Sociodemographic and earthquake-related determinants of hygiene behaviors among adults after the February 6, 2023 Kahramanmaraş earthquakes: a cross-sectional study in Adıyaman, Türkiye

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Abstract Background Earthquakes disrupt the conditions that sustain hygiene, yet the relative contributions of sociodemographic characteristics and direct earthquake exposures to hygiene behaviors among adult survivors are poorly understood. Prior work in the same region identified post-traumatic stress as a strong correlate of hygiene; the present study asked which sociodemographic and exposure variables independently shape hygiene behaviors when both domains are modeled together. Methods This cross-sectional study recruited 417 adults in Adıyaman (November 2023 to February 2024) from family health centers (FHCs) inside container settlements and from standard FHCs serving the general urban population. Hygiene behaviors were measured with the 23-item Hygiene Inventory. A two-block hierarchical linear regression entered sociodemographic variables first and earthquake-related exposures second. Post-hoc sensitivity analyses tested the employment finding, including a model that excluded married non-working women (housewives) and a three-category recoding of employment status. Results Participants (mean age 36.9 ± 11.8 years; 57.6% women; 15.8% in container settlements) had a mean total Hygiene Inventory score of 49.1 ± 11.2. The final model explained 32.0% of the variance (ΔR² = 0.034 for the earthquake block; p < 0.001). Independent predictors were marital status (β = 0.254), age (β = −0.254), non-working status (β = 0.173), education (β = 0.160), physical injury (β = −0.146), and female sex (β = 0.113); all p < 0.05. Sensitivity analyses located the non-working effect entirely within the housewife subgroup ( n = 80; 56.8 ± 11.3 vs. 47.3 ± 10.4 for the remainder; Cohen’s d = 0.90); once housewives were excluded, the employment coefficient was no longer significant (β = 2.03; p = 0.27). Conclusions Hygiene behaviors in this post-earthquake sample were shaped chiefly by stable sociodemographic characteristics, with earthquake-related physical injury adding an independent decrement. The advantage attached to non-working status was not an unemployment effect but reflected the household-centered routines of married housewives. Post-disaster hygiene interventions should prioritize older adults, less-educated adults, and those with earthquake-related injuries, while recognizing that the domestic role held by many women may protect rather than compromise their hygiene practice.

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