A Survey of Hand Washing Behavior

1. A Survey of Hand Washing Behavior Prepared for September 2003 JOB NO

2. Research Objectives • The American Society for Microbiology is interested in continuing to monitor hand washing habits of people in public restrooms. • The objective of the research is to observe adults in restrooms at major metropolitan airports to determine the portion who wash their hands, and also to poll the American public to determine how frequently they say they wash their hands in several situations: • After petting a dog or cat • Before handling or eating food • After coughing or sneezing • After using a public restroom • After handling money • After changing a diaper • After using the bathroom in their home • The purpose of this research is to increase public awareness of the importance of hand washing.

3. Methodology – Airport Observation • Wirthlin Worldwide observed the behavior of 7541 individuals in public restrooms located • in major metropolitan airports in the U.S. and Canada and recorded whether they washed their hands after using the facilities. The research was conducted in six different cities: Observers discreetly watched and recorded whether adults using public restrooms washed their hands. Observers were instructed to groom themselves (comb their hair, put on make-up, etc.) while observing and to rotate bathrooms every hour or so to avoid counting repeat users more than once. Observers were also instructed to wash their hands no more than 10 percent of the time.

4. Methodology – Telephone Poll • Wirthlin Worldwide conducted 1,000 telephone interviews between August 22 and August 26, 2003. • The data is nationally representative and is stratified by census region and weighted to represent the U.S. population’s gender, education and ethnicity composure. • This method assures a valid national probability sample.

5. Executive Summary • Ninety-five percent of adults say they always wash their hands after using public restrooms; however, just 78 percent were observed doing so. • Among observational findings from public restrooms located in major airports, the dirtiest hands were in New York. Thirty percent of people using restrooms in New York airports did not wash their hands after using facilities. • In contrast to airports in the U.S., the vast majority of travelers using the airport restrooms in Toronto, Canada – a city which experienced a major SARS outbreak – washed almost every time. • Across all cities, women washed their hands more than men (83 percent vs. 74 percent). • This disparity was most pronounced in Dallas where 92 percent of women traveling through Dallas/Fort Worth Airport washed their hands, compared to only 69 percent of men.

6. Executive Summary, continued • Americans also say they are likely to wash their hands before handling or eating foods (80 percent) and after changing a diaper (75 percent). However, many do not wash after petting a dog or cat or after coughing or sneezing. • One quarter of Americans perceive the possibility of illnesses, such as SARS, to be at least somewhat threatening; the same number say they have increased the frequency of their hand washing to combat illnesses.

7. Detailed Findings

8. Airport Observation – Among Complete Sample – Based on the observation of 7,541 individuals in public restrooms located in major airports

9. Airport Observation – Among Males – Based on the observation of 4,046 males

10. Airport Observation – Among Females – Based on the observation of 3,495 females

11. Hand Washing HabitsHow Often Are Americans Washing Their Hands? – Total Sample – After petting a dog or cat 44% (17%) After using the bathroom in your home 87% (8%) Always wash my hands Before handling or eating food 80% (14%) After changing a diaper 75% (2%) (Usually wash my hands) After coughing or sneezing 31% (27%) After using a public restroom 95% (3%) After handling money 22% (16%) Q: I am going to read you a list of activities, and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after…

12. Less than half of American men wash their hands after coughing or sneezing (and only three-quarters of men always wash their hands before handling food) – Men vs. Women – Q: I am going to read you a list of activities, and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after…

13. Only eight out of ten young adults always wash their hands after using their bathroom at home – By Age – Q: I am going to read you a list of activities, and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after…

14. Those with less education are more diligent about washing their hands after petting a dog or cat, handling money and before handling food – By Education and Income Level– Q: I am going to read you a list of activities, and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after…

15. There are no significant changes from 1996 to 2000 in the percent of people who say they always wash their hands – Among U.S. Adults – Q: I am going to read you a list of activities, and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after…

16. There has been no significant change in the handwashing habits of American men over the last seven years – Among Males – Q: I am going to read you a list of activities, and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after…

17. In 2003 women seem slightly less likely to wash their hands after petting a dog or cat – Among Females – Q: I am going to read you a list of activities, and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after…

18. A quarter of Americans perceive the threat of illnesses, such as SARS, to be at least somewhat threatening SARS – Total Sample – Norwalk Virus Q: How severe do you perceive the threat of SARS and other illnesses like the cruise ship industry’s Norwalk virus, to be to the average American? Please use a five point where a “1” is not at all threatening and a “5” is extremely threatening

19. The reaction to this threat is relatively consistent among both genders and among all ages – By Gender and Age – Q: How severe do you perceive the threat of SARS and other illnesses, like the cruise ship industry’s Norwalk virus, to be to the average American? Please use a five point scale where a “1” is not at all threatening and a “5” is extremely threatening.

20. The less educated and those among the lower income bracket feel more threatened by these illnesses – By Education and Income Level – Q: How severe do you perceive the threat of SARS and other illnesses, like the cruise ship industry’s Norwalk virus, to be to the average American? Please use a five point scale where a “1” is not at all threatening and a “5” is extremely threatening.

21. Fear of Illness Behavior Changes – Total Sample – Change travel plans 8% Wear a mask in an airport 1% Avoid people with severe colds 32% Gone to the doctor more frequently 8% Avoid public transportation 12% Increase frequency of handwashing 26% Carry sanitizing lotion 24% Q: Have you done any of the following things differently, or changed your behaviors in response to the SARS epidemic or Norwalk virus?

22. Women are far more likely to avoid people with severe colds and to carry sanitizing lotion – Men vs. Women – Q: Have you done any of the following things differently, or changed your behaviors in response to the SARS epidemic or Norwalk virus?

23. Older Americans are significantly more likely to avoid people with severe colds – By Age – Q: Have you done any of the following things differently, or changed your behaviors in response to the SARS epidemic or Norwalk virus?

24. Those with less education and those in a lower income bracket are more likely to have increased their hand washing in response to the threat of illness – By Education and Income Level – Q: Have you done any of the following things differently, or changed your behaviors in response to the SARS epidemic or Norwalk virus?

25. Demographics – Among U.S. Adults – Gender 48% Male 52% Female Household Income 18% Less than $20,000 12% $20,000 to $30,000 11% $30,000 to $40,000 9% $40,000 to $50,000 28% $50,000 or more Age 22% Younger than 35 38% 35-54 38% 55 or older Education 17% Some high school 33% High school grad 27% Some college 16% College grad 8% Post grad