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Study shows public restroom intervention reduced open defecation in San Francisco’s Tenderloin neighborhood

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A new study—led by UC Berkeley School of Public Health postdoctoral researcher Heather K. Amato and co-authored by Environmental Health Sciences Professor Jay Graham—found that increased access to public toilets reduced feces reports to the San Francisco Department of Public Works, especially in neighborhoods with people experiencing homelessness (PEH).

PEH face barriers to accessing safe, clean, and reliable places to go to the bathroom, and are often forced to practice open defecation on streets and sidewalks. Due to high human feces complaint rates to the 311 Customer Service Center, the City and County 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 program featured the installation of 33 free-to-use public toilets on sidewalks throughout San Francisco, including in neighborhoods with large numbers of unhoused residents, such as the Mission, Civic Center, Embarcadero, and Tenderloin areas.

Along with restrooms, Pit Stops are equipped with paid staff who monitor the stations during the day. They also provide running water, soap, and other services including dog waste bags and needle disposal boxes.

The UC Berkeley team’s research, published in BMC Public Health in September 2022, measured the impact of the Pit Stop program on reports of exposed feces between January 1, 2014, and January 1, 2020. Publicly available 311 reports of feces were spatially and temporally matched with Pit Stop stations. Results were measured based on whether rates of reports declined in a 500 meter zone around each installed restroom relative to the rates of reports pre-intervention in 27 locations throughout 10 San Francisco neighborhoods.

In the six-month period prior to the installation of new Pit Stop toilets, feces reports were on the rise in San Francisco. For example, from 2008-21, there were 1,465 feces-related calls per 1,000 residents in the Tenderloin and 1,430 in the Civic Center. When comparing pre- and post-intervention, feces reports declined by 12.47 reports per week on average and continued to decline during the six-month post-intervention period.

“The overall findings were largely driven by reductions observed in the Tenderloin, a San Francisco neighborhood with many people experiencing homelessness,” Amato said. “By adding several public toilets in the Tenderloin, the Department of Public Works diverted feces from the streets, protecting unhoused folks from exposure to harmful pathogens found in human waste.”

Amato said that the new Pit Stop toilets did not have as dramatic an effect on feces reports  in other neighborhoods, such as the Mission and South of Market, but those neighborhoods were only equipped with a few Pit Stop toilets between 2014 and 2020. “These neighborhoods also have high numbers of unhoused people (and high rates of feces reports) who would benefit from additional Pit Stop locations, Amato said.”

“The lack of restrooms in public spaces is an indicator of our lack of empathy for members of our community who may not have access to a toilet,” Graham said. He added that inaccessibility of toilets not only affects unhoused people, but also delivery drivers and other essential workers who have limited options for restroom availability. “We need to recognize that human waste happens and that sanitation is a cornerstone to not just health but also dignity,” he said.

The researchers suggest that the Pit Stop interventions may need to be replicated in other locations of the city where there is a need.

“Expanding the Pit Stop program in these and others throughout the city will ensure that everyone has reliable access to sanitation facilities,” Amato said.

Read the full paper published in BMC Public Health and watch the accompanying video here.

Co-authors include Heather K. Amato, Douglas Martin, Christopher M. Hoover, and Jay P. Graham of the University of California, Berkeley, California. Dr. Amato is now a postdoctoral researcher in the Department of Civil and Environmental Engineering at UC Berkeley and graduated from the PhD program in Environmental Health Sciences at Berkeley Public Health this August. Mr. Martin is a UC Berkeley-UCSF Joint Medical Program student. Dr. Hoover completed his PhD last year in the Division of Environmental Health Sciences at Berkeley Public Health.