Abstract：
Open defecation due to a lack of access to sanitation facilities remains a public health issue in the United States. People experiencing homelessness face barriers to accessing sanitation facilities, and are often forced to practice open defecation on streets and sidewalks. Exposed feces may contain harmful pathogens posing a significant threat to public health, especially among unhoused persons living near open defecation sites. The City of San Francisco\'s Department of Public Works implemented the Pit Stop Program to provide the unhoused and the general public with improved access to sanitation with the goal of reducing fecal contamination on streets and sidewalks. The objective of this study was to assess the impact of these public restroom interventions on reports of exposed feces in San Francisco, California.
We evaluated the impact of various public restroom interventions implemented from January 1, 2014 to January 1, 2020 on reports of exposed feces, captured through a 311 municipal service. Publicly available 311 reports of exposed feces were spatially and temporally matched to 31 Pit Stop restroom interventions at 27 locations across 10 San Francisco neighborhoods. We conducted an interrupted time-series analysis to compare pre- versus post-intervention rates of feces reports near the restrooms.
Feces reports declined by 12.47 reports per week after the installation of 13 Pit Stop restrooms (p-value = 0.0002). In the same restrooms, the rate of reports per week declined from the six-month pre-intervention period to the post-intervention period (slope change = -0.024 [95% CI = -0.033, -0.014]). In a subset of restrooms, where new installations were made (Mission and Golden Gate Park), and in another subset of restrooms where restroom attendants were provided (Mission, Castro/Upper Market, and Financial District/South Beach), feces reports also declined.
Increased access to public toilets reduced feces reports in San Francisco, especially in neighborhoods with people experiencing homelessness. The addition of restroom attendants also appeared to have reduced feces reports in some neighborhoods with PEH. These interventions should be audited for implementation quality, observed utilization data, and user experience at the neighborhood level in order to tailor sanitation interventions to neighborhood-specific needs.
We evaluated the impact of various public restroom interventions implemented from January 1, 2014 to January 1, 2020 on reports of exposed feces, captured through a 311 municipal service. Publicly available 311 reports of exposed feces were spatially and temporally matched to 31 Pit Stop restroom interventions at 27 locations across 10 San Francisco neighborhoods. We conducted an interrupted time-series analysis to compare pre- versus post-intervention rates of feces reports near the restrooms.
Feces reports declined by 12.47 reports per week after the installation of 13 Pit Stop restrooms (p-value = 0.0002). In the same restrooms, the rate of reports per week declined from the six-month pre-intervention period to the post-intervention period (slope change = -0.024 [95% CI = -0.033, -0.014]). In a subset of restrooms, where new installations were made (Mission and Golden Gate Park), and in another subset of restrooms where restroom attendants were provided (Mission, Castro/Upper Market, and Financial District/South Beach), feces reports also declined.
Increased access to public toilets reduced feces reports in San Francisco, especially in neighborhoods with people experiencing homelessness. The addition of restroom attendants also appeared to have reduced feces reports in some neighborhoods with PEH. These interventions should be audited for implementation quality, observed utilization data, and user experience at the neighborhood level in order to tailor sanitation interventions to neighborhood-specific needs.
摘要：
在美国，由于缺乏卫生设施而导致的露天排便仍然是一个公共卫生问题。无家可归的人在获得卫生设施方面面临障碍，经常被迫在街道和人行道上露天排便。暴露的粪便可能含有有害病原体，对公众健康构成重大威胁，尤其是住在露天排便地点附近的无住房者。旧金山市公共工程部实施了PitStop计划，为无住房和普通公众提供改善的卫生设施，以减少街道和人行道上的粪便污染。这项研究的目的是评估这些公共厕所干预措施对旧金山粪便暴露报告的影响，加州
我们评估了2014年1月1日至2020年1月1日实施的各种公共厕所干预措施对粪便暴露报告的影响，通过311市政服务捕获。公开提供的311份粪便暴露报告在空间和时间上与旧金山10个社区27个地点的31个PitStop洗手间干预措施相匹配。我们进行了中断的时间序列分析，以比较洗手间附近粪便报告的干预前后的比率。
在安装了13个PitStop洗手间（p值=0.0002）后，粪便报告每周减少12.47份。在同样的洗手间，干预前6个月至干预后,每周报告率下降(斜率变化=-0.024[95%CI=-0.033,-0.014]).在一部分厕所里，在那里进行了新的安装（任务和金门公园），以及在另一个提供洗手间服务员的洗手间子集(任务，卡斯特罗/上层市场，和金融区/南海滩)，粪便报告也有所下降。
增加公共厕所的使用减少了旧金山的粪便报告，尤其是在有无家可归的人的社区。在一些患有PEH的社区中，洗手间服务员的加入似乎也减少了粪便报告。这些干预措施应进行实施质量审计，观察到的利用率数据，以及社区一级的用户体验，以便根据社区特定需求定制卫生干预措施。
我们评估了2014年1月1日至2020年1月1日实施的各种公共厕所干预措施对粪便暴露报告的影响，通过311市政服务捕获。公开提供的311份粪便暴露报告在空间和时间上与旧金山10个社区27个地点的31个PitStop洗手间干预措施相匹配。我们进行了中断的时间序列分析，以比较洗手间附近粪便报告的干预前后的比率。
在安装了13个PitStop洗手间（p值=0.0002）后，粪便报告每周减少12.47份。在同样的洗手间，干预前6个月至干预后,每周报告率下降(斜率变化=-0.024[95%CI=-0.033,-0.014]).在一部分厕所里，在那里进行了新的安装（任务和金门公园），以及在另一个提供洗手间服务员的洗手间子集(任务，卡斯特罗/上层市场，和金融区/南海滩)，粪便报告也有所下降。
增加公共厕所的使用减少了旧金山的粪便报告，尤其是在有无家可归的人的社区。在一些患有PEH的社区中，洗手间服务员的加入似乎也减少了粪便报告。这些干预措施应进行实施质量审计，观察到的利用率数据，以及社区一级的用户体验，以便根据社区特定需求定制卫生干预措施。
