There is increasing appreciation that latrine access does not imply use-many individuals who own latrines do not consistently use them. Little is known, however, about the determinants of latrine use, particularly among those with variable defecation behaviors. Using the integrated behavior model of water, sanitation, and hygiene framework, we sought to characterize determinants of latrine use in rural Ecuador. We interviewed 197 adults living in three communities with a survey consisting of 70 psychosocial defecation-related questions. Questions were excluded from analysis if responses lacked variability or at least 10% of respondents did not provide a definitive answer. All interviewed individuals had access to a privately owned or shared latrine. We then applied adaptive elastic nets (ENET) and supervised principal component analysis (SPCA) to a reduced dataset of 45 questions among 154 individuals with complete data to select determinants that predict self-reported latrine use. Latrine use was common, but not universal, in the sample (76%). The SPCA model identified six determinants and adaptive ENET selected five determinants. Three indicators were represented in both models-latrine users were more likely to report that their latrine is clean enough to use and also more likely to report daily latrine use; while those reporting that elderly men were not latrine users were less likely to use latrines themselves. Our findings suggest that social norms are important predictors of latrine use, whereas knowledge of the health benefits of sanitation may not be as important. These determinants are informative for promotion of latrine adoption.

Rural, natural resource dependent communities are especially vulnerable to climate change, and their input is critical in developing solutions, but the study of risk perception within and among vulnerable communities remains underdeveloped. Our multidisciplinary research team used a mixed-methods approach to document, analyze, and conceptualize the interacting factors that shape vulnerability and to explore community members' perceptions of the role and relative importance of climate change compared to other factors in three rural communities in Ecuador. Economic instability, lack of access to basic services, and environmental degradation are perceived as greater threats to community well being than increasing seasonal variability and flooding. Programs and policies directed at climate change adaptation should integrate climate and non-climate related stressors. Our findings also point to a greater need for collaboration across public health, poverty alleviation, and environmental management fields through practical research targeting assistance to vulnerable populations.