Cities are often judged by how they look on the outside. However, personal hygiene might be a better barometer of cleanliness than litter-free sidewalks or manicured landscaping. The truth is: American cities are not equal in terms of how often residents shower, brush their teeth, and put on fresh underwear. That kind of cleanliness is a high priority in some places, while bad breath, germy hands, and body odor are par for the course in others.

This can seriously affect an individual’s well-being and the overall health of a certain location. For instance, according to the CDC, washing hands with soap and water could prevent 23-40% of all episodes of diarrhea and 16-21% of colds and respiratory illnesses. Frequent handwashing is also beneficial to stop the spread of serious diseases and viruses like influenza, Ebola, or the coronavirus. When you put it all together, a person’s private hygiene behaviors directly affect the health and well-being of all residents and contribute to the overall cleanliness of their city.

Since Quality Logo Products sells about 800,000 hand sanitizers each year, we were curious to know whether they are put to good use! We’ve all seen sanitizing stations at busy malls and restaurants, but are they just for show? Are cities as clean as they strive to be? The only way to figure out which cities have the best hygiene habits — and which are more lax when it comes to personal care — was to choose 25 of America’s largest metropolises and partner with an independent research firm to survey at least 100 people in each. When all was said and done, we had in-depth surveys of 2,732 individuals and some fascinating insights into America’s personal hygiene behaviors. (See the methodology here.)

Curious to see which cities have the least hygienic residents and how your own personal behaviors stack up? Read on for the results of our study.

Personal Hygiene in the U.S.

Overall, the 25 locations we surveyed had varying levels of attention to personal hygiene. The results below are an aggregated set of data about the behaviors for all the residents we surveyed in the following states:

Arizona

California

Colorado

Florida

Georgia

Illinois

Nevada

New York

North Carolina

Ohio

Pennnsylvania

Indiana

Louisiana

Maryland

Massachusetts

Michigan

Minnesota

Missouri

Tennessee

Texas

Virginia

Washington

Most Americans in the surveyed metropolises shower almost every day (averaging 6.2 showers per week), brush their teeth twice on most days (11.7 times per week), and change their bed sheets every 2.5 weeks.

As many as a quarter of Americans go 3 days between showers and let their teeth get a little grimy before taking action. One in 10 Americans haven’t changed their bed sheets in two months or longer. Finally, a little over 4% of Americans have been wearing the same underwear for 4 days or longer. Maybe it’s time to do some laundry?

There is a case to be made that daily showering might not be necessary. However, microbial analysis of the fungi, bacteria, dead skin cells, pollen, pet dander, and bodily fluids that accumulate on bed sheets is enough to make anyone lose sleep. Meanwhile, skipping laundry day and recycling underwear can lead to itchiness, rashes, yeast infections, UTIs, and questionable odors. Let’s not forget about all that could happen when you don’t brush your teeth for a couple of days. These behaviors can lead to bad health down the road, and in turn, contribute to the overall cleanliness and health of a person’s entire city. It’s enough to make anyone want to grab the soap.

Hygiene Report Cards for 25 Cities

Let’s break that aggregated data down even further. We spoke with residents in 25 major metropolises across those listed states and found that behavior changed from location to location, resulting in some cities being more hygienic than others.

To judge a city’s overall hygiene, we crunched the data and generated scores based on six equally weighted criteria:

How often residents shower or bathe How often they brush their teeth How often they change their bedsheets How often they change their shirts and underwear How often they clean their homes (specifically, scrubbing toilets and mopping floors) How often they wash their hands after using the toilet

Miami-Ft. Lauderdale residents got top marks, making their location the most hygienic metro area in the U.S. Also earning high scores for overall cleanliness: New Orleans, Charlotte, Detroit, and New York. Be sure to pack your hand sanitizer if you’re headed to the places at the bottom of the list. Seattle residents are the nation’s grungiest followed by Denver, Washington, DC, the San Francisco-Oakland-San Jose corridor, and Pittsburgh.

Hygiene Highs and Lows Across the U.S.

Here is a closer look at how cities compare on key behaviors. As mentioned, these personal behaviors all contribute to the overall cleanliness of a particular city.

With an average annual temperature of 77ºF and persistent humidity, it makes sense that residents of Miami and Ft. Lauderdale might shower more often than people in cooler climates. Still, weather alone doesn’t explain the big discrepancy in bathing habits across the country. Boston can get brutally cold, yet it has the second-highest percentage of residents who shower more than once a day.

Las Vegas has an average annual temperature of 80ºF with highs typically in the triple digits over the summer, but almost 9% of residents routinely go 4 to 5 days or longer between showers. Residents in San Francisco and Washington, DC are also more likely to go long stretches without bathing, probably making for some pretty smelly bus rides.

New York City has no shortage of iconic spots for a first kiss , but before you pucker up, you might want to make sure your mate isn’t among the 13.7% of foul-mouthed Big Apple residents who haven’t brushed their teeth in several days. New Yorkers were most likely to skip brushing their teeth, followed by residents of Washington, DC, and Dallas-Ft. Worth. To find the freshest breath in the country, head to Miami, Nashville, or Philadelphia.

While New Yorkers are less likely to brush their teeth, their sheets are the most likely to be freshly laundered. Our survey found that New York, Houston, and Miami residents were most likely to change their linens once a week or more, while Los Angeles residents were worst at washing their bedsheets on a regular basis — 1 in 6 L.A. residents sleep in the same set of sheets for two months or longer. San Francisco and Indianapolis residents weren’t far behind when it comes to bedding.

Washington, DC might be where the nation’s health policies are debated and approved, but it turns out that residents of the Beltway are less conscientious about their own hygiene. Almost 1 in 5 Washington, DC residents wear the same underwear for four days or longer, and 1 in 4 often skip washing their hands after using the toilet — both rates were significantly greater than other cities.

Measuring Concern About Germs

All of this data might be surprising, but it makes sense to see why the cities have these behaviors. After all, a germaphobe is going to wash their hands way more often than someone who isn’t fazed by those pesky particles. We looked into which cities in the United States are the most germophobic.

If you cringe a little at the thought of using a gas station toilet, touching the rubber handrail on an escalator, or shaking a stranger’s hand… you’re not alone. Most Americans are aware of the germs and microorganisms that are all around us, but the degree to which we worry about it varies greatly.

We asked people: “On a scale of 1-5, how concerned are you about coming into contact with germs in public places?” 1 was “not concerned at all” and 5 was “extremely concerned”. The average score nationally was 3.3.

Perhaps taking a “what doesn’t kill you makes you stronger” approach, nearly a third of Denver residents answered “1” or “2.” This isn’t necessarily a bad approach considering hygiene hypothesis that says excessive cleanliness prevents children from developing strong immune systems and makes it more likely that they’ll have allergies later in life. Chicago and Pittsburgh residents were also comparatively unconcerned about germs.

At the other end of the spectrum, Miami-Ft. Lauderdale residents were most likely to reply with a “4” or “5,” followed by San Francisco, New York City, New Orleans, and Washington, DC residents. More than half of those cities’ populations were very concerned about germs. Of course, they might have reason to be. New York and Washington, DC residents were also among the most likely to get sick with a cold or flu multiple times each year.

Odds of Getting Sick

A city may or may not be concerned with germs, but how is that affecting their health? We took a look at how often residents get a cold or the flu in the surveyed cities and found some surprising stats.

Can where you live influence how likely you are to catch a cold or flu? Maybe. We asked people how often they get sick with a cold or flu in a typical year. The average response was 2-3 times a year, but it varied by location.

Washington, DC and New York City scored poorly on several measures of hygiene and cleanliness — particularly hand washing after using the toilet – and they had comparatively higher percentages of residents reporting getting sick 4 to 5 times a year or more.

On the other hand, Atlanta and Charlotte residents were most likely to wash their hands and were among the least likely to get sick.

It’s not a perfect correlation. Factors including population density, percentage of people taking public transportation , and weather patterns can also influence the spread of disease. In any given year, different cities and states can be particularly active on the CDC’s influenza map .

The Problem of ‘Presenteeism’

Do you know that person who refuses to take a sick day? Well, they could be bringing a crazy amount of germs to the workplace. Some cities are more likely to have “presenteeism” problems than others.

Depending on who you ask, people who show up to work with red noses and boxes of tissues are either hardworking troupers or pariahs putting the whole office at risk. We asked people how often they go to work while ill with a cold or flu. Overall, 12.7% said “never,” 65.9% said “sometimes,” and 21.4% said they “often” go to work sick.

It’s frustrating for managers when employees call in sick. However, the alternative — having contagious workers spread germs through the office — can be a lot worse. The economic cost of “presenteeism” has been estimated at $150 billion a year in terms of lost productivity and spread of disease.

We found geographic differences in how willing people were to take a sick day. More than 1 in 4 workers in Denver, Las Vegas, Pittsburgh, New York, and Seattle said they “often” go to work while sick with a cold or flu. By contrast, residents of St. Louis and Washington, DC, were least likely to drag themselves into work while sick. Dallas, Charlotte, and Philadelphia residents were also comparatively more willing to take a sick day as needed.

Presenteeism by Profession

It isn’t just a particular city that houses folks who are willing to go to work even when they’re sick. It turns out your occupation may also determine whether or you’re willing to bring germs with you to work.

We analyzed the responses by profession to learn more about presenteeism. In the process, we discovered that teachers and retail salespeople are most likely to report for work sick. Nearly 3 in 10 teachers said they “often” go to work while suffering from a cold or flu. Recent research found that high job demands, stress, and economic insecurity were key factors in whether people report for work sick.

‘Employees Must Wash Hands Before Returning to Work’ … But Do They?

People in the workplace should, in theory, wash their hands after using the bathroom. However, this isn’t always the case, especially in certain industries. The numbers just might surprise you!

Have you ever wondered if those signs in bathrooms reminding employees to wash their hands before returning to work are really necessary? It turns out, they are but they might not be taken to heart. Overall, 39.3% of Americans sometimes skip washing our hands after using the toilet. Bankers are most likely to skip washing their hands, but healthcare workers also cut corners pretty regularly. Teachers are the most diligent about handwashing.

This attention to handwashing is extremely important, especially as epidemics like coronavirus (COVID-19) or other respiratory diseases spread across the nation. No matter what industry you are part of, take some time to wash your hands for at least 20 seconds with warm water and soap.

Conclusion

The consequences of poor hygiene can be minor — romantic moments lost to bad breath or an unpleasant commute to work because of someone’s body odor — or they can be more serious like getting the flu or contracting a disease. Although good hygiene can’t fully protect you from getting sick , other people’s bad habits can expose you to viruses and germs unnecessarily, which can have a social and economic impact in your respective city.

Cultural norms are a significant factor in hygiene practices around the world, but our survey results suggest they might be a factor between cities as well. Different cities have different vibes and personalities, and it turns out they have slightly different hygiene norms as well.

Whatever the reason for the variation in behavior, the differences are interesting. If you’re concerned about germs, taking some hand sanitizer out in public might not be a bad idea no matter where you live.

Methodology

We surveyed a total of 2,732 people, polling at least 100 residents in each of 25 major cities across the United States. The cities were chosen based on population, media market size, and geographic location. Surveys were conducted online.

Respondents ranged in age from 18 to 82, with a median age of 33. There were 46% men and 54% women. In terms of relationship status:

40.9% were married

29.8% were single

15% were in a relationship, living together

8% were in a relationship, living separately

The remaining 6.3% were divorced, separated, or widowed

The median household income was $50,001–$75,000 a year with 31.4% of respondents earning more and 44.1% earning less. Our survey respondents included:

207 people who work in healthcare, medicine, or pharmacy

177 people who work in finance, insurance, or banking

149 people who work in retail sales

141 educators (Pre-K through 12th grade)

131 people who work in arts, entertainment, or photography

119 people who work in construction, roofing, or building trades

103 people who work in hotel, hospitality, restaurant, or food services

87 people who work in government or public administration

Fair Use

If you’re a journalist or blogger interested in covering this project, feel free to use any of the images or graphics above. All we ask is that you kindly credit Quality Logo Products® and link back to this page so your readers can learn more about our study and its methodology.