key: cord-0783839-7jey7aal authors: Hollis, NaTasha D.; Thierry, JoAnn M.; Garcia-Williams, Amanda title: Self-reported handwashing and surface disinfection behaviors by U.S. adults with disabilities to prevent COVID-19, Spring 2020 date: 2021-04-04 journal: Disabil Health J DOI: 10.1016/j.dhjo.2021.101096 sha: 2bb89510fee8713c24b7a1c8f2c3e7ef717dc193 doc_id: 783839 cord_uid: 7jey7aal BACKGROUND: Handwashing and surface cleaning and disinfection are two hygiene behaviors promoted to prevent the spread of COVID-19. Persons with disabilities may be at increased risk for severe COVID-19 illness due to underlying medical conditions that have been associated with COVID-19. OBJECTIVE: This study aims to describe self-reported hygiene behaviors among U.S. adults with disabilities to prevent transmission of COVID-19. METHODS: Data were obtained from the March 2020 Porter Novelli ConsumerStyles survey. This study includes 6,463 U.S. adults (≥18 years) who participated in the survey (58.2% response rate). Participants were asked about frequent handwashing and surface disinfection. Participants were also asked six questions to assess disability status and disability type. Prevalence estimates with 95% confidence intervals were calculated; chi-square tests were conducted. RESULTS: A total of 1,295 (20.3%) of survey participants reported at least one disability and their hygiene-related behavior. Overall, 91.3% of respondents with disabilities reported frequent handwashing; only 72% reported frequent surface disinfection. Those with hearing, vision, cognition, mobility, self-care, and independent living disabilities (range: 77.9%-90.6%) were significantly less likely than those without any disability (94.0%) to report frequent handwashing. People with vision (62.2%) and independent living (66.8%) disabilities were less likely to report frequent surface disinfection than those without any disability (74.6%). CONCLUSIONS: Practices such as handwashing and disinfecting surfaces are effective for reducing and preventing the spread of COVID-19. Promotion of hygiene-related practices among people with disabilities is essential. Tailored communications and implementation of evidence-based strategies are needed to address hygiene-related behaviors among the subgroups of people with disabilities most affected. SARS-CoV-2, the novel coronavirus which causes coronavirus disease 2019 (COVID- 19) , spreads from person-to-person through respiratory droplets when in close contact, or less commonly through contact with contaminated surfaces 1 . Frequent handwashing and cleaning and disinfection of surfaces in the home are two hygiene-related preventative behaviors promoted during the COVID-19 pandemic. 1 Evidence suggests that people with certain underlying medical conditions such as cancer, obesity, serious heart conditions and Type 2 diabetes are at increased risk for severe illness from COVID-19. 2,3 Some adults with disabilities may be at increased risk for severe illness because of the presence of serious underlying medical conditions; studies have shown that adults with disabilities are three times more likely to have heart disease, stroke, diabetes, or cancer than adults without disabilities. 4 Broadly defined, disability is a physical or mental impairment that substantially limits one or more major life activity. 5 Approximately 61 million adults living in the U.S. have a disability, representing ~26% of the adult population. 6 To date, little work has been done examining hygiene-related behaviors among adults with disabilities. The purpose of this study is to describe self-reported hygiene-related behaviors among U.S. adults with disabilities and compare those to adults without disabilities during the COVID-19 pandemic. Results will be used to inform targeted communication efforts among people with disabilities. J o u r n a l P r e -p r o o f To assess hygiene-related practices in response to coronavirus, respondents were asked: "What, if any, precautions are you taking to prevent coronavirus;" respondents were also asked to "Select all that apply" by responding 'yes' or 'no' to a series of actions. For the current study, we include responses for "Washing hands often with soap and water," or "Disinfecting surfaces at home/work often," referred to as frequent handwashing and frequent surface disinfection henceforth. Coronavirus was used in the question stem rather than COVID-19 to make the question non-technical and plain language. To assess disability, respondents were asked six standard disability questions. 8 Respondent were asked to "Please answer yes or no to each of the following questions: Are you deaf or have serious difficulty hearing; Are you blind or have serious difficulty seeing, even when wearing glasses; Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions; Do you have serious difficulty walking or climbing stairs; Do you have difficulty dressing or bathing; and, Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as J o u r n a l P r e -p r o o f visiting a doctor's office or shopping?" Disability status is defined as a 'yes' response to any of these questions. Disability type is defined based on the 'yes' response indicative of hearing, vision, cognition, mobility, self-care, and independent living. Disability types are not mutually exclusive. Adults with disability were limited to those who reported information on hygienerelated behaviors (n=1,295). Respondents with missing information were excluded so that our study sample contained only respondents with complete information. Select demographic variables (gender, age, income, education, race/ethnicity, and U.S. census region) were assessed for hygiene-related behaviors by disability status and disability type. Weighted frequencies were calculated using SAS version 9.4 (SAS Institute). We calculated prevalence estimates with 95% confidence intervals (CI) among adults who reported any disability and by disability type for handwashing and surface disinfecting, overall and by demographic characteristics. We also calculated these measures among people without any disability who reported information on hygiene-related behaviors (n=5,095), and these were compared to people with a disability (n=1,295). Comparisons were made using chi-squared tests and a p-value of <0.05 was considered statistically significant. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy 1 . (Table 2) . When compared to people without any disability, those with hearing, vision, cognition, mobility, self-care, and independent living disabilities were all significantly less likely to report frequent handwashing (Table 2) . Factors associated with frequent handwashing included gender, age, income, and race/ethnicity among people with hearing disabilities and education level among those with mobility disabilities (Table 2) . Frequent surface disinfection prevalence also varied by disability type, ranging from 62.2% (95% CI: 52.6-71.8) for people with vision impairment to 72.0% (95% CI: 66.6-77.4) for those with cognitive disability (Table 3) . When compared to people without any disability, those with vision and independent living disabilities were significantly less likely to report frequent surface disinfection (Table 3) . Factors associated with frequent surface disinfection included income among people with cognitive disabilities, gender and education among people with J o u r n a l P r e -p r o o f mobility disabilities, and age and income among those with independent living disabilities ( Table 3 ). There are a growing number of peer-reviewed articles addressing COVID-19 and people with disabilities; 9-13 however, they are general and were not focused on hygiene-related preventative behaviors. This study found that self-reported rates of frequent handwashing among people with any disability were lower than those without a disability. The prevalence of frequent surface disinfection was similar between those with and without a disability, however, for both groups this behavior was only reported by <75% of respondents. People with vision disabilities and independent living disabilities reported lower rates of both frequent handwashing and surface disinfection, when compared to people without disabilities. Additionally, people with hearing, cognition, mobility, and self-care disabilities reported lower rates of handwashing compared to people without those disabilities. Few pre-pandemic studies have examined hygiene-related behaviors among people with disability, 14-17 so little information exists to help explain these differences in behavior. Frequent handwashing has been found to be associated with decreased risk of infection with SARS-CoV-2, 18 therefore it is critical to identify strategies to promote this behavior among people with disabilities who, may be at increased risk for severe illness from COVID-19 because of higher prevalence of underlying conditions. Several of the factors associated with hygiene compliance among different demographic groups (gender, age, race/ethnicity, education, and household income) were consistent with work conducted among general populations which have been reported during the COVID-19 pandemic 19-21 and during previous respiratory pandemics. 22 COVID-19) evidence used to update the list of underlying medical conditions that increase a person's risk of severe illness from COVID-19 COVID-19) guidance for people with underlying health conditions Disability and Physical Activity -United States Prevalence of disabilities and health care access by disability status and type among adults-United States Department of Health and Human Services implementation guidance on data collection standards for race, ethnicity, sex, primary language, and disability Assessing the impact of COVID-19 on persons with disabilities: development of a novel survey The public health response to the COVID-19 pandemic for people with disabilities Unraveling the Invisible but Harmful Impact of COVID-19 on Deaf Older Adults and Older Adults with Hearing Loss Intellectual and developmental disability and COVID-19 case-fatality trends: TriNetX analysis Impact of COVID-19 pandemic on people living with visual disability Using a motion-controlled game to teach four elementary school children with intellectual disabilities to improve hand hygiene Comparative efficacy of a simplified handwashing program for improvement in hand hygiene and reduction of school absenteeism among children with intellectual disability To evaluate the effects of a simplified hand washing improvement program in schoolchildren with mild intellectual disability: a pilot study Using computer-assisted method to teach children with intellectual disabilities handwashing skills Case-control study of use of personal protective measures and risk for SARS-CoV-2 infection, Thailand. Emerg Infect Dis Disparities in Coronavirus 2019 Reported Incidence, Knowledge, and Behavior Among US Adults