Abstract
Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA (n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population. Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink. Heavy drinking, injection drug use, and sleeping outdoors were identified as significant risk factors for reduced hygiene practices. People experiencing homelessness who also engage in these activities may be among the most difficult to reach for intervention, yet targeted efforts may decrease illness risk associated with reduced hygiene. Housed friends and family play a critical role in assisting homeless individuals maintain hygiene by providing showers and laundry facilities.
Highlights
Access to adequate sanitation infrastructure, including toilets, showers and hand washing facilities, has long been identified as a precursor for personal hygiene and good health [1,2]
Reduced availability of public toilets in the United States in the last decade has a disproportionately negative impact on hygiene among the very poor persons who utilize these facilities for daily self-care [3,4]
Participants were recruited in the patient waiting area and clinic lobby of a large urban healthcare provider for homeless persons, the Boston Health Care for the Homeless Program (BHCHP), during four daylong enrollment events
Summary
Access to adequate sanitation infrastructure, including toilets, showers and hand washing facilities, has long been identified as a precursor for personal hygiene and good health [1,2]. Reduced availability of public toilets in the United States in the last decade has a disproportionately negative impact on hygiene among the very poor persons who utilize these facilities for daily self-care [3,4]. While good personal hygiene is well known to reduce risk of infectious disease and improve mental health, access to sanitation facilities and hygiene behaviors among people experiencing homelessness in the United States have received little attention [5,6,7,8,9]. In high-income countries, despite substantial investment in sanitation infrastructure and the near-elimination of many waterborne diseases, very poor persons and individuals experiencing homelessness may lack regular
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