Costa et al. BMC Public Health 2012, 12:73 http://www.biomedcentral.com/1471-2458/12/73 contributes to the diagnosis of pregnant women, mainly through serum conversion studies [9]. The serologic diagnosis in pregnant adolescents can be obtained through the following tests: Indirect Immuno- fluorescence (IIF); Enzyme-Linked Immunoabsorbent Assay (ELISA); Enzyme Linked Fluorescent Assay (ELFA); IgG Avidity Assay and Sabin-Feldman Dye Test (DT); [10,11] Western Blot Reaction [10] and Immu- noadsorption Combined with Agglutination (IgM-ISA) [12]. The IIF test can be used in IgG antibodies research [13]. The ELISA is a double antibody sandwich test similar to the IIF for IgM and IgG detection during the first trimester of pregnancy. The ELISA technique is used more because it has a greater sensibility and speci- ficity than the IIF technique [11]. The Avidity Assay is recognized as the linking force between the specific IgG and the epitope of the protein Toxoplasma gondii. Besides identifying IgM antibodies in detectable patients, it is the most efficient technique to define the stage of the T. gondii infection [7,9]. This test has been used mainly in the acute toxoplasmosis diagnosis of the pregnant adolescent [14], identifying the most probable period of infection, differing the acute infections from the previous ones with only one serum sample [13,15]. Despite helping in the diagnosis of the recent and previous infection by the T. gondii, it is necessary to use a serologic tests panel for a more cer- tain infection diagnosis [16]. In the USA, the Centers for Disease Control (CDC) recommend the adoption of individual measures in the primary prevention of toxoplasmosis in pregnancy, based on criteria related to the preventive behavior directed to food hygiene [17]. Most of the studies regarding toxoplasmosis in preg- nancy in Brazil [18,19] and other countries [20-28], try to estimate the prevalence of the disease or infection and its determinant factors. As an example, we cite a study with 425 pregnant girls who were receiving prena- tal care in basic health care units in the city of Pelotas, Rio Grande do Sul, Brazil which identified that 65% of the pregnant girls did not know about the disease, while most associated it with having cats as pets and less than one third of them associated it with the handling and the consumption of undercooked raw meats and raw vegetables [29]. However, the understanding of the pre- ventive behavior regarding this disease in pregnancy can efficiently contribute to the creation of public policies in Public Health Care System, particularly in the adoles- cent woman’s health area [30,31]. There have been few studies about the preventive behavior in pregnant adolescents. The published works deal with risk behaviors associated to toxoplasmosis in pregnant women [32,33]. Thus, this article analyzes the preventive behavior for toxoplasmosis and its Page 2 of 8 determinants in the Public Health Care System among pregnant adolescents in the state of Ceara, Brazil. Ceara is the third state of the Northeast region of Brazil with 8.439.947 inhabitants, and with 61.9% of this population self-acknowledged as non-white, a Portuguese word for a mix of white, black and indigenous ethnicities. The population of the state is 86.5% catholic and the climate is hot and semi-arid [34]. Methods A cross-sectional study was done from March 2009 to October 2010 with pregnant adolescents attended in the prenatal assistance program of the Public Health Care System in the city of Fortaleza, Brazil. Fortaleza is the capital of the state of Ceara, having 2.448.920 inhabi- tants and an 89.4% rate in relation to the years of formal educational [35]. The Public Health Care System of For- taleza consists of 92 primary healthcare centers, one medical specialty center, one high-complexity hospital, ten medium-complexity hospitals, and 43 healthcare centers for collection of material for serological tests for toxoplasmosis, divided into six sanitary regions in Forta- leza [34]. For the pregnant adolescents sample size calculations, in the healthcare centers, we used an expected fre- quency of 50% of pregnant adolescents with preventive behavior for toxoplasmosis, a confidence level of 95% and a margin of error of 5%. Based on these criteria, the minimum expected sample calculated was 341 pregnant adolescents. Six healthcare centers were selected, one center from each of the six sanitary regions in the city. Two more healthcare centers were included in the divisions which presented a greater number of prenatal consultations. The pregnant adolescents selection was made through proportionate stratified sampling design. We performed a random poll with the pregnant adolescents registered in each healthcare center of the research to identify the adolescents who were surveyed. The dependent variable was the preventive and non- preventive behavior for toxoplasmosis. According to the CDC guidelines [17], we considered having a preventive behavior for toxoplasmosis, the pregnant adolescents who matched all the following criteria: not eating under- cooked or partially cooked meat weekly, washing fruits and vegetables by immersing them into water with sodium hypochlorite (bleach) before eating them, drink- ing water from the public water supply, not handling sand, not having kittens as pets, wearing gloves when cleaning the kittens’ litter box, cleaning kitchen utensils (cutting boards, dishes, kitchen counters) and washing their hands with warm water and soap after handling raw meat and unwashed fruits and vegetables. The inde- pendent variables were: age group, marital status,