Cardiovascular disease risk factors and health behaviors of ultra-Orthodox Jewish women in Israel: a comparison study.

Objectives: Women from low socio-economic, culturally insular populations are at increased risk for cardiovascular disease (CVD). The ultra-Orthodox Jewish (UOJ) community in Israel is a rapidly growing low socio-economic, insular, cultural-ethnic minority with numerous obstacles to health. The current cross-sectional study investigates CVD-related health behaviors and risk factors in a sample of UOJ females, comparing sample characteristics with the general population. Design: Self-administered questionnaires completed by a cluster randomized sample of 239 UOJ women included demographics, CVD-related health behaviors (consumption of fruit, vegetables, and sweetened beverages; hours of sleep; secondhand smoke exposure; and physical activity engagement) and risk factors (BMI, reported diagnoses of diabetes, high blood pressure, and heart disease). Results: Compared with the general population, UOJ women were less likely to consume 5 fruits and vegetables a day (12.7% vs. 24.3%, p < .001); more likely to consume ≥ 5 cups of sweetened beverages a week (18.6% vs. 12.6%, p = .019), and more likely to sleep <7 hours a night (62.0% vs. 50.6%, p = .002). UOJ women also reported less secondhand smoke exposure (7.2% vs. 51.4%, p < .001) and higher rates of physical activity recommendation adherence (60.1% vs. 25.6%, p < .0001) than the general population. Obesity was higher in UOJ women (24.3% vs. 16.1%, p < .0001). Increased parity and reduced moderate physical activity were associated with increased BMI. Increased parity was also associated with reduced sleep. Grand multiparous women (a 68% prevalence rate), in particular, were more likely to be overweight or obese than women with less than 5 children. Conclusions: This study suggests that health promotion interventions in this population target healthy weight maintenance, nutrition, and physical activity.

Two-Phase Evaluation of a Community-Based Lifestyle Intervention for Palestinian Women in East Jerusalem: A Quasi-Experimental Study Followed by Dissemination.

Palestinian-Arab women are at increased risk of cardiovascular disease due to high prevalence of diabetes and other risk factors. The current study investigates the effectiveness of an intensive group-based intervention on lifestyle habits that can prevent diabetes and cardiovascular disease. To that end, we conducted a group-based intervention based on the diabetes prevention program in two consecutive phases. The first phase consisted of a quasi-experimental study and the second phase included community-wide dissemination, with a 6-month follow-up. Findings from the quasi-experiment indicate increased consumption of fruit, vegetables and whole grains, weight reduction (-2.21 kg, p < 0.01), and a significant increase in the average daily steps in the intervention group (from 4456 to 6404). Findings from the dissemination indicate that average daily vegetables consumption increased from 1.76 to 2.32/day as did physical activity and average daily steps (from 4804 to 5827). There was a significant reduction in blood pressure, total cholesterol and LDL. These gains were sustained over 6 months following the intervention. This community-based, culturally adapted, health-promotion intervention led to improved nutrition and physical activity which were maintained after 6 months. Collaboration with community centers and local community partners created an effective channel for dissemination of the program to pre-clinical individuals.

Determinants of health behavior inequalities: a cross-sectional study from Israel.

Health behaviors are shaped by the opportunities people have; and the choices they make according to these opportunities. Inequality in economic, cultural and social resources causes disparities in health and health behaviors. Jerusalem has a multiethnic structure, mainly made up of Jews and Arabs. Arabs and Ultra-Orthodox Jews are disadvantaged in terms of socio-economic and health indicators. The purpose of this study is to determine the factors associated with three health behaviors: physical activity (PA), fruit and vegetable consumption, and smoking. This cross-sectional study was conducted among 1682 adults from a stratified sample by age, sex and neighborhood from 2011 to 2015, in accordance with the Healthy Cities project. Univariate analyses were conducted by Chi-square test of independence; and multivariate analyses by logistic regression models. Of the total population, 12% do adequate amounts of PA; 17.6% consume adequate amounts of fruits/vegetables; and 19.4% are current smokers. Multivariate analyses indicates for both genders: ethnicity/religion and education level is associated with doing PA; ethnicity/religion, education and income level is associated with fruit/vegetable consumption; and ethnicity/religion, and age is associated with smoking. However, gender significantly modifies the effect of ethnicity/religion for all the three health behaviors. Gender disparities regarding health behaviors are higher among Arabs and Ultra-Orthodox Jews. In similar economic, cultural and social circumstances, men and women have similar health behaviors; and unequal opportunity to education and income creates a vicious gender inequality cycle. Therefore, to reduce health behavior inequalities, besides economic and cultural inequalities, social and gender inequalities should also be reduced.

A smoke-free medical campus in Jerusalem: data for action.

BACKGROUND: Establishing smoke-free environments is a major component of tobacco control policy. The introduction of a smoke-free policy in medical campuses may serve as a role model for other educational and health institutions but little has been published about their prevalence or impact. In 2012, the Faculty of Medicine at Hebrew University-Hadassah in Jerusalem, Israel launched a smoke-free Medical Campus initiative. This study examined smoking behaviours, cigarette smoke exposure and attitudes towards the smoke-free campus policy among students and employees. METHODS: Using a self-administered questionnaire, data was collected from medical, dental and pharmacy students, as well as employees of the school of pharmacy. We approached the entire target population in 2013 (N = 449), with a response rate of 72.5 % (N = 313). RESULTS: The rate of smoking was 8.3 % (95 % CI 5.5-11.9 %). Most participants reported daily exposure or exposure several times a week to cigarette smoke (65.8 %). Overall, 98.0 % had reported seeing people smoke in open campus areas and 27.2 % indoors. Most participants supported the smoking ban inside buildings (94.2 %) but fewer supported (40.8 %) a complete ban of smoking throughout the campus, including outside areas. Only 18.4 % agreed that a policy prohibiting smoking was unfair to smokers. A multivariable analysis showed that support for a complete ban on smoking on campus was higher among non-smokers than for smokers (OR = 9.5, 95 % CI 2.2-31.5, p = 0.02). CONCLUSIONS: The smoke-free policy does not have total compliance, despite the strong support among both students and employees for a smoke-free medical campus. The data collected will assist policy makers move towards a total smoke-free medical campus and will aid tobacco control efforts in Israel and other countries.

Correlation between pre-employment screening X-ray finding of spondylolysis and sickness absenteeism due to low back pain among policemen of the Israeli police force.

STUDY DESIGN: A historical prospective case/control study of the significance and correlation between pre-employment findings of L5-S1 spondylolysis and sickness absenteeism due to low back pain among police officers. OBJECTIVES: Examining the importance of pre-employment lumbar spine radiographs as a prediction of work absenteeism. SUMMARY OF BACKGROUND DATA: Spondylolysis is a defect in the pars interarticularis. Its etiology remains controversial, it is a common condition among young athletes, and it carries genetic predisposition. Although described mostly as an incidental radiographic finding in the adult population, spondylolysis is implicated as a contributing factor to low back pain, although the cause-and-effect relation is not clear. METHODS: One hundred and sixty-nine police officers with L5-S1 spondylolysis were identified out of 3988 examined. Incidence density of sickness absenteeism due to low back pain was calculated for the patients and the controls. The Cox's proportional hazard model was used for comparison between the two groups, controlling for possible confounding variables. RESULTS: Similar incidence of sickness absenteeism due to low back pain was found among the patients and controls. The total duration of sickness absenteeism, however, was 2.7 times higher in the spondylolysis group than the controls. Prevalence of spondylolysis is origin specific, denoting genetic predisposition to this condition. Total sickness absenteeism not related to low back pain was not significantly different between the two study groups. CONCLUSIONS: There is low predictive value of pre-employment lumbar spine radiograph as a screening tool predicting sickness absenteeism due to low back pain. Spondylolysis, however, may increase the duration of sickness absenteeism in patients with low back pain.

A "smoke-free" hospital in Israel--a possible mission.

BACKGROUND: A revised antismoking law in Israel (August 2001) called for a complete ban of smoking in hospitals. An evaluation of a hospital process and short-term outcome of implementing such policy may guideline its sustainability. METHODS: Two cross-sectional, random-sample surveys of employees 3 months before policy implementation, and 6-9 months post-implementation. The pre-implementation survey included 368 employees (90.4% response rate) and the post-implementation survey, 364 (92.8% response rate). RESULTS: The 'smoke-free' policy significantly reduced smoking in the unauthorized areas. Before implementation, 63% of staff reported frequently observing smoking in the hospital, compared to 40% 6 months post-policy implementation (P < 0.001). Significantly more smokers reported leaving their workplace to smoke (17% pre- vs. 62% post-implementation, P < 0.0001). Sixty-five percent of smokers, in both surveys, agreed that "a smoke-free policy is unfair to smokers". Fewer nonsmokers subscribed to this belief: 42% pre- and 34% post-implementation. Smoker prevalence remained unchanged (19%). CONCLUSIONS: Implementation of a "smoke-free" policy is an effective way to reduce smoking in the hospital environment. More effort is required, however, to help staff quit smoking altogether.