a nationwide survey on some hygienic behaviors of iranian children and adolescents: the caspian - iv study

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.