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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

Our take —

This survey, conducted once before the COVID-19 pandemic (October 2019) and once during the pandemic (June 2020), indicated that self-reported handwashing behaviors increased among U.S. adults. Handwashing rates improved particularly after coughing, sneezing, or blowing one’s nose, as well as before eating in a restaurant or at home. Younger, male, and non-Hispanic White adults reported lower rates of handwashing; these results may assist in targeting public health promotion strategies.

Study design


Study population and setting

This study examined self-reported handwashing behavior, using repeated nationally representative surveys of U.S. adults in October, 2019 (n=3,624) and June, 2020 (n=4,053). Both surveys asked the question “In which of these situations/settings are you most likely to remember to wash your hands?” and offered six non-exclusive responses from which to choose. In addition, the surveys collected demographic, household, health status, and employment/income information. The authors used multivariable logistic regression to test for associations between calendar year and self-reported hand-washing behavior.

Summary of Main Findings

Overall, self-reported handwashing behavior increased from October 2019 to June 2020, particularly after coughing/sneezing/blowing one’s nose (53% in Oct 2019 to 71% in June 2020), eating at a restaurant (55% to 71%), and before eating at home (63% to 74%). The proportion of respondents reporting handwashing was consistently high across both years before preparing food at home (87% to 86%), after using the bathroom at home (86% to 90%), and after using the bathroom in public (96% to 95%). Self-reported handwashing behaviors were lower, on average, for younger, male, and/or non-Hispanic White respondents. After adjusting for demographic and socioeconomic factors, the odds of reporting hand-washing before eating at home, before eating at a restaurant, after using the bathroom at home, and after coughing/sneezing/blowing one’s nose were all higher in 2020 than in 2019 (odds ratios, respectively: 1.72, 2.01, 1.41, and 2.28).

Study Strengths

The study utilized a relatively simple, repeated cross-sectional descriptive design to assess the prevalence of handwashing behaviors.


The survey relied on self-reported behaviors, which are likely to be higher than actual handwashing behaviors due to social desirability bias. This bias may be larger for the June 2020 survey round, given increased social pressure to wash hands during the pandemic, which might overestimate the change from 2019 to 2020. The study did not repeatedly survey the same individuals over time, and so could not directly test the hypothesis that people changed their behaviors over time. The online nature of the survey may have resulted in a study population that differed from the general population of U.S. adults with respect to handwashing behavior. Finally, hand sanitizer use as a supplement or substitute for handwashing was not considered.

Value added

This study shows both changes in handwashing behavior over time, and demographics of handwashing behavior in a representative survey.

This review was posted on: 29 October 2020