title: A Nationwide Survey on Some Hygienic Behaviors of Iranian Children and Adolescents: The CASPIAN-IV Study.
abstract: BACKGROUND
  This study aims to assess the frequency of some hygienic behaviors that is, tooth brushing and hand-washing, in Iranian school students at national level.
  
  
  METHODS
  This nationwide study was conducted in 2011-2012 among 14,880 elementary, secondary and high school students who were selected by random cluster stratified multistage sampling from 30 provinces in Iran. We used the global school-based health survey questionnaire of the World Health Organization.
  
  
  RESULTS
  The population of this survey consisted of 13,486 children and adolescents (participation rate of 90.6%) including 49.2% girls and 75.6% urban inhabitants. The mean age of participants was 12.5 years (12.3-12.6, 95% confidence interval) According to the self-report of students, 26.9% of them (20.2% of boys and 33.9% of girls) brushed their teeth more than once a day, 37.8% of boys and 42.1% of girls brushed their teeth once a day. In general, girls brushed their teeth more than boys. The frequency of those students who never brushed their teeth was twice in rural than in urban students (11.4% vs. 6.2%, respectively). In total, 3.4% of the students stated that their school had not an appropriate place for washing hands after toilet, with three-fold higher frequency in rural than in urban schools (6.8% vs. 2.3%, respectively). 85% of students (87% of girls vs. 83% of boys) reported that they had always washed their hands after toilet, 10.1% did it occasionally and 4.1% did not.
  
  
  CONCLUSIONS
  This nationwide survey revealed that Iranian students have an acceptable level of hygienic behaviors both in urban and rural areas; however, still it is necessary to improve school health facilities and hygienic habits in Iranian students.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Morteza
authors.initials: M
authors.lastname: Sadinejad
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.affiliation: Department of Public Health, Alborz University of Medical Sciences, Karaj, Iran ; Department of Epidemiology, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Qorbani
authors.affiliation: Department of Community Medicine, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.
authors.forename: Armindokht
authors.initials: A
authors.lastname: Shahsanai
authors.affiliation: Department of Adolescents, Youth, and School Health, Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran ; Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
authors.forename: Mohammad Esmaeel
authors.initials: ME
authors.lastname: Motlagh
authors.affiliation: Department of Adolescents, Youth, and School Health, Bureau of Population, Family, and School Health, Ministry of Health and Medical Education, Tehran, Iran.
authors.forename: Gelayol
authors.initials: G
authors.lastname: Ardalan
authors.affiliation: Department of Epidemiology, Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ramin
authors.initials: R
authors.lastname: Heshmat
authors.affiliation: Department of Pediatrics, Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Keikha
keywords: Children and adolescents; Iran; hygiene; school