N95 filtering facepiece respirator fit assessment outcomes by gender, age, race, and facial hair in a community population sample

The necessity for respiratory protection has increased due to global threats such as pandemics, industrial accidents, and extreme weather events. The effectiveness of N95 filtering facepiece respirators depends on how well they fit the user's face and seal sufficiently. The objective of this study was to assess the critical issue of N95 filtering facepiece respirator fit test pass rates in the general population, specifically examining the influences of gender, age group, and race. Methods This cross-sectional study was conducted with Minnesota State Fair attendees in 2021 and 2022. Participants were asked to complete a demographic questionnaire, which included details on age, gender, race/ethnicity, and facial hair. A quantitative single-exercise fit assessment of N95 filtering facepiece respirators was conducted using a TSI PortaCount Pro+ (Model 8038). The assessment was based on the talking exercise derived from the Occupational Safety and Health Administration respiratory protection protocol, with a criterion of a fit factor ≥100 for passing the fit assessment. Descriptive statistics and multiple logistic regression analyses were performed using RStudio (version 4.4.2) to assess the influence of demographic variables on respirator fit assessment results. Results A total of 384 participants were enrolled, with 63.8% being female and 80.2% identifying as White. Respirator fit assessment pass rates were significantly lower for males with facial hair compared to females and males without facial hair. None of the participants with full beards achieved an acceptable fit. Participants aged 19 yrs or younger had the highest pass rates. Females were 83% more likely to pass the fit assessment compared with males without facial hair (odds ratio [OR] = 1.83, 95% CI: 1.02 to 3.38), while males with facial hair were 68% less likely to pass the fit assessment than males without facial hair (OR = 0.32, 95% CI: 0.13 to 0.73). Nonlinear age-related differences in fit assessment results were observed, with the lowest odds of passing among participants in their 30 and 40 s compared with those aged 19 yrs or younger. No significant differences in the fit assessment pass rates between racial and ethnic groups were observed. Conclusion Gender, age, and facial hair type were found to significantly affect the likelihood of participants passing the fit assessment for N95 filtering facepiece respirators. No significant disparities were observed among racial and ethnic groups. These findings underscore the importance of considering gender, age, and facial hair when developing public health guidelines for respirator protection.