Kindergarten children who don't wash their hands with soap before eating or after going to the toilet, who drink from the same cups and dry their hands on "collective" towels are more likely to be sick than those who observe hygienic habits. But a new study of Jerusalem preschoolers found that who were taught to wash properly, use paper towels and drink from their own cups actually adopted these habits for months on end. The Health Ministry study did not see a significant reduction in absenteeism from preschools, apparently because children with mild colds were brought to class nevertheless by parents who didn't want to miss work, said study head Dr. Laura Rosen. The researchers were not able to keep track of actual respiratory (colds) and gastroenterological (diarrheal) diseases among the children and how their prevalence was affected by hand washing, but they hope to do so in the next study. Although the study was carried out with the full participation of the Education Ministry, with funding from the Health Ministry's chief scientist's and associate director-general's offices and the Jerusalem Municipality, Rosen found that the level of knowledge among kindergarten teachers on the connection between hygienic habits and health was mediocre. "Many didn't know about why it is important to wash hands with soap. Many didn't have a clue," Rosen said. Much work must be done to educate the educators, she said. She added that many kindergartens used a common cloth towel to save money on paper towels, but that electric dryers would have been a larger initial expense but would save money in the long run. Previous studies on hand washing in Israeli day-care centers, kindergartens and schools as a means to prevent infection have suffered from serious methodological flaws, thus Rosen and colleagues initiated the current study, which avoided most of them. The study encompassed 1,029 children aged three and four in 40 kindergartens in the capital. It compared Jewish children in state-religious institutions with those in state (non-religious) ones and found that, before the intervention, many or most of the observant children washed their hands with plain water before eating and after going to the toilet (as required by religious ritual), but fewer used soap than the secular children. Rosen, whose study has just been published in the journal Preventive Medicine, told The Jerusalem Post that it was the most successful so far in changing children's hygienic habits. "It's important to change behavior, and we succeeded in a lot of children. No one else has had such results. The next step is to determine whether the washing will reduce disease and absenteeism."