title: Regional disparity in hygienic behaviors of Iranian children and adolescents: The CASPIAN-IV study.
abstract: Background:This study aimed to assess the pattern of hygienic behaviors of Iranian children and adolescents at national and sub-national levels according to the socioeconomic status (SES) of their living region.Methods:Data were obtained from the fourth national school-based surveillance survey entitled, "CASPIANIV study" (2011-2012). It was conducted among 14,880 students, aged 6-18 years, who were selected by multistage random cluster sampling from 30 provinces in Iran. We used the World Health Organization Global School-based Student Health Survey (WHO- GSHS) questionnaire. Data were analyzed at national and subnational levels according to the SES of the living region.Results:Overall, 13,486 students (49.2% girls) with the mean (SD) age of 12.50 (3.36) years participated in this study (participation rate: 90.6%). At the national level, 67.21% of the participants had daily tooth brushing, the frequencies for always washing hands after using the toilet, washing hands before eating, and washing hands with soap in school were 85.61%, 56.53%, and 50.32%, respectively. The frequency of daily tooth brushing had no significant difference according to the SES of the living region. In all of the categories of washing hands, the West region (second high SES rank) had the highest frequency of hygienic behaviors (p<0.001).Conclusion:In general, the reported hygienic behaviors were at an acceptable level; however, a large comprehensive health-promoting plan should be considered for all children and adolescents at the national and subnational levels taking into account the disparities according to their SES.
authors.affiliation: PhD, Assistant Professor, Dietary Supplements and Probiotics Research Center, Alborz University of Medical Sciences, Karaj, Iran, & Chronic Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. mqorbani1379@yahoo.com.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Qorbani
authors.affiliation: MD, Professor, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran. kelishadi@med.mui.ac.ir.
authors.forename: Roya
authors.initials: R
authors.lastname: Kelishadi
authors.affiliation: PhD, Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran. shdjalalinia@gmail.com.
authors.forename: Shirin
authors.initials: S
authors.lastname: Djalalinia
authors.affiliation: MD, Professor, Department of Pediatrics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. mohammad-motlagh1389@yahoo.com.
authors.forename: Mohammad Esmaeil
authors.initials: ME
authors.lastname: Motlagh
authors.affiliation: PhD, Assistant Professor, Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran. amir_kasaeian@yahoo.com.
authors.forename: Amir
authors.initials: A
authors.lastname: Kasaeian
authors.affiliation: MD, Assistant Professor, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran. ardalan_gelayol@yahoo.com.
authors.forename: Gelayol
authors.initials: G
authors.lastname: Ardalan
authors.affiliation: MD, Chronic Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. gshafiee.endocrine@gmail.com.
authors.forename: Gita
authors.initials: G
authors.lastname: Shafiee
authors.affiliation: MD, Assistant Professor, Department of Pediatrics, Alborz University of Medical Sciences, Karaj, Iran. omidsafari@gmail.com.
authors.forename: Omid
authors.initials: O
authors.lastname: Safari
authors.affiliation: PhD, Associate Professor, Chronic Disease Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran. rheshmat@tums.ac.ir.
authors.forename: Ramin
authors.initials: R
authors.lastname: Heshmat
authors.affiliation: MD, Medical Students' Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. sadegh.b.mahdavi@gmail.com.
authors.forename: Sadegh
authors.initials: S
authors.lastname: Baradaran Mahdavi
keywords: Children and Adolescents; Hand Washing; Hygienic Behaviors; Iran; Tooth Brushing