Health behavior and religiosity among Israeli Jews

Research findings have shown the protective effect of religiosity --among both Christians and Israeli Jews--in terms of morbidity and mortality. To explore the relationship between religiosity and health behavior as a possible explanation for these findings we conducted 3056 telephone interviews, representing the Israeli adult urban Jewish population. Health status, health behavior, frequency of medical checkups, and eating habits were measured. Logistic regressions were used to estimate the religiosity gradient on health behavior, controlling for other personal characteristics. We found a lower prevalence of stress and smoking among religious persons; we also found that religious women exercise less than secular women and that religious people--both men and women--are more obese than their secular counterparts. While no religiosity gradient was found with relation to the frequency of blood pressure, cholesterol and dental checkups, religious women are less likely to undergo breast examinations and mammography. Finally, religious people generally follow a healthier dietary regime, consuming less meat, dairy products and coffee, and much more fish. The lower smoking rates, lower levels of stress, and the healthier dietary regime are consistent with the previously shown longer life expectancy of religious people; however, obesity might become a risk factor in this community.

Comparative genomics of the lactic acid bacteria

Lactic acid-producing bacteria are associated with various plant and animal niches and play a key role in the production of fermented foods and beverages. We report nine genome sequences representing the phylogenetic and functional diversity of these bacteria. The small genomes of lactic acid bacteria encode a broad repertoire of transporters for efficient carbon and nitrogen acquisition from the nutritionally rich environments they inhabit and reflect a limited range of biosynthetic capabilities that indicate both prototrophic and auxotrophic strains. Phylogenetic analyses, comparison of gene content across the group, and reconstruction of ancestral gene sets indicate a combination of extensive gene loss and key gene acquisitions via horizontal gene transfer during the coevolution of lactic acid bacteria with their habitats.

"Getting AIDS: not in my back yard." Results from a national knowledge, attitudes and practices survey

BACKGROUND

Israel, as a country of immigration, has a heterogeneous distribution of risk for human immunodeficiency virus. Therefore, general population-based surveys of sexual behaviors among young adults may be useful for guiding prevention policy. To the best of our knowledge, the present survey is the first one among Israeli adults ever published.

OBJECTIVES

To survey knowledge, attitudes and practices regarding sexually transmitted infections in Israeli adults in order to target the future AIDS public campaigns for the general population.

METHODS

A national sample of 800 individuals, aged 18-45, was interviewed telephonically in September 2000.

RESULTS

The average number of sexual partners reported in the previous 3 months was 1.3. Accurate knowledge on HIV transmission modes was expressed by 99% of respondents for unprotected sexual intercourse, 97% for re-use of needles and syringes, and 85% for mother-to-child infection. However, incorrect notions on transmission were also prevalent (34% for insect bites, 29% for kissing and 21% for public toilets). Prevention of STIs and prevention of pregnancy were the most common reasons for using condoms (72-73%); HIV prevention was the motivation for 39%. Fifty percent of single individuals without steady partners always/usually used condoms. It was decided that women need empowerment to negotiate condom use.

CONCLUSIONS

Gaps were found between knowledge (at high level), attitudes (perceiving greater risk for others than themselves) and behavioral practices (combining low level of partner exchange with widespread disregard for safe sex). Promptly implemented, these findings will serve as a baseline for further surveys.

Who are the sedentary people in Israel? A public health indicator

BACKGROUND

Increasing physical activity and thereby reducing a sedentary lifestyle can lower the risk of chronic diseases. Raising the population's involvement in physical activity is a major challenge for public health and healthcare services.

OBJECTIVES

To identify subpopulations with a sedentary lifestyle and low levels of adherence to physical activity recommendations.

METHODS

The Israel Center for Disease Control performed two national surveys during 2002-2003, interviewing 7,307 Jewish Israelis and 1,826 Arab Israelis over age 21. Respondents were asked if they engaged in physical activity lasting at least 20 consecutive minutes, and if so how frequently: less than once a week, once or twice a week, nearly every day or every day.

RESULTS

Arab respondents were less physically active than Jewish respondents after adjusting for gender, age, level of religiosity, marital status, education, self-reported health, smoking, body mass index, and type of survey. Multiple logistic regression analysis run separately for Jews and Arabs found a more sedentary lifestyle, in both groups, among women, the less educated, those who were married and those with poor subjective health. Among Jews, younger age, increased religiosity, smoking and high BMI were associated with a sedentary lifestyle.

CONCLUSIONS

The Jewish population is in need of more targeted and specific interventions for lower adhering subpopulations, such as women, the less educated and those with other risk factors. In the Arab population a more thorough understanding of the benefits of physical activity is needed; however, it seems that a general intervention is required to decrease the prevalence of a sedentary lifestyle all round.

Multiethnic differences in smoking in Israel: Pooled analysis from three national surveys

BACKGROUND

Smoking is a major public health risk and information regarding high-risk groups is needed to plan, implement and evaluate interventions aimed at lowering the number of smokers.

METHODS

During the years 1999-2001 data was collected regarding the smoking behaviour of the Israeli population in three national surveys. All three surveys included ages 25-64 and two included also ages 21-25 and over 64.

RESULTS

Smoking was associated with age, sex, ethnicity, education and religiosity after adjusting for the various demographic characteristics of the survey population. The prevalence of smoking among Arab and immigrant men from the former Soviet Union is higher than among Jewish men. Among women the opposite association exists. The older, religious and more educated reported smoking less frequently. In the Jewish population respondents, defining themselves as secular, reported higher rates of smoking. Only in women was marital status associated with smoking. A few specific high-risk groups for smoking can be identified such as young, less educated men, Arab men, single Jewish women and young immigrant men and women.

CONCLUSIONS

The three ethnic groups residing in Israel differ in the prevalence of smoking; each has a distinct pattern of smoking, positioning them at different stages within the conceptual framework of the larger smoking pandemic. Ethnicity, religiosity, age and education are associated with smoking in both sexes. This calls for specific tailored interventions aimed at younger men with less education, Arab men, and young immigrants.

[Knowledge and attitude regarding use of anabolic steroids among youth exercising in fitness centers]

A survey on knowledge and attitudes towards the use of steroids in youth who exercise in fitness centers was conducted in a national sample of fitness centers in Israel. A total of 528 participants aged 13-18 years completed the questionnaire. Fitness centers were chosen by cluster samples. Forty five percent of the respondents believe that the use of steroids improves physical fitness and 41% believe that most well-known athletes use steroids. Ten percent of respondents believe that the use of steroids is popular among young people in gym centers. Overall, 7% stated that they tended to use steroids and a significantly lower percentage were aware of the side effects of steroids. The role of the physician is essential to identify the patients at risk, to deliver accurate information, to minimize harm and to follow-up. There is also a need for health education in schools, fitness centers and the community, concerning the use of steroids among young people.

Smoking prevention campaign for youth in Israel

BACKGROUND

Smoking rates among teenagers have increased in many countries including Israel. Youth smoking prevention programs have developed considerably in recent years and the present study examines results of mass media anti-smoking campaign in Israel.

METHODS

Two telephone interviews were conducted one moth and 9 months after exposure to TV advertisements. The two surveys consisted of random samples of Israeli adolescents aged 12-18 years.

RESULTS

After one month, 77% of the survey participants remembered the slogan of the TV ads, and 30% used it. After 9 months, 32% remembered it and 6% used it. 28% said they were affected by the TV ads. After 9 months, 25% increased their awareness about anti-smoking behaviors, 2% claimed to have stopped smoking, and 1% claimed to have decreased smoking). Significant changes in anti-smoking awareness were found in survey participants who were exposed to TV ads and also participated in a school program.

Health knowledge, attitudes, and practice (KAP)--a basis for health promotion policy in Israel

OBJECTIVE

To review how health promotion policy can be based on research data.

DATA SOURCES

The Department of Health Promotion, Ministry of Health, Israel, in collaboration with Midgam Research and Consultation Company and the Israel Center for Disease Control have conducted ongoing research on health knowledge, attitudes, and practice in Israel as a basis for health policy.

MAIN FINDINGS

Based on data from 1995 to 2000: 1. There is a positive trend in healthy dietary habits. 2. There is no decrease in smoking rates. 3. There is an increase in drinking rates of wine. 4. There is an increase in aerobic exercise. More Israelis declare they eat healthy foods, but currently this is only for 50% of the population. There is a need for health promotion efforts to further increase positive dietary habits. There is an immediate need for extensive health promotion efforts to decrease smoking rates in Israel. Also, there is a need for health promotion campaigns to decrease drinking in Israel. Although more people are participating in aerobic physical exercise, there is a need to further increase this number.

CONCLUSION

Data on health knowledge, attitudes, and practice is an important source for health promotion policy. By trends seen in a national survey of health knowledge, attitudes, and practice conducted every two years, additional health promotion policy can be shaped.

Positive changes in sun-related behavior in Israel (1994-1998)

BACKGROUND

Current preventive measures against skin cancer focus on individual sun protection and early detection. Solar radiation in Israel is powerful, and about one-half of its population is fair skinned. We investigated whether public awareness efforts yielded changes in sun-related behaviors in Israel from 1994 to 1998.

METHODS

The Department of Health Promotion in the Ministry of Health in Israel has been conducting an ongoing research on health knowledge, attitude, and practice, including six closed questions about sun-related behaviors in a general questionnaire. Independent samples of about 3,000 people representing the adult Jewish population (18 years old and above) were surveyed in 1994, 1996, and 1998. Response rates in 1994 and 1996 were about 85 and 80% in 1998.

RESULTS

The number of people reporting sun protection behaviors increased from 34% in 1994 to 41% in 1996 and to 46% in 1998. Periodic medical skin examination increased from 9% of the responders in 1994, to 13% in 1996 and to 16% in 1998. The number of people reporting having fair skin increased from 28% in 1994 to 41% in 1996 and to 43% in 1998.

CONCLUSIONS

There were positive changes in sun-related awareness and behaviors in Israel between 1994 and 1998. These findings support the conclusion that positive gains were associated with the health promotion efforts conducted by the Israel Cancer Society, Ministry of Health, and other Israeli organizations throughout these years.

Routine childhood screening for hyperlipidemia in Israel

Screening of children and adolescents for hyperlipidemia is controversial. We performed a cholesterol surveillance study of 806 children aged between 6 and 14 years. The initial cholesterol screening test was done by finger stick in the non-fasting state. Children with cholesterol values exceeding 4.55 mmol/l ("borderline" risk) and their parents had their lipid profiles measured following a 12 h fast by venipuncture. The incidence of coronary risk factors in the families of children with hypercholesterolemia was estimated. Of the initial group, 71 children had total capillary cholesterol levels > or = 4.55 mmol/l, and in 65 of these children serum lipid profile was reexamined after an overnight fast. Fifty-five children were found to have total venous cholesterol (TVC) levels < 4.55 mmol/l, and 27 of the 55 had a low density lipoprotein (LDL) cholesterol level > 3.4 mmol/l ("borderline" risk). A positive correlation was found between TVC and LDL-cholesterol levels. Of the hypercholesterolemic children 49% had a parent with hyperlipidemia and 13% had a family history of premature myocardial infarction (before 55 years of age). We conclude that screening of children based on the presence of hypercholesterolemia or its possible complications in other family members may fail to identify many of the children with hypercholesterolemia. Thus, if thorough identification of young children with hypercholesterolemia is desired, inclusive population screening would be the most effective approach.

Bicycle helmets in Israel: observed change in usage following a nationwide campaign

Bicycle-related head injuries are an important cause of injury and death among bicycle riders. The use of bicycle helmets could reduce the rate of serious head trauma among bicyclists involved in accidents. A nationwide survey was conducted in Israel to determine the usage of such helmets. This survey preceded a media campaign encouraging the use of bicycle helmets. A second survey compared the rates of helmet usage following the media campaign with those rates prior to the campaign. A modest but significant increase in the use of bicycle helmets was observed. In order to further increase this rate, additional educational campaigns are needed and possibly the enactment of legislation.

Trends in the prevalence of dental caries in Israel

This study's objective was to assess the prevalence of dental caries in five-year-olds and twelve-year-olds in Jerusalem, Israel. A total of 166 children comprised the younger group; and 147 children represented the twelve- to thirteen-year-olds. Examinations took place in the classrooms under natural lighting, using a mouth mirror and a probe. It was found that 27.7 percent of the younger children were caries-free, with a mean dif(t) value of 3.65 +/- 3.58. At the age of twelve years, only 4.8 percent were caries-free, with a mean DMF (T) value of 4.9 +/- 3.09. Nearly 58 percent of these carious permanent teeth had been treated. In Jerusalem, fluoridation of the water supply was implemented only recently. There are signs of increased public awareness of prevention methods.

Utilization of preventive services by pregnant women in Jerusalem--a cross sectional study

A study was made of health service utilization patterns during pregnancy of 279 young mothers, a representative sample of the Jewish population in Jerusalem. Only 47% reported that they used the municipal family health centers (FHCs) for prenatal care. Some 82% reported that they had resorted to more than one source of care during pregnancy. Sources other than the FHC were: regular Sick Fund doctor service (33%); private practitioners (25%); hospital-based services (25%). Among the FHC users, there was an unexpectedly high percentage of women of Asian-African origin and of those living in remote neighborhoods. Under-utilization was frequent among wealthy women, those with higher education and members of the Orthodox religious sector. While there was general satisfaction with the service, lower gratification was associated with higher utilization. This phenomenon may intimate that there may be a process of negative selection among women who use the service, when other alternatives are not readily available.

[Segev health promotion project in Jerusalem elementary schools]

The health-promotion and education project, Segev, is an Israeli version of the American Health Foundation's Know Your Body project. The aim of this cohort study was to change knowledge, attitudes, health behavior and risk factors for cardiovascular disease in elementary school children. We present the results of questionnaires about knowledge of, and attitudes to health in 656 Jewish children who started first grade in 1983-4 and completed 4 questionnaires in the first and third grades. The results indicate a statistically significant increase in knowledge and attitude scores in the experimental group after 1 and 3 years of intervention. They indicate that changes in knowledge of, and attitudes to health are possible after even a relatively short school health education program.

Primary prevention of cardiovascular diseases in childhood: changes in serum total cholesterol, high density lipoprotein, and body mass index after 2 years of intervention in Jerusalem schoolchildren age 7-9 years

A school health education and promotion program, the Israeli version of the American Health Foundation's "Know Your Body" program, was developed by the Department of Public Health of the Municipality of Jerusalem in 1983. Eight experimental and eight control schools participated in this cohort study of Arab and Jewish first-grade children. After the first 2 years of intervention, comparison of experimental and control groups showed a significant increase in serum high density lipoproteins among Jewish children and a decrease in serum total cholesterol and body mass index among both Jewish and Arab children. These results indicate that changes in cardiovascular disease risk factors such as blood total cholesterol, high density lipoproteins, and body mass index are possible after a health education program is introduced to first-grade students for a relatively short period of time.

The prevalence of middle ear pathologies in Jerusalem school children

In the years 1984-85, 2,664 Jerusalem school children aged between 8 and 13 years were checked for middle ear pathologies. This pilot study was part of a preventive medicine project that was also on the alert for cases where hearing problems had led to academic underachievement. The children were checked at school by an otolaryngologist using a pneumatic otoscope. 1.5% of them suffered from secretory otitis media, 3% from attic retractions, 0.3% from chronic otitis media, and 0.07% from cholesteatoma. The total number of children who had middle ear pathologies was 132 (4.95%). In a parallel group of 2,486 children checked by the routine pass/fail portable audiometry test performed by a nurse, only 1% were found to have middle ear pathologies. According to these middle ear findings, we concluded that the vast majority of the pathologies can be detected by a simple tympanometry and we recommend routine audiometric and tympanometric examinations for school children in grades A and B, and a repeated tympanometry at age 10 years.

Serum cholesterol (total, low-density lipoprotein, and high-density lipoprotein cholesterol), triglyceride levels, and fat consumption among Jerusalem Arab and Jewish schoolchildren

As part of initial health screening for the "Know Your Body" Program-based comprehensive health education program, 841 Jerusalem first- and second-grade schoolchildren were tested for total serum cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. The same population, which included 643 Jewish (76.5%) and 198 Arab children (23.5%), had their nutritional habits evaluated by means of a parent-completed food-frequency questionnaire. Arab schoolchildren had significantly lower total, high-density lipoprotein, and low-density lipoprotein cholesterol levels and higher triglyceride levels than the Jewish children studied (total cholesterol: Arab mean, 153.1 mg/dl, Jewish mean, 170.3 mg/dl; high-density lipoprotein cholesterol: Arab mean, 46.4 mg/dl, Jewish mean, 48.5 mg/dl; low-density lipoprotein cholesterol: Arab mean, 90.7 mg/dl, Jewish mean, 108.5 mg/dl; triglycerides: Arab mean, 77.9 mg/dl, Jewish mean, 66.3 mg/dl). No significant differences in consumption level of foods high in saturated fats and/or cholesterol were found between populations, although the Arab children showed a tendency to eat more of these foods. Significant differences in total cholesterol values were also found among Jewish children of different origins, but no significant differences were found in consumption levels of saturated fats and cholesterol. Further studies are needed to determine the reasons for the differences in total cholesterol and lipoprotein levels found between Jewish and Arab schoolchildren.

Occupational therapy in mother and child health care centers

This paper describes the results of an infant stimulation program that involved mothers and their infants registered at Mother and Child Health Care centers in Jerusalem. A questionnaire was used to evaluate the mothers' knowledge, attitudes, and practices regarding the developmental needs of their infants. A developmental assessment was used to evaluate the infants' reaching and grasping abilities at 4 months of age. The questionnaire was completed by 175 mothers in the program (the experimental group) and a control group of 124 mothers. The results showed that, despite demographic differences that were likely to positively affect the control group's scores, the experimental group's scores were significantly higher. The results of the developmental assessment administered to 107 infants in the experimental group and 74 infants in the control group also indicated that, on 4 out of 5 reaching and grasping items, the experimental group performed significantly better. This study emphasizes the value of structuring a developmental curriculum for newborn infants and their mothers within an occupational therapy program.

Determinants of blood pressure in 7th grade Jerusalem school children

The determinants of blood pressure level were analyzed in a group of 1154 Jerusalem school children aged 12. After controlling for age, significant differences in blood pressure measurements were found between three groups: boys, pre-menarche girls and post-menarche girls. A comparison of the means of selected biological variables showed that girls who have reached menarche have levels of systolic blood pressure, weight, height and Quetelet's index higher than boys and pre-menarche girls. However, levels of triceps skinfold thickness and pulse rate were similar in the two groups of girls and higher than in boys. Using multiple regression analysis, we found that much of the variance (boys 29%, post-menarche girls 21% and pre-menarche girls 15%) of systolic blood pressure could be explained by a combination of biological variables (Quetelet, pulse rate, triceps skinfold thickness and height) while these variables explained a much smaller proportion (boys 12%, post-menarche girls 17% and pre-menarche 9%) of diastolic blood pressure variance. The predictive power of systolic blood pressure by the measured biological variables was higher in boys than in girls. However, diastolic blood pressure was better predicted by the biological variables in the group of girls with menarche than in other groups. Elevated blood pressure was observed in 3.2% of the examined children. High values for Quetelet's index were observed in 6.4%. The prevalence of elevated measurements of blood pressure and Quetelet's index were significantly higher in girls with menarche. Among children aged 12, the association between sociodemographic characteristics and blood pressure level was weak, as measured in multiple regression analysis.

Use of iron supplements in infancy: a field trial

Iron-deficiency anaemia in infancy, which is an important public health problem even in countries where gross malnutrition is not prevalent, can be prevented by iron supplementation or by fortification of infant foods with iron. A programme of iron supplementation was carried out in two places in Israel through the Maternal and Child Health services in the course of their routine duties. Though 89% of the mothers complied and gave iron supplements to their infants for a period of 1-9 months, only 26% continued for the full 9 months. A stastically significant difference was found in the haemoglobin and mean erythrocyte volume levels between the iron-supplemented group and the controls. The results indicate that the use of a higher daily dose of iron for a shorter period might lead to better compliance and greater benefits.

Determinants of blood pressure in Jerusalem schoolchildren

In 1982, 113 first- and second-graders attending an elementary school in West Jerusalem had their blood pressure (BP), height, weight, and resting pulse measured. Three successive BP readings were taken. The mean of the second and third readings was used for data analysis. Mean systolic blood pressure (SBP) was 98.30 +/- 8.51 mm Hg and mean diastolic blood pressure (DBP) was 67.63 +/- 6.85 mm Hg. An analysis of covariance was performed in order to determine the contribution of each independent variable (height, weight-for-height, sex, age, and resting pulse) to the variance in BP, while adjusting for all other independent variables. Height, weight-for-height, and resting pulse were all found to be significantly associated with both SBP and DBP. Children in the upper quartile of weight-for-height had a mean adjusted SBP that was 10.2 mm Hg higher than those in the lower quartile and a mean adjusted DBP that was 7.9 mm Hg higher. Children in the upper quartile of height (for age) had mean adjusted SBP and DBP that were 6.1 and 4.7 mm Hg higher, respectively, than those of children in the lower quartile. Sex and age showed no significant association with SBP. The associations between DBP and both sex and age were not statistically significant (P less than 0.10), but there was a trend for girls and older children to have a slightly higher DBP. In a subsample of 93 children who had both resting pulse and recovery index measured (using the Modified Harvard Step Test for children).(ABSTRACT TRUNCATED AT 250 WORDS)

Epstein-Barr virus and infectious mononucleosis in children

The presence of IgG antibodies to Epstein-Barr virus (EBV) has been investigated in two groups of children aged 3 to 35 months. The test group consisted of 31 children from an institution in which a high incidence of suspected infectious mononucleosis (IMN) was found. The control group comprised 54 children, aged 1 to 26 months, with noninfectious diseases. In the test group, 29 of the 31 children were positive for IgG anti-EBV antibodies in the serum, whereas only 5 children were positive in the control group. None of the children in the test group had detectable heterophile antibodies, and most of them did not show the typical symptoms of IMN. The reliability of diagnosing IMN in early childhood, by means of detection of anti-EBV serum antibody levels, is discussed.

Risk factors for coronary heart disease among Jerusalem schoolchildren: preliminary findings

The presence of risk factors for cardiovascular diseases were investigated in 7- and 11-year-old schoolchildren (808 subjects). Data analysis was performed according to sex, age, and country of origin of the father. The following variables were investigated: weight, height, total plasma cholesterol (TCH), high density lipoprotein cholesterol (HDL), plasma triglycerides, and systolic and diastolic blood pressure. Significant differences were found between sex, age, and origin groups for most variables. The prevalence of hypercholesterolemia (greater than 180 mg/dl) varied between 9.6 and 14.1%, in the different sex and age groups, and that of low HDL cholesterol (less than 40 mg/dl), 6.8-12.1%. Elevated systolic blood pressure (greater than 130 mm Hg) was found in 4.4-6.7% of the 7-year-old children, and in 13,4-18.6% of the 11 year-olds. Elevated diastolic blood pressure (greater than 85 mm Hg) was found predominantly in the 11-year-old children, 6.2-9.1%. These findings demonstrate the necessity to initiate health programs related to prevention of cardiovascular diseases in childhood.