Restroom access and health among people experiencing homelessness: a focus on San Diego, CA

Access to restrooms is vital to personal and public health, particularly among people experiencing homelessness (PEH). This study investigated how restroom access is associated with three domains of self-reported physical health (voiding and defecation-related conditions; skin conditions; and hypertension) among PEH in San Diego, CA. Data from 115 structured interviews with PEH (67.8% male, 40.0% mono-racially White, 57.4% rough sleeping) indicated that 37.4% (n = 43) reported typically using public restroom facilities, 38.3% (n = 44) reported private facilities, and 23.5% (n = 27) reported typically engaging in open defecation. There were moderate to strong associations between urinary, gastrointestinal, and dermatological health conditions and stressors/barriers related to restroom access. The proportion of participants with >= 1 skin-related health conditions who engaged in open defecation was substantially higher (40%) compared to participants who reported no skin-related health conditions who engaged in open defecation (17.9%) (chi(2)(df = 1,108) = 5.25, p = 0.02). Participants who reported >= 3 voiding or defecation-related health conditions or >= 1 skin-related health conditions reported higher mean restroom-related impediments to health relative to participants without these health conditions. Restricted restroom access may prevent PEH from fulfilling their basic sanitation and hygiene needs, and may exacerbate urinary, gastrointestinal, and skin health conditions.