants’owndevices.Participantswereaskedtocompletetheexperimentinaquietandsuitableenvironmenttominimisesourcesofdistraction.Participantsweretoldtheywouldbepresentedwithanumberofmalefacesandinstructedtoratethemonfacialattractivenessonascalefrom1to7.Tofamiliariseparticipantswiththeexperiment,anexampletrialwithafacefromtheCFDthatwasnotusedinthemainexperimentwasincluded.The160stimulidescribedabovewerethenindividuallypresentedtoparticipantsinarandomorder.Therefore,eachparticipantwaspresentedwitheachfacefourtimes(medicalmask,clothmask,book,non-occluded).Participantsratedthefacesusingthenumberkeys1–7.Afterratingthefaces,participantswereaskedtoindicatetheirage,ethnicityandlevelofagreementonafive-pointLikertscaletothefollowingtwostatementsassessingattitudestowardsfacemasks:“Facemaskshavebecomepartofeverydaylifeinthepastyear”and“TheuseoffacemasksiseffectiveinpreventingthespreadofCOVID-19”.Finally,participantsweredebriefedandreceivedcoursecreditascompensationfortheirparticipation.DesignThisstudyuseda2 × 4within-subjectsdesign.Theindependentvariablesweretypeofocclusion(fourlevels:medicalmask,clothmask,notebook,andnoocclusion)andbaseattractiveness(lowvshigh).Thedependentvariablewasparticipants’facialattractivenessratings,whichweremeasuredusingaseven-pointLikertscalerangingfromveryunattractivetoveryattractive.ResultsThefulldatasetisavailableathttps://osf.io/9p5q7/.Themeanattractivenessratingsforeachofthefourocclusionconditionsarepresentedbelow(Fig. 2).Theyshowthatfaceslowinbaseattractivenesswereratedaslessattractivethanthosehighinbaseattractivenessacrosstypesofocclusions,buttherearealsosmallereffectsofocclusiontype.Fig.2Meanattractivenessratingsforthefourocclusionconditionsforthefacesthatwereinitiallyratedasattractiveorunattractive.Theerrorbarsshow ± onestandarderrorcalculatedfromwithinparticipantvarianceFullsizeimageThedatawereanalysedusingatwo‐wayrepeated-measuresanalysisofvariance(ANOVA).Assphericitywasviolatedfortheeffectofocclusion,aGreenhouse–Geisseradjustmentwasapplied.Theanalysisrevealedamaineffectofbaseattractiveness,withfaceshighinbaseattractivenessratedassignificantlymoreattractivethanthoselowinbaseattractiveness:F(1,40) = 235.94,p