Habits of personal hygiene are mostly acquired during childhood, and are, therefore, influenced by one’s family. Poor hygiene habits are a risk factor for preventable disease and social rejection. Social Determinants of Health (SDH) consist of contextual factors, structural mechanisms, and the individual’s socioeconomic position, which, via intermediary determinants, result in inequities of health and well–being. Dysfunctional family situations may, therefore, be generated by an unequal distribution of factors determining SDH. Little attention has been paid to the influence of the family on personal hygiene and the perception of social rejection in children. We designed a study to examine differences in personal hygiene and in the perception of social rejection between children in reception centers and children living in a family setting. A validated questionnaire on children’s personal hygiene habits was completed by 51 children in reception centers and 454 children in normal families. Hygiene habits were more deficient among the children in reception centers than among the other children in all dimensions studied. Deficient hygiene habits were observed in the offspring of families affected by the main features of social inequality, who were more likely to perceive social rejection for this reason and less likely to consider their family as the greatest influence on their personal hygiene practices.

HICORIN® is a reliable and valid instrument that integrally assesses the habits and knowledge in personal hygiene in children between 7-12 years old. It is applicable in educative and social and health environments and in children from different socioeconomic levels.

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25Aims 26 To examine differences in personal hygiene and in the perception of social rejection between 27 children in reception centers and children living in a family setting. 28 Background 29 Little attention has been paid to the influence of the family as a unit on the personal hygiene 30 behaviors of children. 31 Design 32 Cross-sectional study. 33 Methods 34Children aged between 7-12 years were recruited from 2015 through 2017 from two centers in 35 the Network of State Care Centers and from three schools selected from a rural, suburban and 36 urban setting in the same region. A validated questionnaire on child personal hygiene habits 37 was completed by 51 children in reception centers and 454 in normal families. 38 Results 39Data shows worse results for the majority personal hygiene habits studied in children in 40 reception centers than in children living in families. Multiple logistic regressions showed lower 41 frequency of body washing, hand washing after defecating, use of soap in hand washing, tooth 42 brushing, and dentist visits during the previous year. Also, a significantly higher proportion of 43 children in reception centers had experienced social rejection for being dirty and smelling bad 44 in comparison to the children living in families. 45 Conclusions 46 Deficient hygiene habits were observed in the offspring of families affected by the main 47 features of social inequality, who were more likely to perceive social rejection for this reason 48 and less likely to consider their family as the greatest influence on their personal hygiene 3 49 practices. Promoting family practices designed to improve personal hygiene habits are needed 50 specially in vulnerable families. 51 52 4 74An inadequate family income is considered as a primary cause of poor health in 75 children [13,14], but the role of the family as social determinant has not been sufficiently 76 considered, although SDH-related factors are known to affect the capacity of families to care 77 for their children [15]. However, researchers have often analyzed the family in a fragmented 78 manner rather than as a unit. For instance, it has been investigated whether the wealth of 79 families and relationships with parents predict healthy behaviors in young people [16] or 80 whether parental educational level is associated with personal hygiene habits [17]. 81 Over recent years, the risk of family poverty has been increased by economic 82 recession, family breakups, and migration, among other factors [18]. Economic inequalities 83 and the lack of effective social policies have also affected the most vulnerable, generating 84 unstructured and dysfunctional families [19]. In extreme cases, such as abuse or abandonment, 85 the state can move children into reception centers for their protection and safety [20]. Children 86 in reception centers (CRCs) have been described as invisible [21], and there has been little 87 research on their health-related lifestyles. 88 Analysis of the influence of the family as SDH involves the identi...