Restroom Access Research Articles

Restroom access and health among people experiencing homelessness: A focus on San Diego, CA

ABSTRACT Access to restrooms is vital to personal and public health, particularly among people experiencing homelessness (PEH). This study investigated how restroom access is associated with three domains of self-reported physical health (voiding and defecation-related conditions; skin conditions; and hypertension) among PEH in San Diego, CA. Data from 115 structured interviews with PEH (67.8% male, 40.0% mono-racially White, 57.4% rough sleeping) indicated that 37.4% (n = 43) reported typically using public restroom facilities, 38.3% (n = 44) reported typically using private facilities, and 23.5% (n = 27) reported typically engaging in open defecation. There were moderate to strong associations between urinary, gastrointestinal, and dermatological health conditions and stressors/barriers related to restroom access. The proportion of participants with ≥1 skin-related health conditions who engaged in open defecation was substantially higher (40%) compared to participants who reported no skin-related health conditions who engaged in open defecation (17.9%) (χ2(df = 1,108) = 5.25, p = 0.02). Participants who reported ≥3 voiding or defecation-related health conditions or ≥1 skin-related health conditions reported higher mean restroom-related impediments to health relative to participants without these health conditions. Restricted restroom access may prevent PEH from fulfilling their basic sanitation and hygiene needs, and may exacerbate urinary, gastrointestinal, and skin health conditions.

Public Restroom Access and Mental Health Among Gender-Minoritized Individuals in China

This cross-sectional study assesses the adequacy of gender-neutral public restrooms and examines the association of public restroom–related stress with mental health among gender-diverse individuals in China.

Developing evidence for building sanitation justice: A multi methods approach to understanding public restroom quantity, quality, accessibility, and user experiences.

Access to basic sanitation is a human right and a critical environmental determinant of health. In this paper, we detail the development of three tools to investigate sanitation justice: (1) our public restroom spatial database, (2) our field assessment tool, and (3) survey of restroom access experiences. We document our process to collect these data in a consistent, health equity-driven framework. Together, these tools comprise a suite of methods for the examination of public restrooms from the macro- to the micro-level, and highlight key opportunities to promote health and well-being among restroom-reliant populations (e.g., people experiencing homelessness) by advancing sanitation justice in the built environment. With an illustrative case study, we demonstrate how methods triangulation, using the tools in concert, can provide a comprehensive assessment of basic sanitation access in a given region-San Diego, CA. We also detail how each tool can also be used separately to assess key sanitation justice and health equity questions that may be of interest to researchers, public health practitioners, policymakers, and advocates, including: (1) where do public restrooms exist (mapping)?; (2) how accessible are public restroom facilities, and what health-supportive features do they have (field assessment)?; and (3) what are the experiences of people most reliant on the available public restroom facilities (survey)? The results of our case study demonstrate that these adaptable tools can be used to provide meaningful data on and a holistic picture of public restroom quantity, quality, accessibility, and the experiences of public restroom users in a given region.

Where can you go on the go? An Assessment of Public Restroom Access along Transit in San Diego

For people “on the go” like public transit riders, restroom access can be a valued amenity, especially as cities seek to curb greenhouse gas emissions by reducing auto-dependence. However, little research exists on public restroom access along transit lines. This study: 1) visualizes the distribution of available restrooms along trolley lines in San Diego, California; and 2) assesses the basic health-supportive features of available transit-adjacent restrooms. Results show low restroom availability, especially at stations with the highest volumes of riders. Results also reveal limited access and low quality of the restroom facilities that are available.

Humans peeing: Justice-involved women's access to toilets in public spaces.

Justice-involved women face myriad challenges as they negotiate the terms of community supervision and manage the long-term implications and stigma of living with a criminal record. Major tasks that women juggle include securing safe, affordable housing, finding and retaining employment, accessing physical and mental health care (including substance use treatment), and handling relationships with family, friends, children, and intimate partners. In addition to these responsibilities, women must meet their basic physiological needs to eat, sleep, and use the toilet. Women's ability to safely meet their personal care needs may impact their capacity to manage their criminal-legal challenges. This study uses qualitative methods to understand justice-involved women's lived experiences related to urination. Specifically, the study reports on a thematic analysis of 8 focus groups conducted with justice-involved women (n = 58) and the results of a toilet audit conducted in the downtown areas of the small city in the United States where the focus group participants were living. Findings suggest that women had limited access to restrooms and reported urinating outside. Lack of restroom access impacted their engagement with social services support and employment and their ability to travel through public spaces. Women perceived their public toilet options as unsafe, increasing their sense of vulnerability and reinforcing the idea that they did not have full access to citizenship in the community because of their criminal-legal involvement. The exclusion and denial of women's humanity that is perpetuated by a lack of public toilet access impacts women's psychosocial outcomes. City governments, social service agencies, and employers are encouraged to consider how lack of toilet access may impact their public safety and criminal-legal objectives and expand opportunities for people to access safe restroom facilities.

Organizational Directives and the Persistence of Racial Discrimination in U.S. Public Accommodations

Public accommodations have been key sites of racial inequality in the United States for well over a century. Relative to employment and housing, however, systematic analyses of discrimination in public accommodations remain scarce in the sociological literature. Especially important may be whether and/or how organizational norms and directives underpin contemporary occurrences of racialized differential treatment in public accommodations. Based on an analysis of 319 closed case investigations gathered from Freedom of Information Act (FOIA) requests to civil rights commissions across 18 U.S. cities and states (2015–2020), findings reveal that African Americans and, in particular, African American men are frequent targets in formal complaints of racial discrimination in public accommodations. Building on theoretical expositions regarding the organizational foundations of inequality, case materials suggest that organizations’ ideal patron norms, policies, and directives play a foundational role in producing these racial disparities. Several purportedly “colorblind” institutionalized tools (e.g., admission tickets, restroom access, tote/bookbag rules, and dress codes) were also found to be central to these processes. As such, I argue that organizations of public accommodation contribute to the (re)creation of racial hierarchies as they normalize, direct, weaponize, and legitimize gatekeepers’ profiling and discretion—discretion which is often imbued with explicit or implicit stereotypes of the iconic ghetto/Negro—in these incidents.

Self-Description of a University-Community Partnership to Advocate for Restroom Access Policy Change in Chicago.

Transgender, nonbinary, and gender-non-conforming individuals face significant obstacles accessing public restrooms, resulting in negative mental and physical health consequences. We describe the Chicago Restroom Access Project, a university and community partnership aimed at reforming restroom laws in Chicago and the state of Illinois. A range of community-engagement approaches were used, including recruiting, mobilizing, and partnering with diverse stakeholders, amplifying the voices of under-represented members of the impacted community, collecting data for evidence-based decision-making, fluid membership, and diffuse leadership. Outcomes included developing resources for public education, changing the City of Chicago Human Rights Ordinance, changing Illinois state law on single-occupancy restrooms, and implementing restroom reform at an educational institution. Lessons learned are also described. The methods and principles of this partnership provide approaches that can be used to advocate for reform and policy change for restroom access throughout the country.

Ease of restroom access influences fluid consumption habits and health in classroom teachers

Objectives. There are rising concerns about the health of classroom teachers in the USA, including stress, hypertension and frequent urinary tract infections. Teacher working conditions are likely a contributor to their health concerns. Many teachers report that they cannot easily take a restroom break at work, and therefore they consume minimal water or other fluids. This study investigated the relationship between restroom access and fluid consumption and the prevalence of renal and cardiovascular health complications in classroom teachers. Methods. The responses of 844 teachers (92% women, 8% men; 65.1% between age 26 and 45 years) to an online survey about restroom accessibility, fluid consumption and health were analyzed using descriptive statistics, χ2 analyses and logistic regression. Results. Fifty-nine percent of teachers could not easily take a restroom break, and 54.7% consumed fewer than 2 cups of water per workday. Furthermore, 44.8% reported being pre-hypertensive and 4.9% reported being hypertensive. Teachers with insufficient restroom access were significantly more likely to report frequent urinary tract infections. Conclusions. This study demonstrates a relationship between restroom access, fluid consumption and renal/cardiovascular health in classroom teachers. Future research should directly investigate how teacher work environment impacts renal and cardiovascular health.

Health Disparities Among Workers With Standing Position and Limited Restroom Access: A Cosmetics Saleswomen Study in South Korea.

Korean cosmetics sales workers in department stores face harmful working environments, including limited restroom access, working long hours in a standing position, and customer violence. This study investigated health disparities between cosmetics saleswomen and the general population of working women in South Korea. We assessed the prevalence of health indicators, including physician-diagnosed disease, using a cross-sectional survey of 860 Korean cosmetics saleswomen in September 2018. Health indicators of cosmetics saleswomen were compared to those of general working women from the nationally representative datasets (e.g., National Health Insurance Service-National Sample Cohort). We estimated age-standardized prevalence ratios (SPRs) for health outcomes, including physical, mental, and health-related behavioral conditions. Cosmetics saleswomen were more likely to be diagnosed or treated for physical and mental conditions (e.g., cystitis SPR: 4.03, 95% confidence interval [CI]: 3.48-4.65; plantar fasciitis SPR: 23.48, 95% CI: 18.12-29.93; varicose vein SPR: 38.41, 95% CI: 32.18-45.49; and depression SPR: 11.18, 95% CI: 8.53-14.40) compared to general working women. Prevalence of smoking and hazardous alcohol consumption was also higher among cosmetics saleswomen than those of general women workers. Given our findings, further research is needed to identify work-related risk factors that could deteriorate cosmetic sales workers' health in South Korea.

Design and development of a self-propelled indoor wheelchair with direct toilet accessibility

Purpose Existing wheelchair (WC) designs lack independent toilet accessibility, transferability and indoor manoeuvrability combined in a WC. In this regard, a new WC model is proposed to simultaneously accommodate these distinct and essential features. In this open-source hardware project, the design, analysis and fabrication of a new active commode WC for indoor applications are performed. Materials and method A field survey is conducted to identify the requirements of users so as to choose specific features and design constraints for the WC. In this multipurpose self-propelled model, a temporarily detachable circular section is fitted in the seat position to access the water closet bowl. This hinged portion can be released by gravity before reaching above the closet basin. After the toilet usage, the circular lid can be brought back to the initial seating using a lever mechanism and a spring-loaded lock restrains its downward movement. Thereafter, it can be used as an ordinary WC for indoor applications. Moreover, a small wheel with 22 in diameter and removable hand-rests ensured the transferability between utilities. A CAD model is prepared and numerical simulation is performed to verify the structural stability of the design. Results The optimized model is fabricated using standard manufacturing practices and is delivered to different persons with disabilities to collect user feedback. A systematic skill test is conducted to validate the compliance of the prototype with the user requirements including transferability and independent restroom access. Conclusion The opinions from most of the users are positive which categorically indicated that the proposed design addresses the multipurpose mobility requirements at indoors. Implications for rehabilitation The expected outcomes and implications of the current commode WC project with regard to rehabilitation purpose are enlisted below: In the present scenario, a WC user is heavily dependent on external assistance to access private spaces in general and toilets in particular. The introduced model is capable to address this shortcoming by enabling the user to access the toilet utility directly by self propelling. Indeed, for a person with locomotor disability, a WC is the natural extension of his physical body. Thereby, this multipurpose commode WC design offers much Independence and greater flexibility to the indoor movements. The proposed design instils confidence to a WC user to access and transfer between facilities by means of self effort. Consequently it is expected to improve the quality of one’s personal life significantly. Importantly, this is an open-source project, those who are interested in rehabilitation motives can modify the present design to suit their local requirements especially in resource-limited settings.

Under The Law: The historic Bostock opinion and LGBTQ rights in schools

In Bostock v. Clayton, the U.S. Supreme Court held that discrimination against employees because they are gao or transgender violates the Civil Rights Act of 1964. Robert Kim summarizes the case and explains what the ruling means for schools. LGBTQ educators have historically faced discrimination, but such actions are now prohibited in nearly all public, private, and charter schools. Religious schools, however, may be exempt, and the ruling does not address other issues of discrimination in schools, such restroom access.

Beyond the bathroom wars: Increasing gender-free restroom access in libraries

In May 2016, protesters affiliated with the student organization Justice for Queer and Trans Students occupied the University of Vermont’s (UVM) Dean of Libraries’ office to demand that the David W. Howe Memorial Library (then known as the Bailey/Howe Library) immediately convert select gender-segregated restrooms—meaning those labeled for use for only men or only women—to gender-free restrooms to accommodate the needs of trans and gender non-conforming students during spring finals week. The protest followed the delivery of a petition with more than 1,000 signatures seeking change, as well as ongoing conversations between the libraries and student activists. Student organizer Lindsey “Z.” McCarron told The Vermont Cynic, “This is an immediate and real need that is affecting people’s health and safety every day.”

Reassessing Gender Neutrality

Since the 1970s, advocates have used the term gender neutral to press for legal change in contexts ranging from employment discrimination to marriage equality to public restroom access. Drawing on analyses of all Supreme Court cases, federal courts of appeals cases, and Supreme Court amicus briefs in which the terms gender neutral/neutrality, sex neutral/neutrality, or sexually neutral/sexual neutrality appear, this study examines how US courts have defined gender neutrality and what the scope and limits of its legal application have been. We find that the courts have defined gender neutrality narrowly as facial neutrality, but nonetheless that this limited understanding has transformed some areas of the law, even if it has had little impact on others. Our analysis confirms earlier feminist skepticism about the sufficiency of gender neutrality to guarantee equality but also points to areas in which the law has yet to exploit the idea's significant potential to address discrimination on the basis of sex, sexual orientation, and gender identity.

Toileting Behaviors and Bladder Symptoms in Women Who Limit Restroom Use at Work: A Cross-Sectional Study.

While lower urinary tract symptoms and bladder behaviors are known to be associated with certain occupations, little is known about restroom access or environmental factors which may contribute to this relationship. We aimed to characterize reasons that women limit restroom use at work. We also sought to determine whether women who limit use at work report more unhealthy bladder habits and lower urinary tract symptoms. We performed a cross-sectional study of full-time working women in the United States. Women completed validated questionnaires recording toileting behaviors, lower urinary tract symptoms and perceptions of the occupational toilet environment. We compared women who limited restroom use at work most or all of the time to those who did not limit or did so occasionally or sometimes. Of the 3,062 women in the final analytical sample 11% reported limiting restroom use at work most or all of the time. This group reported lower satisfaction with restroom cleanliness and privacy in particular. They more frequently identified toilet factors of poor quality, limited accessibility and restricted use by employer. The prevalence of unhealthy bladder habits was significantly higher among women who limited restroom use, as was the prevalence of urgency, monthly urinary incontinence and infrequent voiding. In this cross-sectional study of women working full time those who limited restroom use at work reported a higher prevalence of unhealthy bladder habits and certain urinary disorders. Future studies should determine whether limited restroom use at work is a modifiable risk factor for unhealthy bladder habits and bladder health outcomes.

Administering Biology: How “Bathroom Bills” Criminalize and Stigmatize Trans and Gender Nonconforming People in Public Space

Public administration scholarship pertaining to transgender individuals focuses on the implementation of nondiscrimination policies, particularly with respect to employment (Colvin 2007, 2008; Elias 2017). This literature contributes greatly to our understanding of how to maintain open and accessible workplaces for transgender people; however, the effects of the recent politicization of public restroom access for transgender people, such as North Carolina’s HB 2, has yet to receive the same attention. This article argues that the recent surge of “bathroom bills” introduced across various states and localities makes opportunities for transgender and gender nonconforming people to successfully and safely inhabit public space impossible, and uses quantitative and qualitative analysis to illustrate the consequences of these policies. Focusing on seventy-one bills introduced between 2014 and 2018, this article shows that efforts to restrict bathroom access took two forms: first, legalizing discrimination against transgender and gender nonconforming people in public and second, making trans or gender nonconforming embodiment a criminal act. The article concludes with recommendations from architecture, city planning, and Trans Studies scholarship for public administration scholars and practitioners to consider as they continue to design and implement policies to address the unique needs of transgender individuals.

#HerToo? Academic Exclusion in the Age of #MeToo

#HerToo?Academic Exclusion in the Age of #MeToo Amber Pouliot (bio) This article began life as an essay about the difficulties and dangers women face at academic conferences. It was inspired by my own and my fellow female delegates' experiences of being threatened, followed, and groped in the neighborhood near our conference venue—classic #MeToo territory—and also by the realization that safety at conferences should be conceptualized in more capacious terms. Acutely aware of my own oversights and shortcomings when I had organized conferences in the past, the essay argued that safety should encompass issues like accessibility for disabled and neuro-diverse delegates; it stressed the need for pronoun badges for all delegates and restroom access that matches gender identity; it argued for sliding fees that reflect the pay gaps that exist not just between men and women but also between white women and women of color. But when I pitched the essay to four online higher education sites, two rejected the essay outright, one suggested it could be published if I focused on the sexual harassment that women faced (the implication being that I should not consider separately the issues of accessibility that different women experience depending on the intersection of their identities), and one published the article after removing all references to the impact of racial discrimination, transphobia, ableism, and poverty on conference-going women. The academy's apparent unwillingness to confront the ways in which it disadvantages certain women—even in this climate of increased awareness of pervasive sexism and sexual violence—inspired the piece published here. The point of this essay is that the academy is a hostile place for women, but it is more difficult for women who are not white, cis, and heterosexual. The Me Too movement was founded thirteen years ago by Tarana Burke to support survivors of sexual violence. The women with whom she worked were primarily young black women and women of color living in low-wealth communities, and Me Too was intended to validate their experiences, promote healing, and provide survivors and allies with resources appropriate to their communities. But in the process of its transformation into the viral #MeToo hashtag, the traumas of black and marginalized women that underpin this movement were quickly forgotten. Burke voiced her dismay in a letter extracted in Essence Magazine: [End Page 229] I was pained to watch Black women, yet again, being erased from the narrative … I started doing this work because there were so few resources and recourses for us, which is why it cuts deep to hear sisters, who are largely responsible for my visibility, saying the current iteration of the #MeToo movement isn't for them.1 #MeToo has now been co-opted by the academy, where the extent of sexual abuse, harassment, and bullying is coming to light in articles, blogs, and crowdsourced documents. Despite its potential to unite survivors, hold perpetrators accountable, and change abusive norms in higher education, there is a real risk that the academic iteration will become another tool of exclusion that erases the unique experiences of black and minority ethnic women, trans women, poor women, and disabled women—just as Burke herself was nearly erased from the movement she created when Alyssa Milano tweeted #MeToo in 2017. If we in the academy choose to invoke #MeToo, we must remember that this movement has always been both educational and intersectional, with Burke developing a culturally-informed curriculum to discuss sexual violence within the Black community and in society at large. Similarly, the 'me too' movement seeks to support folks working within their communities to attend to the specific needs of their community/communities, i.e. supporting disabled trans survivors of color working to lead and craft events/toolkits/etc. with other disabled trans survivors.2 #MeToo makes it possible to imagine real transformation within the academy by unifying survivors. However, we must not allow it to become a tool that only or primarily helps white, cis women by treating women as a monolith and failing to create adequate space for consideration of the unique ways in which women of color, trans women and nonbinary people, disabled women, and poor women experience abuses of power...

Gender Identity Nondiscrimination Laws in Public Accommodations: a Review of Evidence Regarding Safety and Privacy in Public Restrooms, Locker Rooms, and Changing Rooms

Legislation, regulations, litigation, and ballot propositions affecting public restroom access for transgender people increased drastically in the last three years. Opponents of gender identity inclusive public accommodations nondiscrimination laws often cite fear of safety and privacy violations in public restrooms if such laws are passed, while proponents argue that such laws are needed to protect transgender people and concerns regarding safety and privacy violations are unfounded. No empirical evidence has been gathered to test such laws’ effects. This study presents findings from matched pairs analyses of localities in Massachusetts with and without gender identity inclusive public accommodation nondiscrimination ordinances. Data come from public record requests of criminal incident reports related to assault, sex crimes, and voyeurism in public restrooms, locker rooms, and dressing rooms to measure safety and privacy violations in these spaces. This study finds that the passage of such laws is not related to the number or frequency of criminal incidents in these spaces. Additionally, the study finds that reports of privacy and safety violations in public restrooms, locker rooms, and changing rooms are exceedingly rare. This study provides evidence that fears of increased safety and privacy violations as a result of nondiscrimination laws are not empirically grounded.

Against Shaming: Preserving Dignity, Decency, and a Moral-Educative Mission in American Schools

Shaming has become a substantial phenomenon in K-12 schools. Educational shaming punishments stigmatize the targeted student by exposing him or her to the school community’s condemnation. Designed to penalize behavior through degradation, school shaming punishments include strip searches, forced apologies, dress code violation determinations, and transgender student restroom access denials. While there has been an extensive amount of legal scholarship that explores criminal shaming sanctions, there has been almost no critical assessment of shaming punishments in schools. This Article fills this gap by advocating for the invalidation of school shaming punishments through a legal theory lenses. Specifically, the article draws upon the analogous critical rejection of shaming punishments in the criminal law context by Professors Dan Markel, Martha Nussbaum, Stephen Garvey, Toni Massaro, and Eric Posner to argue for their removal from the educational context. This extrapolation concludes that schools should not utilize shaming punishments as they conflict with dignity, decency, and a moral-educative mission — the very pedagogical goals and civic aims of education of children in American public schools.

Discreet to excrete in the concrete jungle: women bike messengers and their inventive urban strategies in three US cities

In spite of the radical changes brought in by new communication technologies, bicycle messengers are still integral to many urban economies throughout the world. While all messengers creatively navigate through dense, hostile traffic on the streets, women face additional challenges in this male-dominated occupation. They not only confront gendered expectations, difficulties, and harassment from co-workers and the public, but also experience struggles to access restrooms during their workday. This is an overlooked – but crucial – corporeal challenge of bike messengering: how, when, and where to excrete while on the job. The issue of restroom access is compounded by instances of gendered policing, based on a stereotype that a bike messenger is an aggressive male. Drawing from ethnographic research in two North American cities and additional interview material, this article will first offer an overview of the job and then examine how women messengers work in this male-dominated occupational world. Next, it will consider inequities of toilet access, gate keeping and belonging, and how messengers are excluded from office restroom facilities. Finally, it will examine rationale for, as well as the geographic strategies that women messengers employ during their workdays in order to excrete in (relative) peace.

P-035 Reasons that Retail Store Managers Deny Employee Restroom Access to Individuals with Inflammatory Bowel Disease that Have Urgent Medical Concerns

Restroom Access legislation provides individuals with inflammatory bowel disease and other medical needs access to employee bathrooms in retail stores. This law has been passed by 14 state legislatures and rejected by one. Washington, DC does not have restroom access legislation. However, this jurisdiction neighbors a state that has passed restroom access legislation and a state that has rejected the legislation. The reasons for lack of passage are uncertain. This study surveyed retail store managers in Washington, DC about employee bathroom access for individuals with medical needs. Managers of Washington, DC retail stores with dedicated employee bathrooms were surveyed. Stores within one mile of a university medical center were included in the survey. All stores open during the surveying period were included. There were no exclusion factors. The store type, manager gender and age, bathroom access for individuals with medical needs and reasons for denial of bathroom access were obtained. A database, maintaining retail store and manager confidentiality, was created. Qualitative evaluation and quantitative analysis using Fisher Exact test with significance set at P < 0.05 were performed. The study was approved by the university Institutional Review Board. Thirty-one managers (16 male, 15 female; most frequent age 20-30) of stores with employee bathrooms were surveyed. There were 13 clothing stores, 5 food specialty stores, 5 shoe stores, 3 health and beauty stores, 3 convenience stores and 2 antique/art stores. Twenty-four of 31 managers (77.4%; 13 male, 11 female) indicated that they could not allow an individual with medical needs access to an employee bathroom. Twenty-two of 24 (92%) managers indicated that corporate or store policy restricted restroom use. Additionally, 13 managers (54%) expressed concerns about safety, 10 (42%) about property loss, 1 (4%) about the potential for abuse, and 1 (4%) about the potential of affecting their “high end clientele”. The managers' gender and age did not influence the rate that policy (P = 1.000), safety (P = 0.1228 and P = 0.1942) or property loss (P = 1.000) was stated to be the reason for denial of restroom access. There was no difference in the rate at which managers of clothing stores compared to other stores stated that policy (P = 1.000), safety (P = 0.4622) or property loss (P = 0.4521) was the reason for denial of restroom access. Restroom Access Laws provide individuals with inflammatory bowel disease and other medical conditions emergency access to employee bathrooms in retail stores. However, there is not universal acceptance of this legislation. This survey revealed that store policy was the primary reason given for denial of restroom access. Further questioning discovered that concerns about safety and property loss most often influenced store policy. The managers' gender, age and the type of store did not influence emergency restroom access. This study is important because it offers insight into factors that can affect restroom access for individuals with medical needs. Understanding the reasons for denial of access to restrooms has the potential to assist in developing legislation that will address retail store concerns.