Establishing priorities for diabetes action goals according to key opinion leaders and health professionals.

BACKGROUND: The ever-increasing burden of diabetes and the limited resources highlight the need for prioritization of national action goals for diabetes management. The Israeli National Diabetes Council (INDC) initiated a prioritization process aiming to set a top list of diabetes related goals, as suggested by decision makers and health professionals. METHODS: A 2-step prioritization process, including a small (n = 32) circle of key opinion leaders of the INDC and a larger (n = 195) nationwide circle of diabetes health professionals consisting of physicians, nurses, and dieticians working in diabetes care centers, hospitals and family practice clinics, was established. An online questionnaire presenting 45 different action areas in diabetes prevention and care was distributed to the INDC members who ranked the 3 top diabetes priorities based on their individual interpretation of importance and applicability. The 7 highest ranking priorities were later presented to hospital-based and community diabetes health professionals. These professionals selected the 3 top priorities, based on their perceived importance. RESULTS: Council members opted mostly for action areas regarding specific populations, such as clinics for adult type-1 diabetes patients, diabetic foot, and pediatric and adolescent patients, while the health professionals' top priorities were mostly in the general field of prevention, namely high-risk prediabetes population, prevention of obesity, and promotion of healthy life-style. In addition, priorities differed between hospital and community health professionals as well as between different professional groups. CONCLUSIONS: A national prioritization process of action areas in diabetes prevention and care is attainable. The resulting item list is affected by professional considerations. These priorities may direct efforts in the implementation of interventions to improve national-level diabetes management.

Associations between socioeconomic and family determinants and weight-control behaviours among adolescents.

OBJECTIVES: Family factors may play a role in adolescents' weight-control behaviours (WCB), and economic determinants strongly affect adolescents' health in terms of unhealthy weight-control behaviours (UWCB). This study examines the nexus of socioeconomic status, perceived family wealth, and number of employed parents and Israeli adolescents' WCB and asks whether family-related variables mediate WCB. METHODS: Data from the 2014 Israeli Health Behaviour in School-Aged Children study are analysed using structural equation modelling. RESULTS: High family affluence and high perceived family wealth are negatively associated with UWCB. Having two employed parents related to lower levels of UWCB. Family-related variables such as family communication and support and parental monitoring mitigate UWCB. Family meals have a significantly positive effect on healthy weight-control behaviour (HWCB) and a significantly negative impact on unhealthy weight-control activities. CONCLUSIONS: The findings suggest that economic factors such as socioeconomic status and number of employed parents should be taken into account in long-term weight-control practice. The combination of WCB and family meals is the most effective method for adolescents' healthy weight-control behaviour.

Trends in Tobacco Use among Children and Adolescents in Israel, 1998-2015.

OBJECTIVES: This study aims to measure trends in cigarette smoking among children and adolescents in Israel, focusing on school grade, sex, and ethnicity. We hypothesized that smoking would be higher among boys and Arab-Israelis, rates would grow with age, and there would be a decline over time. METHODS: Data were derived from the Health Behavior in School-aged Children study between 1998 and 2015 in Israel. The total sample included 56,513 students in grades 6, 8, and 10, with 29,411 girls and 27,102 boys. Descriptive analysis described trends of smoking behavior according to grade, sex, ethnicity, family affluence, and year of study. multivariate logistic regression analysis examined predicting variables. RESULTS: Smoking was higher among boys in all grades, ethnic groups, and years of study, with the highest frequencies among Arab-Israelis. Trends over the years show a decline from 1998 to 2004, followed by an increase for both sexes. The increase was more prominent among girls. Logistic regression analysis revealed strong associations between smoking and grade, sex, ethnicity, and year of study. CONCLUSIONS: The results of this study can significantly enhance the development and implementation of smoking prevention and control programs among students in Israel.

What Is it About Perceived Discrimination That Can Lead Immigrant Adolescents to Alcohol Use and Delinquency? The Mediating Role of Feelings of Alienation.

BACKGROUND: Despite research examining the relationship between discrimination and alcohol use and delinquency among adolescents, little is understood about the mechanism behind the relationship. OBJECTIVES: On the basis of Strain Theory, the current study examined a new theoretical model in which feelings of alienation (from the self, peers, and Israeli society) mediate the relationship between discrimination and alcohol use and delinquency. METHODS: A one-year follow-up study was conducted with 146 at-risk youth from the Former Soviet Union and Ethiopia in Israel (63% male), from disadvantaged low socioeconomic neighborhoods. At Time 1 (T1), adolescents were asked about their experiences of discrimination, feelings of alienation, and levels of problem alcohol use (past month/ever drunkenness, past month binge drinking, and regular daily drinking). At time 2 (T2), the participants were again asked as to their experiences of alienation, alcohol use, and delinquency. RESULTS: Perceived discrimination at T1 significantly predicted feelings of alienation at T2, when controlling for the relationship with alienation at T1. Feelings of alienation (from the self and Israeli society) fully mediated the relationship between discrimination and alcohol use. However, there was a direct relationship between discrimination and delinquency. CONCLUSIONS: Findings emphasize the negative impact of discrimination on adolescents. They suggest that during the critical developmental period of adolescence, feelings of discrimination may be internalized into negative emotions which may lead to involvement in deviant behaviors. Results suggest a need to help adolescents process and make sense of the discriminatory experiences they perceive.

Social Capital as a Moderator of the Relationship Between Perceived Discrimination and Alcohol and Cannabis Use Among Immigrant and Non-immigrant Adolescents in Israel.

Literature highlights the relationship between perceived discrimination and frequency and severity of alcohol and cannabis use. One mechanism for explaining this is the nature of perceived discrimination as a potentially traumatic interpersonal stressor, which can lead to the depletion of social and personal resources. Within a Recovery Capital (RC) framework, the current study explores whether the existence of social capital in the form of parental monitoring, friend and teacher support can buffer the relationship between perceived discrimination and alcohol and cannabis use among immigrant and non-immigrant adolescents, by replenishing the depleted resources. The study included a representative sample of 8,598 students in Israel, aged 11-18, from the Health Behaviors of School Aged Children (HBSC) 2013-2014 data: 1503 immigrant adolescents from the Former Soviet Union [FSU] (N = 955) and Ethiopia (N = 548) and 7086 non-immigrants. Results confirmed that perceived discrimination was positively related to substance use; all three forms of social capital were negatively related to alcohol and cannabis use and moderated the relationship between perceived discrimination and substance use, with the exception of friend support in the case of alcohol use. When all three social capital measures were included together, the adult social capital measures were significant predictors of substance use. Results suggest that levels of social capital, especially as provided by parents and teachers, can help young people, both immigrant and majority group adolescents, to cope with perceived discrimination.

The role of identity and psychosomatic symptoms as mediating the relationship between discrimination and risk behaviors among first and second generation immigrant adolescents.

The study examines psychosomatic symptoms, and host and heritage identities as mediators of the relationship between discrimination and aggressive behavior and substance use. Israeli data from the 2013-14 Health Behaviors of School-aged Children study included a representative sample of 1503 first- and second-generation immigrant adolescents aged 11-17 years (45.2% male) from the Former Soviet Union and Ethiopia in Israel. Structural equation modeling, controlling for age, gender, family affluence and immigrant generation, showed different pathways for the two groups. For FSU-heritage adolescents, the relationship between discrimination and aggressive behavior and substance use was partially mediated by psychosomatic symptoms. Lower host and heritage identities also predicted psychosomatic symptoms. For Ethiopian-heritage adolescents, the relationship between discrimination and outcomes was fully mediated by psychosomatic symptoms and a weaker host identity. Results support an externalizing model, whereby discrimination leads to a weaker host identity and increased psychosomatic symptoms, associated with substance use and aggressive behavior.

Investigating cannabis use normalization by distinguishing between experimental and regular use: a multilevel study in 31 countries.

OBJECTIVE: This research examined whether national population-level cannabis frequency rates moderate the strength of the relationship between individual-level psychosocial and behavioral risk factors (poor parental communication, bullying, fighting, etc.) and different levels of adolescent cannabis use (abstinence, experimental use, and regular use). METHOD: Data from the 2009/2010 Health Behaviour in School-Aged Children survey (N = 62,009, age = 15 years) from 31 countries were analyzed using multinomial hierarchical linear modeling. RESULTS: Analyses showed that adolescents who reported experimental cannabis use and who lived in relatively high cannabis frequency countries were less likely than their counterparts in low cannabis frequency countries to present some of the cannabis-related psychosocial and behavioral risk factors. Conversely, regular cannabis use tended to occur among high-risk adolescents to an equal degree in high and low cannabis frequency countries. CONCLUSIONS: The findings suggest that the normality of cannabis use in the youth population is important to consider when investigating the relationship between risk factors and cannabis use.

Exploring substance use normalization among adolescents: a multilevel study in 35 countries.

The substance use normalization thesis predicts that adolescent substance users are less likely to report substance use risk factors in high than in low prevalence countries. This study tests whether national population-level alcohol, cigarette and cannabis prevalence rates moderate the strength of the relationship between individual level social and behavioral risk factors and individual level alcohol, cigarette and cannabis use. Data from 2009/2010 Health Behaviour in School-Aged Children Study (N = 68,045, age = 15) from 35 countries was analyzed using logistic Hierarchical Linear Modeling. As expected based on low cannabis prevalence rates in all countries studied, no evidence of normalization was found for recent cannabis use. Also in line with the normalization thesis, results show that for substance use that reaches above 40% in at least some of the countries studied (drunkenness, alcohol and cigarette use), adolescents who reported use are less likely to report social and behavioral risk factors in high prevalence countries than in low prevalence countries. However, support for the normalization thesis was only partial in that results show that in models where evidence for normalization was found, there are risk factors that predict substance use to an equal degree regardless of country level prevalence rates. The current research shows that the normalization thesis is a useful framework for understanding the contextual aspects of adolescent alcohol, tobacco, and cannabis use. The study has implications for drug prevention as it suggests that selective prevention efforts may be particularly useful in low prevalence countries where screening based on risk factors may usefully identify adolescents at most risk for developing drug use problems. This approach may be less useful in high prevalence countries where screening based on risk factors is less likely to satisfactorily identify those at risk for developing drug use problems.

Attention to the media and worry over becoming infected: the case of the Swine Flu (H1N1) Epidemic of 2009.

This paper examines the relationship between attention to the mass media and concern about becoming infected with H1N1 in two nationwide random samples interviewed during the flu epidemic of 2009. The first sample (N = 1004) was taken at the end of the first wave of the outbreak in the US and the second sample (N = 1006) was taken as the second wave was accelerating. The data were gathered by the Pew Research Center for the People & the Press. Over the period studied, the percentage worried about becoming infected increased in almost all social categories of respondents. With social category controlled, both those who followed the H1N1 outbreak closely and those who were more interested in reports about it were more likely to be worried about becoming infected. As time went on, interest in media reports declined, but worry over infection continued to increase. Our findings imply that despite the decrease in the percentage of the population expressing interest and following the news, media exposure was the most important factor as it explained the likelihood of being concerned about the possibility of infection.