Structured observation is often used to evaluate handwashing behavior. We assessed reactivity to structured observation in rural Bangladesh by distributing soap containing acceleration sensors and performing structured observation 4 days later. Sensors recorded the number of times soap was moved. In 45 participating households, the median number of sensor soap movements during the 5-hour time block on pre-observation days was 3.7 (range 0.3-10.6). During the structured observation, the median number of sensor soap movements was 5.0 (range 0-18.0), a 35% increase, P = 0.0004. Compared with the same 5-hour time block on pre-observation days, the number of sensor soap movements increased during structured observation by ≥ 20% in 62% of households, and by ≥ 100% in 22% of households. The increase in sensor soap movements during structured observation, compared with pre-observation days, indicates substantial reactivity to the presence of the observer. These findings call into question the validity of structured observation for measurement of handwashing behavior.

Summaryobjective To investigate the effectiveness of a hygiene promotion intervention based on germ awareness in increasing handwashing with soap on key occasions (after faecal contact and before eating) in rural Indian households.methods Cluster randomised trial of a hygiene promotion intervention in five intervention and five control villages. Handwashing was assessed through structured observation in a random sample of 30 households per village. Additionally, soap use was monitored in a sub-sample of 10 households per village using electronic motion detectors embedded in soap bars.results The intervention reached 40% of the target population. Germ awareness increased as well as reported handwashing (a possible indicator of perceived social norms). Observed handwashing with soap on key occasions was rare (6%), especially after faecal contact (2%). Observed handwashing with soap on key occasions did not change 4 weeks after the intervention in either the intervention arm ()1%, 95% CI )2% ⁄ +0.3%), or the control arm (+0.4%, 95% CI )1% ⁄ +2%). Data from motion detectors indicated a significant but small increase in overall soap use in the intervention arm. We cannot confidently identify the nature of this increase except to say that there was no change in a key measure of handwashing after defecation.conclusion The intervention proved scalable and effective in raising hygiene awareness. There was some evidence of an impact on soap use but not on the primary outcome of handwashing at key times. However, the results do not exclude that changes in knowledge and social norms may lay the foundations for behaviour change in the longer term.

We evaluated the utility of electronic loggers to measure the effects of a simple intervention designed to influence the rates of hand washing with soap within enclosed toilets and bathrooms in low-income urban households in Kerala, India. 58 households were given three items with embedded electronic loggers for a period of 2-5 days. Two logged soaps tracked hand and body washing in the bathroom. The third logged item was a water vessel used for flushing the toilet and for post-defecation anal cleansing; this served as a marker of toilet use. In addition, 28 households in a Soap by toilet arm were given an additional logged soap, to be kept by the toilet, and used for hand washing. Compared with the Soap in bathroom arm, the loggers in the Soap by toilet households recorded 73% greater daily use of soaps designated for hand washing (t(36)=2.92, p<0.01) and 172% greater use within 2 minutes of the use of the water vessel (t(36)=3.51, p = 0.001). We conclude that the loggers were capable of detecting changes in the rates of hand washing with soap and changes in hand washing with soap after use of the toilet. Further adoption of logger technologies would enable more insightful studies of hand washing within urban environments.

Adolescence is an important stage of life when health behaviors and attitudes are established. The purpose of this research was to assess health risk behaviors among Guatemalan students in both an urban and rural school. Items were adapted from the Global School-based Student Health Survey and were used to measure and compare the prevalence of risk behaviors between these two demographically and culturally distant school-based samples. In general, the prevalence of adolescent health risk behaviors in both schools was lower than other Latin American countries. Many health risk behaviors were associated with location (urban vs. rural settings) and/or gender. Tobacco use, alcohol use, and sexual activity were higher among urban students. Boys were more likely than girls to use alcohol, use tobacco, and be sexually active. In addition, the prevalence of mental health problems was higher among girls and rural students. These findings imply that measures should be taken to design effective and appropriate health strategies for adolescents attending these schools. Health promotion programs in schools and communities should assist the youth in developing positive health behaviors and cultivating healthy lifestyles in an effort to reduce risk behaviors among adolescent populations. Further research is needed to extend our understanding of risk factors of health behavior in these adolescent populations and to identify effective preventative approaches and strategies that specifically cater to the location and culture of the students.

Findings indicate that there are ongoing shifts in youth brand preference in Mexico, and that these shifts might be related to marketing and advertising practices. There is an ongoing need for monitoring marketing and advertising practices in an effort to protect adolescents from tobacco company exploits.