title: Oral Hygiene and Handwashing Practices among Middle School Students in 15 Latin American and Caribbean Countries.
abstract: OBJECTIVE
  To examine the relationship between infrequent toothbrushing and infrequent handwashing among middle school students from 15 Latin American and Caribbean countries (Antigua and Barbuda, Argentina, British Virgin Islands, Cayman Islands, Costa Rica, Grenada, Guatemala, Guyana, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and Grenadines, Suriname, Trinidad and Tobago, and Uruguay).
  
  
  METHODS
  A secondary analysis was done of nationally-representative data from 33 174 middle school students who participated in the Global School-based Student Health Survey (GSHS) between 2006 and 2011.
  
  
  RESULTS
  In all 15 countries, the association between rarely brushing or cleaning teeth and rarely handwashing after using the toilet was significant for both boys and girls. The pooled odds ratio for this association was 6.7 (5.8, 7.7).
  
  
  CONCLUSIONS
  Healthcare providers who notice signs of poor dental hygiene or infrequent bathing in adolescents should consider providing comprehensive hygiene education to their patients, since infrequent oral and body hygiene behaviours tend to co-exist and both are threats to health.
authors.affiliation: Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA.
authors.forename: T R
authors.initials: TR
authors.lastname: McKittrick
authors.affiliation: Department of Global and Community Health, George Mason University, 4400 Drive 5B7, Fairfax VA 22030, USA. kjacobse@gmu.edu.
authors.forename: K H
authors.initials: KH
authors.lastname: Jacobsen