Predictors of basic hygiene practices among people experiencing homelessness in Japan during the COVID-19 pandemic: evidence from a cross-sectional study

This study aimed to evaluate basic hygiene behaviors and access to sanitation facilities and COVID-19 infection prevention behaviors among people experiencing homeless (PEH) in Japan. We also sought to examine predictors associated with poor hygiene practices. A total of 228 PEH from the Northern, Western, and Southern Japan were recruited for interview surveys on demographics, barriers to accessing water, sanitation and hygiene facilities, and hygiene practices. Participants generally reported low difficulty in accessing sanitation facilities such as showers, laundry facilities, and handwashing stations. However, basic hygiene behaviors were not consistently practiced, as only 28.4% of participants reported showering daily and 31.0% reported washing their hands with soap five or more times per day. In contrast, COVID-19 prevention behaviors were widely practiced, with 94.3% using hand sanitizer, 83.8% always wearing masks, and 61.5% always or often practicing social distancing. Multivariable regression analysis showed that sleeping outdoors (β = 0.37, p < 0.001), being homeless for four years or longer (β = 0.17, p = 0.03), and heavy alcohol intake (β = 0.13, p = 0.05) were associated with poorer hygiene practices. In conclusion, although sanitation facilities were relatively accessible among PEH in Japan, poor hygiene practices remained associated with unstable living conditions and heavy alcohol intake, highlighting that access alone may not ensure adequate hygiene behaviors.