These data from a nationally representative sample suggest that in the spring of 2020, most U.S. adults were taking hygiene-related precautions to prevent COVID-19. The fact that almost all adults surveyed said that they were washing their hands often with soap and water to prevent COVID-19 is encouraging, as handwashing is an important way to prevent the spread of COVID-19 and other viruses.
Nearly three-quarters of adults said that they were disinfecting surfaces at home and work often to prevent COVID-19. This percentage, although high, is not as high as the percentage for handwashing. Compared to handwashing, disinfecting surfaces often may be a relatively novel behavior (i.e., people may be less familiar with the importance of frequent disinfection than they are with frequent handwashing) potentially making it harder to adopt this practice [6]. Disinfecting surfaces frequently could be more time-consuming and difficult than handwashing; this could contribute to the lower adherence to this practice. Unfamiliarity with how to disinfect surfaces [7] and, possibly, unavailability and cost of disinfectant, may also contribute to this lower adherence percentage.
This study identified several demographic characteristics associated with hygiene-related practices. Men less often reported both handwashing and disinfecting; this finding is consistent with previous research showing that men engage in protective behaviors (e.g., handwashing) less often than women, even during epidemics [8, 9], and a finding consistent with work conducted during the COVID-19 pandemic [10]. Additionally, those with self-rated poor health were less likely to report handwashing and disinfecting to prevent COVID-19. As evidence indicates that COVID-19 disproportionately affects men and people with underlying health conditions, it may be particularly important for men and people in poor health to take preventive action to protect themselves from COVID-19 [11, 12].
Additional demographic characteristics were associated with a higher prevalence of hygiene-related COVID-19 prevention practices. Generally, frequent handwashing and disinfecting increased with age, although the pattern was stronger for handwashing. Compared to non-Hispanic Whites, non-Hispanic Blacks and Hispanics reported higher disinfecting rates. Current data indicate that COVID-19 causes a disproportionate burden of severe illness and death among older people and among racial and ethnic minority groups [11–13]. It is unclear why these particular groups had higher rates of prevention practices, while other vulnerable groups (i.e., men and people in poor health) did not. More research is needed to clarify these relationships. These data, along with data showing a high rate of cloth face covering use among non-Hispanic Blacks and Hispanics [14], also suggest that individual adherence to CDC guidance is unlikely to explain the racial/ethnic disparity in rates and outcomes of COVID-19; rather, this may be due to systemic racial inequity issues.
Our findings also suggest that people with lower income and education levels are less likely to take these precautions, although these patterns were, again, stronger for handwashing. People with lower income or education levels may face barriers to engaging in these behaviors. For example, they may be more likely to be classified as essential workers and work outside the home during the pandemic [15] and therefore have less time to clean. They may also have less access to water to use for handwashing; recent data indicate that lower income communities disproportionately lack access to clean water and indoor plumbing [16]. More research is needed to better understand the relationship between income, education, and these hygiene practices.
Where people live seems to be related to hygiene-related prevention practices. Those in the south and west regions of the U.S. had lower rates of handwashing compared to those living in the northeast and people living in non-metropolitan areas had lower rates of disinfecting surfaces than those living in metropolitan areas. These findings may be related to the fact that when the survey was conducted, most COVID-19 cases were in more densely populated metropolitan areas and a large COVID-19 outbreak was occurring in in the northeast region of the U.S. [17].