Despite the role of hand washing and sanitizing in controlling the spread of viruses [1
], non-compliance with hand sanitization remains a puzzle and major public health concern. Several studies conducted during the pandemic have argued that non-compliance with hand sanitizing is an impulsive decision, which could be explained by people’s myopic time perspective [2
]. However, this proposition is conditional on the government’s requirements for hand sanitization; it may influence people’s subjective judgement of hand sanitization. The impulsivity of not maintaining hand-sanitization requirements must be studied in a pandemic-free situation, where people practice hand sanitization for rational health benefit purposes. Few studies, however, exist on human hand-sanitization behavior in non-pandemic scenarios. Ong et al. [4
] studied hand-washing tasks from the viewpoint of hyperbolic discounting (which refers to placing a disproportionately higher tendency on present than on future returns) before the pandemic in the USA and found that infrequent hand-washing behavior was positively and significantly associated with hyperbolic discounting. This finding suggests that deviation from hand-sanitizing procedures, even in pandemic-neutral scenarios, could be denoted as contextually impulsive. However, no such study has been conducted in Japan. This study fills this gap in the literature and provides evidence regarding how impulsivity and impatience are associated with hand-sanitization behavior among the Japanese population. Conducting an impulsivity study of hand sanitization in Japan provides additional substantiation of the understanding and explanation of hand-sanitization behavior because hand sanitizing is considered a rational practice in Japan, not only for the perceived health benefits but also for maintaining long-standing social etiquette [5
Many studies have used hyperbolic discounting as an instrument for comprehending people’s impulsive behavior [6
]. It refers to the situation in which a participant opts for a small immediate reward rather than a large later reward; this action consequently becomes pronounced as a maladaptive decision [7
]. Hyperbolic discounting plays an important role in the decision-making process of individuals, in both monetary terms and in various behaviors related to health problems [8
]. The practice of using hyperbolic discounting to analyze risky health behavior is not new in the literature [9
]. For example, Bickel et al. [10
] and Mitchell [11
] found that monetary discounting rates are continuously higher in current smokers than in nonsmokers. Hyperbolic discounting also showed a consistent relationship with alcohol consumption behavior. Vuchinich and Simpson [12
] found that higher discount rates were seen in “problem drinkers” and in heavy social drinkers compared with light social drinkers. Moreover, Ikeda [13
] reported that hyperbolic discounters are more susceptible to experiencing high body weight. Regarding the behavior to seek health checkups, Fang and Wang [14
] found that women suffering from a present bias were more likely to not undergo mammography tests.
Impulsivity or hyperbolic discounting could be linked to the trait-based nature of infrequent hand sanitizing in Japan, which is often conditional and inconsistent [15
]. Sanitizing hands after outdoor activities or after doing any housekeeping/work-related activities protect a person from any form of underlying health threat, which will eventually improve their current and future health status [16
]. However, the side effects related to the use of hand sanitizers, such as their continued use, could lead to dry, cracked skin as well as redness or discoloration, which might discourage people from frequently using such products [18
]. Thus, for short-term convenience, a person could sacrifice his/her current long-term health. Similarly, people who infrequently sanitize their hands, who only see the present convenience and are not strategic thinkers, would choose small immediate rewards over large future rewards, which indicates an impulsive choice.
Given that impulsivity is linked to several irrational health behaviors [12
] and that Japanese people’s hand-sanitization practices are often conditional and inconsistent [15
], we used two aspects of time discounting, impatience and impulsivity, to explain hand-sanitizing behavior in Japan in a pandemic-neutral scenario. First, the impatience variable is formulated by discount rates, and higher discount rates mean a higher degree of impatience, which would result in more infrequent hand-sanitizing behavior. Thus, we hypothesize that higher discounters tend not to sanitize their hands as frequently than others. Second, hyperbolic discounting can be explained from the impulsivity perspective, wherein hyperbolic individuals make present-biased intertemporal choices. Therefore, in this study we hypothesize that by making time-inconsistent choices, hyperbolic discounters are likely to not sanitize hands after performing any household/work-related activities or after being in public spaces.
This study contributes to the literature in at least three ways. First, to the best of our knowledge, this is the first study in Japan to attempt to establish a relationship between time discounting and hand-sanitizing behavior outside the circumstance of any major outbreak. Second, this study captures how the decision to frequently sanitize hands reflects the rational health perspective of people in Japan following numerous previous outbreaks. Third, this study performed a subsample analysis using a broader age group and gender analysis to deeply understand impatience and impulsivity among various age- and gender-based groups.
The probit regression results provide evidence of the association between hand-sanitizing behavior and the two aspects of time discounting, as shown in Table 5
. The first specification (Model 1.1) includes the two main time-discounting variables, whereas the second specification (Model 1.2) includes the respondents’ demographic characteristics. The third specification (Model 1.3) adds the household’s financial aspects, such as income, assets, and the degree of financial satisfaction. The fourth specification (Model 1.4) includes psychological features, such as risk preference and health anxiety. Finally, risky health behaviors such as smoking, drinking, and gambling were added to the fifth model (Model 1.5).
The results in Table 5
show that the impatience variable has an insignificant association with hand-sanitizing behavior, whereas hyperbolic discounting shows a significantly negative association with hand-sanitizing behavior across all models at a 5% significance level. In addition, most demographic and other control variables indicate consistent effects across the models in terms of signs and significance levels. Male gender, marriage, log of household income, and log of household assets had negative and significant effects on hand-sanitizing behavior. However, financial satisfaction was positively associated with hand-sanitizing behavior at the 1% significance level.
The categorization of various socioeconomic and demographic characteristics by age and gender revealed significant findings regarding hand-sanitizing behavior, as shown in Table 6
. We observed that hyperbolic discounting is negatively and significantly associated with hand-sanitizing behavior, but only for females of both younger and older age groups. Moreover, the important variables that were not previously significant in the full-sample analysis became significant in the subsample analysis. Specifically, we observed that age is positively associated with hand-sanitizing behavior, but only among females aged 65 years and over. Interestingly, older females who live alone and have a larger household size show a positive association with hand-sanitizing behavior. Compared with their counterparts, only men over the age of 65 years who have at least one child are favorably associated with hand-sanitizing behavior. Moreover, younger females with health anxiety tended to comply more with hand-sanitizing practices. In addition, younger males and females who consume alcohol or engage in pathological gambling, respectively, exhibit a negative association with hand-sanitizing behavior. Apart from the log of household income, variables such as the log of household assets and financial satisfaction continue to be significant under the subsample analysis, with the exception that their significance level varies by age and gender.
We investigated hand-sanitizing behavior among the Japanese population from the viewpoint of impatience and impulsivity in a pandemic-neutral scenario. Our results showed that impatience was not related to hand-sanitizing behavior. Thus, our results do not support previous findings on the impact of impatience on other health-damaging behaviors, such as tobacco use, alcohol consumption, and gambling [21
]. For hyperbolic discounting, our results are consistent with existing studies conducted before the pandemic, in which participants who showed steeper time discounting in the monetary discounting task also tended to discount steeply in the handwashing task [4
]. Moreover, several other studies conducted during the COVID-19 pandemic, such as Soofi, Najafi, and Karami-Matin [2
] and Camargo et al. [3
], have indicated that individuals with present-biases (myopic view) are less likely to adhere to COVID-19 preventative behaviors, such as staying at home and hand washing. However, the effects of hyperbolic discounting on hand-sanitization behavior differ considerably by gender and age group, of which only females of both younger and older age groups are influenced by this time-discounting facet. Although no studies currently exist that performed a sub-sample analysis of hand-sanitization behavior by gender and broader age group, a study by Ong, Graves, and Berry [4
] found that female gender was associated with greater time discounting (higher impulsivity) in hand-washing procedures.
For demographic variables, we found that males were less likely to engage in frequent handwashing behavior than their female counterparts. This finding is consistent with those of many other studies conducted before the pandemic [22
]. Furthermore, the age variable only appeared significant among respondents who were female and of the older age group, which showed more frequent hand-sanitizing behavior. This finding is consistent with previous studies, such as Haston et al. [24
], who found that a higher percentage of older women in the USA reported washing their hands in multiple situations than men.
Among the sociological variables, we found that the association between marriage and hand-sanitizing behavior was insignificant and erratic across models. This inconsistency is supported by previous studies, in which Natnael et al. [25
] suggested that marital status was not significantly related to hand hygiene practices, whereas Yang, et al. [26
] provided contradictory results. Moreover, older females who were living alone were more likely to frequently sanitize their hands. According to Czaja et al. [27
], owing to changes in living circumstances, an elderly Japanese woman would engage in better lifestyle and health promotion initiatives, such as washing and sanitizing hands [28
Household size and having children are favorably associated with hand hygiene practices, with the effects being marginally significant among elderly people of both genders. Our results imply that people aged 65 or over who were living in a household with more family members and children complied most with hand-sanitizing behavior. We argue that older populations are one of the most vulnerable groups for infectious disease prevention. Thus, complying with hand hygiene practices is usually reported to be stricter in this age group compared with the younger population [25
The results on household wealth structure revealed that older males and younger females with higher assets are less likely to practice hand sanitizing, which is inconsistent with several findings [29
]. A possible reason is that rich individuals are more likely to develop pandemic fatigue and experience a decline in preventative measures such as hand sanitization [32
]. In addition, financially satisfied respondents were more likely to practice hand sanitization, which is consistent with previous studies [33
]. In particular, financially satisfied older males and younger females practiced frequent hand sanitizing more than other groups, which is consistent with the findings of [34
Among psychological and risky health behavior elements, health anxiety is favorably associated with hand-sanitizing behavior, but only among younger females. Research has shown that men are less cooperative than females in terms of public health behavior and are less likely to take care of their health and undergo regular testing and screening [34
]. Furthermore, younger males who engaged in alcohol consumption behavior were less likely to practice hand disinfection. However, the opposite effect was observed in younger females. Traditional gender standards and perceived risk vulnerability may explain these gender group trends, as males are sometimes seen as bigger risk-takers than their female counterparts. Finally, we found that among the participants, largely younger female gamblers deviated from handwashing behavior. This is supported by the notion that gambling acts as a paradigm for the irrationality of human choice behavior in risk-taking and decision-making processes [35
Several limitations of this study should be considered when interpreting these findings. First, there could be a subjectivity issue in the definition of the main dependent variable of “frequent hand sanitizing” (could be interpreted differently by different respondents), which is a common limitation in these kinds of studies. Second, our study had a relatively small sample size; thus, to make sufficient inferences of the current findings to the broader population in Japan, a more comprehensive study with a larger dataset is needed. Third, the discount rates in this study were produced from two hypothetical questions on intertemporal monetary choices. As such, there is a chance that the results obtained here cannot be applied to real-life situations because they do not precisely show an individual’s reactions to an anxiety-provoking situation.
This study investigated the relationship between handwashing behavior and two aspects of time discounting: impatience and hyperbolic discounting. We hypothesized that impatience and hyperbolic discounting would be negatively associated with frequent hand sanitization. The results of the probit regression showed that people who were hyperbolic discounters were more likely to deviate from frequent hand-sanitization behavior, which seems to be more pronounced among females of both younger and older age, compared to their counterparts. However, there were no notable impacts of the impatience variable on any of the models and specifications. The signs and significance levels of all other control variables vary across genders and broader age groups.
Our findings help establish a significant relationship between hyperbolic discounting and hand-sanitizing behavior outside of the circumstances of any major outbreak in Japan. As the country had experienced several outbreaks, we could justify our position based on why non-compliance with frequent hand sanitization in a pandemic-neutral scenario could be treated as impulsive behavior. This was achieved by linking people’s behavioral responses with a rational health perspective and increased health anxiety. As this study revealed that impulsive people were less likely to engage in frequent hand-sanitizing behavior, we believe that one-size-fits-all policies may not solve the non-hand-sanitization issue outside the pandemic context. Special programs should be directed towards people showing impulsivity towards hand-sanitizing behavior, such as older males and younger females, even when the pandemic situation eases. Therefore, it is recommended that future time-preference research should focus on subsamples of gender and age to gain a more thorough insight into discounting properties among this group and how these factors affect their hand-sanitization behavior within the pandemic-neutral setting.