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Homelessness is an emerging public health concern in rural areas where homelessness is on the rise, infectious disease outbreaks are becoming increasingly common, and PEH face unique WASH-related challenges compared to their urban counterparts. We conducted an exploratory study to understand the impacts of unmet WASH needs among rural PEH and their intersection with drug use through in-depth interviews (n = 10). Eligible participants were 18 years or older, lived in one of five Central Appalachian counties, and had experienced homelessness in the previous six months. Using thematic analysis, we identified factors that inhibit WASH access, and adverse health and well-being outcomes that result from unmet WASH needs. We also explore how WASH experiences compare among rural PEH who self-reported drug use to those who did not. Our findings revealed that factors at multiple levels inhibited WASH access, including stigma and place-based characteristics, which contributed to the adverse physical, mental, and emotional health of PEH. Comparisons between PEH who used drugs to those that did not revealed the intricate relationship between WASH, homelessness, and substance use in communities impacted by the opioid epidemic. Expanded WASH facilities that are safe and available with no prerequisites can address inadequate access among rural PEH and collaboration with harm reduction services may be advantageous to reach those who inject drugs.<\/jats:p>","DOI":"10.1371\/journal.pwat.0000019","type":"journal-article","created":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T17:28:21Z","timestamp":1653499701000},"page":"e0000019","update-policy":"https:\/\/doi.org\/10.1371\/journal.pwat.corrections_policy","source":"Crossref","is-referenced-by-count":23,"title":["\u2018You feel how you look\u2019: Exploring the impacts of unmet water, sanitation, and hygiene needs among rural people experiencing homelessness and their intersection with drug use"],"prefix":"10.1371","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3839-5637","authenticated-orcid":true,"given":"April M.","family":"Ballard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0521-2438","authenticated-orcid":true,"given":"Hannah L. 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Walters","year":"2014","journal-title":"Water Policy"},{"issue":"1","key":"pwat.0000019.ref038","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2166\/wh.2015.248","article-title":"Water, sanitation and hygiene for homeless people","volume":"14","author":"SMN Uddin","year":"2016","journal-title":"Journal of water and health"},{"key":"pwat.0000019.ref039","author":"World Health Organization","year":"2021","journal-title":"Progress on household drinking water, sanitation and hygiene 2000\u20132020: five years into the SDGs"},{"key":"pwat.0000019.ref040","article-title":"United Nations High Commissioner for Refugees","year":"2020","journal-title":"Practical Guidance for Refugee Settings"},{"issue":"9","key":"pwat.0000019.ref041","doi-asserted-by":"crossref","first-page":"1238","DOI":"10.2105\/AJPH.2018.304531","article-title":"Open Defecation Sites, Unmet Sanitation Needs, and Potential Sanitary Risks in Atlanta, Georgia, 2017\u20132018","volume":"108","author":"D Capone","year":"2018","journal-title":"Am J Public Health"},{"issue":"5","key":"pwat.0000019.ref042","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1089\/env.2018.0030","article-title":"Open Defecation in the United States: Perspectives from the Streets","volume":"12","author":"EA Frye","year":"2019","journal-title":"Environ Justice"},{"issue":"3","key":"pwat.0000019.ref043","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.ijheh.2018.12.004","article-title":"A systematic scoping review of environmental health conditions and hygiene behaviors in homeless shelters","volume":"222","author":"M Moffa","year":"2019","journal-title":"Int J Hyg Environ Health"},{"issue":"8","key":"pwat.0000019.ref044","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3390\/ijerph14080928","article-title":"Personal Hygiene Practices among Urban Homeless Persons in Boston, MA","volume":"14","author":"JH Leibler","year":"2017","journal-title":"Int J Environ Res Public Health"},{"issue":"11","key":"pwat.0000019.ref045","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.puhe.2010.07.002","article-title":"Public toilets down the drain? 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Willison","year":"2017","journal-title":"Health Policy"},{"issue":"7","key":"pwat.0000019.ref048","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1080\/02723638.2016.1142150","article-title":"The right to infrastructure: a struggle for sanitation in Fresno, California homeless encampments","volume":"37","author":"J. Speer","year":"2016","journal-title":"Urban Geogr"},{"key":"pwat.0000019.ref049","doi-asserted-by":"crossref","first-page":"102431","DOI":"10.1016\/j.healthplace.2020.102431","article-title":"Menstruation and homelessness: Challenges faced living in shelters and on the street in New York City","volume":"66","author":"M Sommer","year":"2020","journal-title":"Health & Place"},{"key":"pwat.0000019.ref050","first-page":"2019","article-title":"Chan School of Public Health, Robert Wood Johnson Foundation, and National Public Radio","volume":"1","author":"T.H. Harvard","year":"2019","journal-title":"Life in Rural America: Part II. Public Opinion Poll Series"},{"issue":"2","key":"pwat.0000019.ref051","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1037\/h0095809","article-title":"Conceptualizing homelessness in rural Appalachia: Understanding contextual factors relevant to community mental health practice","volume":"36","author":"SR Shamblin","year":"2012","journal-title":"Journal of Rural Mental Health"},{"issue":"2","key":"pwat.0000019.ref052","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1037\/rmh0000064","article-title":"Substance use in rural Central Appalachia: Current status and treatment considerations","volume":"41","author":"LN Moody","year":"2017","journal-title":"Journal of Rural Mental Health"},{"issue":"10","key":"pwat.0000019.ref053","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1002\/pds.1626","article-title":"Recent changes in drug poisoning mortality in the United States by urban\u2013rural status and by drug type","volume":"17","author":"LJ Paulozzi","year":"2008","journal-title":"Pharmacoepidemiology and drug safety"},{"issue":"3","key":"pwat.0000019.ref054","doi-asserted-by":"crossref","first-page":"220","DOI":"10.3109\/00952990.2011.643971","article-title":"A comparison of rural and urban nonmedical prescription opioid users\u2019 lifetime and recent drug use","volume":"38","author":"AM Young","year":"2012","journal-title":"The American journal of drug and alcohol abuse"},{"key":"pwat.0000019.ref055","doi-asserted-by":"crossref","first-page":"46","DOI":"10.4018\/978-1-7998-2787-0.ch003","article-title":"Causes and Implications of the Opioid Crisis in Rural America","author":"BA Rivas","year":"2020","journal-title":"Handbook of Research on Leadership and Advocacy for Children and Families in Rural Poverty: IGI Global"},{"issue":"4","key":"pwat.0000019.ref056","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1080\/03124070802428191","article-title":"Homelessness and substance abuse: Which comes first?","volume":"61","author":"G Johnson","year":"2008","journal-title":"Australian Social Work"},{"issue":"S2","key":"pwat.0000019.ref057","doi-asserted-by":"crossref","first-page":"S282","DOI":"10.2105\/AJPH.2013.301302","article-title":"Substance-use disorders and poverty as prospective predictors of first-time homelessness in the United States","volume":"103","author":"RG Thompson","year":"2013","journal-title":"Am J Public Health"},{"issue":"1","key":"pwat.0000019.ref058","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1086\/320879","article-title":"Risk factors for skin and soft-tissue abscesses among injection drug users: a case-control study","volume":"33","author":"EL Murphy","year":"2001","journal-title":"Clin Infect Dis"},{"issue":"5","key":"pwat.0000019.ref059","first-page":"595","article-title":"Bacterial infections and skin cleaning prior to injection among intravenous drug users","volume":"107","author":"D Vlahov","year":"1992","journal-title":"Public health reports (Washington, DC: 1974)"},{"issue":"6","key":"pwat.0000019.ref060","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1097\/ADM.0000000000000346","article-title":"Risk Factors Associated with Skin and Soft Tissue Infections among Hospitalized People Who Inject Drugs","volume":"11","author":"KT Phillips","year":"2017","journal-title":"Journal of Addiction Medicine"},{"key":"pwat.0000019.ref061","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.drugalcdep.2016.11.029","article-title":"A systematic review of injecting-related injury and disease among people who inject drugs","volume":"171","author":"S Larney","year":"2017","journal-title":"Drug Alcohol Depend"},{"key":"pwat.0000019.ref062","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.drugalcdep.2018.03.049","article-title":"Injection drug use, HIV\/HCV, and related services in nonurban areas of the United States: A systematic review","volume":"188","author":"CE Paquette","year":"2018","journal-title":"Drug Alcohol Depend"},{"key":"pwat.0000019.ref063","unstructured":"Medically Underserved Areas Find [Internet]."},{"key":"pwat.0000019.ref064","article-title":"Appalachian Regional Commission- Designated Distressed Counties","volume":"2019","author":"AR Commission","year":"2019","journal-title":"Fiscal Year"},{"issue":"4","key":"pwat.0000019.ref065","doi-asserted-by":"crossref","first-page":"e13593","DOI":"10.2196\/13593","article-title":"Using Web-Based Pin-Drop Maps to Capture Activity Spaces Among Young Adults Who Use Drugs in Rural Areas: Cross-Sectional Survey","volume":"5","author":"HLF Cooper","year":"2019","journal-title":"JMIR Public Health Surveill"},{"key":"pwat.0000019.ref066","unstructured":"Young AM, Livingston M, Vickers-Smith R, Cooper HLF. Emergence of Wasp Dope in Rural Appalachian Kentucky. Addiction.n\/a(n\/a)."},{"key":"pwat.0000019.ref067","article-title":"National Association of Counties and Appalachian Regional Commission","year":"2019","journal-title":"Opioids in Appalachia: The Role of Counties in Reversing a Regional Epidemic"},{"key":"pwat.0000019.ref068","article-title":"QuickFacts","author":"US Census Bureau","year":"2019","journal-title":"American Community Survey 5-year estimates"},{"key":"pwat.0000019.ref069","author":"Kentucky Housing Corporation","year":"2019","journal-title":"K-Count (formerly Point-In-Time Count) Results"},{"issue":"4","key":"pwat.0000019.ref070","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1606\/1044-3894.2016.97.39","article-title":"Do we really know how many are homeless?: An analysis of the point-in-time homelessness count","volume":"97","author":"M Schneider","year":"2016","journal-title":"Families in Society"},{"key":"pwat.0000019.ref071","first-page":"1","article-title":"Maslow\u2019s hierarchy of needs","volume":"1","author":"S. McLeod","year":"2007","journal-title":"Simply psychology"},{"issue":"7","key":"pwat.0000019.ref072","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1037\/0003-066X.32.7.513","article-title":"Toward an experimental ecology of human development","volume":"32","author":"U. Bronfenbrenner","year":"1977","journal-title":"American psychologist"},{"key":"pwat.0000019.ref073","volume-title":"Ecological systems theory","author":"U. Bronfenbrenner","year":"1992"},{"issue":"6","key":"pwat.0000019.ref074","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1037\/0012-1649.22.6.723","article-title":"Ecology of the family as a context for human development: Research perspectives","volume":"22","author":"U. Bronfenbrenner","year":"1986","journal-title":"Developmental psychology"},{"key":"pwat.0000019.ref075","volume-title":"Grounded theory: Objectivist and constructivist methods","author":"K. Charmaz","year":"2003","edition":"2"},{"issue":"4","key":"pwat.0000019.ref076","first-page":"54","article-title":"Critical analysis of Maslow\u2019s hierarchy of need","volume":"2","author":"S. King-Hill","year":"2015","journal-title":"The STeP Journal (Student Teacher Perspectives)"},{"issue":"1","key":"pwat.0000019.ref077","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1007\/BF01807482","article-title":"Maslow\u2019s hierarchy of needs revisited","volume":"27","author":"D. Frame","year":"1996","journal-title":"Interchange"},{"issue":"1","key":"pwat.0000019.ref078","first-page":"1","article-title":"Improving Maslow\u2019s hierarchy of needs: new approach to needs hierarchy","volume":"1","author":"B. Nemati","year":"2013","journal-title":"Applied Mathematics in Engineering, Management and Technology"},{"issue":"8","key":"pwat.0000019.ref079","doi-asserted-by":"crossref","first-page":"e0220114","DOI":"10.1371\/journal.pone.0220114","article-title":"\u2019It\u2019s like a burden on the head\u2019: Redefining adequate menstrual hygiene management throughout women\u2019s varied life stages in Odisha, India","volume":"14","author":"ER MacRae","year":"2019","journal-title":"PLoS One"},{"key":"pwat.0000019.ref080","volume-title":"WASH in Schools empowers girls\u2019 education in Freetown, Sierra Leone: An assessment of menstrual hygiene management in schools","author":"B Caruso","year":"2013"},{"key":"pwat.0000019.ref081","volume-title":"WASH in Schools empowers girls\u2019 education in rural Cochabamba, Bolivia: An assessment of menstrual hygiene management in schools","author":"J Long","year":"2013"},{"key":"pwat.0000019.ref082","volume-title":"WASH in schools empowers girls\u2019 education in Masbate Province and Metro Manila, Philippines: an assessment of menstrual hygiene management in schools","author":"J Haver","year":"2013"},{"issue":"11","key":"pwat.0000019.ref083","doi-asserted-by":"crossref","first-page":"827","DOI":"10.3109\/01612840.2013.831149","article-title":"\u2019The Second Thing to Hell is Living under that Bridge\u2019: Narratives of Women Living with Victimization, Serious Mental Illness, and in Homelessness","volume":"34","author":"R Bonugli","year":"2013","journal-title":"Issues Ment Health Nurs"},{"issue":"2\u20133","key":"pwat.0000019.ref084","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1300\/J013v31n02_07","article-title":"Reproductive health of homeless adolescent women in seattle, Washington, USA","volume":"31","author":"J. Ensign","year":"2001","journal-title":"Women and Health"},{"key":"pwat.0000019.ref085","volume-title":"Hard lives, mean streets: Violence in the lives of homeless women","author":"JL Jasinski","year":"2010"},{"key":"pwat.0000019.ref086","volume-title":"World Health Organization","year":"2020"},{"issue":"11","key":"pwat.0000019.ref087","doi-asserted-by":"crossref","first-page":"e763","DOI":"10.1016\/S2542-5196(21)00283-7","article-title":"Public handwashing for basic hygiene in people experiencing homelessness","volume":"5","author":"AM Ballard","year":"2021","journal-title":"The Lancet Planetary Health"},{"issue":"48","key":"pwat.0000019.ref088","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.15585\/mmwr.mm6448a3","article-title":"Syringe service programs for persons who inject drugs in urban, suburban, and rural areas\u2014United States, 2013","volume":"64","author":"DCD Jarlais","year":"2015","journal-title":"Morbidity and mortality weekly report"},{"issue":"18","key":"pwat.0000019.ref089","doi-asserted-by":"crossref","first-page":"529","DOI":"10.15585\/mmwr.mm6718a5","article-title":"Access to Syringe Services Programs\u2014Kentucky, North Carolina, and West Virginia, 2013\u20132017","volume":"67","author":"D Bixler","year":"2018","journal-title":"MMWR Morbidity and mortality weekly report"},{"issue":"3","key":"pwat.0000019.ref090","doi-asserted-by":"crossref","first-page":"279","DOI":"10.17763\/haer.62.3.8323320856251826","article-title":"Understanding and validity in qualitative research","volume":"62","author":"J Maxwell","year":"1992","journal-title":"Harvard educational review"},{"issue":"2","key":"pwat.0000019.ref091","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1007\/s11135-006-9000-3","article-title":"Validity and qualitative research: An oxymoron?","volume":"41","author":"AJ Onwuegbuzie","year":"2007","journal-title":"Quality & quantity"}],"container-title":["PLOS Water"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pwat.0000019","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,25]],"date-time":"2022-05-25T17:29:48Z","timestamp":1653499788000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pwat.0000019"}},"subtitle":[],"editor":[{"given":"Joel Msafiri","family":"Francis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,5,25]]},"references-count":91,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2022,5,25]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pwat.0000019","relation":{},"ISSN":["2767-3219"],"issn-type":[{"value":"2767-3219","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,25]]}}}