title: Enabling hygienic behavior among preschoolers: improving environmental conditions through a multifaceted intervention.
abstract: OBJECTIVE
  Environmental conditions often serve as critical enabling factors for health promotion. This article describes the effect of a preschool hygiene intervention program on classroom environmental conditions.
  
  
  METHODS
  Cluster randomized trial, with randomization at the level of the preschool.
  
  
  METHODS
  State-run preschools in Jerusalem.
  
  
  METHODS
  Forty secular and religious Jerusalem preschools (including 1029 children).
  
  
  METHODS
  A multidisciplinary hygiene intervention that included changes to the preschool environment.
  
  
  METHODS
  Presence of soap, soap dispenser, paper towel, paper towel dispenser, cloth towels, communal cup, or personal cups.
  
  
  METHODS
  Generalized estimating equations and Fisher's exact test were used to estimate the effect of the intervention program on environmental conditions.
  
  
  RESULTS
  Information was obtained from most (97.9%) visits. Baseline environmental hygienic conditions were poor. Relative to the control group, the following environmental conditions were better in the intervention group after program implementation: soap (odds ratio [OR] = 14.7; p < .01), paper towels (OR = 13.5; p < .01), communal cups (OR = .05; p < .01), soap dispensers (secular preschools only, p < .01), individual cups (secular, p < .01; religious, OR = 18.7; p < .02).
  
  
  CONCLUSIONS
  Environmental hygiene in the Israeli preschools studied was deficient at baseline but amenable to change. Improvement in environmental conditions was a necessary enabling factor for the changes in hand-washing behavior that were observed among the children. Sustained environmental change is possible in the preschool environment.
authors.affiliation: School of Public Health, Tel Aviv University, Israel. rosenl@post.tau.ac.il
authors.forename: Laura
authors.initials: L
authors.lastname: Rosen
authors.forename: David
authors.initials: D
authors.lastname: Zucker
authors.forename: David
authors.initials: D
authors.lastname: Brody
authors.forename: Dan
authors.initials: D
authors.lastname: Engelhard
authors.forename: Marina
authors.initials: M
authors.lastname: Meir
authors.forename: Orly
authors.initials: O
authors.lastname: Manor
mesh_terms: D002652:Child Behavior; D002675:Child, Preschool; D004779:Environment Design; D006235:Hand Disinfection; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D006920:Hygiene; D007557:Israel; D012572:School Health Services / Q000458:organization & administration*; D012578:Schools, Nursery / Q000458:organization & administration*