Did Americans Remember to Wash Their Hands More During COVID-19?

This study compares a survey from October 2019 with one from June 2020, in the first months of the COVID-19 pandemic.

Washing hands often, especially at times when germs are likely to be picked up or passed on, is one way to slow the spread of SARS-CoV-2, the virus that causes COVID-19, and of other germs spread through the air or by the fecal-oral route. Studies around the world had found moderate to high levels of self-reported handwashing during the pandemic, but little was known about how U.S. adults' habits had changed. CDC researchers compared answers to the same question asked before and during the pandemic.

The surveys

The data came from the ConsumerStyles surveys run by Porter Novelli Public Services through Ipsos' Knowledge Panel, an online panel recruited at random by mail and designed to represent the U.S. population. Responses were weighted to match the population on sex, age, income, race and ethnicity, household size, education, region and metropolitan residence.

Both surveys asked: "In which of these situations/settings are you most likely to remember to wash your hands?" Respondents could pick any of six situations, shown in random order.

What changed

After adjusting for demographic and economic differences, the odds of remembering to wash hands in 2020 were significantly higher in four situations: 2.28 times higher after coughing, sneezing or blowing one's nose, 2.01 times before eating at a restaurant, 1.72 times before eating at home, and 1.41 times after using the bathroom at home. The biggest gain came after respiratory symptoms. Even so, fewer than 75% of respondents in 2020 said they remembered to wash their hands before eating at home, before eating at a restaurant or after coughing or sneezing.

Both men and women reported remembering more often in 2020 before meals and after respiratory symptoms. Young adults aged 18–24 improved after respiratory symptoms, while adults 25 and older improved before meals and after respiratory symptoms. Black and Hispanic respondents improved after respiratory symptoms; White respondents improved before eating at home and at a restaurant, after using the bathroom at home and after respiratory symptoms.

Who remembers less

In both years:

• Men were less likely than women to remember before eating at a restaurant, before preparing food, after using the bathroom at home and after respiratory symptoms.
• Young adults aged 18–24 were less likely than adults aged 45–74 to remember before eating at a restaurant, before preparing food and after respiratory symptoms.
• Black respondents were more likely than White respondents to remember before eating at home or at a restaurant, after using the bathroom at home and after respiratory symptoms, and Hispanic respondents were more likely than White respondents to remember before meals and after respiratory symptoms.

The study did not explore why. The authors point to earlier research finding that older adults saw their own COVID-19 risk as higher than younger adults did, that women have seen themselves at greater risk than men in past respiratory pandemics, and that men and younger adults knew less about symptoms and transmission. Because older adults and Black and Hispanic people had been disproportionately affected by COVID-19, their preventive habits mattered especially.

Limits

• A snapshot at two points cannot show whether the pandemic itself caused the change, or something else such as local hygiene campaigns.
• Judging significance by non-overlapping confidence intervals is conservative and may miss real differences.
• People who join online panels may differ from the public despite weighting.
• Self-reports can be skewed by memory or by the wish to give the expected answer.
• The survey did not ask about access to soap and water, how people washed, or use of hand sanitizer, which is recommended when soap and water are not available.

What the authors recommend

Keep promoting frequent handwashing, especially after coughing, sneezing or blowing one's nose and before eating, with messages tailored to men, young adults and White adults. Past efforts that worked include hygiene education, providing handwashing supplies, environmental cues and health communication. Better handwashing helps against COVID-19 and against other infections spread through the air or by the fecal-oral route.

Sources

• Haston JC, Miller GF, Berendes D, et al. Characteristics Associated with Adults Remembering to Wash Hands in Multiple Situations Before and During the COVID-19 Pandemic — United States, October 2019 and June 2020. MMWR Morb Mortal Wkly Rep 69(40). https://www.cdc.gov/mmwr/volumes/69/wr/mm6940a2.htm
• CDC, when and how to wash your hands: https://www.cdc.gov/handwashing/when-how-handwashing.html